bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and complications associated with tunneling and pseudotunneling techniques during PICC and Midline insertion
Authors: Elli Stefano , Cavalli Silvia , Fantini Valentina , Fragapane Marco , Salvoldi Nicola , Zappa Paolo , Zedde Daniela , Impaziente Sabrina , D’Amata Dario
Published: October 2024

Introduction:

Peripherally Inserted Central Catheters and Midline Catheters are particularly attractive because of their favorable risk/benefit ratio. If the ideal venipuncture site is in an area inappropriate for catheter emergence, a valid alternative is the tunneling technique, which allows the exit site to be moved to reach the optimal position. There are two main types of tunneling techniques: standard tunnel, using a tunneling device (metal tunneler or peel-away tunneler), and pseudo-tunnel. As much as both are recognized as appropriate and safe, there are still few literature data indicating the criteria for choosing and using the two techniques and the possible related complications.

Methods:

This retrospective observational investigation analyzed data regarding intra- and post-procedural complications of tunneled catheters inserted using two different techniques. The sample was stratified into three subgroups: (1) Standard Tunnel (patients with no PLT or INR disorders), (2) Pseudotunnel (patients with no PLT or INR disorders), and (3) Pseudotunnel (patients with any PLT or INR disorder). Data regarding the procedure, at 24 h and 7 days were collected and analyzed.

Results:

A total of 143 patients who underwent tunneled catheter insertion were included in the study. Among these, 113 patients were divided into subgroups 1 and 2 and 30 were assigned to subgroup 3. No significant differences were found among the three subgroups regarding immediate, short, and medium-term tunnel complications.

Conclusions:

The findings of this study suggest that both standard and pseudo-tunnels provide comparable levels of safety and comfort for patients. It was noted that Pseudotunnel offers an equivalent level of safety for patients with coagulation disorders related to PLT and INR, rendering it comparable to a “minimally invasive procedure,” which necessitates the same precautions as a non-tunneled PICC.
Failure mechanisms and influencing factors on orthopaedic knee implant failure – A comprehensive review
Authors: Jeyalakshmi P. , Ramkumar P.
Published: October 2024

Background

Total knee replacement (TKR) is an effective orthopaedic surgical procedure to confront osteoarthritis and restore bone joint mobility, relieve pain, and enhance the quality of life. The improvements in implant design and the use of high-wear resistance polyethylene bearings improve the survival of implants. Despite the advancements, the implants still failed and required revision surgery. Also, with an increase in the trend of young patients getting knee replacements, there is a possibility of a higher revision rate. Thus, understanding the failure cause, failure mechanisms and the influencing factors is pertinent.

Methods

A systematic review of the available literature was performed for different modes of failure. All the observations are collated and found the more predominant failure modes. Also, the data pertaining to the failure mechanisms, and the influencing factors of the failure mechanisms are collected from various literature and provided comprehensively.

Results

Infection (30%) becomes the primary cause of implant failure followed by loosening (20%) and instability (18%). The types of wear on knee implants are polyethylene wear, backside wear, impingement wear, and corrosive wear. The factors influencing these wear are material processing, shelf age, implant design, surface topography, and activity level.

Conclusions

Moderately cross-linked, and sequentially processed polyethylene has better wear resistance. Less conformal contact with minimum shelf age provides less wear at articulation and backside. A polished tibial tray with a sophisticated locking mechanism reduces the backside wear of PE, and proper design consideration could reduce impingement wear.
Globalisation, tourism and environmental kuznets curve
Authors: Mahadevan Renuka , Suardi Sandy
Published: October 2024

This paper investigates the Environmental Kuznets Curve (EKC) in developed and developing countries, examining the nonlinear impact of tourism on carbon emissions and ecological footprint from 1990 to 2019. Using a panel fixed effects model, results show a tourism-extended EKC for developed countries but a U-shaped relationship for developing countries. The study uniquely distinguishes between trade and financial globalization, de jure and de facto globalization, to assess economic globalization’s potential to moderate tourism’s environmental impact. Developed countries experience detrimental effects from trade de jure globalization, while developing countries benefit from expanding trade de facto and financial de jure globalization. These findings inform eco-friendly tourism initiatives and globalization strategies.
Much more than a biological phenomenon: A qualitative study of women’s experiences of brain fog across their reproductive journey
Authors: Johnson Hannah , Ogden Jane
Published: October 2024

