bluuebunny/crossref_metadata_2025 huggingface dataset:
The Negative Effects of Tourist Trampling on the Soil Physical Properties and Microbial Community Composition in a Natural Oak Forest
Authors: Shang Qing , Li Changfu , Liu Yanchun
Published: August 2024

Tourist trampling is a serious disturbance affecting the soil structure and microbial community in forests. However, it is still unclear whether the response of soil microorganisms to trampling is attributed to the alterations in soil physical (soil bulk density and total porosity) or soil chemical (total nitrogen and soil organic carbon) properties. To determine the response and mechanism of soil microbial community composition to tourist trampling, we conducted a field experiment including four levels of trampling intensity (control, mild, moderate, and severe) at the Baotianman forest ecotourism area. With increasing trampling intensity, soil bulk density showed a substantially increasing pattern, whereas soil total porosity, total nitrogen, and soil organic carbon showed a decreasing trend. Compared to the insignificant change under mild trampling, moderate and severe trampling significantly decreased soil bacterial PLFAs (phospholipid fatty acids) by 46.6% and 57.5%, and fungal PLFAs by 36.3% and 61.5%, respectively. Severe trampling showed a significantly negative effect (−4.37%) on the proportion of soil bacterial PLFAs. Changes in soil bulk density and porosity induced by trampling, rather than total nitrogen and soil organic carbon, played a greater role in regulating soil microbial community composition. These findings suggest that soil microbial community composition and biomass are significantly influenced by the changes in soil texture and aeration conditions caused by tourist trampling.
Forest Products Trade-Environment Nexus through the Lens of Carbon Neutrality Targets: The Role of Rural Bioenergy
Authors: Mi Li , Huang Yongjun , Sohail Muhammad Tayyab
Published: August 2024

Environmental sustainability is the primary objective of policymakers all around the globe. The most viable option to deal with this situation is to increase the use of renewable energy sources, particularly bioenergy, a carbon-neutral energy source. Trading activities in clean and green products can also enhance environmental performance. The literature on the impact of bioenergy and trade in environmental goods on ecological sustainability is growing. However, the empirical literature has not shed light on the impact of forest products trade (FPT) and rural bioenergy on environmental sustainability, leaving a significant gap in the literature. To address this gap, this analysis examines the impact of FPT and rural bioenergy on environmental sustainability using 23 economies from 2000 to 2022. Empirical estimates of the model are obtained by applying several estimation techniques, such as fixed effects (FE), random effects (RE), two-stage least squares (2SLS), generalized method of moments (GMM), and cross-sectional autoregressive distributed lag (CS-ARDL). The findings confirm that FPT and rural bioenergy reduce CO2 emissions and contribute to environmental sustainability. The estimates of control variables of economic growth, industrialization, technological development, urbanization, and financial development are positively significant, confirming that these factors increase carbon footprints and thus hurt environmental sustainability. In contrast, political stability negatively impacts carbon emissions and thus promotes environmental sustainability. In light of these findings, policymakers should encourage forest products trade and rural bioenergy to achieve environmental sustainability.
Timber Extraction by Farm Tractors in Low-Removal-Intensity Continuous Cover Forestry: A Simulation of Operational Performance and Fuel Consumption
Authors: Forkuo Gabriel Osei , Marcu Marina Viorela , Iordache Eugen , Borz Stelian Alexandru
Published: August 2024

Farm tractors represent a possible option for forwarding operations in continuous cover forestry, given the generally lower removal intensities, relatively high dispersion of timber, and heightened concerns regarding the environmental impact of operations. This study evaluated the performance of a farm tractor fitted with an externally operated crane and a bunk for forwarding operations, using field-documented data on operational speed, production, and fuel use, as well as data from high-resolution video recordings for a detailed time-and-motion study. Using this knowledge, performance simulations were run based on extraction distance and log size, to describe the variability in fuel use, cycle time, and productivity, and to estimate the operational cost. The results of the simulation showed important differences in operational speed across different work elements, involving machine movement. Although the extraction distance had effects, log size was found as the important factor driving the variability in cycle time, productivity, fuel use, and cost. The differences in performance based on the variability in extraction distance and log size may serve as a guideline for operational planning, costing, and environmental assessment regarding emissions under various operating conditions.
Enhancing Effect of Adding Previously Fermented Juice and Sudan Grass on the Quality of Alfalfa Silage
Authors: Dawuti Yisilayi , Kuerban Zaituniguli , Cheng Zhize , Guo Penghui , Gao Jinlan , Yimingniyazi Amanula
Published: August 2024

