bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing as health professionals through community volunteering: exploring the value of a partnership between medical students and primary schools online compared to in-person
Authors: Cardoso Pinto Alexandra M. , Patel Sajan B. , Stephens Morwenna , Guha Payal , Baptista Ana , Smith Susan
Published: January 2023

Introduction

Imperial College Teddy Bear Hospital (ICSM-TBH) is a student-led volunteering group, which uses interactive, play-based teaching to educate school pupils aged 5–7 years about healthy lifestyles and healthcare. During the COVID-19 pandemic, volunteering sessions shifted online. The aim of this study was to compare the value of online and in-person ICSM-TBH volunteering for volunteers and school pupils.

Methods

Undergraduate university students at Imperial College London (medicine can be taken as a first degree in the UK) who volunteered with ICSM-TBH between 2019 and 22 were invited to complete an anonymous online questionnaire evaluating their experiences of volunteering online and in-person through Likert-scale questions. Those who completed the questionnaire were also invited to an interview. Teachers who hosted online ICSM-TBH sessions were also invited to an in-person interview, exploring their view of their pupils’ experiences with these sessions. Questionnaire results were analysed through descriptive statistics. Interviews were analysed through inductive thematic analysis.

Results

Thirty-two university students completed the questionnaire. Of these, 9 experienced both in-person and online volunteering, all of whom preferred in-person volunteering. For those who only volunteered in-person, 92% reported that ICSM-TBH sessions were a positive experience, compared to 100% who volunteered online; 92% in person volunteers agreed or strongly agreed that ICSM-TBH volunteering in person improved their mood, compared to 89% online; and 100% agreed or strongly agreed that ICSM-TBH volunteering in person helped them feel part of a community, compared to 84% online. A total of 12 volunteers and 4 teachers were interviewed, from whom five themes emerged: interaction and engagement (interaction and engagement between pupils and volunteers was more readily achieved in-person); personal and professional development (both online and in-person sessions enabled volunteers to gain valuable skills); community and social (greater sense of community was established in-person); emotional wellbeing and enjoyment (both modalities were enjoyed by volunteers and pupils); and workload (online sessions were more convenient for volunteers but with risk of screen fatigue).

Conclusion

Overall, both in-person and online volunteering were of substantial benefit to volunteers and school pupils. However, most teachers and volunteers preferred in-person volunteering.
Burnout in Israeli medical students: a national survey
Authors: Gilbey Peter , Moffat Mandy , Sharabi-Nov Adi , Cohen Omri , Kroszynski Galit Neufeld , Karnieli-Miller Orit , Gillis Roni , Urkin Jacob , Moscovici Khen
Published: January 2023

Introduction

Professional burnout is characterized by loss of enthusiasm for work, cynicism, and a low sense of personal efficacy. Burnout may adversely affect medical professionalism. Burnout is common in clinicians and varying rates have been reported in medical students. No data exist regarding the prevalence of burnout among Israeli medical students. The aims of this study were to assess the rate of burnout in Israeli medical students and to identify students who were particularly susceptible to burnout.

Methods

A cross-sectional questionnaire design was employed, gathering data from medical students in all years of study across three medical schools. Burnout was measured using the Maslach Burnout Inventory Student Survey (MBI-SS), translated into Hebrew.

Results

Of the 2160 students in the participating medical schools, 966 (44.7%) completed MBI-SS and demographic questionnaires. The overall burnout rate was 50.6%. Multivariate logistic regression analysis yielded that female gender, age under 25, advanced year of study, studying at a specific medical school and not being a parent are all significantly correlated with higher levels of burnout.

Conclusions

A high rate of burnout was found. The identification of young women who are not parents during advanced years of studies as being at-risk is important, in order to guide the development of burnout prevention interventions.
Interoperability of heterogeneous health information systems: a systematic literature review
Authors: Torab-Miandoab Amir , Samad-Soltani Taha , Jodati Ahmadreza , Rezaei-Hachesu Peyman
Published: January 2023

Background

The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources. Accordingly, there is an urgent need to develop integration mechanisms among the various health information systems. The aim of this review was to investigate the interoperability requirements for heterogeneous health information systems and to summarize and present them.

Methods

In accordance with the PRISMA guideline, a broad electronic search of all literature was conducted on the topic through six databases, including PubMed, Web of science, Scopus, MEDLINE, Cochrane Library and Embase to 25 July 2022. The inclusion criteria were to select English-written articles available in full text with the closest objectives. 36 articles were selected for further analysis.

Results

Interoperability has been raised in the field of health information systems from 2003 and now it is one of the topics of interest to researchers. The projects done in this field are mostly in the national scope and to achieve the electronic health record. HL7 FHIR, CDA, HIPAA and SNOMED-CT, SOA, RIM, XML, API, JAVA and SQL are among the most important requirements for implementing interoperability. In order to guarantee the concept of data exchange, semantic interaction is the best choice because the systems can recognize and process semantically similar information homogeneously.