Whilst ‘brain fog’ is mostly considered a biological problem little is understood about an individual’s experience. This qualitative study explored women’s experiences of brain fog focusing on those at the start (aged 18–25; n = 10) and end (aged 45–60; n = 10) of their reproductive journey. Descriptive thematic analysis described three themes: (i) ‘daily disruptions’ describing cognitive dysfunctions and the main triggers; (ii) ‘the cycle of impact’ with a focus on women’s emotional experiences and how these can exacerbate brain fog; (iii) ‘taking control’ highlighting the use of self-care, physical prompts and Hormonal Replacement Therapy (HRT) to manage brain fog. Transcending these themes was the notion of ‘crisis of identity’ illustrating the negative impact of brain fog on the women’s sense of self with some older women describing acceptance and finding it less challenging. Brain fog is much more than a biological phenomenon and has broader implications for a woman’s sense of self.
Model texts as a feedback instrument in second language writing: A systematic review
Authors: Nguyen Long Quoc , Dao Phung , Nguyen Bao Trang Thi
Published: October 2024

The potential of model texts as a feedback instrument (MTFI) in second language (L2) writing has been explored for about two decades and continues to receive increasing interest from L2 scholars. However, to date, there is still an absence of a comprehensive review of studies in this particular area. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedure, this study aims to fill this gap by systematically reviewing 25 empirical studies on MTFI dating up to 1 April 2023, specifically focusing on three main aspects: study contexts, methodological characteristics, and primary areas of focus and key findings. The results revealed that existing MTFI studies (1) largely targeted low-intermediate English as a foreign language (EFL) learners at primary schools, (2) primarily adopted a quasi-experimental design involving a three-stage narrative writing task in a classroom-based setting, (3) predominantly focused on writing as a process, and (4) consistently reported MTFI’s potential for promoting L2 writing gains, especially in terms of lexical aspects. These results not only further our understanding about the effect of MTFI on different dimensions of task performance and L2 learning (i.e. L2 writing), but also provide some pedagogical implications for practices. Suggestions for addressing methodological issues in future studies are provided to advance this research domain.
Ion crystal size and structure in Paul traps
Authors: Kotana Appala Naidu , Mohanty Atanu K
Published: October 2024

This article presents a relationship between the size of an ion crystal in a Paul trap and the radio frequency potential applied on the central ring electrode. Using a simple and elegant derivation it has been shown that the distance of an ion in the crystal from the trap center is proportional to [Formula: see text] power of the applied radio frequency voltage. The validity of this power law has been demonstrated on ion crystals having up to 13 ions. A spring-mass model has been presented to predict structure of ion crystals in Paul traps operating in the Dehmelt regime. Structures are obtained by minimizing the total potential energy stored in an ion ensemble. The total potential energy is taken to be the sum of the electrostatic potential due to ion–ion interaction and the potential energy stored in the springs. Structures of crystals having up to 13 ions predicted by our model have been verified by comparing them with results obtained by direct numerical simulations.
The Great Lockdown and Economic Voting: Estimating the Impact of the COVID-19 Recession on the 2020 US Presidential Election
Authors: Sircar Indraneel
Published: October 2024

The 2020 US presidential election was won by Democrat challenger Joseph Biden over Republican incumbent Donald Trump and was contested during the global Coronavirus Disease 2019 (COVID-19) pandemic. Unemployment increased sharply during the pandemic but was followed by a large federal relief package. We investigate whether there was economic voting in the 2020 election, that is, whether the increased unemployment rate and the subsequent government response during the pandemic affected Trump’s vote negatively or positively overall. We examine 48 states (by excluding Alaska, Hawaii, and DC). Using a triple-differences (DDD) model (that is, examining changes in a candidate’s county-level vote-share depending on the change in unemployment and historical Republican-Democrat partisanship), we predict what would have happened if the increase in unemployment rate in between March and October 2020 had been more modest. Although many states show significant negative expected impacts on the Trump vote, we predict that only when when the unemployment rates experience little change during the pandemic would overall results have swung in the incumbent’s favour – and only then in Arizona and Georgia.
Enhancing understanding of broad-based pedagogical leadership in Finnish early childhood education through cultural artifacts
Authors: Roponen Hannele Marjaana , Fonsén Elina , Ukkonen-Mikkola Tuulikki , Ahtiainen Raisa
Published: October 2024

This ethnographic case study examines the artifacts of the leadership culture of one Finnish early childhood education (ECE) center and how they appear from the perspective of broad-based pedagogical leadership. Qualitative content analysis with a directed approach was guided by Pasquale Gagliardi’s and Mary Hatch’s definitions of artifacts. In addition, artifacts were analyzed through broad-based pedagogical leadership. Based on the analysis, thirteen activities, six verbal expressions, and thirteen objects of leadership culture were found in the data. Most of the artifacts were indirect pedagogical leadership, and some had several purposes due to staff interpretations. The interpretations varied both between the leaders and the staff but also within the staff. The findings indicate that symbolic leadership is present in many leadership situations and that a lack of knowledge about the symbolic and cultural dimensions of leadership can undermine leaders’ good intentions. The results of the study can be utilized in practical work in leading organizational cultures and in structuring pedagogical leadership in ECE. Additionally, the research has theoretical implications by enriching leadership research in ECE and enhancing the concept of broad-based pedagogical leadership, which can be used in leadership training programs in the field of education.
“Sisters Are Doin’ It for Themselves”: Gender Differences in Singles’ Well-Being
Authors: Hoan Elaine , MacDonald Geoff
Published: October 2024

