bluuebunny/crossref_metadata_2025 huggingface dataset:
An integrated simulation system using fuzzy logic and network simulator 3 (ns-3) for actor node selection in wireless sensor and actor networks (WSANs): Performance evaluation considering different parameters
Authors: Liu Yi
Published: February 2025

The wireless sensor and actor networks (WSANs) are considered a fundamental technology for the Internet of Things (IoT). These networks comprise numerous sensor and actor nodes and are anticipated to be utilized in various sectors. In WSANs, actor nodes must be positioned and moved optimally to ensure an efficient communication network among the actor nodes, as well as connecting actor nodes with sensor and other actor nodes. This research focuses on the selection process of actor nodes within WSANs. The proposed system selects the optimal actor node by employing fuzzy logic (FL) and the network simulator 3 (ns-3). We investigate the performance of the proposed FL-based system by taking into account three parameters: distance to event from actor (DEA), number of sensors per actor (NSA), and task accomplishment time (TAT). The output parameter is the actor selection decision (ASD). We carried out qualitative evaluation by FL-based system. The simulation results revealed that ASD decreases as TAT, NSA, and DEA increase. We carried out a quantitative evaluation by using the ns-3 simulator. The performance evaluation demonstrated that packet loss increases by increasing NSA. Also, as TAT increases, both packet loss and delay time increase. Among the three actor nodes, Actor2 exhibited the best performance.
Adaptive variable step-size extrication strategy of the intelligent vehicle for the sudden concave obstacle in the garage scenario
Authors: Sun Xu , Yue Ming , Liu Minghao , Wang Heyang , Hou Wenbin
Published: February 2025

Aiming at the problem of the intelligent vehicle encountering the sudden concave obstacle and being unable to extricate under the garage scenario, this paper proposes an adaptive variable step-size extrication strategy based on the improved Hybrid A* algorithm, which guarantees path smoothing and enables effective extrication. Firstly, the collision constraints are established based on the collision detection model, where the double-circle model is employed, such that the proposed method is computationally less intensive while having a low redundancy space. Secondly, an improved Hybrid A* algorithm is proposed, which adds the node position penalty term based on the vehicle body coordinate system in the extension process, by which, the smoothness of paths can be guaranteed and the number of extended nodes can be reduced greatly. Finally, the relevant sizes between the vehicle and the concave obstacle, and the detection distance of the detection equipment are used as reference information to present an adaptive variable step-size extrication strategy. Simulation experiments of the improved Hybrid A* algorithm and adaptive variable step-size strategy are performed on Matlab software, where the vertical garage and the diagonal 45° garage are used as two different scenarios, and the results verify the feasibility and effectiveness of the strategy.
Suppression mechanism investigations on BVI noise of rotor with anhedral blade tip
Authors: Bian Wei , Zhao Qijun , Chen Xi , Wang Bo , Zhao Guoqing
Published: February 2025

In order to capture the formation and evolution of blade tip vortex and blade vortex interaction (BVI) events, the high-fidelity hybrid TENO8-THINC reconstruction scheme is proposed to simulate unsteady flowfield of rotor. The hybrid scheme ensures robustness and stability in capturing the discontinuities while minimizing numerical dissipation in the smooth regions dominated by the tip vortices, thus significantly improving the detail capture ability of vortex field and providing accurate aerodynamic input for noise prediction. The noise characteristics of BVI state and non-BVI state are newly investigated by decomposing Farassat 1A formula into thickness, load amplitude and load derivative terms, and the results demonstrate that the dominant factor of BVI noise is the load derivative term. Then, the sound pressure time histories of oblique and parallel interaction regions of OLS rotor in BVI state are calculated and compared, and it indicates that oblique interaction on the advancing side has the greatest influence on BVI noise. Finally, parameter analysis of the influence of anhedral tip blades on BVI noise is carried out, illustrating that anhedral blade divides the main blade tip vortex into two vortex systems with similar intensity, which alleviates the strength of oblique interaction on the advancing side and parallel interaction, so as to achieve the purpose of BVI noise reduction, and the reduction of sound pressure level is nearly 5 dB.
Stigmatising space-times: Addressing healthcare stigma beyond interpersonal interactions
Authors: Nourse Gemma , Farrugia Adrian , Seear Kate , Lenton Emily , Cama Elena , Treloar Carla
Published: February 2025

Stigma related to blood-borne viruses (BBVs) and sexually transmitted infections (STIs) has been shown to undermine the quality of healthcare. Given the pervasiveness and multiple manifestations of stigma within healthcare settings, recent research has argued that stigma should be addressed ‘universally’ i.e. for all stigmatising attributes and conditions, across all healthcare services. As part of the development of a universal approach to stigma, we analyse 20 interviews conducted with key stakeholders with expertise in BBVs, STIs and stigma in Australian healthcare settings. Inspired by research that addresses stigma as a biopolitical and spatial-temporal phenomenon, we examine how stigma weaves through relationships between people, time, space and technologies of healthcare provision. We begin with a discussion of funding structures and time constraints, followed by an examination of matters relating to the geographical location of the clinic and, finally, an analysis of smaller scale service environment space-times. In doing so, we bring attention to significant spatial-temporal matters that shape the production of stigma and address the need to balance universal concerns about healthcare quality with the specific forms of stigma that can emerge in relation to particular health issues and populations, such as BBVs and STIs. Overall, we examine how ambitious responses to stigma such as that proposed by the ‘universal precautions’ approach broaden our focus beyond interpersonal interactions and help draw attention to a wider range of objects, spaces and temporal dynamics that must be addressed in any effort to address stigma.
The associations between attentional control, episodic memory, and Alzheimer's disease biomarkers of tau and neurodegeneration
Authors: Stojanovic Marta , Millar Peter R , McKay Nicole S , Aschenbrenner Andrew J , Balota David A , Hassenstab Jason , Benzinger Tammie LS , Morris John C , Ances Beau M
Published: February 2025

