bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP)
Authors: Amer Saba,a Abdulmalik , Alshoabi Sultan Abdulwadoud , Qurashi Abdulaziz A. , Alhazmi Fahad H. , Al-Rudini Rawda Yehia
Published: October 2023

Twin reversed arterial perfusion (TRAP) sequence is a rare pregnancy complication occurs in an identical twin pregnancy that share a single placenta. TRAP sequence is a twin’s pregnancy includes a normal-developed viable pump fetus and an abnormal usually nonviable acardiac fetus. The nonviable acardiac fetus depends on the pump fetus for his blood supply and put the pump fetus at risk of high cardiac output heart failure and congenital anomalies with high mortality rate. Gray-scale ultrasound and color and pulsed Doppler imaging is a noninvasive accessible imaging modality for the diagnosis of TRAP sequence.

Early diagnosis of such conditions is mandatory in order to apply the proper therapeutic measures and to help the normal developed pump fetus to survive. The main goal of management is to interrupt blood supply to the nonviable acardiac fetus to reduce the strain on the heart of the pump fetus thus, increase the chance of survival.

doi: https://doi.org/10.12669/pjms.40.1.8088

How to cite this: Amer SA, Alshoabi SA, Qurashi AA, Alhazmi FH, Al-Rudini RY. Ultrasound Doppler findings of a Twin Reversed Arterial Perfusion Sequence (TRAP). Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.8088

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Time to treat the climate and nature crisis as one indivisible global health emergency
Authors: Zielinski Chris
Published: October 2023

doi: https://doi.org/10.12669/pjms.40.1.8841

How to cite this: Zielinski C. Time to treat the climate and nature crisis as one indivisible global health emergency. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.8841

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Συγκριτική μελέτη της επίδρασης της περιοχικής (συνδυασμένης υπαραχνοειδούς – επισκληριδίου) αναισθησίας στην αποτελεσματικότητα και ασφάλεια της οπισθοηβικής ριζικής προστατεκτομής σε ασθενείς με κλινικά εντοπισμένο καρκίνο του προστάτη
Authors: Πικραμένος Κωνσταντίνος
Published: October 2023

Ο καρκίνος του προστάτη είναι ο δεύτερος συχνότερος καρκίνος στους άνδρες και αποτελεί τη δεύτερη αιτία θανάτου αυτών από καρκίνο. Η ριζική προστατεκτομή παραμένει ο χρυσός κανόνας για την αντιμετώπιση της νόσου. Ο σκοπός της μελέτης είναι η σύγκριση δυο διαφορετικών μεθόδων αναισθησίας και συγκεκριμένα της γενικής και της συνδυασμένης περιοχική αναισθησία (υπαραχνοειδούς - επισκληριδίου) σε ασθενείς που υποβάλλονται σε οπισθοηβική ριζική προστατεκτομή. Στην μελέτη συμπεριλήφθηκαν 60 ασθενείς με διαγνωσμένο καρκίνο του προστάτη, χωρισμένοι σε 2 ομάδες ανάλογα με το είδος της αναισθησίας που χρησιμοποιήθηκε κατά το χειρουργείο, περιοχική ή γενική. Προεγχειρητικά συμπληρώθηκε πλήρες ιστορικό με ερωτηματολόγιο στυτικής δυσλειτουργίας IIEF-5 και έντυπο συγκατάθεσης. Όλοι οι ασθενείς υποβλήθηκαν σε οπισθοηβική ριζική προστατεκτομή. Κατά την διάρκεια της επέμβασης, καταγράφηκαν η αιμοδυναμική παρακολούθηση, η απώλεια αίματος, η αναγκαιότητα μετάγγισης και η συνολική διάρκεια της επέμβασης. Μετεγχειρητικά καταγράφηκαν τα ζωτικά σημεία, εστάλη εργαστηριακός (αιματολογικός-βιοχημικός) έλεγχος για 72 ώρες και εκτιμήθηκε το μετεγχειρητικό άλγος και οι συνολικές μέρες νοσηλείας. Τέλος, εκτιμήθηκε η ιστολογική εξέταση και οι μετεγχειρητικές τιμές PSA, για τον έλεγχο υποτροπής, η στυτική λειτουργία, η ικανοποίηση των ασθενών και η εγκράτεια των ούρων έως και 12 μήνες από την επέμβαση. Όλοι οι ασθενείς ολοκλήρωσαν την επέμβαση επιτυχώς και εξήλθαν από το νοσοκομείο χωρίς επιπλοκές. Κατα την διάρκεια της επέμβασης παρατηρήθηκε στατιστικά σημαντική διαφορά με αυξημένη μέση αρτηριακή πίεση και σφίξεις αλλά και αυξημένο συνολικό χρόνο επέμβασης, στην ομάδα της γενικής αναισθησίας. Μετεγχειρητικά οι ασθενείς με γενική αναισθησία είχαν μεγαλύτερη πτώση του αιματοκρίτη, ενώ δεν καταγράφηκε στατιστική σημαντική διαφορά στις άλλες παραμέτρους. Δεν υπήρχε διαφορά στη συχνότητα βιοχημικής υποτροπής της νόσου μεταξύ των δυο μεθόδων αλλά και ούτε στο βαθμό ικανοποίησης των ασθενών και στη συχνότητα στυτικής λειτουργίας στους 12 μήνες μετεγχειρητικά. Η οπισθοηβική ριζική προστατεκτομή μπορεί με ασφάλεια να διενεργηθεί υπό συνδυασμένη περιοχική αναισθησία, έχοντας μάλιστα και πλεονεκτήματα όσον αφορά την διεγχειρητική αιμορραγία, την αιμοδυναμική σταθερότητα του ασθενούς και τις ημέρες νοσηλείας, χωρίς να επηρεάζεται το ογκολογικό και το λειτουργικό αποτέλεσμα.
Development of alternative pulse width modulation methods for conventional and multilevel voltage source inverters
Authors: Πατεράκης Φώτης-Κωνσταντίνος
Published: October 2023