Silage preservation is critical for livestock’s stable forage supply during cold seasons and fostering the recycling of agricultural byproducts. We assessed the effects of adding previously fermented juices (PFJ) and different proportions of Sorghum Sudanense (Piper) Stapf (Sudan grass) on the silage quality of Medicago sativa L. (alfalfa). A 50% alfalfa and 50% Sudan grass (M50) mixture exhibited superior performance in sensory evaluation and fermentation quality. The addition of PFJ (PFJI group) further enhanced quality, and increasing the proportion of alfalfa improved the nutritional quality. However, PFJI had no significant effect on the degradation rates of these nutritional indicators (p > 0.05). As alfalfa proportion increased, the disappearance rates of dry matter, crude protein, neutral detergent fiber, and acid detergent fiber in silage increased. Principal component, correlation, and membership function analyses revealed that treatment with M50 without PFJ (PFJ0+M50) had the best effect, followed by treatment with 25% alfalfa and 75% Sudan grass (PFJ0+M25) and 100% alfalfa (PFJ0+M0). Therefore, the mixing ratio of alfalfa and Sudan grass should be maintained between 25% and 50% to optimize the nutritional and fermentation qualities of silage. These findings offer crucial guidance for alfalfa silage preparation, promoting enhanced livestock industry productivity and sustainable agricultural development.
Artisanal Cream Cheese Fermented with Kefir Grains
Authors: Freitas Denise Rossi , Kamimura Eliana Setsuko , Mazalli Mônica Roberta
Published: August 2024

This is the first study that investigates the effect of kefir with an emphasis on the production of short-chain fatty acids (SCFAs) during the fermentation process in food products. The products developed and characterized were an artisanal cream cheese without cream and one with added cream, and for the analysis of the fatty acid profile, both cream cheeses were compared with commercial cream cheese. The artisanal cream cheese had a high amount of lactic acid bacteria characterizing the product formed by Lactobacilli and a low concentration of lactose due to the fermentation process. Compared to commercial cream cheese, our products without and with added cream had a higher concentration of short-chain fatty acids (SCFAs), especially butyric acid, which is important for the health of the gastrointestinal tract, omega 3, and oleic fatty acid, which has been associated with the prevention and control of some diseases. Overall, the artisanal cream cheese cream with fermented cream with kefir grains is a functional product with an innovative character compared to current products on the market and was well accepted by the younger public. This new product comes as an option for those who need to change their eating habits and maintain a healthy lifestyle.
Nanoparticle-Enhanced Fish Feed: Benefits and Challenges
Authors: Dube Edith
Published: August 2024

Aquaculture production is continuously increasing, consequently increasing the demand for feed. Unfortunately, the reliance on fish meal and fish oil also raises sustainability issues due to overfishing and resource depletion. Nanoparticle-enhanced feed presents a promising solution to these challenges. Nanoparticles, with their large surface area-to-volume ratio and encapsulation capabilities, significantly improve nutrient delivery, absorption, and utilization, enhancing growth and health. Their immune-modulatory and antimicrobial properties reduce antibiotic use and support sustainability. This review explores different nanoparticles in fish feed, including metal-based, non-metal-based, and composite types, each offering benefits for fish growth and health. It highlights the advantages of nanoparticle-enhanced feed, such as improved nutrient delivery, immune enhancement, antimicrobial action, stress reduction, and environmental sustainability. Concerns like potential toxicity, safety, bioaccumulation, and environmental impacts of nanoparticles, together with measures of addressing these concerns, are also highlighted. The review concludes with insights into future research directions.
Effects of Several Tea-like Plants on Liver Injury Induced by Alcohol via Their Antioxidation, Anti-Inflammation, and Regulation of Gut Microbiota
Authors: Cheng Jin , Luo Min , Zhou Dan-Dan , Huang Siyu , Xiong Ruogu , Wu Sixia , Saimaiti Adila , Li Bangyan , Shang Ao , Tang Guo-Yi , Li Huabin
Published: August 2024

Liver injury induced by alcohol is a serious global health problem. Several tea-like plants are widely used as beverages, which are drunk like tea. In this study, the hepatoprotective effects of eight tea-like plant extracts with the intake of 200 mg/kg.bw/day were investigated and compared using a C57BL/6J mouse model of acute alcohol exposure, including sweet tea, vine tea, Rabdosia serra kudo, broadleaf holly leaf, mulberry leaf, bamboo leaf, Camellia nitidissima, and Akebia trifoliata peels. The results showed that the eight tea-like plants had hepatoprotective effects to different degrees against acute alcohol exposure via enhancing the activities of alcoholic metabolism enzymes, ameliorating oxidative stress and inflammation in the liver, as well as regulating gut microbiota. In particular, sweet tea, bamboo leaf, mulberry leaf, and Camellia nitidissima increased the activities of alcohol dehydrogenase or aldehyde dehydrogenase. Among these tea-like plants, sweet tea and Camellia nitidissima had the greatest hepatoprotective effects, and their bioactive compounds were determined by high-performance liquid chromatography. Chlorogenic acid, rutin, and ellagic acid were identified in sweet tea, and epicatechin, rutin, and ellagic acid were identified in Camellia nitidissima, which could contribute to their hepatoprotective action. These tea-like plants could be drunk or developed into functional food against alcoholic liver injury, especially sweet tea and Camellia nitidissima. In the future, the effects of sweet tea and Camellia nitidissima on chronic alcoholic liver diseases should be further investigated.
Effect of Oscillating Magnetic Fields (OMFs) and Pulsed Electric Fields (PEFs) on Supercooling Preservation of Atlantic Salmon (Salmo salar L.) Fillets
Authors: Lee Dongyoung , Tang Jinwen , Lee Seung Hyun , Jun Soojin
Published: August 2024

