bluuebunny/crossref_metadata_2025 huggingface dataset:
Memorable wellness tourism experiences: Scale development and validation
Authors: Dahanayake Shakila , Wanninayake Bandara , Ranasinghe Ruwan
Published: January 2025

This study aimed to develop and validate a memorable wellness tourism experiences scale to address an existing theoretical gap. Prior research reveals significant variation in tourist expectations of memorable experiences, indicating a need for focused studies in specialized areas such as wellness tourism. Inconsistencies and subjectivity in memorable tourism experience constructs reveal a gap in universally accepted frameworks and theoretical coherence. Employing a rigorous multi-phase methodological approach, the study combined deductive and inductive strategies. An extensive literature review, complemented by qualitative interviews, generated an initial pool of 40 items across 10 dimensions. These items were subjected to exploratory factor analysis using data from a questionnaire survey of 307 international wellness tourists, refining the scale to 31 items across six dimensions. Subsequent validation through confirmatory factor analysis with a larger sample of 622 participants confirmed the scale's reliability and validity, yielding 29 items within six dimensions. The scale dimensions—professionalism, meaningfulness, environmental aesthetics, tranquil ambience, novelty, and value for money—exhibited strong internal consistency and construct validity, confirming the robustness of the instrument. The scale thus offers a comprehensive and reliable tool for assessing memorable experiences in wellness tourism. It enhances both theoretical and practical understanding, thereby contributing to improved service offerings and deeper insights within the wellness tourism sector.
Metasurface Based Dual Cp Antenna for S Band Communication
Authors: Shobana M. , Pandeeswari R. , Sinha Manoranjan
Published: January 2025

This article proposes a dual circularly polarized antenna with high gain, isolation and wideband characteristics. The proposed antenna consists of a microstrip patch antenna fed with 90° hybrid coupler. The gain of the parent antenna is increased from 3 dB to 7.1 dB. The high gain of 7.1 dB is due to superstrate based metasurface configuration consisting of periodic arrangement of unit cells placed on FR4 substrate and suspended by air gap with the help of non-dielectric spacers. The antenna is fabricated and measurement shows the antenna has good impedance matching across 2 to 3 GHz. The impedance bandwidth of the proposed antenna is 0.8 GHz (2.04–2.84 GHz) with fractional bandwidth of 32.78% and maximum return loss observed at 2.2 GHz and 2.7 GHz. The hybrid coupler provides LHCP and RHCP from 2–3 GHz. The antenna offers wide port isolation >13 dB. The proposed antenna can be promoted for satellite communication replacing bulk array antennas.
Optimising surgical efficiency by designing lightweight skull-PSI assemblies and curved fixture plates for cranial reconstruction using FEA
Authors: Jindal Prashant , Kalra Anirudh , Dadwal Naveen , Goel Aparna , Gupta Vipin , Reinwald Yvonne , Breedon Philip , Juneja Mamta
Published: January 2025

Cranial reconstruction using implants is critical for protecting intracranial structures and restoring cerebral hemodynamics in cases of cranial defects caused by accidents, diseases or cancer. Patient-specific implants (PSIs) made from materials such as polyether-ether-ketone (PEEK), are required to be lightweight, high in strength and capable of mimicking the natural bone structure. Effective fastening mechanisms using the required number of fixture plates are essential for seamless integration between the PSI and the cavity of a defected skull for successful cranial reconstruction. This study explores the optimal number and shape of fixture plates required to join a Skull-PSI assembly, such that the overall weight of the PSI remains minimal, and to ensure that these assemblies do not fail when subjected to heavy external loads of 950 N. PEEK material was used for PSI, natural bone for the defected skull and Titanium Alloy (Ti-6Al-4 V) for the fixture plates. Conventional straight shaped fixture plates often require manual bending for correct fitment on the Skull-PSI curved surface, which increases a surgeon's time and effort. Curved shaped fixture plates were designed, to save on this time and effort and enhance the contact surface area with the Skull-PSI surface. Four, three and two numbered, straight and curved shaped fixture plates were investigated using Finite Element Analysis (FEA) techniques. Three numbered, curved shaped fixture plates were found to be optimal, to generate a 7-gram lightweight PSI that could successfully sustain external loads up-to 950 N without failure. Ultimately, these design improvements would benefit both patient and surgeon in aspects of surgery time and patient comfort.
Eco-sustainable luxury jewellery firms: The case of Courbet's social entrepreneurship model Theme of the case: sustainable business models (SBMs) and social entrepreneurship
Authors: Lejealle Catherine , Ruaud Sabine , Delecolle Thierry
Published: January 2025

Manuel Mallen co-founded Courbet in 2018, an eco-sustainable luxury jewellery firm, with the objective of being the first Maison on Place Vendôme (Paris) to market laboratory-grown diamonds. This case discusses the challenges faced by this French entrepreneur as he confronts traditional luxury brands that sell diamonds from open-pit mining and claim responsible practices. The seven largest diamond producers, representing 75% of world production and grouped in the Natural Diamond Council (NDC), financed a public report (the Trucost report), showcasing their compliance with Corporate Social Responsibility (CSR), threatening Courbet's assertions about eco-luxury. By comparing the components of sustainability (economic, social, and environmental) and value (proposition, creation, and capture), how can Courbet leverage a new business model against traditional jewellery brands? The case also questions whether Courbet's alignment with the 17 United Nations (UN) Sustainable Development Goals (SDGs) can foster market evolution towards sustainability and social change.
Leveraging natural language processing for automated assessment and feedback production in virtual education settings
Authors: Liang Meng
Published: January 2025