Background

While episodic memory decline is the most common cognitive symptom of Alzheimer's disease (AD), changes in attentional control have also been found to be sensitive to early AD pathology. The relations between longitudinal trajectories of these specific cognitive domains, especially attentional control, and biomarkers of tau and neurodegeneration have not been thoroughly examined.

Objective

We examined whether baseline tau positron emission tomography (PET) and cortical thickness, relatively later markers within the AD cascade, predicted cross-sectional and longitudinal changes in episodic memory and attentional control.

Methods

Cognitively normal individuals ([Clinical Dementia Rating CDR®] = 0; n = 249) at baseline completed a magnetic resonance imaging (MRI), tau PET, and multiple assessments of episodic memory and attentional control. Generalized additive mixed-effects models examined whether tau PET summary measure and cortical thickness signature predicted cross-sectional and longitudinal trajectories of attentional control and episodic memory.

Results

Higher tau PET and lower MRI cortical thickness were generally associated with worse cross-sectional cognitive performance. Our exploratory analyses found cortex-wide associations between tau PET and episodic memory, with limited suggestions of region-specific associations with attentional control. On longitudinal follow-up, higher tau PET was associated with a greater decline in episodic memory.

Conclusions

These results indicate that tau PET is particularly sensitive to detecting longitudinal changes in episodic memory. This further informs relevant endpoints for clinical drug trials in cognitively normal individuals. Future studies might consider longer follow-ups and lag associations between changes in AD biomarkers and changes in cognition.
Regulation of glial ApoE secretion by the mevalonate pathway is independent of ApoE isoform
Authors: Milstein Joshua L , Kulas Joshua A , Kamal Aria , Lo An B , Ferris Heather A
Published: February 2025

Background

Lipids synthesized in astrocytes are distributed to other brain cells in high-density lipoprotein-like ApoE particles. ApoE, which is a powerful genetic risk factor for developing Alzheimer's disease, is secreted differently depending on genotype. Secretion of ApoE from mouse astrocytes is regulated by the mevalonate pathway.

Objective

We aimed to understand if the regulation of ApoE secretion from astrocytes by the mevalonate pathway was the same between mouse ApoE and ApoE from humanized mice, and if this is impacted by ApoE isoform.

Methods

Astrocyte-enriched glial cultures from wild-type and humanized ApoE targeted-replacement mice were treated with pharmacological inhibitors of various steps along the mevalonate pathway and ApoE in the conditioned media was measured.

Results

We show that statins and prenylation inhibitors, but not specific cholesterol inhibitors, reduce extracellular ApoE lipoparticle levels in astrocyte-enriched glial cultures, and that this occurs in cells harboring either the mouse ApoE or any of the three human ApoE genotypes to a similar extent. We find that geranylgeranylation modulates ApoE release from astrocytes, and it does so independent of ApoE genotype.

Conclusions

Our results suggest that prenylation broadly regulates ApoE secretion from astrocytes regardless of ApoE genotype, and that this is mediated specifically by geranylgeranylation. Therefore, our data implicates geranylgeranylation as a general mechanism modulating ApoE release from astrocytes, but likely is not responsible for the reported baseline differences in ApoE secretion seen in vivo and in vitro across genotypes.
Optimal configuration and economic benefit analysis of photovoltaic energy storage for enterprises
Authors: Lv Longjin , Yang Yueping
Published: February 2025

The new energy system constructed by energy storage and photovoltaic power generation systems can effectively solve the problem of transformer overload operation in some enterprises. It can reduce electricity costs and achieve low-carbon emissions reduction. In this paper, we establish a nonlinear mathematical programming model to determine the optimal configuration of photovoltaic power generation and energy storage systems. The model fully considers the following factors: initial investment cost of photovoltaic and energy storage systems, system maintenance cost, government subsidies for photovoltaic power generation, charging rules for grid sales electricity prices, photovoltaic grid connected electricity prices, photovoltaic production forecasting, and electricity load forecasting of related industrial enterprises. We determine the optimal installed capacity for photovoltaic power generation, energy storage capacity, and the optimal charging and discharging strategy for the energy storage system by MATLAB. This optimization strategy can ensure that the electricity consumption of enterprises does not exceed the rated capacity, and effectively reduce the basic and electricity prices of enterprises, achieving cost reduction and efficiency increase. Finally, A typical enterprise is selected for analysis. The results indicate that the proposed model can not only effectively reduce the peak electricity load of enterprises, but also significantly reduce the investment return period of photovoltaic energy storage.
Investigating the Effect of Elevation and Sex-Based Differences on Shoulder Proprioceptive Accuracy
Authors: Alexandrov Alexander , Morton Amy , Molino Janine , Pelusi Jonathan , Chrostek Cynthia A. , Crisco Joseph J. , Arcand Michel A.
Published: February 2025

Background:

Evaluating shoulder proprioception provides functional data that supplement imaging for the diagnosis/rehabilitation of rotator cuff injuries. There is a need for a system capable of establishing normal ranges for proprioceptive accuracy in healthy shoulders during unrestricted 3-dimensional motion.

