bluuebunny/crossref_metadata_2025 huggingface dataset:
Validition of Circulation Systems e-Modules Based Learning Cycle 8E
Authors: Rosiana Yuni , Syafii Wan , Putra Riki Apriyandi , Futra Dedi
Published: October 2023

This study is aimed for developing an electronic module (e-module) on the material of circulation system based on learning cycle 8e. This type of research and development used the Analysis, Design, Development, Implementation and Evaluation (ADDIE) model. The used research instruments were interview sheets and validation questionnaires. The e-module was validated by three experts and the validated aspects were included aspects of didactic, construction and technical. The obtained data were analyzed quantitatively and described descriptively. The results of the study found that the didactic aspect obtained  the highest validity value of 96.15% in the II learning material. While the construction aspect found the highest validity value in learning material III was 95.63%. In the technical aspect, the highest score was obtained in learning material III of 93.75%. Therefore, it can be concluded that the e-module circulation system based on learning cycle 8e has good quality and can be used in learning activities.
Diversity of Diurnal Beetles in Banguntapan District Yogyakarta
Authors: Putra Ichsan Luqmana Indra , Unida Tazkiah
Published: October 2023

Beetles are insects that have the highest species diversity and abundance of individuals and have various roles in the ecosystem. Changes in land use will certainly affect the diversity, abundance, and dominance of beetles in an ecosystem. This study aims to determine species diversity, species abundance, and individual dominance of beetles, and to compare beetle diversity on non-built land (rice fields and vacant land) compared to built-up land (4 UAD campus and housing). The method in this study is a survey method. Sampling was carried out in October-December 2021 at each sampling location for the UAD 4 campus area, rice fields, housing, and vacant land in Banguntapan District, DIY using pitfall trap planted in the morning and taken in the afternoon, also direct sampling was carried out using bare hand. The beetles that have been obtained are then taken to the laboratory for the identification process. The highest beetle diversity index value was in the rice fields of Banguntapan District, DIY, which was 2,302, while the lowest beetle diversity index value was on campus 4, which was 0.725. The beetle species with the highest species abundance was Gonocephalum sp., while the beetle with the lowest species abundance was Bradycellus nigrinus, Cassida circumdata, Aspidomorpha sanctaecrusis, Verania lineata, and Onthophagus sp. The dominant beetle was Gonocephalum sp., while the less dominant beetle was B. nigrinus.
Analysis of the dynamics of the prevalence of tobacco smoking and the incidence of malignant neoplasms in the Russian Federation in 2011–2021
Authors: Salagay O. O. , Sakharova G. M. , Antonov N. S. , Shakhzadova A. O.
Published: October 2023

Tobacco is an important risk factor for malignant neoplasms (MN). The article provides an analysis of the incidence of MN for 2011–2021 in the Russian Federation among men and women with different levels of tobacco smoking. Materials and methods. The analysis includes the incidence of cancer of the trachea, bronchi and lung (TBLC), laryngeal cancer (LC) (tobacco is a high risk factor), liver cancer (a low risk). Time series of standardized indicators of morbidity per 100 thousand population for 2011–2021 were analyzed. with the calculation of linear trend models. The influence of the smoking prevalence on the morbidity dynamics was assessed by comparing the morbidity trends in periods characterized by an increase and decrease in smoking among men and women, taking into account the 5-year latent period of the development of MN (2011–2017, 2018–2021). Results. In 1990–2013, the prevalence of smoking steadily decreased among men and significantly increased among women. After the adoption in 2013 of Federal Anti-Tobacco Law, smoking among women, as well as among men, began to steadily decline. In 2011–2017, there was a decrease in the incidence of TBLC, LC among men and an increase among women. In 2018–2021 there was the same downward trend among men and women. The incidence of liver cancer among men and women increased during 2011–2021. Conclusion. The incidence of TBLC, LC is significantly associated with the smoking prevalence. A decrease in the smoking prevalence among the population may lead to a decrease in the incidence of tobacco-related MN.
Full-scale trafficability testing of prototype submersible matting systems
Authors: Rutherford Benjamin , Collins Andrew , Tyler Zachary , Border Patrick , Boc Stanley , Rushing Timothy
Published: October 2023

This report describes the full-scale evaluation of prototype submersible matting systems (SUBMAT) at a test site at the US Army Engineer Research and Development Center’s Vicksburg, Mississippi, site. The SUBMAT prototypes were designed to bridge the gap between high and low tide at a beach interface to enable 24-hour operation at an expeditionary watercraft landing site. This phase of the SUBMAT prototype development was intended to determine prototype system durability by applying military vehicle loads representing a combat brigade insertion across a littoral zone. The two mat systems evaluated in this study were the PYRACELL Road Building System (PRBS) and a basaltic rebar mat system. The results of the study showed that the PRBS system was able to sustain 1,000 Medium Tactical Vehicle Replacement, 350 Heavy Expanded Mobility Tactical Truck, and over 150 M1A1 main battle tank passes without significant damage. The basaltic rebar mat failed early in the test and was removed from further consideration for the SUBMAT application. Observations and lessons learned from this phase of the prototype PRBS development will be used to improve the PRBS design and modify its installation procedures for improved efficiency.
Assessing the effects of distinct biologic therapies on rheumatoid arthritis pain by nociceptive, neuropathic and nociplastic pain components: a randomised feasibility study
Authors: Ahmed Liban , Biddle Kathryn , Blundell Anna , Koushesh Soraya , Kiely Patrick , Mein Gill , Sedgwick Philip , Sofat Nidhi
Published: October 2023

