bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidendrum manusalinasiae (Orchidaceae: Laeliinae), new species from the high Andean forests of Manu National Park, Cusco, Perú
Authors: ALFARO LUCERO E. , SALINAS JULIAN DUARTE , HÁGSATER ERIC , CANO ASUNCIÓN
Published: September 2024

We describe and illustrate a new species of Epidendrum from the high Andean forests of Manu National Park, Cusco. Epidendrum manusalinasiae belongs the Saxicola group. Information on its distribution, habitat, phenology, and conservation status is provided. The new species is compared with E. churubambense, E. herreranum and E. tetartociclium from which it is distinguished by having leaves elliptic to widely elliptic, flowers pale yellow to green, sepals sometimes tinged red-brown, column and calli creamy yellow, lip disc with large, fleshy thickened, forming wide cordiform platform, wider than mid-lobe and reaching its base and mid-lobe whit distal portion plicated forward, whit a sub-lobed appearance in natural position.
Airway Issues in Management of Severe Cut-Throat Injuries
Authors: Caleb Manya , Hassan Solomon , Ibrahim Jibrila , Ime Inoh , Maisallah Jafar , Stephen Yikawe
Published: September 2024

Introduction: Open or incised anterior neck injuries inflicted by sharp implements may be described as Cut-throat injuries (CTIs). The managing team is immediately confronted with airway management options, therefore, a close collaboration between the surgeon and the anesthetist is required to adopt a strategy that will guarantee a safe airway and ensure a successful outcome. In this article, we discuss the factors that led us to perform tracheostomy before repair while avoiding a rule of tracheostomy for all. Method: A prospective study was conducted at Federal Medical Centre, Gusau, between January 2019 -August 2023. Nine (9) patients presented with zone II cut-throat injuries and the choice of airway management was discussed between the surgeon and the anesthetist focused on symptoms of air obstruction and findings within the larynx that could lead to airway obstruction once repair was done. Result: There were nine patients (9) with the age range of 18-60 years. Tracheostomy rate was 55.6% (n=5). There is a positive correlation (+1) between tracheostomy and laryngeal edema. A subset of patients, 22.2% (n=2) was selected for repair without a tracheostomy. Conclusion: The choice of perfect airway management should result from constructive collaboration between the surgeon and the anesthetist. Tracheostomy should be considered in patients with asymptomatic laryngeal edema.
An Empirical Investigation into an Economic Analysis of State Road Transport Undertakings in India
Authors: Singh Swapnil , Parihar Mahendra
Published: September 2024

State Road Transport Undertakings have been the backbone of the transportation network in India since their inception. These corporations were set up to provide a sustainable and cheap mode of transport for citizens of India, along with providing connectivity to rural parts of the nation. Over the years, the financial and physical performance of most State Road Transport Undertakings has dropped significantly. The social goal, political influence and poor management have been some of the major factors contributing to the losses made by most of the State Road Transport Undertakings. We have conducted this study by considering eight State Road Transport Undertakings, which are loss and profit-making, to understand the factors responsible for improving the physical factors of these State Road Transport Undertakings. To undertake this objective, we used correlation analysis and feature importance analysis using random forest regressor. We have proposed some policy-based measures for each State Road Transport Undertaking analysed based on the results and analysis.

JEL Codes: C12, I38, L32, L91, N35, O53, R41, R42
The Impact of Air Pollution on Consumer Spending
Authors: Kim Sanghwa , Trusov Michael
Published: September 2024

Air pollution is a growing threat to economies and societies. Despite the common knowledge that air pollution impairs emotions and cognition and, hence, behavioral outcomes, the impact of air pollution on consumer spending remains an open question. Analyzing air quality readings and individual-level credit card transactions in South Korea, this article shows that consumers spend more money when air quality is poorer. This correlation is more prominent in hedonic categories, such as entertainment or leisure activities, where the nature of consumption is characterized by greater emotional benefits. The authors consider potential explanations, and the leading hypothesis is that consumers treat spending as a mood-regulating resource. The results survive an array of robustness checks and are supported in a controlled experiment, reinforcing a causal inference behind the main findings. The authors provide implications for stakeholders to develop a sustainable marketing program that not only pursues managerial interests but also concerns consumer welfare in the face of environmental change.
Public opinion and the teaching profession
Authors: Vail Kathleen
Published: September 2024

Negative public perception of schools nationally impacts the teaching profession in direct and indirect ways. This perception has depressed the number of students in teacher preparation programs at universities. Indirectly, public perception affects teacher working conditions, compensation, and morale. Education advocates and researchers talk about the historical roots of perception of teachers, how and why negative perceptions persist, and how teachers can change the narrative.
An Object-Relations Analysis of Psalm 131
Authors: Ho Shirley S.
Published: September 2024