Purpose:

To conduct passive joint position sense (JPS) testing in men and women with no history of shoulder injury using a novel testing system, identifying differences in proprioceptive accuracy based on sex, shoulder elevation, and crossbody position.

Study Design:

Controlled laboratory study.

Methods:

We recruited 20 (10 male and 10 female) healthy participants aged between 18 and 25 years for JPS testing. Participants used a single wrist-worn sensor, and our primary outcome was errors in position matching (first guiding a participant's dominant arm from a neutral starting position to a target position and then having participants independently return from the start position to the same target) across 12 targets comprised of all possible combinations of shoulder elevation angles (EAs) (30°, 60°, 90°, and 120°) and crossbody angles (CAs) (0°, 45°, and 90°). A linear mixed model was employed to evaluate sex- and position-based differences in JPS accuracy.

Results:

Position-matching accuracy increased in both males and females as target EAs increased from 30° to 120° ( P < .001). The greatest EA position-matching accuracy in both sexes was observed at EAs of 90° and 120° ( P < .0001). A change in the direction of error was observed in both males and females as target EAs increased from 90° to 120°, transitioning from positive (overshooting) to negative (undershooting) error ( P < .005). A sex-based difference was observed at EAs of 60°, 90°, and 120° in the 90° CA plane, where females exhibited more negative CA matching error compared with males ( P < .01).

Conclusion:

Proprioceptive accuracy increased in both sexes at higher shoulder elevations. In the 90° CA plane, females demonstrated greater CA undershoot than males.

Clinical Relevance:

While magnetic resonance imaging and ultrasound are effective tools for determining the size/age of rotator cuff tears, they do not provide functional prognostic insight for pain or mobility. Proprioceptive testing, as a functional metric based on free shoulder motion, may assist in clinically characterizing a patient's shoulder injury and rehabilitative success at multiple time points.
“YouTube” for Surgical Training and Education in Donor Nephrectomy: Friend or Foe?
Authors: El-Mahrouk Mohamed , Jaradat Derar , Eichler Tim , Sucher Robert , Margreiter Christian , Lederer Andri , Karitnig Robert , Geisler Antonia , Jahn Nora , Hau Hans Michael
Published: February 2025

Background

The COVID-19 pandemic has accelerated the shift toward e-learning and online education in surgical training. With the increasing prevalence of end-stage chronic kidney disease, kidney transplantation is in high demand. Donor safety is crucial in nephrectomy procedures, highlighting the importance of effective training. This study evaluates the quality and effectiveness of YouTube videos focusing on laparoscopic and robotic donor nephrectomy for surgical education.

Methods

On October 24, 2023, searches on YouTube for “laparoscopic live donor nephrectomy” and “robotic live donor nephrectomy” returned 121 videos, with 63 included in the study. Popularity was evaluated using the Video Power Index (VPI), while reliability and quality were assessed using the LAP-VEGaS Video Assessment Tool and Journal of the American Medical Association (JAMA) benchmark criteria. Additionally, a structured descriptive tool called the “Live Donor Nephrectomy Completeness (LDNC)” was created to evaluate the completeness and educational value of procedural technical steps.

Results

Out of 63 videos reviewed, laparoscopic surgical procedures were depicted in 71.4% of them, while robotic approaches were shown in 28.6%. Academic backgrounds were associated with 54% of the videos, and individual physician backgrounds with 46%. Mean scores were LAP-VEGaS 9.79 ± 3.87, VPI 6.32 ± 3.31, and LDNC 9.68 ± 1.97. JAMA scores varied, with 34.9% receiving 1 point, 34.9% receiving 2 points, 17.5% receiving 3 points, and 12.7% receiving 4 points. Academic videos scored significantly higher in LAP-VEGaS and LDNC (all p < .01). While LAP-VEGaS, VPI, and LDNC scores correlated significantly (all p < .05), no correlation was found between JAMA score and other scoring systems. Videos with more clicks and likes showed significantly better scores across all measures (all p < .05).