Background
Pain management is a major unmet need in people with rheumatoid arthritis (RA). Although many patients are treated with Disease Modifying Anti-Rheumatic Drugs (DMARDS), including biologic therapies, many people with RA continue to experience significant pain. We aimed to determine whether performing a comprehensive pain evaluation is feasible in people with active RA receiving conventional DMARDs and biologic therapies.
Methods
The BIORA-PAIN feasibility study was an open-label, randomised trial, which recruited participants suitable for treatment with biologic therapy. The primary feasibility outcomes were recruitment, randomisation and retention of eligible participants. All participants underwent pain assessment for nociceptive, neuropathic and nociplastic pain during the 12-month study period, with quarterly assessments for VAS (Visual Analogue Scale) pain, painDETECT and QST (Quantitative Sensory Testing). This trial was registered in clinicaltrials.gov NCT04255134.
Results
During the study period, 93 participants were screened of whom 25 were eligible; 13 were randomised to adalimumab and 12 to abatacept. Participant recruitment was lower than expected due to the Covid-19 pandemic. Pain assessments were practical in the clinical trial setting. An improvement was observed for VAS pain from baseline over 12 months, with a mean (SEM) of 3.7(0.82) in the abatacept group and 2.3(1.1) in the adalimumab group. There was a reduction in painDETECT and improvement in QST measures in both treatment groups during the study. Participant feedback included that some of the questionnaire-based pain assessments were lengthy and overlapped in their content. Adverse events were similar in both groups. There was one death due to Covid-19.
Conclusions
This first-ever feasibility study of a randomised controlled trial assessing distinct modalities of pain in RA met its progression criteria. This study demonstrates that it is feasible to assess participants with active RA for specific modalities of pain, including nociceptive, neuropathic and nociplastic elements. Our data suggests it is possible to stratify people for RA based on pain features. The differences in pain outcomes between abatacept and adalimumab treated groups warrants further investigation.
Trial Registration
NCT04255134, Registered on Feb 5, 2020
Role of Apache Iv and Serum Amylase Along With Urinary Amylase in Predicting Outcome of Blunt Trauma Abdomen – A Prospective Study
Authors: KATYAYAN ILA , AHMAD SHABI , SINGH SANTOSH KUMAR
Published: October 2023

Introduction- Blunt trauma abdomen is a leading cause of morbidity and mortality among all age groups. The pre-existing anatomical scoring systems assess the extent of injury. We worked on evaluating the use of APACHEIV which is a physiological system and hence, determines the impact of injury, in predicting the outcome of blunt trauma abdomen. We also studied the role of serial serum and urinary amylase levels in predicting specific intra-abdominal organ injured. Though the role of biochemical markers is of meagre importance in a well- equipped tertiary care centre. But in countries like India, where a majority population still depends on primary and secondary health care which are equipped with very minimal infrastructure, these markers can play a small role in triaging patients and deciding further plan of action.
Aims and objectives- To assess the role of serum and urinary amylase levels in predicting intra-abdominal organ injured. To assess the role of APACHE IV in predicting outcome of blunt trauma abdomen in terms of mortality and morbidity.
Materials and Methods- This was a prospective study carried out in the Department of Surgery of M.L.N. Medical College, Prayagraj and associated Swaroop Rani Nehru Hospital. All patients above 16 years of age with Blunt trauma abdomen were part of the study. APACHE IV score at the time of hospital admission and serum and urinary amylase on day 1, 3 and 5 was calculated.
Results- Significant correlation was seen between liver injury and urine amylase on day1 and 3; between spleen injury and urine amylase levels on day 3 and GIT injury and urine amylase on day 1 and day 5. Also, high APACHE IV score was associated with increased mortality and morbidity. Morbidity was determined particularly in terms of length of hospital stay, APACHE IV score of >44 was associated with hospital stay of more than 9 days.
A Discrete Hybrid Grey Wolf Optimizer Algorithm to solve Quadratic Assignment Problem
Authors: Panwar Karuna , Deep Kusum
Published: October 2023

Grey Wolf Optimizer (GWO) is one of the popular swarm intelligence-based algorithms that derived its inspiration from the hunting behaviour of wolves. GWO has been found quite an effective algorithm for solving various optimization problems. It has demonstrated impressive results, which makes it a strong candidate for finding optimal solutions to NP-hard problems. This study proposes a discrete Hybrid Grey Wolf Optimizer (HGWO) that combines GWO with Tabu Search (TS) to address the well-known combinatorial optimization problem, the Quadratic Assignment Problem (QAP). The development of efficient techniques for the QAP is an active area of research, which motivates our attempts to propose HGWO. As QAP is a combinatorial optimization problem, the continuous values obtained from the classical GWO are converted to discrete values using the largest real value mapping. In HGWO, the position of each individual is first updated by GWO and further improved by TS. The performance of HGWO is evaluated through computational experiments over 100 QAP benchmark instances. The numerical results are compared with other well-known algorithms from the literature. Also, for an unbiased and rigorous comparison, statistical tests such as Friedman non-parametric test and Wilcoxon signed rank test are conducted. The analysis of obtained numerical results demonstrated that HGWO has merit in solving QAP.
A qualitative exploration of women’s expectations of birth and knowledge of birth interventions following antenatal education
Authors: Davies Anna , Larkin Michael , Willis Lucy , Mampitiya Narendra , Lynch Mary , Toolan Miriam , Fraser Abigail , Rawling Kate , Plachcinski Rachel , Barnfield Sonia , Smith Margaret , Burden Christy , Merriel Abi
Published: October 2023