With the rapid development of online teaching, the traditional teacher face-to-face evaluation and feedback model in online teaching faces problems such as high labor costs, low efficiency, and insufficient personalization. The application of natural language processing technology in the field of education has become a trend. Based on this choice, this article applied natural language processing to achieve automated evaluation and personalized feedback of online teaching processes. This article chose to use recurrent neural network (RNN) algorithm for text generation, and adopted Seq2Seq-based (Sequence-to-Sequence) recurrent neural network framework for automatic text feedback generation. Then, a group of student performance data was collected and divided into a control group and an experimental group, and comparisons were made between manual feedback and automatically generated feedback, respectively. Finally, the effectiveness and impact of automatic evaluation and feedback generation were evaluated by comparing the performance data and analysis results of two groups of students. The average accuracy of the automatic evaluation system designed in this article was 95.6%, which was higher than the 84.5% of manual evaluation. The accuracy of the automatic evaluation system designed in this article was higher, and the time spent on manual evaluation and automatic evaluation was compared. The average time spent on manual evaluation was 62.2 seconds, while automatic evaluation shortened the time to 36.98 seconds. For the feedback results, the graphical curves of the manually generated and automatically generated feedback results in terms of feedback on student grades were basically consistent, which can fully prove that the automatically generated feedback results have high accuracy. The remarkable efficacy of natural language processing (NLP) in online education is vividly illustrated by a recent study, where an NLP model notched an impressive average ROUGE score of 93.8 points. This achievement outstrips the performance of three other algorithmic models in the realm of automatic assessment and feedback generation. Such comparative experiments underscore the transformative potential of NLP technology, significantly boosting teaching efficiency and enriching the learning experience by adeptly tackling the perennial challenges of evaluation and feedback in online education settings.
Incorporating Percutaneous Laser Ablation for Early Breast Cancer Treatment: A Systematic Review
Authors: Matsumoto Danielle Ramos Martin , Facina Gil
Published: January 2025

Objectives: We conducted a systematic review to compile the findings of all published studies on the use of percutaneous laser ablation (PLA) in the treatment of early-stage breast cancer. We aimed to identify appropriate methodology as well as parameters for the selection of suitable patients to optimize outcomes with the use of PLA. Additionally, we aimed to analyze whether this method is a viable alternative to current surgical treatments employed. Methods: The PRISMA 2020 method was applied. The terms “laser ablation” AND “breast cancer” were used to select all articles published up to January 2024 on the PubMed and Embase platforms. Articles in English were included. Only original articles were considered for this systematic review. Review articles, editorials, letters, and studies ex-vivo or not performed in humans were excluded. Results: Seventeen articles, including 308 patients were analyzed. Among the studies describing the complete response rate to assess treatment success, there was no residual tumor after ablation in 74.4% of the patients. MRI was the best exam to evaluate the effectiveness of the ablative procedure with a NPV of 92% to 100%. Skin burn was the most commonly observed complication, occurring in 6% of patients. Other less frequent complications were hematoma/bleeding, pain, nodulation, erythema, seroma, and fat necrosis. Conclusions: The use of PLA remains restricted to cases with specific indications or within the context of research protocols. However, future studies may validate this promising technique for the local treatment of early-stage breast cancer. This study was registered at INPLASY (registration number: INPLASY2024100045)
Integrating Artificial Intelligence in Medical Writing: Balancing Technological Innovation and Human Expertise, with Practical Applications in Lower Extremity Wounds Care
Authors: Thaichana Pak , Oo Myo Zin , Thorup Gabriel Leiden , Chansakaow Chayatorn , Arworn Supapong , Rerkasem Kittipan
Published: January 2025

Artificial Intelligence (AI) is revolutionizing medical writing by enhancing the efficiency and precision of healthcare communication and health research. This review explores the transformative integration of AI in medical writing, highlighting its dual role of enhancing efficiency while maintaining the crucial elements of human expertise. AI technologies, including natural language processing and AI-driven literature review tools, have significantly advanced, facilitating rapid draft generation, literature summarization, and consistency in medical documentation. Key applications include aiding study design, enhancing content drafting, and optimizing literature reviews through specific AI tools. Moreover, this review delves into practical applications of AI in the context of lower extremity wounds, specifically ischemic leg ulcers, demonstrating how AI can streamline the synthesis of relevant literature. While AI presents notable advantages, it also raises ethical concerns, such as potential biases and data privacy issues, highlighting the need for human oversight in the writing process. A proposed future framework suggests that AI could take over routine tasks, allowing medical writers to devote more attention to analytical and ethical aspects. Additionally, there is a strong need for further research on the cost-effectiveness of both clinical trials utilizing AI interventions and the incorporation of AI in medical writing. Ultimately, balancing the integration of AI in medical writing promises to improve both healthcare communication and health research, ensuring the production of high-quality, patient-centric and research-focused content.
Multicenter analysis of the incidence of in-stent stenosis following the deployment of flow-redirection endoluminal device in the treatment of intracranial aneurysms
Authors: Gajjar Avi A. , Sioutas Georgios S. , Custozzo Amanda , Salem Mohamed M. , Field Nicholas C. , Shekhtman Oleg , Davis Pierce , Prabhala Tarun , Jankowitz Brian T. , Dalfino John C. , Boulos Alan S. , Burkhardt Jan-Karl , Paul Alexandra R. , Srinivasan Visish M.
Published: January 2025

