bluuebunny/crossref_metadata_2025 huggingface dataset:
Apixaban in patients with nonvalvular atrial fibrillation, heart failure and low body weight: A report from a global federated research dataset
Authors: Monzo Luca , Baudry Guillaume , Hernandez Gema , Denquin Olivier , Savarese Gianluigi , Lip Gregory Y. H. , Girerd Nicolas
Published: February 2025

Background

Atrial fibrillation (AF) and low body weight (BW, <60 kg) are common in patients with heart failure (HF). However, the safety and effectiveness of direct oral anticoagulants (DOACs) in this group remain unclear. This study compares the efficacy and safety of apixaban versus vitamin K antagonists (VKAs) in patients with nonvalvular AF, low BW and HF.

Methods

We analysed 155,152 patients with HF and AF, weighing ≤100 kg and treated with oral anticoagulants (apixaban 86,493; VKA 68,659), from the TriNetX Global Research Network. Outcomes included ischaemic stroke/systemic embolism (SEE), clinically relevant bleedings, intracranial haemorrhage (ICH), all‐cause death and net clinical benefit (composite of stroke/SEE, bleedings and all‐cause death) across three BW categories: 60–100 kg (reference), 50–60 kg (low BW) and ≤50 kg (very low BW). Propensity score matching was used to balance the treatment groups.

Results

Patients with low BW had a higher risk of adverse events compared to those with reference BW, regardless of treatment. Apixaban consistently reduced the risk of ischaemic stroke/SEE and bleeding (including ICH) across all BW ranges (all p‐interaction >.10), and improved net clinical benefit compared to VKA (reference BW: HR .82 [95% CI: .80–.84]; low BW: HR .79 [95% CI: .74–.85]; very low BW: HR .86 [95% CI: .78–.95], p‐interaction = .366). However, a significant BW‐treatment interaction was observed for all‐cause mortality, indicating reduced relative effectiveness of apixaban vs. VKA as BW decreases.

Conclusion

In this large real‐world analysis, treatment with apixaban was associated with a superior effectiveness and safety profile compared to VKA in patients with AF, HF and low BW. These results remained consistent, albeit slightly attenuated, in patients with very low BW. These findings provide preliminary evidence supporting the use of apixaban in this high‐risk population.
Environmental conditions can indirectly affect passive pathogen spread by altering insect dispersal
Authors: Constancio Natalie , Szendrei Zsofia
Published: February 2025

Climate change impacts agriculture through shifts in regional environmental conditions, significantly altering insect vector and plant pathogen interactions. Plant pathogens that rely on insect vectors often have a positive density dependent relationship, with high vector abundance increasing pathogen spread. However, for pathogens that do not rely on insect vectors, the relationship can be more difficult to predict. Furthermore, environmental conditions, such as temperature and relative humidity, can indirectly alter pathogen spread by impacting vector reproduction or behavior. Therefore, studies examining the interactions between passively transmitted pathogens and potential insect vectors under varying environmental conditions are critical to understanding pathogen spread. Onion thrips, Thrips tabaci Lindeman (Thysanoptera: Thripidae), is the main insect pest of onion (Allium cepa) and co‐occurs with many pathogens, including Colletotrichum coccodes Wallr (Glomerellales: Glomerellaceae), a fungal pathogen of onion. We conducted two experiments to understand how different densities of onion thrips and environmental conditions affect pathogen spread. To first determine how onion thrips density affects pathogen spread, we released 0, 5, or 25 onion thrips on C. coccodes inoculated plants, that were symptomatic, and allowed them to move between the symptomatic and asymptomatic plants. Next, to determine the effects of environmental conditions on pathogen spread, we altered temperature and relative humidity and added either 0 or 5 onion thrips to the experiment. Onion thrips dispersal, damage distribution, and pathogen spread 13 days after onion thrips were released were assessed for each experiment. Our results indicate that C. coccodes was only disseminated in the presence of onion thrips and dispersal increased at the 25 onion thrips density. Pathogen spread also increased at 33°C compared with 22°C, regardless of relative humidity. Overall, our study highlights how changes in insect abundance, which can be directly affected by environmental conditions, can alter pathogen spread.
Digital Module 37: Introduction to Item Response Tree (IRTree) Models
Authors: Kim Nana , Deng Jiayi , Wong Yun Leng
Published: February 2025

Module Abstract

Item response tree (IRTree) models, an item response modeling approach that incorporates a tree structure, have become a popular method for many applications in measurement. IRTree models characterize the underlying response processes using a decision tree structure, where the internal decision outcome at each node is parameterized with an item response theory (IRT) model. Such models provide a flexible way of investigating and modeling underlying response processes, which can be useful for examining sources of individual differences in measurement and addressing measurement issues that traditional IRT models cannot deal with. In this module, we discuss the conceptual framework of IRTree models and demonstrate examples of their applications in the context of both cognitive and noncognitive assessments. We also introduce some possible extensions of the model and provide a demonstration of an example data analysis in R.
Lockdown's double edge: Past remedies, future uncertainties
Authors: Krishnamurthy Shivani , Kaur Harpreet
Published: February 2025