Background
Expectations of birth, and whether they are met, influence postnatal psychological wellbeing. Intrapartum interventions, for example induction, are increasing due to a changing pregnant population and evolving evidence, which may contribute to a mismatch between expectations and birth experience. NICE recommends antenatal education (ANE) to prepare women for labour and birth, but there is no mandated NHS ANE curriculum. We aimed to explore women’s expectations of childbirth and their understanding of common interventions and complications following NHS and non-NHS ANE.
Method
Qualitative focus groups were conducted with postnatal women (< 12 months postpartum) aged ≥ 16, who had received antenatal care at a single NHS Trust. A semi-structured topic guide was used to explore birth expectations following attendance at ANE and knowledge of birth interventions and complications. Data were transcribed and thematic analysis was undertaken by at least two researchers.
Results
46 women (mean age: 33.5years; 81% white British) participated across eight groups. Sixty-five percent were primiparous, 35% had a caesarean birth. Fifty percent attended NHS ANE and 59% non-NHS ANE. Participants perceived that a ‘hierarchy of birth’ was presented within ANE classes, where a ‘better birth’ involved vaginal birth, minimal pain relief and limited intervention. Participants described expectations of control and choice over their birth, though some described being encouraged to be open-minded about the course it may take. Participants identified a mismatch between their expectations and subsequent experiences, which adversely impacted their psychological wellbeing. While participants received information about common birth interventions and complications, limited time spent on these during classes resulted in expectations that they were rare. Participants felt that receiving sensitively presented information about the frequency of interventions could prepare women and support their psychological wellbeing after birth.
Conclusions
Women’s expectations of birth are informed by ANE which may precipitate a mismatch between expectations and experience. Better information about risk factors and frequency of labour and birth interventions may support women to develop evidence-informed expectations of birth, reducing the expectation-experience gap, with consequent impact on maternal postnatal wellbeing. A mandatory minimum curriculum for ANE is needed to ensure high-quality education is available to all.
Interpreting clinical trial outcomes marred by placebo response with an assessment of false-negative and true-negative clinical trials in depression using propensity-weighting
Authors: Gomeni Roberto , Hopkins Seth , Bressolle-Gomeni Francoise , Fava Maurizio
Published: October 2023

The objective of this study was to evaluate the performances of the propensity score weighted (PSW) methodology in a post-hoc re-analysis of a failed and a negative RCTs in major depressive disorders. The conventional study designs, randomizations, and statistical approaches do not account for the baseline distribution of major non-specific prognostic and confounding factors such as the individual propensity to show a placebo effect (PE). Therefore, the conventional analysis approaches implicitly assume that the baseline PE is the same for all subjects in the trial even if this assumption is not supported by our knowledge on the impact of PE on the estimated treatment effect (TE). The consequence of this assumption is an inflation of false negative results (type II error) in presence of a high proportion of subjects with high PE and an inflation of false positive (type I error) in presence of a high proportion of subjects with low PE value. Differently from the conventional approach, the inverse of the estimated PE probability was used as weight in the mixed-effects analysis to assess TE in the PSW analysis. The results of this analysis indicated an enhanced signal of drug response in the failed trial (ClinicalTrials.gov NCT00584974) and confirmed the absence of drug effect in the negative trial (ClinicalTrials.gov NCT0058497). This approach can be considered as a reference approach that minimize the risk of inflating either type I or type II error in contrast to what happens in the analyses of RCT studies conducted with the conventional statistical methodology.
A New Subtype of Papillary Ductal Carcinoma in Situ with Tall Cell and Reversed Polarity Morphology: A Rare Case
Authors: Zhong Ruiqi , Chang Ziyi , Wang Xiuhong , Zhong Dingrong
Published: October 2023

Papillary ductal carcinoma in situ (DCIS) is a subtype of DCIS characterized by the neoplastic proliferation of epithelial cells with a papillary structure and confined to the mammary ductal-lobular system. Tall cell carcinoma with reversed polarity (TCCRP) is a rare subtype of invasive breast carcinoma with low malignant potential, which has recently been recognized as a separate entity in the 2019 WHO Classification of breast tumors. Here, we describe the case of a 54-year-old woman with a finding of growing nodular lesion through breast ultrasonographic screenings, whose morphological features, immunohistochemical results, and molecular genetic studies suggest overlapping features of DCIS and TCCRP. Therefore, we hypothesized that it might be a new DCIS subtype with tall cells and reversed polarity of the mammary gland.
A prediction model of preeclampsia in hyperglycemia pregnancy
Authors: Fang Yan , Liu Huali , Li Yuan , Cheng Ji , Wang Xia , Shen Bing , Chen Hongbo , Wang Qunhua
Published: October 2023