The experience of singles has been largely overlooked in relationship science, garnering a need for understanding correlates of singles’ well-being. Gender is an important focus of well-being research, and qualitative work on singlehood has suggested that men and women may have experiences of singlehood that differ in important ways. In this study ( N = 5941; 50% men; Mage = 31.74), we provide the first comprehensive, descriptive profile of gender differences on a suite of variables with important ties to well-being in singlehood; satisfaction with relationship status, life satisfaction, sexual satisfaction, and desire for a partner. Our results suggest that single women, on average, report higher levels of satisfaction with relationship status, life satisfaction, sexual satisfaction, and lower desire for a partner. Exploratory analyses showed significant gender interactions with age and ethnicity. Overall, these findings suggest that women are, on average, happier in singlehood than men.
Posting of third-country nationals in the EEA: Need for clarification of the conditions in a legislative initiative
Authors: Verschueren Herwig
Published: October 2024

The posting of employees within the European Economic Area (EEA) has been the subject of political and legal discussion for years. Recently, this has been fuelled by the increase in posting within the EEA of employees from third countries. This article addresses the legal aspects of this kind of posting. It will show that the conditions under which third-country nationals can be posted within the EEA are not entirely clear. This is also true for the measures that Member States can take to control this form of posting. Therefore, this article argues in favour of a legislative initiative that specifies and clarifies these conditions. First, it briefly recalls the legal context of posting. It also provides some figures and discusses why these employees are particularly vulnerable. Next, this article examines the case law of the Court of Justice regarding the measures taken by Member States to control the posting of third-country nationals. It addresses the questions that have remained open following this case law. Finally, it elaborates on the idea of a legislative initiative and indicates what this could consist of.
Age- and Sex-Related Differences in Music Requests on a Radio Show for Children
Authors: von Berg Markus , Wolf Anna-Christina , Steffens Jochen
Published: October 2024

In research on the development of musical preferences, children are often asked either to evaluate musical pieces that have been previously selected by adult experimenters, or to give self-reports on preferences for different musical styles. This study involved analyzing a sample of 1,412 freely and publicly expressed music requests from children aged between 4 and 11 years taken from a German radio program, with regard to age- and sex-specific differences. The music was categorized into genres, as listed on Spotify, and examined using methods of music information retrieval provided by the Spotify Developer application programming interface. Results showed that, at younger ages, the requests were generally more evenly distributed across different genres. Regarding single genres, we observed small positive relationships between age and the likelihood of requesting the genres pop or electro and small negative relationships between age and the likelihood of requesting A capella, German songwriter, indie, theme songs, or children's music. Furthermore, we found that boys requested significantly more rock or hip-hop, whereas girls had a higher tendency to ask for pop. Finally, age- (but no sex-) related differences regarding the Spotify features of valence and liveness of the requested music were found, which were related to the preference for children's music at younger ages. The results thus suggest that previous findings regarding differences between boys and girls and an increasing formation of distinct genre preferences during infancy also apply to single song requests made on a radio show.
College Students’ Learning Experience and Engagement in the Smart Classroom: The Mediating Role of Self-Efficacy in the Background of COVID-19
Authors: Wang Yanli , Liu Sijia , Pu Linjie , Mao Xiaolong , Shen Sha
Published: October 2024

Previous studies suggest that learning experience influences students’ academic engagement and self-efficacy mediates the association between them, and the sub-types of self-efficacy are distinct and play different roles. However, the different roles of self-efficacy sub-types, especially in blended learning environments, have yet to be explored. The present study investigated the potential mechanism of sub-types of self-efficacy on the relationship between the learning experience and academic engagement in a smart classroom environment in the background of COVID-19. Three hundred-eight participants volunteered in this study and finished the survey, including the learning experience, self-efficacy, and academic engagement questionnaire. The results showed that learning experience significantly influences academic engagement, and sub-types of self-efficacy play different roles in the relationship between learning experience and academic engagement. Furthermore, only academic and behavioral self-efficacy mediated the relationship between them. The results of this study have specific implications for creating a sustainable blended learning environment and promoting students’ academic engagement.
Implications of Policies and Governance on Financial Sustainability in the Light of Earning Management: An Evidence from an Emerging Economy
Authors: Qaim Sarah , Ellahi Nazima
Published: October 2024