Οι πολυεπίπεδοι μετατροπείς έχουν προσελκύσει μεγάλο ενδιαφέρον τόσο στην ακαδημαϊκή κοινότητα όσο και στη βιομηχανία τις τελευταίες δεκαετίες. Ως εκ τούτου, η διερεύνηση και η ανάπτυξη στρατηγικών διαμόρφωσης σε αντιστροφείς πολλαπλών επιπέδων αναδεικνύεται ως αναγκαιότητα για τη βιομηχανία και τους ερευνητές. Στην παρούσα διδακτορική διατριβή συζητούνται και προτείνονται εναλλακτικές μέθοδοι διαμόρφωσης κατάλληλες για συμβατικούς μονοφασικούς αντιστροφείς τριών επιπέδων και ειδικότερα για πολυεπίπεδους αντιστροφείς καταιονισμού H-γέφυρας. Η θεωρία των ίσων περιοχών αναμορφώνεται και παρουσιάζεται και προτείνονται τροποποιήσεις της. Οι τροποποιήσεις αυτές συγκρίνονται με άλλα γνωστά σχήματα διαμόρφωσης, όπως τα σχήματα διαμόρφωσης με βάση τα φέροντα και οι τεχνικές διαμόρφωσης εύρους παλμού με προγραμματισμό.Το πλεονέκτημα της τροποποιημένης διαμόρφωσης εύρους παλμών ίσων περιοχών (EAPWM) είναι η αλγοριθμική της απλότητα λόγω των απλών αλγεβρικών σχέσεων, η οποία οδηγεί σε μικρότερη υπολογιστική προσπάθεια. Προτείνεται μια πλήρως μαθηματική διατύπωση για τη διαμόρφωση Equal Areas τόσο για συμβατικούς όσο και για πολυεπίπεδους αντιστροφείς. Η EAPWM αποδεικνύεται ότι παράγει καλά διαμορφωμένες διακοπτόμενες τάσεις εξόδου που έχουν χαμηλή συνολική αρμονική παραμόρφωση ακόμη και σε χαμηλές συχνότητες μεταγωγής. Η σπουδαιότητα αυτής της διατριβής συμπληρώνεται από τα αποτελέσματα, που παράγονται μετά την εφαρμογή της EAPWM σε αντιστροφείς πολλαπλών επιπέδων, τα οποία μπορούν να χρησιμοποιηθούν ως ακριβέστερη αναφορά σε σύγκριση με άλλες στρατηγικές διαμόρφωσης. Επιπλέον, αυτή η στρατηγική άμεσης διαμόρφωσης επεκτάθηκε ώστε να λειτουργεί σε υψηλότερους λόγους διαμόρφωσης πλάτους, με γραμμικό τρόπο, ενώ εισέρχεται στην περιοχή υπερδιαμόρφωσης. Στο πλαίσιο αυτό, αναπτύχθηκαν τροποποιημένοι αλγόριθμοι που χρησιμοποιούν διαφορετικά κριτήρια για τον υπολογισμό του πλάτους των παλμών και της τοποθέτησής τους εντός του χρονικού διαστήματος. Η μέθοδος των ίσων περιοχών, που εφαρμόζεται στους συμβατικούς μονοφασικούς αντιστροφείς, χρησιμοποιεί περιττούς αριθμούς παλμών ανά ημιπερίοδο, διατηρώντας ακέραιες αναλογίες συχνοτήτων σε αντίθεση με την εφαρμογή της στους πολυεπίπεδους αντιστροφείς, όπου εμφανίζονται μη ακέραιες αναλογίες συχνοτήτων λόγω της εφαρμογής ανά επίπεδο.Η εφαρμογή της μεθόδου επαληθεύεται με προσομοιώσεις σε συνδυασμό με πειραματικές εργασίες με τη χρήση ενός πρωτότυπου αντιστροφέα πλήρους κλίμακας.
The genome sequence of the Rock Grayling, Hipparchia semele (Linnaeus, 1758)
Authors: Macgregor Callum J. , Saccheri Ilik J. ,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: October 2023

We present a genome assembly from an individual female Hipparchia semele (the Rock Grayling; Arthropoda; Insecta; Lepidoptera; Nymphalidae). The genome sequence is 403.4 megabases in span. Most of the assembly is scaffolded into 30 chromosomal pseudomolecules, including the W and Z sex chromosomes. The mitochondrial genome has also been assembled and is 15.22 kilobases in length. Gene annotation of this assembly on Ensembl identified 17,540 protein coding genes.
Structuring Educational Material When Mastering Quantities in Elementary School
Authors: Nalimova I. , Stasyuk O.
Published: October 2023