This article examines the multifaceted impact of the pandemic on students' education and mental health, drawing on both an analysis of existing literature and firsthand testimonials from adolescents during the lockdown. It highlights significant challenges, including technological barriers, mental health struggles, and the exacerbation of educational inequalities. Through personal accounts, the article illustrates varied experiences: while some students faced obstacles such as a lack of devices and motivation, others demonstrated resilience and adaptability by finding innovative solutions to continue their education. Positive outcomes, such as increased digital literacy and community support, are acknowledged but often overshadowed by the focus on negative effects. The article emphasizes the long‐term implications of learning losses and the psychological impact on young people, urging for a more balanced view that includes success stories. Furthermore, it calls for immediate actions to address disparities in educational resources, including mental health support, skill development programs, and financial assistance. By advocating for youth‐centric policies, the article aims to empower students to overcome the challenges presented by the pandemic and build a brighter future.
The Association of Cyberspace and Attention‐Deficit Hyperactivity Disorder Symptoms in Children During the COVID‐19 Pandemic: A Systematic Review
Authors: Abdoli Maryam , Rahimi Majid , Dianati Ali , Daniali Seyede Shahrbanoo , Kelishadi Roya
Published: February 2025

Background

The negative impact of the COVID‐19 pandemic on the mental health of children has been considered. Children with attention‐deficit and hyperactivity disorder (ADHD) are likely to be more vulnerable too. This study aimed to provide a systematic review of evidence regarding the association between screen usage and symptoms of ADHD during the COVID‐19 pandemic.

Methods

This review adhered to PRISMA guidelines. Systematic searches were conducted in PubMed, Scopus, Web of Sciences and Cochrane Library.

Results

Of 130 identified reports, 8 papers covering 1587 subjects were included. The spent time on different types of screen time from TV to video games among children and adolescents with ADHD increased. The majority of studies showed that a surge in screen time was associated with the worsening of ADHD symptoms such as irritation, inattention, hyperactivity and oppositional defiant disorders (ODDs). The finding confirmed the severity of ADHD symptoms in individuals with a history of addictive or problematic usage of media was higher in comparison with others. One study found that educational screen time was not associated with disturbances in ADHD symptoms. In addition, ADHD symptoms during the COVID‐19 pandemic were influenced by prior mental health situations.

Conclusions

The current findings suggest considering the negative association of excess screen time with ADHD symptoms, monitoring of screen time particularly for recreational purposes should be monitored to prevent negative consequences in children and adolescents with ADHD. On the other hand, designing educational and treatment interventions based on digital technology could not be ignored.
Education
Authors: Moses Yolanda
Published: February 2025

Diversity, equity, and inclusion initiatives in the university are increasingly valorized, but have we made progress in supporting diverse faculty and students? Synthesizing contributions in this issue that advocate for meaningful faculty diversity and genuine forms of care in the university, this essay reflects on why, even after decades of such diversity initiatives, higher education still struggles with the underrepresentation of minority scholars. Even as legal frameworks such as the Government Issued Bill (GI Bill) (in its seven iterations to date) have shifted toward greater inclusion and the Civil Rights movement opened new pathways that continue to expand today, we must go beyond counting diverse bodies in the academy toward meaningful practices that allow diverse scholars to thrive. Drawing on Moten and Harney's notion of the undercommons urges us to reflect and take action in our own teaching and research roles in the system to build spaces of radical refusal and collective dissent that challenge traditional ideas about the role of the university in society. Such a project requires centering students in their own learning, putting higher education within a larger late capitalism neoliberal context, and holding administrators accountable for their leadership and support of diversity initiatives. Collectively, such actions have the potential to move the university toward the sustained and genuine diversity and inclusion efforts we need to remain relevant.
Experience of Aging‐In‐Place in Older Adults Living Alone With Chronic Disease in Rural Areas in South Korea: A Grounded Theory Approach
Authors: Park Go‐Eun , Jang Hye‐Young
Published: February 2025

Rural areas in South Korea lack adequate healthcare facilities, and many older people wish to continue living in their current environment despite these challenges. This study derives a substantive theory on the aging‐in‐place process among older people living alone with chronic diseases in rural areas. Purposeful and theoretical sampling were used to select 18 participants. In‐depth interviews were conducted over 3 months, and data were analyzed using Strauss and Corbin's grounded theory method. Twelve categories and 28 subcategories were identified, with the core category being “enduring inconvenience and utilizing available resources to live in a familiar environment.” Participants faced challenges such as limited healthcare, isolation, and difficulty managing chronic illnesses. However, their desire to age in place was rooted in preserving their hometown's history. To cope, they practiced healthy behaviors, used social welfare services, and adapted their homes for safety. Four stages emerged: “preserving,” “enduring,” “utilizing,” and “living.” Our findings highlight the need for policies supporting older people with chronic diseases in rural areas to maintain their independence and connection to familiar environments.
CsTCP14‐CsIAA4 module‐mediated repression of auxin signaling regulates citrus somatic embryogenesis
Authors: Wang Peng‐Bo , Duan Yao‐Yuan , Quan Ru‐Meng , Feng Meng‐Qi , Ren Jie , Tang Yong‐Yu , Qing Mei , Xie Kai‐Dong , Guo Wen‐Wu , Wu Xiao‐Meng
Published: February 2025

Somatic embryogenesis (SE) is an important in vitro regeneration approach for plants, especially in biotechnological manipulations. However, SE capability is difficult to modulate and deteriorates over time. Glycerol medium is effective in SE induction of citrus, while the mechanisms remain unclear.

