bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovation in practice: A deviant case analysis of a locally developed assessment tool used in a psychiatric and addiction clinic in Sweden
Authors: Härd Sofia
Published: March 2024

This article analyses the use of a locally developed assessment tool designed to generate aggregated data to evaluate the work of a psychiatric and addiction clinic. The use of tools, methods and interventions in the Swedish social services is usually based on recommendations in national guidelines established by the National Board of Health and Welfare (NBHW). Thus, a locally produced and systematically used assessment tool provides an interesting deviant case for discussing knowledge production and use from the perspective of evidence‐based practice. The assessment tool was characterised by the specific psychiatric and addiction clinic context, where local needs and prerequisites were prioritised over the recommendations found in NBHW guidelines. The empirics comprise interviews with 12 professionals who used the tool, where experience of using the tool was analysed using a thematic analysis. The findings can be summarised in three main conclusions. First, tinkering of tools and methods is not necessarily associated with limited practice applicability or relevance. Second, professionals are more likely to appreciate a tool if that tool is designed with a treatment and conversation rationality in mind. Third, rather than perceived as more valid than other types of knowledge, NBHW‐recommended tools are associated with a certain shape or style – but a shape or style that is permeated by legitimacy.
What is the environmental impact of a blood transfusion? A life cycle assessment of transfusion services across England
Authors: Hibbs Stephen P. , Thomas Stephen , Agarwal Nikhil , Andrews Charlotte , Eskander Sylvia , Abdalla Aaliyah Sharif , Staves Julie , Eckelman Matthew J. , Murphy Michael F.
Published: March 2024

Background

Healthcare activities significantly contribute to greenhouse gas (GHG) emissions. Blood transfusions require complex, interlinked processes to collect, manufacture, and supply. Their contribution to healthcare emissions and avenues for mitigation is unknown.

Study Design and Methods

We performed a life cycle assessment (LCA) for red blood cell (RBC) transfusions across England where 1.36 million units are transfused annually. We defined the process flow with seven categories: donation, transportation, manufacturing, testing, stockholding, hospital transfusion, and disposal. We used direct measurements, manufacturer data, bioengineering databases, and surveys to assess electrical power usage, embodied carbon in disposable materials and reagents, and direct emissions through transportation, refrigerant leakage, and disposal.

Results

The central estimate of carbon footprint per unit of RBC transfused was 7.56 kg CO2 equivalent (CO2eq). The largest contribution was from transportation (2.8 kg CO2eq, 36% of total). The second largest was from hospital transfusion processes (1.9 kg CO2eq, 26%), driven mostly by refrigeration. The third largest was donation (1.3 kg CO2eq, 17%) due to the plastic blood packs. Total emissions from RBC transfusion are ~10.3 million kg CO2eq/year.

Discussion

This is the first study to estimate GHG emissions attributable to RBC transfusion, quantifying the contributions of each stage of the process. Primary areas for mitigation may include electric vehicles for the blood service fleet, improving the energy efficiency of refrigeration, using renewable sources of electricity, changing the plastic of blood packs, and using methods of disposal other than incineration.
Locating Former Nazi Terror Sites: A Methodological 'How-To' for Archaeological Research and Heritage Management
Authors:   Universität Innsbruck, Hausmair Barbara , Dézsi Attila ,   Landesamt für Denkmalpflege im Regierungspräsidium Stuttgart
Published: March 2024

Since the 1980s, there have been increasing efforts by heritage offices in Germany and Austria, and many of the countries that were occupied by Nazi Germany during World War II, to locate places of former Nazi terror and, where possible, to protect them from further destruction in order to preserve them as places of remembrance for the victims of National Socialism. However, methodological considerations and approaches for locating, recording, and eventually assessing the 'heritage value' of former Nazi terror sites remain rather obscure, since little has been published on the methodological approaches taken by different institutions. This article presents a systematic workflow for recording former sites of Nazi terror, which was developed in the framework of the Natzweiler-Concentration-Camp-System-Project based at the Heritage Office of the State of Baden-Württemberg (Landesamt für Denkmalpflege im Regierungspräsidium Stuttgart). It aims to provide a methodological 'How-To' for creating archaeological inventories of former Nazi camps, associated sites and whole 'landscapes of destruction', hints at where to locate useful primary sources, but also to critically reflect on challenges encountered during the project and how they could be approached in the future.
Sodium adsorption on nanometer-thick TiO2 channel thin-film transistors for enhanced drain currents
Authors: Miyazawa Ryo , Suzuki Haruto , Takeda Hibiki , Miura Masanori , Ahmmad Bashir , Hirose Fumihiko
Published: March 2024