The article discusses one of the ways to achieve subject and meta-subject results in teaching mathematics to junior schoolchildren – structuring educational material. The results of diagnosing the knowledge and skills of third and fourth grade students on the topic “Quantities” are presented and analyzed; Some approaches to developing schoolchildren’s ability to structure knowledge on this topic are outlined. Examples of graphic models that a primary school teacher can use when teaching mathematics are given
Methods of Using a Skipping Rope As a Sports Object in Physical Education Lessons in Elementary School
Authors: Ovchinnikov Yu. , Yakunina V.
Published: October 2023

A modern physical education lesson in a secondary school is multifunctional. The article reveals the method of using a sports equipment - a jump rope, characterizes its ergonomic properties and the relationship with the biomechanics of movements that affect the body. Methodological recommendations are presented for young professionals entering the profession on using a skipping rope during and after school hours. The social significance of sports equipment in the education and health improvement of not only children, but also their entire family has been demonstrated.
A.S. Makarenko: Experience of Educational Work with Difficult and Underachieving Students
Authors: Nevskaya S.
Published: October 2023

The article reveals the leading provisions of the pedagogical concept of A.S. Makarenko on educational work with difficult and underachieving students, lays out the conditions that make it possible to form a positive attitude of schoolchildren towards acquiring knowledge, and also provides methodological recommendations for educational work with children and adolescents, tested and successfully confirmed in practice by an outstanding domestic teacher. Familiarity with the scientific experience that underlay his work will certainly be useful for both teachers and organizers of modern Russian school education.
Peculiarities of moral upbringing of convicts in corrective colonies of Ukraine
Authors:   Drogobych Ivan Franko State Pedagogical University, Ivakh Svitlana , Kupets Oleksandr ,   Drogobych Ivan Franko State Pedagogical University
Published: October 2023

The article emphasizes the multifaceted nature of the problem of moral upbringing and selfupbringing of convicts in corrective colonies. Their main tasks include: cultivation of moral consciousness; development of moral feelings; development of skills and habits of socially acceptable behaviour; bridging gaps and correction of defects of moral consciousness; eradication of negative feelings and antisocial habits. It is noted that on the way to solving the specified objectives, there arise many difficulties that are caused by the individual characteristics of the convicts (relative weakness of motivation, pronounced egocentric orientation, tendency to negative influence). It has been established that the effectiveness of moral upbringing of convicts largely depends on the pedagogical guidance in the upbringing process in corrective institutions, and one of the main tasks of educators is to create optimal psychological and pedagogical conditions for self-upbringing and moral development of convicts. There have been singled out two groups of factors (social and pedagogical) which directly affect the moral formation and personality development of convicts. Their characteristic features have been revealed. It is emphasized that social influence can be both spontaneous and organized, and pedagogical influence is always goal-oriented and planned, the most controlled and favourable to shape moral behaviour. There have been defined the stages of the convict’s moral development: getting the personality ready to reinterpret information about morality by determining its value and significance for the personality; analytic-synthetic transformation of information; developing options and choosing the right program of actions in specific situations.
Complex analysis of literary text in the methodical training of future language and literature teachers
Authors:   State Institution Luhansk Taras Shevchenko National University, Nikitina Alla , Lapko Olena ,   State Institution Luhansk Taras Shevchenko National University
Published: October 2023

The article is dedicated to the current issue of the methodical preparation of future language and literature teachers capable of implementing text-centered and integrated approaches to teaching Ukrainian language and literature in modern secondary education institutions. One of the means of implementing these approaches is the analysis of literary text, particularly the text of lyrical works, which is the most challenging for students to perceive and understand. Carrying out tasks in contemporary language and literature education requires the future high-level language and literature teacher to possess not only linguistic and literary analytical skills but also the ability to select optimal methodical techniques for working with texts during Ukrainian language and literature lessons, i.e., conducting methodical analysis of texts as type of professional activity. The study explores the essence of complex (integrated) philological and methodical analysis of lyrical texts, defines its approximate scheme and stages of implementation, justifies the place and significance of such analysis in the process of forming subject-methodical competence of future language and literature teachers. The authors consider the subject-methodical competence of language and literature teachers as a comprehensive ability to apply a system of scientific philological and methodical knowledge, skills, communicative abilities, judgments and convictions directed at their effective application in the field of language and literature education. The ability to conduct complex philological-methodical analysis of lyrical texts is considered as an essential characteristic of the subject-methodical competence of a language and literature teacher.
Civic identity of students of higher pedagogical education: challenges of globalization processes
Authors:   H. S. Skovoroda Kharkiv National Pedagogical University, Vitvitskyi Vadym
Published: October 2023