We found that auxin signaling reduced soon after the citrus embryogenic callus (EC) was transferred to glycerol medium, and the expression of CsTCP14 and AUX/IAA gene CsIAA4 was induced by glycerol. Overexpression of CsIAAm that encodes a stable indole‐3‐acetic acid (IAA) protein suppressed auxin signaling in EC and enhanced SE. CsTCP14 bound to the promoter of CsIAA4 and activate CsIAA4 expression in EC with strong SE competence. Overexpression of CsTCP14 activated CsIAA4 expression and reduced auxin signaling in citrus EC, and thus enhanced SE.

Application of exogenous IAA inhibits SE, while the auxin signaling inhibitor p‐chlorophenoxyisobutyric acid (PCIB) enhances SE in citrus. The SE enhancement effect of CsIAA4 and CsTCP14 overexpression on EC was alleviated by exogenous IAA, but reinforced by PCIB.

We uncover the regulatory pathway of CsTCP14‐CsIAA4 module‐mediated repression of auxin signaling in glycerol‐induced citrus SE, which deepens our understanding of SE mechanisms in plants and supports modulation of SE in citrus breeding via biotechnological approaches.
Contrasting and altitude‐specific temporal trends in functional, phylogenetic, and species diversity in Austrian butterfly communities
Authors: Ulrich Werner , Habel Jan Christian , Gros Patrick , Schmitt Thomas
Published: February 2025

Climate change and anthropogenic alteration of landscapes negatively impact the abundance and species diversity of plant and animal communities worldwide. Much less is known about the effects on phylogenetic diversity and community functioning. Here we use long‐term butterfly data (1980–2022) from the Austrian Alps along an elevation gradient. We assessed how communities adjust structures and functionality to increasing temperatures, and how these changes are linked to trait expression and community functioning. Species diversity decreased at low and intermediate altitudes, and increased at high ones. Functional diversity was lower than expected by a random model at intermediate and high altitudes and increased with time at high, but not at intermediate and low altitudes. Phylogenetic diversity did not show significant temporal trends at low altitude, but increased with time at intermediate and high altitudes. Multifunctionality significantly decreased at intermediate and high altitudes and was not significantly correlated with functional diversity, but was negatively correlated with phylogenetic diversity. We argue that the ongoing homogenisation of Alpine butterfly communities strongly affects species, functional and phylogenetic diversity. The assessment of species richness and diversity alone, as provided by common species surveys, might give a false impression about the state and functional diversity of Alpine insect communities in the course of climate change. The directions of faunal changes heavily depend on altitude and therefore on specific climatic conditions. Higher altitudes face decreasing butterfly multifunctionality despite of increasing species richness due to climate induced altitudinal up‐hill shifts of many species. We conclude that studies on community time series should include phylogenetic and functional diversity besides of being focused on richness and endangerment. Red lists might be extended by categories on functional importance and phylogenetic distinctness.
Impact of ERP Reliability Cutoffs on Sample Characteristics and Effect Sizes: Performance‐Monitoring ERPs in Psychosis and Healthy Controls
Authors: Heindorf Gavin , Holbrook Amanda , Park Bohyun , Light Gregory A. , Rast Philippe , Foti Dan , Kotov Roman , Clayson Peter E.
Published: February 2025

In studies of event‐related brain potentials (ERPs), it is common practice to exclude participants for having too few trials for analysis to ensure adequate score reliability (i.e., internal consistency). However, in research involving clinical samples, the impact of increasingly rigorous reliability standards on factors such as sample generalizability, patient versus control effect sizes, and effect sizes for within‐group correlations with external variables is unclear. This study systematically evaluated whether different ERP reliability cutoffs impacted these factors in psychosis. Error‐related negativity (ERN) and error positivity (Pe) were assessed during a modified flanker task in 97 patients with psychosis and 104 healthy comparison participants, who also completed measures of cognition and psychiatric symptoms. ERP reliability cutoffs had notably different effects on the factors considered. A recommended reliability cutoff of 0.80 resulted in sample bias due to systematic exclusion of patients with relatively few task errors, lower reported psychiatric symptoms, and higher levels of cognitive functioning. ERP score reliability lower than 0.80 resulted in generally smaller between‐ and within‐group effect sizes, likely misrepresenting effect sizes. Imposing rigorous ERP reliability standards in studies of psychotic disorders might exclude high‐functioning patients, which raises important considerations for the generalizability of clinical ERP research. Moving forward, we recommend examining characteristics of excluded participants, optimizing paradigms and processing pipelines for use in clinical samples, justifying reliability thresholds, and routinely reporting score reliability of all measurements, ERP or otherwise, used to examine individual differences, especially in clinical research.
“Through Thick and Thin” How Black Educators Support Urban Students' Postsecondary Plans
Authors: Sageman Joseph
Published: February 2025

How does exposure to Black educators influence minority students' postsecondary planning processes and long‐run educational ambitions? Prior studies have documented positive effects of student‐teacher racial matches on achievement and non‐academic outcomes, but quantitative research designs are often unable to uncover the mechanisms underlying these effects. Through 107 interviews with high school seniors, teachers, and counselors in Philadelphia, I find that Black educators have an outsized impact on their minority students' postsecondary trajectories through a combination of empathic engagement and presumed proximity. I propose four distinct mechanisms through which Black educators may influence their students' future plans: increasing students' contact with postsecondary advisers, raising students' feelings of belonging in school, offering counseling expertise that is specifically relevant to students of color, and strengthening students' self‐efficacy. This paper justifies policy efforts to diversify teacher and counselor workforces and suggests ways that White teachers may more effectively support their minority students.
Multicenter retrospective evaluation of norepinephrine extravasation in dogs and cats (2015–2021): 14 cases
Authors: Vasquez Maria P. , Daly Meredith , Boyd Corrin J. , Crandell Dawn E. , Hall Kelly E. , Mays Erin Long , Ngwenyama Tandi , Ortolani Jennifer , Smith M. Ryan , Hoehne Sabrina N. , Martin Linda , Davidow Elizabeth B.
Published: February 2025

Objective

To document clinical complications and intervention options associated with norepinephrine (NE) extravasation in dogs and cats.

