bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons learned from Percutaneous Indirect Annuloplasty in the Treatment of Mitral Regurgitation and Future Perspectives
Authors: Aittigrine Souhila , Chiali Nabil , Tozzi Piergiorgio
Published: April 2023

Mitral annuloplasty is the most performed surgical procedure in the treatment of mitral valve regurgitation. However, the morbidity and mortality risks associated with this procedure limit its broader application, especially in patients with comorbidities or less severe mitral valve regurgitation. A less invasive percutaneous approach associated with lesser morbidity might offer advantages compared with mitral annuloplasty in some patients. In order to find such an approach, the use of the coronary sinus has been extensively explored. The anatomical relationship between the coronary sinus and the posterior annulus of the mitral valve inspired several creative solutions to restore mitral leaflets coaptation. Coronary sinus annuloplasty attempts to replicate the results of surgical annuloplasty by reducing the antero-posterior diameter of the mitral annulus. In the present manuscript, we performed a systematic review of the devices using the coronary sinus as a key element to correct mitral regurgitation, including two devices still in preclinical phase and those currently awaiting premarket approval. We discussed the most recently published results related to percutaneous annuloplasty, highlighted the pros and cons of each approach, and summarized the lessons learned to improve clinical results.
The US Centers for Medicare & Medicaid Services’ (CMS) failure to provide payment for invasive FFR has resulted in worse and inequitable Medicare beneficiary healthcare.
Authors: Dorros Gerald
Published: April 2023

The unintended consequences of the US Centers for Medicare & Medicaid Services’ (CMS) decision not to pay for invasive diagnostic FFR (Fractional Flow Reserve) has precluded its routine diagnostic use in hundreds of thousands of Medicare Beneficiaries, who suffered inappropriate coronary stent procedures (PCI) that worsened Medicare beneficiaries’ clinical outcomes: 20% of PCI patients have no or uncertain clinical indications but are operated upon, nevertheless, and 33% of potential PCI stenoses are non-ischemic and require no PCI. These unnecessary PCIs, often confounded by aging’s anatomical and comorbid complexities, result in preventable complications, repeat procedures, worse clinical outcomes, unwarranted deaths, and an avoidable $1 billion annual expenditure. The best coronary artery disease (CAD) patient care requires astute clinical assessment coupled with diagnostic physiologic ischemic lesion categorization, which directly links lesion treatment to patient management. CMS’ unrealistic expectation that their bundled payment to a single healthcare provider payment would motivate providers to maximize their profits through efficiently coordinated and improved care was naive; this foolish policy of eschewing invasive FFR payment and expecting providers to absorb the FFR pressure wire’s cost, has inflicted potential irreparable harm on all Medicare beneficiaries. CMS has forsaken its mission to attain the “highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes”.
Managing the Symptoms of Multiple Sclerosis
Authors: Sneha Bagchi , Lauren Gluck , Langston Christopher
Published: April 2023

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that is characterized by recurrent bouts of acute neuroinflammation and chronic neurodegeneration. Treatments for MS are aimed at prevention of disability in the future or restoring function in the present. Prevention treatments disrupt the underlying disease pathology, whereas restorative treatments address not only the disease’s primary effects on the central nervous system, but also secondary effects on other parts of the body and tertiary effects on each patient’s psychosocial functioning. MS symptoms can have primary, secondary, and tertiary components, which can interlock and reinforce each other. Restorative treatment should tease apart these components and address them separately. In this article on symptom management, we focus on treatments that aim to maximize each component of function.
Role of Mass Media and Public Health Communications in COVID-19 Vaccination
Authors: Anwar Ayesha , Malik Meryem , Raees Vaneeza , Anwar Maryem , Anwar Anjum
Published: April 2023

Vaccines offer life-saving protection against diseases and keep us safe from the harmful effects. The speedy development of vaccines during COVID-19 pandemic has reduced the coronavirus’s transmissibility and severity. COVID-19 vaccine development was challenging but the global scientific collaboration and use of resources including extensive funding made it possible. COVID-19 vaccines were deployed in controlled phases for general public use, initially offering them to the first responders and those vulnerable to life threatening effects of virus. However, it was observed that the general population has widespread vaccine hesitancy. Mass media plays a critical role in influencing people’s attitudes and practices. A common man cannot comprehend correlation from causation and jumps to conclusions. Media has the power to unite the world on one platform for a common cause. It is a source for the public to seek information, but like a double ended sword, this platform that provides information, also gives misinformation. On one hand, the public uses the media to seek information for vaccine safety and efficacy and on the other hand, to propagate unverified conspiracies against vaccines. In this review, we analyze the role of mass media and public health communications in COVID-19 vaccination from December 11, 2020, to September 15, 2021, and draw scientific inferences. We have discussed vaccine hesitancy and some prominent reasons that instil fear among the public, including the implausible claims of vaccines being the carriers of Radio Frequency Identification (RFID) microchips, impairing the reproductive systems, converting humans to hybrids, and the misconceptions about herd immunity. A consequential role of media was observed in keeping the world updated and motivated by tracking the vaccine number, distribution and deployment through live dashboards. We saw an upward trend in vaccination numbers with media campaigns, social media vaccination surveys, and socio-medico evidence. Thus, we have proposed a model for developing public awareness and health promotion using media as a tool for better distribution and administration of COVID-19 vaccines. With this, health organizations can gain widespread public trust, manage anti-vaccine movements, overcome threats faced due to vaccine conspiracy theories and eventually overcome the COVID-19 and future pandemics.
Clinical Intuition and Working Memory: Implications for Training and Supervision
Authors: John Michael
Published: April 2023