Introduction

The Flow Re-direction Endoluminal Device (FRED) is a novel flow diverter with a unique double stent design, with an inner stent composed of 48 nitinol wires, and an outer stent with 16 nitinol wires. It is designed for endovascular cerebral aneurysm treatment, although, limited data exist regarding in-stent stenosis (ISS) rates associated with FRED devices.

Methods

A registry encompassing two North American comprehensive stroke centers was the base of this study. We longitudinally assessed patients implanted with FRED devices, emphasizing baseline demographics, aneurysmal characteristics, procedural data, aneurysmal occlusion, and the incidence of ISS.

Results

In our cohort of 87 patients receiving 88 FRED devices, ISS occurred in 10.4% (9) of cases. Mild ISS (<50%) was noted in 8.0% (7) of patients, moderate ISS (50–75%) in 1.1% (1), and severe ISS (>75%) in 1.1% (1). Analysis indicated ISS in 17.0% (8) of patients with the FRED device and 5.7% (2) with the FRED-X device; all ISS cases in the FRED-X group were mild. Differences in ISS rates between device types were not significant ( p = 0.122). Delayed thrombotic events were documented in 6.9% (6) of patients. Aneurysm occlusion rates, measured via the Raymond–Roy Scale (RRS), showed adequate occlusion (RRS 1 or 2) in 68.8% at 3 months, 74.6% at 6 months, and 89.3% at 12 months.

Conclusions

The study elucidates the efficacy and safety profile of FRED devices, presenting favorable aneurysm occlusion rates and low retreatment needs while underscoring the manageability of ISS.
Basic education headteacher leadership in Ghana: A review of empirical studies from 1994 to 2022
Authors: Dare Philip Saagyum , Henderson Linda , Babaeff Robyn
Published: January 2025

This review examines the landscape of Ghana's Basic Education (BE) Headteacher Leadership (HTL) literature, revealing essential insights from empirical studies conducted between 1994 and 2022. It originated from the lack of a systematic review summarizing evidence on HTL training, preparation, and practices implemented across the sector. However, research shows Ghana does not provide formal HTL training programs for BE Headteachers before recruitment. Employing the PRISMA framework, we analyzed 23 peer-reviewed empirical studies related to BE HTL, published across ERIC, ProQuest, Scopus, EThOS, and Web of Science databases. The purpose was to identify the key characteristics that define Ghana's BE HTL. Findings reveal the absence of formal HTL training before recruitment, non-conventional recruitment criteria, and diverse leadership practices, predominantly transformational leadership, shaped by international training programs like Leadership for Learning. The literature also offers cultural factors that may inhibit training programs’ learning transfer and ways to mitigate them. A trend towards self-directed and informal professional development among Headteachers was identified, suggesting a resilient but unstandardized approach to leadership development to address these systemic gaps. These findings provide a reference for present and future Headteachers and point to the essential need for developing leadership frameworks tailored to Ghana's BE HTL context.
Psychometric properties of the Recovery Experience Questionnaire in a coaching population
Authors: Braun Landon M. , Wahl Carly A. , Meyer Barbara B.
Published: January 2025

Recognized as the process of psychophysiological unwinding from the demands of work and other stressors, occupational recovery has been a popular topic of study over the past decade. Building on the recovery research in occupational workers and more recently athletes, sport and performance psychology scholars have begun to consider the occupational recovery of the team around the team (i.e., athletic trainers and sport psychology professionals). Like the aforementioned professionals, coaches may be able to use recovery to buffer work-related stressors which can impact their health, work performance, and career longevity. That said, there is a dearth of research on coach recovery, perhaps due to a lack of appropriate measures to study occupational recovery in this specific population. The purpose of the current study, therefore, was to validate the Recovery Experience Questionnaire (REQ) in a coaching population. A sample of 237 collegiate and professional coaches (148 males, 89 females) were recruited from various sports, competitive levels, and roles. In addition to assessing two forms of reliability, a confirmatory factor analysis (CFA) was conducted to evaluate the four latent variable measurement model of the REQ. Furthermore, correlational analyses were used to demonstrate discriminant validity between the REQ and a measure of perceived stress. Collectively, the results suggest that the REQ possesses strong psychometric properties and is a measure worthy of further exploration and use in an elite coaching population.
Exploring weight bias, fatphobia, and diversity training among collegiate athletic coaches
Authors: Cadavid Andrea , Hamrick Sydney , Terrell Kassie R , Hamadi Hanadi Y , Zeglin Robert J
Published: January 2025