The purpose of this study is to analyze the impact of corporate governance and policies on financial sustainability in the presence of earnings management as the moderator in an emerging economy-Pakistan. The study’s population is the manufacturing industry of Pakistan that has 25 sectors and 295 firms listed with the Pakistan stock exchange PSX. Data was collected from Thomson Reuters Datastream for all the 295 firms. Panel data analysis was carried out to examine the impact of the variables of interest. Analysis reveals that out of the two independent variables; that is, corporate governance and policies, the former has a significant impact on financial sustainability. Furthermore, in direct relation earnings management is negatively affecting the financial sustainability of the corporates and the impact is significant with the p-value of .044. Earnings management as a moderator also has a negatively significant impact on the relationship between corporate governance, policies, and financial sustainability with a p-value of .042. This study would help the government and policymakers in making sustainable policies and frameworks.
Effect of Leader Kindness on Service Sabotage and the Role of Feeling of Elevation and Employee Wellbeing: A Study of Municipal Employees in Kirikkale Province of Turkey
Authors: Bozaci İbrahim , Gürer Alper
Published: October 2024

While the stimuli related to negative situations like disasters affect people emotionally negatively, good behaviors toward those in difficult situations can cause us to experience positive emotions or reduce the effects of them. However, it is seen that exposure to kindness related stimuli and perceptions about them have not been sufficiently examined in the organizational context. In this research, the effect of perceptions toward leader’s kindness behaviors on service sabotage and the mediating role of feeling of elevation and employee well-being are investigated through a descriptive field study. In this direction, a questionnaire containing the research variables was applied to the employees of a municipality in Kırıkkale province of Turkey. As a result, it was found that perceptions toward leader kindness behaviors affect service sabotage in the negative direction, and employees’ sense of elevation and well-being positively. In addition, employee wellbeing was found to play a mediating role in the effect of perceptions toward kindness on service sabotage. The findings of the study suggest that perceptions about leader kindness behaviors may have important organizational outcomes. Finally, recommendations for researchers and organizations were developed.
Relationship Between Hip and Groin Pain and Hip Range of Motion in Amateur Soccer and Australian Rules Football Players
Authors: Mosler Andrea B. , Heerey Joshua J. , Kemp Joanne L. , Semciw Adam I. , King Matthew G. , Agricola Rintje , Lawrenson Peter R. , Scholes Mark J. , Mentiplay Benjamin F. , Crossley Kay M.
Published: October 2024

Background:

The relationship between hip/groin pain and hip range of motion (ROM) is unclear.

Purpose:

To explore the relationship between hip/groin pain and hip joint ROM and examine the influence of sex and cam morphology on this relationship.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Included were 184 amateur soccer and Australian Rules football players (276 hips; 20% women; median age, 26 years; interquartile range, 24-30 years) with hip/groin pain >6 months and a positive flexion-adduction-internal-rotation (FADIR) test, and 50 matched asymptomatic control players (98 hips; 28% women, median age, 26 years; interquartile range, 23-31 years). Hip ROM measures were flexion, internal and external rotation at 90° of hip flexion, total rotation (internal and external), and bent-knee fall out (BKFO). Cam morphology was determined from anteroposterior pelvis or 45° Dunn radiographs, defined by an alpha angle ≥60°. Linear regression models with generalized estimating equations were used to examine the relationship between group (symptomatic and asymptomatic) and each ROM measure. Interaction terms (group × cam morphology or group × sex) were included to examine if relationships between group and hip ROM were influenced by cam morphology or sex. Where appropriate, models were adjusted for sex, age, and cam morphology.

Results:

An interaction between the relationship between group × cam and internal rotation ROM was found. Symptomatic players with cam morphology had lower internal rotation ROM than controls with cam morphology (adjusted mean difference [AMD] = −4.5°; 95% CI, −7.4° to −1.6°). Hip/groin pain was not associated with internal rotation ROM if cam morphology was absent. A significant interaction was also found for group × sex and BKFO and total rotation ROM. Symptomatic women had lower total rotation ROM than control women (AMD = −8.2°; 95% CI, −14.1° to −2.2°), but no difference was seen in men. BKFO range was lower in men with hip/groin pain compared with control men (AMD = 1.6 cm; 95% CI, 0.3-3.0 cm), but no difference was seen in women. Flexion and external rotation ROM did not differ between symptomatic and control hips.