Competence with emergent intuitive awareness, from fringe-of-consciousness hunches to compelling difference-in-kind realisations, is an imprecise qualitative skill and, on this basis, one generally overlooked in clinical psychology training and supervision. This situation is at marked odds with an expanding literature highlighting that intuitions emerging from unconscious inferential cognition serve as a primary resource in the decision-making of expert practitioners across a dissimilar range of professions. Additionally, (i) over forty years extensive and distinct research into working memory conclusively demonstrates that System 1 autonomous inferential reasoning is the mind’s powerhouse, yet moreover (ii) plays a determining role in attention allocation and thereby meta-level reasoning processes (i.e., System 2; cognitive control/metacognition), the very constituents of reflective practice. In short, the case appears overwhelming for clinical intuition competency training. Additionally, a substantial reflective practice training literature which could readily be modified to include clinical intuition considerations sits immediately at hand. One difficulty, however, is that an accommodating model which will seamlessly link, firstly, difference-in-kind S1 emergent awareness, and, secondly, meta-level reflective practice, is yet to be highlighted. Remarkably, coherence-based reasoning sits in plain sight as a potential bridging position. Finally, expanding upon elementary suggestions in the literature, the toolbox skills ‘slow-onset speech’, ‘affective inquiry’, and ‘therapeutic presence’ are put forward as therapy technique functional for enhancing a clinician’s intuition sensitivity.
Helicobacter Pylori is the Cause of Human Gastric Cancer
Authors: Barukčić Ilija
Published: April 2023

Background—Helicobacter pylori (HP) infection has been repeatedly reported to be associated with human gastric cancer (GC). However, Epstein Bar virus (EBV) has been found in gastric cancer tissues too. It is therefore not surprising that it proved difficult to establish a causal relationship between Helicobacter pylori and gastric cancer. A systematic review and meta-analysis of observational studies was performed to re-investigate the relationship between Helicobacter pylori and gastric cancer. Material and methods—The electronic database PubMed was searched for titles and abstracts of studies which investigated the relationship between HP and GC. Four eligible Japanese studies were included in this meta-analysis (196 incident gastric cancers among a total of 14792 individuals). The data available were analysed by new statistical methods. This study considers 5% as a reasonable cut-off for statistical significance. Results—The studies reviewed provided highly significant evidence that a HP infection is a necessary condition of GC. In everyday language, without a helicobacter pylori infection, no human gastric cancer (P Value < .004). In the same respect, the causal relationship between HP and GC was highly significant too. Conclusion—In a systematic review and meta-analysis, it was possible to establish a causal relationship between HP and GC. Helicobacter pylori is the cause of human gastric cancer. Keywords: Helicobacter pylori, human gastric cancer, cause effect relationshi
Drug-resistant Stem Cell Models for the Hormone-responsive Luminal A Breast Cancer
Authors: Telang Nitin
Published: April 2023

Background: Progression of early stage breast cancer to advanced stage metastatic disease represents a major cause of death in women. The Luminal A breast cancer subtype exhibits acceptable response to Chemo-endocrine and targeted therapy. However, these treatment options are associated with intrinsic/acquired therapy resistance and emergence chemo-resistant cancer initiating stem cell population, and resultant progression to advanced stage metastatic disease. These limitations emphasize an unmet need for the development of reliable models for cancer stem cells that facilitate identification of efficacious therapeutic alternatives. Documented human consumption, low systemic toxicity, preclinical cancer growth inhibitory efficacy and stem cell targeting efficacy of natural products, such as dietary phytochemicals and nutritional herbs, provide mechanistic leads for these agents as testable therapeutic alternatives. Objectives: The objectives of the present review are to i.) Provide a systematic discussion of published evidence relevant conceptual background of conventional/targeted therapy and nutritional herbs as testable alternatives, ii.) Growth inhibitory efficacy of nutritional herbs in a cellular model for the Luminal A breast cancer, iii.) Breast cancer stem cell biology and stem cell models for therapy-resistant breast cancer, and iv.) Future research directions. Conclusions: Collectively, all the elements discussed in the present review validate mechanism-based experimental approaches to identify and prioritize potential therapeutic alternatives. Future Research: This review provides a rationale for investigations on patient-derived tumor samples that may minimize extrapolation of the preclinical data for their clinical relevance and translatability.
Lead Drug Discover Strategies from Natural Medicines Based on Network Pharmacology
Authors: Ma Shitang , Hou Jiafu , Liu Shijuan , Zhu Fucheng , Wei Peipei , Feng Chengtao , Chen Naidong
Published: April 2023