Background
Hyperglycemia in pregnancy (HIP) and preeclampsia (PE) are common pregnancy complications. Identifying high-risk factors for preeclampsia in pregnant women with hyperglycemia and predicting the occurrence of preeclampsia can contribute to disease grading management. This study aimed to develop a predictive model for the development of PE in pregnant women with HIP through the information of routine pregnancy care to provide a primary screening for more effective interventions.
Method
The clinical data from 951 pregnant women with hyperglycemia who delivered after 34 weeks of gestation were collected retrospectively. Observation indicators included liver and kidney function factors testing at 24–29+ 6 weeks gestation, maternal age, and basal blood pressure. The indicators were screened univariately, and the "rms" package was applied to explore the factors associated with PE in HIP pregnancy by stepwise regression. Multivariable logistic regression analysis was used to develop the prediction model. Based on the above results, a nomogram was constructed to predict the risk of PE occurrence in pregnant women with HIP. Then, evaluate the model from different perspectives. The internal validation was performed using the bootstrap procedure.
Results
Multivariate logistic regression analysis showed that cystatin C, uric acid, glutamyl aminotransferase, urea nitrogen, and basal systolic blood pressure as predictors of PE in pregnancy with HIP. The predictive model yielded an area under curve (AUC) value of 0.8031 (95% CI:0.7383–0.8679), with an optimal threshold of 0.0805, at which point the sensitivity was 0.8307 and specificity of 0.6604. Hosmer–Lemeshow test values were P = 0.3736, Brier score value was 0.0461. After 1000 Bootstrap re-samplings for internal validation, the AUC was 0.7886, the Brier score was 0.0478 and the predicted probability of the calibration curve was similar to the actual probability. A nomogram was constructed based on the above to visualize the model.
Conclusion
This study developed a model for predicting PE in pregnant women with HIP, achieving high predictive performance of PE risk through the information of routine pregnancy care.
Assessment of Spatial-temporal Variation of Precipitation and Meteorological Drought in Shanxi Province, China
Authors: Wei Ting , Zhao Xuehua
Published: October 2023

In this study, the spatial and temporal characteristics of rainfall and the risk of meteorological drought based on precipitation data observed in 22 meteorological stations from 1961–2020 across Shanxi province in China were analyzed. Four precipitation indices and modified Mann-Kendall test were used to analyze the patterns and trends of precipitation. Furthermore, the risk analysis for drought duration and severity of meteorological drought were analyzed with entropy copula. Results showed that the precipitation distribution is irregular and precipitation in central northern parts of Shanxi is more concentrated than that in southern Shanxi. The annual and seasonal precipitation concentration showed no significant change in most stations, while the daily precipitation concentration decreased in a few areas. Results also disclose that the number of droughts ranged from 61 to 80 during 1961–2020 and Shanxi tends to dry. The most severe drought event lasts for 27 months and the largest severity is 29.7. The entropy copula is suitable for drought frequency analysis and return period calculation and results indicate that the middle and northern parts of Shanxi are at high risk of drought according to the entropy copula calculated joint return period.
Comparison of Diagnostic Accuracies of Frailty Assessment Tools for Frailty in Older People
Authors: Li Li , Chongyang Zhao , Cong Deng , Yuhui Zhang , Qin Wang , Deying Kang
Published: October 2023

Background
Frailty has become one of the most serious global public health challenges. Whether the assessments tools of frailty are useful needs to be elucidated.
Objectives
This study aims to evaluate the diagnostic accuracy of measurement tools for frailty in older people.
Design
This study was registered on PROSPERO (registration number: CRD: 42023415074.) Medline, Web of Science, Embase, China Knowledge Resource Integrated Database (CNKI), Wanfang databases, and VIP databases were searched from their inception to March 31, 2022.
Measurements
Two reviewers independently assessed the quality of the included studies based on the Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2) tool in Review manager 5.4.1 software. Besides, a summary receiver operating characteristics (SROC) curve was plotted and area under curve (AUC) was calculated to evaluate the accuracy of the frailty assessment tool.
Results
A total of 23 articles were included. The sample size ranges from 7060(range:45-1037).We used the Fried phenotype(FP) scale as a reference standard. The pooled sensitivity, specificity and AUC of FRAIL was 0.75 (95% Confidence Interval 0.56–0.88), 0.81 (95% CI: 0.71–0.88) and 0.88 (95% CI: 0.85–0.91), respectively; the pooled sensitivity, specificity and AUC of PRISMA-7 scale was 0.81 (95% CI: 0.71–0.88), 0.78 (95% CI: 0.69–0.85) and 0.86 (95% CI: 0.82–0.88), respectively; the pooled sensitivity, specificity and AUC of GFI was 0.72 (95% CI: 0.62–0.80), 0.74 (95% CI: 0.67–0.81) and AUC of 0.79 (95% CI: 0.76–0.83), respectively.
Conclusion
Our study suggests that, compared with the FP scale, the FRAIL and PRISMA-7 scales have a wide range of applications in the frail older population.
Biosorption performance toward Co(II) and Cd(II) by irradiated Fusarium solani biomass
Authors: Mousa Abeer Mohamed , Abdel-Galil Ezzat , Zhran Mostafa
Published: October 2023

