bluuebunny/crossref_metadata_2025 huggingface dataset:
Educating Learners with SEND in One Private Mainstream School in Dubai: Effectiveness and Challenges of Policy Implementation
Authors: Badawieh Muntaha , Abukari Abdulai , Gaad Eman
Published: May 2023

This study investigates the SEND policy implementation in one private school in Dubai. It highlights whether the school’s teachers and support staff adopted and effectively implemented the SEND inclusion policy. The investigation process focuses on three areas which are curriculum modifications, Assessment differentiation, and teacher’s professional development. A qualitative research study of semi-structured interviews has been conducted to investigate the effectiveness and challenges of SEND policy implementation; for this purpose, interviews were conducted with the school’s teachers for data analysis; the researcher has decided to use the qualitative approach because it shows a subjective evaluation of beliefs, behaviour, and attitudes, the total number of participants were two subject teachers and one school principal. This study investigated all the significant aspects, and the overall result was conducted to provide the proper recommendations. The qualitative study findings indicate that the school policy implementation is very effective, and teachers’ awareness of the inclusion policy is appropriate. Nevertheless, they face difficulties in accommodating students’ needs in the classroom due to the massive number of students in each classroom. Also, it showed that the inclusion support team acts as a backbone in supporting the teachers through the weekly meetings, which help them modify the curriculum and accommodate the assessment for their students. In terms of challenges, the school has few numbers of inclusion support teachers; therefore, it leads to some challenges teachers face when implementing the policy.
Introduction
Authors: Cornelissen Gunther , Peyerimhoff Norbert
Published: May 2023

The chapter contains an overview of the main new results in the book: a spectral characterisation of covering equivalence of Riemannian manifolds using spectra of finitely many twisted Laplacians, a more detailed version for non-arithmetic Riemann surfaces, a version using the length spectrum. It also contains a spectral characterisation of weak conjugacy. The chapter contains pointers forward to other chapters that contain an exposition of the basic tools and methods, as well as detailed constructions, proofs and examples.
Length Spectrum
Authors: Cornelissen Gunther , Peyerimhoff Norbert
Published: May 2023

In this chapter, we prove a version of the main result using the length spectrum instead of the Laplace spectrum, in case the manifold is negatively curved. We introduce the L-series corresponding to a unitary representation of the fundamental group, recall its convergence properties in relation to volume entropy, and its behaviour in finite covers.
Spectra, Group Representations and Twisted Laplacians
Authors: Cornelissen Gunther , Peyerimhoff Norbert
Published: May 2023

In this chapter, we review basic notions about spectra, group representations, and twisted Laplace operators. We first recall how to define the spectrum and the spectral zeta function for a general symmetric second order elliptic differential operator acting on smooth sections of a Hermitian line bundle. We prove that the non-zero spectrum (i.e., the spectral zeta function) determines the entire spectrum on an odd-dimensional manifold, but also give an example showing that this is not always true for even-dimensional manifolds; the example is obstructed by the non-vanishing of some topological genus. After setting up some notation from representation theory, we discuss G-sets and weak conjugacy (“Gaßmann equivalence”) of subgroups of a group, explaining the interrelations. In the final sections, we introduce twisted Laplacians, corresponding to unitary representations of the fundamental group. After this, we focus on the case of a twisted Laplacian arising from a finite Galois cover of manifolds and we relate the spectrum on the top manifold to that of the induced representation on the bottom manifold. We relate the multiplicity of zero in the spectrum to the multiplicity of the trivial representation in the given representation, and finally we show that, contrary to the general case, the multiplicity of zero in the spectrum of a twisted Laplacian is determined from the non-zero spectrum, provided one also knows the usual Laplace spectrum of the manifold.
Representations with a Unique Monomial Structure
Authors: Cornelissen Gunther , Peyerimhoff Norbert
Published: May 2023

In this chapter, we recall the notion of monomial structures (and their isomorphism) on a representation, show a natural monomial structure on induced representations, and introduce solitary characters (characters whose induced representation has a unique monomial structure up to isomorphism); these characters may be used to detect conjugacy of subgroups. We also recall a specific type of wreath product construction and state and prove Bart de Smit’s theorem on the existence of solitary characters for these (and a follow-up result of Pintonello for characters of degree two)—these were previously formulated and used in the context of number theory, but we present them abstractly. We give an application to covering equivalence in a very specific setup of manifolds, and also count the number of required characters, based on a formula for the commutator of a wreath product.
Construction of Suitable Covers and Proof of the Main Theorem
Authors: Cornelissen Gunther , Peyerimhoff Norbert
Published: May 2023

In this chapter, we set up some theory concerning the action of isometries on fundamental groups and first homology groups. More specifically, we show that the action of a finite group of isometries on the first homology group of a manifold corresponds to conjugation by a lift to the orbifold fundamental group of the quotient. This result is then used to give a necessary and sufficient condition for realising a certain wreath product by a Galois cover (by an explicit construction of the corresponding subgroup of the fundamental group)—a problem similar to the algebraic problem of inverse Galois theory. The required condition, called (∗), is a representation-theoretic property of the action on homology. Using the representation theoretical results from the previous chapter, this allows us to finish the proof of the main theorem of the text, describing covering equivalence of manifolds through spectra of twisted Laplacians.
Geometric Construction of the Covering Manifold
Authors: Cornelissen Gunther , Peyerimhoff Norbert
Published: May 2023