Sodium adsorption on nanometer-thick-TiO2-channel thin-film transistors (TFTs) are examined for enhancing the drain current. In the TFTs, the channel thickness of TiO2 is set as thin as ∼16 nm. The TiO2 film is deposited by atomic layer deposition using plasma excited humified Ar, followed by crystallization into the anatase phase by thermal annealing at 500 °C in air. The gate oxide is a 300 nm thick SiO2 film, which is grown on a highly doped n+ Si substrate. The n+ Si substrate is used as the gate electrode. The drain and source electrodes of Ti are deposited by an electron beam evaporation at room temperature. The TiO2 channel is covered with multiple layers of aluminum silicate and SiO2 films to enhance the Na sorptivity. The multiple films consist of combinations of 1 nm thick SiO2 and 0.16 nm thick aluminum silicate. The channel length and width are 60 and 1000 μm, respectively. The TFT without the Na adsorption exhibits a field effect mobility of ∼0.5 cm2/V s, where the drain current is recorded around 30 μA with a gate voltage of 10 V. With immersion of the TFT in a 10 mM NaCl solution, the drain current is enhanced to the order of mA. The simulation with an equivalent circuit with source and drain resistances suggests that the field effect mobility is enhanced to ∼30 cm2/V s with the adsorption of Na. In this paper, we discuss the operation mechanism of the Na adsorbed TiO2 TFT and its applicability as TFT-based high current switch devices and sensors.
Solution of nonlinear Lamb waves in plates with discontinuous thickness
Authors: Zuo Weiyi , An Zhiwu , Zhang Bixing , Hu Zhongtao
Published: March 2024

Nonlinear Lamb waves can propagate over long distances in plate and shell structures and are sensitive to the early fatigue damage of materials. Therefore, they offer unique advantages in the fields of nondestructive testing and material health monitoring. Plate and shell structures with discontinuous thicknesses (e.g., ribs, stiffeners, or joints) will cause nonlinear Lamb wave scattering, and it is necessary to study the scattering processes of nonlinear Lamb waves at discontinuities and how these processes impact the resulting signal characteristics. Thus, nonlinear Lamb waves can be used to identify the structural characteristics and defect characteristics of signals in practical applications. In this paper, the propagating and scattering processes of the second harmonic of a Lamb wave in a discontinuous plate are studied, including the contributions of the evanescent Lamb modes near the discontinuity and the nonlinear boundary effect at the discontinuity. The scattering characteristics of the second harmonics with respect to the frequency and geometry of the plate are analyzed. In addition, the integral formula is adjusted to improve the computational stability under different numbers of Lamb wave modes. Transient finite element simulation is used to validate the proposed method.
Physical science research needed to evaluate the viability and risks of marine cloud brightening
Authors: Feingold Graham , Ghate Virendra P. , Russell Lynn M. , Blossey Peter , Cantrell Will , Christensen Matthew W. , Diamond Michael S. , Gettelman Andrew , Glassmeier Franziska , Gryspeerdt Edward , Haywood James , Hoffmann Fabian , Kaul Colleen M. , Lebsock Matthew , McComiskey Allison C. , McCoy Daniel T. , Ming Yi , Mülmenstädt Johannes , Possner Anna , Prabhakaran Prasanth , Quinn Patricia K. , Schmidt K. Sebastian , Shaw Raymond A. , Singer Clare E. , Sorooshian Armin , Toll Velle , Wan Jessica S. , Wood Robert , Yang Fan , Zhang Jianhao , Zheng Xue
Published: March 2024

Marine cloud brightening (MCB) is the deliberate injection of aerosol particles into shallow marine clouds to increase their reflection of solar radiation and reduce the amount of energy absorbed by the climate system. From the physical science perspective, the consensus of a broad international group of scientists is that the viability of MCB will ultimately depend on whether observations and models can robustly assess the scale-up of local-to-global brightening in today’s climate and identify strategies that will ensure an equitable geographical distribution of the benefits and risks associated with projected regional changes in temperature and precipitation. To address the physical science knowledge gaps required to assess the societal implications of MCB, we propose a substantial and targeted program of research—field and laboratory experiments, monitoring, and numerical modeling across a range of scales.
The largest freshwater odontocete: A South Asian river dolphin relative from the proto-Amazonia
Authors: Benites-Palomino Aldo , Aguirre-Fernández Gabriel , Baby Patrice , Ochoa Diana , Altamirano Ali , Flynn John J. , Sánchez-Villagra Marcelo R. , Tejada Julia V. , de Muizon Christian , Salas-Gismondi Rodolfo
Published: March 2024

Several dolphin lineages have independently invaded freshwater systems. Among these, the evolution of the South Asian river dolphin
Platanista
and its relatives (Platanistidae) remains virtually unknown as fossils are scarce. Here, we describe
Pebanista yacuruna
gen. et sp. nov., a dolphin from the Miocene proto-Amazonia of Peru, recovered in phylogenies as the closest relative of
Platanista
. Morphological characters such as an elongated rostrum and large supraorbital crests, along with ecological interpretations, indicate that this odontocete was fully adapted to fresh waters.
Pebanista
constitutes the largest freshwater odontocete known, with an estimated body length of 3 meters, highlighting the ample resource availability and biotic diversity in the region, during the Early to Middle Miocene. The finding of
Pebanista
in proto-Amazonian layers attests that platanistids ventured into freshwater ecosystems not only in South Asia but also in South America, before the modern Amazon River dolphin, during a crucial moment for the Amazonian evolution.
ERK-activated CK-2 triggers blastema formation during appendage regeneration
Authors: Zhang Xiao-Shuai , Wei Lin , Zhang Wei , Zhang Fei-Xue , Li Lin , Li Liang , Wen Yejie , Zhang Jia-Hui , Liu Suning , Yuan Dongwei , Liu Yanmei , Ren Chonghua , Li Sheng
Published: March 2024