Conclusion:

Cam morphology was an effect modifier of the relationship between hip/groin pain and internal rotation ROM. Sex-related differences were also observed in the relationship between hip/groin pain and hip ROM.
Teaching Professional Use of Social Networking Sites Through a Hypothetical Case Study
Authors: Sharma Daneshwar
Published: October 2024

Organizations use social networking sites (SNSs) to create collaborative communication channels among employees, consumers, and clients. Organizations expect future employees to be well trained in using SNSs. However, students do not accept SNSs as a professional channel of communication since they use SNSs for fun and socializing. A hypothetical case study was developed to explain the consequences of the unmindful use of SNSs in a professional context. The article discusses the need to use a case study in this context. The effectiveness of the case is assessed through a survey questionnaire. Recommendations for BPC faculty for using the case are also discussed.
Discovering the common latent structure of commercial districts focusing on the spatial co-occurrence relationship between stores
Authors: Inagaki Kazuya , Hara Yusuke
Published: October 2024

Store agglomeration in a commercial district is considered to follow synergistic and complementary relationships between stores. The micro-interactions, that is, co-occurrence relationships, between stores are thought to create commercial districts’ universality and characteristics. This study aims to empirically identify latent attributes that can explain the mechanism of store agglomeration from the co-occurrence relationships between stores in commercial districts, and to identify universal characteristics in store agglomeration. We represented store agglomeration as a store co-occurrence network with stores as nodes and co-occurrence relationships between stores as links in 10 major commercial districts in Japan. We estimated latent attributes of stores that generated the store co-occurrence network and empirically clarified the quantitative and qualitative nature of store agglomeration. The co-occurrence networks of stores with estimated latent attributes were compared across those of districts, and the co-occurrence patterns common to latent attributes were clarified. The estimated latent attributes were empirically shown to have more explanatory power for the store agglomeration than the conventional business category classification, suggesting their usefulness as a new classification axis for stores. In addition, by comparing 10 districts, common co-occurrence relationships were extracted, and the universal spatial structure of store agglomeration was empirically clarified.
An early economic evaluation of WireSafe™ to prevent guidewire retention in central venous catheter procedures
Authors: Mattock R , Hanbury A , Morys-Edge M. , Corp A. , Lawton R
Published: October 2024

Background

Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a ‘Never Event’ by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective.

Methods

We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50).

Results

NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398).

Conclusions

The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness.
Long-term real-world evidence of CPX-351 of high-risk patients with AML identified high rate of negative MRD and prolonged OS
Authors: Cluzeau Thomas , Guolo Fabio , Chiche Edmond , Minetto Paola , Rahme Ramy , Bertoli Sarah , Fianchi Luana , Micol Jean-Baptiste , Gottardi Michele , Peterlin Pierre , Galimberti Sara , Thomas Xavier , Rizzuto Giuliana , Legrand Olivier , Rondoni Michela , Raffoux Emmanuel , Bertani Giambattista , Caulier Alexis , D’Argenio Michelina , Bonmati Caroline , Billio Atto , Lejeune Caroline , Scappini Barbara , Pigneux Arnaud , Zappasodi Patrizia , Recher Christan , Grimaldi Francesco , Ades Lionel , Lemoli Roberto M.
Published: October 2024

CPX-351 has been approved for patients with therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (MRC-AML). No extensive data are available on measurable residual disease (MRD) and long-term clinical outcome using CPX-351 in AML in real life. We retrospectively collected data from 168 patients in 36 centers in France and Italy who had received 1 or 2 cycles of induction with CPX-351. All patients were aged >18 years and had newly diagnosed, untreated t-AML or MRC-AML. With a median follow-up of 3 years, the median overall survival (OS) was 13.3 months. The median OS was 20.4 months vs 12.9 months for patients with MRD below or above 10–3, respectively (P = .006). In a multivariate analysis, only MRD >10–3 was associated with a poorer OS (hazard ratio, 2.6; 95% confidence interval, 1.2-5.5; P = .013). We also observed a trend toward a better median OS in patients who underwent hematopoietic stem cell transplantation with MRD <10–3 (not reached vs 26.0 months; P = .06). Achievement of MRD negativity contributed to the improvement of OS in the overall population and, maybe, in patients receiving transplant. These data provide the rationale for the 2 ongoing studies evaluating CPX-351 vs 7+3 in non–MRC-AML and non–t-AML using MRD as the primary end point for ALFA-2101 phase 2 clinical trial and event-free survival for AMLSG 30-18 phase 3 clinical trial.
Ibrutinib for therapy of steroid-refractory chronic graft-versus-host disease: a multicenter real-world analysis
Authors: Pidala Joseph , Kim Jongphil , Kalos Denise , Cutler Corey , DeFilipp Zachariah , Flowers Mary E. D. , Hamilton Betty K. , Chin Kuo-Kai , Rotta Marcello , El Jurdi Najla , Hamadani Mehdi , Ahmed Gulrayz , Kitko Carrie , Ponce Doris , Sung Anthony , Tang Helen , Farhadfar Nosha , Nemecek Eneida , Pusic Iskra , Qayed Muna , Rangarajan Hemalatha , Hogan William , Etra Aaron , Jaglowski Samantha
Published: October 2024