The need for therapeutics to overcome development of existing diseases research to discover new lead agents. In the face of public health challenges worldwide, natural medicines play a pivotal role in innovative lead drug discovery. Network pharmacology can easily construct complicated poly-pharmacology network based on lead compound, biological function, and bioactive target proteins, which meets the overall feature of natural medicines, and enable to elucidate the action mechanism at molecule-protein level with systematic view. In this work, we first summarized the recent progress delineating lead drug development and its interaction with natural medicines. Second, we focused on the relationship between natural medicines and network pharmacology. Additionally, we discussed current issues and potential prospects for the lead drug discover from natural medicines by network pharmacology. Further investigations should be focus on relevant structural analysis for biological experiment, also the dynamic and quantitative network development. In summary, it is a rational approach for innovative lead drug discovery, and with the development of structure and biology research, this approach makes it a very powerful method for the lead molecules in a high-throughput manner from a comprehensive and powerful special multi-compound to target protein/disease poly pharmacology network.
Feasibility of Inclusive Education in Greece: Current Challenges, Difficulties, and Opportunities
Authors: Mantzikos Constantinos , Lappa Christina
Published: April 2023

Statements made by major governmental and non-governmental bodies and organizations (UNESCO, UNICEF, UNFPA, UNDP, and the World Bank), members of various governments, and during significant historical conferences (Dakar, 2000, Amman, 1996, and Jomtien, 1990) emphasized the importance of ‘Education for All’. This is a message that reflects the spirit and philosophy of inclusive education, an education free of discrimination, barriers, limitations, and stigmatization; an education guided by respect, acceptance, solidarity, and understanding. The aim of this article is to introduce the concept of Inclusive Education, and to emphasize the significance of educational transformations and modifications to be made in order to promote and implement inclusive education in schools. In addition, the barriers and advantages/benefits are discussed, and inclusive policies and practices that contribute to the creation of a more democratic school are presented. According to the analysis of this topic, many important actions must be taken in order to achieve inclusive education in each school in Greece.
A Qualitative Assessment of a Worksite Nutrition Education Intervention
Authors: Thomas Debera , Gardner Julia , Adams Alison , Lopez Nanette , Sutliffe Jay
Published: April 2023

To assess the experience of participants who had previously completed a Community Chronic Disease Prevention intervention involving a micronutrient-dense plant-rich dietary intervention. Qualitative interviews were conducted individually or in groups of 2-3. There was a total of twelve participants who had completed a Community Chronic Disease Prevention intervention of 9- or 12-week duration. Questions were designed to be open-ended to maximize the diversity of responses and to allow exploration of a full range of participant views. Interviews were conducted at locations convenient to participants. Employees of a university or regional hospital who had completed a Community Chronic Disease Prevention dietary intervention 1.5-2 years previously. Audio-tape interviews were recorded, transcribed verbatim, and analyzed for common themes and thematic patterns. Participants reported their experiences and adherence to the dietary guidelines post-intervention. Common themes were identified, including a sense of well-being and increased mindfulness. Intervention features that facilitated adherence included regular contact, the educational component, and cooking demonstrations and tastings. Barriers to adhering to the intervention included life-long habits, as well as cultural and family issues. Identification of the experiences of individuals who have participated in a Community Chronic Disease Prevention will provide a basis for incorporating social, emotional, and psychological support into future studies.
Effects of Obstructive Sleep Apnea and Insomnia on Cognitive Function
Authors: Seda Gilbert , Shrivastava Sharonya
Published: April 2023

Purpose of Review. Obstructive sleep apnea and chronic insomnia are the most common sleep disorders in adults. Both sleep disorders can adversely affect physical and mental well-being. Cognitive function has been extensively studied in relation to chronic insomnia and obstructive sleep apnea. This paper reviews the recent studies investigating the cognitive effects of insomnia and obstructive sleep apnea as well as the potential benefits of treatment. Recent Findings. Recent studies indicate that insomnia is associated with impairments in attention, memory, and executive function. Chronic insomnia may have a moderating role in mild cognitive impairment and Alzheimer’s dementia. Mood and anxiety disorders may moderate the effects of insomnia on cognitive function. Hyperarousal and short sleep time associated with insomnia are risk factors for cognitive impairment. Cognitive behavior therapy for insomnia may improve cognitive function but more studies are needed. Nonbenzodiazepine receptor agonists improve insomnia without causing cognitive impairment. Benzodiazepine use is associated with cognitive impairment. Obstructive sleep apnea is associated with impairments in attention, concentration, memory, and executive function with apnea severity as measured by the apnea hypopnea index and severity of nocturnal hypoxemia being the largest risk factors. Untreated obstructive sleep apnea may have a significant impact on the progression of mild cognitive impairment and Alzheimer’s dementia. The impact of obstructive sleep apnea treatment, particularly with continuous positive airway pressure, appears to mitigate and slow the rate of cognitive decline but more randomized controlled studies are needed. Summary. Standardized cognitive assessments and larger, long-term controlled prospective studies with diverse populations are needed to further elucidate the cognitive impairments associated with chronic insomnia and obstructive sleep apnea. More studies are needed on the benefits of various treatments for obstructive sleep apnea and insomnia.
Atrio-ventricular nodal ablation with biventricular pacing in atrial fibrillation with narrow QRS – a novel strategy to reduce mortality independent of underling left ventricular function.
Authors: Bhattacharyya Maitreyee , Sahu Ankit , Kapoor Aditya
Published: April 2023