Appendage regeneration relies on the formation of blastema, a heterogeneous cellular structure formed at the injury site. However, little is known about the early injury-activated signaling pathways that trigger blastema formation during appendage regeneration. Here, we provide compelling evidence that the extracellular signal–regulated kinase (ERK)–activated casein kinase 2 (CK-2), which has not been previously implicated in appendage regeneration, triggers blastema formation during leg regeneration in the American cockroach,
Periplaneta americana
. After amputation, CK-2 undergoes rapid activation through ERK-induced phosphorylation within blastema cells. RNAi knockdown of
CK-2
severely impairs blastema formation by repressing cell proliferation through down-regulating mitosis-related genes. Evolutionarily, the regenerative role of CK-2 is conserved in zebrafish caudal fin regeneration via promoting blastema cell proliferation. Together, we find and demonstrate that the ERK-activated CK-2 triggers blastema formation in both cockroach and zebrafish, helping explore initiation factors during appendage regeneration.
Millimeter-scale magnetic implants paired with a fully integrated wearable device for wireless biophysical and biochemical sensing
Authors: Wan Ji , Nie Zhongyi , Xu Jie , Zhang Zixuan , Yao Shenglian , Xiang Zehua , Lin Xiang , Lu Yuxing , Xu Chen , Zhao Pengcheng , Wang Yiran , Zhang Jingyan , Wang Yaozheng , Zhang Shaotong , Wang Jinzhuo , Man Weitao , Zhang Min , Han Mengdi
Published: March 2024

Implantable sensors can directly interface with various organs for precise evaluation of health status. However, extracting signals from such sensors mainly requires transcutaneous wires, integrated circuit chips, or cumbersome readout equipment, which increases the risks of infection, reduces biocompatibility, or limits portability. Here, we develop a set of millimeter-scale, chip-less, and battery-less magnetic implants paired with a fully integrated wearable device for measuring biophysical and biochemical signals. The wearable device can induce a large amplitude damped vibration of the magnetic implants and capture their subsequent motions wirelessly. These motions reflect the biophysical conditions surrounding the implants and the concentration of a specific biochemical depending on the surface modification. Experiments in rat models demonstrate the capabilities of measuring cerebrospinal fluid (CSF) viscosity, intracranial pressure, and CSF glucose levels. This miniaturized system opens the possibility for continuous, wireless monitoring of a wide range of biophysical and biochemical conditions within the living organism.
Elastic energy-recycling actuators for efficient robots
Authors: Krimsky Erez , Collins Steven H.
Published: March 2024

Electric motors are widely used in robots but waste energy in many applications. We introduce an elastic energy-recycling actuator that maintains the versatility of motors while improving energy efficiency in cyclic tasks. The actuator comprises a motor in parallel with an array of springs that can be individually engaged and disengaged, while retaining stored energy, by pairs of low-power electroadhesive clutches. We developed a prototype actuator and tested it in five repetitive tasks with features common in robotic applications but difficult to perform efficiently. The actuator reduced power consumption by at least 50% in all cases and by 97% in the best case. Elastic energy recovery, controlled by low-power clutches, can improve the efficiency of mobile robots, assistive devices, and other engineered systems.
Reactivating PTEN to impair glioma stem cells by inhibiting cytosolic iron-sulfur assembly
Authors: Yin Jianxing , Ge Xin , Ding Fangshu , He Liuguijie , Song Keying , Shi Zhumei , Ge Zehe , Zhang Junxia , Ji Jing , Wang Xiefeng , Zhao Ningwei , Shu Chuanjun , Lin Fan , Wang Qianghu , Zhou Qigang , Cao Yuandong , Liu Wentao , Ye Dan , Rich Jeremy N. , Wang Xiuxing , You Yongping , Qian Xu
Published: March 2024