To examine the activity of ibrutinib in steroid-refractory chronic graft-versus-host disease (SR-cGVHD) after the US Food and Drug Administration approval, we conducted a multicenter retrospective study. Data were standardly collected (N = 270 from 19 centers). Involved organs included skin (75%), eye (61%), mouth (54%), joint/fascia (47%), gastrointestinal (GI) (26%), lung (27%), liver (19%), genital (7%), and others (4.4%). The National Institutes of Health (NIH) severity was mild in 5.7%, moderate 42%, and severe 53%. Thirty-nine percent had overlap subtype. Karnofsky performance status (KPS) was ≥80% in 72%. The median prednisone was 0.21 mg/kg (0-2.27). Ibrutinib was started at a median of 18.2 months after cGVHD onset and in earlier lines of therapy (second line, 26%; third, 30%; fourth, 21%; fifth, 9.6%; sixth, 10%; seventh or higher, 1.2%). Among evaluable patients, the 6-month NIH overall response rate (ORR; complete response [CR]/partial response [PR]) was 45% (PR 42%; CR 3%). The median duration of response was 15 months (range, 1-46). Liver involvement had association with 6-month ORR (multivariate [MVA] odds ratio, 5.49; 95% confidence interval [CI], 2.3-14.2; P < .001). The best overall response was 56%, with most (86%) achieving by 1 to 3 months. With a median follow-up for survivors of 30.5 months, failure-free survival (FFS) was 59% (53%-65%) at 6 months and 41% (36%-48%) at 12 months. On MVA, increased age (hazard ratio [HR], 1.01; 95% CI, 1.0-1.02; P = .033), higher baseline prednisone (HR, 1.92; 95% CI, 1.09-3.38; P = .032), and lung involvement (HR, 1.58; 95% CI, 1.1-2.28; P = .016) had worse FFS. Ibrutinib discontinuation was most commonly due to progressive cGVHD (44%) or toxicity (42%). These data support that ibrutinib has activity in SR-cGVHD, provide new insight into factors associated with response and FFS, and demonstrate the toxicity profile associated with discontinuation.
Engagement/Disengagement Characteristics of Pull-Type Diaphragm Spring Clutch for Heavy-Duty Commercial Vehicles
Authors: Yan Zhengfeng , Wu Bingbing , Gao Xinming , Bai Xianxu
Published: October 2024

Considering that the clutch cover assembly and driven disc assembly show common effect on the engagement/disengagement characteristics of the pull-type diaphragm spring clutches for heavy-duty commercial vehicles, the diaphragm spring, cushion plate, and friction plate, are thoroughly analyzed in this paper. The A-L method and the micro-element method are used to analyze the mechanical properties of diaphragm spring and cushion plate, respectively. The mechanical characteristics are obtained via numerical simulation, and the deformation and load mechanical characteristics of the cushion plate are verified by experimental tests. According to the relationship between the pressure plate temperature and the friction coefficient of the friction plate, the influence of the change of the friction coefficient on the transmission torque characteristics of the clutch is analyzed. In view of the torque fluctuation in the process of engagement/disengagement, the mathematical model of torsional characteristics is established with consideration of the torsional characteristics of torsional damper. Modeling and simulation of the handling characteristics are carried out to evaluate the influence of the boosting characteristics of the hydraulic operated pneumatic booster on the clutch pedal operating force separation characteristics. Specific tests are also conducted, and the effectiveness of the established models is verified.
Associations between genotype, phenotype and behaviours measured by the Rett syndrome behaviour questionnaire in Rett syndrome
Authors: Downs Jenny , Wong Kingsley , Leonard Helen
Published: October 2024

Introduction

Rett syndrome (RTT) is a rare neurodevelopmental disorder with developmental impairments, comorbidities, and abnormal behaviours such as hand stereotypies and emotional features. The Rett Syndrome Behaviour Questionnaire (RSBQ) was developed to describe the behavioural and emotional features of RTT. Little is known how RSBQ scores are associated with genetic and clinical characteristics in RTT. This study investigated relationships between genotype, age, walking, hand function, sleep, and RSBQ total and subscale scores in RTT.

Methods

This is a cross-sectional analysis of data collected in the Australian Rett Syndrome Database and the International Rett Syndrome Phenotype Database. Parent caregivers completed the RSBQ and Sleep Disturbance Scale for Children [subscales for disorders of initiating and maintaining sleep (DIMS), disorders of excessive somnolence (DOES)], and provided information on age, variant type, functional abilities (mobility, hand function), seizure frequency and gastrointestinal problems. Associations between the RSBQ scores and the independent variables were modelled using linear regression.