Psalm 131 employs the metaphorical imagery of an infant and mother to portray the relationship between the psalmist and YHWH. Since this imagery is critical in understanding the psalmist and the overall message of the psalm, I utilize psychoanalytical Object-Relations theory in reading the psalm. This interpretive framework offers insights into the language, structure, and movement of the psalm that might otherwise be overlooked. This essay reveals the foundational role of YHWH, particularly in relation to his absence and presence as primary caregiver in the development of the false self and the restoration of the true self-identity of the psalmist. The restoration of the psalmist’s true self-identity is further supported by the larger canonical context in which the Torah of Psalm 119 functions as an object-relations transitional object for the psalmist.
Kinematics of two-wheeler cyclists toward head-ground contact after vehicle collisions
Authors: Liu Ao , Nie Bingbing , Liu Yu , Li Guibing
Published: September 2024

Ground contact is the main source for head injuries of two-wheeler (TW) cyclists in vehicle collision accidents, and there is still a lack of understanding of TW cyclist ground impact kinematics. The purpose of the current study is therefore to investigate the kinematics of TW cyclists toward head-ground contact after vehicle collisions via multi-body modeling of vehicle-to-TW crashes under different scenarios. The results indicate that: a lower relative height of pelvis to vehicle bonnet leading edge and vehicle impact speed are more likely to induce a forward landing kinematics to TW cyclists, while higher values of these parameters are generally associated with the backward rolling or soaring movement; TW cyclists are more likely to drop to the side of the vehicle when the TW is moving or with a large offset distance from the center line of the struck vehicle; the head-first ground contact configuration is generally associated with shorter bicyclists in sedan impacts, bicyclists in MPV crashes and all TW cyclists in the crashes with a high vehicle impact speed (>30 km/h); the head-ground contact velocity of TW cyclists is significantly higher in the rear-end dropping cases, and shows relatively high correlation to vehicle impact speed but low correlation to TW moving speed; the head-ground contact velocity of TW cyclists is strongly affected by the body motion before head-ground impact, and head-first contacts could have an either low or high ground contact velocity. The findings may provide preliminary reference for future strategies of TW cyclist ground injury prevention.
A Machine Learning Approach to Solve the E-commerce Box-Sizing Problem
Authors: Kandula Shanthan , Roy Debjit , Akartunalı Kerem
Published: September 2024

E-commerce packages are notorious for their inefficient usage of space. More than one-quarter volume of a typical e-commerce package comprises air and filler material. The inefficient usage of space significantly reduces the transportation and distribution capacity increasing the operational costs. Therefore, designing an optimal set of packaging box sizes is crucial for improving efficiency. We present the first learning-based framework to determine the optimal packaging box sizes. In particular, we propose a three-stage optimization framework that combines unsupervised learning, reinforcement learning, and tree search to design box sizes. The package optimization problem is formulated into a sequential decision-making task called the box-sizing game. A neural network agent is then designed to play the game and learn heuristic rules to solve the problem. In addition, a tree-search operator is developed to improve the performance of the learned networks. When benchmarked with company-based optimization formulation and two alternate optimization models, we find that our ML-based approach can effectively solve large-scale problems within a stipulated time. We evaluated our model on real-world datasets supplied by a large e-commerce platform. The framework is currently adopted by a large e-commerce company across its 28 fulfillment centers, which is estimated to save the company about 7.1 million USD annually. In addition, it is estimated that paper consumption will be reduced by 2,080 metric tons and greenhouse gas emissions by 1,960 metric tons annually. The presented optimization framework serves as a decision support tool for designing packaging boxes at large e-commerce warehouses.
Labour, the Environment and International and European Law: One journey or worlds apart?
Authors: van Schadewijk Matthijs
Published: September 2024

The transition to an environmentally sustainable economy raises Herculean challenges for labour law. From a labour law perspective, perhaps the biggest question is the extent to which the environment is an interest that is and should be recognised and protected by labour law. Although the answer to this question is different for each national legal system, the influence of international and European law cannot be ignored. Starting from this assumption, the author analyses to what extent international and European law may influence the recognition of the environment as an interest of national labour law. To this end, the author analyses the overarching principles that characterise the interrelation between labour and the environment in the hard and soft law of the UN, ILO and EU. Subsequently, three areas of national labour law which may be influenced by the supranational framework are identified and discussed: job transition, work-related mobility of employees and remuneration. The author finds that the supranational framework provides arguments to assert that the environment has a place in labour law and is a legitimate interest in the balancing exercise between employer and employee. Nevertheless, a substantive place for labour law in the supranational framework seems lacking. The supranational framework is primarily concerned with compensating employees for the negative effects of the green transition and offers limited support for a broader integration of the environment into the employment relationship. Consequently, it makes few connections with labour law and contains few (hard or soft) obligations for both employers and employees. In the view of the author, this is a missed opportunity.
Patient Participant Perspectives on Implementation of Long-Acting Cabotegravir and Rilpivirine: Results From the Cabotegravir and Rilpivirine Implementation Study in European Locations (CARISEL) Study
Authors: Gutner Cassidy A. , van der Valk Marc , Portilla Joaquin , Jeanmaire Eliette , Belkhir Leïla , Lutz Thomas , DeMoor Rebecca , Trehan Rekha , Scherzer Jenny , Pascual-Bernáldez Miguel , Ait-Khaled Mounir , Hernandez Beatriz , de Ruiter Annemiek , Anand Savita Bakhshi , Low Emma L. , Hadi Monica , Barnes Nicola , Sevdalis Nick , Mohammed Perry , Czarnogorski Maggie
Published: September 2024