Conclusions

The health industry has become more complex and has new needs. Interoperability meets this needs by communicating between the output and input of processor systems and making easier to access the data in the required formats.
Temporal relationship between atherogenic dyslipidemia and inflammation and their joint cumulative effect on type 2 diabetes onset: a longitudinal cohort study
Authors: Lan Yulong , Chen Guanzhi , Wu Dan , Ding Xiong , Huang Zegui , Wang Xianxuan , Balmer Lois , Li Xingang , Song Manshu , Wang Wei , Wu Shouling , Chen Youren
Published: January 2023

Background

Concurrent atherogenic dyslipidemia and elevated inflammation are commonly observed in overt hyperglycemia and have long been proposed to contribute to diabetogenesis. However, the temporal relationship between them and the effect of their cumulative co-exposure on future incident type 2 diabetes (T2D) remains unclear.

Methods

Longitudinal analysis of data on 52,224 participants from a real-world, prospective cohort study (Kailuan Study) was performed to address the temporal relationship between high-sensitivity C-reactive protein (hsCRP) and the atherogenic index of plasma (AIP, calculated as triglyceride/high-density lipoprotein) in an approximately 4-year exposure period (2006/2007 to 2010/2011). After excluding 8824 participants with known diabetes, 43,360 nondiabetic participants were included for further analysis of the T2D outcome. Cox regression models were used to examine the adjusted hazard ratios (aHRs) upon the cumulative hsCRP (CumCRP) and AIP (CumAIP) in the exposure period.

Results

In temporal analysis, the adjusted standardized correlation coefficient (β1) of hsCRP_2006/2007 and AIP_2010/2011 was 0.0740 (95% CI, 0.0659 to 0.0820; P < 0.001), whereas the standardized correlation coefficient (β2) of AIP_2006/2007 and hsCRP_2010/2011 was − 0.0293 (95% CI, − 0.0385 to − 0.0201; P < 0.001), which was significantly less than β1 (P < 0.001). During a median follow-up of 7.9 years, 5,118 T2D cases occurred. Isolated exposure to CumAIP or CumCRP was dose-dependently associated with T2D risks, independent of traditional risk factors. Significant interactions were observed between the median CumAIP (− 0.0701) and CumCRP thresholds (1, 3 mg/L) (P = 0.0308). Compared to CumAIP < − 0.0701 and CumCRP < 1 mg/L, those in the same CumAIP stratum but with increasing CumCRP levels had an approximately 1.5-fold higher T2D risk; those in higher CumAIP stratum had significantly higher aHRs (95% CIs): 1.64 (1.45–1.86), 1.87 (1.68–2.09), and 2.04 (1.81–2.30), respectively, in the CumCRP < 1, 1 ≤ CumCRP < 3, CumCRP ≥ 3 mg/L strata. Additionally, the T2D risks in the co-exposure were more prominent in nonhypertensive, nondyslipidemic, nonprediabetic, or female participants.

Conclusions

These findings suggest a stronger association between elevated hsCRP and future AIP changes than vice versa and highlight the urgent need for combined assessment and management of chronic inflammation and atherogenic dyslipidemia in primary prevention, particularly for those with subclinical risks of T2D.
CCND2 and miR-206 as potential biomarkers in the clinical diagnosis of thyroid carcinoma by fine-needle aspiration cytology
Authors: Yuan Shifa , Liu Zhijun , Yu Shanshan , Wang Xiaolei , Shi Jian
Published: January 2023

Background

To investigate the relationship between cyclin D2 (CCND2) and miR-206 expression in fine-needle aspiration cytology of thyroid carcinoma.

Methods

A total of 65 patients with thyroid carcinoma were selected as the subjects and 65 patients with benign thyroid nodules were in control group. The fine-needle aspiration cytology of thyroid nodules was performed. CCND2 and miR-206 levels were detected by PCR.

Results

Compared with the patients with benign thyroid nodules, the expression level of miR-206 in fine-needle aspiration cytology of thyroid cancer patients decreased significantly and the expression level of CCND2 increased significantly. CCND2 and miR-206 expression was negatively correlated in thyroid cancer tissues. Area under curve (AUC) of miR-206 level in the diagnosis of thyroid cancer was 0.889, and the sensitivity and specificity were 92.3% and 81.5%, respectively. AUC of CCND2 level in the diagnosis of thyroid cancer was 0.837, and the sensitivity and specificity were 67.7% and 89.2%, respectively. The AUC of combined detection of CCND2 and miR-206 in the diagnosis of thyroid cancer was 0.959, and the sensitivity and specificity were 93.8% and 87.7%, respectively. The levels of miR-206 and CCND2 were significantly correlated with TNM staging and lymph node metastasis.