Historically, clinical studies have demonstrated conflicting results for rate-control versus rhythm-control strategy in patients with permanent atrial fibrillation (AF) in terms of long-term mortality and morbidity. The concept of atrioventricular (AV) nodal ablation coupled with permanent biventricular pacing has recently been advocated as the closest approach to obtain a physiological reset especially in AF patients having underlying ventricular dysfunction. Herein, we present a critical analysis and detailed review based on prior and currently available evidence based on the ablation in permanent atrial fibrillation – cardiac resynchronization therapy (APAF-CRT) mortality trial.
Communication Between the Plasma Membrane and Cytosolic Cardiac Pacemakers: A Role for Melatonin?
Authors: Dowse H. , VanKirk T.
Published: April 2023

We review here briefly the essentials of the vertebrate cardiac pacemaking system consisting of the populations of ion channels that drive heartbeat. In addition to the sarcolemmal system, there is a second ion channel-based oscillator consisting centrally of a reciprocating Ca2+ flow between the sarcoplasmic reticulum and the cytosol regulated by release through ryanodine receptors and active return by the Sarcoplasmic/Endoplasmic Reticulum Calcium ATPase. We review the considerable similarity between vertebrate and the fly heart pacemakers. In our work with Drosophila, we have shown that melatonin is capable of increasing the rhythmicity of the fly heart to a remarkable level. This is true even in flies bearing mutations that severely damage ion channels central to the plasma membrane pacemaker. We review here evidence showing that mutations in the gene encoding the fly Calcium ATPase have severe effects on heart function. We present further evidence from our work that melatonin has only a modest effect in reversing these defects. We have hypothesized that melatonin acts by altering the relationship between the sarcolemmal and cytosolic oscillators and cite these and previous findings as provocative in this regard.
Bidirectional Regulation of NAD(P)H Quinone Dehydrogenase 1 Expression in Mouse Hepatic Stellate Cells- Acute versus Long-Term Ethanol Exposure
Authors: Yang Hong , Zhang Ningya , Guo ZhongMao
Published: April 2023

Conclusions: Our findings suggest that ethanol upregulates NQO1 expression by activating the AhR-Nrf2 pathway. Long-term ethanol exposure sustains low level of AhR protein and diminishes the inducibility of its target genes Nrf2 and NQO1 by BaP. These findings will contribute to understanding the synergistic toxicity of ethanol and polycyclic aromatic hydrocarbon compounds, such as BaP.
Effect of MMR Vaccination to Mitigate Severe Sequelae Associated With COVID-19: Challenges and Lessons Learned
Authors: Noverr Mairi , Yano Junko , Hagensee Michael , Lin Hui , Meyaski Mary , Meyaski Erin , Cameron Jennifer , Shellito Judd , Trauth Amber , Fidel Paul
Published: April 2023

Mortality in COVID-19 cases was strongly associated with progressive lung inflammation and eventual sepsis. There is mounting evidence that live attenuated vaccines commonly administered during childhood, also provide beneficial non-specific immune effects, including reduced mortality and hospitalization due to unrelated infections. It has been proposed that live attenuated vaccine-associated non-specific effects are a result of inducing trained innate immunity to function more effectively against broader infections. In support of this, our laboratory has reported that immunization with a live attenuated fungal strain induces a novel form of trained innate immunity which provides protection against various inducers of sepsis in mice via myeloid-derived suppressor cells. Accordingly, we initiated a randomized control clinical trial with the live attenuated Measles, Mumps, Rubella (MMR) vaccine in healthcare workers in the greater New Orleans area aimed at preventing/reducing severe lung inflammation/sepsis associated with COVID-19 (ClinicalTrials.gov Identifier: NCT04475081). Included was an outcome to evaluate the myeloid-derived suppressor cell populations in blood between those administered the MMR vaccine vs placebo. The unanticipated emergency approval of several COVID-19 vaccines in the midst of the MMR clinical trials eliminated the ability to examine effects of the MMR vaccine on COVID-19-related health status. Unfortunately, we were also unable to show any impact of the MMR vaccine on peripheral blood myeloid-derived suppressor cells due to several inherent limitations (low percentages of blood leukocytes, small sample size), that also included a collaboration with a similar trial (CROWN CORONATION; ClinicalTrials.gov Identifier: NCT04333732) in St. Louis, MO. In contrast, monitoring the COVID-19 vaccine response in trial participants revealed that high COVID-19 antibody titers occurred more often in those who received the MMR vaccine vs placebo. While the trial was largely inconclusive, lessons learned from addressing several trial-associated challenges may aid future studies that test the non-specific beneficial immune effects of live attenuated vaccines.
Plasma technology instead of suture and glue in pterygium removal surgery with conjunctival rotational flap; A 1 year follow up Case report
Authors: Nejat Farhad , Eghtedari Shima
Published: April 2023