Salmon, rich in protein and omega-3 fatty acids, has a short shelf life of 1 to 3 days when stored at 2 to 8 °C. Freezing, used for long-term preservation, often results in ice crystal formation. Ice crystals can cause structural damage, leading to cell wall rupture, which can affect the texture and cause nutrient loss. Ultimately, this process reduces the overall quality of the salmon. Supercooling, which cools food below its freezing temperature without forming ice crystals, offers an alternative. This study investigated the effects of oscillating magnetic fields (OMFs) and pulsed electric fields (PEFs) on ice crystal formation during salmon supercooling. The results showed that using OMFs and PEFs in supercooling reduced the storage temperature of salmon, maintaining a similar thiobarbituric acid reactive substances (TBARS) value to that of frozen and refrigerated samples. There was no significant difference in meat color between the fresh and frozen samples, and drip loss weight was comparable between the fresh and supercooled samples. The microbiological counts were the lowest in the supercooled samples compared to the frozen and refrigerated ones. These findings suggest that supercooling storage with OMFs and PEFs can mitigate quality degradation in salmon typically associated with freezing.
Preparation and Characterization of Responsive Cellulose-Based Gel Microspheres for Enhanced Oil Recovery
Authors: Yin Peng , Shi Fang , Luo Mingjian , Wu Jingchun , Zhao Bo , Zhang Chunlong , Shen Yi , Chen Yanbing
Published: August 2024

As an important means to enhance oil recovery, ternary composite flooding (ASP flooding for short) technology has achieved remarkable results in Daqing Oilfield. Alkalis, surfactants and polymers are mixed in specific proportions and injected into the reservoir to give full play to the synergistic effect of each component, which can effectively enhance the fluidity of crude oil and greatly improve the oil recovery. At present, the technology for further improving oil recovery after ternary composite flooding is not mature and belongs to the stage of technical exploration. The presence of alkaline substances significantly alters the reservoir’s physical properties and causes considerable corrosion to the equipment used in its development. This is detrimental to both the environment and production. Therefore, it is necessary to develop green displacement control agents. In the reservoir environment post-ASP flooding, 2-(methylamino)ethyl methacrylate and glycidyl methacrylate were chosen as monomers to synthesize a polymer responsive to alkali, and then grafted with cellulose nanocrystals to form microspheres of alkali-resistant swelling hydrogel. Cellulose nanocrystals (CNCs) modified with functional groups and other materials were utilized to fabricate hydrogel microspheres. The product’s structure was characterized and validated using Fourier transform infrared spectroscopy and X-ray diffraction. The infrared spectrum revealed characteristic absorption peaks of CNCs at 1165 cm−1, 1577 cm−1, 1746 cm−1, and 3342 cm−1. The diffraction spectrum corroborated the findings of the infrared analysis, indicating that the functional modification occurred on the CNC surface. After evaluating the swelling and erosion resistance of the hydrogel microspheres under various alkaline conditions, the optimal particle size for compatibility with the target reservoir was determined to be 6 μm. The potential of cellulose-based gel microspheres to enhance oil recovery was assessed through the evaluation of Zeta potential and laboratory physical simulations of oil displacement. The study revealed that the absolute value of the Zeta potential for gel microspheres exceeds 30 in an alkaline environment with pH values ranging from 7 to 14, exhibiting a phenomenon where stronger alkalinity correlates with a greater absolute value of Zeta potential. The dispersion stability spans from good to excellent. The laboratory oil displacement simulation experiment was conducted using a cellulose-based gel microsphere system following weak alkali ASP flooding within the pH value range from 7 to 10. The experimental interventions yielded recovery rates of 2.98%, 3.20%, 3.31%, and 3.38%, respectively. The study indicates that cellulose-based gel microspheres exhibit good adaptability in alkaline reservoirs. This research offers a theoretical foundation and experimental approaches to enhance oil recovery techniques post-ASP flooding.
Preparation of Complex Polysaccharide Gels with Zanthoxylum bungeanum Essential Oil and Their Application in Fish Preservation
Authors: Xue Shan , Li Chao , Xiong Zhouyi
Published: August 2024

In this study, novel functional ZEO-complex gels were prepared using sodium alginate, inulin, grape seed extract (GSE), and Zanthoxylum bungeanum essential oil (ZEO) as the primary raw materials. The effect of the addition of inulin, GSE, and ZEO on water vapor permeability (WVP), tensile strength (TS), and elongation at break (EAB) of ZEO-complex polysaccharide gels was investigated. A comprehensive score (Y) for evaluating the characteristics of ZEO-complex polysaccharide gels was established by principal component analysis. MATLAB analysis and box-Behnken design describe each factor’s four-dimensional and three-dimensional interactions. It was found that Y could reach the maximum value when the ZEO addition was at a moderate level (C = 2%). The optimum preparation process of ZEO-complex polysaccharide gels was as follows: the addition of inulin was at 0.84%, the addition of GSE was at 0.04%, and the addition of ZEO was at 2.0785%; in this way, the Y of ZEO-complex polysaccharide gels reached the maximum (0.82276). Optical scanning and X-ray diffraction tests confirmed that the prepared ZEO-complex gels have a smooth and continuous microstructure, good water insulation, and mechanical properties. The storage test results show that ZEO-complex polysaccharide gels could play a significant role in the storage and fresh-keeping of grass carp, and the physicochemical properties of complex polysaccharide gels were improved by adding ZEO. In addition, according to the correlation of fish index changes during storage, adding ZEO in complex polysaccharide gels was closely correlated with the changes in fish TBARS and TVB-N oxidation decay indices. In conclusion, the ZEO-complex polysaccharide gels prepared in this study had excellent water insulation, mechanical properties, and outstanding fresh-keeping effects on grass carp.
Migration Challenges and Their Impact on the Primary Healthcare System—A Qualitative Research
Authors: Partyka Olga , Pajewska Monika , Czerw Aleksandra , Sygit Katarzyna , Lyubinets Oleh , Banaś Tomasz , Małecki Krzysztof , Grochans Elżbieta , Grochans Szymon , Cybulska Anna , Schneider-Matyka Daria , Cipora Elżbieta , Kaczmarski Mateusz , Sośnicki Krzysztof , Dykowska Grażyna , Sienkiewicz Zofia , Strzępek Łukasz , Bandurska Ewa , Ciećko Weronika , Drobnik Jarosław , Pobrotyn Piotr , Sierocka Aleksandra , Marczak Michał , Kozlowski Remigiusz
Published: August 2024