Glioblastoma, the most lethal primary brain tumor, harbors glioma stem cells (GSCs) that not only initiate and maintain malignant phenotypes but also enhance therapeutic resistance. Although frequently mutated in glioblastomas, the function and regulation of PTEN in PTEN-intact GSCs are unknown. Here, we found that PTEN directly interacted with MMS19 and competitively disrupted MMS19-based cytosolic iron-sulfur (Fe-S) cluster assembly (CIA) machinery in differentiated glioma cells. PTEN was specifically succinated at cysteine (C) 211 in GSCs compared with matched differentiated glioma cells. Isotope tracing coupled with mass spectrometry analysis confirmed that fumarate, generated by adenylosuccinate lyase (ADSL) in the de novo purine synthesis pathway that is highly activated in GSCs, promoted PTEN C211 succination. This modification abrogated the interaction between PTEN and MMS19, reactivating the CIA machinery pathway in GSCs. Functionally, inhibiting PTEN C211 succination by reexpressing a PTEN C211S mutant, depleting ADSL by shRNAs, or consuming fumarate by the US Food and Drug Administration–approved prescription drug
N
-acetylcysteine (NAC) impaired GSC maintenance. Reexpressing PTEN C211S or treating with NAC sensitized GSC-derived brain tumors to temozolomide and irradiation, the standard-of-care treatments for patients with glioblastoma, by slowing CIA machinery–mediated DNA damage repair. These findings reveal an immediately practicable strategy to target GSCs to treat glioblastoma by combination therapy with repurposed NAC.
Genomic analysis of inter-hospital transmission of vancomycin-resistant
Enterococcus faecium
sequence type 80 isolated during an outbreak in Hiroshima, Japan
Authors: Segawa Takaya , Masuda Kanako , Hisatsune Junzo , Ishida-Kuroki Kasumi , Sugawara Yo , Kuwabara Masao , Nishikawa Hideki , Hiratsuka Takahiro , Aota Tatsuaki , Tao Yasuo , Iwahashi Yoshimi , Ueda Kuniko , Mae Kaori , Masumoto Ken , Kitagawa Hiroki , Komatsuzawa Hitoshi , Ohge Hiroki , Sugai Motoyuki
Published: March 2024

Outbreaks caused by vancomycin-resistant enterococci that transcend jurisdictional boundaries are occurring worldwide. This study focused on a vancomycin-resistant enterococcus outbreak that occurred between 2018 and 2021 across two cities in Hiroshima, Japan. The study involved genetic and phylogenetic analyses using whole-genome sequencing of 103 isolates of vancomycin-resistant enterococci to identify the source and transmission routes of the outbreak. Phylogenetic analysis was performed using core genome multilocus sequence typing and core single-nucleotide polymorphisms; infection routes between hospitals were inferred using BadTrIP. The outbreak was caused by
Enterococcus faecium
sequence type (ST) 80 carrying the
vanA
plasmid, which was derived from strain A10290 isolated in India. Of the 103 isolates, 93 were
E. faecium
ST80 transmitted across hospitals. The circular
vanA
plasmid of the Hiroshima isolates was similar to the
vanA
plasmid of strain A10290 and transferred from
E. faecium
ST80 to other STs of
E. faecium
and other
Enterococcus
species by conjugation. The inferred transmission routes across hospitals suggest the existence of a central hospital serving as a hub, propagating vancomycin-resistant enterococci to multiple hospitals. Our study highlights the importance of early intervention at the key central hospital to prevent the spread of the infection to small medical facilities, such as nursing homes, with limited medical resources and a high number of vulnerable individuals.
Deep metagenomic characterization of the gut virome in pregnant women with preeclampsia
Authors: Lv Li-Juan , Wen Ji-Ying , Zhang Yue , Guo Ruo-Chun , Li Hui , Yi Zhou-Ting , He Tian-Wen , Chen Min-Chai , Chen Yang , Wu Xiao-Yan , Li Sheng-hui , Kang Jian , Hou Ya-Ping , Yan Qiu-long , Yin Ai-Hua
Published: March 2024

Preeclampsia (PE), a pregnancy-specific syndrome, has been associated with the gut bacteriome. Here, to investigate the impact of the gut virome on the development of PE, we identified over 8,000 nonredundant viruses from the fecal metagenomes of 40 early-onset PE and 37 healthy pregnant women and profiled their abundances. Comparison and correlation analysis showed that PE-enriched viruses frequently connected to
Blautia
species enriched in PE. By contrast, bacteria linked to PE-depleted viruses were often the Bacteroidaceae members such as
Bacteroides
spp.,
Phocaeicola
spp.,
Parabacteroides
spp., and
Alistipes shahii
. In terms of viral function, PE-depleted viruses had auxiliary metabolic genes that participated in the metabolism of simple and complex polysaccharides, sulfur metabolism, lipopolysaccharide biosynthesis, and peptidoglycan biosynthesis, while PE-enriched viruses had a gene encoding cyclic pyranopterin monophosphate synthase, which seemed to be special, that participates in the biosynthesis of the molybdenum cofactor. Furthermore, the classification model based on gut viral signatures was developed to discriminate PE patients from healthy controls and showed an area under the receiver operating characteristic curve of 0.922 that was better than that of the bacterium-based model. This study opens up new avenues for further research, providing valuable insights into the PE gut virome and offering potential directions for future mechanistic and therapeutic investigations, with the ultimate goal of improving the diagnosis and management of PE.

