bluuebunny/crossref_metadata_2025 huggingface dataset:
Διερεύνηση λειωμένου αγωγού διανομής ηλεκτρικής ενέργειας ή εσωτερικής ηλεκτρικής εγκατάστασης κτηρίου σε περιβάλλον πυρκαγιάς, ως προς το ενδεχόμενο να είναι θύμα ή θύτης αυτής
Authors: Μουζακίτης Παναγιώτης
Published: June 2024

Η διατριβή αυτή αφορά θερμικά φαινόμενα εμφανιζόμενα σε γραμμές διανομής μέσης και χαμηλής τάσης, καθώς και σε γραμμές χαμηλής τάσης εντός κατοικημένων χώρων, σε σχέση με την εκδήλωση πυρκαγιάς. Στο κεφάλαιο 1 γίνεται μια εισαγωγή που αφορά το μεγάλο πρόβλημα των δασικών πυρκαγιών και των πυρκαγιών εσωτερικών χώρων, καθώς και στις σχέσεις που διέπουν τη μετάδοσή τους. Επίσης, γίνεται αναφορά στις σχέσεις που υπολογίζουν την αύξηση των θερμοκρασιών στους ρευματοφόρους αγωγούς, σε περίπτωση υπερέντασης ή βραχυκυκλώματος. Στο Κεφάλαιο 2 αναλύεται ο σκοπός της παρούσας διατριβής. Στο Κεφάλαιο 3 αναλύεται το ηλεκτρικό τόξο και το βραχυκύκλωμα στους αγωγούς διανομής μέσης και χαμηλής τάσης του Ελληνικού Δικτύου Διανομής Ηλεκτρικής Ενέργειας. Στο Κεφάλαιο 4 εξετάζεται η δημιουργία χάλκινων τηγμάτων, η πτώση τους στο έδαφος και οι θερμοκρασίες αυτών κατά τη διάρκεια της πτώσης τους και κατά τη διάρκεια επαφής τους με το έδαφος. Ακολούθως, εξετάζεται η δυνατότητα έναυσης πυρκαγιάς σε ξύλινο δάπεδο (κόντρα πλακέ) λόγω της επαφής του με τα υπό μελέτη τήγματα. Στο Κεφάλαιο 5 δίδονται τα συμπεράσματα των υπολογισμών για τους αγωγούς αλουμινίου του δικτύου διανομής και τους αγωγούς χαλκού των εσωτερικών ηλεκτρικών εγκαταστάσεων. Τέλος, στο Κεφάλαιο 6 αναφέρεται η συμβολή της εργασίας στην έρευνα και στις πρακτικές εφαρμογές. Από την έρευνα προέκυψε ότι κατά το βραχυκύκλωμα μεταξύ αγωγών διανομής μέσης και χαμηλής τάσης δεν δημιουργούνται τήγματα, γιατί οι θερμοκρασίες που προκύπτουν είναι πολύ μικρές. Εντός κατοικημένων χώρων και κυρίως εργοστασίων, όπου το ύψος μπορεί να είναι 15-20 μέτρα περίπου, μπορούν να δημιουργηθούν τήγματα 0.5, 1, 2 ή και 3mm διαμέτρου, τα οποία υπό προϋποθέσεις μπορούν να προκαλέσουν πυρκαγιά αν έρθουν σε επαφή με κατάλληλο υλικό. Τα δύο Παραρτήματα που ακολουθούν διευκολύνουν τον αναγνώστη στην κατανόηση βασικών εννοιών που αναφέρονται στο κείμενο, αλλά αποτελούν ανεξάρτητο επιστημονικό πεδίο, απαραίτητο, όμως, όπως ο ιονισμός του ατμοσφαιρικού αέρα (Παράρτημα Ι) και των φαινομένων μεταφοράς θερμότητας (Παράρτημα ΙΙ).
Η επίδραση της χορήγησης υψηλών δόσεων γλυκοκορτικοειδών στον οστικό μεταβολισμό σε νεοδιαγνωσθέντες ασθενείς με πολλαπλή σκλήρυνση
Authors: Σημαιάκης Γεώργιος
Published: June 2024