Introduction

CARISEL is an implementation–effectiveness “hybrid” study examining the perspectives of people living with HIV-1 (patient study participants [PSPs]) on cabotegravir (CAB) plus rilpivirine (RPV) long-acting (LA) dosed every 2 months (Q2M) across 5 European countries.

Methods

PSPs completed questionnaires on acceptability (Acceptability of Intervention Measure), appropriateness (Intervention Appropriateness Measure), and feasibility (Feasibility of Intervention Measure) at their first (Month [M] 1), third (M4), and seventh (M12) injection visits. Semistructured qualitative interviews were also conducted.

Results

Overall, 437 PSPs were enrolled, of whom 430 received treatment. Median (interquartile range) age was 44 (37-51) years, 25.3% (n = 109/430) were female (sex at birth), and 21.9% (n = 94/430) were persons of color. Across time points, PSPs found CAB + RPV LA highly acceptable, appropriate, and feasible (mean scores ≥4.47/5). Qualitative data supported these observations.

Conclusions

PSPs found CAB + RPV LA Q2M to be an acceptable, appropriate, and feasible treatment option.
Drafting a Cybersecurity Standard for Outer Space Missions: On Critical Infrastructure, China, and the Indispensability of a Global Inclusive Approach
Authors: Segate Riccardo Vecellio
Published: September 2024

Despite limited progress within international institutions, the need for articulating a regulatory framework for cyber operations in outer space is becoming a pressing concern. One precondition for regulation is to share cybersecurity and outer-space common terminology that can inform the negotiation of standards, policies and laws. While the UN Institute for Disarmament Research has recently issued a baseline policy glossary, binding technical definitions are missing, and the lack of a binding international cybersecurity regime adds to the obsolescence of a binding outer-space regime tracing back to half a century ago. As the IEEE SA embarks on the drafting of the first-ever technical standard for cybersecure-by- design outer-space missions, scoping and conceptual challenges abound. Technical standards are US-centred, non-binding, engineering-intensive exercises, where lawyers and Asian jurisdictions are only marginally involved; nevertheless, as China’s framework for cybersecurity is refined and its involvement in outer-space policing deepens, its disengagement from Western-driven standard-setting bodies appears unsustainable. Drawing on the specific challenge of defining what makes a cyber system ‘mission-critical’, I expose the necessity to examine how domestic cybersecurity laws from a diverse range of States identify ‘critical’ information infrastructure. Generalising therefrom, I advocate a jurisdictionally inclusive process that combines American supremacy in technical standard-setting for outer-space missions with Chinese normative contributions to cybersecurity regulation, including on data localisation and mandatory multilevel cyber-hygiene requirements. I further argue that involving legal experts from a diverse range of jurisdictions and sociolegal cultures may enhance the global reception of standardisation outputs, thus securing higher degrees of voluntary compliance therewith. This could foster cooperation and promote regional and global satellite cybersecurity.
Examining the Role of Stress and Team Support in Decision Making under Uncertainty and Time Pressure
Authors: Younas Sana , Khanum Saeeda
Published: September 2024

Background. Previous research has examined the individual effects of uncertainty, time pressure, perceived stress, and team support on decision making. However, scant research has investigated how team support and perceived stress collectively influence providers’ perception of decision conflict and satisfaction with decision. Objectives. The present study aims to fill this void by examining the potential mediating role of perceived stress and team support in the relationship between time pressure, uncertainty, decision satisfaction, and decision conflict. Methods. Obstetrics and gynecology (Obs and Gynae) physicians ( N = 347) working in tertiary care hospitals were approached through snowball and purposive convenient sampling. Self-reported data were collected in the form of questionnaires. Results. Structural equation modeling was used to uncover the complex linkages. Perceived stress was found to be a significant mediator between uncertainty and decision conflict ( b = −0.033, P < 0.05). In addition, team support was also found to be a significant mediator between uncertainty and decision satisfaction ( b = 0.082, P < 0.05) as well as between time pressure and decision satisfaction ( b = 0.086, P < 0.05). Conclusion. Team support acts as a bridge between uncertainty and decision satisfaction and also between time pressure and decision satisfaction, underscoring its critical role in provider perceptions of decision making in the Obs and Gynae context. Implications. This study highlights the significance of managing stress, enhancing team support, and giving priority to patient-centered care. These findings provide insights into risk and uncertainty management in medical decision making, advancing patient-centered care, and optimizing health care outcomes.