Many fields have called for a shift from a weight-normative to a weight-inclusive approach. However, there is still a paucity of research investigating such a shift within college athletic coaching. This quantitative study investigated weight bias, fatphobia, and diversity training among collegiate athletic coaches (n = 68). A cross-sectional survey design using random convenience sampling was used and findings revealed the prevalence of weight bias and fatphobia among coaches, with many endorsing harmful weight normative beliefs that can exacerbate negative mental health outcomes, such as disordered eating, among student athletes. The results also indicated a significant lack of diversity training related to size and body composition, highlighting a crucial gap in coaches’ preparation to foster a weight-inclusive environment that supports athletes’ mental and physical well-being. This research is a call for athletic departments to adopt weight-inclusive coaching practices, ensuring that athletes of all sizes can thrive in a supportive environment. Recommendations and resources for inclusive coaching practices are also provided.
Development and validation of inverted head form orientation for helmet testing using a pneumatic linear impact system
Authors: Cardinal Madysn D , Marino Anthony P , DesJardins John D , Batt Gregory
Published: January 2025

Despite growing public health awareness of concussions and their cognitive sequelae, research has predominantly focused on generic bulk-head form impact metrics rather than the study of how brain tissue responds to head impacts. In this paper, the authors develop and validate a novel testing fixture that can configure standard head forms in an inverted orientation, with the future goal of testing inverted cadaveric specimens with gravity-driven perfusion of the head. The inverted testing fixture was integrated with an existing pneumatic linear impactor system and suspended a Hybrid III instrumented head and neck form on an x–y linear sliding carriage. Validation studies compared impacts in upright and inverted orientations, with and without a football helmet, at 5.5 and 7.4 m/s. Angular velocity and linear acceleration measures were found to be similar. The results support the use of the novel fixture for studying inverted cadaveric specimens during simulated concussive impacts.
Influence of tactics and situational variables on goal scoring in European football
Authors: Plakias Spyridon , Armatas Vasilis , Mitrotasios Michalis
Published: January 2025

This study aimed to explore how contextual variables, team formations, and playing styles influence the number of goals scored in football matches. It further investigated whether these factors vary across different competition levels, providing a nuanced analysis that could benefit strategic planning in football. Employing a dataset from regular season matches in top-division leagues across 11 European countries, this study categorized observations into three groups (levels) based on Union of European Football Associations (UEFA) rankings. The research analyzed 3004 matches, correlating 10 nominal factors – including match location, team ranking, number of central forwards and central defenders, and various playing styles – with the number of goals scored using a Poisson Generalized Linear Mixed Model. The analysis revealed that home teams generally score more goals, emphasizing the advantage of playing at home. Higher-ranked teams were also more likely to score, while playing against a higher-ranked opponent decreased the likelihood of scoring. The study highlighted that direct play and counter-attacks are more effective than possession play across different leagues. Interestingly, the number of central forwards and defenders within team formations showed various effects on goal scoring, depending on the league’s level. The findings encourage a more strategic approach to match preparation, emphasizing the need to adapt tactics not only to the strengths and weaknesses of the opponent but also to the broader context of the league’s competitive level.
Full-thickness arthroscopic rotator cuff repair demonstrates low repair failure rates and high return to sport rates in patients aged 30 years and under at 9-year follow-up: A single-center case series
Authors: Ifarraguerri Anna M , Berk Alexander N , Gachigi Kennedy K , Collins Michael S , Dib Aseel , Siparsky Patrick , Schiffern Shadley , Hamid Nady , Martin Anthony , Saltzman Bryan M
Published: January 2025

Purpose

The purpose of this study is to assess the long-term clinical complications, outcomes, and return to sport (RTS) rates in patients aged 30 or younger with a primary full-thickness arthroscopic rotator cuff repair (ARCR).

Methods

All patients who underwent a primary full-thickness ARCR at age 30 years or younger from 2003 to 2021 with a minimum of a 2-year follow-up were included. Complications, repeat surgeries, and return to sport rates were collected.

Results

32 patients underwent primary full-thickness rotator cuff repair with a mean follow-up of 9.3[2.7–17.9] years. 5(15.6%) patients had postoperative shoulder stiffness, and persistent postoperative shoulder pain was reported in 4(12.5%) patients. There were 3(9.4%) reported repair failures, with complete rotator cuff re-tears reported in 2(6.3%) shoulders and partial rotator cuff re-tear in 1(3.1%) shoulder. There were 4(12.5%) reoperations at an average of 8.7[0.65–22.7] months from primary rotator cuff repair and 2(6.3%) revision rotator cuff repairs. There was a 78.6% RTS rate at an average of 6.5[4–12] months postoperatively, with 8(72.7%) athletes returning to the sport at the same level they initially participated in pre-surgery.

Conclusion

Patients aged 30 and under who underwent full-thickness ARCR experienced promising clinical outcomes at an average 9-year follow-up.