In 2020 it is estimated that 281 million people were international migrants. Migrants constitute a potentially vulnerable population in terms of facing discrimination, poor living and housing conditions, and insufficient access to healthcare services. Due to the armed conflict in Ukraine in 2022, almost 10 million people crossed the Polish border within a year of the outbreak of the conflict. The objective of this paper is to present the use of primary healthcare services by people migrating from Ukraine to Poland and identify the barriers in access to healthcare by this group of persons. This study used a qualitative research technique in the form of an expert interview using individual in-depth interviews (IDI). The study group consisted of professionally active primary healthcare providers (doctors, nurses, and facility managers) in Poland. Research was carried out in the areas regarding the availability of healthcare, the potential threats and challenges, and possible system solutions. The results showed that the most common cause for doctor’s appointments among migrants are respiratory infections, including COVID-19. Many cases were related to back pain, mainly resulting from the physical work of the patients. Additionally, some barriers to access and the provision of healthcare services for patients from Ukraine were identified. The majority (75%) of respondents indicated language as a significant barrier when providing services. Based on the study results, we recommend creating a dedicated website and telephone hotline for this group of persons as well as the use of traditional media to distribute information about access to healthcare services. It is also essential to focus on assistance for older people, since they may experience more difficulties with language and navigating the healthcare system.
Correction: Duevel et al. Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers. Healthcare 2024, 12, 1157
Authors: Duevel Juliane A. , Gruhn Sebastian , Grosser John , Elkenkamp Svenja , Greiner Wolfgang
Published: August 2024

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Family Members’ Explanatory Models of Cancer Anorexia–Cachexia
Authors: McClement Susan
Published: August 2024

The experience of bearing witness to the lack of appetite and involuntary weight loss that characterizes cancer anorexia–cachexia syndrome (CACS) is reported to be stressful for family members. Research identifies that family members engage in a wide range of behaviors in response to a relative who shows minimal interest in eating and is literally ‘wasting away’ before their eyes. Some families, though concerned about the symptoms of CACS, do not dwell excessively on the patient’s nutritional intake while others continually harass the patient to eat and petition health care providers for aggressive nutritional interventions to eat in an attempt to stave off further physical deterioration. While studies have detailed how family members respond to a terminally ill relative with CACS, empirical work explicating the explanatory models of CACS that they hold is lacking. Explanatory models (EMs) reflect the beliefs and ideas that families have about why illness and symptoms occur, the extent to which they can be controlled, how they should be treated, and how interventions should be evaluated. To address this gap in the literature, a grounded theory study guided by Kleinman’s Explanatory Model questions was conducted with 25 family members of advanced cancer patients. The core category of ‘Wayfaring’ integrates the key categories of the model and maps onto Kleinman’s questions about CACS onset, etiology, natural course, physiological processes/anatomical structures involved, treatment, and the impacts of disease on patient and family. Findings suggest that a divergence between some biomedical constructions of CACS and explanatory models held by family members may fuel the family–health care provider conflict, thereby providing direction for communication with families about care of the patient with anorexia–cachexia.
Effects of Hormonal Replacement Therapy and Mindfulness-Based Stress Reduction on Climacteric Symptoms Following Risk-Reducing Salpingo-Oophorectomy
Authors: Ali Amira Mohammed , Al-Dossary Saeed A. , Laranjeira Carlos , Amer Faten , Hallit Souheil , Alkhamees Abdulmajeed A. , Aljubilah Aljawharah Fahad , Aljaberi Musheer A. , Alzeiby Ebtesam Abdullah , Fadlalmola Hammad Ali , Pakai Annamaria , Khatatbeh Haitham
Published: August 2024