Purpose: To introduce a novel technique using PANIS method (Plasma assisted noninvasive surgery) in pterygium removal surgery with conjunctival rotation flap. Methods: Two patients (1 male, 1 Female) with grade 3 and 4 of pterygium, based on SLIT2 grading system, underwent surgery with local anesthesia, removing pterygium tissue from cornea and also all related subtenon. Then surgeon used residual conjunctiva to cover bare sclera using rotational method. Fusion of the border of conjunctival flaps from nasal to superior occurred by plasma spots. UCVA, BCVA, OSDI and patient satisfaction were evaluated before, 1 month, 6 months and 1 year after the surgery, as well as 1 day and 1 week post-operation examinations included slit-lamp and external check-up that has been done by the surgeon. Results: Patients with primary pterygium, underwent surgery with PANIS method. Last follow-up session in 1 year, showed significant improvement in astigmatism and 1 line in BCVA. There were no complications and side effects during and after the surgery and also other reported complication included diplopia in lateral gaze, granuloma and scarring was not observed and no recurrence have been seen in the follow-up period and patients were satisfied. Additionally 1 day and 1 week slit-lamp examination showed plasma spots caused good attachment of conjunctival tissue with ocular surface. Conclusion: After treating 2 patients with PANIS method, it seems that plasma spots can be a good substitute for suture or glue in pterygium surgery with conjunctival rotational flap, because it's easy and fast way for fusing the conjunctival flap without any complication or side effect.
Value-Based Approach in Psychology
Authors: G. Kraslavskaya , A. Milovanova
Published: April 2023

The article reveals the essence of the value-oriented approach in psychology, the methodology of its application in the practical work of a psychologist, as well as the need to form the position of a "student" at the client At present, when the whole world is experiencing a state of instability, the work of psychologists in society is more important than ever. The psychological community tries to find, synthesize methods and tools that will show high efficiency in working with clients and will have a long-term effect. The purpose of this article is to introduce readers to the value-oriented approach (VOP) in psychology, which is the latest psychological direction that summarizes the achievements of psychological science and formulates universal principles of psychological practice. The VOP methodology represents a conceptually new approach to solving psychological problems. The psychological problem is seen not as a hindrance that needs to be addressed, but as a positive feedback from life. In the philosophy of this approach, life is seen as a sentient, supportive force for the existence of man, and man as a part of the whole associated with reality through many physical, mental and spiritual connections. In the case when a person violates harmony in relations with reality by his actions, he receives a signal about this in the form of various problematic circumstances and psychological difficulties. The work also uses the results of a study of the use of a VOP - approach among young people (100 people) aged 19 to 30 years. It seems to the authors of this article that the method of effective psychological assistance to people at the present time, which helps and teaches to cope with problems, is the method of value-oriented psychology. There is one wise popular statement: "If you want to feed a person - give him fish, and if you want him to be full all your life - teach him to fish."
Surgical Learners Do Not Teach Skills According to How They Were Taught
Authors: Hanstein Regina , Cole John , Saks Benjamin , Lo Yungtai , Binder Carl , Levy I.
Published: April 2023

Background: Surgeons are expected to teach students, residents and colleagues about surgical skills. The critical assumption that a “first-learner” will default to teaching a “second-learner” what they were taught, in the way they were taught, was investigated. Methods: Thirty-six medical students without experience tying a locking, sliding knot were divided into 18 pairs of first- and second-learners. 4 pairs were assigned to the “traditional teaching” (T) protocol group, 5 pairs were assigned to the “operant-teaching” (O) group and 9 pairs were “informed of the importance of the operant teaching strategy” before instruction and assigned to the “operant-informed” (OI) group. First-learners were taught to tie the locking, sliding knot according to one teaching protocol (T, O, or OI). Successful first-learners were asked to teach a second-learner. For the first-learners, time from the start of their instruction to the first constructed knot, time to tie 10 consecutive knots, and accuracy of knots (number of incorrectly constructed knots) were recorded. For second-learners, time from start of instruction to the first constructed knot, time to tie 10 knots, and accuracy of knots were recorded. Results: All first-learners, in all groups, were able to accurately tie a locking, sliding knot. During self-practice, all T-group first-learners lost the ability to tie the knot. Between the 5 O- and 9 OI- first-learners, only one OI-group first-learner lost the ability to tie the knot. After instruction from the 16 successful first-learners, 16 second-learners were able to tie to the knot. The error rate for second learners was 93% for the T-group, 20% in O-group and 12.5% in OI-group. Time to tie the first knot were different between the three teaching groups for both the first and second-learners (p=0.007 and p=0.041, respectively). The average time to tie the 10 knots was similar between first-learner (p=0.336) and second-learner O- and OI-groups (p=0.788). Conclusion: Demonstration-based teaching results in incomplete skills which deteriorate. Contrary to the assumption that successful first-learners would teach the way they were taught, first-learners abandon the teaching strategy when tasked with teaching a second-learner. Our results emphasize the importance of incorporating teaching curriculums into surgical education.
A Comparison of the Prediction Capabilities of Large Scale Time Series Algorithms
Authors: Simmons Susan , Bastin Kornelia , LaBarr Aric , Healey Christopher
Published: April 2023