Highlights

Stressors in hospital settings such as the complexity and uncertainty of tasks create stress among physicians, potentially leading to decision conflicts. Team support plays a fundamental role in mitigating the negative effects of stressors such as time pressure and uncertainty. Implementing stress management and team support interventions such as cognitive-behavioral therapy and mindfulness may enhance decision making among Obs and Gynae physicians.
Successful use of an eye gaze AAC communication board by a young adult with advanced Sanfilippo Syndrome (MPS IIIA): Case report
Authors: Brennan Christine , Matthews Abigail , Tennant Sherri
Published: September 2024

Sanfilippo syndrome (Mucopolysaccharidosis Type III or MPS III) is a family of rare, lysosomal disorders characterized by progressive cognitive and motor deterioration. Even though individuals with MPS III present with complex communication needs, research regarding augmentative and alternative communication (AAC) in this population is scarce. While life expectancy for individuals with MPS IIIA typically does not exceed 20 years of age, this case report involves a 22-year-old adult with postregression MPS IIIA. Prior to this study, the participant could not communicate using speech and only responded to yes/no questions using eye blink responses. The participant was given a low-tech AAC system utilizing eye gaze so that she could respond to a variety of caregiver questions and take conversational turns. The following communication outcomes were measured during each session in which caregivers used the AAC system: number of eye gaze responses, total number of responses (using any means), the percent of responses to questions asked, and the total count of expressive vocabulary words available to the participant with the AAC system. Increases were observed in the number of eye gaze responses per session and in the expressive vocabulary accessible via the eye gaze board. A higher percentage of responses given caregiver questions was noted for the intervention sessions (71%) compared to the baseline sessions (55%). There were also qualitative changes characterized by the types of questions the participant could respond to during conversational exchanges. Despite the progression of MPS IIIA, the results suggest that use of the eye gaze board resulted in quantitative and qualitative changes in functional communication. This case report provides preliminary evidence that AAC can improve communication in a young adult with postregression MPS IIIA.
Unpacking conflict-ridden everyday life: Perspectives from life-environmentalism
Authors: Yamamoto Daisaku , Noda Takehito
Published: September 2024

This paper examines the concept of life-environmentalism ( seikatsu kankyō shugi), which emerged in the 1980s as a shared research framework among Japanese social scientists studying the adverse effects of modern industrialization of everyday life in rural communities. Despite its recognition in Japan, the life-environmentalist approach remains largely unknown to Anglophone literature. While the recently published book, Everyday Life-Environmentalism, provides an introductory English-language text, it lacks thorough theoretical articulation of the approach in relation to contemporary Anglophone approaches. This paper centers on actor-network theory, a widely circulated approach within post-human and more-than-human geographies, as a comparative frame of reference to elucidate key characteristics of life-environmentalism. Through a comparative examination of the applications of these approaches to a local case study, we suggest that life-environmentalism offers valuable insights when analyzing socioenvironmental controversies and community-level responses, particularly in contexts where a long-standing social community is central to the analysis.
Ultrasonographic Effectiveness in Hypotensive Patients
Authors: Günaydın İsa , Kekeç Zeynep , Ay Mehmet Oğuzhan
Published: September 2024

Objective:

This study aimed to investigate the efficacy of sonography in reducing morbidity and mortality among patients with shock, particularly in the emergency department (ED). By employing the “Rapid Ultrasound for Shock and Hypotension” (RUSH) protocol with ED patients, the aim was to assess its contribution to patient outcomes.

Materials and Methods:

This prospective, cross-sectional study spanned 2 years and was conducted in a university-based emergency department. Overall, 100 adult patients with blood pressure ≤90/60 mmHg and shock index >1 were enrolled. The RUSH protocol was followed for each patient.

Results:

The study comprised 35 females and 65 males, with a mean age of 57.12 ± 17.1 years. The RUSH assessment indicated that 50 patients had fluid volume indices below 1.5 cm, predominantly presenting with hypovolemic shock (55%). Extended Focused Assessment with Sonography in Trauma (E-FAST) examination revealed free abdominal fluid in 18% of the patients. Cardiogenic shock, including arrhythmia and heart failure, was diagnosed in 9 patients each. Nine patients experienced obstructive shock. Initial RUSH protocol diagnoses included hypovolemic shock ( n = 55), distributional shock ( n = 19), cardiogenic shock ( n = 8), obstructive shock ( n = 6), and complex shock ( n = 12).