The article presents the author’s vision of the problem of forming the civic identity of students of higher pedagogical education in the process of practical psychological and pedagogical training. The stated problem is considered in the context of globalization challenges. The research was carried out based on systemic, synergistic and technological approaches at the interdisciplinary level. Scientific research was conducted based on the principles of: comprehensiveness, mutual responsibility of the state and participants in the educational process. The methods of analysis (historical-pedagogical, systemic, survey-analytical), generalization were applied – to determine the state of scientific development of the problem, substantiation of the theoretical basis of the research, content analysis is of current regulatory documents, comparison and heuristic forecasting – to substantiate the conclusions. The key concept in this study is considered by the author to be a permanent awareness by a citizen of Ukraine of his political and legal connection with the Ukrainian people and civil society. Indicators of civic identity, based on the research materials, can be: a sense of pride for one’s Motherland, readiness and desire to live and work in a certain political and legal field, understanding of national and European values. Among such values, state symbols are identified as primary. Also, indicators of civic identity include active social and political life, in-depth understanding of legal education and legal awareness, ecology of thinking and life, tolerant attitude to the values and beliefs of representatives of other cultures, as well as to regional and national-linguistic features, readiness to protect the sovereignty and territorial integrity of Ukraine. The article defines the globalization challenge of the formation of civic identity as follows: prevention of situations of viewing the world only through the eyes of one’s own culture. This multifaceted challenge can be overcome with the resources of cultural socialization of youth, in particular in network communication, support and continuation of national traditions, personalization of educational influences. The prospect of further development of the topic is the disclosure of the practices of cooperation of institutions of higher pedagogical education of Ukraine and other countries of the world in the direction of the formation of active citizenship, the development of a system of common traditions and activities.
We need to support those who speak up, for everyone's safety
Authors: Foster Sam
Published: October 2023

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, reflects on the need to support those who speak up
Foundation for implementing a comprehensive vascular access excellence initiative organization-wide to improve vascular access device insertion and standardize care: best practice for an acute care hospital
Authors: Campos Cheryl , Lopez Megan , Irwin-Nieto Vanessa , Richards Randy , Deen Melissa R. , Lalata Agnes
Published: October 2023

Introduction:

In 2016, a 263-bed public district hospital in California trialed a peripheral intravenous catheter (PIVC) inserted using ultrasound, with the potential to increase first attempt success in difficult intravenous access (DIVA) patients. This led to the implementation of a hospital-wide initiative to improve nursing vascular access skills and expedite vascular access device (VAD) placement.

Methods:

To trial a PIVC and ultrasound-guided (USG) insertion, a training program was developed and led to a doctoral Capstone project piloting an evidence-based nurse-driven protocol for the identification of DIVA patients. A Vascular Access Committee was established to achieve vascular access excellence throughout the hospital by increasing the number of nurses with advanced skills in VAD placement and by developing a central venous access device (CVAD) insertion and maintenance bundle to decrease the incidence of central line-associated bloodstream infections (CLABSI). With ongoing support of nursing leadership and achievement of ANCC Magnet Recognition® in 2021, the hospital developed a comprehensive initiative to provide patients with a consistent level of nursing expertise for VAD placement across all shifts.

Results:

Requests for USGPIVCs increased throughout the hospital, DIVA patients themselves requested ultrasound guidance be used for PIVC insertions, and there were fewer requests for Emergency Department (ED) physicians to insert CVADs. From the related Doctor of Nursing Practice (DNP) Capstone project, there were higher first-attempt cannulation successes, longer PIVC dwell times, and a reduction in devices and supplies utilized. The CVAD bundles resulted in the number of central line-associated bloodstream infections decreasing from four in 2019 to one in 2020. Since the initiative's inception, a total of 92 nurses completed the USGPIVC insertion training, and patient access to advanced-skilled clinicians is now available around the clock.

Discussion:

This manuscript discusses the initiative implemented to standardize patient care through a collaborative multidisciplinary approach and has potential generalizability to other acute care hospitals to reduce associated healthcare costs and to prevent poor patient outcomes by expediting the arrival of a vascular access nurse for DIVA patients.

Conclusion:

The vascular access excellence initiative implemented provided an effective strategy to enhance the skills and confidence of nurses in VAD placement and improved efficiency in processes to expedite the arrival of an advanced skilled nurse to place VADs on DIVA. Targeted educational initiatives improved patient outcomes by reducing catheter-related bloodstream infections.
God of Holy Love
Authors: Jonathan C. Rutledge  , Jordan Wessling
Published: October 2023

In the exceptional book Divine Holiness and Divine Action, Mark Murphy defends what he calls the holiness framework for divine action. The purpose of our essay-response to Murphy’s book is to consider an alternative framework for divine action, what we call the agapist framework. We argue that the latter framework is more probable than Murphy’s holiness framework with respect to select theological desiderata.
An Introduction to the Symposium on Mark Murphy’s Divine Holiness and Divine Action
Authors: Jordan Wessling
Published: October 2023

The purpose of this essay is to introduce the symposium within the Journal of Analytic Theology on Mark Murphy’s latest book, Divine Holiness and Divine Action. To this end, the main aims of Murphy’s book are presented and the essays within the symposium are summarized.
Ancestral Sin is not Pelagian
Authors: Haratine Parker
Published: October 2023

