bluuebunny/crossref_metadata_2025 huggingface dataset:
Phytochemicals in Cancer Chemoprevention: Preclinical and Clinical Studies
Authors: Lekhak Nitish , Bhattarai Hitesh Kumar
Published: December 2024

Phytochemicals, chemicals from plants, have garnered huge attention for their potential ability to prevent cancer. In vivo and preclinical models show that they do so often by affecting the hallmarks of cancer. Phytochemicals affect key pathways involved in the survival, genome maintenance, proliferation, senescence, and transendothelial migration of cancer cells. Some phytochemicals, namely antioxidants, can scavenge and quench reactive oxygen species (ROS) to prevent lipid peroxidation and DNA damage. They also trigger apoptosis by stopping the cell cycle at checkpoints to initiate the DNA damage response. Numerous in vitro and in vivo studies suggest that phytochemicals hinder cancer onset and progression by modifying major cell signaling pathways such as JAK/STAT, PI3K/Akt, Wnt, NF-kB, TGF-β, and MAPK. It is a well-known fact that the occurrence of cancer is in itself a very intricate process involving multiple mechanisms concurrently. Cancer prevention using phytochemicals is also an equally complex process that requires investigation and understanding of a myriad of processes going on in the cells and tissues. While many in vitro and preclinical studies have established that phytochemicals may be potential chemopreventive agents of cancer, their role in clinical randomized control trials needs to be established. This paper aims to shed light on the dynamics of chemoprevention using phytochemicals.
Research on the dynamic response of semi-enclosed sound barrier on viaduct under train pulsating wind and wheel-rail excitation
Authors: Sun Liangming , Liu Shuguang , Wang Wenli , Zhao Hanbing
Published: December 2024

This study develops a coupled train-viaduct dynamic analysis model to investigate the dynamic response of semi-enclosed sound barriers on viaducts in light rail transit. During the iterative process of this model, fluctuating wind produced by the train is introduced and combined with wheel-rail loads to analyze the dynamic response of sound barriers. Based on the above model, in the time domain, there are significant differences in the vibration displacement and acceleration under combined excitation when the train head enters and the tail exits the sound barrier region. In the frequency domain, the vibration acceleration level under combined excitation increases significantly within the 0–5 Hz frequency. The parameter analysis results indicate that the total vibration acceleration level is higher at the measuring points close to the direction of travel. As the train speed increases, the effect of fluctuating wind becomes more significant in the low-frequency range (1–3.15 Hz). The smaller number of train formations also improved the vibration acceleration level difference between the combined and wheel-rail excitation.
Advancements of PAPI for the exascale generation
Authors: Jagode Heike , Danalis Anthony , Congiu Giuseppe , Barry Daniel , Castaldo Anthony , Dongarra Jack
Published: December 2024

The Performance Application Programming Interface (PAPI) serves as a coherent, operating-system-independent interface for accessing performance counter data across a wide range of hardware and software components. PAPI can operate autonomously as a performance monitoring library and tool for application analysis. However, its true value emerges when it functions as a middleware for numerous third-party profiling, tracing, and sampling toolkits, establishing itself as a universal interface for hardware counter analysis. In this role, PAPI manages the intricacies of each hardware component, presenting a streamlined API to higher-level toolkits. Within the Exascale Computing Project (ECP), PAPI has expanded its capabilities in performance counter monitoring and incorporated support for power management across cutting-edge hardware and software technologies. This includes performance and power monitoring for AMD GPUs through integration with AMD ROCm and ROCm-SMI, Intel Ponte Vecchio GPUs via Intel’s oneAPI Level Zero, and NVIDIA GPUs through the CUPTI Profiling API. Additionally, PAPI is compatible with interconnects, the latest CPUs, and ARM chips. These enhancements have been implemented while preserving the standard PAPI interface and methodology for utilizing low-level performance counters in CPUs, GPUs, on/off-chip memory, interconnects, and the I/O system, encompassing energy and power management. To strengthen PAPI’s sustainability, ECP has facilitated its integration into Spack and E4S, ensuring software robustness through continuous integration and continuous deployment. In addition to hardware counter-based data, PAPI now supports the registration and monitoring of Software-Defined Events. This feature exposes the internal behavior of runtime systems and libraries like PaRSEC, SLATE, Magma, to applications utilizing those libraries, broadening the scope of performance events to include software-based information. Additionally, PAPI has been expanded with the Counter Analysis Toolkit, aiding in native performance counter disambiguation through micro-benchmarks. These micro-benchmarks probe various essential aspects of modern chips, contributing to the classification of raw performance events. In summary, ECP has enabled PAPI to include comprehensive counter analysis capabilities, advanced performance and power monitoring support for exascale hardware components, and broadened the scope of performance events to encompass not only hardware-related metrics but also software-based information.
Health anxiety and related factors among the rural population: A cross-sectional study in China
Authors: Jiang Zhihui , Cao Gaohui , Suomi Reima , Zha Daolin
Published: December 2024