Conclusion:

The RUSH protocol has emerged as an early, systematic, and practical method for assessing patients with hypotension and shock in the ED. It may also offer the potential to enhance patient management and outcomes.
Phosphodiesterase 4 is overexpressed in keloid epidermal scars and its inhibition reduces keratinocyte fibrotic alterations
Authors: Milara Javier , Ribera Pilar , Marín Severiano , Montero Paula , Roger Inés , Cortijo Julio
Published: September 2024

Background

Epidermal remodeling and hypertrophy are hallmarks of skin fibrotic disorders, and keratinocyte to mesenchymal (EMT)-like transformations drive epidermis alteration in skin fibrosis such as keloids and hypertrophic scars (HTS). While phosphodiesterase 4 (PDE4) inhibitors have shown effectiveness in various fibrotic disorders, their role in skin fibrosis is not fully understood. This study aimed to explore the specific role of PDE4B in epidermal remodeling and hypertrophy seen in skin fibrosis.

Methods

In vitro experiments examined the effects of inhibiting PDE4A-D (with Roflumilast) or PDE4B (with siRNA) on TGFβ1-induced EMT differentiation and dedifferentiation in human 3D epidermis. In vivo studies investigated the impact of PDE4 inhibition on HOCl-induced skin fibrosis and epidermal hypertrophy in mice, employing both preventive and therapeutic approaches.

Results

The study found increased levels of PDE4B (mRNA, protein) in keloids > HTS compared to healthy epidermis, as well as in TGFβ-stimulated 3D epidermis. Keloids and HTS epidermis exhibited elevated levels of collagen Iα1, fibronectin, αSMA, N-cadherin, and NOX4 mRNA, along with decreased levels of E-cadherin and ZO-1, confirming an EMT process. Inhibition of both PDE4A-D and PDE4B prevented TGFβ1-induced Smad3 and ERK1/2 phosphorylation and mesenchymal differentiation in vitro. PDE4A-D inhibition also promoted mesenchymal dedifferentiation and reduced TGFβ1-induced ROS and keratinocyte senescence by rescuing PPM1A, a Smad3 phosphatase. In vivo, PDE4 inhibition mitigated HOCl-induced epidermal hypertrophy in mice in both preventive and therapeutic settings.

Conclusions

Overall, the study supports the potential of PDE4 inhibitors, particularly PDE4B, in treating skin fibrosis, including keloids and HTS, shedding light on their functional role in this condition.
Tensor product algorithms for inference of contact network from epidemiological data
Authors: Dolgov Sergey , Savostyanov Dmitry
Published: September 2024

We consider a problem of inferring contact network from nodal states observed during an epidemiological process. In a black-box Bayesian optimisation framework this problem reduces to a discrete likelihood optimisation over the set of possible networks. The cardinality of this set grows combinatorially with the number of network nodes, which makes this optimisation computationally challenging. For each network, its likelihood is the probability for the observed data to appear during the evolution of the epidemiological process on this network. This probability can be very small, particularly if the network is significantly different from the ground truth network, from which the observed data actually appear. A commonly used stochastic simulation algorithm struggles to recover rare events and hence to estimate small probabilities and likelihoods. In this paper we replace the stochastic simulation with solving the chemical master equation for the probabilities of all network states. Since this equation also suffers from the curse of dimensionality, we apply tensor train approximations to overcome it and enable fast and accurate computations. Numerical simulations demonstrate efficient black-box Bayesian inference of the network.
Medical visits and mortality among dementia patients during the COVID-19 pandemic compared to rates predicted from 2019
Authors: Ghosh Kaushik , Stewart Susan T. , Raghunathan Trivellore , Cutler David M.
Published: September 2024

Background

During the COVID-19 pandemic, patients with Alzheimer’s disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes.

Methods

Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors’ office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January–December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths — due to COVID and non-COVID causes — and changes in care use in the beneficiary’s state of residence.

Results

Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p < .001). Emergency/inpatient visits declined (by 9 percent, p < .001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p < .001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49).

Conclusions

Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits.
Interaction effects of the COVID-19 pandemic and regional deprivation on self-rated health: a cross-sectional study
Authors: Jeon Hajae , Lee Junbok , Choi Mingee , Kim Bomgyeol , Lee Sang Gyu , Shin Jaeyong
Published: September 2024

Background

Recent studies have attempted to analyze the changes in self-rated health (SRH) during the coronavirus disease 2019 (COVID-19) pandemic. However, the results have been inconsistent. Notably, SRH is subjective, and responses may vary across and within countries because of sociocultural differences. Thus, we aimed to examine whether the interaction effects between the COVID-19 pandemic and regional deprivation influenced SRH in South Korea.

Methods

The study population comprised 877,778 participants from the Korea Community Health Survey. The data were collected from 2018 to 2021. Multiple regression analysis was employed to determine the relationship between SRH and the interaction between the COVID-19 pandemic status and the socioeconomic level of residential areas.

