bluuebunny/crossref_metadata_2025 huggingface dataset:
83 Success of Amoxicillin Oral Challenges in Children at Low Risk of Allergy Requiring Antibiotic in the Emergency Department
Authors: Gervais Camille , Panetta Luc , Roy Helene , Desroches Anne , Buithieu Maria , Pellerin Stephanie , Ovetchkine Philippe , Trottier Evelyne D
Published: September 2023

Background

Up to 10% of children are labelled as penicillin allergic, requiring the use of suboptimal antibiotics as an alternative. In these children, a low-risk oral challenge with amoxicillin can be done to evaluate the accuracy of this allergy. An oral challenge pre-written order was implemented in our institution’s emergency department (ED).

Objectives

The aim of this study was to assess the success of the amoxicillin oral challenges in children labelled penicillin allergic in the ED.

Design/Methods

This is an ongoing prospective observational study conducted at a tertiary care paediatric hospital. Children considered at low risk of penicillin allergy (https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Medicaments/Outil_aide-decision_allergies-EN_VF.pdf) and requiring amoxicillin according to the ED physician were prescribed an amoxicillin challenge according to a pre-written order set. In the absence of a reaction, patients were discharged with an amoxicillin prescription. Parents were contacted one month after the challenge to assess for late-onset reactions.

Results

Since June 2021, 70 children (24 female) underwent an amoxicillin challenge in the ED (Figure 1). The patients’ median age was 1 yo (6 months–12 yo). The most frequent discharge diagnoses in the ED were otitis media (65%) and pneumonia (24%). The challenge was successful in the ED for 69/70 (99%) patients. Sixty-two (89%) patients were successfully contacted for a follow-up phone call. Among them, 55/62 (89%) did not present any reaction. In total, 7/62 (11%) of the children had a reported reaction, one (1%) child had an immediate reaction to the challenge in the ED, while 6/62 (10%) had a rash appearing 1 to 61 days after the first dose of antibiotics. No severe reactions were reported by the parents after discharge from the ED. A correlation between the amoxicillin administration and the delayed reaction was considered less likely for 3/6 patients because of the later onset of symptoms (28-61 days). The three other patients were considered not to have a penicillin allergy after formal assessment at the allergy clinic.

Conclusion

Using a standardized pre-written order set for an amoxicillin challenge in the ED allowed 99% of participating children to be discharged safely with an amoxicillin prescription. Despite 10% presenting a rash after discharge, none were considered to have a late-onset reaction. This removed safely and rapidly the label of “penicillin allergy” from those paediatric ED patients, allowing optimal first-line antibiotics. It also eliminates the need for a consultation with an allergist in the majority of patients.
86 Incidence of Pulmonary Thromboembolism in Canadian Children: A 3-Year National Surveillance Study
Authors: Ramsay Lily , Krmpotic Kristina , Moorehead Paul , Chan Anthony K C , Plint Amy C
Published: September 2023

Introduction/Background

Pulmonary thromboembolism (PTE) is a rare but life-threatening event for which adequate epidemiological data in paediatrics are lacking. Best estimates regarding the epidemiology of PTE in Canadian children were published over two decades ago, using information obtained from a national registry of paediatric thromboembolic disease which only examined pulmonary embolism as a related complication. It is likely that the true rates of pulmonary thromboembolism in Canadian children are higher.

Objectives

To determine the minimum national incidence of PTE in children (neonate up to <18 years) by age, gender, and province / territory of residence using an existing national surveillance system.

Design/Methods

Through the Canadian Paediatric Surveillance program, over 2,800 paediatricians and subspecialists practicing in Canada were contacted monthly from January 2020 to December 2022. Using a standardized definition of PTE and pre-specified diagnostic criteria, clinicians were requested to report all new suspected or confirmed cases.

Results

During the 3-year study period, 58 cases of PTE were reported, documenting a minimum average annual national incidence of 2.4 per million Canadian children. Females accounted for 77.6% (n=45) cases. Patients ranged in age from 2 months to 17.9 years (median age 15.8 years; interquartile rate 13.3 to 16.7 years). Incidence rates (reported as average annual per million children) varied by age: 0-4 years, 0.7; 5-9 years, 0.2; 10-14 years, 2.0; 15-18 years, 6.6; and also by province: Newfoundland, 21.3; Saskatchewan, 4.6; British Columbia, 4.5; New Brunswick, 4.4; Alberta, 3.5; Nova Scotia, 1.8; Ontario, 1.6; Manitoba, 1.0; Quebec, 0.9.

Conclusion

Although the overall minimum average annual national incidence of PTE in Canada is 2.4 per million children, adolescents, particularly females, appear to be at highest risk of disease. It is not clear whether geographic distribution of cases disproportionate to provincial census may be related to regional differences in diagnostic practices, population-related risk factors (e.g., obesity, genetic thrombophilias, OCP prescribing), or reporting of cases.
94 Understanding Parental Behaviours Related to Infant Sleep Environment
Authors: Smith Jennifer , Johnstone Julie , Mahant Sanjay , Shouldice Michelle
Published: September 2023

Introduction/Background

Sudden unexplained death in infants continues to make up a significant proportion of infant deaths. Despite wide dissemination of Canadian Paediatric Society and American Academy of Paediatrics safe sleep recommendations, studies demonstrate significant caregiver nonadherence to the recommendations. Few studies have examined caregiver reasons for low uptake of recommendations. There is an urgent need to understand these issues not only for individual providers counseling about sleep, but also for implementation of public health initiatives which attempt to target parental behaviour change.