Breast Cancer Associated Susceptibility Proteins Type 1/2 (BRCA1/2) promote cellular functioning by modulating NRF2-mediated antioxidant signaling. Redox failure in women with BRCA1/2 insufficiency increases the risk for breast/ovarian/uterine cancers. Risk-reducing salpingo-oophorectomy (RRSO) is a prophylactic surgery of the reproductive organs, which is frequently conducted by the age of 40 to lower the occurrence of cancer in women with BRCA1/2 mutations. However, abrupt estrogen decline following RRSO causes ovarian failure, which implicates various cellular physiological processes, resulting in the increased release of free radicals and subsequent severe onset of menopausal symptoms. Comfort measures (e.g., hormonal replacement therapy (HRT) and mindfulness-based stress reduction (MBSR)) may improve chronological menopause-related quality of life, but their specific effects are not clear in women with gene mutations. Aiming to fill the gap, this study used path analysis to examine the effects of HRT and MBSR on menopausal symptoms among RRSO patients (N = 199, mean age = 50.5 ± 6.7 years). HRT directly alleviated the levels of urogenital symptoms (β = −0.195, p = 0.005), which mediated its indirect significant effects on the somatic–vegetative and psychological symptoms of menopause (β = −0.046, −0.067; both p values = 0.004, respectively), especially in BRCA2 carriers and in women who were currently physically active, premenopausal at the time of RRSO, had a high BMI, and had no history of breast cancer. It increased the severity of urogenital symptoms in women with a history of cancer. MBSR, on the other hand, was associated with indirect increases in the intensity of the somatic–vegetative and psychological symptoms of menopause (β = 0.108, 0.029; p = 0.003, 0.033, respectively). It exerted positive direct effects on different menopausal symptoms in multigroup analysis. The results suggest that young women undergoing recent RRSO may benefit from HRT at an individual level, while their need for extensive measures to optimize their psychological wellbeing is ongoing. The adverse effects of MBSR, which are captured in the present study, imply that MBSR may interfere with redox sensitivity associated with estradiol fluctuations in BRCA1/2 carriers. Investigations are needed to test this hypothesis and elaborate on the underlying mechanisms in these women.
CALL TO ECLS—Acronym for Reporting Patients for Extracorporeal Cardiopulmonary Resuscitation Procedure from Prehospital Setting to Destination Centers
Authors: Sanak Tomasz , Putowski Mateusz , Dąbrowski Marek , Kwinta Anna , Zawisza Katarzyna , Morajda Andrzej , Puślecki Mateusz
Published: August 2024

The acronym CALL TO ECLS has been proposed as a potential tool to support decision-making in critical communication moments when qualifying a patient for the ECPR procedure. The aim of this study is to assess the accuracy of the acronym and validate its content. Validation is crucial to ensure that the acronym is theoretically correct and includes the necessary information that must be conveyed by EMS during the qualification of a patient with out-of-hospital cardiac arrest for ECMO. A survey was conducted using the LimeSurvey platform through the Survey Research System of the Jagiellonian University Medical College over a 6-month period (from December 2022 to May 2023). Usefulness, importance, clarity, and unambiguity were rated on a 4-point Likert scale, from 1 (not useful, not important, unclear, ambiguous) to 4 (useful, important, clear, unambiguous). On the 4-point scale, the Content Validity Index (I-CVI) was calculated as the percentage of subject matter experts who rated the criterion as having a level of importance/clarity/validity/uniqueness of 3 or 4. The Scale-level Content Validity Index (S-CVI) based on the average method was computed as the average of I-CVI scores (S-CVI-AVE) for all considered criteria (protocol). The number of fully completed surveys by experts was 35, and partial completion was obtained in 63 cases. All criteria were deemed significant/useful, with I-CVI coefficients ranging from 0.87 to 0.97. Similarly, the importance of all criteria was confirmed, as all I-CVI coefficients were greater than 0.78 (ranging from 0.83 to 0.97). The average I-CVI score for the ten considered criteria in terms of usefulness/significance and importance exceeded 0.9, indicating high validity of the tool/protocol/acronym. Based on the survey results and analysis of responses provided by experts, a second version was created, incorporating additional explanations. In Criterion 10, an explanation was added—“Signs of life”—during conventional cardiopulmonary resuscitation (ROSC, motor response during CPR). It has been shown that the acronym CALL TO ECLS, according to experts, is accurate and contains the necessary content, and can serve as a system to facilitate communication between the pre-hospital environment and specialized units responsible for qualifying patients for the ECPR.
“In the Village That She Comes from, Most of the People Don’t Know Anything about Cervical Cancer”: A Health Systems Appraisal of Cervical Cancer Prevention Services in Tanzania
Authors: Chelva Melinda , Kaushal Sanchit , West Nicola , Erwin Erica , Yuma Safina , Sleeth Jessica , Yahya-Malima Khadija I. , Shelley Donna , Risso-Gill Isabelle , Yeates Karen
Published: August 2024