Conclusions

miR-206 and CCND2 may become new biomarkers for clinical diagnosis of thyroid cancer based on the fine-needle aspiration cytology of thyroid nodules.
Integrating case management for patients with complex needs in the ground practice: the importance of context in evaluative designs
Authors: Hudon Catherine , Kessler Rodger
Published: January 2023

Responding to complex needs calls for integrating care across providers, settings and sectors. Among models to improve integrated care, case management demonstrates a good evidence base of facilitating the appropriate delivery of healthcare services. Since case management is a complex, multi component intervention, with its component parts interacting in a non-linear manner, effectiveness is largely influenced by the context in which the intervention is implemented. This paper discusses how to respond to implementation challenges to evaluating complex interventions for patients with complex needs. Building on the example of case management, we suggest that documenting innovation effectiveness remains important, but that evaluation needs to include theory-based and systems perspectives. We also suggest that implementation science needs to be part of intervention design while engaging stakeholders to define the most relevant research questions and implementation effectiveness, to optimize successful implementation and sustainability.
In-country availability of medical abortion medicines: a description of the framework and methodology of the WHO landscape assessments
Authors: Rehnström Loi Ulrika , Prata Ndola , Grossman Amy , Lavelanet Antonella , Williams Natalie , Ganatra Bela
Published: January 2023

Background

Availability of quality-assured medical abortion medicines plays a crucial role in providing comprehensive abortion care. However, access to these medicines is still restricted for many abortion seekers. Increasing availability of affordable, quality-assured mifepristone and misoprostol is important to improve access to safe medical abortion services. Driven by the outcomes of a global consultation hosted by the World Health Organization and the Swedish International Development Cooperation Agency in 2018, we decided to holistically examine access to medical abortion medicines from supply to demand. The overarching principle of the national landscape assessments was to generate evidence to support policy dialog and policymaking that is contextual to the needs of the country. This paper aims to describe the framework and methodological approach used in the World Health Organization landscape assessments of medical abortion medicines at country-level.

Methods

A country assessment protocol was developed to guide the methodology of the World Health Organization landscape assessments. The assessment protocol included adaptation of an existing availability framework, an online desk review and literature review for existing data available for the country of interest, country-level key informant interviews, and analysis of the data to identify barriers and opportunities to improve medical abortion availability.

Conclusion

The availability framework and methodology will allow the identification of key barriers that limit readiness of medical abortion medicines, and the development of opportunities to overcome those barriers. The national landscape assessments will provide directions for future investments and offer guidance for policy and programming on medical abortion care.
Women’s voice on changes in childbirth care practices: a qualitative approach to women’s experiences in Brazilian private hospitals participating in the Adequate Childbirth Project
Authors: Rodrigues Andreza Pereira , de Oliveira Débora Cecília Chaves , Gomes Maysa Luduvice , de Azevedo Nicida Lucia Regina , Torres Jacqueline Alves , da Trindade Dias Coutinho Amanda , de Souza Cravo Beatriz da Silva Soares , Dantas Juliana Guimarães , Oliveira Thays Basílio , Domingues Rosa Maria Soares Madeira
Published: January 2023

Background

In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The National Supplementary Health Agency proposed the Adequate Childbirth Project (PPA), a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. The objective of this study is to assess how the participation of women in the process of improving quality childbirth care occurred in two hospitals participating in the PPA.

Method

Qualitative study, based on interviews with 102 women attended at two hospitals that took part in the first and second stages of the “Healthy Birth”, an evaluative hospital-based research, conducted in 2017–2018, that assessed the degree of implementation and the effects of PPA. After thematic content analysis, supported by MaxQda software, three categories emerged: (1) how women gathered knowledge about the PPA, (2) how women perceived it, and (3) which are their suggestions for the PPA improvement.

Results

The PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the “new” model of care. Visits to the maternity hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women have expectations of a relationship with maternity that is not limited to the moment of delivery. The listening channels established between hospitals and women are fragile and not systematized. By increasing the supply of listening spaces, one can also increase the request to leave their suggestions and contributions, and thus gain more allies in improving the project. Women are not yet included as PPA agents and their voices are silenced.

Conclusions

Women’s participation to improve childbirth care is relevant and necessary. The women’s voice in the PPA is still incipient, and maternity hospitals and health plan operators should create strategies to insert and engage them. Women’s voices should be listened to not only during but also before and after childbirth.
Effect of mobile application types on stroke rehabilitation: a systematic review
Authors: Szeto Stephen G. , Wan Hoyee , Alavinia Mohammad , Dukelow Sean , MacNeill Heather
Published: January 2023

Background

Stroke is a significant contributor of worldwide disability and morbidity with substantial economic consequences. Rehabilitation is a vital component of stroke recovery, but inpatient stroke rehabilitation programs can struggle to meet the recommended hours of therapy per day outlined by the Canadian Stroke Best Practices and American Heart Association. Mobile applications (apps) are an emerging technology which may help bridge this deficit, however this area is understudied. The purpose of this study is to review the effect of mobile apps for stroke rehabilitation on stroke impairments and functional outcomes. Specifically, this paper will delve into the impact of varying mobile app types on stroke rehabilitation.

Methods

This systematic review included 29 studies: 11 randomized control trials and 18 quasi-experimental studies. Data extrapolation mapped 5 mobile app types (therapy apps, education apps, rehab videos, reminders, and a combination of rehab videos with reminders) to stroke deficits (motor paresis, aphasia, neglect), adherence to exercise, activities of daily living (ADLs), quality of life, secondary stroke prevention, and depression and anxiety.

Results

There were multiple studies supporting the use of therapy apps for motor paresis or aphasia, rehab videos for exercise adherence, and reminders for exercise adherence. For permutations involving other app types with stroke deficits or functional outcomes (adherence to exercise, ADLs, quality of life, secondary stroke prevention, depression and anxiety), the results were either non-significant or limited by a paucity of studies.