In this chapter, we provide a geometric construction of a manifold extending a given Galois cover to a wreath product, using composita and fiber products. For this to be possible, a certain assumption on the homology, previously called (∗), needs to be strengthened to a new condition (∗∗) (equivalent in most cases). To motivate and use this new condition, we first recall the connection between homology of a quotient and coinvariants. Apart from geometric tools, the construction is also based on the vanishing of certain group cohomology, which is used to prove the existence of certain isometries of manifolds. In the final section, we give a universal property of the wreath product in relation to coverings of manifolds, just like there is such a universal property in the theory of Galois extensions of fields.
The ETHNA System and Support Tools
Authors: González-Esteban Elsa
Published: May 2023

The article deals with ethics governance systems in the field of research and innovation at the organisational level, both for organisations performing and funding research and innovation activities. In particular, it proposes and argues for a system called ETHNA System. Informed by a deliberative and participatory concept of ethics governance, as well as by the dimensions of responsibility in research and innovation – anticipation, inclusion, reflection and responsiveness – it proposes a modular design of ethics governance based on four mechanisms: a responsible research and innovation (RRI) Office(r); a Code of Ethics and Good Practices in research and innovation (R&I); an ethics committee on R&I and an ethics line. Moreover, to ensure continuous improvement, a system for monitoring the process and the achievement of results is provided. The system also offers specific details of the implementation process paying attention to four issues: research integrity, gender perspective, open access and public engagement.
Vector Boson Fusion topology and simplified models for dark matter searches at colliders
Authors: Duque-Escobar Santiago , Ocampo-Henao Daniel , Ruiz-Álvarez José D.
Published: May 2023

Abstract

In this paper, we study the possible searches at colliders using Vector Boson Fusion topology in the context of Simplified Models signatures. We examine the possible physics reach of these searches with regard to monojet-type searches, and determine how these two signatures are complementary. We determine the generic characteristics for dark matter signatures in the LHC if the underlying physics imply Vector Boson Fusion type of production.
Bicuspid aortic valve aortopathy is characterized by embryonic epithelial to mesenchymal transition and endothelial instability
Authors: Freiholtz David , Bergman Otto , Lång Karin , Poujade Flore-Anne , Paloschi Valentina , Granath Carl , Lindeman Jan H. N. , Olsson Christian , Franco-Cereceda Anders , Eriksson Per , Björck Hanna M.
Published: May 2023

Bicuspid aortic valve (BAV) is the most common congenital heart malformation frequently associated with ascending aortic aneurysm (AscAA). Epithelial to mesenchymal transition (EMT) may play a role in BAV-associated AscAA. The aim of the study was to investigate the type of EMT associated with BAV aortopathy using patients with a tricuspid aortic valve (TAV) as a reference. The state of the endothelium was further evaluated. Aortic biopsies were taken from patients undergoing open-heart surgery. Aortic intima/media miRNA and gene expression was analyzed using Affymetrix human transcriptomic array. Histological staining assessed structure, localization, and protein expression. Migration/proliferation was assessed using ORIS migration assay. We show different EMT types associated with BAV and TAV AscAA. Specifically, in BAV-associated aortopathy, EMT genes related to endocardial cushion formation were enriched. Further, BAV vascular smooth muscle cells were less proliferative and migratory. In contrast, TAV aneurysmal aortas displayed a fibrotic EMT phenotype with medial degenerative insults. Further, non-dilated BAV aortas showed a lower miRNA-200c-associated endothelial basement membrane LAMC1 expression and lower CD31 expression, accompanied by increased endothelial permeability indicated by increased albumin infiltration. Embryonic EMT is a characteristic of BAV aortopathy, associated with endothelial instability and vascular permeability of the non-dilated aortic wall.

Key messages

Embryonic EMT is a feature of BAV-associated aortopathy.

Endothelial integrity is compromised in BAV aortas prior to dilatation.

Non-dilated BAV ascending aortas are more permeable than aortas of tricuspid aortic valve patients.
Robust structural optimization in presence of manufacturing uncertainties through a boundary-perturbation method
Authors: Pozzi Matteo , Bonaccorsi Giacomo , Kim Hyunsun Alicia , Braghin Francesco
Published: May 2023

Most manufacturing processes are inevitably characterized by process tolerances that ultimately affect the way a component behaves and complies with the design requirements. These uncertainties determine the real performance of a structure, with their impact growing with increasing deviations from the nominal values. This work introduces a simple approach, applicable to both static and dynamic cases, to conduct robust structural topology optimization in presence of manufacturing uncertainties. This approach, based on the level set method, makes use of a computationally efficient boundary-perturbation technique to describe over- and under-etching errors. Compared to the existing methods, it does not require a frequent re-initialization of the level set function, nor does it require a mapping between the etched structures and the nominal one. Moreover, compared to the standard case with uniform uncertainty, the technique presented in this work allows dealing with arbitrary spatially varying errors without increasing the computational cost.
Trends in incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fractures in people aged 50 years and above: retrospective cohort study using UK primary care data
Authors: Avgerinou Christina , Petersen Irene , Clegg Andrew , West Robert M. , Osborn David , Walters Kate
Published: May 2023

This study used primary care data to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK during 2000–2018 accounting for age, sex, calendar year and social deprivation. More than 3 million people aged 50–99 years were included. We found that men living in the most deprived areas had a 45% higher risk of being diagnosed with osteoporosis and 50% higher risk of fragility fracture compared to men living in the least deprived areas.