Introduction: Cervical cancer is the fourth most common cancer in women globally. It is the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Research has shown an association between low levels of risk perception and knowledge of the prevention, risks, signs, etiology, and treatment of cervical cancer and low screening uptake, as contributing to high rates of cervical cancer-related mortality. However, there is scant literature on the perspectives of a wider group of stakeholders (e.g., policymakers, healthcare providers (HCPs), and women at risk), especially those living in rural and semi-rural settings. The main objective of this study is to understand knowledge and perspectives on cervical cancer risk and screening among these populations. Methods: We adapted Risso-Gill and colleagues’ framework for a Health Systems Appraisal (HSA), to identify HCPs’ perspective of the extent to which health system requirements for effective cervical cancer screening, prevention, and control are in place in Tanzania. We adapted interview topic guides for cervical cancer screening using the HSA framework approach. Study participants (69 in total) were interviewed between 2014 and 2018—participants included key stakeholders, HCPs, and women at risk for cervical cancer. The data were analyzed using reflexive thematic analysis methodology. Results: Seven themes emerged from our analysis of semi-structured interviews and focus groups: (1) knowledge of the role of screening and preventive care/services (e.g., prevention, risks, signs, etiology, and treatment), (2) training and knowledge of HCPs, (3) knowledge of cervical cancer screening among women at risk, (4) beliefs about cervical cancer screening, (5) role of traditional medicine, (6) risk factors, and (7) symptoms and signs. Conclusions: Our results demonstrate that there is a low level of knowledge of the role of screening and preventive services among stakeholders, HCPs, and women living in rural and semi-rural locations in Tanzania. There is a critical need to implement more initiatives and programs to increase the uptake of screening and related services and allow women to make more informed decisions on their health.
A Comprehensive Analysis of Road Crashes at Characteristic Infrastructural Locations: Integrating Data, Expert Assessments, and Artificial Intelligence
Authors: Ivanišević Tijana , Vujanić Milan , Senić Aleksandar , Trifunović Aleksandar , Čičević Svetlana
Published: August 2024

Road crashes, although random events, frequently occur on roads. However, certain characteristic infrastructural locations require detailed analysis regarding the frequency of road crashes. This study examines the dynamics of road crashes at characteristic infrastructural locations in Serbia from 2018 to 2022, focusing on bridges, tunnels, railroad crossings, and road work zones. Using data on road crashes from official reports, the analysis includes trends in crash rates, fatalities, injuries, and material damage during the above-mentioned time frame. In addition to the data analysis, 22 experts from the fields of traffic engineering ranked the mentioned characteristic infrastructural locations in terms of road safety. The same questions were asked to six different artificial intelligence software programs. The findings reveal significant variations in crash rates across different infrastructures, with bridges and road work zones having the highest number of crashes. Expert assessment is in line with the analysis of the results, while artificial intelligence gives a completely opposite assessment.
A Systematic Review and Meta-Analysis of Randomized Trials to Evaluate the Impact of Exercise on Heart Rate Variability Post-Bariatric Surgery
Authors: Bitencourt Tulio H. B. , de Oliveira Camila Marcondes , Porto Andrey A. , de Andrade Davi C. , Garner David M. , Raimundo Rodrigo D. , Valenti Vitor E.
Published: August 2024

Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on heart rate variability (HRV) in patients submitted to bariatric surgery. The searches were made via MEDLINE/PubMed (via the National Library of Medicine), EMBASE, Web of Science, and Scopus databases. We included non-blind, single-, or double-blind randomized control trials in patients older than 18 years of age submitted to bariatric surgery. The intervention group should be submitted to an exercise training protocol, including aerobic, strength, and other exercise modality after bariatric surgery. We documented 245 studies, and after screening and eligibility phases, only 4 were included. We observed no significant change for the SDNN: subtotal = 19.74 (CI: −4.98, 44.45), p = 0.12, I2 = 85% (very low quality of evidence); pNN50: subtotal = 13.09 (CI: −9.17, 35.35), p = 0.25, I2 = 93% (very low quality of evidence); RMSSD: subtotal = 8.44 (CI: −3.61, 25.50), p = 0.17, I2 = 95% (very low quality of evidence); SD1: subtotal = 9.36 (CI: −4.48, 23.21), p = 0.19, I2 = 96% (very low quality of evidence). We could not detect significant effects of exercise on resting HRV after bariatric surgery. The low certainty of the results via the evidence level analysis suggest further studies might be beneficial.
Prognostic Role of Tissue Iron Deficiency Measured by sTfR Levels in Heart Failure Patients without Systemic Iron Deficiency or Anemia
Authors: Ramos-Polo Raúl , Ras-Jiménez Maria del Mar , Francesch Manzano Josep , Jovells-Vaqué Silvia , Morillas Climent Herminio , Pons-Riverola Alexandra , Yun Viladomat Sergi , Moliner Borja Pedro , Diez-Lopez Carles , González-Costello José , Garcia-Romero Elena , Herrador Lorena , de Frutos Seminario Fernando , Enjuanes Grau Cristina , Tajes Orduña Marta , Comin-Colet Josep
Published: August 2024