Conclusion

Amidst the challenges posed by the pandemic on surgical education, YouTube has emerged as a valuable resource for learning about laparoscopic and robotic donor nephrectomy for living kidney donation. However, the quality and reliability of these videos vary greatly, and many lack thorough reviews, leading to incomplete information. To enhance their educational value, it's proposed that videos undergo professional evaluation before publication and adhere to standardized, structured, and validated scoring systems, ensuring logical structure and improved quality.
Sample-Size Planning in Item-Response Theory: A Tutorial
Authors: Schroeders Ulrich , Gnambs Timo
Published: February 2025

Although item-response-theory (IRT) models offer well-established psychometric advantages over traditional scoring methods, they remain underused in practice. Following a brief introduction to the IRT framework, we emphasize its major advantages and explore potential applications in various research areas. The main part of this tutorial provides a comprehensive, step-by-step guide to Monte Carlo simulation-based sample-size estimation in IRT, which is essential for obtaining precise estimates of item and person parameters, structural effects, and model fit. Accurate a priori sample-size estimation is also crucial for effective study planning, especially in preregistration and registered reports. We highlight 10 key decisions, organized into four areas: (a) determining the data-generation model, (b) defining the test design and the process of missing values, (c) selecting the IRT model and parameters of interest, and (d) setting up and running the Monte Carlo simulation. The procedure is illustrated with examples from educational, personality, and clinical psychology. An extensively annotated and easily customizable syntax is available in an online repository.
Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft With Concomitant Meniscal Allograft Transplantation
Authors: Groothoff Jonathan D. , Villa Richard S. , Glover Mark A. , Mason Thomas W. , Fiegen Anthony P. , van der List Jelle P. , Waterman Brian R.
Published: February 2025

Background:

Primary arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft offers excellent long-term results for patients with ACL tears. When concurrent meniscal damage is present, the preferred treatment is repair of the meniscus. However, meniscectomy may be needed, which can result in insufficient meniscal function.

Indications:

ACL reconstruction performed concomitantly with meniscal allograft transplantation (MAT) is indicated for patients with ACL tears and meniscal insufficiency. This procedure is typically reserved for younger, active patients, such as the 38-year-old woman in this presentation.

Technique Description:

The patient was placed in the supine position. The BTB graft was harvested first using a standard medial midline incision. A posterior meniscus root tunnel was drilled, followed by drilling of the femoral tunnel for ACL reconstruction. The tibial tunnel for ACL reconstruction was subsequently created, after which tapping was performed for anterior meniscus root fixation. The meniscal allograft was secured using alternating vertical mattress inside-out sutures. Finally, the BTB graft was passed through the tibial and femoral tunnels.

Results:

Outcomes following ACL reconstruction with BTB autograft and MAT are positive, with a 5-year survival between 84% and 91%. ACL reinjury and long-term development of osteoarthritis are the most common complications. In this case, the patient returned to work within 7 months and reported 0 out of 10 pain.

Discussion/Conclusion:

ACL reconstruction with BTB autograft and concomitant MAT is a viable treatment option for patients with ACL tears in the context of meniscal deficiency.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Continuous non-contact monitoring of neonatal activity
Authors: Addison Paul S. , Gerstmann Dale , Clemmer Jeffrey , Nelson Rena , Gunturi Mridula , Montgomery Dean , Ajizian Sam
Published: February 2025

Purpose

Neonatal activity is an important physiological parameter in the neonatal intensive care unit (NICU). The degree of neonatal activity is associated with under and over-sedation and may also indicate the onset of disease. Activity may also cause motion noise on physiological signals leading to false readings of important parameters such as heart rate, respiratory rate or oxygen saturation or, in extreme cases, a failure to calculate the parameter at all. Here we report on a novel neonatal activity monitoring technology we have developed using a Random Forest machine learning algorithm trained on features extracted from a depth video stream from a commercially available depth sensing camera.

Methods

A cohort of twenty neonates took part in the study where depth information was acquired from various camera locations above and to the side of each neonate. Depth data were processed to provide features indicating changes corresponding to the activity of the neonate and then input into a Random Forest model which was trained and tested using a leave-one-out cross validation paradigm.

Results

Applying the thresholds found in training the Random Forest model during testing with leave-one-out cross validation, the mean (standard deviation) of the sensitivity and specificity of the optimal points and the corresponding area under the receiver operator curve (ROC-AUC) were 92.0% (8.8%), 93.2% (11.1%) and 97.7% (2.5%) respectively. The activity identified by the model also appeared to match well with noisy segments on the corresponding respiratory flow signal.

Conclusions

The results reported here indicate the viability of continuous non-contact monitoring of neonatal activity using a depth sensing camera system.
Effectiveness and cost-effectiveness of chiropractic and physiotherapy for chronic low back pain: a multicenter RCT in Sweden
Authors: Gedin Filip , Skeppholm Martin , Sparring Vibeke , Zethraeus Niklas
Published: February 2025

Objective

To evaluate the effectiveness and cost-effectiveness of physiotherapy, chiropractic care, and the combination of physiotherapy and chiropractic care compared with information and advice for the treatment of patients with nonspecific chronic low-back pain (CLBP) in Sweden.

Design

A multicentre pragmatic randomized controlled trial.

Setting

Ten primary care rehabilitation units in Sweden.

Participants

Eighty-eight participants with nonspecific CLBP.

Interventions

The participants were randomly assigned to receive physiotherapy, chiropractic care, combination treatment, or information and advice.

Main outcome measures

This study measured the Oswestry Disability Index (ODI), health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), working status, and costs.