Conclusion

Mobile apps demonstrate potential to assist with stroke recovery and augment face to face rehabilitation, however, development of a mobile app should be carefully planned when targeting specific stroke deficits or functional outcomes. This study found that mobile app types which mimicked principles of effective face-to-face therapy (massed practice, task-specific practice, goal-oriented practice, multisensory stimulation, rhythmic cueing, feedback, social interaction, and constraint-induced therapy) and education (interactivity, feedback, repetition, practice exercises, social learning) had the greatest benefits.

Protocol registration PROPSERO (ID CRD42021186534). Registered 21 February 2021
Detection of iron deficiency anemia by medical images: a comparative study of machine learning algorithms
Authors: Appiahene Peter , Asare Justice Williams , Donkoh Emmanuel Timmy , Dimauro Giovanni , Maglietta Rosalia
Published: January 2023

Background

Anemia is one of the global public health problems that affect children and pregnant women. Anemia occurs when the level of red blood cells within the body decreases or when the structure of the red blood cells is destroyed or when the Hb level in the red blood cell is below the normal threshold, which results from one or more increased red cell destructions, blood loss, defective cell production or a depleted sum of Red Blood Cells.

Methods

The method used in this study is divided into three phases: the datasets were gathered, which is the palm, pre-processed the image, which comprised; Extracted images, and augmented images, segmented the Region of Interest of the images and acquired their various components of the CIE L*a*b* colour space (also referred to as the CIELAB), and finally developed the proposed models for the detection of anemia using the various algorithms, which include CNN, k-NN, Nave Bayes, SVM, and Decision Tree. The experiment utilized 527 initial datasets, rotation, flipping and translation were utilized and augmented the dataset to 2635. We randomly divided the augmented dataset into 70%, 10%, and 20% and trained, validated and tested the models respectively.

Results

The results of the study justify that the models performed appropriately when the palm is used to detect anemia, with the Naïve Bayes achieving a 99.96% accuracy while the SVM achieved the lowest accuracy of 96.34%, as the CNN also performed better with an accuracy of 99.92% in detecting anemia.

Conclusions

The invasive method of detecting anemia is expensive and time-consuming; however, anemia can be detected through the use of non-invasive methods such as machine learning algorithms which is efficient, cost-effective and takes less time. In this work, we compared machine learning models such as CNN, k-NN, Decision Tree, Naïve Bayes, and SVM to detect anemia using images of the palm. Finally, the study supports other similar studies on the potency of the Machine Learning Algorithm as a non-invasive method in detecting iron deficiency anemia.
Protein degradation: expanding the toolbox to restrain cancer drug resistance
Authors: Ming Hui , Li Bowen , Jiang Jingwen , Qin Siyuan , Nice Edouard C. , He Weifeng , Lang Tingyuan , Huang Canhua
Published: January 2023

Despite significant progress in clinical management, drug resistance remains a major obstacle. Recent research based on protein degradation to restrain drug resistance has attracted wide attention, and several therapeutic strategies such as inhibition of proteasome with bortezomib and proteolysis-targeting chimeric have been developed. Compared with intervention at the transcriptional level, targeting the degradation process seems to be a more rapid and direct strategy. Proteasomal proteolysis and lysosomal proteolysis are the most critical quality control systems responsible for the degradation of proteins or organelles. Although proteasomal and lysosomal inhibitors (e.g., bortezomib and chloroquine) have achieved certain improvements in some clinical application scenarios, their routine application in practice is still a long way off, which is due to the lack of precise targeting capabilities and inevitable side effects. In-depth studies on the regulatory mechanism of critical protein degradation regulators, including E3 ubiquitin ligases, deubiquitylating enzymes (DUBs), and chaperones, are expected to provide precise clues for developing targeting strategies and reducing side effects. Here, we discuss the underlying mechanisms of protein degradation in regulating drug efflux, drug metabolism, DNA repair, drug target alteration, downstream bypass signaling, sustaining of stemness, and tumor microenvironment remodeling to delineate the functional roles of protein degradation in drug resistance. We also highlight specific E3 ligases, DUBs, and chaperones, discussing possible strategies modulating protein degradation to target cancer drug resistance. A systematic summary of the molecular basis by which protein degradation regulates tumor drug resistance will help facilitate the development of appropriate clinical strategies.
Retraction Note: M2 macrophage-derived extracellular vesicles promote gastric cancer progression via a microRNA-130b-3p/MLL3/GRHL2 signaling cascade
Authors: Zhang Yu , Meng Wenbo , Yue Ping , Li Xun
Published: January 2023

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s13046-020-01626-7.
Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis
Authors: Abate Semagn Mekonnen , Basu Bivash , Jemal Bedru , Ahmed Siraj , Mantefardo Bahru , Taye Tagesse
Published: January 2023

Background

The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission and the incidence of mortality. However, the body of evidence on the clinical outcomes among patients with MV is still uncertain.

Objective

The objective of this study was to investigate the pattern of disease and determinants of mortality among patients receiving mechanical ventilation in Southern Ethiopia.