Purpose

a) To estimate the incidence trends of a recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK over time; b) to describe differences according to age, sex, and social deprivation.

Methods

This is a longitudinal population-based cohort study using routinely collected primary care data obtained via IQVIA Medical Research Database (IMRD). All patients aged 50–99 years registered with a practice participating in THIN (The Health Improvement Network) between 2000–2018 were included. The first recorded diagnosis of osteoporosis, osteopenia, or fragility fracture was used to estimate incidence rates (IR) per 10,000 person-years at risk. Poisson regression was used to provide Incidence Rate Ratios (IRR) adjusted by age, sex, social deprivation, calendar year, and practice effect.

Results

The year-specific adjusted IRR of recorded osteoporosis was highest in 2009 in women [IRR 1.44(95%CI 1.38–1.50)], whereas in men it was highest in 2013–2014 [IRR 1.94(95%CI 1.72–2.18)] compared to 2000. The year-specific adjusted IRR of fragility fracture was highest in 2012 in women [IRR 1.77(95%CI 1.69–1.85)], whereas in men it was highest in 2013 [IRR 1.64(95%CI 1.51–1.78)] compared to 2000. Men in the most deprived areas had a higher risk of being diagnosed with osteoporosis [IRR 1.45(95%CI 1.38–1.53)], osteopenia [IRR 1.17(95%CI 1.09–1.26)], and fragility fracture [IRR 1.50(95%CI 1.44–1.56)] compared to those living in the least deprived areas, but smaller differences were seen in women.

Conclusion

Use of fracture risk assessment tools may enhance the detection of osteoporosis cases in primary care. Further research is needed on the effect of social deprivation on diagnosis of osteoporosis and fractures.
Nonlinear Stability and Existence of Two-Dimensional Compressible Current-Vortex Sheets
Authors: Morando Alessandro , Secchi Paolo , Trebeschi Paola , Yuan Difan
Published: May 2023

We are concerned with the nonlinear stability and existence of two-dimensional current-vortex sheets in ideal compressible magnetohydrodynamics. This is a nonlinear hyperbolic initial-boundary value problem with a characteristic free boundary. It is well-known that current-vortex sheets may be at most weakly (neutrally) stable due to the existence of surface waves solutions that yield a loss of derivatives in the energy estimate of the solution with respect to the source terms. We first identify a sufficient condition ensuring the weak stability of the linearized current-vortex sheets problem. Under this stability condition for the background state, we show that the linearized problem obeys an energy estimate in anisotropic weighted Sobolev spaces with a loss of derivatives. Based on the weakly linear stability results, we then establish the local-in-time existence and nonlinear stability of current-vortex sheets by a suitable Nash–Moser iteration, provided that the stability condition is satisfied at each point of the initial discontinuity. This result gives a new confirmation of the stabilizing effect of sufficiently strong magnetic fields on Kelvin–Helmholtz instabilities.
Compact embeddings, eigenvalue problems, and subelliptic Brezis–Nirenberg equations involving singularity on stratified Lie groups
Authors: Ghosh Sekhar , Kumar Vishvesh , Ruzhansky Michael
Published: May 2023

The purpose of this paper is twofold: first we study an eigenvalue problem for the fractional p-sub-Laplacian over the fractional Folland–Stein–Sobolev spaces on stratified Lie groups. We apply variational methods to investigate the eigenvalue problems. We conclude the positivity of the first eigenfunction via the strong minimum principle for the fractional p-sub-Laplacian. Moreover, we deduce that the first eigenvalue is simple and isolated. Secondly, utilising established properties, we prove the existence of at least two weak solutions via the Nehari manifold technique to a class of subelliptic singular problems associated with the fractional p-sub-Laplacian on stratified Lie groups. We also investigate the boundedness of positive weak solutions to the considered problem via the Moser iteration technique. The results obtained here are also new even for the case $$p=2$$

p
=
2

with $$\mathbb {G}$$
G
being the Heisenberg group.
Modulation of the oxidative damage, inflammation, and apoptosis-related genes by dicinnamoyl-L-tartaric acid in liver cancer
Authors: Elmetwalli Alaa , Hashish Shimaa Mustafa , Hassan Mervat G. , El-Magd Mohammed Abu , El-Naggar Sabry Ali , Tolba Amina M. , Salama Afrah Fatthi
Published: May 2023