Objectives

Our study aimed to explore parental perceptions, beliefs and influences regarding safe infant sleep environment and factors contributing to parental behaviour related to sleep environment.

Design/Methods

A qualitative study utilizing ground theory methodology was conducted with in-depth individual interviews of 14 parents of infants less than six months admitted to a large paediatric hospital in Toronto, Canada. Data collection occurred from November 2017 to January 2018, until a saturation of themes was reached. Interview transcripts were analyzed for recurrent and emergent themes and a coding structure was developed.

Results

Interviews with caregivers were completed, and a range of sleep locations and environments were described. Most caregivers reported that a bassinet or crib was the main sleeping location, but most infants were also placed in other locations at various times, including infant swings, couches, and bed-sharing with caregivers. Three dominant themes affecting decision-making about sleep location were identified: 1. safety, 2. feasibility and convenience and, 3. perception of infant preference and developmental needs. These factors were often present simultaneously in parental decision-making, frequently acting in opposition to one another. Caregivers’ methods of mitigating harm were often counter to recommendations, such as using pillows to prevent rolling. Information sources regarding sleep choices typically included family, friends, healthcare providers and media. Most caregivers placed greater significance on healthcare recommendations than the advice of family members.

Conclusion

This study identified key factors that impact caregivers’ decision-making regarding infant sleep. These results can inform healthcare providers counselling about safe sleep recommendations and public health interventions aimed at increasing adherence to safe sleep recommendations and reducing preventable infant deaths.
97 Handwriting Speed in Juvenile Idiopathic Arthritis Using the Detailed Assessment of Speed of Handwriting
Authors: Marchak Caitlin , James Sarah , Davidson Iris , Brown Jennifer , Houghton Kristin
Published: September 2023

Background

Juvenile idiopathic arthritis (JIA) is the most common cause of arthritis in children. Common symptoms include pain, joint stiffness, joint swelling, fatigue, and decreased physical function. Over 50% of children have hand or wrist involvement and handwriting is the most commonly reported functional limitation in daily activities. To date there has been limited study of the specific limitations of handwriting in children with JIA.

Objectives

To better understand handwriting limitations in children with JIA, this pilot study aimed to: (a) describe handwriting speed measured by the Detailed Assessment of Speed of Handwriting (DASH), a standardized assessment of handwriting speed; (b) compare the DASH scores with age- and sex-matched normative data; (c) examine the association between DASH scores and active wrist and hand arthritis; and (d) explore associations between DASH scores and grip strength, quality of life, function, and pain.

Design/Methods

Participants diagnosed with JIA and actively followed by the paediatric rheumatology clinic at a large tertiary care centre underwent physician assessment with active joint count, occupational therapist (OT) assessment including administration of the DASH, and grip strength measurement by a physiotherapist. Participant-reported outcomes included questionnaires on function (Childhood Health Assessment Questionnaire [CHAQ]), pain, and quality of life (QOL).

Results

A total of 12 participants aged 9-15 years (M = 12.7y) completed the study. The mean DASH score was 35th percentile (SD = 23) for all participants, 58th percentile (SD = 14) with active hand/wrist arthritis, 25th percentile (SD = 19) with history of hand/wrist arthritis, and 24th percentile (SD = 25) with no history of hand/wrist arthritis. Grip strength was low overall (M = 18th percentile, SD = 28), and lower in participants with active hand/wrist arthritis (M = 4th percentile, SD = 5) and history of hand/wrist arthritis (M = 5th percentile, SD = 7). DASH scores were negatively associated with grip strength (r = -.31), and positively associated with QOL (r = .41) and pain (r = .43). There was no relationship between the DASH and the CHAQ.

Conclusion

Handwriting speed difficulties are common in children with JIA and may not relate to arthritis disease activity, pain, or function. Handwriting speed may be used in the clinic as a screen to identify children who may benefit from a full OT handwriting assessment. In the absence of access to OT, general guidance can be provided to schools to support a child with JIA in the classroom.
C2 (Clinical Case) Complicated Sinusitis in an Adolescent Swimmer in the COVID-19 Pandemic: An Unexpected Microbial Player
Authors: Abeytunge Kawmadi , Algain Sulwan , Ranger Adrianna , Tay KengYeow , Cabrera Ana , Sowerby Leigh , Barton-Forbes Michelle
Published: September 2023

Introduction/Background

There are increasing reports of complicated sinusitis following post-pandemic viral surges. Streptococcus anginosus and Staphylococcus aureus (SA) are common causes. However, unusual pathogens may need to be considered in the face of inadequate therapeutic response.