The goal of the current study was to identify suitable fungi from sewage contaminated sites and evaluate how well they biosorption and reduce Co(II) and Cd(II). The Fusarium solani fungus was chosen to complete this study because it provided the maximum biosorption yield for Co(II) and Cd(II) compared to the other isolated fungi. The biosorption behavior of Fusarium solani towards Co(II) and Cd(II) was investigated under different gamma radiation doses of 0, 1, 3, and 5 kGy. Fusarium solani biomass exposed to 5 kGy (FS-5) is characterized by SEM, FTIR, and TGA. The FT-IR spectrums of FS-5 revealed the presence of hydroxyl, amino acids, carboxylic, and carbon groups. The scanning electron microscope (SEM) clearly revealed the surface texture and shape of fungal biomass.It has been shown and extensively explored how biosorption experimental parameters including pH, initial adsorbate concentration, agitation period, and fungal biomass weight affect the process. The biosorption process is very fast, according to experimental results, and the equilibrium was attained in about 25 minutes. At pH 5.0, the highest biosorption was experienced. Pseudo-first-order and pseudo-second-order kinetic models were used to test kinetic data. The best fit was obtained with the pseudo-second-order kinetic model. The biosorption followed Langmuir isothermal models with R2 > 0.991. Co(II) and Cd(II) biosorption rates were 4.44 and 21.0 mg/g respectively. The values of thermodynamic parameters (ΔGo, ΔHo, and ΔSo) were determined by Van’t Hoff plot which showed that the biosportion of Co(II) and Cd(II) was feasible, endothermic, and spontaneous. The breakthrough capacities for Co2+ and Cd2+ ions take the order: Cd2+ > Co2+, which is consistent with data, obtained using the batch method.
Experimental investigation of maximum impact force exerted by dry granular flows on a rigid barrier
Authors: Yuan Jinke , Wen Jiwei , Pei Zuan
Published: October 2023

Rigid barriers are protective structures widely used in mountainous regions to resist the destructive impacts of dry granular flows originating from shallow landslides or collapses. The determination of the maximum impact force exerted by dry granular flows is crucial in designing rigid barriers. In this study, we conducted laboratory tests in which we examined the weight and particle shape of dry granular flows, as well as the drop height, incident angle, and thickness of the rigid barrier, to investigate the impact force on the rigid barrier. The results indicated that the strongest impact was concentrated at the centre of the rigid barrier, particularly in the lower centre area of the barrier. A new approach is proposed to estimate the maximum impact force on rigid barriers exerted by dry granular flows. In addition, a new impact equation for calculating the maximum impact force that explicitly considers the effects of rigid barrier structural properties on the impact dynamics based on the modulus, Poisson's ratio, and thickness and the particle shape effects based on different shape coefficients is proposed. Based on this new approach, agreement between the prediction results and the observation results was obtained.
Temperature crack suppression measures of mass concrete for tunnel
Authors: Xie Jiangsheng , Li Wen-qiang
Published: October 2023

In order to solve the problem of engineering structure safety caused by temperature crack of mass concrete in tunnel, the construction measures and monitoring data of mass concrete in Yangcheng Xihu tunnel are analyzed. First of all, six construction measures were put forward to suppress temperature cracks, including pouring in layers, controlling vibration quality, controlling the temperature of concrete entering mold, controlling mold removal time, concrete curing and controlling support removal time. Then, the High Performance Dual-Grating Temperature-Strain Sensor was used to monitor the temperature and strain of construction site structure intelligently. Based on the data analysis of the temperature and strain of the floor, side wall and top slab, it is pointed out that the temperature of the floor, side wall and top slab increases sharply first and then decreases slowly due to the release of a large amount of hydration heat during the hardening process of concrete. Due to the poor thermal conductivity of concrete, the hydration heat generated in the middle center of the floor, side wall and top slab can not be transferred to the surface of concrete in time, so the temperature is generally "high in the center and low on both sides". Due to the effect of thermal expansion and cold contraction of concrete, the strain variation trend of the floor, side wall and top slab is similar to that of temperature, showing a sharp increase at first, and then a slow decrease. Based on the mechanism of temperature crack, the variation law of temperature and strain during mass concrete pouring is analyzed, which provides reference for subsequent engineering construction.
Stress behaviors of distal femoral cartilage defect and repair
Authors: Lyu Linwei , Yang Chen , Dai Weichao , Wang Shilei , Zhang Chunqiu , Zielinska Teresa
Published: October 2023