Various thinkers are concerned that the Orthodox view of Ancestral Sin does not avoid the age-old Augustinian concern of Pelagianism. After all, the doctrine of Ancestral Sin maintains that fallen human beings do not necessarily or inevitably commit actual sins. In contemporary literature, this claim could be articulated as a denial of the ‘inevitability thesis.’ A denial of the inevitability thesis, so contemporary thinkers maintain, seems to imply both that human beings can place themselves in right relation to God as well as the Pelagian denial that all require Christ's work to attain this right relation to God. This article demonstrates that the Ancestral Sin, along with a denial of the inevitability thesis, is neither Pelagian nor Semi-Pelagian. I show that the doctrine of Ancestral Sin denies (Semi-) Pelagianism in various ways. I show that, for Ancestral Sin to entail (Semi-) Pelagianism, one must commit to several assumptions, each of which is plausibly deniable and none of which Orthodox thinkers affirm.
God’s Things
Authors: Samuel Fleischacker
Published: October 2023

This response to Mark Murphy’s Divine Holiness and Divine Action constructs an account of what Murphy calls “secondary holiness” — the holiness of everything other than God — oriented to the Jewish tradition. On the theory that differences come out most sharply against a background of similarities, an initial section lays out what the author shares with Murphy methodologically. The essay then offers a reading of the aesthetic and ethical significance of Jewish ritual practices that delimit holy objects and times. Central to the ethical aspect of this account is an analysis of what it might mean, in interpersonal relationships, to respect certain things as “sacred” to another; this leads to the suggestion that regarding certain things as sacred to God may be a basis on which to develop a personal relationship with God.
Toughest of Loves
Authors: Wessling Jordan
Published: October 2023

Some Christian theologians and philosophers maintain that God’s punishments are always (at least partly) motivated by redemptive love for those punished, even when these punishments are considerably severe (e.g., killings or damnations). However, advocates of such a conception of divine punishment face significant challenges. Perhaps most fundamentally, it is not entirely apparent how severe and loving features of divine punishment might be understood to fit together within a viable theological model. In this article this foundational issue is addressed. By culling resources from St. Gregory of Nyssa, the present aim is to proffer a contemporary model of divine punishment that naturally combines redemptive love for those punished with apparently harsh treatment.
The labour process and workers’ rights at Mercado Libre: hiding exploitation through regulation in the digital economy
Authors: Atzeni Maurizio
Published: October 2023

E-commerce platforms such as, most famously, Amazon use digitalised production systems in their warehouses. In this article we examine how such digitalised systems impact upon the labour process, the organisation of work and working condition in the warehouse of Mercado Libre in Argentina, the largest e-commerce platform there and in Latin America. In many respects, this case is aligned with the evidence emerging from similar studies on Amazon. The ubiquitous combination of algorithmic management with discretionary human management has limited the sphere of workers’ autonomy and spaces of resistance, increased control to virtually any productive or unproductive time spent by workers in the warehouse and imposed stressful working conditions on workers, often with negative implications for health and safety. These conditions of exploitation common to digitalised workplaces have, however, been strengthened by the company’s hiring strategy, based extensively on labour broking, on the high turnover of a young workforce, and the strategic use of the existing institutional regulatory framework and formal trade union representation to buffer management from workers’ complaints. In this sense it is not regulation as such that is the key to better working conditions in the digitalised labour process but rather how that regulatory framework is effectively used and contested by workers’ struggles on the ground to get concessions.
Mapping resistance-associated anthelmintic interactions in the model nematode Caenorhabditis elegans
Authors: Rehborg Elena G. , Wheeler Nicolas J. , Zamanian Mostafa
Published: October 2023

Parasitic nematodes infect billions of people and are mainly controlled by anthelmintic mass drug administration (MDA). While there are growing efforts to better understand mechanisms of anthelmintic resistance in human and animal populations, it is unclear how resistance mechanisms that alter susceptibility to one drug affect the interactions and efficacy of drugs used in combination. Mutations that alter drug permeability across primary nematode barriers have been identified as potential resistance mechanisms using the model nematode Caenorhabditis elegans. We leveraged high-throughput assays in this model system to measure altered anthelmintic susceptibility in response to genetic perturbations of potential cuticular, amphidial, and alimentary routes of drug entry. Mutations in genes associated with these tissue barriers differentially altered susceptibility to the major anthelmintic classes (macrocyclic lactones, benzimidazoles, and nicotinic acetylcholine receptor agonists) as measured by animal development. We investigated two-way anthelmintic interactions across C. elegans genetic backgrounds that confer resistance or hypersensitivity to one or more drugs. We observe that genetic perturbations that alter susceptibility to a single drug can shift the drug interaction landscape and lead to the appearance of novel synergistic and antagonistic interactions. This work establishes a framework for investigating combinatorial therapies in model nematodes that can potentially be translated to amenable parasite species.
Relative bed allocation for COVID-19 patients, EHR investments, and COVID-19 mortality outcomes
Authors: Patel Pankaj C. , Tsionas Mike G. , Devaraj Srikant
Published: October 2023

Managing flexibility in the relative bed allocation for COVID-19 and non-COVID-19 patients was a key challenge for hospitals during the COVID-19 pandemic. Based on organizational information processing theory (OIPT), we propose that the local electronic health record (EHR) systems could improve patient outcomes through improved bed allocation in the local area. In an empirical analysis of county-level weekly hospital data in the US, relative capacity of beds in hospitals with higher EHR was associated with lower 7-, 14-, and 21-day forward-looking COVID-19 death rate at the county-level. Testing for cross-state variation in non-pharmaceutical interventions along contiguous county border-pair analysis to control for spatial correlation varying between state variations in non-pharmaceutical intervention policies, 2SLS analysis using quality ratings, and using foot-traffic data at the US hospitals our findings are generally supported. The findings have implications for policymakers and stakeholders of the local healthcare supply chains and EHR systems.
Orientation of internet use, government trust, and public environmental satisfaction an empirical study in Mainland China
Authors: Chen Jinghuan , Yang Li , Zheng Lijuan
Published: October 2023