Case Description

A previously healthy 13-year-old boy presented with fever, facial pain, and headache two weeks following presumed COVID-19 infection based on exposure history and symptoms. While recovering, he had been swimming daily and recalled inhaling pool water. On examination he was febrile with a tender mid-forehead swelling and left periorbital swelling without features of orbital cellulitis. There was no meningism or focal neurological deficits. Investigations revealed leukocytosis (19.1 x109/L), elevated CRP (156.8 mg/L) and sterile blood cultures. Head imaging confirmed sinusitis complicated by Pott’s puffy tumor, a small subdural empyema and sinus venous thrombosis. Ceftriaxone, metronidazole, and vancomycin were initiated with de-escalation of the latter to cloxacillin after sinus cultures grew methicillin-sensitive SA. Despite broadening to meropenem and vancomycin, he progressed to develop cerebritis. Legionella species identified from intracranial sampling using 16s RNA, allowed targeted therapy with levofloxacin and successful resolution after six weeks of therapy.

Discussion

The development of this patient’s Pott’s puffy tumor and intracranial complications seemed consistent with post-viral sinusitis in terms of onset and growth of SA. However, his inadequate response to broad-spectrum therapy and sterile cultures from intracranial sampling prompted request for 16sRNA testing. Subsequent disclosure of freshwater swimming exposure with aspiration event raised concerns for water-borne pathogens such as Legionella. The aspiration event occurring in presence of persisting congestion, resulted in Legionella species seeding already inflamed sinuses and further tracking intracranially. Without special cultures required to recover Legionella, this pathogen was initially missed, resulting in disease progression and delayed targeted therapy. Fluroquinolones or macrolides are required for treatment of this pathogen.

Conclusion

Given that post-viral sinusitis may be anticipated during viral surges, practitioners should consider the role of waterborne pathogens in hosts with significant swimming exposure who worsen on usual therapy. Microbiology and infectious diseases involvement is encouraged to optimize detection and management of waterborne infection. Practitioners are reminded that in the face of therapeutic failure, it is critical to revisit the history for unusual exposures, determine immunocompetence, and explore potential bug-drug mismatch.
C10 (Clinical Case) Precocious Puberty in Internationally Adopted Children: A Tale of Two Thelarches
Authors: Shapka Larissa , MacDonnell Heather
Published: September 2023

Introduction/Background

Internationally adopted (IA) children may commonly experience post-adoption medical issues in the infectious, nutritional, developmental and psychological domains. We present a rare endocrinologic case of 2 biologically unrelated children adopted into the same Canadian family with diagnoses of idiopathic central precocious puberty (CPP), years after adoption.

Case Description

A 13-month-old female was adopted from Kazakhstan with a past history of prematurity (29 weeks gestational age), grade II intraventricular hemorrhage, query hypoxic ischemic encephalopathy, perinatal CMV infection, and malnourishment. She demonstrated catch-up growth after adoption and was monitored for developmental concerns. She presented at 7 years 9 months with report of thelarche at 6 years 6 months, pubarche at 7 years 6 months and accelerated height velocity. Bone age was advanced by 3 years (+4 SD). By Endocrinology consultation at 8 years 1 month, gonadotropin-releasing hormone (GnRH) stimulation test confirmed CPP. There was no central nervous system (CNS) symptomatology. Leuprolide was initiated to minimize psychosocial impacts of CPP and not necessarily to improve final adult height.

Seven years after their first adoption, the family welcomed a female child from Vietnam, aged 2 years 11 months. Medical profile included malnutrition and atopic dermatitis. Thelarche was noted at 5 years 4 months. By Endocrinology consultation at 5 years 5 months, she had isolated breast development with accelerated height velocity. Bone age was advanced by 2.5 years (+3 SD). GnRH stimulation test revealed CPP. Leuprolide was started. MRI brain showed no CNS lesion, which confirmed the diagnosis of idiopathic CPP.

Discussion

Whereas there is a rare, but documented, increased prevalence of CPP among IA children, etiology is unclear. Theories postulate that it may be related to rapid catch-up growth post-adoption or past exposure to endocrine disruptors. Awareness of this risk may vary. Initial post-adoption consults often focus on other medical and developmental screening. Depending on the age at adoption, counselling about puberty may seem remote. This may impact the timing at which pubertal concerns are identified. As early identification of CPP provides an opportunity to intervene to preserve adult height, as well as minimize psychosocial impact on the child, pubertal surveillance should not be overlooked. Based on caregiver feedback from our cases, we now include counselling on, and examination for, early pubertal changes in our IA clinic visits.

Conclusion

IA children are at increased risk of central precocious puberty. Paediatric clinicians and caregivers should be aware of this risk to allow for timely identification and treatment of this condition.
The relationship between low handgrip strength with or without asymmetry and fall risk among middle-aged and older males in China: evidence from the China Health and Retirement Longitudinal Study
Authors: Wang Yilin , Huang Yalian , Chen Xiaoyan
Published: September 2023

Purpose

This study sought to explore the potential correlation between low handgrip strength (HGS) with or without asymmetry and fall risk in middle-aged and older Chinese adults.