IMPORTANCE

The importance of this study lies in its exploration of the previously overlooked but potentially critical role of the gut virome in preeclampsia (PE). While the association between PE and the gut bacteriome has been recognized, this research takes a pioneering step into understanding how the gut virome, represented by over 8,000 nonredundant viruses, contributes to this condition. The findings reveal intriguing connections between PE-enriched viruses and specific gut bacteria, such as the prevalence of
Blautia
species in individuals with PE, contrasting with bacteria linked to PE-depleted viruses, including members of the Bacteroidaceae family. These viral interactions and associations provide a deeper understanding of the complex dynamics at play in PE.
Polymorphic transformations of titanium oxides contribute to economic uranium mineralization in sandstone
Authors: Yin Shuo , Yan Zhaobin , Fu Jiali , Zhang Wen , Liu Hong , Xia Fei , Wang Qingfei
Published: March 2024

Sandstone-hosted uranium (U) deposits provide a significant U resource for nuclear energy worldwide. Driven by redox reactions, tetravalent uranium-bearing minerals are commonly associated with reductants (e.g., pyrite and organic matter). However, numerous observations have revealed that tetravalent uranium-bearing minerals can spatially coexist with chemically stabilized titanium oxides in sandstone-hosted U deposits, requiring a complementary mechanism to interpret these findings. We present a new model based on in situ texture, trace-element content, and titanium isotopic ratio, as well as polymorph type and related transformation for titanium oxides from the Yaojia Formation of the southwestern Songliao Basin in northeast China. Specifically, in our model, abundant nanopores were generated during the spontaneous transformation of anatase to rutile, producing a porous material for hexavalent U adsorption. Facilitated by a U-rich source rock, adsorbed U in porous titanium oxide from the lower Yaojia Formation was up to several thousand parts per million. In order to minimize surface energy, a subsequent decrease in surface area by merging small pores is inevitable. When the evolved surface area was small enough, hexavalent U would be desorbed and subsequently transformed to tetravalent U by local reductants, forming uraninite nanoparticles on the surface of U-rich rutile with relatively large pores. Our newly proposed mechanism not only contributes to a better understanding of economic U mineralization in sandstone, but also suggests that U occurred as uranium oxide instead of brannerite in sandstone-hosted U deposits, providing a nano-mineralogical perspective required for industrial processing.
Pancreatic neuroendocrine tumour resection in circumportal pancreas: a rare anatomical anomaly with important surgical implications
Authors: Do Jee Eun , Goh Su Kah , Saxon Sarah , Thomson John-Edwin
Published: March 2024

Various congenital anomalies of the pancreas have been reported due to its complex embryological development involving the fusion of two separate buds. Circumportal pancreas is a rare anatomical anomaly where the pancreatic head and uncinate process fuse abnormally with the pancreatic body, encasing the portal vein and/or superior mesenteric vein completely. This anomaly poses several challenges to hepatobiliary surgeons, as the encasement of the portal vein by the abnormal pancreatic tissue makes an additional parenchymal transection necessary. Vascular variants have also been reported with circumportal pancreas, which, if not recognised preoperatively, can be catastrophic. Therefore, careful preoperative evaluation and planning are essential, to ensure safe pancreatic resection and recovery in a patient with circumportal pancreas. We present a case of a successful subtotal pancreatectomy and splenectomy in a patient with circumportal pancreas, for a suspected pancreatic duct adenocarcinoma. The aim of this case report is to contribute valuable insights that can aid hepatobiliary surgeons in enhancing their preoperative planning when encountered with patients with similar anatomical variances.
Malignant phyllodes tumour of the breast with early recurrence in a young patient
Authors: Klooz Andrea , Kumar Terrence , Maxwell Jessica
Published: March 2024

A young woman in her 20s was found to have a left breast malignant phyllodes tumour by ultrasound-guided core needle biopsy, after identifying a palpable lump. She then underwent lumpectomy excision with >1 cm gross margins; however, final pathology demonstrated <1 cm margins at the superior margin. She then underwent re-excision of superior and medial margins to ensure at least a 1 cm margin. Biopsy tract was not excised at initial or re-excision surgery. Approximately 6 weeks after completion lumpectomy, the patient noted a new palpable mass near the previous biopsy site and underwent punch biopsy. Final pathology of this new mass was concordant with early recurrence. The patient then underwent lumpectomy of the new mass along with excision of the overlying skin and biopsy tract with >1 cm margins.
Acute pericarditis as the presenting symptom of a case of oesophageal carcinoma
Authors: Kasim Sarah Mohd , Hussain Sara , Alsharhan Maryam Abdulrahman , Al-Najjar Firas Jaafar Kareem
Published: March 2024

Oesophageal carcinoma is a globally prevalent form of cancer. Patients with advanced disease often experience progressive dysphagia and weight loss as initial symptoms, but pericarditis is an uncommon presentation. This study describes a young man who presented with pericarditis and was diagnosed with oesophageal squamous cell carcinoma. The patient’s diagnosis came after presenting with intermittent chest pain. His diagnostic tests included an ECG showing ST elevation, echocardiography showing pericardial effusion and elevated inflammatory markers. His imaging tests revealed a neoplastic lesion in the lower oesophagus with metastases. He was initially treated as a case of pericarditis, followed by palliative chemotherapy for his cancer. Pericarditis, as the initial presentation of oesophageal carcinoma, is rare. There have only been 19 cases reported and published in the literature. Treatment depends on the stage of the disease. This case emphasises the importance of considering malignancy in unusual presentations of pericarditis, especially in young patients.
Intraosseous myolipoma of the calcaneus
Authors: Sobota Jana Kerstin Betty , Kienapfel Hanna , Werner Mathias , Vogt Dominik Maximilian
Published: March 2024