Since December 31, 2020, the world has closely monitored the progress and outcomes of the SARS-CoV-2 coronavirus (COVID). This paper focuses on two goals. First, we compare time series algorithms for predicting fatalities during the COVID pandemic. Second, we examine how domain affects algorithm choice by comparing our COVID results to historical and current weekly temperature data analyses. Critical interest revolves around tracking and predicting the effects of COVID. Throughout the past three years, many researchers have created models and built visualizations to observe this disease’s progression and impact, both regionally and worldwide. Researchers have recently proposed using machine learning to forecast the progression of COVID. With the increased interest in time series methods and the different algorithms available, this paper explores these techniques’ accuracy and computational expense. We compare time series analysis approaches for forecasting COVID fatalities from March 11, 2020, to December 28, 2021. The time series models we include are those that can be automatically created to scale to large datasets. Statistical analysis is used to identify significant differences in performance. To investigate generalizability, we apply the same algorithms to predict temperature data, a standard example dataset due to its seasonal and trend components. An analysis is performed both for historical data (1970s) and current data (2020s). Results allow us to: (1) identify significant differences in algorithm performance versus pandemic data with different time series patterns; (2) examine the performance of time series algorithms trained on shorter, constant-length training sets; and (3) determine whether variations in temperature due to climate changes affect how temperature data should now be predicted. We conclude by discussing how domain and data patterns inform the decision of which time series algorithms to consider when predicting future events from historical or existing data. Our results illustrate that no one method is always the best. Careful consideration of the data’s domain, the time period in question, and the length of time to analyze must be considered when deciding which algorithm to choose.
Cardiovascular Issues in Patients with Malignant Lymphoma: A Narrative Review
Authors: Shibusawa Motoharu , Imamine Erika
Published: April 2023

Cardiovascular issues are important concerns in malignant lymphoma treatment. These issues can be broadly categorized into two groups: the invasion of malignant lymphoma into the heart and cardiovascular disease related to malignant lymphoma treatment. In terms of malignant lymphoma invasion of the heart, the presence of a heart lesion of malignant lymphoma often presents with heart-related symptoms and findings such as chest pain, heart failure, and arrhythmias. Notably, heart failure and arrhythmias can be fatal. The identification of heart lesions of malignant lymphoma will result in appropriate management and survival improvement. As for cardiovascular disease associated with malignant lymphoma treatment, the incidence and types of cardiovascular disease, management, and follow-up planning should be identified before starting treatment. This identification and plan will allow an understanding of the risk of developing cardiovascular disease and appropriate management and follow-up. In clinical practice, it is important to keep in mind that cardiac issues in patients with malignant lymphoma should be identified, assessed, and managed before initiating treatment.
Target Therapy vs the Immune Check Point Inhibitors in Lung Cancer: Costs and Caps Platform
Authors: Guirgis Helmy
Published: April 2023

The immune check point inhibitors (ICI) and target therapy (TT) Osimertinib (Osi) prolonged survival in advanced/metastatic non-small cell lung cancer (a/m-NSCLC). Costs of ICI were previously investigated (ESMED, July 2022) while TT being overlooked. In 2022, insulin monthly cost was capped at $35 for Medicare patients. We aimed to 1- Attach a $ amount to results of the major relevant TT and ICI clinical studies and weigh their relative costs 2- Reason that utilization threshold caps are necessary to contain cost of extended therapy Methods: In this prospective observational study, annual costs of the approved and widely used TT were calculated as the monthly optimal dose x 12. Costs of the 5-approved ICI in 1-st-line a/m NSCLC were calculated as mg/m2 or per 80 kg x price x number of cycles. Results: Median annual 5-TT cost was $228,000 vs 5-ICI of $134,786 at 1.69 ratio. At 10%, estimated coverage of pharmacy and nursing costs, ratio dropped to 1.52. The 1-3-year Osi costs were $248,372-$745,116, Crizotinib $226,308 -$678,924 and Larotrectinib $399,372-$1,198,116. Pembrolizumab were $134,796-$404,388, Atezolizumab $124,761-$374,283 and Cemiplimab $125,108-$375,324. Applying $500,000 caps, the ICI 3-year costs were all below threshold. TT medium 3-year cost was $684,000, exceeding cap by $184,000, Osi by $245,116 and Crizotinib by $178,924. Larotrectinib 2-3-year costs were higher by $298,744 - $698,116. We reasoned that if 1,000 US patients treated with TT at the annual median, cost mounts to $684,000,000. In Europe, 2,000 patients’ cost would be $1,368,000,000. Conclusions: The median TT/ICI was more costly at 1.52 ratio. Drug costs were determined by the number of re-purchases, the 1st-buy, if followed, was considered a down payment. Cap implementations are necessary to contain costs of extended therapy.
Use of a Biphasic Calcium Sulphate Graft to Treat Posterior Maxillary Atrophies by Avoiding a Lateral Sinus Approach
Authors: Baranes David , Kurtzman Gregori
Published: April 2023