Σκοπός: Η θεραπεία με ενδοφλεβίως χορηγούμενες υψηλές δόσεις γλυκοκορτικοειδών (ΓΚ) αντιπροσωπεύει την πρώτη επιλογή θεραπείας για τις υποτροπές της πoλλαπλής σκλήρυνσης (ΠΣ). Η χρόνια από του στόματος χορήγηση ΓΚ συσχετίζεται με την απώλεια οστικής μάζας, ενώ τα δεδομένα σχετικά με τις ενδοφλεβίως χορηγούμενες υψηλές δόσεις ΓΚ παραμένουν αντικρουόμενα. Μέθοδοι: Είκοσι πέντε νεοδιαγνωσθέντες ασθενείς με ΠΣ (διάμεση ηλικία: 37 έτη, εύρος: 18 - 45 έτη) μελετήθηκαν προοπτικά για τις επιδράσεις των ενδοφλεβίως χορηγούμενων υψηλών δόσεων ΓΚ στην οστική μάζα και στον οστικό μεταβολισμό. Στους ασθενείς χορηγήθηκαν ενδοφλεβίως 1000 mg μεθυλπρεδνιζολόνης ημερησίως για 5 διαδοχικές ημέρες, ακολουθούμενα από 60 mg από του στόματος πρεδνιζολόνης ημερησίως με σταδιακή μείωση της δόσης, για χρονικό διάστημα 21 ημερών έως της πλήρους διακοπής. Οι βιοχημικές παράμετροι του οστικού μεταβολισμού προσδιορίστηκαν πριν από τη χορήγηση ΓΚ και στη συνέχεια τις ημέρες 2, 4, 6 και 90 και στους μήνες 6, 12, 18 και 24 μετά τη θεραπεία με ΓΚ. Η οστική πυκνομετρία οσφυϊκής μοίρας της σπονδυλικής στήλης (ΟΜΣΣ), αριστερού και δεξιού ισχίου καθώς και ολόσωμη μέτρηση λιπώδους και άλιπης μάζας με τη μέθοδο απορροφησιομετρίας ακτίνων X διπλής ενέργειας (DXA) αξιολογήθηκαν πριν από τη χορήγηση ΓΚ και στη συνέχεια κάθε έξι μήνες. Αποτελέσματα: Δέκα ασθενείς ολοκλήρωσαν τη μελέτη. Το οστικό κλάσμα αλκαλικής φωσφατάσης (BAP) και το αμινο-τελικό προπεπτίδιο του προκολλαγόνου Τύπου 1 (P1NP) έδειξαν σημαντική αύξηση την 90η ημέρα (p <0,05). Παρατηρήθηκε μία μη σημαντική μείωση της οστικής μάζας σε όλες τις θέσεις 6 μήνες από τη χορήγηση ΓΚ, η οποία στην πορεία της παρακολούθησης έδειξε τάση αποκατάστασης. Συμπεράσματα: Η χορήγηση υψηλών δόσεων ΓΚ δε φαίνεται να έχει μακροπρόθεσμη αρνητική επίδραση στην οστική μάζα σε αυτή την ομάδα ασθενών. Η παρατηρούμενη παροδική αύξηση στους δείκτες οστικής κατασκευής πιθανώς υποδηλώνει μια φάση αυξημένου ρυθμού οστικής ανακατασκευής ως «απάντηση» στις αρχικές, επιβλαβείς δράσεις των χορηγηθέντων ΓΚ. Η διενέργεια περαιτέρω προοπτικών μελετών με μεγαλύτερο μέγεθος δείγματος σε παρόμοια επιλεγμένους ασθενείς κρίνεται απαραίτητη.
A EDUCAÇÃO INTERPROFISSIONAL NO CURSO DE BACHARELADO INTERDISCIPLINAR EM SAÚDE: UMA ANÁLISE DOCUMENTAL
Authors: Alaíde Alves Santana Luciana , Meireles Everson , Da Silva Ramos Arisne Munique , De Sousa Pinho Paloma , Peixoto Lima Aline Maria
Published: June 2024

Este artigo apresenta um Roteiro de Análise de Projetos Pedagógicos de Cursos (PPC) da área da saúde com foco na Educação Interprofissional (EIP), bem como realiza uma análise documental do Projeto Pedagógico do Curso de Bacharelado Interdisciplinar em Saúde (BIS) do Centro de Ciências da Saúde da UFRB . O Roteiro, denominado Avaliação da Educação Interprofissional (EIP) em cursos da área da saúde, foi elaborado após extensa revisão da literatura sobre EIP e validado em seu conteúdo junto a especialistas sobre o tema. Este instrumento permite a avaliação global de Projetos Pedagógicos de Curso da área da saúde com foco na EIP, bem como os elementos centrais que estruturam a educação interprofissional em ementas de componentes curriculares dos cursos. A análise documental do PPC, de um ponto de vista global, permitiu identificar referência direta à interprofissionalidade em diferentes seções estruturantes do documento. Na análise das ementas, observou-se que a dimensão de atenção à saúde centrada no usuário-família-comunidade esteve mais destacada. Identificou-se ainda que, embora o curso tenha um componente transversal que envolve ações junto à comunidade e foca no trabalho em equipes de estudantes de diferentes cursos, parece haver a necessidade de maior destaque para esta dimensão do trabalho interprofissional e colaborativo no documento. O estudo apontou que o Roteiro é efetivo para a avaliação da presença da EIP em projetos de curso e permitiu concluir que a formação inicial preparatória ofertada por meio do BIS possui diversos mecanismos favoráveis à EIP.
Palavras Chave: Avaliação. Educação Interprofissional. Formação em Saúde. Interdisciplinaridade.
Cyber threats and key mitigation strategies
Authors: Waynforth Chris
Published: June 2024

UK organisations – and perhaps most notably the National Health Service (NHS) – are the focus of serious overhauls in IT provision and strategy. But it seems that far too little of the effort and expense is geared towards security. While increased efficiency and productivity are important, any gains in those areas are doomed to be undermined if security is not an intrinsic part of IT improvement programmes.
PROGRAMA INSTITUCIONAL DE BOLSA DE INICIAÇÃO À DOCÊNCIA (PIBID) NO CONTEXTO DA PANDEMIA DO COVID- 19:
Authors: Miranda Cardoso Coutinho Taís , Sena Santos Matheus , Leite Rodrigues Tainara , Oliveira Ramos Evódio Maurício
Published: June 2024