Objective: To find contact stress distributions of femoral condyle cartilage under defect and repaired status.
Methods: 6 mini-pigs were selected to divide into intact group, defect group and repair group. 4 pigs in defect group were performed 4 types of cartilage defect, including circle, triangle, square and trapezoid. Defect samples were repaired with two kinds of artificial cartilages. Contact stress distributions of joint contact surfaces were measured and analyzed using thin-film pressure sensor under standard standing loads.
Results: The maximum stress in the stress concentration area caused by cartilage defect were enhanced by 3.4 or 4.6 times of normal stress, even 6.2 times. The soft artificial cartilage fixation caused abnormal stress distribution at the defect area. Hard artificial cartilage was close to the level of natural cartilage. Stress concentration at the defect edge was almost eliminated, but the stress distribution in the whole contact area was still different from intact group. In addition, the peak stress point changed in the defect group and repaired group while compared with intact group.
Conclusions: Cartilage defect resulted in the variations of original intact contact stress distribution. Artificial cartilage repairing could relieve stress concentration but not recover to healthy status yet. Our findings could provide evidences for better rehabilitation of articular cartilage injury.
AKAP8L as a Novel Prognostic Biomarker Correlated with Immune Infiltrates in Gastric Cancer
Authors: Zhang Nie , Liu Hong , Yang Jiankang , Zhong Fei
Published: October 2023

Background
Stomach adenocarcinoma (STAD), the most common histologic type of gastric cancer (GC), has unclear molecular mechanisms. A-kinase anchoring protein 8 (AKAP8L) is significantly linked to various tumor processes, including immune invasion and metabolism. However, the role of AKAP8L in STAD development remains enigmatic. This study illuminates AKAP8L’s molecular mechanism, metabolic implications in STAD progression, and potential as a prognostic biomarker.
Methods
Employing diverse databases (TCGA, TIMER, GEPIA, Human Protein Atlas, GSEA), we examined the AKAP8L-STAD correlation. Comparative AKAP8L mRNA/protein analysis was conducted in STAD vs. normal tissues. Immunohistochemistry assays validated the findings in stomach samples from STAD patients. The connection of AKAP8L to clinical attributes is revealed. The prognostic potential was assessed via Kaplan‒Meier analysis and Cox regression. AKAP8L’s link to STAD immune cell infiltration was explored through TIMER. STRING was used to construct the AKAP8L-binding protein network. The R package clusterProfiler enriches AKAP8L’s functions. Immune infiltration’s relationship with AKAP8L in STAD was analyzed via the single-sample GSEA (ssGSEA) method from the R package GSVA and the TIMER database. The diagnostic potential of AKAP8L was assessed using the receiver operating characteristic (ROC) curve, quantified by the area under the curve (AUC) score.
Results
Pancancer analysis revealed upregulated AKAP8L expression in STAD tissues compared to normal tissues, with elevated expression correlated with poor prognosis. The ROC curve indicated that the possible diagnostic biomarker AKAP8L (AUC = 0.821) might exist. Low survival, tumor stage, sample type, subgroup, tumor grade, and lymph node metastasis are all related to higher AKAP8L expression. AKAP8L was connected with tumor-infiltrating lymphocytes (TILs), including immune supporting cells and immunosuppressive cells, and was substantially linked with several immunological marker sets in STAD. Further enrichment analysis showed that the carcinogenicity of AKAP8L may be related to "phosphoinositide metabolism", which provides a novel idea for treating STAD.
Conclusion
In STAD development, upregulated AKAP8L emerges as a key factor associated with immune cell infiltration levels and cellular metabolism. AKAP8L may hold promise as a biomarker, prognostically signifying a more unfavorable outcome for individuals afflicted by STAD.
Barriers and facilitators in developing patient versions of clinical practice guidelines - qualitative interviews on experiences of international guideline producers
Authors: Meyer Nora , Hauprich Julia , Breuing Jessica , Hellbrecht Irma , Wahlen Sarah , Könsgen Nadja , Bühn Stefanie , Becker Monika , Blödt Susanne , Carl Günther , Follmann Markus , Frenz Stefanie , Langer Thomas , Nothacker Monika , Schaefer Corinna , Pieper Dawid
Published: October 2023

Background
Several guideline organizations produce patient versions of clinical practice guidelines (PVGs) which translate recommendations into simple language. A former study of our working group revealed that few guideline organizations publish their methods used to develop PVGs. Clear definitions of PVGs do not prevail and their purposes often remain unclear. We aimed to explore experts’ perspectives on developing, disseminating and implementing PVGs to discuss and incorporate these experiences when consenting on methodological guidance and further improving PVGs.
Methods
We conducted 17 semi-structured telephone interviews with international experts working with PVGs from September 2021 through January 2022. We conducted the interviews in English or German, they were recorded and transcribed verbatim. We utilized Mayring’s qualitative content analysis with MAXQDA software to analyze the data.
Results
A total of 19 participants from 16 different organizations and 8 different countries participated. Most were female (16/19) and their experience in working with PVGs ranged from 1 to 20 years. All follow methodological standards when developing PVGs, but the extent of these standards and their public accessibility differs. Aims and target groups of PVGs vary between organizations. Facilitators for developing PVGs are working with a multidisciplinary team, financial resources, consultation processes and a high-quality underlying CPG. Facilitators for disseminating and implementing PVGs are using various strategies. Barriers, on the other hand, are the lack of these factors. All participants mentioned patient involvement as a key aspect in PVG development.
Conclusion
The steps in the PVG development process are largely similar across the countries. Focus is placed on the involvement of patients in the development process, although the extent of participation varies. The experts collectively attribute great importance to PVGs overall, but in order to constantly adapt to medical progress and changing conditions, the focus in the future must be more on formats like living guidelines. Although there are different views on the mandatory development of PVGs, there is a consistent call for more transparency regarding the methodology used for PVGs.
New vs. old - A randomised cross over study on the effectiveness of digital and analog learning methods for learning anatomical structures in physiotherapy education
Authors: Pagels Larissa , Eschke Robert-Christopher , Luedtke Kerstin
Published: October 2023