Design

Cases were identified between 2015 and 2021. Because this is an uncommon complication, the findings are compiled as a descriptive retrospective study.

Setting

Cases were provided from 4 universities and 2 private practice groups in the United States, Canada, and Australia.

Animals

Fourteen patients (13 dogs, 1 cat) that experienced extravasation events (16 total).

Interventions

Small animal patients were included where extravasation of a NE constant rate infusion (CRI) was documented. Records were reviewed for information, including suspected underlying condition, description of the interventions pursued after identification of extravasation, clinical signs after extravasation, and survival to discharge or reason for patient death or euthanasia. When available, information was collected pertaining to the NE dose, dilution, total duration of CRI, and duration of CRI before extravasation was recognized.

Measurements and Main Results

The most commonly reported clinical signs after extravasation of NE were skin necrosis (n = 9 [64.3%]) and swelling (n = 6 [42.9%]). In 10 of 16 events (62.5%), discontinuation of the NE CRI and/or application of a warm compress to the extravasation site were performed; these were the most common nonpharmacological rescue measures. Two patients received subcutaneous phentolamine, and 1 patient underwent hyperbaric oxygen therapy. While surgical intervention was recommended for 4 dogs, 2 improved without surgical debridement. The overall survival rate from underlying disease processes was 57% (n = 8), with only 1 patient (7%) euthanized due to an injury from the extravasation.

Conclusions

Severe lesions can result from NE extravasation in dogs and cats, leading to euthanasia. Although phentolamine remains the treatment of choice, lesions may heal with alternative supportive measures.
Cerebral blood flow during simulated central hypovolaemia in people with hypertension: does vertebral artery hypoplasia matter?
Authors: Neumann Sandra , Rodrigues Jonathan C. L. , Simpson Lydia L. , Lawton Chris B. , Burden Daniel , Kobetic Matthew D. , Adams Zoe H. , Hope Katrina , Paton Julian F. R. , Blythe Hazel , Manghat Nathan , Barnes Jill N. , Nightingale Angus K. , Hamilton Mark C. H. , Hart Emma C.
Published: February 2025

Adults with hypertension have higher prevalence of vertebral artery hypoplasia (VAH), which is associated with lower resting cerebral blood flow (CBF). We examined whether VAH impacts the ability to regulate CBF during haemodynamic stress when cardiac output and blood pressure are lowered via body negative pressure (LBNP). Participants underwent magnetic resonance angiography (MRA) at 1.5T during LBNP at 0, −20 and −40 mmHg, and were assigned to VAH (n = 13) or without‐VAH (n = 11) groups post‐acquisition. Phase‐contrast MRA measured flow in the basilar artery (BA), internal carotid arteries (ICA), and the ascending aorta to measure cardiac output (CO). The CO decreased during all levels of LBNP in both groups (LBNP main effect P < 0.0001), whereas MAP was reduced in the group without VAH only (P = 0.0003). BA flow was reduced during LBNP in the group without VAH (P = 0.0267 at −20 mmHg and P < 0.0001 at −40 mmHg) but was surprisingly unchanged in the group with VAH (P > 0.05 all levels LBNP). ICA flow decreased during LBNP (P < 0.0001) and was not different between groups. Total CBF decreased during LBNP in hypertensives without VAH (P = 0.0192 at −20 mmHg and P < 0.0001 at −40 mmHg) but was unchanged in patients with VAH (P > 0.05 at all levels of LBNP). Total peripheral resistance (TPR) increased during LBNP in both groups, but the rise was greater in the group with VAH (−20 mmHg; P = 0.0129, –40 mmHg; P = 0.0016). In summary, hypertensive patients without VAH may tolerate decreases in CBF, whereas patients with VAH evoke a greater systemic TPR response to preserve CBF.

image

Key points

Vertebral artery hypoplasia (VAH) is more common in hypertensive adults and is associated with lower resting cerebral blood flow (CBF), suggesting that VAH might impair the brain's ability to maintain cerebral blood flow during haemodynamic stress using lower body negative pressure.

This study shows that hypertensive patients with VAH maintain CBF during body negative pressure, unlike those without VAH, who experience reductions in CBF. Patients with VAH show a greater rise in total peripheral resistance (TPR), suggesting a compensatory mechanism to maintain cerebral perfusion.

The findings highlight that patients with VAH have an altered physiological response to hypovolaemia, where they may rely on systemic pressor responses to maintain perfusion of posterior brain territories in already hypoperfused circulation.