This study investigated the prevalence and correlates of health anxiety among rural populations in China, due to the unique socio-economic challenges in these areas, such as limited healthcare access. A sample of rural residents ( N = 909) was analyzed to identify key predictors of health anxiety, such as age, education level, living type, anxiety sensitivity, and perceived information overload. Results indicated that older individuals and those with lower educational levels exhibited significantly higher levels of health anxiety. Furthermore, living alone was associated with increased health anxiety, while anxiety sensitivity and perceived information overload were found to exacerbate anxiety levels. These findings highlight the critical need for tailored interventions aimed at mitigating health anxiety in rural areas, thereby contributing to improved mental health outcomes and overall well-being.
Patient engagement, quality of life and chronic pain: A cross-sectional study on endometriosis
Authors: Ahmad Monica , Sechi Cristina , Guerriero Stefano , Guicciardi Marco , Vismara Laura
Published: December 2024

Endometriosis is a chronic condition affecting approximately 1 in 10 women of childbearing age, significantly impacting their daily lives, mental health, and quality of life. This study explores the relationship between chronic pain, patient engagement, and quality of life among women with endometriosis. Utilizing a sample of 354 women the study employed the WHOQOL-BREF, Patient Health Engagement Scale, and Numerical Pain Rating Scale to measure QoL, engagement, and pain intensity, respectively. Results indicated significant correlations between chronic pain and reduced QoL, as well as between higher patient engagement and improved QoL. Structural equation modeling revealed that patient engagement partially mediates the negative impact of chronic pain on QoL, suggesting that active involvement in health management can mitigate some adverse effects of chronic pain. These findings underscore the importance of patient engagement in enhancing QoL and managing endometriosis, highlighting the need for tailored interventions to foster proactive health management among affected women.
Understanding the barriers to hiring autistic people as perceived by employers in the United Kingdom
Authors: Day Marianne , Wood Chantelle , Corker Elizabeth , Freeth Megan
Published: December 2024

Supporting more autistic people into employment is a major priority of the United Kingdom’s National Autism Strategy (2021–2026). However, little is known about the barriers employers perceive to hiring autistic people. A pre-registered cross-sectional survey study was conducted on a nationally representative sample of 1212 individuals with recent hiring experience. The Capability, Opportunity, Motivation – Behaviour framework and the Theoretical Domains Framework were used to identify perceived barriers to hiring autistic people. Results indicated that intentions to hire autistic people and to make adjustments to the hiring process were high. However, barriers existed in relation to knowledge about autism and how to make adjustments, as well as perceived limited opportunities to hire autistic people. Intentions to hire autistic people were higher for younger participants, men, people with higher levels of autism knowledge and those with more experience of previously hiring autistic people. Analysis of qualitative responses revealed employer concerns about workplace relationships, productivity and the need for training and adjustments to hiring processes. This study demonstrated that important targets for intervention are improving employer knowledge of autism and building more inclusive hiring practices. Practical suggestions for implementation are provided. These findings are significant for development of policies aimed at improving employment outcomes for autistic people.

Lay abstract

In the United Kingdom, autistic adults struggle more to find jobs than non-autistic adults, which is a big concern to the government. To help more autistic people get jobs, hiring processes need to be better. By understanding what employers find challenging about hiring autistic people, we can come up with solutions to improve autistic people’s employment chances. A survey of 1212 employers and employees who hire people was conducted to find out what affects employers’ decisions to hire autistic people. Most people said they were open to hiring autistic applicants. This was particularly true for younger employers and men. People who had hired autistic people before were more likely to intend to do so again. However, key barriers to hiring were (1) not knowing enough about autism and (2) problems with how hiring is usually done in organisations. Employers also reported worrying about whether autistic employees would fit in at work, their productivity and the need for better training and changes to hiring methods. Our results indicate that it is important to educate employers about autism and make hiring practices more inclusive.
Shear connector performance analysis for composite bridge deck with corrugated steel sheeting
Authors: Yang Dong , Li Gang , Au Francis T.K. , Zhang Jing , Yuan Ye
Published: December 2024

On the basis of the steel-concrete composite orthotropic bridge deck, corrugated steel plate is introduced as the longitudinal bottom plate, onto which shear connectors are welded to form a new type of composite bridge deck, namely corrugated steel-concrete composite bridge deck. The integration of the steel sheeting and concrete together can make full use of the performance of steel in carrying the load. This paper describes an investigation of a real bridge in Anhui Province, China, focusing on the load-carrying capacity of the corrugated steel-concrete composite deck and the failure mode of the shear connectors. First, the mechanical properties of a shear connector welded onto a corrugated steel-concrete composite bridge deck are simulated and explored experimentally. A set of comparative tests on three groups of push-out specimens are designed and carried out. The test results show that the ultimate load-carrying capacity of the corrugated steel-concrete composite deck is increased by about 45% as compared with the standard specimens and the slip at the interface is reduced by about 34%. A comprehensive parametric study of the three sets of push-out tests is then conducted using the nonlinear finite element method. The parametric analysis shows that the ultimate shear capacity of the shear connector increases with the strengths of the concrete and corrugated steel plate as well as with the diameter of the stud, albeit with diminishing return.
Modern surgical treatments for lymphedema
Authors: Kearns Marie , Kauhanen Susanna , Mani Maria
Published: December 2024