Cancer cells can become resistant to existing treatments over time, so it is important to develop new treatments that target different pathways to stay ahead of this resistance. Many cancer treatments have severe side effects that can be debilitating and even life-threatening. Developing drugs that can effectively treat cancer while minimizing the risks of these side effects is essential for improving the quality of life of cancer patients. The study was designed to explore whether the combination of dicinnamoyl-L-tartaric (CLT) and sorafenib ((SOR), an anti-cancer drug)) could be used to treat hepatocellular carcinoma (HCC) in the animal model and to assess whether this combination would lead to changes in certain biomarkers associated with the tumour. In this study, 120 male mice were divided into 8 groups of 15 mice each. A number of biochemical parameters were measured, including liver functions, oxidative stress (malondialdehyde, (MDA); nitric oxide (NO)), and antioxidative activity (superoxide dismutase (SOD), and glutathione peroxidase (GPx)). Furthermore, the hepatic expressions of Bax, Beclin1, TNF-α, IL1β, and BCl-2 genes were evaluated by qRT-PCR. The combination of SOR and CLT was found to reduce the levels of liver enzymes, such as AST, ALT, ALP, and GGT, and reduce the pathological changes caused by DAB and PB. The upregulation of TNF-α, IL1β, and Bcl-2 genes suggests that the CLT was able to initiate an inflammatory response to combat the tumor, while the downregulation of the Bax and Beclin1 genes indicates that the CLT was able to reduce the risk of apoptosis in the liver. Furthermore, the combination therapy led to increased expression of cytokines, resulting in an enhanced anti-tumor effect.
Tracking the Trauma Epidemic in KwaZulu‐Natal, South Africa
Authors: Tefera Aida , Lutge Elizabeth Eleanor , Moodley Nirvasha , Xaba Xolani Wiseman , Hardcastle Timothy Craig , Brysiewicz Petra , Clarke Damian Luiz
Published: May 2023

Background

Trauma remains an important cause of morbidity and mortality in South Africa, but attempts to track the epidemic are often based on mortality data, or derived from individual health facilities. This project is based on the routine collection of trauma data from all public health facilities in the province of KwaZulu‐Natal (KZN), between 2012 and 2022.

Methods

Hospital level data on trauma over the past ten years was drawn from the district health information system (DHIS). Data relating to assaults, gunshots and motor vehicle collisions (MVCs) were recorded in the emergency rooms, whilst data on admissions are recorded in the wards and intensive care units.

Results

There were 1,263,847 emergency room visits for assaults, gunshots and MVCs over the ten‐year period and trauma admissions ranged between four and five percent of the total number of hospital admissions annually. There was a dramatic decrease in trauma presentations and admissions over 2020/2021 as a result of the COVID lockdowns. Over the entire period, intentional injury was roughly twice as frequent as non‐intentional injury. Intentional trauma had an almost equal ratio of blunt assault to penetrating assault. Gunshot‐related assault increased dramatically over the 2021/2022 collecting period.

Conclusions

The burden of trauma in KZN remains high. The unique feature of this burden is the excessively high rate of intentional trauma in the form of both blunt and penetrating mechanisms. Developing injury‐prevention strategies to reduce the burden of interpersonal violence is more difficult than for unintentional trauma.
Advanced statistics identification of participant and treatment predictors associated with severe adverse effects induced by fluoropyrimidine-based chemotherapy
Authors: Korver Samantha K. , Bowen Joanne M. , Gibson Rachel J. , Ball Imogen A. , Secombe Kate R. , Wain Taylor J. , Logan Richard M. , Tuke Jonathan , Mead Kelly R. , Richards Alison M. , Karapetis Christos S. , Keefe Dorothy M. , Coller Janet K.
Published: May 2023

Purpose

Adverse effects following fluoropyrimidine-based chemotherapy regimens are common. However, there are no current accepted diagnostic markers for prediction prior to treatment, and the underlying mechanisms remain unclear. This study aimed to determine genetic and non-genetic predictors of adverse effects.

Methods

Genomic DNA was analyzed for 25 single nucleotide polymorphisms (SNPs). Demographics, comorbidities, cancer and fluoropyrimidine-based chemotherapy regimen types, and adverse effect data were obtained from clinical records for 155 Australian White participants. Associations were determined by bivariate analysis, logistic regression modeling and Bayesian network analysis.

Results

Twelve different adverse effects were observed in the participants, the most common severe adverse effect was diarrhea (12.9%). Bivariate analysis revealed associations between all adverse effects except neutropenia, between genetic and non-genetic predictors, and between 8 genetic and 12 non-genetic predictors with more than 1 adverse effect. Logistic regression modeling of adverse effects revealed a greater/sole role for six genetic predictors in overall gastrointestinal toxicity, nausea and/or vomiting, constipation, and neutropenia, and for nine non-genetic predictors in diarrhea, mucositis, neuropathy, generalized pain, hand–foot syndrome, skin toxicity, cardiotoxicity and fatigue. The Bayesian network analysis revealed less directly associated predictors (one genetic and six non-genetic) with adverse effects and confirmed associations between six adverse effects, eight genetic predictors and nine non-genetic predictors.

Conclusion

This study is the first to link both genetic and non-genetic predictors with adverse effects following fluoropyrimidine-based chemotherapy. Collectively, we report a wealth of information that warrants further investigation to elucidate the clinical significance, especially associations with genetic predictors and adverse effects.
PET/MRI of hypoxia and vascular function in ER-positive breast cancer: correlations with immunohistochemistry
Authors: Carmona-Bozo Julia C. , Manavaki Roido , Miller Jodi L. , Brodie Cara , Caracò Corradina , Woitek Ramona , Baxter Gabrielle C. , Graves Martin J. , Fryer Tim D. , Provenzano Elena , Gilbert Fiona J.
Published: May 2023

Objectives

To explore the relationship between indices of hypoxia and vascular function from 18F-fluoromisonidazole ([18F]-FMISO)-PET/MRI with immunohistochemical markers of hypoxia and vascularity in oestrogen receptor–positive (ER +) breast cancer.