A man in his 40s presented with an incidental finding of an osteolytic bone lesion. He sustained an ankle injury while inline skating, fracturing his lateral malleolus. Besides the fracture, radiographic imaging on the day of the injury incidentally revealed a well-defined solitary osteolytic lesion with a sclerotic rim within the right calcaneus. MRI showed an intraosseous, fat-containing lesion with focal contrast enhancement, assessed as an intraosseous lipoma with central necrosis. In the pathological analysis of a sample of the lesion an intraosseousmyolipoma of the calcaneus was found—an unexpected and extraordinary finding. To prevent pathological fracturing, curettage and bone grafting were performed using autologous iliac crest bone in combination with allogenous bone chips.
ICGA-GPT: report generation and question answering for indocyanine green angiography images
Authors: Chen Xiaolan , Zhang Weiyi , Zhao Ziwei , Xu Pusheng , Zheng Yingfeng , Shi Danli , He Mingguang
Published: March 2024

Background

Indocyanine green angiography (ICGA) is vital for diagnosing chorioretinal diseases, but its interpretation and patient communication require extensive expertise and time-consuming efforts. We aim to develop a bilingual ICGA report generation and question-answering (QA) system.

Methods

Our dataset comprised 213 129 ICGA images from 2919 participants. The system comprised two stages: image–text alignment for report generation by a multimodal transformer architecture, and large language model (LLM)-based QA with ICGA text reports and human-input questions. Performance was assessed using both qualitative metrics (including Bilingual Evaluation Understudy (BLEU), Consensus-based Image Description Evaluation (CIDEr), Recall-Oriented Understudy for Gisting Evaluation-Longest Common Subsequence (ROUGE-L), Semantic Propositional Image Caption Evaluation (SPICE), accuracy, sensitivity, specificity, precision and F1 score) and subjective evaluation by three experienced ophthalmologists using 5-point scales (5 refers to high quality).

Results

We produced 8757 ICGA reports covering 39 disease-related conditions after bilingual translation (66.7% English, 33.3% Chinese). The ICGA-GPT model’s report generation performance was evaluated with BLEU scores (1–4) of 0.48, 0.44, 0.40 and 0.37; CIDEr of 0.82; ROUGE of 0.41 and SPICE of 0.18. For disease-based metrics, the average specificity, accuracy, precision, sensitivity and F1 score were 0.98, 0.94, 0.70, 0.68 and 0.64, respectively. Assessing the quality of 50 images (100 reports), three ophthalmologists achieved substantial agreement (kappa=0.723 for completeness, kappa=0.738 for accuracy), yielding scores from 3.20 to 3.55. In an interactive QA scenario involving 100 generated answers, the ophthalmologists provided scores of 4.24, 4.22 and 4.10, displaying good consistency (kappa=0.779).

Conclusion

This pioneering study introduces the ICGA-GPT model for report generation and interactive QA for the first time, underscoring the potential of LLMs in assisting with automated ICGA image interpretation.
Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis
Authors: Williamson Thomas R , Kay Robert S , Robinson Patrick G , Murray Andrew D , Clement Nicholas D
Published: March 2024

Objective

To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency.

Design

Systematic epidemiological review and meta-analysis.

Data sources

PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023.

Eligibility criteria

Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites.

Results

20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week.

Conclusion

Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies.

PROSPERO registration number

CRD42023408738.
Assessing patient risk, benefit and outcomes in drug development: an observational study of regorafenib clinical trials
Authors: Dennis Brody , Bratten Chance , Hughes Griffin K , Peña Andriana M , McIntire Ryan , Ladd Chase , Gardner Brooke , Nowlin William , Livingston Reagan , Tuia Jordan , Haslam Alyson , Prasad Vinay , Vassar Matt
Published: March 2024

Objective

Our objective of this study was to analyse all oncological clinical trials using regorafenib to create a complete risk/benefit profile for the drug.

Background

Creating a novel chemotherapy is costly both in time and capital spent for drug manufacturers. To regenerate what they’ve spent, drug manufacturers may attempt to repurpose their medications for new indications via clinical trials. To fully understand the risk/benefits in comparison to a drug’s efficacy, a pooled analysis must be completed.

Methods

We screened PubMed, Embase, Cochrane (CENTRAL) and ClinicalTrials.gov for trials of regorafenib used to treat solid cancers. Next, we extracted median progression-free survival and overall survival in months, adverse event rates and objective response rate (ORR). Studies were deemed positive, negative or indeterminate based on their pre-specified endpoints and tolerability.