Methods

Baseline characteristic data from participants 45+ years of age and data regarding fall events collected from two rounds (2011–2013) of the China Health and Retirement Longitudinal Study were utilized for the present analyses. HGS and HGS asymmetry was defined according to the updated American Society of Hand Therapist. Fall events were identified through self- or proxy-reported details. Logistic regression analyses were employed to gauge the potential relationship between abnormal HGS and fall risk.

Results

In total, 10 563 participants were enrolled in this analysis, of whom 47.49% (5016/10 563) were male. The proportions of low HGS alone, HGS asymmetry alone, and low HGS with asymmetry were 22.23%, 18.34%, and 22.75%, respectively, in males, but just 3.64%, 35.12%, and 6.62% in females. A total of 693 and 1019 fall events were recorded for male (13.82%) and female (18.37%) participants over the 2-year follow-up period, respectively. Significant differences in fall event incidence among different HGS groups were only observed among males. An adjusted logistic regression analysis model confirmed that low HGS with dominant asymmetry was closely related to fall risk among middle-aged and older males [P = 0.014, odds ratio = 1.332, 95% confidence interval: 1.059–1.676).

Conclusion

These results demonstrated that low HGS with dominant asymmetry is a risk factor linked to increased fall risk among middle-aged and older Chinese males.

What is already known on this topic Low HGS or HGS asymmetry is been reported to be linked to an increased risk of falls in middle-aged and older adults; however, little is known about the association between fall risk and low HGS and/or HGS asymmetry. Main messages The prevalence of low HGS alone and low HGS asymmetry in men was significantly higher than in women, while HGS alone asymmetry was more common in women than men. The risk factor for the increased risk of falls in Chinese middle-aged and older men is low and asymmetric HGS, rather than low or asymmetric HGS alone. Low HGS with dominant asymmetry rather than nondominant asymmetry is associated with future fall risk among middle-aged and older Chinese males. Current research questions What is the mechanism for the significant difference in the proportion of abnormal HGS components between the sexes? If female subjects with low HGS and asymmetric HGS were added, would an association be observed between low HGS and asymmetric HGS falls? Is there an association between the severity of asymmetric HGS with weakness and falls?
Attractive gravity probe surface with positive cosmological constant
Authors: Shiromizu Tetsuya , Izumi Keisuke
Published: September 2023

In 4D spacetimes with a positive cosmological constant, we introduce a new geometrical object associated with the cosmological horizon and then show the areal inequality. We also examine the attractive gravity probe surfaces as an indicator for the existence of attractive gravity.
Predictors of height in Romanian infants 6–23 months old: findings from a national representative sample
Authors: Stativa Ecaterina , Rus Adrian V , Lee Wesley C , Salinas Kailei A D , Cossey Hannah M , Lobo Austin , Nanu Michaela
Published: September 2023

Background

The research explored the association between infants’ height and various demographic factors in Romania, a country where such critical information has been lacking.

Methods

This study was conducted on a nationally representative sample and used a family physicians database to determine a sample of 1532 children (713 girls and 819 boys) 6–23 months of age (M = 14.26; SD = 5.15). Infants’ height-for-age z-scores (HAZ) were calculated using the World Health Organization’s computing algorithm. A multiple regression analysis was conducted to investigate whether certain risk factors, such as infant mother’s age, location, marital status, socioeconomic status (SES), as well as infant’s term status at birth, age, anemia, minimum dietary diversity (MDD) and birth order, could significantly predict the HAZ.

Results

The study identified several significant predictors of height. Specifically, lower HAZ was associated with rural living, preterm birth, age 18–23 months, unmarried mothers, anemia, lack of MDD and being third or later born in the family. In contrast, higher HAZ was associated with medium or high maternal SES and older maternal age.

Conclusions

The study underscores the importance of addressing these significant risk factors through distinct interventions to improve height outcomes in at-risk Romanian populations.
Mesoporous polydopamine delivery system for intelligent drug release and photothermal-enhanced chemodynamic therapy using MnO2 as gatekeeper
Authors: Wang Zhaoyang , Li Zekai , Shi Yuehua , Zeng Leyong
Published: September 2023

The non-specific leakage of drugs from nanocarriers seriously weakened the safety and efficacy of chemotherapy, and it was very critical of constructing tumor microenvironment (TME)-responsive delivery nanocarriers, achieving the modulation release of drugs. Herein, using manganese dioxide (MnO2) as gatekeeper, an intelligent nanoplatform based on mesoporous polydopamine (MPDA) was developed to deliver doxorubicin (DOX), by which the DOX release was precisely controlled, and simultaneously the photothermal therapy (PTT) and chemodynamic therapy (CDT) were realized. In normal physiological environment, the stable MnO2 shell effectively avoided the leakage of DOX. However, in TME, the overexpressed glutathione (GSH) degraded MnO2 shell, which caused the DOX release. Moreover, the photothermal effect of MPDA and the Fenton-like reaction of the generated Mn2+ further accelerated the cell death. Thus, the developed MPDA-DOX@MnO2 nanoplatform can intelligently modulate the release of DOX, and the combined CDT/PTT/chemotherapy possessed high-safety and high-efficacy against tumors.
Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial
Authors: Pfeil Alexander , Klemm Philipp , Hueber Axel J , Hoffmann Tobias , Weise Tobias , Oelzner Peter , Knop Stefan , Müller-Ladner Ulf , Lange Uwe , Wolf Gunter , Schett Georg , Simon David , Kleyer Arnd
Published: September 2023

Objective

The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students’ perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).