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.
An enhanced deep intelligent model with feature fusion and ensemble learning for the fault diagnosis of rotating machinery
Authors: Zhuang Kejia , Deng Bin , Chen Huai , Jiang Li , Li Yibing , Hu Jun , Lam Heungfai
Published: December 2024

Vibration signals, serving as critical sources of information for monitoring the status of rotating machinery, demand effective extraction and rational utilization of its features to significantly enhance the accuracy and reliability of fault diagnosis. However, vibration signal features typically manifest as nonlinear and nonstationary, posing a significant challenge in industrial settings. To tackle this challenge, this article proposes an enhanced deep intelligent model based on feature fusion and ensemble learning for practical fault diagnosis of rotating machinery. First, a parallel network structure is introduced to comprehensively and accurately explore the fault characteristics of rotating machinery. This network comprises two branches: the first branch designs an improved one-dimensional convolutional neural network to extract locally robust features from raw signals; the second branch adopts variational mode decomposition to decompose raw signals into a set of intrinsic mode functions and extract comprehensive statistical features in both the time and frequency domains, significantly enhancing the signal representation capability. Subsequently, a deep neural network is used to extract more stable feature information. The features from the two branches are then fused, and the final network output is generated through a softmax regression function. Finally, ensemble learning uses a majority voting scheme to obtain more stable final outputs. To confirm the effectiveness of the proposed method, experiments are conducted on two laboratory cases and one industrial case. The experimental results demonstrate that the proposed method significantly improves fault diagnosis accuracy and reliability in controlled laboratory environments and real-world industrial applications, making it highly applicable for real-time monitoring and predictive maintenance of industrial machinery. These improvements can reduce maintenance costs and downtime, thus enhancing operational efficiency in various industrial settings.
The association between osteoprotegerin and arterial stiffness in a 10-year longitudinal study of patients with type 2 diabetes
Authors: Low Serena , Pek Sharon , Moh Angela , Liu Jian-Jun , Pandian Bhuvaneswari , Ang Keven , Tang Wern Ee , Lim Ziliang , Subramaniam Tavintharan , Sum Chee Fang , Lim Su Chi
Published: December 2024

Introduction: Osteoprotegerin (OPG) inhibits vascular calcification which is central to pathogenesis of arterial stiffness. However, it promotes inflammation by upregulating expression of vascular cell adhesion molecule-1(VCAM-1), thereby contributing to arterial stiffness. We investigated longitudinal association between OPG and arterial stiffness in type 2 diabetes (T2D), causality of the association and mediation by VCAM-1. Methods: This was a prospective cohort study of T2D patients ( N = 1877, mean age 57.0 ± 10.8) with 10 years’ follow-up. Baseline plasma OPG was measured using immunoassay. Pulse wave velocity (PWV) was assessed using applanation tonometry. We examined association between OPG and follow-up PWV using linear mixed model. One-sample Mendelian Randomization (MR) was conducted with rs1385492 as OPG-associated single nucleotide polymorphism (SNP). Results: Baseline natural log (Ln)-transformed OPG was positively associated with baseline and follow-up PWV with adjusted coefficients 0.43 (95%CI 0.05, 0.80; p = .026) and 0.51 (95%CI 0.06 to 0.97; p = .028) respectively. Genetically-predicted higher levels of plasma OPG was associated with higher last follow-up PWV with coefficient 10.81 (95%CI 2.97, 18.65; p = .007) per unit increase in LnOPG. Higher VCAM-1 accounted for 10.2% of association between LnOPG and follow-up PWV. Discussion: Baseline plasma OPG was associated with higher follow-up PWV in patients with T2D, with genetic evidence from MR. This association may be mediated, at least in part, by VCAM-1.
Drug-Eluting Stent versus Interwoven Bare-Metal Stent in Clinically Significant Vein-Graft Anastomotic Stenosis of Hemodialysis Arteriovenous Graft
Authors: Hongsakul Keerati , Khantayanuwong Supawut , Sungsiri Jitpreedee , Janjindamai Phurich , Akkakrisee Surasit , Bannangkoon Kittipitch , Rookkapan Sorracha , Boonsrirat Ussanee
Published: December 2024

Purpose:

To date, no direct comparison has been made between the patency rates of drug-eluting stents (DESs) and interwoven stents (IWSs) in addressing hemodialysis access dysfunction. This study aims to directly compare the primary patency rates of DES and IWS in clinically significant vein-graft anastomotic stenosis of arteriovenous grafts (AVGs).

Material and methods:

Between January 2015 and October 2022, we enrolled all hemodialysis patients with clinically significant vein-graft anastomotic stenosis of AVGs who presented at our institution. Patient demographics, AVG details, lesion characteristics, and primary patency data for each stent group were systemically recorded. Following this, a Kaplan-Meier analysis of the primary stent patency was performed, with statistical significance set at p<0.05.