Results

56 clinical trials were included in our final sample, with 4960 total participants across 13 indications. Most studies (44 of 56; 78.75%) were non-blinded, and a majority were non-randomised (41 of 56; 73.21%). Trials for colorectal cancer started out as positive but became more negative over time. Cumulative risk to patients increased over time while ORR stayed consistently low.

Conclusions

Our findings suggest that since regorafenib’s original Food and Drug Administration (FDA) approval, the risk profile for its original indication increased. The amount of non-randomised, single-arm trials in our sample size was concerning, indicating that higher quality research must be conducted. Our results propose that regorafenib’s efficacy and safety may be more impactful in cancers other than its FDA approvals.
Operational priorities for engaging with India’s private healthcare sector for the control of tuberculosis: a modelling study
Authors: Ricks Saskia , Singh Ananya , Sodhi Ridhima , Pal Arnab , Arinaminpathy Nimalan
Published: March 2024

Objectives

To estimate the potential impact of expanding services offered by the Joint Effort for Elimination of Tuberculosis (JEET), the largest private sector engagement initiative for tuberculosis (TB) in India.

Design

We developed a mathematical model of TB transmission dynamics, coupled with a cost model.

Setting

Ahmedabad and New Delhi, two cities with contrasting levels of JEET coverage.

Participants

Estimated patients with TB in Ahmedabad and New Delhi.

Interventions

We investigated the epidemiological impact of expanding three different public–private support agency (PPSA) services: provider recruitment, uptake of cartridge-based nucleic acid amplification tests and uptake of adherence support mechanisms (specifically government supplied fixed-dose combination drugs), all compared with a continuation of current TB services.

Results

Our results suggest that in Delhi, increasing the use of adherence support mechanisms among private providers should be prioritised, having the lowest incremental cost-per-case-averted between 2020 and 2035 of US$170 000 (US$110 000–US$310 000). Likewise in Ahmedabad, increasing provider recruitment should be prioritised, having the lowest incremental cost-per-case averted of US$18 000 (US$12 000–US$29 000).

Conclusion

Results illustrate how intervention priorities may vary in different settings across India, depending on local conditions, and the existing degree of uptake of PPSA services. Modelling can be a useful tool for identifying these priorities for any given setting.
Development and applications of the Anaesthetists’ Non-Technical Skills behavioural marker system: a systematic review
Authors: Kang Jiamin , Hu Jiale , Yan Chunji , Xing Xueyan , Tu Shumin , Zhou Fang
Published: March 2024

Objectives

To comprehensively synthesise evidence regarding the validity and reliability of the Anaesthetists’ Non-Technical Skills (ANTS) behavioural marker system and its application as a tool for the training and assessment of non-technical skills to improve patient safety.

Design

Systematic review.

Data sources

We employed a citation search strategy. The Scopus and Web of Science databases were searched for articles published from 2002 to May 2022.

Eligibility criteria

English-language publications that applied the ANTS system in a meaningful way, including its use to guide data collection, analysis and reporting.

Data extraction and synthesis

Study screening, data extraction and quality assessment were performed by two independent reviewers. We appraised the quality of included studies using the Joanna Briggs Institute Critical Appraisal Checklists. A framework analysis approach was used to summarise and synthesise the included articles.

Results

54 studies were identified. The ANTS system was applied across a wide variety of study objectives, settings and units of analysis. The methods used in these studies varied and included quantitative (n=42), mixed (n=8) and qualitative (n=4) approaches. Most studies (n=47) used the ANTS system to guide data collection. The most commonly reported reliability statistic was inter-rater reliability (n=35). Validity evidence was reported in 51 (94%) studies. The qualitative application outcomes of the ANTS system provided a reference for the analysis and generation of new theories across disciplines.

Conclusion

Our results suggest that the ANTS system has been used in a wide range of studies. It is an effective tool for assessing non-technical skills. Investigating the methods by which the ANTS system can be evaluated and implemented for training within clinical environments is anticipated to significantly enhance ongoing enhancements in staff performance and patient safety.

PROSPERO registration number

CRD42022297773.
Evidence-informed and consensus-based statements about SAFEty of Physical Agent Modalities Practice in physiotherapy and rehabilitation medicine (SAFE PAMP): a national Delphi of healthcare scientific societies
Authors: Gianola Silvia , Bargeri Silvia , Pellicciari Leonardo , Gambazza Simone , Rossettini Giacomo , Fulvio Anna , Genovese Vincenzo , Benedini Matteo , Proverbio Emanuele , Cecchetto Simone , Castellini Greta , Turolla Andrea
Published: March 2024

Objective

A shared consensus on the safety about physical agent modalities (PAMs) practice in physiotherapy and rehabilitation is lacking. We aimed to develop evidence-informed and consensus-based statements about the safety of PAMs.