Methods

The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student’s perspective using a questionnaire with 16 questions covering six subject areas.

Results

The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach.

Conclusion

The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.
3WJ RNA Nanoparticles-Aptamer Functionalized Exosomes From M2 Macrophages Target BMSCs to Promote the Healing of Bone Fractures
Authors: Shou Jiali , Li Shuyi , Shi Wenzhe , Zhang Sijuan , Zeng Zheng , Guo Zecong , Ye Ziming , Wen Zhuohao , Qiu Huiguo , Wang Jinheng , Zhou Miao
Published: September 2023

Up to now, impaired bone regeneration severely affects the healing of bone fractures, thus bringing tremendous suffering to patients. As a vital mediator between inflammatory response and bone regeneration, M2 macrophage-derived exosomes (M2-Exos) attenuate inflammation and promote tissue repair. However, due to a lack of specific targeting property, M2-Exos will be rapidly eliminated after systematic administration, thus compromising their effectiveness in promoting bone regeneration. To solve this hurdle, we initially harvested and characterized the pro-osteogenic properties of M2-Exos. A bone marrow mesenchymal stem cell (BMSC)-specific aptamer was synthesized and 3-way junction (3WJ) RNA nanoparticles were applied to conjugate the BMSC-specific aptamer and M2-Exos. In vitro assays revealed that M2-Exos bore the representative features of exosomes and significantly promoted the proliferation, migration, and osteogenic differentiation of BMSCs. 3WJ RNA nanoparticles-aptamer functionalized M2-Exos (3WJ-BMSCapt/M2-Exos) maintained the original physical characteristics of M2-Exos, but bore a high specific binding ability to BMSCs. Furthermore, when being systemically administered in the mice model with femoral bone fractures, these functionalized M2-Exos mainly accumulated at the bone fracture site with a slow release of exosomal cargo, thereby significantly accelerating the healing processes compared with the M2-Exos group. Our study indicated that the 3WJ-BMSCapt/M2-Exos with BMSCs targeting ability and controlled release would be a promising strategy to treat bone fractures.
Against domicile as a connecting factor to tax overseas trusts and global wealth
Authors: Lidbetter John
Published: September 2023

An enduring dilemma is how to tax overseas trusts consistently with the Revenue’s competing goals of raising revenue, whilst also attracting wealthy individuals to invest in the UK. This article suggests that the current approach to taxing overseas trusts achieves neither goal. The main issue, it is contended, lies in the connecting factors utilised to charge overseas trusts. This article argues that (i) domicile should be abandoned as a connecting factor to tax trusts and (ii) greater emphasis should be placed on the settlor and beneficiary’s long-term residence.
In vitro modeling of the post-ingestion bioaccessibility of per- and polyfluoroalkyl substances sorbed to soil and house dust
Authors: Parker Bethany A , Valentini Evelyn , Graham Stephen E , Starr James M
Published: September 2023

Per- and polyfluoroalkyl substances (PFAS) are regularly found in soils and dusts, both of which can be consumed by children at relatively high amounts. However, there is little data available to model the bioaccessibility of PFAS in soils and dusts when consumed or to describe how the physiochemical properties of PFAS and soils/dusts might affect bioaccessibility of these chemicals. Because bioaccessibility is an important consideration in estimating absorbed dose for exposure and risk assessments, in the current study, in vitro assays were used to determine bioaccessibility of 14 PFAS in 33 sets of soils and dusts. Bioaccessibility assays were conducted with and without a sink, which was used to account for the removal of PFAS due to their movement across the human intestine. Multiple linear regression with backward elimination showed that a segmented model using PFAS chain length, number of branches, and percent total organic carbon explained 78.0%–88.9% of the variability in PFAS bioaccessibility. In general, PFAS had significantly greater bioaccessibility in soils relative to dusts and the addition of a sink increased bioaccessibility in the test system by as much as 10.8% for soils and 20.3% for dusts. The results from this study indicate that PFAS bioaccessibility in soils and dusts can be predicted using a limited set of physical chemical characteristics and could be used to inform risk assessment models.
Driver mental load identification model Adapting to Urban Road Traffic Scenarios
Authors: Huang Jing , Wei Wei , Peng Xiaoyan , Hu Lin , Chen Huiqin
Published: September 2023

Objective

At present, most research on driver mental load identification is based on a single driving scene. However, the driver mental load model established in a road traffic scene is difficult to adapt to the changes of the surrounding road environment during the actual driving process. We proposed a driver mental load identification model which adapts to urban road traffic scenarios.

Methods

The model includes a driving scene discrimination sub-model and driver load identification sub-model, in which the driving scene discrimination sub-model can quickly and accurately determine the road traffic scene. The driver load identification sub-model selects the best feature subset and the best model algorithm in the scene based on the judgement of the driving scene classification sub-model.