This is important for understanding how VAH impacts cerebrovascular function in hypertensive patients and may influence clinical approaches to managing CBF in disease conditions.
How eco-clubs foster pro-environmental behavior in a school context: a case from Finland
Authors: Huoponen Anssi
Published: February 2025

Promoting pro-environmental behavior with environmental education (EE) has been proven to be challenging due to various school and student-related barriers. Eco-clubs are a widely used pathway in EE, which may help to overcome these barriers. Despite the popularity of eco-clubs, few studies have been conducted on the topic. This study approaches this problem with a case study to examine students’ perceptions of an eco-club in a Finnish general upper secondary school. In the study, 14 of the schools’ eco-club students participated in group interviews, which focused on their perceptions of the eco-club and its activities. Additionally, 100 non-eco-club students participated in a qualitative survey about their perceptions of the eco-club. This study found that eco-club students consider the club important in supporting their environmental actions in the school. They also find the club’s atmosphere and community to be a crucial part of supporting these actions. The members also find that the participation of peers and practical things enable the eco-club activities, while external influences, lack of time, and the reluctance of peers act as a barrier. The results indicate that there is a contradiction between the members’ and non-members’ perceptions of the eco-clubs’ effect on students and the school. While members find the eco-club important in supporting the environmental actions of the students and the school and spreading their influence outside of the school, the lack of knowledge dominates non-members’ perceptions, and some of them find the eco-club unimportant. Based on this research, eco-clubs seem to be a promising pathway in promoting members’ pro-environmental behavior while the club’s influence outside of the club remains small.
Feasibility and acceptability of a personalised primary prevention strategy for women and men at high risk of breast and prostate cancer: the 3PC study protocol for a pilot randomised controlled trial
Authors: Souli Intissar , Lapointe Julie , Kinsley-Marlie Jura , Chiquette Jocelyne , Dorval Michel , Diorio Caroline , Lauzier Sophie , Audet-Walsh Étienne , Bilodeau Steve , Côté Madeleine , Brisson Carmen , Charette Nelson , Fortier Philippe , Paquette Jean-Sébastien , Fradet Yves , Savard Josée , Fradet Vincent , Nabi Hermann
Published: February 2025

Introduction

Several primary prevention strategies, including chemoprevention, prophylactic surgery and lifestyle modifications, have been shown to reduce the risk of breast cancer (BC) and prostate cancer (Pca). However, the uptake of these preventive measures is considered suboptimal, limiting their impact on cancer prevention. A personalised primary prevention strategy has yet to be tested for cancer prevention. Therefore, we aim to determine the feasibility, acceptability and potential benefits and harms of this strategy in women and men at high risk of BC and Pca.

Methods and analysis

This is a two-arm, parallel-group mixed-methods pilot randomised controlled trial with a 1:1 allocation. The study aims to recruit 60 women and 60 men at high risk of BC and PCa in two specialised sites: the Breast Diseases Center and the Department of Urologic Oncology of the CHU de Québec-Université Laval, Canada. Assessments include intentions to uptake, actual uptake rates of primary preventive measures and decision regret. Feasibility and acceptability of the intervention and the study will be measured by quantifying the recruitment rate, appropriateness of randomisation process and satisfaction metrics. Data will be collected using mixed methods. Quantitative measures will be assessed at baseline and 6 months post randomisation. Quantitative analysis will include descriptive statistics for all variables of interest. Generalised linear mixed models with random intercepts will be used to assess the overall intervention effect. Semistructured interviews will be conducted at the end of follow-up, and a thematic analysis will be performed usingNVivoto understand participants’ perspectives.

Ethics and dissemination

The protocol was approved by the Institutional Review Board of CHU de Québec-Université Laval (4 October 2022; 2023-6315). The findings of the study will be published in a peer-reviewed journal and disseminated at national and international conferences and through social media.

Trial registration number

The protocol for this study was registered with the International Clinical Trials Registry (ISRCTN15749766)https://doi.org/10.1186/ISRCTN15749766).
Impact of implementing a nurse-led intraoperative cell saver service in reducing allogeneic red blood cell transfusions in Singapore General Hospital
Authors: He Yingke , Tan Yan Ru , Fu Jing , Gan Yu , Ang Ai Leen , Elisabeth Angelina , Abdullah Hairil Rizal
Published: February 2025

Introduction

Major perioperative blood loss often necessitates allogeneic blood transfusions, leading to adverse outcomes and straining healthcare resources. Intraoperative cell salvage (ICS) offers benefits like reduced adverse reactions, optimised blood resource allocation, and cost-effectiveness. Yet, ICS adoption remains limited. Our aim is to formalise and expand ICS as a routine service to promote wider adoption and improve patient outcomes.

Methods

The model for improvement was adopted for an ICS quality improvement initiative across two Plan-Do-Study-Act cycles. Interventions followed the ‘4E’ framework: education, empowerment, enforcement and embedding reminders. The primary outcome was the number of allogeneic red blood cell (RBC) units transfused per surgery with predicted blood loss >500 mL; the secondary outcome was the percentage of indicated surgeries using ICS. Process measure was percentage of anaesthetic unit nurses trained in ICS. Balancing measures included the number of ICS activations with no blood return and complications during and after ICS.

Results

A total of 152 surgeries used ICS postintervention (January 2023 to April 2024), marking an increase from preintervention levels. The median number of monthly mean allogeneic RBC units transfused per patient demonstrated a significant reduction from 3.10 (preintervention) to 2.44 (postintervention). The percentage of indicated surgeries utilising ICS increased from 1.4% to 12.3%. Cost savings were observed, with potential annual savings close to SGD 500 000. No complications related to the use of ICS were recorded.