Results

Data were available for 365 individuals with RTT [median (range) age 17.8 (2.9–51.9) years, 2 males]. Compared to adults, 2- to 12-year-old children had higher mean Total, Night-time Behaviour and Fear/Anxiety scores. Compared to individuals with a C-terminal deletion, individuals with the p.Arg255* variant had higher mean Total and Night-time Behaviours scores, whereas the p.Arg294* variant had higher mean Mood scores. Individuals with intermediate mobility and hand function abilities had a higher mean Total score. Total RSBQ and subscale scores were similar across categories for seizures, constipation, and reflux, but were higher with abnormal DIMS and abnormal DOES scores.

Conclusion

Except for associations with sleep, the RSBQ measures the behavioural phenotype rather than clinical severity in RTT, as traditionally conceptualised in terms of functional abilities and comorbidities. When designing clinical trials, the RSBQ needs to be complemented by other outcome measures to assess specific core functions and associated comorbidities in RTT.
Diversity of attachment systems in heelwalkers (Mantophasmatodea) – highly specialized, but uniform
Authors: Büscher Thies H. , Gorb Stanislav N. , Eberhard Monika J. B.
Published: October 2024

Background

Heelwalkers possess a highly modified tarsal attachment system. All extant species lift the distalmost tarsomere permanently off the substrate and primarily use their euplantulae for locomotion. The combination of a smooth adhesive pad (arolium) on the pretarsus and fibrillary attachment pads on the euplantulae offers valuable insights for translational approaches, but its infra-order diversity remains unexplored.

Results

We explored the morphology of the tarsal attachment apparatus of Mantophasmatodea based on a representative taxon sampling spanning a large fraction of species of this group and compared morphological differences in the specialized morphology of this system across species and sexes. Our scanning electron microscope investigation of the tarsi of 11 species (52% of all described extant species) revealed an overall very consistent ground pattern and almost no specific adaptations. There are only minor, but mostly clade-specific differences in the shape of the adhesive setae on the tarsal euplantulae and in the morphology and density of the acanthae on the pretarsal arolium. Both features differ primarily between Austrophasmatidae in comparison to the remaining Mantophasmatodea taxa.

Conclusion

We conclude that the strong specialization of the mantophasmatodean tarsal attachment sufficiently copes with the diversity of substrates the insects are exposed to.
Women’s perspectives on the acceptability of risk-based cervical cancer screening
Authors: Remmel Maali-Liina , Suija Kadri , Raudne Riina , Tisler Anna , Ķīvīte-Urtāne Anda , Stankūnas Mindaugas , Nygård Mari , Aasbø Gunvor , Maļina Laura , Uusküla Anneli
Published: October 2024

Background

The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers.

Methods

In this qualitative study, one-to-one semi-structured interviews were conducted with a purposeful sample including women aged 30–65 years to explore women’s perspectives on the acceptability of risk-based CC screening. The study was conducted in Estonia, and interviews were conducted from March to September 2023. Potential participants were approached in person by a member of the study team or by their healthcare providers at primary care or gynaecology clinics. The interview guides were developed based on the concept of acceptability of healthcare interventions.

Results

Twenty participants (mean age 44.5, SD = 8.6) with diverse backgrounds were interviewed. The seven components of acceptability (affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence) were explored as key themes. Generally, women supported risk-based screening. However, we identified several factors that may compromise the acceptability of risk-based screening. The participants were reluctant to accept less intense screening for low-risk women and anticipated that if risk-based approach was implemented, more frequent testing would remain an option. Providing in-person clinician support was expected, requiring additional healthcare resources. Knowledge gaps in CC prevention highlighted the need for accessible information and education. Most women were unworried about sensitive data inclusion in risk score calculations. However, some participants were concerned about potential confidentiality breaches by healthcare workers.

Conclusion

This study indicates that risk-based CC screening is acceptable, except for testing low-risk women less frequently. Our findings underscore the necessity for comprehensive understanding of the needs and concerns of the target group women for program development. Healthcare organizations are required to proactively address these needs by implementing comprehensive information dissemination and efficient communication approaches.
Determinants of oral health among Iranian soldiers: a structural equation modeling study
Authors: Banakar Morteza , Ghannadpour Akram , Behbahanirad Arghavan , Joulaei Hassan , Lankarani Kamran Bagheri
Published: October 2024

Background

Military personnel often face unique challenges in maintaining optimal oral health. This study investigated the oral health status, caries experience, and associated factors among a sample of Iranian soldiers, employing a structural equation modeling (SEM) approach to explore the complex interplay of socioeconomic and behavioral determinants.