Methods

Women aged  > 18 years with biopsy-confirmed, treatment-naïve primary ER + breast cancer underwent [18F]-FMISO-PET/MRI prior to surgery. Parameters of vascular function were derived from DCE-MRI using the extended Tofts model, whilst hypoxia was assessed using the [18F]-FMISO influx rate constant, Ki. Histological tumour sections were stained with CD31, hypoxia-inducible factor (HIF)-1α, and carbonic anhydrase IX (CAIX). The number of tumour microvessels, median vessel diameter, and microvessel density (MVD) were obtained from CD31 immunohistochemistry. HIF-1α and CAIX expression were assessed using histoscores obtained by multiplying the percentage of positive cells stained by the staining intensity. Regression analysis was used to study associations between imaging and immunohistochemistry variables.

Results

Of the lesions examined, 14/22 (64%) were ductal cancers, grade 2 or 3 (19/22; 86%), with 17/22 (77%) HER2-negative. [18F]-FMISO Ki associated negatively with vessel diameter (p = 0.03), MVD (p = 0.02), and CAIX expression (p = 0.002), whilst no significant relationships were found between DCE-MRI pharmacokinetic parameters and immunohistochemical variables. HIF-1α did not significantly associate with any PET/MR imaging indices.

Conclusion

Hypoxia measured by [18F]-FMISO-PET was associated with increased CAIX expression, low MVD, and smaller vessel diameters in ER + breast cancer, further corroborating the link between inadequate vascularity and hypoxia in ER + breast cancer.

Key Points

• Hypoxia, measured by [18F]-FMISO-PET, was associated with low microvessel density and small vessel diameters, corroborating the link between inadequate vascularity and hypoxia in ER + breast cancer.

• Increased CAIX expression was associated with higher levels of hypoxia measured by [18F]-FMISO-PET.

• Morphologic and functional abnormalities of the tumour microvasculature are the major determinants of hypoxia in cancers and support the previously reported perfusion-driven character of hypoxia in breast carcinomas.
Longitudinal follow-up by MR angiography reveals progressive dilatation of the distal aorta after aortic root replacement in Marfan syndrome
Authors: Lenz Alexander , Warncke Malte , Wright Felicia , Weinrich Julius Matthias , Schoennagel Bjoern P. , Henes Frank Oliver , Adam Gerhard , von Kodolitsch Yskert , Schoen Gerhard , Bannas Peter
Published: May 2023

Objectives

To define and compare growth rates of the distal aorta in Marfan patients with and without aortic root replacement using serial MR angiography (MRA).

Methods

We retrospectively included 136 Marfan patients with a total of 645 MRAs who underwent a median of five MRAs (range: 2–13) at 1.5 T and 3 T in annual intervals. Of these, 41 patients (34.8 ± 12 years) had undergone aortic root replacement. The remaining 95 patients (29.0 ± 17 years) still had a native aorta and served as the control group. Thoracic aortic diameters were independently measured at eleven predefined levels. Estimated growth rates were calculated using a mixed effects model adjusted for sex, age, BMI, and medication.

Results

Marfan patients with aortic root replacement revealed the highest mean estimated growth rate in the proximal descending aorta (0.77 mm/year, CI: 0.31–1.21). Mean growth rates at all levels of the distal thoracic aorta were significantly higher in patients with aortic root replacement (0.28–0.77 mm/year) when compared to patients without aortic root replacement (0.03–0.07 mm/year) (all p < 0.001). Antihypertensive medication, gender, and BMI had no significant impact on the distal aortic growth rates.

Conclusion

Distal thoracic aortic diameters increase at a significantly higher rate in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. Further studies are warranted to investigate if the increased growth rate of the distal thoracic aorta after aortic root replacement is caused by altered hemodynamics due to the rigid aortic root graft or due to the general genetic disposition of post-operative Marfan patients.

Clinical relevance statement

High growth rates of the distal aorta after aortic root replacement underline the need for careful life-long aortic imaging of Marfan patients after aortic root replacement.

Key Points

• Aortic growth rates in Marfan patients with aortic root replacement are highest in the mid-aortic arch, the proximal- and mid-descending aorta.

• Growth rates of the distal thoracic aorta are significantly higher in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement.

• Antihypertensive medication, gender, and BMI have no significant impact on distal aortic growth rates in Marfan patients.
SPAM—sub partual analgesia with meptazinol: a prospective cohort study comparing intramuscular with intravenous administration
Authors: Germeshausen Katharina , Linzbach Aissa , Zöllkau Janine , Heimann Yvonne , Schleussner Ekkehard , Groten Tanja , Weschenfelder Friederike
Published: May 2023

Purpose

Safe and effective analgesia sub partu is one of the central issues in optimizing vaginal delivery birth experiences. Meptazinol is a common opiate approved for treating labor pain in the first stage of labor. According to the manufacturer, manual meptazinol can be applied intramuscularly or intravenously. The aim of this study was to compare the two application methods in terms of efficacy in pain relief, occurrence of side effects and treatment satisfaction.