Results

The post-pandemic groups (odds ratio [OR] = 2.25, P < .0001; OR = 2.29, P < .0001) had significantly higher odds of reporting favorable SRH than the pre-pandemic groups (OR = 0.96, P < .0001). However, the difference in ORs based on regional socioeconomic status was small.

Conclusions

SRH showed an overall increase in the post-pandemic groups relative to that in the disadvantaged pre-pandemic group. Possible reasons include changes in individuals’ health perceptions through social comparison and the effective implementation of COVID-19 containment measures in South Korea. This paradoxical phenomenon has been named the “Eye of the Hurricane,” as the vast majority of people who had not been infected by the virus may have viewed their health situation more favorably than they ordinarily would.
Clinician perspectives and recommendations regarding design of clinical prediction models for deteriorating patients in acute care
Authors: Blythe Robin , Naicker Sundresan , White Nicole , Donovan Raelene , Scott Ian A. , McKelliget Andrew , McPhail Steven M
Published: September 2024

Background

Successful deployment of clinical prediction models for clinical deterioration relates not only to predictive performance but to integration into the decision making process. Models may demonstrate good discrimination and calibration, but fail to match the needs of practising acute care clinicians who receive, interpret, and act upon model outputs or alerts. We sought to understand how prediction models for clinical deterioration, also known as early warning scores (EWS), influence the decision-making of clinicians who regularly use them and elicit their perspectives on model design to guide future deterioration model development and implementation.

Methods

Nurses and doctors who regularly receive or respond to EWS alerts in two digital metropolitan hospitals were interviewed for up to one hour between February 2022 and March 2023 using semi-structured formats. We grouped interview data into sub-themes and then into general themes using reflexive thematic analysis. Themes were then mapped to a model of clinical decision making using deductive framework mapping to develop a set of practical recommendations for future deterioration model development and deployment.

Results

Fifteen nurses (n = 8) and doctors (n = 7) were interviewed for a mean duration of 42 min. Participants emphasised the importance of using predictive tools for supporting rather than supplanting critical thinking, avoiding over-protocolising care, incorporating important contextual information and focusing on how clinicians generate, test, and select diagnostic hypotheses when managing deteriorating patients. These themes were incorporated into a conceptual model which informed recommendations that clinical deterioration prediction models demonstrate transparency and interactivity, generate outputs tailored to the tasks and responsibilities of end-users, avoid priming clinicians with potential diagnoses before patients were physically assessed, and support the process of deciding upon subsequent management.

Conclusions

Prediction models for deteriorating inpatients may be more impactful if they are designed in accordance with the decision-making processes of acute care clinicians. Models should produce actionable outputs that assist with, rather than supplant, critical thinking.
Formal and informal human milk donation in New Zealand: a mixed-method national survey
Authors: Harris Shalee , Bloomfield Frank H. , Muelbert Mariana
Published: September 2024

Background

Mother’s milk provides optimal nutrition for infants. Donor human milk (DHM) is recommended for low birthweight infants when mother’s milk is unavailable. Little is known about human milk (HM) donation practices in New Zealand (NZ), where few HM banks are available. This study aimed to investigate parents’ and health professionals’ (HP) experiences with formal and informal HM donation in NZ.

Methods

Two electronic surveys were disseminated in 2022 to parents and HPs involved with HM donation in NZ. The surveys covered respondents’ views and experiences with HM donation. HPs were also asked about HM donation practices in their workplace. Chi-squared and Fisher-Freeman-Halton exact tests were used for quantitative analysis and qualitative data were thematically analysed using inductive approach.

Results

A total of 232 HP and 496 parents completed the surveys. Most parents either donated (52%) or sought DHM (26%) for their infant and most donations were informal, arranged between individuals (52%) or through hospital staff (22%). HP reported DHM was used in 86% of facilities, with only 20% of donations facilitated by HM banks. Almost half (48%) of HP stated they would like to use DHM in their workplace but access was limited. The most common screening processes undertaken by parents and HP before informal HM donation were lifestyle including smoking status, medication, drug and alcohol intake (44% and 36%, respectively) and serological screening such as CMV, HIV, Hepatitis C or B (30% and 39%, respectively). Pasteurisation of DHM obtained informally was not common. Most donors were satisfied with their HM donation experiences (informal and/or formal, 91%) and most respondents supported use of DHM in hospitals and community. Participants reported HM donation could be improved (e.g., better access) and identified potential benefits (e.g., species-specific nutrition) and risks (e.g., pathogens) for the infant. Potential benefits for the donor were also identified (e.g., altruism), but respondents acknowledged potential negative impacts (e.g., cost).