Methods

Six hundred and thirty patients on mechanical ventilation were followed for 28 days, and multilevel analysis was used to account for the clustering effect of ICU care in the region.

Results

The incidence of 28-day mortality among patients with MV was 49% (95% CI: 36–58). The multilevel multivariate analysis revealed that being diabetic, having GSC < 8, and night time admission (AOR = 7.4; 95% CI: 2.96–18.38), (AOR = 5.9; (5% CI: 3.23, 10.69), and (AOR = 2.5; 95% CI: 1.24, 5.05) were predictors.

Conclusion

The higher 28-day mortality among ICU patients on mechanical ventilation in our study might be attributed to factors such as delayed patient presentation, lack of resources, insufficient healthcare infrastructure, lack of trained staff, and financial constraints.

Trial Registration. The protocol was registered retrospectively on (NCT05303831).
Cystic pancreatic lymphangioma: a case report
Authors: Assefa Hiwote Girma , Merga Tafese Gudissa , Godu Binyam Gebremedhin
Published: January 2023

Background

Lymphangiomas are benign vascular tumors arising from the lymphatic system. They commonly affect the head and neck regions. Pancreatic involvement is extremely rare. Even though they are rare, it should be considered as a differential diagnosis for patients who present with pancreatic mass.

Case presentation

We report the case of a 6-year-old African male patient who presented with abdominal mass and dull aching pain of 6 months duration. He was examined and underwent excision, with biopsy showing pancreatic lymphangioma.

Conclusion

These tumors are benign and slow growing and have potential to regress spontaneously. Thus, most literature agrees that surgical interventions should be reserved for symptomatic cases.
Infectivity and transmissibility of an avian H3N1 influenza virus in pigs
Authors: Stadejek Wojciech , Chiers Koen , Van Reeth Kristien
Published: January 2023

In 2019 a low pathogenic H3N1 avian influenza virus (AIV) caused an outbreak in Belgian poultry farms, characterized by an unusually high mortality in chickens. Influenza A viruses of the H1 and H3 subtype can infect pigs and become established in swine populations. Therefore, the H3N1 epizootic raised concern about AIV transmission to pigs and from pigs to humans. Here, we assessed the replication efficiency of this virus in explants of the porcine respiratory tract and in pigs, using virus titration and/or RT-qPCR. We also examined transmission from directly, intranasally inoculated pigs to contact pigs. The H3N1 AIV replicated to moderate titers in explants of the bronchioles and lungs, but not in the nasal mucosa or trachea. In the pig infection study, infectious virus was only detected in a few lung samples collected between 1 and 3 days post-inoculation. Virus titers were between 1.7 and 4.8 log10 TCID50. In line with the ex vivo experiment, no virus was isolated from the upper respiratory tract of pigs. In the transmission experiment, we could not detect virus transmission from directly inoculated to contact pigs. An increase in serum antibody titers was observed only in the inoculated pigs. We conclude that the porcine respiratory tract tissue explants can be a useful tool to assess the replication efficiency of AIVs in pigs. The H3N1 AIV examined here is unlikely to pose a risk to swine populations. However, continuous risk assessment studies of emerging AIVs in pigs are necessary, since different virus strains will have different genotypic and phenotypic traits.
Topography and climate of Mount Karanfil (Pozantı/Adana)
Authors: Çetin Muhammed , Meydan Ali
Published: January 2023

The goal of this study is to investigate the impact of the topographic features of Mount Karanfil and its surroundings on the local climate. Mount Karanfil, located in the Mediterranean Basin, has a unique ecological position due to its topography. This study analyzed temperature, precipitation, and wind conditions at Mount Karanfil from 1980 to 2018 using data from the General Directorate of Meteorology (MGM). The temperature indices were calculated using the Clima data and the ArcGIS v10.5 software package. The temperature indices series was analyzed using cluster analysis in ArcGIS v10.5 before being used to calculate the maximum and minimum temperature and precipitation values for each month. The spatial estimation method IDW interpolation was then applied to these data. The initial analysis showed significant differences in temperature, precipitation, and wind conditions between this location and others. This may be due to the southern aspect of the landscape, which receives more precipitation than other slopes and is affected by south-oriented sectoral winds that bring abundant precipitation to the southern slopes. The results of the temperature indices analysis showed that evaporation tends to increase on hot days with high maximum temperatures compared to days with low minimum temperatures. The Emberger bioclimatic index also confirmed the typical Mediterranean climate of mild, rainy winters and hot, dry summers. In addition to the regional climate and geology, the geomorphologic conditions of the mountainous mass and the specific valley profiles of the Ecemis stream and Cakıt stream (such as the strait valley) were found to influence the local climate. These valley profiles, which are composed of narrow and deep dolomitic and limestone layers, showed differences in climate due to their slope, elevation, and aspect, as analyzed using digital elevation models with a resolution of 10–20 m. These topographic analyses revealed that elevation decreases and humidity increases in alluvial valley floors.
Rheological and Mechanical Properties of Kenaf and Jute Fiber-Reinforced Cement Composites
Authors: Gwon Seongwoo , Han Seong Ho , Vu Thanh Duc , Kim Chanyoung , Shin Myoungsu
Published: January 2023