Results

The study revealed no statistically significant differences in any of the outcome measures when physiotherapy, chiropractic care, and combination treatment with information and advice were compared (p > 0.05). The ODI changes between baseline and the 6-month follow-up ranged from 6.13 to 12.56 across the treatment groups, indicating reduced disability in all groups. Compared with the other treatment options, the combination treatment resulted in the greatest QALY gain (0.418) and lowest cost (SEK 3,081).

Conclusion

Compared with alternative standalone treatment options, the combination treatment strategy resulted in greater QALY gain and lower costs from a heath care perspective. Although the study did not detect statistically significant differences in outcomes or costs among the treatment options, the combination treatment showed promising potential for cost-effectiveness. Given the small sample size and low statistical power of the study, further clinical trials with fewer treatment arms and a focus on the combination group are warranted to confirm these findings. The insights gained from this study are important for informing the design and conduct of future clinical studies investigating the effectiveness, costs and cost-effectiveness of treatments for CLBP.

Trial registration

The study is registered in the ISRCTN registry (2017-02-20: ISRCTN15830360).
Prevalence of mistreatment in veterinary medical education; a survey of 3rd year veterinary students at a single university
Authors: Barnes Katherine H. , Johnson Stephanie , Liu Chin-Chi , Aulakh Karanvir S.
Published: February 2025

Background

Improving quality of life in veterinary medicine has emerged as an important topic. One factor which may influence quality of life in medical education is mistreatment (verbal abuse, power abuse, and physical abuse to establish and maintain a power hierarchy). Although it has been documented in medical education, its occurrence in veterinary education is not yet known.

Methods

Third year veterinary students were invited to participate in an anonymous and voluntary survey on mistreatment during the preclinical and clinical education. Students were asked if they witnessed and/or experienced a mistreatment, the type of mistreatment, and the person responsible for administering the mistreatment. Quality of life scores were obtained using the Medical Outcomes Trust short form questionnaire (SF-36). An analysis of variance (ANOVA) model followed by pairwise Least Significant Difference post hoc comparison was used to investigate the relationship variables.

Results

Fifty-five of 60 students (91.7%) that completed the questions on mistreatment indicated that they experienced and/or witnessed a mistreatment during veterinary education. 92% of students that experienced a mistreatment said that it interfered with the learning environment but only 29% of students reported the mistreatment at the time that it occurred. The most common mistreatment was public humiliation (78.3%) followed by special treatment based on gender (63.3%) and racially or ethnically offensive remarks (28.3%). Only racially or ethnically insensitive remarks were associated with a lower quality of life score in the social functioning category (p = 0.0131).

Conclusions

Mistreatment frequently occurred during the preclinical and clinical education of veterinary students in this population and interfered with the learning environment. The only mistreatment associated with a lower quality of life score was racially insensitive remarks. Programs to educate students and clinicians/staff about mistreatment and how to handle education in a stressful clinical and a preclinical setting may be of benefit in the future.

Clinical trial number

Not applicable.
Ethnic diversity and inclusiveness among medical residents in the Netherlands: results from a single-centered survey study
Authors: Al-Hassany Linda , Zaal Rianne J. , Stegers-Jager Karen M. , Zandbergen Adrienne A. M.
Published: February 2025

Purpose of study

Despite the recognized importance of an ethnically diverse healthcare workforce, the current population of medical specialists does not adequately reflect our society. To further unravel how and at which stages of the career path such diversity loss occurs, we studied ethnic diversity and perceptions of inclusiveness among medical residents.

Materials and methods

We conducted a cross-sectional study among all residents of Erasmus Medical Center in the highly multicultural city of Rotterdam, the Netherlands. An online survey was distributed, in which we inquired about (i) ethnic diversity and (ii) perceptions of inclusivity. The latter outcome includes sense of belonging to the team of supervisors, measured by perceived level of resemblance between residents and their supervisor(s), while focusing on ethnic, cultural, and socioeconomic levels. Residents from different specialties were divided into four groups, according to their medical specialty, i.e., surgical specialties, internal medicine specialties, overall diagnostic/supportive specialties, and family medicine & intellectual disability medicine. Descriptive statistics were applied.

Results

From the total of 986 invited residents, 493 (50.0%) participated (median age 32 years [IQR 30–34]), consisting of 346 (70.2%) females. Results showed that the majority, 335 (68.2%) were of Dutch origin, 90 (18.3%) were children of migrants, and 66 (13.4%) were migrants. We observed notable differences across medical specialties, with the highest degree of ethnic diversity in surgical specialties. Except for residents from supportive specialties, residents from other specialties who are (children of) migrants reported significantly more often that they experienced differences on ethnic and/or cultural levels with their supervisors than residents of Dutch origin.

Conclusion

While (children of) migrants were underrepresented in this cohort, especially given the demographic distribution of the region of Rotterdam, a comparison of our results with previously published census data on medical students cohorts indicates no substantial loss of ethnic diversity in the transition from medical student to residency. Yet, these groups scored lower on questions related to sense of belonging.