Background
According to the German Physiotherapy Education and Qualification Regulations, teaching of anatomical structures is one of the fundamental subjects of physiotherapy education. Besides exhibits and models, anatomy atlases are usually used as teaching and learning tools. These are available in both analog form as printed books or in digital form as a mobile application. Furthermore, the use of digital teaching and learning tools is steadily increasing within the education of health professionals.
Aim
To assess the efficacy of a digital educational tool in contrast to an analog anatomical atlas in acquiring knowledge about anatomical structures.
Material and method:
Data collection took place in the context of an anatomy tutorial for students of the bachelor's degree program in physiotherapy. In a cross-over design, the students completed two learning assignments, each with different learning materials provided, either with an anatomy app on a tablet or with an anatomy atlas as a book. The tests to assess knowledge immediately after the task, consisted of questions about the anatomical structures of the knee as well as the shoulder. In addition, the students' satisfaction with the learning materials provided, their assessment of the learning success and their affinity to digital learning materials were surveyed with a questionnaire using a 5-point Likert scale and a free-text field. The data was analysed descriptively and the group differences were calculated using t-tests.
Results
Thirty students participated. The group comparison showed a significantly better outcome for the group that prepared with the analog anatomy atlas for the questions on the knee than the comparison group that used the anatomy app (t(28) = 2.6; p = 0.007). For the questions concerning the shoulder, there was no significant difference between the digital and analog groups (t(28) = 1.14; p = 0.26). The questionnaire showed that satisfaction with the analog anatomy atlas was significantly higher than with the anatomy app. 93.34% rated at least "somewhat satisfied" in the question about the analog learning tool. In contrast, 72.67% of students partially or fully agreed that they "enjoy learning with digital learning tools”.
Discussion
Learning anatomical structures with digital learning tools does not offer a clear advantage over learning with analog learning tools. The results of the questionnaire also show greater satisfaction with the analog anatomy atlas than with the anatomy app. Whereas most students stated that they also learn anatomical structures themselves with digital learning tools. Satisfaction with the learning tool seems to play a central role in their effectiveness. In addition, sufficient time must be provided for users to familiarize themselves with the user interface as well as the digital applications in order to use them effectively.
Spatiotemporal patterns of surface ozone exposure inequality in China
Authors: Li Bin , Ni Jinmian , Liu Jianhua , Zhao Yue , Liu Lijun , Jin Jiming , He Chao
Published: October 2023

The escalating concentration of surface ozone (O3) across China is increasingly highlighting potential threats to public health, ecological balance, and economic sustainability. Using a 1km x 1km dataset of O3 concentrations, this research employs subpopulation demographic data combined with a population-weighted quality model. Its aim is to evaluate quantitatively the differences in O3 exposure among various subpopulations within China, both at a provincial and urban cluster level. Additionally, an exposure disparity indicator was devised to establish unambiguous exposure risks among significant urban agglomerations at varying O3 concentration levels. The findings reveal that as of 2018, the population-weighted average concentration of O3 for all subgroups has experienced a significant uptick, surpassing the average O3 concentration (118µg/m3). Notably, the middle-aged demographic exhibited the highest O3 exposure level at 135.7µg/m3, which is significantly elevated compared to other age brackets. Concurrently, there exists a prominent positive correlation between educational attainment and O3 exposure levels, with the medium-income bracket showing the greatest susceptibility to O3 exposure risks. From an industrial vantage point, the secondary sector demographic is the most adversely impacted by O3 exposure. Geographically, urban populations experience slightly more elevated O3 levels than their rural counterparts, and the subpopulations in the North China, East China, and Central China regions manifest significantly higher O3 exposure levels compared to other areas. These findings not only underscore the intricate interplay between public health and environmental justice but further accentuate the indispensability of granular subgroup strategies in environmental health risk assessments. Moreover, this research furnishes invaluable scientific groundwork for crafting targeted public health interventions and sustainable air quality management policies.
Innovative Training Camp Approach for Seamless Transition from Preclinical Education to Clinical Practice among Respiratory Therapy Students in Taiwan
Authors: Yang Shih Hsing , Tseng Hui Yun , Jung Fang
Published: October 2023