Study Design

Retrospective Case Series; Level of Evidence, 4
When Do Parties Lie? Misinformation and Radical-Right Populism Across 26 Countries
Authors: Törnberg Petter , Chueri Juliana
Published: January 2025

The spread of misinformation has emerged as a global concern. Academic attention has recently shifted to emphasize the role of political elites as drivers of misinformation. Yet, little is known of the relationship between party politics and the spread of misinformation—in part due to a dearth of cross-national empirical data needed for comparative study. This article examines which parties are more likely to spread misinformation, by drawing on a comprehensive database of 32M tweets from parliamentarians in 26 countries, spanning 6 years and several election periods. The dataset is combined with external databases such as Parlgov and V-Dem, linking the spread of misinformation to detailed information about political parties and cabinets, thus enabling a comparative politics approach to misinformation. Using multilevel analysis with random country intercepts, we find that radical-right populism is the strongest determinant for the propensity to spread misinformation. Populism, left-wing populism, and right-wing politics are not linked to the spread of misinformation. These results suggest that political misinformation should be understood as part and parcel of the current wave of radical right populism, and its opposition to liberal democratic institution.
Nurses’ professional roles: Supervision and support during meals in caring for adult inpatients with anorexia nervosa – a qualitative study
Authors: Davén Josefine , Hellzen Ove , Kristiansen Lisbeth , Häggström Marie
Published: January 2025

This study aims to describe how nurses perceive their professional roles in providing meal support for adult inpatients with anorexia nervosa. A qualitative design and reflexive thematic analysis were used, as well as the SRQR (i.e. Standards for Reporting Qualitative Research) reporting guidelines for accuracy and completeness. Personal interviews were conducted with 11 nursing staff in a general psychiatric inpatient ward. The results revealed an overarching theme: performing meal support – fluent shifting between roles, with two themes : acting as a supervisor, monitoring food intake, and getting into the supportive and helping role. Both themes further consisted of three subthemes each. The results show nurses’ ability to shift between roles and adapt to patients’ needs at the same time as maintaining treatment structure during meal support. Moving between differences in approach is important in fostering a therapeutic relationship and facilitating patient recovery. Balancing this is especially vital in nursing and involves meeting challenging responsibilities at the same time as addressing individual patient requirements.
Registered nurses’ desire to work in nursing: An integrative review
Authors: Luoma-aho Sanna , Peltola Sanna , Vierula Jonna , Ikonen Riikka , Soikkeli-Jalonen Anu , Haavisto Elina
Published: January 2025

The World Health Organization (WHO) estimates that, by 2030, nine million nurses and midwives will be needed because there is currently a global nursing shortage. The aim of this study was to describe registered nurses’ (RNs) desire to work in nursing based on previous studies. CINAHL, MEDLINE, NURSING AND ALLIED HEALTH databases were searched for original research. No time limit was used in the searches. The PRISMA checklist was used to reflect rigour of methods. Eighteen primary studies were appraised and included in the review. RNs expressed a desire to work in the nursing profession due to the rewarding work, smoothness of work, interesting work duties, versatile career opportunities, support for one's well-being and an inner desire to help others. Work–life balance is crucial for RNs’ well-being. Nursing management should offer flexible hours and shifts to improve retention. Adequate resources and visible appreciation for RNs are essential and, while fair pay is important, it alone is not enough to ensure long-term retention.
Malnutrition in Spine Oncology: Where Are We and What Are We Measuring?
Authors: De la Garza Ramos Rafael , Charest-Morin Raphaële , Goodwin C. Rory , Zuckerman Scott L. , Laufer Ilya , Dea Nicolas , Sahgal Arjun , Rhines Laurence D. , Gokaslan Ziya L. , Bettegowda Chetan , Versteeg Anne L. , Chen Hanbo , Cordula Netzer , Sciubba Daniel M. , O’Toole John E. , Fehlings Michael G. , Kumar Naresh , Disch Alexander C. , Stephens Byron , Goldschlager Tony , Weber Michael H. , Shin John H. ,   AO Spine Knowledge Forum Tumor
Published: January 2025

Study design

Scoping review.

Objective

To identify which markers are used as surrogates for malnutrition in metastatic spine disease and which are the most studied outcomes associated with it.

Methods

A scoping review was performed by searching the PubMed/Medline, EMBASE, and Web of Science databases up to July 2022. We searched for articles exploring markers of malnutrition in spine oncology patients including but not limited to albumin, body weight, weight loss, and nutrition indices. A narrative synthesis was performed.

Results

A total of 61 articles reporting on 31,385 patients met inclusion criteria. There were 13 different surrogate markers of nutrition, with the most common being albumin in 67% of studies (n = 41), body weight/BMI in 34% (n = 21), and muscle mass in 28% (n = 17). The most common studied outcomes were survival in 82% (n = 50), complications in 28% (n = 17), and length of stay in 10% (n = 6) of studies. Quality of life and functional outcomes were assessed in 2% (n = 1) and 3% (n = 2) of studies, respectively. Out of 61 studies, 18% (n = 11) found no association between the examined markers and outcome.