Results:

A total of 51 patients (19 men and 32 women; mean age=64 years; range=49–79 years) were enrolled. Among them, 16 were treated with DES and 35 were treated with IWS. Notably, the most common stent placement location in each group was the vein-graft anastomosis of the brachioaxillary grafts, and the primary patency rate was monitored over a follow-up period of 24 months. At 6, 12, and 24 months, the primary patency rates for DES vs IWS were 100% vs 62.7%, 91.7% vs 38.8%, and 62.9% vs 21.4%, respectively (p<0.001).

Conclusion:

Our findings suggest that DES may be a more effective treatment choice for clinically significant vein-graft anastomotic stenosis in AVGs for hemodialysis access than nondrug-coated IWS.

Clinical Impact

Drug-eluting stents (DES) have been widely recognized for their efficacy in reducing reintervention rates in coronary and femoropopliteal pathologies. However, their application in managing failing hemodialysis access remains inadequately explored. This study highlights the promising potential of DES in addressing clinically significant vein-graft anastomotic stenosis in hemodialysis arteriovenous grafts (AVG). DES may represent a viable alternative for mitigating substantial immediate recoil stenosis following balloon angioplasty and for preventing early restenosis at the vein-graft anastomosis of AVG, offering a novel therapeutic avenue for future clinical practice.
Balancing the Scale: Weighing In on Communicating About Diabetes and Weight
Authors: Baxi Srivastava Sneha
Published: December 2024

Biases and stigma related to health, diabetes, and obesity are an obstacle to providing respectful, empathetic, holistic care. Recognizing explicit and implicit biases and understanding the detrimental consequences is key to the stigma that exists, and the impact that it has on patient care is key. Health care professionals have a responsibility to communicate with patients with respect, empathy, and honesty, ensuring the person is at the center of care. There are a multitude of ways to positively change the landscape in which biases exist.
Medication therapy problems detected at community pharmacy INR checks
Authors: Nagge Jeff , Moussa Michelle , Zerai Amleset , Champigny Joey , Woodill Lisa
Published: December 2024

Background:

Despite the shift towards direct-acting anticoagulants, warfarin remains widely used in Canada and is traditionally managed by family physicians through laboratory-based international normalized ratio (INR) testing. The Community Pharmacy Anticoagulation Management Service (CPAMS) in Nova Scotia represents an innovative approach, enabling community pharmacists to conduct point-of-care (POC) INR testing and manage warfarin therapy. A potential benefit of this approach is the opportunity to identify non-warfarin medication therapy problems (nwMTPs) during routine visits.

Method:

We conducted a prospective, multicentre, observational study across 40 community pharmacies in Nova Scotia, part of CPAMS’s second phase. Pharmacists documented nwMTPs identified in patients with atrial fibrillation during routine POC INR visits using the Qualtrics Insight Platform, categorizing them by indication, effectiveness, safety, or adherence, alongside corresponding interventions.

Results:

Over 6 months, 43 nwMTPs were submitted from 13 unique pharmacies. There were 3404 POC INR tests in patients with atrial fibrillation, yielding an estimated nwMTP detection rate of 1.26 (95% CI, 0.69 to 2.32) per 100 INR tests. The most common nwMTP category was “Indication,” primarily requiring additional therapy. Pharmacists frequently intervened by recommending medication adjustments or providing patient education.

Discussion:

The findings highlight a modest, yet potentially significant role of pharmacists in detecting and managing diverse MTPs during focused warfarin management assessments. The predominance of indication-related problems underscores unmet therapeutic needs in patients on warfarin.

Conclusion:

This study illustrates the potential of pharmacist-led POC INR testing in community settings to identify and address nwMTPs, contributing to comprehensive patient care.
Research on learning and evaluation model of traditional sports skills of ethnic minorities using optimized spiking deep residual network
Authors: Wang Jiacheng , He Zhongliang , Zhang Binggang
Published: December 2024

The athletic performance of competitors in sporting events is influenced by a range of parameters. It is challenging for coaches to develop specialized, scientific training programs for athletes’ problems because the standard sports performance prediction approach makes it impossible to obtain precise findings and the related data analysis promptly. A sports performance prediction using the Spiking Deep Residual Network based Coati Optimization Algorithm (SPP-SDRN-COA) is proposed in this manuscript. Initially, the input data was collected from the historical data of ethnic minority athletics. Afterward, data was fed to pre-processing. In pre-processing, the Domain Transform Filtering (DTF) method removed noise by using DTF. Next, the pre-processed data was given to the Spiking Deep Residual Network (SDRN) which classified the sports performance of an athlete’s strengths and weakness. In general, SDRN does not show any optimization adaption methods to determine the optimum parameter to offer an accurate prediction. The Coati Optimization Algorithm (COA) is proposed in this manuscript to optimize the SDRN classifier that detects the strengths and weaknesses of the sports performance in an accurate manner. The proposed SPP – SDRN – COA is implemented using the MATLAB platform. By using the proposed SPP – SDRN – COA based sports performance prediction, the method provides higher accuracy and better prediction. Additionally, coaches can analyze athletic performance and gain a more thorough understanding of athletes’ strength levels than using the conventional performance prediction method.
A case report of lupus panniculitis-induced facial lipoatrophy successfully treated with injectable hyaluronic acid
Authors: Green Rebecca , Hardin Jori , Robertson Lynne , Remington Todd
Published: December 2024