Conclusion

Informal HM donation in NZ is common. Most parents and HP support the use of DHM; however, improvements to current practices are needed to ensure safer and more equitable access to DHM.
Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial
Authors: Kristensen-Alvarez Anna , Fode Mikkel , Stroomberg Hein Vincent , Nielsen Kurt Krøyer , Arch Albert , Lönn Lars Birger , Taudorf Mikkel , Widecrantz Steven John , Røder Andreas
Published: September 2024

Background

One-fourth of men older than 70 years have lower urinary tract symptoms (LUTS) that impair their quality of life. Transurethral resection of the prostate (TURP) is considered the gold standard for surgical treatment of LUTS caused by benign prostatic hyperplasia (BPH) that cannot be managed conservatively or pharmacologically. However, TURP is only an option for patients fit for surgery and can result in complications. Transurethral microwave thermotherapy (TUMT) and prostatic artery embolisation (PAE) are alternative minimally invasive surgical therapies (MISTs) performed in an outpatient setting. Both treatments have shown to reduce LUTS with a similar post-procedure outcome in mean International Prostate Symptom Score (IPSS). It is however still unknown if TUMT and PAE perform equally well as they have never been directly compared in a randomised clinical trial. The objective of this clinical trial is to assess if PAE is non-inferior to TUMT in reducing LUTS secondary to BPH.

Methods

This study is designed as a multicentre, non-inferiority, open-label randomised clinical trial. Patients will be randomised with a 1:1 allocation ratio between treatments. The primary outcome is the IPSS of the two arms after 6 months. The primary outcome will be evaluated using a 95% confidence interval against the predefined non-inferiority margin of + 3 points in IPSS. Secondary objectives include the comparison of patient-reported and functional outcomes at short- and long-term follow-up. We will follow the patients for 5 years to track long-term effect. Assuming a difference in mean IPSS after treatment of 1 point with an SD of 5 and a non-inferiority margin set at the threshold for a clinically non-meaningful difference of + 3 points, the calculated sample size was 100 patients per arm. To compensate for 10% dropout, the study will include 223 patients.

Discussion

In this first randomised clinical trial to compare two MISTs, we expect non-inferiority of PAE to TUMT. The most prominent problems with MIST BPH treatments are the unknown long-term effect and the lack of proper selection of candidates for a specific procedure. With analysis of the secondary outcomes, we aspire to contribute to a better understanding of durability and provide knowledge to guide treatment decisions.

Trial registration

ClinicalTrials.gov NCT05686525. Registered on January 17, 2023,
https://clinicaltrials.gov/study/NCT05686525.
Deubiquitinase USP10 promotes osteosarcoma autophagy and progression through regulating GSK3β-ULK1 axis
Authors: Feng Zuxi , Ou Yanghuan , Deng Xueqiang , Deng Minghao , Yan Xiaohua , Chen Leifeng , Zhou Fan , Hao Liang
Published: September 2024

Background

Deubiquitinating enzymes (DUBs) are pivotal in maintaining cell homeostasis by regulating substrate protein ubiquitination in both healthy and cancer cells. Ubiquitin-specific protease 10 (USP10) belongs to the DUB family. In this study, we investigated the clinical and pathological significance of USP10 and Unc-51-like autophagy activating kinase 1 (ULK1) in osteosarcoma (OS), as well as the mechanism of USP10 action in ULK1-mediated autophagy and disease progression.

Results

The analysis of OS and adjacent normal tissues demonstrated that USP10 and ULK1 were significantly overexpressed in OS, and a positive association between their expression and malignant properties was observed. USP10 knockdown in OS cells reduced ULK1 mRNA and protein expression, whereas USP10 overexpression increased ULK1 mRNA and protein expression. In vitro experiments showed that USP10 induced autophagy, cell proliferation, and invasion by enhancing ULK1 expression in OS cell lines. Furthermore, we found that the regulation of ULK1-mediated autophagy, cell proliferation, and invasion in OS by USP10 was dependent on glycogen synthase kinase 3β (GSK3β) activity. Mechanistically, USP10 promoted ULK1 transcription by interacting with and stabilising GSK3β through deubiquitination, which, in turn, increased the activity of the ULK1 promoter, thereby accelerating OS progression. Using a xenograft mouse model, we showed that Spautin-1, a small-molecule inhibitor targeting USP10, significantly reduced OS development, with its anti-tumour activity significantly enhanced when combined with the chemotherapeutic agent cisplatin.

Conclusion

Collectively, we demonstrated that the USP10-GSK3β-ULK1 axis promoted autophagy, cell proliferation, and invasion in OS. The findings imply that targeting USP10 may offer a promising therapeutic avenue for treating OS.
Reproductive healthcare utilization for women in the sex trade: a qualitative study
Authors: Birger Lior , Benyamini Yael , Goor Yael , Sahar Zohar , Peled Einat
Published: September 2024

Background

Women in the sex trade encounter significant challenges in obtaining reproductive healthcare. Reports of reproductive healthcare for women in the sex trade center on the prevention and termination of pregnancies, yet most women in the sex trade globally experience full term pregnancies and bear children. This study aimed to explore barriers and enabling factors to providing reproductive healthcare for women in the sex trade in Israel.