Clinical trial number

Not applicable.
Mechanical stimulation in plants: molecular insights, morphological adaptations, and agricultural applications in monocots
Authors: Hansen Annalene , Gladala-Kostarz Agnieszka , Hindhaugh Rebecca , Doonan John H. , Bosch Maurice
Published: February 2025

Mechanical stimulation, including wind exposure, is a common environmental factor for plants and can significantly impact plant phenotype, development, and growth. Most responses to external mechanical stimulation are defined by the term thigmomorphogenesis. While these morphogenetic changes in growth and development may not be immediately apparent, their end-results can be substantial. Although mostly studied in dicotyledonous plants, recently monocot grasses, particularly cereal crops, have received more attention. This review summarizes current knowledge on mechanical stimulation in plants, particularly focusing on the molecular, physiological, and phenological responses in cereals, and explores practical applications to sustainably improve the resilience of agricultural crops.
Association between antibiotics and treatment efficacy in metastatic urothelial carcinoma patients
Authors: Braun Avery , Deng Mengying , Hasler Jill S. , Bukavina Laura , Handorf Elizabeth , Abbosh Philip H.
Published: February 2025

Background

Antibiotic therapy (ABT)-induced dysbiosis may affect the efficacy of immune checkpoint inhibitors (ICI) therapy. We investigated the association between ABT and real-world overall survival (rwOS) and progression-free survival (rwPFS) in patients with metastatic urothelial carcinoma (mUC) receiving ICI or cisplatin-based chemotherapy (CIS).

Methods

Three thousand, one hundred seventy-nine patients were included from a nationwide electronic health record-derived de-identified database. Three-month landmark Kaplan–Meier methods and log-rank tests were used to estimate rwOS/PFS between treatment modalities based on ABT groups (stratified by exposure, timing, excretion mode, and administration route). Cox proportional models with time-varying coefficients were used to investigate the associations between ABT, treatment modality, and rwOS/PFS.

Results

A total of 402 (27.1%) ICI and 655 (38.6%) CIS patients received ABT (p < 0.001). ICI receipt (OR 0.65, p < 0.001) and advanced age (OR 0.98, p < 0.001) were associated with lower ABT use.

ICI exclusive findings included a negative correlation with rwOS in patients who received post-treatment initiated (ICI median: pre—13.2 vs post—7.9 vs none—13.3 months; p = 0.009), oral (median oral—9.6 vs none—13.3 months, p = 0.03), and renally cleared (median renal—9.9 vs none—13.3 months, p = 0.04) ABT.

ABT’s effect was negatively associated with rwOS in ICI patients within first 6 months (HR 1.36, 95% CI 1.107–1.74, p = 0.01) but not thereafter (p = 0.7).

Conclusions

This study identified a potential ICI-specific negative correlation between ABT and rwOS in patients with mUC, specifically those exposed to ABT pills and receipt before treatment initiation. These results emphasize the importance of antibiotic stewardship and continued investigation of the role of gut microbiome in mUC treatment efficacy.
Relationship of tobacco smoking to cause-specific mortality: contemporary estimates from Australia
Authors: Joshy Grace , Soga Kay , Thurber Katherine A. , Egger Sam , Weber Marianne F. , Sarich Peter , Welsh Jennifer , Korda Rosemary J. , Yazidjoglou Amelia , Nguyen Mai T H , Paige Ellie , Gourley Michelle , Canfell Karen , Banks Emily
Published: February 2025

Background

Tobacco industry activities and reduced smoking prevalence can foster under-appreciation of risks and under-investment in tobacco control. Reliable evidence on contemporary smoking impacts, including cause-specific mortality and attributable deaths, remains critical.

Methods

Prospective study of 178,169 cancer- and cardiovascular-disease-free individuals aged ≥ 45 years joining the 45 and Up Study in 2005–2009, with linked questionnaire, hospitalisation, cancer registry and death data to November 2017. Cause-specific mortality hazard ratios (HR) by smoking status, intensity and recency were estimated, adjusted for potential confounding factors. Population attributable fractions were estimated.

Results

There were 13,608 deaths during 9.3 years median follow-up (1.68 M person-years); at baseline, 7.9% of participants currently and 33.6% formerly smoked. Mortality was elevated with current versus never smoking for virtually all causes, including chronic lung disease (HR = 36.32, 95%CI = 26.18–50.40), lung cancer (17.85, 14.38–22.17) and oro-pharyngeal cancers (7.86, 4.11–15.02); lower respiratory infection, peripheral vascular disease, oesophageal cancer, liver cancer and cancer of unknown primary (risk 3–5 times as high); and coronary heart disease, cerebrovascular disease and cancers of urinary tract, pancreas, kidney, stomach and prostate (risk at least two-fold); former versus never-smoking demonstrated similar patterns with attenuated risks. Mortality increased with smoking intensity, remaining appreciable for 1–14 cigarettes/day (e.g. lung cancer HR = 13.00, 95%CI = 9.50–17.80). Excess smoking-related mortality was largely avoided with cessation aged < 45 years. In 2019, 24,285 deaths (one-in-every-six deaths, 15.3%), among Australians aged ≥ 45 years, were attributable to tobacco smoking.