Lupus panniculitis is a chronic subtype of cutaneous lupus erythematosus. It typically presents as tender, firm subcutaneous nodules on the proximal extremities, face, and/or trunk and can leave behind disfiguring scarring or lipoatrophy in the post-inflammatory phase. When a patient presents with physical or emotional distress secondary to lupus panniculitis-induced lipoatrophy, there are variable data on treatment with autologous fat transfer and injectable fillers. We present the case of a 37-year-old female presenting with lipoatrophy of the right cheek, after 2 years of quiescent disease, undergoing successful volume restoration with injectable hyaluronic acid filler.
Charting the Path: Unraveling the Research on Organizations and Certification Schemes (1999–2022)
Authors: Castillo Nicole , Ponce Oliva Roberto D. , Diaz Tautiva Julián Andrés
Published: December 2024

Certification schemes are a significant focal point for organizations, offering promising avenues for achieving excellence, fostering innovation, and promoting sustainability. However, our understanding of the relationship between organizations and certification schemes remains limited and fragmented. This study addresses this knowledge gap by elucidating the evolution of research on this topic within the categories of business and economics, engineering, and sustainability. We conducted a comprehensive literature synthesis spanning from 1999 to 2022, employing a four-stage PRISMA protocol. The analysis incorporated bibliometric methods to uncover the underlying knowledge structure within the literature. Notably, the Institut National De La Recherche Agronomique in France and the Journal of Cleaner Production emerged as the most productive institutions and journals in this domain. Furthermore, Olivier Boiral stood out as the most co-cited author. Additionally, we identified thirteen distinct research clusters. We propose future research directions based on these clusters, considering the categories of business and economics, engineering, and sustainability. The results enhance the ongoing discussion regarding the worldwide adoption of certification schemes and their viability as strategies to tackle grand challenges, particularly in the context of global environmental change.
What Radiographic and Spinopelvic Parameters do Spine Surgeons Consider in Decision-Making for Treatment of Degenerative Lumbar Spondylolisthesis?
Authors: Cabrera Juan P. , Virk Michael S. , Cho Samuel K. , Muthu Sathish , Ambrosio Luca , Yoon S. Tim , Buser Zorica , Wang Jeffrey C. , Diwan Ashish D. , Hsieh Patrick C. , The AO Spine Knowledge Forum Degenerative
Published: December 2024

Study Design

Cross-sectional survey.

Objective

Surgical treatment of degenerative lumbar spondylolisthesis is remarkably varied due to heterogeneity of clinical-radiological presentations. This study aimed to assess which spinopelvic radiological parameters were considered for decision-making.

Methods

Survey distributed to International AO Spine members to analyze surgeons’ considerations for treatment. Data collected includes demographics, training background, years of experience, and treatment decisions based on various radiographical findings, including segmental and global spinopelvic parameters.

Results

From 479 responses, the most frequently radiological parameter considered was slippage on dynamic X-rays (79.1%), followed by disc height (78.9%), global sagittal balance SVA (71.4%), and PI-LL mismatch (69.7%), while the least important was absolute spondylolisthesis on static lateral radiograph (22.8%). Fellowship-trained surgeons were likelier to use SVA (OR = 1.73, 95% CI = 1.02-2.99, P = 0.049), and disc height (2.13, 1.14-3.98, P < 0.05). There was no difference between orthopedics and neurosurgery in applying SVA and PI-LL mismatch. Surgeons from Asia Pacific emphasizes segmental lordosis (2.39, 1.11-5.15, P = 0.026) as from Latin America (2.55, 1.09-5.95, P = 0.030) and Middle East (4.33, 1.66-11.28, P = 0.003). However, surgeons from Latin America and Middle East also significant consider disc height (2.95, 1.07-8.15, P = 0.037) and (3.03, 1.04-8.83, P = 0.043), respectively. Additionally, the surgeons’ age was associated with using angular motion on flexion-extension radiographs, and volume of treated cases yearly with consideration for disc height.

Conclusions

Treatment of degenerative lumbar spondylolisthesis was influenced by slippage on dynamic radiographs, disc height, global alignment, and PI-LL mismatch. Surgeons’ age and Region, fellowship-trained, and volume of treated cases were significantly associated to apply these radiological parameters.
Characteristics of High-Risk Bipolar Bone Loss Lesions Using 3-Dimensional Imaging
Authors: Golijanin Petar , Arner Justin W. , Ryan Claire B. , Zai Qais , Peebles Liam A. , Peebles Annalise M. , Ganokroj Phob , Whalen Ryan J. , Eble Stephanie K. , Rider Danielle , Ninković Srdjan , Provencher Matthew T.
Published: December 2024

Background:

The concept of on-track versus off-track bone lesions in glenohumeral instability continues to evolve. Although much has been ascertained from an original biomechanical model, bony pathological changes, especially on 3-dimensional (3D) imaging, have not been fully evaluated.