Public environmental satisfaction is related to the healthy living standard of human beings and sustainable development of an economic society. In the context of the continuous updating of Internet technologies, it is necessary to study the correlation between Internet use and public environmental satisfaction, but few studies have focused on the effect of the orientation of Internet use on public environmental satisfaction, and its mediating mechanisms. This study considered survey data from the China Social Survey 2019 which were conducted in a sample of 5,112 residents, SPSS 16.0 and ordinary least squares regression model was used to analyze the relationship between orientation of Internet use, government trust and public environmental satisfaction. The results showed politically-oriented Internet use was positively correlated with public environmental satisfaction, and entertainment-oriented Internet use did not correlate with public environmental satisfaction. Furthermore, government trust partially mediated the relation between politically-oriented Internet use and public environmental satisfaction. Several implication policies are suggested for improving public environmental satisfaction. This study takes into account individual initiative and government’s control of information during Internet use, emphasizes the impact of different individual Internet use preferences on environmental satisfaction in the web environment with strong government control. By incorporating individual factors at the micro level and social factors at the macro level, this paper is in order to improve public environmental satisfaction.
Efficacy and safety of patients with chronic kidney disease undergoing left atrial appendage closure for atrial fibrillation
Authors: Liu Chaofan , Han Shaojie , Cui Kaijun , Wang Fang
Published: October 2023

Background

The relative safety and efficacy of left atrial appendage closure (LAAC) for atrial fibrillation (AF) in patients with chronic kidney disease (CKD) have not been well defined. To evaluate the results in this cohort, we conducted a systematic review and meta-analysis of observational studies.

Methods

We searched the PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception to January 2023 for all relevant studies. Our inclusion criteria were met by twelve observational studies that included 61324 patients altogether.

Results

Compared with no CKD group, in-hospital mortality (OR: 2.84, 95% CI: 2.12–3.81, p<0.01, I2 = 0%), acute kidney injury (AKI) (OR: 4.39,95% CI:4.00–4.83, P<0.01, I2 = 3%), major bleeding events (OR: 1.44, 95% CI: 1.29–1.60, p<0.01 I2 = 0%), and pericardial effusion/tamponade (OR 1.30; 95% CI 1.13–1.51, p < 0.01; I2 = 0%) were more common in the CKD group, especially in patients with end-stage renal disease (ESRD). No significant difference was observed in the occurrence of stroke (OR: 1.24, 95% CI: 0.86–1.78, P = 0.25, I2 = 0%), LAAC success rates (OR: 1.02, 95% CI: 0.33–3.16, p = 0.97, I2 = 58%) and vascular access complications (OR: 1.13, 95% CI: 0.91–1.39, p = 0.28, I2 = 0%) between the two groups. During the follow-up, there was no difference in the risk of stroke between the two groups.

Conclusions

CKD patients who receive LAAC have a greater risk of in-hospital mortality, AKI, pericardial effusion/tamponade, and major bleeding events than those without CKD, especially in patients with ESRD. No significant difference in the risk of stroke was found in the long-term follow-up after LAAC between the two groups, demonstrating a similar efficacy of LAAC to prevent stroke in CKD patients.
Utilizing principal component analysis in the identification of clinically relevant changes in patient HLA single antigen bead solid phase testing patterns
Authors: Cornaby Caleb , Weimer Eric T.
Published: October 2023

Background

HLA antibody testing is essential for successful solid-organ allocation, patient monitoring post-transplant, and risk assessment for both solid-organ and hematopoietic transplant patients. Luminex solid-phase testing is the most common method for identifying HLA antibody specificities, making it one of the most complex immunoassays as each panel contains over 90 specificities for both HLA class I and HLA class II with most of the analysis being performed manually in the vendor-provided software. Principal component analysis (PCA), used in machine learning, is a feature extraction method often utilized to assess data with many variables.

Methods & findings

In our study, solid organ transplant patients who exhibited HLA donor-specific antibodies (DSAs) were used to characterize the utility of PCA-derived analysis when compared to a control group of post-transplant and pre-transplant patients. ROC analysis was utilized to determine a potential threshold for the PCA-derived analysis that would indicate a significant change in a patient’s single antigen bead pattern. To evaluate if the algorithm could identify differences in patterns on HLA class I and HLA class II single antigen bead results using the optimized threshold, HLA antibody test results were analyzed using PCA-derived analysis and compared to the clinical results for each patient sample. The PCA-derived algorithm had a sensitivity of 100% (95% CI, 73.54%-100%), a specificity of 75% (95% CI, 56.30%-92.54%), with a PPV of 65% (95% CI, 52.50%-83.90%) and an NPV of 100%, in identifying new reactivity that differed from the patients historic HLA antibody pattern. Additionally, PCA-derived analysis was utilized to assess the potential over-reactivity of single antigen beads for both HLA class I and HLA class II antibody panels. This assessment of antibody results identified several beads in both the HLA class I and HLA class II antibody panel which exhibit over reactivity from 2018 to the present time.