Conclusions

Smoking continues to cause a substantial proportion of deaths in low-prevalence settings, including Australia, highlighting the importance of accelerated tobacco control.
Forecasting total and cause-specific health expenditures for 116 health conditions in Norway, 2022–2050
Authors: Kinge Jonas Minet , Øien Henning , Dieleman Joseph L. , Reme Bjørn-Atle , Knudsen Ann Kristin Skrindo , Godager Geir , Selbæk Geir , Frich Jan C. , Barış Enis , Murray Christopher J. L. , Vollset Stein Emil
Published: February 2025

Background

This study forecasts total and cause-specific health expenditures in Norway to 2050 and quantifies the contribution of four key drivers—total population growth, population aging, changes in disease prevalence, and cost per case—on future health care spending.

Methods

We forecast spending for 116 health conditions in Norway from 2022 to 2050, using historical and forecasted data of population growth, disease prevalence, gross domestic product (GDP), health spending, and residual factors. Our analysis included a reference scenario that forecasted disease-specific health spending; two alternative scenarios examining the effects of alternative unit cost developments; and a scenario examining the consequences of improved behavioral and metabolic risk factors.

Results

Health spending increased from 10.6% (95% uncertainty interval, 10.2–11.1) of GDP in 2022 to 14.3% (13.0–15.7) in 2050 in the reference scenario. Among the top aggregate causes of Norwegian health spending in 2022, the spending for neurological disorders rose the most, from 1.7% (1.6–1.8) to 2.7% (2.3–3.1) of GDP, surpassing mental and substance use disorders which rose from 2.2% (2.1–2.3) to 2.4% (2.2–2.6) of GDP. Of the 116 single conditions analyzed, dementias accounted for the highest spending in 2022. This expenditure was forecasted to increase considerably from 1.1% (1.09–1.2) to 1.9% (1.6–2.2) of GDP by 2050, largely due to population aging. Spending on other old-age-related conditions like falls, stroke, and diabetes, was also forecasted to increase. Increased population, aging, and spending per case contributed to increased future spending. Reduced behavioral and metabolic risks were forecasted to increase the number of elderly persons and reduce age-specific disease prevalence but had little impact on forecasted health spending.

Conclusions

Health spending growth was forecasted regardless of the scenario, and Norway needs to plan for this. However, policymakers can curb total spending growth, while maintaining health care quality and output, by ensuring more efficient allocation and effective use of resources. While the overall impact of behavioral and metabolic risk reductions on total healthcare spending was modest, reducing risk factors is needed if countries aim to achieve a healthier, longer-living population.
Anti-hypertensive medication adherence, socioeconomic status, and cognitive aging in the Chinese community-dwelling middle-aged and older adults ≥ 45 years: a population-based longitudinal study
Authors: Li Chenglong , He Daijun , Liu Yufan , Yang Chao , Zhang Luxia
Published: February 2025

Background

It remains unclear whether anti-hypertensive medication use is associated with cognitive aging in general Chinese middle-aged and older adults, as well as the interplay with socioeconomic status (SES). We aim to examine associations of anti-hypertensive medication adherence, SES, and cognitive aging in Chinese middle-aged and older adults.

Methods

Our study was based on the China Health and Retirement Longitudinal Study, an ongoing longitudinal national survey recruiting community-dwelling adults aged ≥ 45 years. Baseline anti-hypertensive medication use was assessed at wave 1. Longitudinal adherence to anti-hypertensive medication was assessed during waves 1 and 2. SES was assessed using income, education, employment, and medical insurance. The annual rate of cognitive change was assessed using cognitive Z scores. Linear mixed models were used to examine longitudinal associations.

Results

A total of 9229 participants were included (mean [SD] age: 57.1 [8.9] years; men: 50.8%). After controlling for blood pressure and other characteristics, participants taking anti-hypertensive medication at baseline, compared to participants not using medication, had a significantly decelerated decline in global cognition (β = 0.014; 95% confidence interval [CI], 0.003 to 0.025 SD/year; P = 0.01) and memory (β = 0.021; 95% CI, 0.008 to 0.034 SD/year; P = 0.001), respectively. Similarly, participants with high anti-hypertensive medication adherence during follow-up had slower declines in global cognition (β = 0.014; 95% CI, 0.002 to 0.027 SD/year; P = 0.02) and memory (β = 0.023; 95% CI, 0.008 to 0.038 SD/year; P = 0.003), compared to the low adherence group. There were no significant differences in cognitive decline between hypertension participants using or persistently adhering to medication and normotension participants. The SES significantly interacted with anti-hypertensive medication in associations with cognitive aging, with more evident associations observed in low SES subgroup (all P for interaction < 0.05). Several sensitivity analyses were conducted, observing consistent findings.