O presente trabalho trata-se de um relato de experiência escrito por bolsistas do Programa Institucional de Bolsa de Iniciação à docência (PIBID), do curso de Educação Física- Licencitura da Universidade Estadual de Feira de Santana (UEFS), e tem como objetivo expor experiências vivenciadas no programa durante o período de outubro de 2020 junto a uma escola pública estadual  de Feira de Santana, na Bahia no contexto da pandemia do COVID-19.  A vivência de uma sala de aula real através do PIBID
proporciona um suporte significativo para a formação dos graduandos e enriquece a formação de novas práticas e metodologias didáticas a fim de superar os desafios do ser professor na atualidade. Porém, devido a pandemia, o ensino remoto é apresentado pelo governo como a melhor possibilidade de continuação das aulas nas escolas estaduais. O trabalho foi articulado em tópicos, abordamos sobre as experiências significativas do PIBID junto ao ensino remoto e as dificuldades do ensino remoto no contexto escolar  no período da pandemia. Durante este estudo, narramos experiências positivas e as dificuldades enfrentadas no programa no contexto escolar, como a possibilidade de nos aproximarmos do nosso campo de atuação e a exposição de problemáticas relacionadas a questões financeiras, como por exemplo a deficiência de ferramentas tecnológicas entre os alunos que dificultam a participação nas aulas on-line.
CORPO, A IMAGEM CORPORAL, A ADOLESCÊNCIA E A INSATISFAÇÃO CORPORAL FEMININA.
Authors: De Almeida Lôbo Moreira Halley Victória , Borges de Andrade Carla
Published: June 2024

Este estudo é parte integrande de uma dissertação em andamento, no Mestrado em Desenho, Cultura e Interatividade, e tem por objetivo reunir os conceitos fundantes da pesquisa, bem como apresentar o estado do conhecimento que construímos sobre o objeto. Dentre esses conceitos, aqui nos reportamos aos de corpo, imagem corporal, adolescência e instisfação corporal feminina, com base na literatura disponível. Assim, o estudo, possui abordagem qualitativa, utiliza o método da pesquisa bibliográfica e se classifica como explicativo.
Impact of 3D printing on Orthopedic Surgery in India: Has the Technology Really Arrived!
Authors:   Department of Orthopaedics, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India,, Jain Mantu , Sharma Vyom ,   Department of Orthopaedics, Military Hospital Khadki and AFMC, Pune, Maharashtra, India,, Sood Chetan ,   Department of Orthopaedics, Base Hospital Guwahati, Guwahati, Assam, India,, Shyam Ashok ,   Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
Published: June 2024

Surgical innovations have driven advancements in patient care, leading to improved surgical results and decreased patient morbidity. The integration of new technical advancements in orthopedic surgery is linked to the clinical advantages, ethical challenges, financial factors, and its broader influence on the global health-care sector [1]. 3D printing in orthopedic surgery is a developing technique that is rapidly gaining recognition and positively impacting patient results. The widespread influence and usefulness of 3D printing in orthopedics have been confirmed through reports detailing its application in complex trauma, complex hip revision surgeries, and various other areas such as complex spine deformity for pedicle screw trajectory guides, 3D printed implants, and bio-scaffolds [2-5]. The amount of scientific literature on the use of 3D printing in orthopedics has significantly increased in the past decade, both internationally and in India [6]. However, it has this quickly rising trend in the field of orthopedic surgery “really arrived in India.”
A Unique Presentation of Vertebral Body Osteochondroma of Sixth Cervical Spine Causing Myelopathic Symptoms: Management with En bloc Excision and Cervical Fusion
Authors:   Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India., Pisal Tushar , Gurnani Sagar ,   Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India., Kuity Kaman ,   Department of Orthopaedic Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India.
Published: June 2024

Introduction: Vertebral body osteochondroma presenting with myelopathic symptoms is exceptionally rare entity of spinal osteochondroma which arises from the posterior surface of vertebral body and leading to spinal canal stenosis and cord compression. Early definitive diagnosis and subsequent successful treatment is necessary in such cases to prevent life threatening complications. Case Report: In this context, we report a case of a 20-years old female presented with mechanical neck pain, unsteady gait, giddiness with neurological deficit for the past 3 months. An MRI of the cervical spine revealed a mass growing from the posterior aspect of the C6 vertebral body and extending toward the vertebral canal, causing marked spinal cord compression. Conclusion: The following case report not only describes the rare presentations of vertebral body osteochondroma but also emphasizes on surgical management by en bloc resection of tumor and anterior cervical fusion, resulting in a favorable outcome without any recurrence. Keywords: Vertebral body osteochondroma, corpectomy, en bloc excision, cervical fusion
V-Y Quadricepsplasty for Knee Stiffness Post Total Knee Arthroplasty: A Case Report and Literature Review
Authors:   Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon,, Ramlawi Akram Al , Issa Mohamad ,   Department of Orthopaedic Surgery, Duke University Medical Center, Durham, USA., Nassar Joseph E ,   Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon,, Naja Ahmad Salaheddine ,   Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon,, Saghieh Said ,   Department of Orthopaedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon,
Published: June 2024

Introduction: Knee stiffness post-total knee arthroplasty (TKA) represents a common and challenging complication. Standard treatment protocols primarily include physical therapy, manipulation under anesthesia (MUA), fibrotic tissue release, lysis of adhesions (LOA), and in refractory cases, revision arthroplasty. However, these interventions often show minimal improvement in refractory cases. This report introduces V-Y quadricepsplasty as an innovative approach for addressing knee stiffness post-TKA, particularly in cases unresponsive to MUA and LOA, without any evidence of prosthetic component malposition or failure. Case Report: We present a case involving a middle-aged woman experiencing persistent knee stiffness post-TKA, unresponsive to both MUA and LOA. Diagnostic evaluations confirmed no malposition or failure of the prosthetic component. The patient underwent a successful V-Y quadricepsplasty, which resulted in significant improvement in her condition. Conclusion: This case underscores the efficacy of V-Y quadricepsplasty in managing knee stiffness post-TKA, especially in cases where traditional treatments such as MUA and LOA are ineffective and there is no evidence of prosthetic component failure or malposition. This approach potentially offers a new avenue for treatment in similar clinical scenarios. Keywords: V-Y quadricepsplasty, total knee arthroplasty, knee, stiffness.
Bayesian neuromorphic imaging for single-photon LiDAR
Authors: Yao Dan , Mora-Martín Germán , Gyongy Istvan , Scholes Stirling , Leach Jonathan , McLaughlin Stephen , Altmann Yoann
Published: June 2024