Augmentation of the maxillary sinus when severe atrophy and/or pneumatization of the sinus has occurred results in minimal crestal height that will not allow simultaneous implant placement has been a clinical challenge. The lateral sinus augmentation approach has been traditionally utilized in these clinical situations, but there are known complications such as membrane tears and increased post-operative issues that follow use of this technique. This article aims to propose a new technique utilizing specific surgical instruments, making it possible to increase the height of the crestal bone under the maxillary sinus in cases of significant atrophy, without complications using a two-stage crestal approach with a bi-phasic calcium sulphate as the graft material. The article will discuss the technique, present a case example and review 51 cases representing initially 1-3 mm sub sinus crestal bone heights that the technique was utilized with.
Transcriptomics and Brain Volumetrics Define the Causes of Cognitive Impairment in Patients with CIRS and Support the use of VIP in Treatment
Authors: R Shoemaker , A Heyman , David Lark
Published: April 2023

Problems with executive cognitive function, including recent memory, concentration, word finding, confusion, decreased assimilation, and disorientation, can have a variety of sources of disease, including inflammation, metabolic disturbances, and degenerative processes that are typically found in diseases where chronic fatigue is present. The problems presented by multiple coexisting cognitive symptoms are finding: 1) a single diagnostic test that has a history of use by clinicians working with brain-injured patients, such as NeuroQuant (NQ); 2) that is affordable, accurate, and reliable to use as a measure of benefits, or lack of same; and 3) screening, causation, and sequential features of therapy. Furthermore, the complexity of brain injury shows us the limitations of human versus machine-based testing, with advances in transcriptomics leading the way in a new world of diagnostics and therapies that follow gene activation studies. The objective of this report was to retrospectively look at results of the transcriptomic testing of white blood cells, combined with a brain volumetric imaging study, in an observational study to provide a basis to identify the specific causation of brain injury caused by exposure to the interior environment of water-damaged buildings (WDB). By comparing transcriptomic abnormalities with known volumetric patterns of injury to cortical grey matter, enlargement of superior lateral ventricles and atrophy of grey matter nuclei, we demonstrate the feasibility of treatment of brain injury employing noninvasive methods in preparation for novel treatments previously shown to be effective. We intend to use these tests sequentially in a before-and-after fashion to show correction of metabolic and inflammatory conditions found in chronic inflammatory response syndrome (CIRS) in a subsequent study.
Ethical Concerns in Dermatology and Cosmetic Applications
Authors: Keskinbora Kadircan , Kumbasar Eda
Published: April 2023

Our aim in this article is to consider ethical concerns and sensitivities in Dermatology and Cosmetic applications. It is appropriate for dermatologists to make cosmetic applications and use artificial intelligence aid as experts who know the structure and diseases of the skin best. The practice of cosmetology by physicians other than dermatologists creates ethical problems. Women are especially more interested in dermatology. Body dysmorphic disorders are more common in women. When dermatologists evaluate the cosmetic dermatology patient and create a treatment plan, if there are unrealistic expectations, the patient should be guided correctly by considering the patient's wishes. Social media applications, which have attracted attention in recent years, have caused an increase in body dysmorphic disorders in individuals. Cosmetology is a division that can never be separated from dermatology. Patients frequently apply to cosmetic dermatology because of hyperpigmentation problems, aging problems, hair problems, toxin applications, dermal filler procedures, chemical peels, and mesotherapy, and ablative laser procedures. Burns resulting from laser epilation applications performed in aesthetic centers, complications such as tissue necrosis caused by dermal filler procedures performed by non-physicians, cosmetic problems, soft tissue infections, and allergic reactions resulting from applications such as mesotherapy and platelet-rich plasma are diseases frequently seen in dermatology outpatient clinics. Another important issue is the materials used in platelet-rich plasma, mesotherapy, toxin application, and dermal filler applications must be in the Class 3 Medical device category. Patients who apply to clinics for treatment should be made aware of this issue and patients should be protected from the complications that these medications may cause. Physicians should not use products that do not have class 3 certificates in cosmetic dermatology to keep the cost of the product low, especially when choosing materials. In medicine, there is always an aesthetic concern beyond technical or even scientific concerns. We think that it is necessary to express and elaborate on the concerns arising from the ethical issues that are experienced or may be experienced in dermatology practices. Physicians always try to take the patient's psychological and pathological problems into consideration. However, ethical concerns should not be forgotten when treating the field of aesthetics.
Relations Between State Institutions in Indonesia after the Amendment to the 1945 Constitution
Authors: Sarkawi
Published: April 2023