Purpose:

To compare the differences in on-track versus off-track lesions to characterize glenoid and humeral head bone defects using 3D modeling software.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A consecutive cohort of 75 patients with recurrent anterior instability, with evidence of Hill-Sachs lesions (HSLs) and glenoid bone loss (GBL) and a mean age of 27.1 years (range, 18-48 years), were reviewed. 3D models of unilateral proximal humeri and glenoids were reconstructed. The volume, surface area, width, and depth of identified HSLs were quantified, along with their location (medial, superior) and orientation (Hill-Sachs angle). The percentage, width, and length of GBL as well as the glenoid track status were calculated. The on-track and off-track groups were compared using the Mann-Whitney U test.

Results:

The off-track group had greater HSL surface area (374.23 vs 272.64 mm2, respectively; P = .001), more HSL medialization (14.96 vs 17.62 mm, respectively; P = .028), greater HSL volume (603.08 vs 433.61 mm3, respectively; P = .007), and a greater mean HSL width (16.06 vs 11.53 mm, respectively; P = .001) than the on-track group. The off-track group also had greater GBL (22.55% vs 17.73%, respectively; P = .037), a greater GBL width (6.92 vs 3.58 mm, respectively; P < .001), and a greater GBL length (21.61 vs 16.1mm, respectively; P = .015) than the on-track group. Further analysis of large off-track lesions revealed a greater Hill-Sachs angle (33.16° vs 26.20°, respectively; P = .035) and a more superior extent of HSLs compared with borderline off-track and on-track lesions.

Conclusion:

Off-track lesions were found to have larger GBL, a larger HSL width, a more medialized HSL, and greater HSL surface area. This study outlines the specific characteristics of high-risk bipolar bone loss lesions to simplify the identification of patients in a clinical setting and aid in appropriate treatment planning.
Phone-Based Parental Support Program for Caries Prevention in Children: A Randomized Controlled Trial
Authors: Brännemo I. , Hasselblad T. , Levinsson A. , Dahllöf G. , Tsilingaridis G.
Published: December 2024

Introduction:

Children referred for comprehensive dental care under general anesthesia, due to severe early childhood caries, have a high risk of continued caries progression in posttreatment years.

Objectives:

To assess the effect of a phone-delivered, motivational interviewing–based parental support program on caries recurrence and oral health habits in preschool children treated under general anesthesia for severe early childhood caries.

Methods:

The prospective design of this 2-arm randomized clinical trial (allocation ratio 1:1; blinded outcome assessment) comprised 151 patients from pediatric dental departments in the Stockholm region of Sweden. Inclusion criteria were healthy children aged <6 y with early childhood caries who were scheduled for treatment under general anesthesia. Control group parents received standard advice on toothbrushing and sugar reduction. Intervention group parents received planned phone counseling with an oral health coach every other week for 1 y, based on motivational interviewing principles, offered in Arabic, English, Polish, Turkish, and Swedish. The primary outcome was caries progression 1 and 2 y postsurgery, assessed using the International Caries Detection and Assessment System. Secondary outcomes were parent-reported daily toothbrushing and dietary habits.

Results:

Sixty-five percent of the control group and 77% of the intervention group experienced caries relapse on at least 1 new surface after 1 y (nonsignificant). At the 2-y follow-up, relapse rates were 53% (control group) and 71% (intervention group; P < 0.05) compared with baseline. The intervention group was significantly less likely to engage in adverse oral health behaviors such as snacking on sweets (intervention group, 10%; control group 33%) and sweet drinks (intervention group 9%; control group, 29%) after 1 y. No group differences in daily fluoride toothpaste brushing occurred.

Conclusion:

The motivational interviewing–based parental support program improved dietary habits but showed no effect on caries recurrence in children treated under general anesthesia for early childhood caries. ClinicalTrials.gov NCT02487043

Knowledge Transfer Statement:

The findings of this study can assist clinicians, public health leaders, and researchers in tailoring preventative behavior-focused programs for early childhood caries. These results may improve the understanding of how behavioral interventions that involve parents of young children affect caries prevention, highlighting approaches that are less likely to be effective and guiding future efforts toward more promising strategies for high-risk populations.
Facial artificial intelligence in ophthalmology and medicine: fundamental and transformative applications
Authors: Chan Jeremy Jia Hao , Leung Pak Wing , Kilgour Helena , Dervenis Panagiotis
Published: December 2024

The integration of artificial intelligence (AI) in healthcare, particularly in the domain of facial processing tasks, has witnessed substantial growth in the 21st century. However, this requires sufficient appraisal for clinicians and researchers to adequately understand nomenclature and key concepts commonly used in this field. This article aims to elucidate the diverse applications of facial processing tasks, such as facial landmark extraction, face detection, face tracking, facial expression recognition and action unit detection, and their relevance to ophthalmology and other medical specialties. The keywords ‘ophthalmology’, ‘facial artificial intelligence’, ‘facial recognition’ and ‘periorbital measurements’ were used on PubMed and Ovid, between September 2012 and September 2022, to identify and screen for eligible articles. Studies reporting on human patients in ophthalmology, plastic, maxillofacial and cosmetic surgery with ocular lesions whose facial biometrics were processed by AI and written in the English language were included. A total of 291 and 513 articles were identified on PubMed and Ovid respectively. Twenty articles were included for analysis in this literature review after duplicates, inaccessible articles and articles without full manuscripts were excluded. Although fully automated algorithms can share the workload in healthcare systems and relieve strains on manpower, rigorous testing is crucial, followed by the challenges of convincing management bodies that it would work in reality, coupled with the costs of implementing specialised functional hardware and software. While patients have a valid concern that it would reduce physical contact with clinicians, it is important for clinicians not to replace clinical decision-making with AI alone.
Targeted interferon therapy with modakafusp alfa for relapsed or refractory multiple myeloma
Authors: Vogl Dan T. , Atrash Shebli , Holstein Sarah A. , Nadeem Omar , Benson Don , Chaudry Maria , Biran Noa , Suryanarayan Kaveri , Li Cheryl , Liu Yuyin , Collins Sabrina , Parot Xavier , Kaufman Jonathan L.
Published: December 2024