Study design and setting

A RAND-modified Delphi Rounds’ survey was used to reach a consensus. We established a steering committee of the Italian Association of Physiotherapy (Associazione Italiana di Fisioterapia) to identify areas and questions for developing statements about the safety of the most commonly used PAMs in physiotherapy and rehabilitation. We invited 28 National Scientific and Technical Societies, including forensics and lay members, as a multidisciplinary and multiprofessional panel of experts to evaluate the nine proposed statements and formulate additional inputs. The level of agreement was measured using a 9-point Likert scale, with consensus in the Delphi Rounds assessed using the rating proportion with a threshold of 75%.

Results

Overall, 17 (61%) out of 28 scientific and technical societies participated, involving their most representative members. The panel of experts mainly consisted of clinicians (88%) with expertise in musculoskeletal (47%), pelvic floor (24%), neurological (18%) and lymphatic (6%) disorders with a median experience of 30 years (IQR=17–36). Two Delphi rounds were necessary to reach a consensus. The final approved criteria list comprised nine statements about the safety of nine PAMs (ie, electrical stimulation neuromodulation, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, hot thermal agents, cryotherapy and therapeutic ultrasound) in adult patients with a general note about populations subgroups.

Conclusions

The resulting consensus-based statements inform patients, healthcare professionals and policy-makers regarding the safe application of PAMs in physiotherapy and rehabilitation practice. Future research is needed to extend this consensus on paediatric and frail populations, such as immunocompromised patients.
REST: a preoperative tailored sleep intervention for patients undergoing total knee replacement – feasibility study for a randomised controlled trial
Authors: Bertram Wendy , Penfold Chris , Glynn Joel , Johnson Emma , Burston Amanda , Rayment Dane , Howells Nicholas , White Simon , Wylde Vikki , Gooberman-Hill Rachael , Blom Ashley , Whale Katie
Published: March 2024

Objectives

To test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement.

Design

Feasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study.

Setting

Two National Health Service (NHS) secondary care hospitals in England and Wales.

Participants

Preoperative adult patients identified from total knee replacement waiting lists with disturbed sleep, defined as a score of 0–28 on the Sleep Condition Indicator questionnaire.

Intervention

The REST intervention is a preoperative tailored sleep assessment and behavioural intervention package delivered by an Extended Scope Practitioner (ESP), with a follow-up phone call 4 weeks postintervention. All participants received usual care as provided by the participating NHS hospitals.

Outcome measures

The primary aim was to assess the feasibility of conducting a full trial. Patient-reported outcomes were assessed at baseline, 1-week presurgery, and 3 months postsurgery. Data collected to determine feasibility included the number of eligible patients, recruitment rates and intervention adherence. Qualitative work explored the acceptability of the study processes and intervention delivery through interviews with ESPs and patients.

Results

Screening packs were posted to 378 patients and 57 patients were randomised. Of those randomised, 20 had surgery within the study timelines. An appointment was attended by 25/28 (89%) of participants randomised to the intervention. Follow-up outcomes measures were completed by 40/57 (70%) of participants presurgery and 15/57 (26%) postsurgery. Where outcome measures were completed, data completion rates were 80% or higher for outcomes at all time points, apart from the painDETECT: 86% complete at baseline, 72% at presurgery and 67% postsurgery. Interviews indicated that most participants found the study processes and intervention acceptable.

Conclusions

This feasibility study has demonstrated that with some amendments to processes and design, an RCT to evaluate the clinical and cost-effectiveness of the REST intervention is feasible.

Trial registration number

ISRCTN14233189.
Emergency medical dispatchers’ experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study
Authors: Shaw Joanna , Bannister Clara , Ariyibi Ayoola , Fothergill Rachael
Published: March 2024

Objectives

The ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an emergency situation to prevent unnecessary delays in treatment. This study aimed to explore emergency medical dispatchers’ (EMDs) perceptions of the structured protocol they use.

Design

Voluntary participation in semistructured phenomenological focus groups. The participants were asked to discuss their experiences of using Medical Priority Dispatch System Protocol 24 (pregnancy, childbirth and miscarriage). Thematic analysis was applied to code and group topics. Discussion between the EMDs is presented for each theme and their experiences, including quotes, are presented to offer an overview of the maternity protocol and its use.

Setting

A large urban UK ambulance service.

Participants

23 control room staff.

Results

Perceptions of maternity emergencies, challenges with key questions, the need for sensitivity surrounding miscarriage, using prearrival instructions and postdispatch instructions to help patients and ideas for additional ProQA functionality emerged as the five overarching themes. Protocol 24 was considered to reflect many of the clinical factors EMDs associate with maternity emergencies although further factors, including some non-clinical, were suggested for inclusion. Miscarriage and termination-related calls were thought to be challenging as the language of the protocol is designed for pregnancy. However, instructions were generally considered well written and user-friendly, although some were thought to be unnecessary. EMDs were largely positive regarding the ProQA software, but felt backward navigation was difficult if a situation changed.

Conclusions

Maternity calls were considered rewarding but complex by EMDs. We suggest changes including the use of more sensitive language in response to miscarriage and termination and make recommendations for the omission and inclusion of specific instructions, as well as enhancements to key questions and functionality. Further research is needed to ensure focus group findings are generalisable to other services, particularly in other countries.