Methods

132 patients with singleton term pregnancies and intended vaginal delivery, receiving meptazinol during first stage of labor were included in this prospective cohort study from 05/2020 to 01/2021. We evaluated effectiveness in pain relief and treatment satisfaction using numeric rating scales (NRS) and documented the occurrence of adverse effects. Chi-square test or Fisher exact test were used to compare categorical data and Mann–Whitney U test to compare continuous data between the two treatment groups. Statistical analysis was done by SPSS 27.0. A p value < 0.05 was considered to indicate statistical significance (two tailed).

Results

Meptazinol decreased labor pain significantly from a NRS of 8 (IQR 8–10) to 6 (IQR 4.75–8) in both treatment groups with no difference in effectiveness between the groups. Frequency of effective pain reduction of a decrease of 2 or more on the NRS did not differ between groups (39.4% vs 54.5%, p = 0.116), as the occurrence of adverse effects. 12% of the newborns were admitted to NICU, the median NApH was 7.195.

Conclusion

Meptazinol significantly reduces labor pain regardless of the method of application: intramuscular or intravenous. According to our data, no preferable route could be identified. The comparably poorer perinatal outcome in our study cohort hinders us to confirm that meptazinol is safe and can be recommended without restrictions.
Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study
Authors: Ratajczak-Tretel B. , Lambert A. Tancin , Al-Ani R. , Arntzen K. , Bakkejord G. K. , Bekkeseth H. M. O. , Bjerkeli V. , Eldøen G. , Gulsvik A. K. , Halvorsen B. , Høie G. A. , Ihle-Hansen H. , Ihle-Hansen H. , Ingebrigtsen S. , Kremer C. , Krogseth S. B. , Kruuse C. , Kurz M. , Nakstad I. , Novotny V. , Næss H. , Qazi R. , Rezaj M. K. , Rørholt D. M. , Steffensen L. H. , Sømark J. , Tobro H. , Truelsen T. C. , Wassvik L. , Ægidius K. L. , Atar D. , Aamodt Anne Hege ,   NOR-FIB study group
Published: May 2023

Background

Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study.

Method

The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA2DS2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF.

Results

In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7.

Conclusion

Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.
Time to surgery is not an oncological risk factor in HCC patients undergoing liver resection
Authors: Otto Carlos Constantin , Wang Guanwu , Mantas Anna , Heise Daniel , Bruners Philipp , Lang Sven Arke , Ulmer Tom Florian , Neumann Ulf Peter , Heij Lara Rosaline , Bednarsch Jan
Published: May 2023

Purpose

Given limitations of the health care systems in case of unforeseeable events, e.g., the COVID pandemic as well as trends in prehabilitation, time from diagnosis to surgery (time to surgery, (TTS)) has become a research issue in malignancies. Thus, we investigated whether TTS is associated with oncological outcome in HCC patients undergoing surgery.

Methods

A monocentric cohort of 217 patients undergoing liver resection for HCC between 2009 and 2021 was analyzed. Individuals were grouped according to TTS and compared regarding clinical characteristics. Overall survival (OS) and recurrence-free survival (RFS) was compared using Kaplan-Meier analysis and investigated by univariate and multivariable Cox regressions.

Results

TTS was not associated with OS (p=0.126) or RFS (p=0.761) of the study cohort in univariate analysis. In multivariable analysis age (p=0.028), ASA (p=0.027), INR (0.016), number of HCC nodules (p=0.026), microvascular invasion (MVI;p<0.001), and postoperative complications (p<0.001) were associated with OS and INR (p=0.005), and number of HCC nodules (p<0.001) and MVI (p<0.001) were associated with RFS. A comparative analysis of TTS subgroups was conducted (group 1, ≤30 days,n=55; group 2, 31–60 days,n=79; group 3, 61–90 days,n=45; group 4, >90 days,n=38). Here, the median OS were 62, 41, 38, and 40 months (p=0.602 log rank) and median RFS were 21, 26, 26, and 25 months (p=0.994 log rank). No statistical difference regarding oncological risk factors were observed between these groups.

Conclusion

TTS is not associated with earlier tumor recurrence or reduced overall survival in surgically treated HCC patients.
Leerstand und Stadterleben aus der Perspektive der Atmosphärenforschung
Authors: Kazig Rainer , Rapp Helena , Bartmus Agnes
Published: May 2023

Dieser Beitrag stellt die Ergebnisse einer explorativen Untersuchung vor, die dem Erleben von leerstehenden Ladenlokalen in der Fußgängerzone von Bad Bergzabern aus der Perspektive der Atmosphärenforschung nachgeht. Viele Zentren von Kleinstädten sind gegenwärtig mehr oder weniger dauerhaft von Leerstand im Einzelhandel betroffen. Er stellt für diese Städte auch deshalb ein Problem dar, weil er die Aufenthalts- und Erlebnisqualität der Zentren mindert. Mit ihrem Fokus auf die Gestimmtheit von Räumen und den Einfluss der unmittelbaren Umgebung auf das subjektive Befinden von Personen, ermöglicht die Atmosphärenforschung, diesen Zusammenhang zu erfassen und differenzierter zu verstehen.