Interferon alfa has activity against multiple myeloma (MM). Modakafusp alfa is an immunocytokine comprising 2 attenuated interferon alfa-2b molecules and an anti-CD38 immunoglobulin G4 antibody, targeting delivery of interferon alfa to CD38-expressing (CD38+) immune and myeloma cells. This phase 1/2 trial enrolled patients with relapsed/refractory multiple myeloma with ≥3 prior lines of treatment and refractory to, or intolerant of, ≥1 proteasome inhibitor and ≥1 immunomodulatory drug. During dose escalation, modakafusp alfa was administered at 10 doses in 4 schedules across 13 cohorts. The primary end point was safety for dose escalation, and overall response rate (ORR) for dose expansion. We enrolled 106 patients who had received a median of 6.5 lines of prior therapy; 84% of patients had myeloma previously refractory to an anti-CD38 antibody. The most feasible dosing schedule was every 4 weeks (Q4W), at which the maximum tolerated dose was 3 mg/kg. Among 30 patients treated at 1.5 mg/kg Q4W, the ORR was 43.3%, with a median duration of response of 15.1 months (95% confidence interval [CI], 7.1-26.1); median progression-free survival was 5.7 months (95% CI, 1.2-14). Grade ≥3 adverse events (AEs) occurred in 28 (93.3%) patients, the most common were neutropenia (66.7%) and thrombocytopenia (46.7%); infections were reported in 8 (26.7%) patients (including grade 3 in 4 [16.7%]). Modakafusp alfa therapy induced upregulation of the type 1 interferon gene signature score, increased CD38 receptor density in CD38+ cells, and innate and adaptive immune cell activation. Modakafusp alfa resulted in antitumor activity and immune activation in patients with MM. AEs were primarily hematologic. This trial was registered at www.clinicaltrials.gov as #NCT03215030.
Building capacity for pediatric hematological diseases in Sub-Saharan Africa
Authors: Chirande Lulu , Namazzi Ruth , Hockenberry Marilyn , Wasswa Peter , Kiguli Sarah , Mulemba Tadala , Gastier-Foster Julie M. , Lyimo Magdalena , Airewele Gladstone , Lubega Joseph , Ozuah Nmazuo
Published: December 2024

The spectrum of hematological diseases in African children includes anemias, bleeding disorders, thromboses, and oncological diseases such as leukemias. Although data are limited, outcomes for these diseases are poorer in Africa. The dearth of specialists, and lack of infrastructure that supports diagnosis and management, have been identified as key barriers to improving outcomes for childhood hematological disorders in Sub-Saharan Africa (SSA). To address these, intentional capacity building efforts addressing education and training, diagnostic capacity, and access to blood products and medicines are needed. This article explores some ongoing efforts in the region aimed at fostering the capacity to identify and treat childhood hematological disorders across a breadth of initiatives targeting the critical themes of education, diagnostic support, and treatment. We also identify existing opportunities through international partnerships, to build sustainable programs that can support children with hematological diseases in SSA.
Digital remote maintenance inhaler adherence interventions in COPD: a systematic review and meta-analysis
Authors: Aung Hnin , Tan Ronnie , Flynn Cara , Divall Pip , Wright Adam , Murphy Anna , Shaw Dominick , Ward Tom J.C. , Greening Neil J.
Published: December 2024

Introduction

Sub-optimal inhaler adherence undermines the efficacy of pharmacotherapy in COPD. Digitalised care pathways are increasingly used to improve inhaler-use behaviour remotely. This review investigated the feasibility and impact of remote electronic inhaler adherence monitoring (EIM) and intervention platforms on clinical outcomes in COPD.

Methods

A literature search was conducted and studies investigating maintenance inhaler use among people with COPD using digital technology were selected. Pairwise and proportional meta-analyses were employed with heterogeneity assessed using I2statistics. When meta-analysis was not feasible, a narrative synthesis of outcomes was conducted.

Results

We included 10 studies including 1432 people with COPD whose maintenance inhaler usage was supported by digital inhalers and apps featuring audiovisual reminders and educational content with or without engagement with healthcare providers (HCPs). Inhaler adherence rate (AR) varied with calculation methods, but an overall suboptimal adherence was observed among people with COPD. HCP-led adherence interventions alongside EIM improved mean AR by 18% (95% CI 9–27)versuspassive EIM only. Enhanced AR may reduce COPD-related healthcare utilisation with little impact on health-related quality of life and exacerbation rate. Despite encountering technical issues among 14% (95% CI 5–23%) of participants, 85% (95% CI 76–94%) found digital platforms convenient to use, while 91% (95% CI 79–100%) perceived inhaler reminders as helpful.