Background. Iron deficiency (ID) is a significant, high-prevalence comorbidity in chronic heart failure (HF) that represents an independent predictor of a worse prognosis. However, a clear-cut diagnosis of ID in HF patients is not assured. The soluble transferrin receptor (sTfR) is a marker that reflects tissue-level iron demand and may be an early marker of ID. However, the impact of sTfR levels on clinical outcomes in non-anemic HF patients with a normal systemic iron status has never been evaluated. Methods. This is a post hoc analysis of an observational, prospective cohort study of 1236 patients with chronic HF of which only those with normal hemoglobin levels and a normal systemic iron status were studied. The final cohort consisted of 215 patients. Tissue ID was defined as levels of sTfR > 75th percentile (1.65 mg/L). Our aim was to describe the association between sTfR and clinical outcomes (all-cause death and HF hospitalization) and to explore its association with a wide array of serum biomarkers. Results. The sTfR level (HR 1.48, 95% CI 1.13–1.96, p = 0.005) and tissue ID (HR 2.14, 95% CI 1.22–3.75, p = 0.008) was associated with all-cause death. However, we found no association between sTfR levels and the risk of HF hospitalization. Furthermore, high sTfR levels were associated with a worse biomarker profile indicating myocardial damage (troponin and NT-proBNP), systemic inflammation (CRP and albumin), and impaired erythropoiesis (erythropoietin). Conclusions. In this cohort, the presence of tissue ID defined by sTfR levels is an independent factor for all-cause death in patients with normal systemic iron parameters.
A Retrospective Observational Study of Continuous Wireless Vital Sign Monitoring via a Medical Grade Wearable Device on Hospitalized Floor Patients
Authors: Weller Grant B. , Mault James , Ventura Maria Eloisa , Adams Justin , Campbell Frank J. , Tremper Kevin K.
Published: August 2024

Background: Continuous vital sign monitoring via wearable technology, combined with algorithm-based notifications, has been utilized for early detection of patient deterioration. In this retrospective observational study, we summarize a large-scale implementation of a continuous monitoring system in medical–surgical units of two hospitals over the course of fifteen (15) months. Methods: An FDA-cleared wireless monitoring device (BioButton®, BioIntelliSense Inc., Golden, CO, USA), was placed on each patient upon admission. The wearable device measures heart rate and respiratory rate at rest, skin temperature, and patient activity levels. High-frequency data (up to 1440 measurements per day) are transmitted to display in exception management software (BioDashboard™, version 2.9, BioIntelliSense Inc.). Algorithmic and rules-based notifications are triggered based on clinical and statistical trending criteria. We present (i) agreement of device readings with bedside charted measurements, (ii) the frequency of notifications, (iii) the occurrence of notifications prior to clinical deterioration events, and (iv) impact on clinical management, including early data on length of stay (LOS). Results: In total, 11,977 patient encounters were monitored at two sites. Bias ±95% limits of agreement were 1.8 ± 12.5 for HR and 0.4 ± 8.0 for RR. The rates of notifications were 0.97 and 0.65 per patient-day at Sites 1 and 2, respectively. Among clinical deteriorations, 73% (66%) had at least one notification within 24 h prior at Site 1 (Site 2). At Site 1, there were 114 cases for which a notification led to a new or changed physician’s order. LOS in the first unit monitored by the system exhibited a decreasing trend from 3.07 days to 2.75 days over 12 months. Conclusions: Wearable continuous vital sign monitoring with the BioIntelliSense BioButton® system enables early detection of clinical deterioration.
Compounded Effects of Multiple Global Crises on Mental Health: A Longitudinal Study of East German Adults
Authors: Richter Ernst Peter , Brähler Elmar , Zenger Markus , Stöbel-Richter Yve , Emmerich Franziska , Junghans Julia , Krause Juliana , Irmscher Lisa , Berth Hendrik
Published: August 2024

The early 2020s witnessed an unprecedented overlap of multiple global crises. This longitudinal study examined the compounded effects of multiple intersecting global crises on mental health outcomes in a representative cohort of East German adults. We investigated how perceived threats (PT) from climate change (PT-CLC), COVID-19 (PT-COV), the Russia–Ukraine War (PT-RUW), and rising costs of living (PT-RCL) will impact various aspects of mental health from 2021 to 2022. This research question addresses whether these crises exacerbate mental health issues and how their effects differ across various mental health outcomes. Methods: We conducted a longitudinal study with 319 participants (mean age 49.9 years, 54.5% female) from the Saxony Longitudinal Study. Data were collected in two waves: March–July 2021 and September–December 2022. We used linear mixed-effects models to analyze both unadjusted group trends and adjusted individual-level effects on physical complaints, mental distress, sleep problems, life satisfaction, and self-rated health. Results: Unadjusted analyses revealed significant increases in mental distress and sleep problems over time, whereas physical complaints, life satisfaction, and self-rated health remained stable at the group level. Adjusted analyses showed that higher PT-RCL and PT-COV were significantly associated with increased physical complaints, mental distress, sleep problems, and decreased life satisfaction, even when group-level changes were not significant. Conclusions: This study highlights the complex impact of intersecting global crises on mental health, emphasizing the importance of considering both population-level trends and individual perceptions. The findings suggest that economic and pandemic-related stressors have more immediate effects on mental health outcomes compared to more distant threats, such as climate change or geopolitical conflicts.
Lumenless and Stylet-Driven Leads for Left Bundle Branch Area Pacing: Materials, Techniques, Benefits, and Trade-Offs of the Two Approaches
Authors: Taddeucci Simone , Mirizzi Gianluca , Santoro Amato
Published: August 2024