This paper proposes a Bayesian approach to enable single photon avalanche diode (SPAD) arrays to be used as pseudo event cameras that report changes in the scene. Motivated by the working principle of event cameras, which produce sparse events associated with light flux changes, we adopt a changepoint detection strategy to generate intensity and depth change event streams from direct time-of-flight (dToF) sequences measured by SPAD arrays. Although not our main goal, the algorithm also produces as a by-product, intensity and depth estimates. Unlike the output of passive event cameras that only correspond to light flux changes, the change events detected from the sequential dToFs can relate to changes in light flux and/or depth. The integration of the proposed Bayesian approach with single-photon LiDAR (SPL) systems provides a novel solution to achieve active neuromorphic 3D imaging that offers the advantages of significantly reduced output redundancy and in particular the capacity to report scene depth changes. For each pixel of the SPAD array, asynchronous events are generated by performing online Bayesian inference to detect changepoints and estimate the model parameters simultaneously from individual single-photon measurements. Experiments are conducted on synthetic data and real dToF measurements acquired by a 172×126 pixel SPAD camera to demonstrate the feasibility and efficiency of the proposed Bayesian approach.
Highly birefringent anti-resonant hollow-core fiber with meniscoid nested structure
Authors: Wang Yang , Zhang Xiaobei , Chen Wei , Zhang Qi , Yang Yong , Li Maochun , Yan Miao , Wang Tingyun
Published: June 2024

We propose a meniscoid nested anti-resonant hollow-core fiber (MAF), wherein the fourfold rotational symmetry structure enables high birefringence and low loss in dual-wavelength range. Numerical investigation and simulation for variations in wall thickness along orthogonal directions are conducted, through which a formulated optimization criterion revealing the relationship between minimum difference in wall thickness and birefringence of 10−5 is obtained. A parameter of beat length to loss ratio η is defined to evaluate MAF performance with respect to birefringence and confinement loss (CL). With optimized MAF structure, the birefringence and CL are improved to 3.62 × 10−5 and 8.5 dB/km at 1.06 µm, 9.83 × 10−5 and 204.1 dB/km at 1.55 µm, respectively. Meanwhile, the bandwidths extend to 172 nm at 1.06 µm and 216 nm at 1.55 µm, and the superior bending resistance characteristics are validated. Our work offers valuable guidance for designing and optimizing highly birefringent anti-resonant hollow-core fiber (ARF), and the proposed MAF has great potential in polarization-dependent transmission and interferometric fiber gyroscopes.
Bioinformatics analyses and experimental validation of ferroptosis-related genes in bronchopulmonary dysplasia pathogenesis
Authors: Luo Yifan , Zhang Zongli , Xi Shibing , Li Tao
Published: June 2024

Objective

We aimed to study the involvement of ferroptosis in the pathogenesis of bronchopulmonary dysplasia (BPD) by conducting bioinformatics analyses and identifying and validating the associated ferroptosis-related genes to explore new directions for treating BPD.

Methods

The dataset GSE32472 on BPD was downloaded from the public genome database. Using R language, differentially expressed genes (DEGs) between the BPD and normal group were screened. In the present study, we adopted weighted gene correlation network analysis (WGCNA) for identifying BPD-related gene modules and ferroptosis-related genes were extracted from FerrDb. Their results were intersected to obtain the hub genes. After that, to explore the hub gene-related signaling pathways, the hub genes were exposed to gene ontology enrichment analysis. With the purpose of verifying the mRNA expression of the hub genes, a single-gene gene set enrichment analysis and quantitative reverse transcription polymerase chain reaction were conducted. Immune cell infiltration in BPD was analyzed using the CIBERSORT inverse fold product algorithm.

Results

A total of 606 DEGs were screened. WGCNA provided the BPD-related gene module darkgreen4. The intersection of DEGs, intramodular genes, and ferroptosis-related genes revealed six ferroptosis-associated hub genes (ACSL1, GALNT14, WIPI1, MAPK14, PROK2, and CREB5). Receiver operating characteristic curve analysis demonstrated that the hub genes screened for BPD were of good diagnostic significance. According to the results of immune infiltration analysis, the proportions of CD8, CD4 naive, and memory resting T cells and M2 macrophage were elevated in the normal group, and the proportions of M0 macrophage, resting mast cell, and neutrophils were increased in the BPD group.