This study investigated the rheological and mechanical properties of cement composites with kenaf and jute fibers for use in shotcrete. The length and volume fractions of the fiber were varied; the rheological properties were analyzed in terms of air content, compression and flexural tests were conducted, and the degree of fiber dispersion was assessed using fluorescence microscopy. The rougher surfaces of the jute fibers led to a higher yield stress and viscosity of the composite compared to the kenaf fibers. The use of 10-mm-long jute fibers at 2.0% volume fraction led to optimal rheological properties while 30-mm-long jute fibers at 1.0% resulted in the worst properties. The yield stress and plastic viscosity exhibited positive and negative correlations with the fiber volume fraction, respectively. This was likely because of the bridging and fluid actions of the bubbles at higher fiber content. For a given fiber content, only the yield stress increases with an increase in fiber length. Although all the mechanical properties deteriorated (compressive strength decreased from 27.5 to 6 MPa, and flexural strength deteriorated from 6.2 to 1.8 MPa), the mixtures failed in a ductile manner. Using 10-mm-long kenaf fibers at 2.0% induced optimal fiber dispersion, whereas the minimum dispersion-coefficient value was found for 5-mm-long kenaf fibers at 0.5%.
The contributions of injury deaths to the gender gap in life expectancy and life disparity in Eastern Mediterranean Region
Authors: Bairami Firoozeh , Hajizadeh Mohammad , Kiadaliri Ali
Published: January 2023

Background

Injury deaths constitute a major avoidable cause of death affecting life expectancy to a different degree in men and women. This study quantified the contributions of injury deaths to the gender gap in life expectancy (GGLE) and life disparity (GGLD) in nine Eastern Mediterranean Region (EMR) countries.

Methods

We retrieved annual data on age-sex specific causes of death from the World Health Organization mortality database for EMR countries with at least 2-year consecutive data during 2010–2019. The injury-related deaths were categorized into five groups: transport accidents, other accidental injuries, intentional self-harm, assault and events of undetermined intent. Considering women as the reference, the GGLE and GGLD were decomposed by age and causes of death, using a continuous-change model.

Results

The largest and smallest GGLE were observed in Kuwait (5.2 years) and Qatar (− 1.2 years), respectively. Qatar (− 2.2 years) and Oman (0.2 years) had the highest and lowest GGLD. The highest contributions of injury deaths to the GGLE/GGLD were seen in Libya (1.8/− 1.2 years), followed by Iran (1.2/− 0.8 years). Among injury causes, transport accidents were the leading cause of GGLE in all countries but Libya and Morocco, with Iran having the greatest contributions (0.6 years). Injury deaths in men aged 15–29 years accounted for 33% [41%] (Kuwait) to 55% [65%] (Oman) of total GGLE [GGLD] attributable to injury deaths.

Conclusions

High injury deaths, particularly transport accidents, among young men contributed substantially to the GGLE and GGLD across nine EMR countries in this study. This highlights the need for implementing preventing policies to reduce the burden of injury deaths specifically in young men.
Diagnostic performance of prospective same-day 18F-FDG PET/MRI and 18F-FDG PET/CT in the staging and response assessment of lymphoma
Authors: Mistry Vijay , Scott Justin R. , Wang Tzu-Yang , Mollee Peter , Miles Kenneth A. , Law W. Phillip , Hapgood Greg
Published: January 2023

Background

Accurate staging and response assessment are essential for prognosis and to guide treatment in patients with lymphoma. The aim of this study was to compare the diagnostic performance of FDG PET/MRI versus FDG PET/CT in adult patients with newly diagnosed Hodgkin and Non- Hodgkin lymphoma.

Methods

In this single centre study, 50 patients were prospectively recruited. FDG PET/MRI was performed after staging FDG PET/CT using a single injection of 18F-FDG. Patients were invited to complete same-day FDG PET/MRI with FDG PET/CT at interim and end of treatment response assessments. Performance was assessed using PET/CT as the reference standard for disease site identification, staging, response assessment with Deauville score and concordance in metabolic activity.

Results

Staging assessment showed perfect agreement (κ = 1.0, P = 0) between PET/MRI and PET/CT using Ann Arbor staging. There was excellent intermodality correlation with disease site identification at staging (κ = 0.976, P < 0.001) with FDG PET/MRI sensitivity of 96% (95% CI, 94–98%) and specificity of 100% (95% CI, 99–100%). There was good correlation of disease site identification at interim assessment (κ = 0.819, P < 0.001) and excellent correlation at end-of-treatment assessment (κ = 1.0, P < 0.001). Intermodality agreement for Deauville scores was good at interim assessment (κ = 0.808, P < 0.001) and excellent at end-of-treatment assessment (κ = 1.0, P = 0). There was good–excellent concordance in SUV max and mean between modalities across timepoints. Minimum calculated radiation patient effective dose saving was 54% between the two modalities per scan.

Conclusion

With high concordance in disease site identification, staging and response assessment, PET/MR is a potentially viable alternative to PET/CT in lymphoma that minimises radiation exposure.
Classification and microsurgical treatment of foramen magnum meningioma
Authors: Wu Pengfei , Guan Yanlei , Wang Minghao , Zhang Luyang , Zhao Dan , Cui Xiao , Liu Jiyuan , Qiu Bo , Tao Jun , Wang Yunjie , Ou Shaowu
Published: January 2023

Background

To investigate the classification and microsurgical treatment of foramen magnum meningioma (FMM).