Conclusion

Assessment of nutritional status in patients with spinal metastases is fundamental. However, there is lack of a comprehensive and consistent way of assessing malnutrition in oncologic spine patients and therefore inconsistency in its relationship with outcomes. A consensus agreement on the assessment and definition of malnutrition in spine tumor patients is needed.
Editorial: Precision Medicine in Spinal Oncology
Authors: Sahgal Arjun , Rhines Laurence
Published: January 2025

This special focus issue from the 2023-2024 AOSpine Knowledge Forum Tumor represents a culmination of years of experience devoted to advancing the care of patients with both metastatic and primary spinal tumors. We have learned much since the fundamental assessments of instability that led to the Spinal Instability Neoplastic Score (SINS), the grading of epidural disease utilizing the Epidural Spinal Cord Compression Scale (aka Bilsky grade), as well as the development of tumor-specific health related quality of life assessments such as the Spine Oncology Study Group Outcome Questionnaire (SOSGOQ). These tools have enabled us to make several prior recommendations for the appropriate use of advanced surgical techniques such as en bloc resection and the use of stereotactic body radiotherapy (SBRT) to optimize patient care.
Stakeholder Perspectives on the Role of Peer Mentors in the Implementation of Long-Acting Antiretroviral Therapy for Use by Adolescents and Young People in Western Kenya: Findings from a Formative Study, KuwaFree! LiveFree!
Authors: Bakari Salim , Whitney Biegon , Dennis Munyoro , Hassan Shukri , Bernard Caitlin , Kaguiri Eunice , Maju Mehar , Apondi Edith , Were Edwin , Patel Rena C.
Published: January 2025

Long-acting antiretroviral treatment (LA ART) is a forthcoming option for adolescents and young people living with HIV (AYPLHIV), but perspectives on using peer mentors to implement LA ART for AYPLHIV are unknown. We conducted seven focus group discussions ( n = 58 participants) from November 2021 to April 2022 in Kenya with four stakeholder groups, including AYPLHIV, healthcare providers, advocates, and policymakers. We used inductive coding and thematic analysis. Our stakeholders articulated peer mentors are crucial in the implementation of LA ART for AYPLHIV in leading communication, facilitating referrals, and providing empathy from lived experiences. Additionally, they can serve as early adopters, help navigate service points, and provide messaging on the benefits and drawbacks of LA ART. They emphasized the necessity of training peer mentors for the LA ART scale-up. Peer mentors are essential for linkage and referring of AYPLHIV to LA ART, and peer mentors' involvement should be integrated into a national implementation plan.
Effects of Neuromuscular Electrical Stimulation on Quadriceps Femoris Muscle Strength and Knee Joint Function in Patients After ACL Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Li Zhikuan , Jin Lingpeng , Chen Zhen , Shang Ziqi , Geng Yue , Tian Siman , Dong Jiangtao
Published: January 2025

Background:

Quadriceps weakness is a common barrier to effective rehabilitation after anterior cruciate ligament (ACL) surgery. Neuromuscular electrical stimulation (NMES)—the application of electrical currents to induce muscle contraction—has been used as part of the postoperative rehabilitation regimen.

Purpose:

To investigate the effects of NMES on the recovery of quadriceps strength and knee function after ACL surgery.

Study Design:

Systematic review; Level of evidence, 1.

Methods:

A search was conducted in the Web of Science, Embase, Cochrane Library, and PubMed databases between inception and August 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were randomized controlled trials of patients undergoing NMES as postoperative rehabilitation after ACL reconstruction or repair, with standard physical therapy as the control intervention. The quality of the included studies was assessed according to the Cochrane Collaboration risk-of-bias tool. Lower limb function was assessed qualitatively, and standardized mean differences (SMDs) in muscle strength and Lysholm scores were analyzed quantitatively and pooled using a random-effects model.

Results:

Eleven studies (N = 202 patients) met our inclusion criteria. The meta-analysis of muscle strength values, which included 9 studies, showed that patients who underwent physical rehabilitation with adjunctive NMES had better recovery and improvement in quadriceps muscle strength compared with standard physical therapy at both short- and long-term follow-ups (≤6 weeks: SMD, 0.53 [95% CI, 0.27-0.79] vs >6 weeks: SMD, 0.59 [95% CI, 0.18-0.99]; p < 0.001). Moreover, subgroup analyses showed that earlier physical rehabilitation with the assistance of NMES resulted in better muscle strength recovery (≤1 week: SMD, 1.48 [95% CI, 0.80-2.17] vs >1 week: SMD, 0.44 [95% CI, 0.21-0.67]; p < 0.001). The meta-analysis of Lysholm scores, which included 3 studies, did not indicate any significant differences between the assisted NMES and control groups.

Conclusion:

Our study demonstrated that in both short- and long-term follow-up studies, postoperative rehabilitation with NMES after ACL surgery significantly increased quadriceps muscle strength compared with standard rehabilitation alone.
Causal Relationships Between 4 Exposure Factors and Rotator Cuff Syndrome Using Mendelian Randomization Analysis
Authors: Zhang Zeyang , Han Shun , Sun Xiaowei , Guo Zelin , Wang Zhiqiang , Sha Peng , Liu Yuchen , Zhang Bing , Liu Yupeng
Published: January 2025

Background:

Although previous studies have investigated the risk factors for rotator cuff syndrome (RCS), there remains controversy due to uncontrolled and uncertain confounding factors in their analyses.