Conclusions

A total of six ferroptosis-associated hub genes in BPD were identified in this study, and they may be potential new therapeutic targets for BPD.
A secreted proteomic footprint for stem cell pluripotency
Authors: Lewis Philip A. , Silajdžić Edina , Smith Helen , Bates Nicola , Smith Christopher A. , Mancini Fabrizio E. , Knight David , Denning Chris , Brison Daniel R. , Kimber Susan J.
Published: June 2024

With a view to developing a much-needed non-invasive method for monitoring the healthy pluripotent state of human stem cells in culture, we undertook proteomic analysis of the waste medium from cultured embryonic (Man-13) and induced (Rebl.PAT) human pluripotent stem cells (hPSCs). Cells were grown in E8 medium to maintain pluripotency, and then transferred to FGF2 and TGFβ deficient E6 media for 48 hours to replicate an early, undirected dissolution of pluripotency. We identified a distinct proteomic footprint associated with early loss of pluripotency in both hPSC lines, and a strong correlation with changes in the transcriptome. We demonstrate that multiplexing of four E8- against four E6- enriched secretome biomarkers provides a robust, diagnostic metric for the pluripotent state. These biomarkers were further confirmed by Western blotting which demonstrated consistent correlation with the pluripotent state across cell lines, and in response to a recovery assay.
Dual- or single rinse? The tubular sealer penetration of endodontic chelating agents
Authors: Ozel Beliz , Ayhan Tuba , Kaptan Figen , Sahin Fikrettin , Karapınar-Kazandağ Meriç
Published: June 2024

Introduction

In this study, we aimed to compare the effectiveness of various chelating agents, ethilenediaminetetraacetic acid (EDTA), citric acid (CA), and etidronic acid (HEDP) mixed in two different forms, in removing the smear layer and promoting the penetration of an endodontic sealer into the dentinal tubules of extracted single-rooted teeth.

Methods

The study used 75 teeth divided into five groups: 17% EDTA, 10% CA, 9% HEDP + NaOCl, 9% HEDP + distilled water (DW), and a control (DW) group. Scanning electron microscopy was used to assess smear layer removal and confocal laser microscopy was used to evaluate tubular sealer penetration at different depths from the apical tip.

Results

Sealer penetration was highest with 17% EDTA and 10% CA as compared with the other agents (p<0.001). At the cervical third, the sealer penetration for EDTA, HEDP + NaOCl, and HEDP + DW groups were significantly different than those in DW (p = 0.020). For the middle third, EDTA, CA, and HEDP + NaOCl groups were significantly higher than those of the DW group (p<0.001). Cervical-level values were significantly higher than apical-level values for HEDP + NaOCl, HEDP + DW, and DW (p<0.001). Smear layer removal was lower with 9% HEDP + DW than with 17% EDTA and 10% CA at all depths (p<0.001). A significancy in smear layer removal was observed between 10% CA and control (p = 0.015) in middle depth.

Conclusion

Within the limitations of this study, highest values were seen in EDTA and CA in terms of sealer penetration and smear layer removal. In the light of these findings, the use of strong chelating agents highlights better clinical efficiency than dual-rinse or single HEDP irrigation.
Association of hospital volume and operative approach with clinical and financial outcomes of elective esophagectomy in the United States
Authors: Mallick Saad , Chervu Nikhil L. , Balian Jeffrey , Charland Nicole , Valenzuela Alberto R. , Sakowitz Sara , Benharash Peyman
Published: June 2024

Introduction

Literature regarding the impact of esophagectomy approach on hospitalizations costs and short-term outcomes is limited. Moreover, few have examined how institutional MIS experience affects costs. We thus examined utilization trends, costs, and short-term outcomes of open and minimally invasive (MIS) esophagectomy as well as assessing the relationship between institutional MIS volume and hospitalization costs.

Methods

All adults undergoing elective esophagectomy were identified from the 2016–2020 Nationwide Readmissions Database. Multiple regression models were used to assess approach with costs, in-hospital mortality, and major complications. Additionally, annual hospital MIS esophagectomy volume was modeled as a restricted cubic spline against costs. Institutions performing > 16 cases/year corresponding with the inflection point were categorized as high-volume hospitals (HVH). We subsequently examined the association of HVH status with costs, in-hospital mortality, and major complications in patients undergoing minimally invasive esophagectomy.

Results

Of an estimated 29,116 patients meeting inclusion, 10,876 (37.4%) underwent MIS esophagectomy. MIS approaches were associated with $10,600 in increased incremental costs (95% CI 8,800–12,500), but lower odds of in-hospital mortality (AOR 0.76; 95% CI 0.61–0.96) or major complications (AOR 0.68; 95% CI 0.60, 0.77). Moreover, HVH status was associated with decreased adjusted costs, as well as lower odds of postoperative complications for patients undergoing MIS operations.

Conclusion

In this nationwide study, MIS esophagectomy was associated with increased hospitalization costs, but improved short-term outcomes. In MIS operations, cost differences were mitigated by volume, as HVH status was linked with decreased costs in the setting of decreased odds of complications. Centralization of care to HVH centers should be considered as MIS approaches are increasingly utilized.
A combination weighting method for debris flow risk assessment based on t-distribution and linear programming optimization algorithm
Authors: Li Li , Lin Hanjie , Qiang Yue , Zhang Yi , Hu Shengchao , Li Hongjian , Liang Siyu , Xu Xinlong
Published: June 2024