Amendments to the 1945 Constitution resulted in changes to state institutions. This is due to changes in the provisions governing state institutions. Some fundamental principles that determine relations between state institutions include the Supremacy of the Constitution, the Presidential System, and the Separation of Powers and Checks and Balances. Based on the description of the discussion in this article, it is concluded that the relationship between state institutions in Indonesia includes: (1) Relations between State Institutions in the Field of Government; (2) Relations Between State Institutions in the field of Legislation; (3) Relations Between State Institutions in the Judicial Sector, namely; (a) Relations between the Supreme Court and the Constitutional Court; (b) Relations between the Supreme Court and the President; (c) Relations between the Supreme Court and the House of Representatives.
Investigation of the impact of radiotherapy on the shoulder joint by ultrasonography in breast cancer patients
Authors: KARATAŞ Serdar , ALICIOĞLU Banu
Published: April 2023

Objectives: This study aimed to investigate the impact of radiotherapy (RT) on the supraspinatus, long head of the biceps and subscapularis tendons, and shoulder subcutenous fat tissue.
Methods: Patients diagnosed with breast cancer who received RT to the anterior chest wall and axillary-supraclavicular region after breast-conserving surgery or mastectomy in our hospital. Overall, 56 (36 RT, 20 control group) patients were enrolled in this study. Pre-RT, post-RT 6-week, 3-month, and 6-month ultrasonographic and clinical assessments were performed.
Results: The mean interval between surgery and RT was 5.6 (range: 2-8) months. Ten (27.7%) patients developed ultrasonographic abnormalities during the post-RT period. However, only 2 of these patients had shoulder pain and restricted range of motion in the shoulder. The thickness of the supraspinatus, biceps and subscapularis tendons were similar between the dominant and non-dominant sides of the control and RT group patients (5.7 mm vs. 5.1 mm, 2.87 mm vs. 2.89 mm, and 4.13 mm vs. 3.97 mm; respectively, p > 0.05). Thirteen patients were given RT on the ipsilateral side, and 23 received RT on the contralateral side. The pre-RT supraspinatus tendon thickness was significantly higher in the ipsilateral group than in the contralateral group (p = 0.026). However, there was no significant difference in the post-RT period (p = 0.408).
Conclusions: In breast cancer patients undergoing adjuvant RT, RT may cause temporary edema in shoulder tendons. In addition, shoulder pain and restricted range of motion of the shoulder joint can be present in these patients.
Determining the traditional methods used by newborn women by giving birth: a descriptive study
Authors: BÜLEZ Aysel , SÖNMEZ Mehtap , ORHAN Merva , GÜNEŞ Aygül
Published: April 2023

Objectives: This study was carried out to determine the traditional practices that women who have just given birth apply to their babies.
Methods: The research is descriptive. The participants were recruited from women who had just given birth to 198 women in a maternity hospital. The data was collected through the personal information form. The chi-square test was used to plan the categorical data in detail as the mean of the research data, as numbers, and as percentages. p < 0.05 was accepted as meaning.
Results: It was determined that traditional practices frequently used by women; The use of the yellow blanket against jaundice, swaddling so that the waist does not sink in, staying warm, being hard as steel, and having straight legs and the use of salt. It was determined that these practices were applied more by mothers who graduated from primary school. Although the frequency of use of applications such as burying the belly in the garden and throwing it in the water was found to be significant by age, it was determined to be used more in the group aged 31 and over. It has been determined that wearing evil eye beads is more common among mothers under the age of 25.
Conclusions: In our study, it was observed that traditional practices were widely applied in the neonatal period. Newborn health should be supported by providing continuous midwifery care to women, education, and health checks.
Zur Kommunikation von Kletternden – eine pragmatisch und lexikalisch orientierte Analyse
Authors: Sakowski Krzysztof
Published: April 2023

Wraz z rosnącym zainteresowaniem alpinizmem, aw szczególności wspinaczką, które słychać nie tylko na świecie, ale także w Niemczech i Polsce, rozpowszechniła się również związana z tym komunikacja w tym szczególnym obszarze. Celem pracy jest pragmatyczne i leksykalne zbadanie socjolektu wspinaczy. Analiza pokazuje możliwe różne konteksty komunikacyjne, analizuje znormalizowane protokoły komunikacyjne, a także przedstawia jakościowe i ilościowe badanie leksykonu wspinaczkowego oraz ujawnia terminy kryjące się za badanymi terminamimotywacje nazewnictwa oraz omawia mechanizmy zapożyczeń, dzięki którym elementy znalazły się w języku niemieckim i polskim. W załączeniu polsko-niemiecki słowniczek terminów wspinaczkowych.