Die Untersuchung baut empirisch auf der Methode der „Parcours commentés“ auf. Als Ergebnisse konnten mit Tristesse, Abwendung und Beschleunigung drei Grundeffekte des Erlebens von Leerstand herausgearbeitet werden. Sie verdeutlichen, auf welche Weise Leerstand grundsätzlich den Aufenthalt und das Erleben in einer Fußgängerzone beeinflusst. Zudem wird sichtbar, durch welche subjektiven Faktoren auf der einen und durch welche konkreten physisch-materiellen Erscheinungen des Leerstandes auf der anderen Seite die Grundeffekte akzentuiert werden. Hieran anknüpfend werden Handlungsmöglichkeiten für einen Umgang mit Situationen längerfristigen Leerstands diskutiert.
Flash glucose monitoring in gestational diabetes mellitus (FLAMINGO): a randomised controlled trial
Authors: Majewska Agata , Stanirowski Paweł Jan , Tatur Jacek , Wojda Barbara , Radosz Iwona , Wielgos Mirosław , Bomba-Opon Dorota Agata
Published: May 2023

Aims

Gestational diabetes mellitus (GDM) is the most common type of hyperglycaemia in pregnancy. GDM is a risk factor of adverse perinatal outcomes, with the incidence rate increasing proportionally to the level of maternal dysglycaemia. Therefore, glycaemic control plays an important role in management of GDM. The aim of this study was to assess the efficacy of flash glucose monitoring (FGM) in GDM.

Materials and methods

This was a non-blinded, randomised controlled trial, that recruited 100 pregnant women diagnosed with GDM between 24 and 28 weeks of gestation at the 1st Department of Obstetrics and Gynaecology, Medical University of Warsaw. After meeting the inclusion criteria patients were randomly allocated to the study group (FGM, n = 50) or control group (self-monitoring of blood glucose—SMBG, n = 50). Clinical and laboratory results were assessed at four follow-up visits. The primary outcome was mean fasting and postprandial glycaemia. The secondary outcomes were perinatal outcomes.

Results

There was no significant difference in mean glycaemia between the groups (p = 0.437) Compared to the control group, the study group significantly reduced their fasting (p = 0.027) and postprandial glycaemia (p = 0.034) during the first 4 weeks following GDM diagnosis, with no significant difference in progression to insulin therapy (OR 1.09, 95% CI 0.47–2.57). Incidence of fetal macrosomia was significantly higher in SMBG as compared to FGM group (OR 5.63, 95% CI 1.16–27.22).

Conclusions

Study results indicate that FGM has an impact on glycaemic control, dietary habits and incidence of fetal macrosomia in patients with GDM.

Trial registration clinicaltrials.gov ID: NCT04422821.
Psychotherapie – zwischen Gesetz und Unmöglichkeit
Authors: Haas Marie-Theres , Möller Anatol
Published: May 2023

Die Psychotherapie ist eine Disziplin, die Menschen mit psychischen Leiden anhand ihrer zur Verfügung stehenden Methoden behandelt. Das 1991 in Kraft getretene Psychotherapiegesetz schafft seit rund drei Jahrzehnten für diesen Berufsstand den rechtlichen Rahmen. Seit einiger Zeit wird über eine Novellierung des Gesetzes diskutiert. Inhalt einer möglichen Gesetzesreform soll primär die Akademisierung der Psychotherapie, wie sie sich in Österreich bereits seit einigen Jahren an wenigen (Privat‑)Universitäten vollzieht bzw. in anderen europäischen Ländern wie in Deutschland seit 2019 in die Wege geleitet worden ist, sein. Jede Zeit verlangt aufgrund ihres dynamischen Geschehens Veränderung. Veränderung als eine kreative Dekonstruktion bestehender Strukturen und gleichzeitig als Schaffung eines Raums, der Neues in sich birgt. Bei all den berufspolitischen Überlegungen muss stets eine Ethik der Ausbildung und klinischen Praxis mitgedacht werden. Dieser Beitrag setzt an diesem Punkt an und gibt einen Kurzabriss über den Status quo des Psychotherapiegesetzes sowie die zur Debatte stehenden inhaltlichen Änderungen einer eventuellen Gesetzesnovellierung. Darüber hinaus werden mögliche Chancen sowie Schwierigkeiten, die eine vollständige Akademisierung des Fachs mit sich bringen könnte, diskutiert.
Impact of polishing system on surface roughness of different ceramic surfaces after various pretreatments and bracket debonding
Authors: Jungbauer Rebecca , Liebermann Anja , Hammer Christian M. , Edelhoff Daniel , Proff Peter , Stawarczyk Bogna
Published: May 2023

Objective

Evaluating various polishing methods after bracket debonding and excessive attachment material removal for different ceramics and pretreatments.

Material and methods

Zirconia (ZrO2), leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with a) silica coated alumina particles (CoJet); LEU and LiSi additionally with b) hydrofluoric acid (HF), c) Monobond Etch&Prime (MEP), d) silicium carbide grinder (SiC) before bracket bonding, shearing off, ARI evaluation, excessive attachment material removal and polishing with i) Sof-Lex Discs (Soflex), ii) polishing paste (Paste), iii) polishing set (Set). Before/after polishing surface roughness (Ra) was measured with a profilometer. Martens hardness parameter were also assessed.