Conclusion

The formalisation and expansion of the ICS service within our institution resulted in notable improvements, including increased ICS adoption rates, reduced reliance on allogeneic blood transfusions and potential cost savings. Future quality improvement efforts should concentrate on further promoting ICS adoption, particularly for surgeries with clinical indications.
Mechanical insufflation-exsufflation use in neuromuscular disease: a single centre cohort study
Authors: Shah Neeraj Mukesh , Kaltsakas Georgios , Madden-Scott Sophie , Apps Chloe , Sheridan Shauna , Ramsay Michelle , Srivastava Shelley , Suh Eui-Sik , D'Cruz Rebecca , Mackie Mike , Weston Nick , Hart Nicholas , Murphy Patrick
Published: February 2025

Introduction

Mechanical insufflation-exsufflation (MIE) is a commonly used therapy to augment secretion clearance in individuals with neuromuscular disease. There are no clear evidence-based guidelines on the settings that should be used in different diagnostic groups and how they should be titrated. We report on the settings used in the largest cohort of individuals using domiciliary MIE in the literature.

Methods

A retrospective observational study reporting on all individuals initiated on MIE for long-term domiciliary use at our centre, 2013–2019.

Results

This study reports on 359 adults established on domiciliary MIE. The most common diagnostic groups were congenital neuromuscular disease (26%), spinal cord injury (23%) and amyotrophic lateral sclerosis (23%). Median age at initiation was 55 years. Median (IQR) insufflation pressure was 35 (30–40) cm H2O and exsufflation pressure was 45 (40–50) cm H2O. Inspiratory time was 2.5 (2.3–2.8) s, expiratory time was 2.7 (2.3–2.8) s, and pause between expiration and inspiration was 2.0 (1.2–2.0) s. Median (IQR) survival following the initiation of MIE was 66 (54–78) months. Increasing age and amyotrophic lateral sclerosis were significantly associated with shorter life expectancy, while the delivery of MIE via oronasal interface compared with tracheostomy was associated with longer life expectancy.

Conclusion

This is the largest reported cohort of adults using domiciliary MIE. The most common groups using MIE were congenital neuromuscular disease, spinal cord injury patients and amyotrophic lateral sclerosis. The range of prescribed settings is narrow, reflecting the limited evidence base in this field and the need to better understand optimal targets for titration of different MIE settings.
Characterising alexithymia in individuals with functional motor disorders: a cross-sectional analysis of the Italian Registry of Functional Motor Disorders
Authors: Ostuzzi Giovanni , Geroin Christian , Gastaldon Chiara , Tedeschi Federico , Clesi Francesca Maria , Trevisan Giacomo , Bidello Giovanni , Vita Giovanni , Marcuzzo Enrico , Sandri Angela , Romito Luigi M , Eleopra Roberto , Tesolin Lucia , Franch Ilaria , Zappia Mario , Nicoletti Alessandra , Demartini Benedetta , Nisticò Veronica , Modugno Nicola , Olivola Enrica , Pilotto Andrea , Padovani Alessandro , Defazio Giovanni , Ercoli Tommaso , Petracca Martina , De Micco Rosa , Dallocchio Carlo , Esposito Marcello , Erro Roberto , Del Prete Eleonora , Amaddeo Francesco , Barbui Corrado , Tinazzi Michele
Published: February 2025

Background

Alexithymia, a personality trait characterised by difficulty in identifying and expressing emotions, may contribute to the onset and clinical presentation of functional motor disorders (FMDs), although this association remains underexplored.

Methods

From the Italian Registry of FMDs, we selected individuals recruited between November 2011 and January 2023, diagnosed with FMD according to Gupta and Lang criteria and assessed for various neurological and psychological features with validated rating scales. The main statistical analysis included regression models using the Toronto Alexithymia Scale 20 items as an explanatory variable for a set of clinical measures, adjusting for sociodemographic factors and correcting for multiple testing.

Results

In a cohort of 483 individuals, 20.7% had possible alexithymia and 31.5% had definite alexithymia. Higher levels of alexithymia were strongly associated with increased severity of depression (β=0.31, p<0.001), anxiety (β=0.32, p<0.001), general psychological distress (β=−0.27, p<0.001), fatigue (β=0.05, p<0.001) and pain (β=0.32, p<0.001) and moderately associated with a slower onset of FMD (β=0.02, p=0.003). Subscale analyses revealed that difficulties identifying feelings contributed most to these associations. No significant association was observed with motor symptom severity.