Purpose:

To perform Mendelian randomization (MR) analysis using single-nucleotide polymorphisms to investigate the causal relationship between RCS and 4 risk factors: type 2 diabetes mellitus (T2DM), high blood pressure (HBP), body mass index (BMI), and low high-density lipoprotein cholesterol (HDL-C).

Study Design:

Descriptive epidemiology study.

Methods:

Genome-wide association study (GWAS) data for T2DM (ebi-a-GCST006867), BMI (ieu-b-40), HBP (finn-b-I9_HYPTENS), HDL-C (ieu-b-109), and RCS (ukb-b-50) were obtained from the IEU Open GWAS Project. The dataset of each risk factor was combined with the dataset of RCS, generating 4 datasets. Potential confounders and single-nucleotide polymorphisms related to RCS were excluded from these datasets. The causal relationships between the exposure factors and RCS were analyzed using 5 regression models: MR-Egger, weighted median estimate (WME), inverse-variance weighting (IVW), simple mode, and weighted mode. Heterogeneity in the causal effects was assessed using MR-Egger regression and IVW analyses. Sensitivity analyses were performed to determine the stability of the results.

Results:

The MR-Egger regression intercepts for T2DM, BMI, HBP, and HDL-C showed no horizontal pleiotropic effects. The results of the Cochran Q test showed P values of .075 and .080 for BMI in the MR-Egger regression and IVW models, respectively, indicating the absence of heterogeneity between BMI and RCS. The results of the weighted median estimate and IVW regression analyses showed a significant causal association between BMI and RCS, with odds ratios of 1.002 (95% CI, 1-1.004; P = .038) and 1.003 (95% CI, 1.001-1.005; P = .0003), respectively. No significant associations were found for T2DM, HDL-C, or HBP.

Conclusion:

In the present study, BMI was positively associated with the risk of developing RCS, while T2DM, HBP, and low HDL-C were not associated with RCS development.
Assessment of Speech Processing and Listening Effort Associated With Speech-on-Speech Masking Using the Visual World Paradigm and Pupillometry
Authors: Abdel-Latif Khaled H. A. , Koelewijn Thomas , Başkent Deniz , Meister Hartmut
Published: January 2025

Speech-on-speech masking is a common and challenging situation in everyday verbal communication. The ability to segregate competing auditory streams is a necessary requirement for focusing attention on the target speech. The Visual World Paradigm (VWP) provides insight into speech processing by capturing gaze fixations on visually presented icons that reflect the speech signal. This study aimed to propose a new VWP to examine the time course of speech segregation when competing sentences are presented and to collect pupil size data as a measure of listening effort. Twelve young normal-hearing participants were presented with competing matrix sentences (structure “name-verb-numeral-adjective-object”) diotically via headphones at four target-to-masker ratios (TMRs), corresponding to intermediate to near perfect speech recognition. The VWP visually presented the number and object words from both the target and masker sentences. Participants were instructed to gaze at the corresponding words of the target sentence without providing verbal responses. The gaze fixations consistently reflected the different TMRs for both number and object words. The slopes of the fixation curves were steeper, and the proportion of target fixations increased with higher TMRs, suggesting more efficient segregation under more favorable conditions. Temporal analysis of pupil data using Bayesian paired sample t-tests showed a corresponding reduction in pupil dilation with increasing TMR, indicating reduced listening effort. The results support the conclusion that the proposed VWP and the captured eye movements and pupil dilation are suitable for objective assessment of sentence-based speech-on-speech segregation and the corresponding listening effort.
Going Beyond Medications for Chronic Pain: Exploring the Alternatives
Authors: Patidar Seema , LaRowe Lisa , Goetzinger Amy , Margolies Skye
Published: January 2025

Chronic pain is prevalent in the US and a major source of disability. Americans are familiar with, and often reliant on, pharmacologic interventions for analgesia. However, nonpharmacologic interventions can be equally effective in reducing pain and related impairment. The complex nature of chronic pain and the specific goal of reducing reliance on opioid analgesics, together, support utilizing a more comprehensive, biopsychosocial approach. Although this approach improves clinical outcomes in this population, ongoing barriers require additional research, along with continuing education, to generate equal support of alternative interventions for pain management. Policy changes and a systemic effort to improve current practices in pain management are critical to provide more comprehensive, interdisciplinary care for all people living with chronic pain.
Working toward Personalized Intervention Advice: A Survey Study on Preference Heterogeneity in Patients with Breast Cancer–Related Fatigue
Authors: Beenhakker Lian , Wijlens Kim A. E. , Bode Christina , Vollenbroek-Hutten Miriam M. R. , Siesling Sabine , van Til Janine A. , Witteveen Annemieke
Published: January 2025