Conclusions

PCA-derived analysis would be ideal to help automatically identify patient samples that have an HLA antibody pattern of reactivity consistent with their history and those which exhibit changes in their antibody patterns which could include donor-specific antibodies, de novo HLA antibodies, and assay interference. A similar method could also be applied to evaluate the over-reactivity of beads in the HLA solid phase assays which would be beneficial for lot comparisons and instructive for transplant centers to better understand which beads are more prone to exhibiting over-reactivity and impact patient care.
Measuring the relevance and impact of innovation and social forces for Transnational Value Chain’s embeddedness in a region
Authors: Cepoi Victor , Pandiloska Jurak Alenka
Published: October 2023

This paper focuses on understanding and explaining TVC embeddedness with the theory of Regional Innovation Systems, Social Fields, and Qualitative Comparative Analysis, which allows us to show the sufficient and necessary conditions for TVC embeddedness in a region. A qualitative-comparative empirical study was conducted in 17 regions in the form of semi-structured, expert Focus Group Interviews. The participants were regional stakeholders, representatives of supportive regional institutions, businesses, and academia, accustomed to the regional innovation processes. The findings show that the strongest effect comes from the presence of the Support for Regional Innovativeness. The presence of Innovations and networks also have to be considered, meanwhile, when it comes to institutions, the results point out that the presence and absence of Institutional framework contribute to the Regional TVC Embeddedness. Lastly, we can also highlight the absence of Cognitive Frames, which are important for Regional TVC Embeddedness. The data presented in the paper does not separate the TIER levels. Different levels could influence the conditions for the embeddedness. Half-products that are closer to the end product tend to have higher added value and are more innovative. Based on a newly developed theory and model, which focuses on social field theory and innovation, the present paper aims to test them in real-life settings. This model explains how the social forces and innovation processes influence the company embeddedness by emphasising the necessary and sufficient conditions to have TVC embeddedness.
Identification of immune-related signatures and pathogenesis differences between thoracic aortic aneurysm patients with bicuspid versus tricuspid valves via weighted gene co-expression network analysis
Authors: Huang Min , Guan Rong , Qiu Jiawei , Gnamey Abla Judith Estelle , Wang Yusi , Tian Hai , Sun Haoran , Shi Hongbo , Sun Wenjing , Jia Xueyuan , Wu Jie
Published: October 2023

Background

Thoracic aortic aneurysm (TAA) occurs due to pathological aortal dilation, and both individuals with normal tricuspid aortic valves (TAV) or abnormal bicuspid aortic valves (BAV), the latter being a congenital condition, are at risk. However, some differences are present between TAA/BAV and TAA/TAV with respect to their pathophysiological processes and molecular mechanisms, but their exact nature is still mostly unknown. Therefore, it is necessary to elucidate TAA developmental differences among BAV vs. TAV patients.

Methods

Publically-available gene expression datasets, aortic tissue derived from TAA/BAV and TAA/TAV individuals, were analyzed by weighted gene co-expression network analysis (WGCNA) to identify gene modules associated with those conditions. Gene Ontology (GO) enrichment analysis was performed on those modules to identify the enriched genes within those modules, which were verified by Gene Set Variation Analysis (GSVA) on a dataset derived from aortic smooth muscle cell gene expression between TAA/TAV and TAV/BAV patients. Immune cell infiltration patterns were then analyzed by CIBERSORT, and a protein-protein interaction (PPI) network was constructed based on WGCNA and enrichment analysis results to identify hub genes, followed by validation via stepwise regression analysis. Three signatures most strongly associated with TAA/TAV were confirmed by receiver operating characteristic (ROC) and decision curve analyses (DCA) between prior-established training and testing gene sets.

Results

WGCNA delineated 2 gene modules being associated with TAA/TAV vs. TAA/BAV; both were enriched for immune-associated genes, such as those relating to immune responses, etc., under enrichment analysis. TAA/TAV and TAA/BAV tissues also had differing infiltrating immune cell proportions, particularly with respect to dendritic, mast and CD4 memory T cells. Identified three signatures, CD86, integrin beta 2 (ITGB2) and alpha M (ITGAM), as yielding the strongest associations with TAA/TAV onset, which was verified by areas under the curve (AUC) at levels approximating 0.8 or above under ROC analysis, indicating their predictive value for TAA/TAV onset. However, we did not examine possible confounding variables, so there are many alternative explanations for this association.