Conclusions

Emotional processing difficulties of individuals with FMD and alexithymia might increase their vulnerability to mental health problems, pain and fatigue, possibly aggravating the overall prognosis. Further research is needed to elucidate the underlying mechanisms linking alexithymia to FMD and to explore the efficacy of interventions targeting emotional awareness and regulation in this population and to prevent long-term mental health burdens.
Convexity subarachnoid haemorrhage from a cerebral dural arteriovenous fistula presenting with low back pain
Authors: Le Jasmin Chau Minh , Ng Jeng Swen , Bacchi Stephen , Waters Michael J , Kimber Thomas
Published: February 2025

Convexity subarachnoid haemorrhage (SAH) has many possible causes. A 76-year-old man presented with back pain, left leg weakness, and hypertension. His brain imaging showed convexity SAH, with additional intraventricular blood and extensive spinal SAH from T3–S2. Following deterioration from a probable further haemorrhage, with development of left foot myoclonus, a spinal digital subtraction angiogram was normal but cerebral angiogram identified a cerebral dural arteriovenous fistula, which was successfully embolised. Convexity SAH has a heterogeneous clinical presentation and dural arteriovenous fistula is a potential cause.
Personal health records: a practical guide for neurologists
Authors: Purcaru Elena , Kings Jude , Ayer Mavis , Kipps Christopher , Pinto Ashwin Arnold
Published: February 2025

Digital tools like smartphone applications and wearable health devices support people to play a greater role in their own care and that of others. Personal health records (PHRs) allow users to store information about their health online, to view records held by healthcare services and to add their own information. PHRs have the potential to help people manage their well-being, improve patient care and provide new ways to offer care. This article describes the benefits that PHRs bring to healthcare, their challenges and the practical steps for establishing a PHR platform to connect neurologists with their patients, based on 4 years of PHR experience in our neurology unit.
Mortality predictors for ICU end-of-life decisions: delta-SOFA and SAPS 3 – retrospective evaluation
Authors: Sala-Trull Maria Carmen , Monedero Pablo , Guillen-Grima Francisco , Leon-Sanz Pilar
Published: February 2025

Objectives

End-of-life decisions in intensive care units (ICUs) are complex, influenced by patient severity, treatment efficacy and resource constraints. This study assessed the predictive value of delta-Sequential Organ Failure Assessment (SOFA) scores on days 2, 3 and 5, both independently and combined with Simplified Acute Physiology Score (SAPS) 3, for in-hospital mortality.

Methods

A retrospective cohort study analysed ICU patients with stays of≥5 days from 2018 to 2020. Clinical data included SAPS 3 and SOFA scores at admission, 48 hours and on days 3 and 5, alongside mortality outcomes. Logistic regression and discriminant analysis identified mortality predictors and evaluated model performance.

Results

Among 200 patients, 26% died in hospital. Non-survivors had significantly higher SAPS 3 scores (mean 51.9±11.9 vs 45.6±11.9 in survivors, p=0.001) and worsening SOFA scores, particularly on days 3 and 5. Combining SAPS 3 with delta-SOFA on day 5 produced an area under the receiver operating characteristic (AUROC) of 0.71 (95% CI: 0.63 to 0.79), indicating moderate predictive ability.

Conclusions

Integrating the delta-SOFA score on day 5 with SAPS 3 improves in-hospital mortality predictions during prolonged ICU stays. Findings suggest early treatment limitations within 48 hours may be premature, as patient responses evolve and shared decision-making becomes more feasible over time.
Deciphering Library Experience of Rural Gen-Z Women: Insights from the LibQUAL Survey
Authors: Shahzadi Sehrish , Khalid Ayesha
Published: February 2025

This research quantifies the female students of the rural area of Bagh (Azad Jammu and Kashmir, Pakistan) regarding library users’ satisfaction through LibQUAL’s 22 core items. This study focusses on the three dimensions of LibQUAL namely the affect of service (AS), information control (IC) and library as place (LP). A total of 280 usable questionnaires were collected from the Gen-Z cohort through random stratified sampling. Path coefficient and t-test analysis extensively assessed the major differences between satisfaction and the available services. Notably, the IC dimension significantly lags behind Gen-Z students’ expectations, as evidenced by 100% disagreement. The results highlight the significance of investing in electronic resources and remote access facilities. This study significantly contributes to SDG5 on gender equality. First, it enriches the existing LibQUAL literature. Second, it expands the understanding of female library users’ expectations. Finally, this study introduces the rural background as a significant factor associated with the three dimensions of library services.
WILL KNOWLEDGE FIELD ACTIVITY WITHIN TECHNOLOGICAL INNOVATION ALLIANCES LEAD TO KNOWLEDGE LEAKAGE: THE MEDIATING ROLE OF KNOWLEDGE FLOW
Authors: ZHOU JIANMING , HE PING , SU MINGHAN
Published: February 2025

Drawing from the perspective of competitive intelligence, this paper conducted an empirical study to find out whether knowledge field activity (KFA) will lead to knowledge leakage by testing the mediating role of knowledge flow with Structural Equation Modelling, so as to alleviate the concerns associated with enhancing KFA of technological innovation alliances (TIA). Data from 157 high-tech firms that have participated in TIA in China confirmed that a high level of KFA in TIA is more likely to cause both intentional and accidental knowledge leakage (AKL), with the occurrence and impact of AKL being greater than intentional knowledge leakage. In addition, the reason behind the KFA leading to both intentional and AKL lies in its promotion of both tacit and explicit knowledge flows (EKFs) within the alliance. A high level of active tacit and EKFs in a competitive intelligence environment can result in intentional and AKL such that both implicit and EKFs play a fully mediating role in the relationship between KFA and intentional as well as AKL. The results reveal the risk of knowledge and technology leakage lurking in the background of highly active enterprise TIA. A comprehensive intellectual property protection mechanism to ensure the secure flow of technological knowledge within enterprise TIA for policymakers and enterprises is discussed in managerial implications.
The Bom Repouso Agpaitic Suite (MG, Brazil): geology, geochemistry and geochronology
Authors: Rosa P. A. S. , Ruberti E. , Enrich G. E. R. , Azzone R. G. , Vasconcelos P. , Thiede D. S.
Published: February 2025