Debris flow risk assessment can provide some reference for debris flow prevention and control projects. In risk assessment, researchers often only focus on the impact of objective or subjective indicators. For this purpose, this paper proposed a weight calculation method based on t-distribution and linear programming optimization algorithm (LPOA). Taking 72 mudslides in Beichuan County as an example, this paper used analytic hierarchy process (AHP), entropy weight method (EWM) and variation coefficient method (VCM) to obtain the initial weights. Based on the initial weights, weight intervals with different confidence levels were obtained by t-distribution. Subsequently, the final weights were obtained by LOPA in the 90% confidence interval. Finally, the final weights were used to calculate the risk score for each debris flow, thus delineating the level of risk for each debris flow. The results showed that this paper’s method can avoid overemphasizing the importance of a particular indicator compared to EWM and VCM. In contrast, EWM and VCM ignored the effect of debris flow frequency on debris flow risk. The assessment results showed that the 72 debris flows in Beichuan County were mainly dominated by moderate and light risks. Of these, there were 8 high risk debris flows, 24 medium risk debris flows, and 40 light risk debris flows. The excellent triggering conditions provide favorable conditions for the formation of high-risk debris flows. Slightly and moderate risk debris flows are mainly located on both sides of highways and rivers, still posing a minor threat to Beichuan County. The proposed fusion weighting method effectively avoids the limitations of single weight calculating method. Through comparison and data analysis, the rationality of the proposed method is verified, which can provide some reference for combination weighting method and debris flow risk assessment.
DNA alterations in ovarian adult granulosa cell tumours: A scoping review protocol
Authors: Karstensen Sven , Kaiser Karsten , Moos Caroline , Poulsen Tim Svenstrup , Jochumsen Kirsten , Høgdall Claus , Lauszus Finn , Høgdall Estrid
Published: June 2024

Background

Identifying and describing molecular alterations in tumors has become common with the development of high-throughput sequencing. However, DNA sequencing in rare tumors, such as ovarian adult granulosa cell tumor (aGCT), often lacks statistical power due to the limited number of cases in each study. Questions regarding personalized treatment or prognostic biomarkers for recurrence or other malignancies therefore still need to be elucidated. This scoping review protocol aims to systematically map the current evidence and identify knowledge gaps regarding DNA alterations, actionable variations and prognostic biomarkers in aGCT.

Methods

This scoping review will be conducted based on Arksey and O’Malley’s methodological framework and later modifications by JBI Evidence Synthesis. The protocol complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. All original publications describing molecular alterations of aGCT will be included. The search will be performed in May 2024 in the following databases: MEDLINE (Ovid), Embase (Ovid), Web of Science Core Collection and Google Scholar (100-top ranked).

Discussion

This scoping review will identify knowledge and gaps in the current understanding of the molecular landscape of aGCT, clinical trials on actionable variations and priorities for future research. As aGCT are rare, a possible limitation will be the small sample sizes and heterogenic study settings.

Scoping review registration

The review protocol is registered at Open Science Framework under https://doi.org/10.17605/OSF.IO/PX4MF.
A feasibility randomised waitlist-controlled trial of a personalised multi-level language treatment for people with aphasia: The remote LUNA study
Authors: Dipper Lucy , Devane Niamh , Barnard Rachel , Botting Nicola , Boyle Mary , Cockayne Lin , Hersh Deborah , Magdalani Carla , Marshall Jane , Swinburn Kate , Cruice Madeline
Published: June 2024

Background

Stroke survivors with aphasia want to improve their everyday talking (discourse). In current UK practice, 90% of speech and language therapists believe discourse assessment and treatment is part of their role but are hampered by barriers in resources, time and expertise. There is a clinical need for well-articulated discourse assessment and treatments. LUNA is a multi-level treatment targeting words, sentences and discourse macrostructure in personal stories that addresses this clinical need.

Objectives

This study aimed to assess the feasibility and acceptability of LUNA trial procedures in a randomised waitlist-controlled trial; and to evaluate preliminary efficacy.

Methods

This paper reports a phase II, waitlist-controlled, proof-of-concept feasibility trial. Participants with chronic aphasia (n = 28) were recruited from the community and randomised to an Immediate (n = 14) or Delayed (n = 14) group. LUNA treatment was delivered twice weekly for 10 weeks via the videoconferencing technology, Zoom. Feasibility was assessed in terms of participant recruitment and retention, adherence, missing data, and treatment fidelity. Preliminary treatment efficacy was assessed in terms of between group differences in outcome measures relating to discourse, language, and psychosocial state.

Results

The remote LUNA trial was feasible: 85% of those eligible consented to the trial; trial retention was 86%; 87% of treatment sessions were delivered as scheduled, and 79% of participants completed 80%+ of the treatment programme; data was missing only for participants who withdrew; treatment fidelity was high at 92% adherence; and only one clinical outcome measure demonstrated ceiling effects. ANCOVA analysis of the clinical outcome measures revealed group differences with medium and large effect sizes, indicating, improvements in the production of words, sentences, discourse macrostructure, overall language functioning (WAB-R), and psychosocial state (VAMS) following LUNA treatment. For most outcomes measured, similar treatment benefits were suggested in a secondary, non-parametric analysis.

Conclusions

Large-scale evaluation of the clinical efficacy and cost-effectiveness of LUNA is warranted and supported by these findings.

Trial registration

Clinical trials registration: NCT05847023 (clinical trials.gov).
Testing for effects of growth rate on isotope trophic discrimination factors and evaluating the performance of Bayesian stable isotope mixing models experimentally: A moment of truth?
Authors: Gurney Kirsty E. B. , Classen Henry L. , Clark Robert G.
Published: June 2024