Background: This study explored the implementation and effectiveness of a preinternship training camp in facilitating a seamless transition from preclinical education to clinical practice among respiratory therapy students in Taiwan. The training camp was designed to enhance students’ knowledge, skills, and confidence in real-world clinical scenarios.
Methods: A cohort of respiratory therapy students participated in the preinternship training camp, which incorporated activities such as instructional workshops, case discussions, simulated patient encounters, and self-directed learning. Quantitative data, including satisfaction ratings and preintervention and postintervention assessment scores, were collected to evaluate the effectiveness of the training camp. Moreover, qualitative feedback was collected from the students and teachers and analyzed to gain deeper insights into the impacts of the training camp.
Results: The results revealed that the participants had high levels of satisfaction with the preinternship training camp, highlighting its positive influence on their preparedness for and attitude toward clinical practice. Our quantitative analysis of the preintervention and postintervention assessment scores demonstrated a slight improvement in the participants’ knowledge and understanding after the training camp. Qualitative feedback from the participants emphasized the benefits of the training camp in enhancing their technical proficiency, patient communication skills, and confidence in handling clinical cases. The participants also reported increased self-assurance and precision in their approach to patient care. Furthermore, the teachers highlighted the effectiveness of the training camp in terms of instructional guidance and curriculum planning; nevertheless, they acknowledged the importance of refining the preparation of technical equipment and creating more realistic patient interaction scenarios.
Conclusion: The innovative strategies employed in the preinternship training camp were effective in facilitating a smooth transition from preclinical education to clinical practice among respiratory therapy students in Taiwan. The quantitative and qualitative data demonstrate the positive impact of the training camp on the students’ knowledge, skills, confidence, and overall preparedness. These findings provide valuable insights for educators and institutions seeking to enhance the educational experience and transition process for respiratory therapy students.
A prospective comparison study utilizing patient-reported outcomes of taxane-related peripheral neuropathy between nab-paclitaxel and standard paclitaxel in patients with breast cancer
Authors: Kida Kumiko , Yamada Akimitsu , Shimada Kazuhiro , Narui Kazutaka , Sugae Sadatoshi , Shimizu Daisuke , Doi Takako , Oba Mari , Endo Itaru , Ishikawa Takashi
Published: October 2023

Background: Characteristics of taxane-induced peripheral neuropathy (PN) could be different between paclitaxel and nab-paclitaxel. The purpose of this prospective observational multicenter cohort study was to compare tri-weekly nab-paclitaxel to weekly standard paclitaxel regarding the severity, onset and recovery of sensory and motor PN in patients with breast cancer.
Methods: Patients with histologically confirmed breast cancer who were scheduled to receive standard weekly paclitaxel (80 mg/m2) or tri-weekly nab-paclitaxel (260 mg/m2) at institutions in our multicenter group were eligible for this study. Sensory and motor PN were evaluated every 3 weeks until PN improved for up to one year using patient-reported outcome.
Results: Between February 2011 and April 2013, 115 patients were enrolled, including 57 and 58 in the paclitaxel and nab-paclitaxel groups, respectively. The incidence of moderate or severe sensory PN was not significantly different between the two groups (p=0.40). The incidence of moderate or higher motor PN was more frequent in the nab-paclitaxel group than in the paclitaxel group (p=0.048). The median period for demonstrating PN were shorter in the nab-paclitaxel group than in the paclitaxel group (sensory, p=0.003; motor, p=0.001). The recovery of motor PN was slower in the nab-paclitaxel group than in the paclitaxel group (p=0.035), while the recovery period of sensory PN was not statistically different.
Conclusion: Nab-paclitaxel induced sensory PN sooner than paclitaxel, and no difference was observed in the severity and recovery duration between the two agents. Motor PN was more severe, started sooner, and improved over a longer period in the nab-paclitaxel-treated patients than in the paclitaxel-treated patients.
Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma
Authors: Liu Guihong , Zhang Xin , Chen Tao , Tang Yu , Hu Binbin , Shi Huashan
Published: October 2023

Background
Accurate restaging and histological assessment of esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT) provide valuable prognostic information. We aimed to elucidate proper classification methods to discriminate and predict prognosis in ESCC patients who received nCRT followed by surgery and in the recurrent subgroup.
Methods
We included 309 patients with ESCC who underwent nCRT followed by complete resection for analysis of overall survival (OS). Among them, 304 patients were eligible for recurrence-free survival (RFS) analysis, and OS analysis was also separately performed on 98 recurrent patients. Tumor regression grade (TRG) was assessed using the modified Ryan scheme and ypTNM was recorded based on the 8th edition of the AJCC TNM classification. The combination of TRG and lymph node status resulted in two ypTN systems: ypTN (four categories) and ypTN (three categories). In the ypTN (four categories) system, the categories were ypT-N-, ypT + N-, ypT-N+, and ypT + N+. When considering ypT + N- and ypT-N + as one category, it produced the ypTN (three categories) system. We plotted Kaplan-Meier survival curves based on various classification methods. The log-rank test was used to examine differences in survival rates and calculate P values. The selected classification methods underwent univariable and multivariable Cox regression analyses.
Results
The mean follow-up period was 39.2 months (range, 0.6–70.4). Compared to classification methods of TRG, ypT, ypN, ypTNM, and ypTN (four categories), ypTN (three categories) performed the best ability to distinguish and predict OS and RFS in overall population with P < 0.001 for overall models and significant differences between adjacent groups. In the recurrent population, we found the binary classification of ypN was a good predictor of OS (ypN- vs. ypN+, HR: 1.819, 95%CI: 1.150–2.878, P = 0.011). The reliability of these classification methods in both the overall population and the recurrent population was confirmed by univariable and multivariable Cox regression analyses.
Conclusions
The prognosis of ESCC patients who received nCRT followed by surgery can be distinguished and predicted by ypTN (three categories) system. Lymph node status was an ideal prognostic classification for the recurrent subgroup.