Results

Irrespective of pretreatment Ra of LEU increased the most, followed by LiSi and ZrO2 (p < 0.001, SiC: p = 0.012), in accordance with the measured Martens hardness parameter. CoJet/SiC caused greater roughness as HF/MEP (p < 0.001). The ZrO2 surface was rougher after polishing with Paste/Set (p < 0.001; p = 0.047). Ra improved in the LEU/CoJet, LEU/SiC and LiSi/SiC groups with Soflex/Set (p < 0.001), in the LiSi/CoJet and LEU/HF groups by Soflex (p = 0.003, p < 0.001) and worsened by Paste (p = 0.017, p < 0.001). Polishing of HF or MEP pretreated LiSi with Set increased Ra (p = 0.001, p < 0.001), so did Paste in the LEU/MEP group (p < 0.001).

Conclusions

Paste couldn’t improve the surfaces. Soflex was the only method decreasing Ra on rough surfaces and not causing roughness worsening. Polishing of LEU/LiSi after MEP, LEU after HF pretreatment doesn´t seem to have any benefit.

Clinical Relevance

To avoid long-term damage to ceramic restorations, special attention should be paid to the polishing method after orthodontic treatment.
Heteroscedasticity of residual spending after risk equalization: a potential source of selection incentives in health insurance markets with premium regulation
Authors: Oskam Michel , van Kleef Richard C. , Douven Rudy
Published: May 2023

Many community-rated health insurance markets include risk equalization (also known as risk adjustment) to mitigate risk selection incentives for competing insurers. Empirical evaluations of risk equalization typically quantify selection incentives through predictable profits and losses net of risk equalization for various groups of consumers (e.g. the healthy versus the chronically ill). The underlying assumption is that absence of predictable profits and losses implies absence of selection incentives. This paper questions this assumption. We show that even when risk equalization perfectly compensates insurers for predictable differences in mean spending between groups, selection incentives are likely to remain. The reason is that the uncertainty about residual spending (i.e., spending net of risk equalization) differs across groups, e.g., the risk of substantial losses is larger for the chronically ill than for the healthy. In a risk-rated market, insurers are likely to charge a higher profit mark-up (to cover uncertainty in residual spending) and a higher safety mark-up (to cover the risk of large losses) to chronically ill than to healthy individuals. When such differentiation is not allowed, insurers face incentives to select in favor of the healthy. Although the exact size of these selection incentives depends on contextual factors, our empirical simulations indicate they can be non-trivial. Our findings suggest that – in addition to the equalization of differences in mean spending between the healthy and the chronically ill – policy measures might be needed to diminish (or compensate insurers for) heteroscedasticity of residual spending across groups.
90K/LGALS3BP expression is upregulated in COVID-19 but may not restrict SARS-CoV-2 infection
Authors: Bosquillon de Jarcy Laure , Akbil Bengisu , Mhlekude Baxolele , Leyens Johanna , Postmus Dylan , Harnisch Greta , Jansen Jenny , Schmidt Marie L. , Aigner Annette , Pott Fabian , Chua Robert Lorenz , Krist Lilian , Gentile Roberta , Mühlemann Barbara , Jones Terence C. , Niemeyer Daniela , Fricke Julia , Keil Thomas , Pischon Tobias , Janke Jürgen , Conrad Christian , Iacobelli Stefano , Drosten Christian , Corman Victor M. , Ralser Markus , Eils Roland , Kurth Florian , Sander Leif , Goffinet Christine
Published: May 2023

Glycoprotein 90K, encoded by the interferon-stimulated gene LGALS3BP, displays broad antiviral activity. It reduces HIV-1 infectivity by interfering with Env maturation and virion incorporation, and increases survival of Influenza A virus-infected mice via antiviral innate immune signaling. Its antiviral potential in SARS-CoV-2 infection remains largely unknown. Here, we analyzed the expression of 90K/LGALS3BP in 44 hospitalized COVID-19 patients at multiple levels. We quantified 90K protein concentrations in serum and PBMCs as well as LGALS3BP mRNA levels. Complementary, we analyzed two single cell RNA-sequencing datasets for expression of LGALS3BP in respiratory specimens and PBMCs from COVID-19 patients. Finally, we analyzed the potential of 90K to interfere with SARS-CoV-2 infection of HEK293T/ACE2, Calu-3 and Caco-2 cells using authentic virus. 90K protein serum concentrations were significantly elevated in COVID-19 patients compared to uninfected sex- and age-matched controls. Furthermore, PBMC-associated concentrations of 90K protein were overall reduced by SARS-CoV-2 infection in vivo, suggesting enhanced secretion into the extracellular space. Mining of published PBMC scRNA-seq datasets uncovered monocyte-specific induction of LGALS3BP mRNA expression in COVID-19 patients. In functional assays, neither 90K overexpression in susceptible cell lines nor exogenous addition of purified 90K consistently inhibited SARS-CoV-2 infection. Our data suggests that 90K/LGALS3BP contributes to the global type I IFN response during SARS-CoV-2 infection in vivo without displaying detectable antiviral properties in vitro.