Results

The results show that the driving scene discrimination sub-model using five vehicle features as feature subsets has the best performance. The driver load identification sub-model based on the best feature subset reduces the feature noise, and the recognition effect is better than the feature set using a single source signal and all data. The best recognition algorithm in different scenarios tends to be consistent, and the support vector machine (SVM) algorithm is better than the K-nearest neighbors (KNN) algorithm.

Conclusion

The proposed driver mental load identification model can discriminate the driving scene quickly and accurately, and then identify the driver mental load. In this way, our model can be more suitable for actual driving and improve the effect of driver mental load identification.
A novel multi-state bogie system reliability evaluation approach by extended d-MC model for high-speed trains
Authors: Fu Yong , Liu Ruoqu , Dai Jisheng , Zhu Wenlong , Liu Xin , Qin Yong
Published: September 2023

Bogie is a pivotal system and plays a critical part in the safety and reliability management of high-speed rail. However, the available bogie system reliability analysis methods lack the consideration of multi-state characteristics, and the common multi-state reliability analysis methods, being an NP-hard problem, lead to low efficiency. In order to overcome these drawbacks, this paper proposes a novel multi-state rail train bogie system reliability analysis approach based on the extended d-MC model. Three different function interactions within the bogie system are considered to build the multi-state bogie system flow network model. Meanwhile, an extended d-MC model is established to remove unnecessary d-MC candidates and duplicates, which greatly enhances the computing efficiency. The bogie system reliability is calculated, and examples are provided. Numerical experiments are carried out for the different operational conditions of the bogie system and are used to test the practicability of the method proposed in this article; it is found that this method outperforms a newly developed method in solving multi-state reliability problems.
Social Norms and Gender Disparities with a Focus on Female Labor Force Participation in South Asia
Authors: Bussolo Maurizio , Ezebuihe Jessy Amarachi , Muñoz Boudet Ana Maria , Poupakis Stavros , Rahman Tasmia , Sarma Nayantara
Published: September 2023

Despite decades of economic growth, gender disparities in South Asia remain remarkably high. Although not the only one, social norms are a crucial driver of various gender outcomes, including differential economic participation. Using repeated cross-sectional data from nationally representative surveys, this study explores long-term trends across gender outcomes and social norms (contrasting attitudes and social normative expectations towards gender roles) in South Asia. The results corroborate the evidence that there has been almost no progress in gender disparities in South Asia over the past half-century. There has been little progress in female labor force participation, age at first birth, agency, and intimate partner violence, while (basic) education is an important exception. The lack of progress is apparent among all layers of society, including women who live in urban areas, are educated, and have higher incomes. Gender attitudes also remain unchanged, while for some issues, they have become more conservative and have a negative relationship with gender outcomes. This negative relationship is even stronger when social normative expectations are considered. More data on social norms and a better understanding of their constraining role may be critical for achieving gender equality in the region.
Tibetan Artemia (Crustacea: Anostraca) mitogenomic biodiversity and population demographics
Authors: Asem Alireza , Yang Chaojie , Mahmoudi Farnaz , Chen Shao-Ying , Long Ben-Chao , Wang Bo , Fu Chun-Zheng , Hontoria Francisco , Rogers D Christopher , Gajardo Gonzalo
Published: September 2023

Hypersaline lakes in arid and semi-arid areas are unique ecosystems that harbour unique extremophile organisms such as Artemia, the paradigmatic example of adaptation to harsh living conditions. We assessed the mitogenomic biodiversity of Artemia species from the Tibetan Plateau, China, a remote and yet minimally disturbed ecosystem with a variety of hypersaline lakes. Analysis of ten Tibetan salt lakes demonstrated the occurrence of two regionally endemic species, Artemia tibetiana and Artemia sorgeloosi, with the latter being the dominant species with eight localities. Both species coexist in Jingyu and Jibu lakes, representing the first case of natural distribution overlap between sexual Artemia species. Artemia sorgeloosi exhibits higher genetic diversity and interpopulation differences, a result consistent with the heterogeneity of local salt lakes, local Artemia population demographics, and their adaptive potentials. Significant FST values demonstrate a gene flow barrier between A. sorgeloosi populations that is compatible with an ‘island biogeography’ distribution pattern, making the Tibetan Plateau a sort of natural laboratory to study intraspecific population differences. Artemia sorgeloosi and the exotic Artemia franciscana were found coexisting in Yangnapen Lake, demonstrating the ability of this invasive species to colonize high-altitude inland habitats, and the need to monitor its presence and eventual expansion.
Reflecting on Progress in and Establishing Benchmarks for Sex and Gender Health Education
Authors: Barr Elizabeth , Chin Eliza Lo , Newman Connie B. , Rojek Mary K. , Sleeper Rebecca , Temkin Sarah M. , Clayton Janine A. , Kantarci Kejal , Kling Juliana M. , McGregor Alyson J. , Schiebinger Londa , Templeton Kim , Viggiano Thomas R. , Wood Susan F. , Werbinski Jan
Published: September 2023