Methods

We retrospectively analyzed 76 patients with FMM and classified them into two classifications, classification ABS according to the relationship between the FMM and the brainstem and classification SIM according to the relationship between the FMM and the vertebral artery (VA). All patients underwent either the far lateral approach (54 cases) or the suboccipital midline approach (22 cases).

Results

Of the 76 cases, 47 cases were located ahead of the brainstem (A), 16 cases at the back of the brainstem (B), and 13 cases were located laterally to the brainstem (S). There were 15 cases located superior to the VA (S), 49 cases were inferior (I), and 12 cases were mixed type (M). Among 76 cases, 71 cases were resected with Simpson grade 2 (93.42%), 3 with Simpson grade 3 (3.95%), and 2 with Simpson grade 4 (2.63%). We summarized four anatomical triangles: triangles SOT, VOT, JVV, and TVV. The mean postoperative Karnofsky performance score was improved in all patients (p < 0.05). However, several complications occurred, including hoarseness and CSF leak.

Conclusion

ABS and SIM classifications are objective indices for choosing the surgical approach and predicting the difficulty of FMMs, and it is of great importance to master the content, position relationship with the tumor, and variable anatomical structures in the four “triangles” for the success of the operation.
The effectiveness of Collaborative Online International Learning (COIL) on intercultural competence development in higher education
Authors: Hackett Simone , Janssen Jeroen , Beach Pamela , Perreault Melanie , Beelen Jos , van Tartwijk Jan
Published: January 2023

In this study we measured the effect of COIL on intercultural competence development using a quasi-experimental design. Our sample consisted of 108 undergraduate students from two universities, one located in the Netherlands (NL) and one in the United States (US). Students’ self-reported intercultural competence was measured using a pre-post survey which included the Cultural Intelligence Scale (CQS) and Multicultural Personality Questionnaire (MPQ). Qualitative data were collected to complement our quantitative findings and to give a deeper insight into the student experience. The data showed a significantly bigger increase in intercultural competence for the US experimental group compared to the US control group, supporting our hypothesis that COIL develops intercultural competence. This difference was not observed for the NL students, possibly due to the NL control group being exposed to other international input during the course.
Novel pyrroline-5-carboxylate reductase 2 (PYCR2) mutation in an Iranian patient with hypomyelinating leukodystrophy: findings of molecular and in silico investigations
Authors: Akbari Maryam , Ebrahimi Tapeh Zeinab , Zaersabet Mona , Rahimi Hamzeh , Ganji Maziar
Published: January 2023

Background

Hypomyelinating leukodystrophy (HLD) is a specific group of leukodystrophies and is characterized by progressive postnatal growth delay that represents a type of clinically overlapping but genetically heterogeneous diseases with autosomal recessive inheritance. Loss-of-function mutations in PYCR2 are one of the main causes of HLD type 10 (HLD10), which is identified by cerebral hypomyelination, inadequate growth, brain atrophy, and movement abnormality. This study aimed to investigate the molecular etiology of HLD10 disorder in an Iranian patient from a consanguineous marriage family.

Results

The DNA samples were extracted from the patient, a 9-year-old girl, and her parents. Whole-exome sequencing was conducted for these samples and the results were eventually confirmed and segregated via Sanger sequencing. Our findings demonstrated a novel homozygous frameshift mutation in PYCR2 gene, c.135dup (NM_013328.4). The heterozygous state of this variant was confirmed in parents. Additionally, this mutation was predicted to exhibit damaging effects through protein sequence alteration.

Conclusions

Such findings are of importance for understanding the underlying pathogenicity mechanisms and for improving genetic counseling knowledge of HLD patients for families.
Survival outcomes and functional results of VOLTAGE-A: Preoperative chemoradiotherapy (CRT) and consolidation nivolumab (nivo) in patients (pts) with both microsatellite stable (MSS) and microsatellite instability–high (MSI-H) locally advanced rectal cancer (LARC).
Authors: Tsukada Yuichiro , Bando Hideaki , Inamori Koji , Wakabayashi Masashi , Togashi Yosuke , Koyama Shohei , Kotani Daisuke , Yuki Satoshi , Komatsu Yoshito , Homma Shigenori , Taketomi Akinobu , Uemura Mamoru , Kato Takeshi , Fukui Makoto , Kojima Motohiro , Sato Akihiro , Nishikawa Hiroyoshi , Ito Masaaki , Yoshino Takayuki
Published: January 2023