Left bundle branch area pacing (LBBPa) is an innovative technique for physiological pacing. Compared with His bundle pacing, LBBPa provides better pacing thresholds, lower rates of macrodislodgment, and a reliable strategy for cardiac resynchronization. LBBPa traditionally employs lumenless leads (LLL), which are characterized by small lead bodies and a fixed helix design. These features guarantee stability, avoid helix retraction, and facilitate easier septal penetration, all contributing to an advantageous learning curve. On the other hand, stylet-driven pacing leads (SDL) have shown comparable success rates related to lumenless pacing leads, although they carry risks of helix retraction and lead fracture. SDL have been increasingly employed with favorable results, as they provide good maneuverability and support during implantation with continuous monitoring of ECG-paced morphology. Different manufacturers are offering a variety of SDL, and new dedicated tools are being developed to simplify lead implantation. In this review, we examine the procedural techniques, advantages, and limitations of the most commonly used pacing leads and tools for LBBPa, and we summarize the complications associated with both lumenless leads (LLL) and stylet-driven leads (SDL).
Visual Prognosis Following Cataract Surgery in Highly Myopic Patients with Prior History of Verisyse Phakic Intraocular Lens Implantation
Authors: Loveless Bosten A. , Moin Kayvon A. , Moshirfar Majid , Olson Tyler V. , Hoopes Phillip C.
Published: August 2024

Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. The Verisyse pIOL was disenclaved and removed through a superior scleral tunnel incision. Cataract extraction with phacoemulsification was then performed through a temporal clear corneal incision. Results: An occurrence rate of 7.9% of eyes with cataract formation was found. Both uncorrected (UDVA) and corrected visual acuity (CDVA) three months after cataract surgery were significantly improved (0.24 ± 0.30 vs. 0.73 ± 0.48; p < 0.001 and 0.10 ± 0.14 vs. 0.30 ± 0.31; p = 0.004, respectively). The UDVA was 20/20 or better in 41% of eyes and 20/40 or better in 65% of eyes. The CDVA was 20/20 or better in 53% of eyes and 20/40 or better in 88% of eyes. The safety and efficacy indices were 1.96 ± 1.68 and 1.60 ± 1.36, respectively. Conclusions: Various complications including cataracts may develop in these patients. Verisyse pIOLs have a lower incidence of cataract formation and are more likely to lead to age-related cataracts rather than the anterior subcapsular cataracts commonly seen in implantable collamer lens (ICL) patients. Patients with a prior history of Verisyse pIOL can expect to have a good visual prognosis after cataract extraction.
Epicardial Adipose Tissue and Psoriasis: A Systematic Review and Meta-Analysis
Authors: Chen Xiaomei , Xiang Hongmei , Lu Jing , Yang Ming
Published: August 2024

Background: As a novel biomarker for cardiovascular diseases, epicardial adipose tissue (EAT) has been linked to psoriasis. We conducted an updated systematic review, building upon a previous report on the relationship between EAT and psoriasis. Methods: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Newcastle–Ottawa Scale. The pooled mean difference (MD) or standardized mean difference (SMD) and the corresponding confidence interval (CIs) were calculated. Results: We included 10 studies with 1287 participants. Five of the included studies were of high methodological quality, while the other five were of moderate quality. The pooled data indicated that psoriasis patients had significantly increased EAT compared to individuals in the control group (SMD 1.53, 95% CI 0.61 to 2.45, 9 studies, 1195 participants). The subgroup analysis showed that psoriasis patients had significantly increased EAT thickness compared with the controls (SMD 2.45, 95% CI 0.73 to 4.17, 5 studies, 657 participants). Similarly, EAT area in single-slice CT images was significantly higher in the psoriasis group than in the control group (SMD 0.45, 95% CI 0.14 to 0.76, 2 studies, 195 participants). The EAT volume based on CT images appeared to be higher in the psoriasis group than in the control group, but the difference was not statistically significant (SMD 0.32, 95% CI −0.06 to 0.70, 2 studies, 343 participants). Conclusions: EAT, especially echocardiographic EAT thickness and CT-determined EAT area, was significantly associated with psoriasis, but CT-determined EAT volume was not.
Efficacy of Coil Embolization in Small, Anterior Circulation Aneurysms in Patients Less Than 40 Years Old
Authors: Park Dong Sun , Roh Hong Gee , Chun Young Il , Jeon Yoo Sung
Published: August 2024

Background: Ruptured and unruptured aneurysms are less common in younger individuals compared to older patients. Endovascular treatment has gained popularity over surgical options in the general population, but surgery remains the primary treatment for younger patients due to concerns about higher recurrence rates with endovascular procedures. Methods: This study compared the immediate and long-term outcomes of endovascular treatment in patients under 40 years with those aged 41–60. The study included 239 patients who underwent endovascular treatment for intracranial aneurysms, divided into two age groups: under 40 and 41–60 years. The rates of immediate radiologic outcomes, complications, and recurrence were assessed. Results: The results showed successful aneurysm obliteration rates of 70.1% in the younger group and 64.0% in the older group. The complication rates were 1.5% in the younger group and 3.5% in the older group, with the older group experiencing more procedure-related complications, though this difference was not statistically significant. Long-term follow-up revealed recurrence rates of 23.2% in the younger group and 18.2% in the older group, with no significant difference. Conclusions: The study suggests that endovascular treatment is as effective and safe for patients under 40 years. Therefore, it may be considered an acceptable first-line treatment for younger patients, aligning its use with that in older populations.