Discerning assimilated diets of wild animals using stable isotopes is well established where potential dietary items in food webs are isotopically distinct. With the advent of mixing models, and Bayesian extensions of such models (Bayesian Stable Isotope Mixing Models, BSIMMs), statistical techniques available for these efforts have been rapidly increasing. The accuracy with which BSIMMs quantify diet, however, depends on several factors including uncertainty in tissue discrimination factors (TDFs; Δ) and identification of appropriate error structures. Whereas performance of BSIMMs has mostly been evaluated with simulations, here we test the efficacy of BSIMMs by raising domestic broiler chicks (Gallus gallus domesticus) on four isotopically distinct diets under controlled environmental conditions, ideal for evaluating factors that affect TDFs and testing how BSIMMs allocate individual birds to diets that vary in isotopic similarity. For both liver and feather tissues, δ13C and δ 15N values differed among dietary groups. Δ13C of liver, but not feather, was negatively related to the rate at which individuals gained body mass. For Δ15N, we identified effects of dietary group, sex, and tissue type, as well as an interaction between sex and tissue type, with females having higher liver Δ15N relative to males. For both tissues, BSIMMs allocated most chicks to correct dietary groups, especially for models using combined TDFs rather than diet-specific TDFs, and those applying a multiplicative error structure. These findings provide new information on how biological processes affect TDFs and confirm that adequately accounting for variability in consumer isotopes is necessary to optimize performance of BSIMMs. Moreover, results demonstrate experimentally that these models reliably characterize consumed diets when appropriately parameterized.
Hair-follicle associated pluripotent (HAP)-cell-sheet implantation enhanced wound healing in diabetic db/db mice
Authors: Hasegawa-Haruki Ayami , Obara Koya , Takaoka Nanako , Shirai Kyoumi , Hamada Yuko , Arakawa Nobuko , Aki Ryoichi , Hoffman Robert M. , Amoh Yasuyuki
Published: June 2024

Diabetes often results in chronic ulcers that fail to heal. Effective treatment for diabetic wounds has not been achieved, although stem-cell-treatment has shown promise. Hair-follicle-associated-pluripotent (HAP)-stem-cells from bulge area of mouse hair follicle have been shown to differentiate into keratinocytes, vascular endothelial cells, smooth muscle cells, and some other types of cells. In the present study, we developed HAP-cell-sheets to determine their effects on wound healing in type-2 diabetes mellitus (db/db) C57BL/6 mouse model. Flow cytometry analysis showed cytokeratin 15 expression in 64% of cells and macrophage expression in 3.6% of cells in HAP-cell-sheets. A scratch cell migration assay in vitro showed the ability of fibroblasts to migrate and proliferate was enhanced when co-cultured with HAP-cell-sheets. To investigate in vivo effects of the HAP-cell-sheets, they were implanted into 10 mm circular full-thickness resection wounds made on the back of db/db mice. Wound closure was facilitated in the implanted group until day 16. The thickness of epithelium and granulation tissue volume at day 7 were significantly increased by the implantation. CD68 positive area and TGF-β1 positive area were significantly increased; meanwhile, iNOS positive area was reduced at day 7 in the HAP-cell-sheets implanted group. After 21 days, CD68 positive areas in the implanted group were reduced to under the control group level, and TGF-β1 positive area had no difference between the two groups. These observations strongly suggest that the HAP-cell-sheets implantation is efficient to facilitate early macrophage activity and to suppress inflammation level. Using immuno-double-staining against CD34 and α-SMA, we found more vigorous angiogenesis in the implanted wound tissue. The present results suggest autologous HAP-cell-sheets can be used to heal refractory diabetic ulcers and have clinical promise.
Knowledge, attitude, and practice towards bacterial multidrug-resistance and structural equation modeling analysis among intensive care unit nurses and physicians
Authors: Ai Zhongping , Fang Yaping , Gao Xiaolan , Wang Li , Yu Min
Published: June 2024

Background

The intensive care unit (ICU) is a department with a high risk of MDR bacteria, and ICU nurses and physicians play critical roles in bacterial multidrug resistance (MDR) prevention.

Objectives

To explore the knowledge, attitudes, and practice (KAP) towards bacterial MDR among ICU nurses and physicians.

Methods

A self-designed questionnaire was administered to collect data. Structural equation modeling (SEM) was applied to assess the associations among study variables.

Results

A total of 369 questionnaires were collected; 43 questionnaires were excluded due to self-contradictory on the trap question or the obviously repeated pattern. Finally, 326 (88.35%) valid questionnaires were included in the analysis. The knowledge, attitudes, and practice were 13.57 ± 1.69 (90.47%, possible range: 0–15), 38.75 ± 2.23 (96.88%, possible range: 8–40), and 47.40 ± 3.59 (94.80%, possible range: 10–50). The SEM showed that knowledge had a direct effect on attitude with a direct effect value of 0.61 (P < 0.001) and a direct negative effect on practice with a direct effect value of -0.30 (P = 0.009). The direct effect of attitude on practice was 0.89 (P < 0.001); the indirect effect of knowledge through attitude on practice was 0.52 (P < 0.001). Job satisfaction had a direct effect on attitude and practice, with an effect value of 0.52 (P = 0.030) and 0.75 (P = 0.040). Being a physician (OR = 0.354, 95%CI: 0.159–0.790, P = 0.011), 5–9.9 years of practice (OR = 4.534, 95%CI: 1.878–8.721, P < 0.001), and ≥ 10 years of practice (OR = 3.369, 95%CI: 1.301–8.721, P = 0.012) were independently associated with good knowledge. The attitude scores (OR = 1.499, 95%CI: 1.227–1.830, P < 0.001), male gender (OR = 0.390, 95%CI: 0.175–0.870, P = 0.022), and 5–9.9 years of experience (OR = 0.373, 95%CI: 0.177–0.787, P = 0.010) were independently associated with proactive practice.

Conclusion

Nurses and physicians in the ICU showed good knowledge, positive attitudes, and proactive practice toward bacterial MDR. Nurses and physicians’ knowledge had a direct effect on their attitude, while attitude might directly influence the practice and also play a mediating role between knowledge and practice. Job satisfaction might directly support the positive attitude and practice toward bacterial MDR.
Health system strengthening in fragile and conflict-affected states: A review of systematic reviews
Authors: Bogale Birke , Scambler Sasha , Mohd Khairuddin Aina Najwa , Gallagher Jennifer E.
Published: June 2024

Background

Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature.