Conclusions

Adhering to anti-hypertensive medication was associated with decelerated cognitive aging in Chinese community-dwelling middle-aged and older adults, especially in participants with low SES. These findings indicate that promoting anti-hypertensive medication use could be important to achieve healthy and inclusive cognitive aging in general Chinese middle-aged and older adults living with hypertension.
The development and application of performance indicators to assess veterinarians’ adherence to the clinical practice Streptococcus suis in weaned pigs guideline
Authors: Wayop Isaura Y.A. , Wagenaar Jaap A. , de Vet Emely , Lambooij Anke , Speksnijder David C.
Published: February 2025

Background

To combat antimicrobial resistance, initiatives have been launched worldwide to reduce antimicrobial use in humans and animals. In the Netherlands, the pig industry has made significant strides in reducing antimicrobial use, yet considerable variation exists in usage and prescription of antimicrobials between different swine farms and swine veterinarians. Clinical practice guidelines have been developed to support veterinarians to further reduce prescription of antimicrobials. In 2014, the Streptococcus suis (S. suis) clinical practice guideline was introduced. To date, no information has been collected about the extent to which veterinarians were using this guideline. Therefore, we developed performance indicators involving a six-step approach using a modified RAND/UCLA method aimed at assessing veterinarians’ adherence to the S. suis guideline. To support our results and to provide a more comprehensive understanding, we developed and circulated a questionnaire. The performance indicators and questionnaire were completed by 33 active swine veterinarians.

Results

The final set of five performance indicators encompassed antimicrobial use, the ratio 1st to 2nd or 3rd choice antimicrobials, the argumentation for using 2nd choice antimicrobials, bacteriological examination including susceptibility testing, and the use of corticosteroids. In the questionnaire, 16 questions were included about veterinarians’ behavior linked to these five performance indicators. The results revealed a wide range in antimicrobial prescription among veterinarians dealing with S. suis-related issues on farms, suggesting that further improvement of antimicrobial stewardship is possible. Our findings show a discrepancy between the performance indicators based on observed data and veterinarians’ self-reported behaviors, particularly concerning the initiation of group treatments and the possibility that the advice provided by veterinarians may not always be consistently implemented in practice.

Conclusions

The developed performance indicators on their own may not adequately reflect veterinarians’ adherence to the guideline, but collectively, they serve as a reliable indicator of adherence. By generating reliable and accurate outcomes, they complement self-reported behavior, which may be subject to unconscious self-report biases. Therefore, performance indicators are essential for use in intervention programs to measure veterinarians’ guideline adherence and should be incorporated into the development process of all clinical veterinary guidelines.
25-Hydroxycholesterol modulates microglial function and exacerbates Alzheimer’s disease pathology: mechanistic insights and therapeutic potential of cholesterol esterification inhibition
Authors: Choi Hayoung , Kim Haeng Jun , Lee Sang-Eun , Song Hyun Ho , Kim Jieun , Han Jihui , Jeong June-Hyun , Lee Do Yup , Chang Sunghoe , Mook-Jung Inhee
Published: February 2025

This study investigates the role of 25-hydroxycholesterol (25HC), a metabolite produced by cholesterol hydroxylase encoded by the Ch25h gene, in modulating microglial function and its potential implications in Alzheimer’s disease (AD) pathology. We demonstrated that 25HC impairs microglial surveillance, reduces phagocytic capacity, and increases the production of pro-inflammatory cytokines. In vivo two-photon microscopy revealed that 25HC administration diminishes microglial response to brain lesions, while flow cytometry confirmed reduced phagocytosis in both in vivo and in vitro models. Additionally, amyloid-beta (Aβ) was shown to upregulate Ch25h expression and elevate 25HC levels in microglia, exacerbating these functional impairments. Mechanistically, 25HC was found to enhance cholesterol esterification, disrupt cell membrane dynamics, and further reduce microglial mobility and phagocytosis. Treatment with Avasimibe, a cholesterol esterification inhibitor, restored membrane dynamics and microglial function, leading to attenuated AD pathology in a 5XFAD mouse model. These findings suggest that 25HC-induced changes in microglial function contribute to AD progression, and targeting cholesterol metabolism could offer therapeutic potential.
Systematic gene expression analysis of putative target genes linked to miR-31 in 83 oral squamous cell carcinoma samples
Authors: Feldges Carolin , Jung Susanne , Purcz Nikolai , Sproll Christoph , Kleinheinz Johannes , Sielker Sonja
Published: February 2025

Background

The development of oral squamous cell carcinoma on the molecular level and the resulting prognosis for patients have remained poorly understood. While AngiomiR-31 was implicated in the progression and metastasis of OSCC. However, this connection has not yet been investigated in more detail and tested for its significance with regard to new therapies and the prognosis of patients.

Methods

Through a systemic analysis of putative target genes of AngiomiR-31 in OSCC, this study aimed to highlight possible prognostic markers and genes that might improve prognostic predictability in patients with oral squamous cell carcinoma, especially regarding AngiomiR-31 as an outstanding mediator of angiogenesis. The study is based on gene data from 83 OSCC samples. Potentially relevant genes were selected and sorted by TNM, grading and UICC in these 83 OSCC whole-genome microarray datasets. Data was analysed and tested for significance.

Results

Through our investigation 20 potential target genes, including tumor suppressor genes, oncogenes and genes not yet categorized, were found and their expression correlated significantly with the expression of AngiomiR-31.

Conclusion

These findings contribute to a more profound understanding of the molecular mechanisms underlying OSCC progression and may have implications for the development of novel therapeutic strategies targeting AngiomiR-31 in OSCC. Further validation of these genes is needed to validate their clinical relevance and potential as prognostic markers or therapeutic targets in OSCC.