Sex and gender influence every aspect of human health; thus, sex- and gender-related topics should be incorporated in all aspects of health education curricula. Sex and gender health education (SGHE) is the rigorous, intersectional, data-driven integration of sex and gender into all elements of health education. A multisectoral group of thought leaders has collaborated to advance SGHE since 2012. This cross-sector collaboration to advance SGHE has been successful on several fronts, primarily developing robust interprofessional SGHE programs, hosting a series of international SGHE summits, developing sex- and gender-specific resources, and broadening the collaboration beyond medical education. However, other deeply entrenched challenges have proven more difficult to address, including accurate and consistent sex and gender reporting in research publications, broadening institutional support for SGHE, and the development and implementation of evaluation plans for assessing learner outcomes and the downstream effects of SGHE on patient care. This commentary reflects on progress made in SGHE over the first decade of the current collaboration (2012–2022), articulates a vision for next steps to advance SGHE, and proposes 4 benchmarks to guide the next decade of SGHE: (1) integrate sex, gender, and intersectionality across health curricula; (2) develop sex- and gender-specific resources for health professionals; (3) improve sex and gender reporting in research publications; and (4) develop evaluation plans to assess learner and patient outcomes.
Primary Adenocarcinoma of the Uterine Cervix: Classification and Grading
Authors: Pirog Edyta Catalina
Published: September 2023

Cervical adenocarcinomas are a group of malignancies with several distinct histologic tumor types, which include endocervical usual type, endometrioid, intestinal, villoglandular, gastric, signet ring, serous, clear cell, and mesonephric. Diagnosis of cervical adenocarcinoma, in particular early diagnosis, and classification of the tumor type may pose a significant challenge. The goal of this article is to review the current classification, diagnostic criteria, adjunct markers, and differential diagnosis of various subtypes of cervical adenocarcinomas. The article presents up-to-date summary of such problematic issues as differentiating glandular tumors from benign mimics, differentiating early invasive lesions from adenocarcinoma in situ, determining the tumor type, and, finally, differentiating primary cervical adenocarcinoma from uterine endometrioid adenocarcinoma. Discussion of human papillomavirus detection in different tumor types is provided.
Adenocarcinoma of the Uterine Cervix: Measuring, Staging, and Synoptic Reporting
Authors: McCluggage W. Glenn
Published: September 2023

Adenocarcinoma of the cervix is increasing in incidence in relative and real terms given the reduction in cervical squamous carcinomas in many developed countries. In this review, various aspects relating to the pathological staging of cervical carcinomas are discussed with emphasis on adenocarcinomas. These include the distinction between adenocarcinoma in situ and invasive lesions and the measurement of invasive adenocarcinomas; both of these issues are often more difficult than with the corresponding squamous lesions. The measurement of multifocal cervical carcinomas is covered with discussion of the International Collaboration on Cancer Reporting recommendations, although these were chiefly proposed for multifocal squamous carcinomas. The issue of adnexal involvement in cervical adenocarcinoma is discussed. A checklist of parameters that should be included on the pathology report of resection specimens of cervical carcinomas is presented, again with particular reference to the International Collaboration on Cancer Reporting recommendations. The advantages of synoptic reporting, in comparison to free text reporting, are discussed.
Glandular Pseudoneoplasms of the Uterine Cervix
Authors: Harrison Beth T. , Nucci Marisa R.
Published: September 2023

Several benign glandular lesions of the uterine cervix can mimic malignancy. These glandular pseudoneoplasms include microglandular hyperplasia, lobular and diffuse laminar types of endocervical glandular hyperplasia, tunnel clusters, adenomyoma of endocervical type, mesonephric hyperplasia, ectopic prostate, endometriosis and tuboendometrioid metaplasia, and the Arias-Stella reaction, among others. Each of these entities may show a variety of unusual morphologic features that complicate the diagnosis. This review covers the clinical and pathologic features of this selected group of glandular pseudoneoplasms, as well as the immunohistochemical and molecular markers that distinguish them from premalignant and malignant lesions in the differential diagnosis. New developments in the molecular characterization of the latter are briefly discussed in regard to their potential utility in the diagnosis of selected challenging cases. For example, recurrent KRAS mutations distinguish microglandular-like endometrial adenocarcinoma from microglandular hyperplasia, as well as mesonephric and mesonephric-like carcinomas from mesonephric hyperplasia; a p53 mutant phenotype favors minimal deviation or gastric-type adenocarcinoma over lobular endocervical glandular hyperplasia (typical), tunnel clusters, endocervical adenomyomas, and other lesions, and p16 positivity has emerged as a very useful marker of human papillomavirus–related neoplasia in the appropriate clinicopathologic setting.
Controversies in Gynecologic Cancer Staging: An AJCC Cancer Staging Manual, Eighth Edition Perspective
Authors: Hagemann Ian S. , Cole Lisa L. , Cosin Jonathan A. , Gress Donna M. , Mutch David G. , Olawaiye Alexander B.
Published: September 2023