Methods

We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet’s ‘high-quality health system framework’.

Results

Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the ‘foundations’ domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.

Conclusion

The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
Two-sample survival tests based on control arm summary statistics
Authors: Feld Jannik , Danzer Moritz Fabian , Faldum Andreas , Hobbach Anastasia Janina , Schmidt Rene
Published: June 2024

The one-sample log-rank test is the preferred method for analysing the outcome of single-arm survival trials. It compares the survival distribution of patients with a prefixed reference survival curve that usually represents the expected outcome under standard of care. However, classical one-sample log-rank tests assume that the reference curve is known, ignoring that it is frequently estimated from historical data and therefore susceptible to sampling error. Neglecting the variability of the reference curve can lead to an inflated type I error rate, as shown in a previous paper. Here, we propose a new survival test that allows to account for the sampling error of the reference curve without knowledge of the full underlying historical survival time data. Our new test allows to perform a valid historical comparison of patient survival times when only a historical survival curve rather than the full historic data is available. It thus applies in settings where the two-sample log-rank test is not applicable as method of choice due to non-availability of historic individual patient survival time data. We develop sample size calculation formulas, give an example application and study the performance of the new test in a simulation study.
Acute internal medicine physicians’ clinical intuition based on acute care telephone referral: A prospective study
Authors: van Dam Paul M. E. L. , Lasso Peña Roberto E. , Mommertz Jody A. , Borggreve Hella F. , van Loon Nicole P. H. , Zelis Noortje , Westerman Dewa , Henry Ronald M. A. , Posthouwer Dirk , Cals Jochen W. L. , Stassen Patricia M.
Published: June 2024

Introduction

In the Netherlands, most emergency department (ED) patients are referred by a general practitioner (GP) or a hospital specialist. Early risk stratification during telephone referral could allow the physician to assess the severity of the patients’ illness in the prehospital setting. We aim to assess the discriminatory value of the acute internal medicine (AIM) physicians’ clinical intuition based on telephone referral of ED patients to predict short-term adverse outcomes, and to investigate on which information their predictions are based.

Methods

In this prospective study, we included adult ED patients who were referred for internal medicine by a GP or a hospital specialist. Primary outcomes were hospital admission and triage category according to the Manchester Triage System (MTS). Secondary outcome was 31-day mortality. The discriminatory performance of the clinical intuition was assessed using an area under the receiver operating characteristics curve (AUC). To identify which information is important to predict adverse outcomes, we performed univariate regression analysis. Agreement between predicted and observed MTS triage category was assessed using intraclass and Spearman’s correlation.

Results

We included 333 patients, of whom 172 (51.7%) were referred by a GP, 146 (43.8%) by a hospital specialist, and 12 (3.6%) by another health professional. The AIM physician’s clinical intuition showed good discriminatory performance regarding hospital admission (AUC 0.72, 95% CI: 0.66–0.78) and 31-day mortality (AUC 0.73, 95% CI: 0.64–0.81). Univariate regression analysis showed that age ≥65 years and a sense of alarm were significant predictors. The predicted and observed triage category were similar in 45.2%, but in 92.5% the prediction did not deviate by more than one category. Intraclass and Spearman’s correlation showed fair agreement between predicted and observed triage category (ICC 0.48, Spearman’s 0.29).

Conclusion

Clinical intuition based on relevant information during a telephone referral can be used to accurately predict short-term outcomes, allowing for early risk stratification in the prehospital setting and managing ED patient flow more effectively.
Lāuga: Understanding Samoan Oratory, Sadat Muaiava (2022)
Authors: Kölling Angela
Published: June 2024

Review of: Lāuga: Understanding Samoan Oratory, Sadat Muaiava (2022)

Wellington: Te Papa Press, 336 pp.,

ISBN 978 0 99513 844 5 (hbk), NZ$45
Andrew Johnston: Selected Poems, Andrew Johnston (2023)
Authors: Berthiot Marine
Published: June 2024

Review of: Andrew Johnston: Selected Poems, Andrew Johnston (2023)

Wellington: Te Herenga Waka University Press, 208 pp.,

ISBN 978 1 77692 069 3 (hbk), NZ$40
EU Green Transition in Times of Geopolitical Pressures: Accelerating or Slowing the Pace Towards Climate Neutrality?
Authors: Pérez de las Heras Beatriz
Published: June 2024

The current climate emergency and the war in Ukraine have placed climate action and energy security at the top of the EU’s agenda. The ‘Fit for 55’ legal package and REPowerEU Plan set out short- and medium-term measures to end EU dependence on Russian fossil fuels and address climate change. The new targets and policy instruments have the potential to accelerate decarbonization of the continent. However, from the perspective of the environment and social equity, serious concerns remain as to the sustainability of the transformation. For example, difficulties in achieving immediate independence from Russian fuels has led some EU countries to increase their use of coal. The accelerated roll-out of renewable energies has increased the demand for materials and land, sparking territorial conflicts and impacting biodiversity. Support from the Social Climate Fund will not meet all the demands of the most vulnerable sections of society for assistance with the costs derived from the energy transitions, such as cleaner heating systems and transport. This paper offers an overview of the EU’s new measures to step up the energy transformation and assesses them through the lens of environmental sustainability and fair transition.
Keywords: renewable energy, energy autonomy, REPowerEU, fair transition