Introduction. Many breast cancer survivors experience cancer-related fatigue (CRF), and several interventions to treat CRF are available. One way to tailor intervention advice is based on patient preferences. In this study, we explore preference heterogeneity regarding between-attribute and within-attribute preferences. In addition, we propose simple decision rules to match preferences to interventions. Methods. Nine attributes were included with dichotomized levels. Participants selected their preferred level per attribute and ranked the attributes using best-worst scaling. Between-attribute and within-attribute preferences were determined, together with their heterogeneity. Using decision rules, matching scores were calculated for a hypothetical intervention. Results. Sixty-seven breast cancer survivors completed the survey. They were on average 52 y old, 4.5 y after diagnosis, experienced CRF (6.5–7.2/10) on 3 dimensions (physical, mental, and emotional), and 43% already followed an intervention for CRF. Overall, participants ranked costs highest. Next to costs, proven effectiveness and type of intervention were also frequently ranked first. Only 13 participants (19%) shared the most common preference pattern of shorter interventions, daily sessions, shorter session time, a psychosocial intervention, no anonymity, and contact with a therapist and peers. Matching scores for a hypothetical intervention with attributes corresponding with the overall within-attribute preferences varied from 44% to 100%. Conclusion. A large heterogeneity in preferences of breast cancer survivors for CRF intervention attributes was demonstrated. Using simple decision rules, the effect of this heterogeneity on linking preferences to interventions with matching scores was demonstrated. Implications. Personalization of intervention advice is necessary due to preference heterogeneity. Tailored advice can result in higher involvement of patients in decision making, intervention adherence and satisfaction, and subsequently a potential higher quality of life after breast cancer.

Highlights

Many breast cancer survivors experience cancer-related fatigue for which many interventions exist. Our results show large preference heterogeneity in breast cancer patients’ preferences for attributes of eHealth interventions. Based on this preference heterogeneity, intervention advice for cancer-related fatigue after breast cancer can be personalized, ultimately improving quality of life after breast cancer.
Self-Assessment of Medical Ethics and Professionalism: Comparison Between Preclinical and Clinical Medical Students
Authors: Naz Shaikh Saima , Abbas Uzair , Shah Tazeen , Uqaili Arsalan Ahmad , Allah Buksh Hudebia , Fatima Mehreen
Published: January 2025

BACKGROUND

Ethics and professionalism are fundamental elements in the practice of medicine consisting of a set of values, behaviors, and relationships that reinforce the trust and respect for the physician in a society. It consists of several key elements that are learnt during their formative years of study. This study aims to compare knowledge and self-reported practice of ethics and professionalism between preclinical and clinical undergraduate medical students.

METHODS

We included 427 medical students including males and females of age 18 and above. They were further divided into preclinical and clinical groups. We assessed knowledge and practice of medical professionalism through a validated questionnaire containing 11 core elements (components) of medical professionalism and ethics. The assessment was carried out by comparing median scores assigned to the components of professionalism against each question. Data was analyzed through SPSS v.22 and GraphPad Prism v.8.

RESULTS

Clinical medical students had significantly higher knowledge of medical professionalism as compared to nonclinical students ( P = .0016). Moreover, among the components of professionalism, there was a significantly higher score for confidentiality ( P = .006), communication skills ( P = .001), self-directed learning ( P = .011), peer and self-assessment ( P = .0011) along with ethics in research and patient care ( P = .0042) in clinical students as compared to preclinical medical students. However, no significant difference was found between students of preclinical and clinical years for honesty, accountability, respect, responsibility, compassion, and maturity ( P > .05). The findings were comparable across students of different ethnicities in our study cohort ( P > .05).

CONCLUSION

Our findings suggest that knowledge and practice of certain elements of ethics and professionalism are enhanced through clinical exposure, however, few remain consistent across different stages of study. Moreover, lack of significant differences in practice of professionalism based on ethnic differences underscores the potential universal standards in medical education.
Criticality is Associated with Future Psychotherapy Response in Patients with Post-Traumatic Stress Disorder—A Pilot Study
Authors: van Lutterveld Remko , Sterk Myrthe , Spitoni Cristian , Kennis Mitzy , van Rooij Sanne J. H. , Geuze Elbert
Published: January 2025

Background

Trauma-focused psychotherapy is treatment of choice for post-traumatic stress disorder (PTSD). However, about half of patients do not respond. Recently, there is increased interest in brain criticality, which assesses the phase transition between order and disorder in brain activity. Operating close to this borderline is theorized to facilitate optimal information processing. We studied if brain criticality is related to future response to treatment, hypothesizing that treatment responders’ brains function closer to criticality.

Methods

Functional magnetic resonance imaging resting-state scans were acquired from 46 male veterans with PTSD around the start of treatment. Psychotherapy consisted of trauma-focused cognitive behavioral therapy, eye movement desensitization and reprocessing, or a combination thereof. Treatment response was assessed using the Clinician-Administered PTSD Scale, and criticality was assessed using an Ising temperature approach for seven canonical brain networks (ie, the visual, somatomotor, dorsal attention, ventral attention, limbic, frontoparietal and default mode networks) to measure distance to criticality.

Results

The brains of prospective treatment responders were closer to criticality than nonresponders (P = 0.017), while no significant interaction effect between group and brain network was observed (P = 0.486). In addition, average criticality across networks correlated with future treatment response (P = 0.028).

Conclusion

These results show that the brains of prospective PTSD psychotherapy treatment responders operate closer to criticality than nonresponders, and this occurs across the entire brain instead of in separate canonical brain networks. These results suggest that effective psychotherapy is mediated by brains operating closer to criticality.