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Background: In VOLTAGE-A, CRT (50.4 Gy with capecitabine of 1,650 mg/m2) followed by five cycles of consolidation Nivo (240 mg q2 weeks [W]) and radical surgery showed 30% of pathological complete response (pCR) in pts with MSS and 60% in MSI-H T3–4 NanyM0 LARC. Here, we report survival outcomes and functional results. Methods: All 39 MSS and 5 MSI-H pts were included in the VOLTAGE-A from Jan 2017 to Oct 2019. Survival outcomes, late adverse events, and patient-reported outcome measurements for urogenital and anal functions were analyzed. Urinary function was evaluated using the International Prostate Symptom Score (I-PSS) periodically at 1W, 1, 3, 6, and 12 months (M), postoperatively. Sexual function in sexually active male pts was evaluated using the International Index of Erectile Function (IIEF) score at 3, 6, and 12M, postoperatively. Anal function was evaluated using the Wexner score, low anterior resection syndrome (LARS) score, and fecal incontinence severity index (FISI) score at 1-year post-surgery. All functional scores were evaluated preoperatively. Results: With a median follow-up of 44.8M (range, 25.7-58.9M), the 3-year relapse-free survival (RFS) and 3-year overall survival (OS) rates were respectively 79.5% and 97.4% in MSS, and 100% each in MSI-H pts. Of the MSS pts, those with pCR, clinical CR (cCR) according to the MSKCC criteria, high PD-L1 expression (tumor proportion score [TPS] ≥1%), and CD8/eTreg ratios of ≥2.5 had a trend of better 3-year RFS and OS than those without. During the follow-up period, one patient developed CTCAE grade 3 immune-related colitis, which was diagnosed 20M after the last dose of Nivo. Postoperative functional results were acceptable in both populations; pre-surgical median I-PSS scores were 3, whereas postsurgical values were 5 (1W), 5.5 (1M), 5 (3M), 4 (6M), and 4 (12M); median IIEF score was 20 at pre-surgery and 6 (3M), 6 (6M), and 8 (12M) at post-surgery; median scores of Wexner, LARS, and FISI were 2, 23, and 7 at pre-surgery, and 9, 30, and 17 at 1-year post-surgery, respectively. Conclusions: Preoperative CRT followed by Nivo showed promising survival outcomes in both MSS and MSI-H LARC pts. The therapeutic effect of pCR, cCR, and certain biomarkers analyzed by pre-CRT samples could be used as prognostic predictors in MSS pts. Clinical trial information: NCT02948348 .[Table: see text]
Regorafenib, ipilimumab, and nivolumab (RIN) in chemotherapy-resistant MSS metastatic colorectal cancer (mCRC).
Authors: Fakih Marwan , Sandhu Jaideep Singh , Lim Dean , Li Sierra , Wang Chongkai
Published: January 2023

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Background: We recently reported on the activity of regorafenib (R), ipilimumab (I) and nivolumab (N) (RIN) in microsatellite stable (MSS) mCRC. Here, we describe mature efficacy data at the recommended phase 2 dose (RP2D) and the results of a new escalation (ESC) cohort of 40 mg to 80 mg regorafenib. Methods: Patients (pts) with chemotherapy resistant MSS mCRC received RIN at (R) at 80 mg QD x 21 days in 4-week(w) cycle, (I) at 1mg/kg Q6w and (N) at 240 mg Q 2w. If no more than 1 dose limiting toxicity (DLT) was noted in 6 evaluable pts, an expansion cohort was assessed at that dose level. Following RP2D establishment and given the increased rate of transient skin toxicity on cycle (C) 1, the protocol was amended to explore a 10-pt cohort with 40 mg/day (R) on C1 with escalation to 80mg/day on C2+. Results: 39 pts with chemotherapy resistant MSS mCRC were enrolled. 29 pts enrolled on the RP2D and 10 pts at the amended 40 to 80mg cohort. At the RP2D and ESC cohorts, 7 and 3 pts had liver metastases (LM), respectively. No significant clinical activity was noted in LM pts (ORR = 0%, median progression free survival (mPFS) = 2 months (mo)). Overall response rate (ORR), disease control rate (DCR), mPFS, median overall survival (OS) in the 22 pts with non-LM (NLM) pts in the RP2D and ESC cohorts were 36% (41% iRECIST), 68% (82% iRECIST), 5.0 mo (6.0 mo iRECIST), > 22 mo (not reached) and 0%, 57% (71.4% iRECIST), 4 mo (4 mo iRECIST), and > 10 mo (not reached). 6/22 NLM at the P2RD remain without PD at 22 mo and beyond. All 7 NLM pts in the ESC cohort progressed by 7 mo from enrollment. ctDNA (Guardant 360) assays were available at baseline and at 4-6 weeks in 23/39 pts. Early ctDNA clearance was confirmed in 8/17 pts at RP2D (4PR and 4SD > 6 mo; mPFS = 11 mo) and 2/6 pts at the ESC cohort (PFS 4.5 mo and 7mo). An ESC vs. RP2D strategy mitigated skin rash (10% vs. 38% grade (G) 3; 20% vs. 66% any G). Other immune related ≥ G3 toxicities are summarized. Conclusions: RIN (80/1/240) has substantial activity in MSS NLM mCRC patients. An ESC strategy of 40/1/240 to 80/1/240 on C2+ reduced transient skin rash and other immune-mediated toxicities but was associated with less favorable clinical outcome. These data suggest that a starting R dose of 80 mg is important in priming the immune response to RIN. The RP2D of 80/1/240 mg is recommended for further investigation in NLM mCRC. Clinical trial information: NCT04362839 . [Table: see text]