Staging systems provide a common language to support clinical research and decision making in patients with cancer. The eighth edition of the AJCC Cancer Staging Manual incorporates updates that reflect evolving clinical practices and scientific insights. The present article summarizes changes that have been made for gynecologic subsites and outlines continued challenges. Gynecologic American Joint Committee on Cancer/International Union Against Cancer staging continues to conform closely to current International Federation of Obstetrics and Gynecology staging. The eighth edition is aligned with the major revision made to International Federation of Obstetrics and Gynecology staging of ovarian cancer in 2014 and contains a unified staging system for ovarian, fallopian tube, and primary peritoneal cancer. Continuing challenges for ovarian cancer include determining the relative significance of intraoperative rupture, surface involvement, and positive washings, which are rank ordered in the new staging system. Another challenge is assignment of a tubal versus ovarian primary site for high-grade serous carcinoma, which cannot be done in a reliable way. In uterine carcinoma, endometrial intraepithelial carcinoma is now recognized as a T1 cancer, and nodal micrometastases have been defined with their own N stage. Also, isolated tumor cells in lymph nodes have been incorporated in the staging of all gynecologic carcinomas. The staging of uterine sarcoma is largely unchanged. Future revisions may consider grouping these tumors with soft tissue sarcomas at large. Staging of cervical cancer is largely unchanged. Nomenclature of early invasive carcinoma and the challenges in defining tumor dimension in cervical carcinoma are discussed. The nodal staging of vulvar cancer now incorporates a vocabulary for isolated tumor cells and micrometastases. Despite the current interest in molecular staging, the eighth edition expert panel did not identify any specific biomarkers for inclusion in stage classification, but several are recommended for collection as ancillary data elements, including p16 status in vulvar, vaginal, and cervical tumors. In the eighth edition, as in the seventh, anatomic factors remain the cornerstone of gynecologic cancer staging.
Genitourinary Updates in the Eighth Edition of the AJCC Cancer Staging Manual
Authors: Spruill Laura S. , Bruner Evelyn T. , Smith Michael Timothy
Published: September 2023

The new, eighth edition of the AJCC Cancer Staging Manual has been published, and there are many and significant changes in the staging for genitourinary organs. Pathologists will necessarily need to study the manual to acquire fluency in the staging. The staging changes and philosophy will be applicable in 2018. The TNM process involved remains the same, but some specific definition changes are present. Prostate staging is now very different; whereas prior staging included pT2a, pT2b, and pT2c, now all organ-confined disease is pT2 without consideration of half gland involvement. Staging of penis cancer previously considered urethral involvement but now corpus spongiosum involvement is considered pT2, and corpus cavernosum involvement is considered pT3 disease irrespective of the urethral involvement based on literature evidence. Invasion of the epididymis as a component of testis staging is now considered pT2 rather than pT1. These are just some of the new changes that will require understanding on the part of the pathologist. This article describes the changes and some of the background supportive literature and provides appropriate explanatory illustrations.
Pathologic Staging of Bone and Soft Tissue Tumors: What Is New in the Eighth Edition of the American Joint Committee on Cancer Staging Manual?
Authors: Laurini Javier A. , Cooper Kumarasen
Published: September 2023

The recently published eighth edition of the AJCC Cancer Staging Manual addresses and incorporates a substantial number of advances in our understanding of bone and soft tissue sarcomas. A greater emphasis has been placed on the anatomic site of origin resulting in new staging systems. In addition, modifications to the existing AJCC prognostic stage groups and implementation of new prognostic stage groups for certain anatomic sites and tumor types were made. Minor changes in the biologic grading of bone sarcomas were also included. For retroperitoneal soft tissue sarcomas, a nomogram providing additional prognostic information has been endorsed by the AJCC Precision Medicine Core and is included as a risk assessment model. Pathologists play a central role in tumor staging and therefore should become familiar with these changes.
Ultrasound-Guided Fine-Needle Aspiration Biopsy of Salivary Glands: A Practical Review
Authors: Wiles Austin B. , Kraft Adele O. , Powers Celeste N.
Published: September 2023

The usage of real-time ultrasound-guided fine-needle aspiration biopsy by cytopathologists has increased the utility of biopsy in management of patients with salivary gland neoplasms. There is significant overlap between cytologic features of salivary gland neoplasms, and likewise, there is analogous overlap between ultrasound radiologic features of these lesions. However, ultrasound radiologic evaluation can provide important information for the cytopathologist when performing and interpreting a biopsy of a salivary gland neoplasm, including the specific anatomic location and structure of a target lesion. We present a practical guide for using ultrasound evaluation in the biopsy of the salivary glands for the practicing cytopathologist including common pitfalls, common lesional characteristics, and relevant lymph node morphological findings.
Sonographic Breast Mimickers: Examples of Cases Outside the Box
Authors: Sanchez Miguel A. , Burga Ana M. , Tismenetsky Mikhail , Goldfischer Mindy
Published: September 2023

Ultrasound in breast imaging has enhanced the field of radiology by using this distinct modality to evaluate breast lesions using unique features that are not available by traditional mammography. These features that are used can help characterize lesions in the breast into benign, suspicious, or malignant entities. However, not all lesions of the breast fall into these set categories, and sampling of the masses may be necessary to avoid pitfalls. In this article, we list the criteria that are classically used to favor benign versus malignant lesions and then have 2 examples that fall outside of the box and needed sampling of the masses for a definitive diagnosis.