The Bom Repouso Agpaitic Suite (BRAS; 76.5-78.4 Ma,
40
Ar/
39
Ar) is situated in a limited area to the south of Minas Gerais State, SE Brazil. The outcrop is approximately one square kilometer in area and is crescent-shaped, with two small satellite plugs. The BRAS is represented by felsic, fine-grained rocks that contain albite, K-feldspar, nepheline, and aegirine/aegirine-augite. In addition, the principal accessory minerals include arfvedsonite, aenigmatite, sodalite, and eudialyte, along with schizolite, astrophyllite, cryolite, niobophyllite, catapleiite, and several other less abundant minerals. The rocks are agpaitic phonolites, characterized by Alkalinity Index ranging of 0.99 to 1.20, with the presence of Na-Ti-Zr silicates and a high content of incompatible elements, especially Zr and REE's. They are also highly depleted in Sr, Ba, MgO, and compatible elements. These rocks are intrusive in the Precambrian migmatitic gneisses of the Socorro Nappe, situated between the Poços de Caldas – Cabo Frio Lineament and Northen Sector from the Serra do Mar Province. The displayed characteristics suggest a greater affinity with the magmatism from the alkaline province of the Poços de Caldas - Cabo Frio Lineament, exhibiting notable similarities with the agpaitic rocks from Poços de Caldas and other occurrences in the province.
FedGPL: Gradient Priority-based Federated Learning Enhancement for In-Vehicle Language Models
Authors: Yang Haomiao , Xue Dongyun , Wang Tianyi , Kwak Jin , Kim Hyunsung
Published: February 2025

The training of Large Language Models (LLMs) for specialized applications like autonomous driving faces significant data privacy challenges. Federated Learning (FL) offers a solution by enabling local data usage while preserving privacy. In this paper, we introduce Gradient Priority-based Federated Learning (FedGPL), a novel strategy to enhance the efficiency of LLM training in autonomous vehicles. FedGPL precomputes gradients on the server to identify critical model layers, allowing vehicles to selectively update these layers with local data. This selective updating reduces computational burden and minimizes the gradient data transmission. Experimental results show that FedGPL achieves comparable accuracy to existing methods while significantly reducing computational and communication costs, making it a promising approach for training advanced language models in autonomous driving.
Service-Oriented Resource Allocation and Task Scheduling for Wi-Fi and Bluetooth Coexistence in Smart Home IoT Systems
Authors: Zhao Di , Niu Tianxu , Song Bin , Du Xiaojiang
Published: February 2025

In IoT-enabled smart home scenarios, heterogeneous communication devices such as Bluetooth (BT) and Wi-Fi are widely used in applications like home automation, remote monitoring, and intelligent device interconnection. However, in such a multi-device coexistence environment, efficiently allocating limited time-frequency resources to mitigate communication interference and enhance system performance has become a critical challenge. To address these issues, this paper proposes a comprehensive solution that integrates master selection, resource allocation, and task scheduling to optimize resource utilization and service quality in smart home IoT systems. For device management, we propose a hierarchical entropy weight method (HEWM), considering factors like device parameters, sensing capabilities, communication performance, and device interoperability. This method ensures efficient and stable selection of the primary device, optimizing network topology and communication efficiency. For resource allocation, we introduce a proximal policy optimization (PPO) algorithm that dynamically adjusts time-frequency resource allocation based on the varying device usage, network load, and communication condition. This adaptive strategy reduces interference between devices and improves system throughput. For task scheduling, we develop a task urgency-based queueing (TUQ) mechanism that prioritizes tasks based on urgency. A task preemption mechanism ensures that high-urgency tasks are processed with minimal delay, enhancing scheduling efficiency and service responsiveness. Simulation results show that the proposed approach significantly outperforms traditional methods in smart home IoT scenarios, achieving higher primary device scores, a 3%-22% improvement in system throughput, and a 5%-36% reduction in task delay.
Enhancing Skin Cancer Diagnosis Through Fine‐Tuning of Pretrained Models: A Two‐Phase Transfer Learning Approach
Authors: Eliwa Entesar Hamed I.
Published: February 2025

Skin cancer is among the most prevalent types of cancer worldwide, and early detection is crucial for improving treatment outcomes and patient survival rates. Traditional diagnostic methods, often reliant on visual examination and manual evaluation, can be subjective and time‐consuming, leading to variability in accuracy. Recent developments in machine learning, particularly using pretrained models and fine‐tuning techniques, offer promising advancements in automating and improving skin cancer classification. This paper explores the application of a two‐phase model using the HAM10000 dataset, which comprises a wide range of skin lesion images. The first phase employs transfer learning with frozen layers, followed by fine‐tuning all layers in the second phase to adapt the models more specifically to the dataset. I evaluate nine pretrained models, including VGG16, VGG19, InceptionV3, Xception (extreme inception), and DenseNet121, assessing their performance based on accuracy, precision, recall, and F1 score metrics. The VGG16 model, after fine‐tuning, achieved the highest test set accuracy of 99.3%, highlighting its potential for highly accurate skin cancer classification. This study provides important insights for clinicians and researchers, demonstrating the efficacy of advanced machine learning models in enhancing diagnostic accuracy and supporting clinical decision‐making in dermatology.