Conclusion

Digitalised interventions can enhance maintenance inhaler adherence in COPD but their overall effect on clinical outcomes remains uncertain. Further work is required to tailor interventions to individuals’ adherence behaviour and investigate their longer-term impact.
Iranian mothers’ perceptions of contextual factors helping them manage pain in labor
Authors: Ghamgosar Faeghe Deljoo , Sadra Muhammad , Yari Hassan , Honarbakhsh Mina
Published: December 2024

Background

The rate of caesarean section in Iran has significantly increased. The main reason cited by Iranian mothers for it is labor pain and fear of it. However, the experience of pain during childbirth has different meanings for mothers in various conditions. Therefore, this study aims to examine the components from the mothers’ perspective that helped them manage pain in labor. The findings of this article may help prevent unnecessary medical interventions.

Methods

The current article is one component of a mixed-method study conducted in Iran. Its primary objective was to develop protocols for maternity unit design to enhance maternal satisfaction, promote husbands’ involvement, and improve pain management. The current study focuses on examining contextual components that are effective in managing pain among 25 mothers selected through stratified purposive sampling. Data collection from mothers who gave birth in four large hospitals in Iran was carried out through unstructured in-depth interviews. The data were analyzed using interpretative phenomenological analysis.

Findings

The data show that two major environmental factors affect mothers’ perception of pain and their ability to control it: (1) Internal and (2) External environments. The main components of the internal factor are identified as “Personal beliefs”, “Self-confidence and lack of fear”, and the external environment includes three subfactors: “Spatial environment”, “Social environment”, and “Interactive environment”. The overall meaning attributed to pain caused by these factors determines how mothers can cope with it.

Conclusion

In this study, self-confidence and a positive mindset were significant factors in managing pain during labor among this group of mothers. Furthermore, each mother’s perception of pain was shaped by a combination of physical, social, and interactive influences. The research identified the importance of support during labor according to mothers’ individual, subjective needs, while improving the physical environment, with a view to reducing interventions and promoting positive experiences for mothers and husbands. Consequently, enhancing internal resources and the birthing environment during labor which involve identifying the optimal blend of physical, mental, and emotional strategies tailored to the specific needs of mothers, can be considered to a potential reduction in the perceived intensity of pain in future.
Implementing an enhanced recovery from surgery pathway to reduce hospital length of stay for primary hip or knee arthroplasty: a budget impact analysis
Authors: Lloyd Melanie , Ademi Zanfina , Harris Ian A. , Naylor Justine , Lewis Peter , de Steiger Richard , Buchbinder Rachelle , Wan Anthony , Ackerman Ilana N.
Published: December 2024

Background

Given growing demand for hip and knee arthroplasty and unsustainable resource requirements, safe and efficient models of care are critical. This study aims to determine the impact on healthcare costs of implementing an enhanced short-stay model of care (ESS-MOC) for arthroplasty at a national level.

Methods

A budget impact analysis was conducted for the years 2023–2030 in the setting of Australian publicly and privately funded hospitals performing hip or knee arthroplasty. The model considered population-based future arthroplasty projections, published data on healthcare costs and resource utilisation, and aggregate health insurer claims data related to minor complexity elective hip or knee arthroplasty for osteoarthritis. The ESS-MOC assigned a conservative hypothesized 30% of eligible patients to an enhanced recovery from surgery (ERAS) pathway which comprised a shortened acute ward stay (average 2 days versus 4 days with current care) and outpatient rehabilitation. The primary outcome was total healthcare cost savings post-ESS-MOC implementation, stratified by joint (knee/hip) and healthcare sector (public/private). Return on investment (ROI) ratio, measuring the return for each dollar invested in implementation, and hospital bed days utilized, were also estimated. Costs are presented in Australian dollars (AUD), at 2023 prices.

Results

Estimated cost savings for 2023–2030 from implementing the ESS-MOC pathway were AUD641 million (95% CI: AUD99 million to AUD1250 million), corresponding to a ROI ratio of AUD8.88 (AUD1.3 to AUD17.9). Total implementation costs for the ESS-MOC were estimated at AUD38 million and AUD34 million for the private and public sectors, respectively. Savings would be 8-fold higher in the private sector (AUD571 million vs. AUD70 million in the public sector), primarily attributable to the > 80,000 rehabilitation bed days saved annually in this sector. For the period 2023–2030, an estimated 337,000 (261,000 to 412,000) acute bed days could be saved (private sector 262,000 [200,000 to 324,000]; public sector 74,000 [57,000 to 92,000]). Less than 10% of eligible patients would need to move into the ERAS pathway to realise cost savings.

Conclusions

Implementation of an enhanced short-stay model of care for eligible arthroplasty patients in Australia would generate significant cost and resource savings, particularly for the private hospital sector.