Conclusions

TAA/TAV pathogenesis was found to be more associated with immune-related gene expression compared to TAA/BAV, and the identification of three strongly-associated genes could facilitate their usage as future biomarkers for diagnosing the likelihood of TAA/TAV onset vs. TAA/BAV, as well as for developing future treatments.
Exploring the mechanisms underlying stroke volume variability reduction in a murine model of heart failure with reduced ejection fraction
Authors: Fernández-Mendoza Gemma , Méndez-Fernández Abraham , Alves-Figueiredo Hugo J. , García-Rivas Gerardo , Santillán Moisés
Published: October 2023

Heart failure with reduced ejection fraction (HFrEF) is accompanied by disregulation of cardiovascular function. Heart rate variability (HRV) is commonly used to assess autonomic dysfunction in HFrEF. However, analysis of stroke volume variability (SVV) may provide additional insights. We examined HRV and SVV in a mouse model of HFrEF. HFrEF mice exhibited reduced stroke volume and ejection fraction versus controls, confirming cardiac contractile dysfunction. HRV was preserved in HFrEF mice. However, SVV was markedly diminished, indicating dissociation between HRV and SVV regulation. Using a mathematical model, we propose that Frank-Starling mechanism abnormalities in HFrEF disrupt SVV independent of HRV. Assessing SVV could thus provide unique insights beyond HRV into cardiovascular control deficits in HFrEF.
Causal inferences and real-world evidence: A comparative effectiveness evaluation of abiraterone acetate against enzalutamide
Authors: Johansson Per , Jonéus Paulina , Langenskiöld Sophie
Published: October 2023

Regulatory authorities are recognizing the need for real-world evidence (RWE) as a complement to randomized controlled trials in the approval of drugs. However, RWE needs to be fit for regulatory purposes. There is an ongoing discussion regarding whether pre-publication of a protocol on appropriate repositories, e.g. ClinicalTrials.gov, would increase the quality of RWE or not. This paper illustrates that an observational study based on a pre-published protocol can entail the same level of detail as a protocol for a randomized experiment. The strategy is exemplified by designing a comparative effectiveness evaluation of abiraterone acetate against enzalutamide in clinical practice. These two cancer drugs are prescribed to patients with advanced prostate cancer. Two complementary designs, including pre-analysis plans, were published before data on outcomes and proxy-outcomes were obtained. The underlying assumptions are assessed and both analyses show an increased mortality risk from being prescribed abiraterone acetate compared to enzalutamide.
Exploring reasons why South African dental therapists are leaving their profession: A theory-informed qualitative study
Authors: Sodo Pumla Pamella , Malele-Kolisa Yolanda , Moola Aneesa , Yengopal Veerasamy , Nemutandani Simon , Jewett Sara
Published: October 2023

Background

Dental therapy is a category of mid-level oral health professional that was introduced to address inequities in oral health service provision in South Africa within a constrained human resource for health context. However, low numbers of registered dental therapists and attrition threaten this strategy.

Aim

This study explored reasons for this attrition, building on the Hertzberg Two-Factor Theory.

Methods

Through a qualitative exploratory study design, in-depth interviews were conducted with former dental therapists to explore their reasons for leaving the profession. They were recruited using snowball sampling. All interviews were audio recorded, transcribed verbatim, and coded in NVIVO12. A team of researchers applied thematic analysis to agree on themes and sub-themes, guided by Hertzberg’s ideas of intrinsic and extrinsic factors.

Findings

All 14 former dental therapists interviewed expressed their passion for the profession, even though their motivations to join the profession varied. Many of their reasons for leaving aligned with extrinsic and intrinsic factors defined in Hertzberg’s Two-Factor Theory. However, they also spoke about a desire for a professional identity that was recognized and respected within the oral health profession, health system, and communities. This is a novel study contribution.

Conclusion

Dental therapist attrition in South Africa is mainly caused by job dissatisfaction and motivation issues resulting from health system level factors. While the Hertzberg Two-Factor Theory helped identify extrinsic and intrinsic factors at an individual level, we used the Human Resources for Health System Development Analytical Framework to identify solutions for dental therapist production, deployment, and retention. Addressing these issues will enhance retention and accessibility to oral health services in the country.
Quantitative radiomics approach to assess acute radiation dermatitis in breast cancer patients
Authors: Park So-Yeon , Park Jong Min , Kim Jung-in , Choi Chang Heon , Chun Minsoo , Chang Ji Hyun , Kim Jin Ho
Published: October 2023

Purpose

We applied a radiomics approach to skin surface images to objectively assess acute radiation dermatitis in patients undergoing radiotherapy for breast cancer.

Methods

A prospective cohort study of 20 patients was conducted. Skin surface images in normal, polarized, and ultraviolet (UV) modes were acquired using a skin analysis device before starting radiotherapy (‘Before RT’), approximately 7 days after the first treatment (’RT D7’), on ‘RT D14’, and approximately 10 days after the radiotherapy ended (‘After RT D10’). Eighteen types of radiomic feature ratios were calculated based on the values acquired ‘Before RT’. We measured skin doses in ipsilateral breasts using optically stimulated luminescent dosimeters on the first day of radiotherapy. Clinical evaluation of acute radiation dermatitis was performed using the Radiation Therapy Oncology Group scoring criteria on ‘RT D14’ and ‘After RT D10’. Several statistical analysis methods were used in this study to test the performance of radiomic features as indicators of radiodermatitis evaluation.

Results

As the skin was damaged by radiation, the energy for normal mode and sum variance for polarized and UV modes decreased significantly for ipsilateral breasts, whereas contralateral breasts exhibited a smaller decrease with statistical significance. The radiomic feature ratios at ‘RT D7’ had strong correlations to skin doses and those at ‘RT D14’ and ‘after RT D10’ with statistical significance.

Conclusions

The energy for normal mode and sum variance for polarized and UV modes demonstrated the potential to evaluate and predict acute radiation, which assists in its appropriate management.