Methods

A cross-sectional study was conducted among 658 male soldiers aged 18–30 years from three military barracks in Fars province, Iran. Data were collected through a structured instrument and clinical oral examinations. The study employs the DMFT index, which measures caries experience based on decayed, missing, and filled teeth, along with the Simplified Oral Hygiene Index (OHI-S) to assess overall oral health status. Structural equation modeling was employed to analyze the complex relationships between socioeconomic factors, oral health behaviors, and oral health outcomes.

Results

The mean DMFT score was 3.57 ± 5.91, and the mean OHIS score was 0.56 ± 1.42. SEM analysis revealed that socioeconomic status (SES) indirectly influenced DMFT and oral hygiene scores, mediated by drug use, oral hygiene practices, dietary sugar consumption, and dental visit frequency. Lower toothbrushing frequency was significantly associated with higher DMFT (Estimate = -0.064, p < 0.001) and OHIS scores (Estimate = -0.637, p < 0.001). Drug use (smoking, qalyan, alcohol) was linked to poorer oral health outcomes, while more frequent dental visits were associated with lower DMFT and OHIS scores.

Conclusion

This study reveals the complex interplay between socioeconomic conditions, oral health behaviors, and oral health outcomes among Iranian soldiers. The findings highlight the need for targeted interventions to address modifiable risk factors and improve access to preventive dental care within military settings. Future longitudinal studies are warranted to elucidate further the causal pathways between these factors and oral health outcomes in military populations.
Assessment of inverse publication bias in safety outcomes: an empirical analysis
Authors: Xing Xing , Zhu Jianan , Shi Linyu , Xu Chang , Lin Lifeng
Published: October 2024

Background

The aims of this study were to assess the presence of inverse publication bias (IPB) in adverse events, evaluate the performance of visual examination, and explore the impact of considering effect direction in statistical tests for such assessments.

Methods

We conducted a cross-sectional study using the SMART Safety, the largest dataset for evidence synthesis of adverse events. The visual assessment was performed using contour-enhanced funnel plots, trim-and-fill funnel plots, and sample-size-based funnel plots. Two authors conducted visual assessments of these plots independently, and their agreements were quantified by the kappa statistics. Additionally, IPB was quantitatively assessed using both the one- and two-sided Egger’s and Peters’ tests.

Results

In the SMART Safety dataset, we identified 277 main meta-analyses of safety outcomes with at least 10 individual estimates after dropping missing data. We found that about 13.7–16.2% of meta-analyses exhibited IPB according to the one-sided test results. The kappa statistics for the visual assessments roughly ranged from 0.3 to 0.5, indicating fair to moderate agreement. Using the one-sided Egger’s test, 57 out of 72 (79.2%) meta-analyses that initially showed significant IPB in the two-sided test changed to non-significant, while the remaining 15 (20.8%) meta-analyses changed from non-significant to significant.

Conclusions

Our findings provide supporting evidence of IPB in the SMART Safety dataset of adverse events. They also suggest the importance of researchers carefully accounting for the direction of statistical tests for IPB, as well as the challenges of assessing IPB using statistical methods, especially considering that the number of studies is typically small. Qualitative assessments may be a necessary supplement to gain a more comprehensive understanding of IPB.
Clinico-demographic profile of burns in the Middle-East and North-Africa (MENA) region: a systematic review and meta-analysis
Authors: Elshahidi Mohamed H.
Published: October 2024

Burn injuries remain a public health issue with risk of mortality and multiple post-burn morbidities. This article aims to systematically review and meta-analyse data about burns in the Middle-East and North-Africa (MENA) region. Methods Pubmed, Web of Science, Scopus, Global Index Medicus, Cochrane Library and Google scholar data were searched from their dates of inception till April 2024. Results One hundred and one studies were included in this review, representing data from twelve countries in the region. Data was sub-grouped into two groups: pediatric group and emergency room (ER) group. The pooled random-effect estimates were male gender 58.6% [95% CI 56.9–60.2%], accidental injury 91.1% [95% CI 85.9–94.5%], scald burn 50% [95% CI 46.7–53.4%], at home injury 79.9% [95% CI 76.7–82.8%], upper limbs involvement 51.7% [95% CI 46.8–56.6%], mean body surface area burned (BSAB) 17.2% [95% CI 14.69–19.84%], second-degree burns 56.5% [95% CI 49–63.8%], length of stay 11.18 days [95% CI 9.68–12.68%] and mortality rate 9.1% [95% CI 7.5–11%]. All included studies were of good quality. Conclusion This review shows scarcity of studies from many countries in the MENA region. These data will inform policy makers and burn specialists about the extent of this public issue in the region.