Methods

We conducted a qualitative study utilizing a grounded theory method. Data were collected through semi-structured interviews, conducted between June 2021 and July 2022. Interviews were conducted with practitioners in healthcare settings (n = 20), practitioners in social services settings (n = 15), and women in the sex trade who received reproductive health care-related medical services (n = 13) in Israel. The interviews were audiotaped, transcribed, and thematically analyzed.

Results

The findings indicated a multilayered structure of healthcare system-related factors and women-related factors. Stigma was noted as a multidimensional barrier, reflected in service providers’ attitude towards women in the sex trade, impairing the patient-provider relationship and impeding women’s help-seeking. However, the creation of a relationship of trust between the women and healthcare providers enabled better health outcomes.

Conclusions

Based on the findings, we propose recommendations for designing and implementing reproductive healthcare services for women in the sex trade. The recommendations offer to (a) include women with lived experiences in planning and providing reproductive healthcare services, (b) adopt a trauma-informed approach, (c) emphasize nonjudgmental care, (d) train healthcare providers to reduce stigma and bias, and (e) enhance the affordability of health services for women experiencing marginalization.
The attitudes and knowledge of family physicians regarding malnutrition in the elderly: a call for action
Authors: Sheffer-Hilel Galia , Kachal Josefa , Biderman Aya , Shahar Danit Rivka , Amar Shimon
Published: September 2024

Background

Malnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly.

Methods

Based on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years.

Results

Surveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients.

Conclusion

We recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.
In vitro antibacterial, antioxidant, in silico molecular docking and ADEMT analysis of chemical constituents from the roots of Acokanthera schimperi and Rhus glutinosa
Authors: Abera Bihon , Melaku Yadessa , Shenkute Kebede , Dekebo Aman , Abdissa Negera , Endale Milkyas , Negassa Temesgen , Woldemariam Messay , Hunsen Mo
Published: September 2024

Acokanthera schimperi is a medicinal plant traditionally used for the treatment of wounds, scabies, and malaria. Rhus glutinosa has been also utilized for the management of ectoparasites and hemorrhoids. Silica gel column chromatography separation of CH2Cl2/MeOH (1:1) extract root of A. schimperi afforded oleic acid (1), lupeol (2), dihydroferulic acid (3), acovenosigenin A- 3-O-α-L-rhamnopyranoside (4) and sucrose (5) whereas CH2Cl2/ MeOH (1:1) and MeOH roots extracts of R. glutinosa afforded β-sitosterol (6), (E)-5-(heptadec-14-en-1-yl)-4,5-dihydroxycyclohex-2-enone (7), methyl gallate (8), and gallic acid (9). The structures of the compounds were established using spectroscopic (1D and 2D NMR) and FT-IR techniques. Disc diffusin and DPPH assay were used, respectively, to evaluate the antibacterial and antioxidant potential of the extracts and isolated compounds. MeOH extract root of A. schimperi showed a modest antibacterial effect against E.coli with an inhibition zone (ZI) of 16 ± 0.0 mm compared to ciprofloxacin (ZI of 27.0 ± 0.0 mm). CH2Cl2/MeOH (1:1) and MeOH root extracts of R. glutinosa showed maximum activity against S. aureus with ZI of 17.3 ± 0.04 and 18.0 ± 0.0 mm, respectively. At 5 mg/mL, the highest activity was noted against S. aureus by 8 with ZI of 18.6 ± 0.08 mm. Dihydroferulic acid (3), methyl gallate (8), and gallic acid (9) displayed potent scavenging of DPPH radical with respective IC50 of 10.66, 7.48, and 6.08 µg/mL, compared with ascorbic acid (IC50 of 5.83 µg/mL). Molecular docking results showed that lupeol (2) exhibited strong binding energy of -7.7 and − 10 kcal/mol towards PDB ID: 4F86 and PDB ID: 3T07, respectively, compared to ciprofloxacin (-6.5 and − 7.2 kcal/mole). Towards PDB ID: 1DNU receptor, compounds 3, 8, and 9 showed minimum binding energy of -5.1, -4.8, and − 4.9 kcal/mol, respectively, compared to ascorbic acid (-5.7 kcal/mol). The Swiss ADME prediction results indicated that compounds 2, 3, 8, and 9 obeyed the Lipinksi rule of five and Veber rule with 0 violations. The in vitro antibacterial and antioxidant results supported by in silico analysis indicated that compounds 2, 3, 8, and 9 can potentially be lead candidates for the treatment of pathogenic and free radical-induced disorders.