bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic and bariatric surgery for adolescents with severe obesity: Benefits, risks, and specific considerations
Authors: Järvholm Kajsa , Janson Annika , Henfridsson Pia , Neovius Martin , Sjögren Lovisa , Olbers Torsten
Published: November 2024

International and national guidelines recommend metabolic and bariatric surgery (MBS) as a treatment option for adolescents with severe obesity, but few countries offer MBS to adolescents in routine clinical care. This narrative review summarizes existing adolescent MBS guidelines and the available underpinning evidence. Two randomized trials and additional prospective studies have demonstrated efficacy and safety in adolescent MBS, and the health benefits appear to be similar or superior to outcomes in adults. However, there are specific challenges regarding the intervention during adolescence related to decision-making capacity and a peak in risk-taking behavior. Adolescents with severe obesity have—as a group—a mental health vulnerability, and specific nutritional concerns need to be addressed in relation to MBS. This review also describes how study findings can be translated into clinical care. We use Sweden as an example, where the National Board of Health and Welfare recommends MBS for selected adolescents with severe obesity aged 15 years or older. We present practical advice for implementing and integrating MBS in adolescents in the framework of multidisciplinary pediatric and adolescent care for obesity.
Pathways to persuasion: The impact of social media influencers’ self-disclosure and follower size on persuasion outcomes
Authors: Kashian Nicole
Published: November 2024

A 2 (influencer type: nano with 5000 followers vs mega with 1.1 million followers) × 2 (influencer self-disclosure: low depth vs high depth) between-subjects online experiment tested the different pathways social media influencers take to achieve persuasion outcomes in one model. Participants viewed an Instagram influencer’s profile page with either 5000 or 1.1 million followers, and a post from the influencer with either low or high depth self-disclosure. Participants then answered questions regarding social attraction, parasocial relationship, perceived expertise, persuasion outcomes, covariates, and demographic information. Results showed three serial pathways facilitate persuasion: two pathways through self-disclosure depth by way of social attraction and parasocial relationship development and another pathway through follower size by way of perceived expertise. This research advances understanding of the influencing process by using theory and empirical precedent to derive and test an integrated model of the influencing process.
Doubling the Graduation Rate for Black Men: The Fortified Classroom
Authors: Fullard David A. , King Joseph A. , Nesler Mitchell S.
Published: November 2024

Increasing the collegiate success rates of men of color is an important goal, as it provides for the economic empowerment of this population and supports social justice and equity. While some interventions have been found to be impactful for men of color, the current study was designed to assess the bicultural education model and an innovative program called the fortified classroom. The bicultural education model suggests that students of color simultaneously commit to both Black and mainstream cultures and step in and out of the repertoires of both. The fortified classroom is an immersive first-year experience that includes academic support that is built into the classrooms. Results suggest that supporting students through this program has a significant positive impact on course completion, term-to-term retention, and graduation rates.
Circulating miRNA profiles as predictive biomarkers for aneurysm healing following endovascular treatment: a prospective study
Authors: Arul Santhosh , Jassen Erik , Ayers-Ringler Jennifer , Mereuta Oana Madalina , Senol Yigit Can , Orscelik Atakan , Ghozy Sherief , Brinjikji Waleed , Kallmes David F , Kadirvel Ramanathan
Published: November 2024

Background

Aneurysm treatments are crucial to minimize the rupture risk. The underlying molecular processes mediating cellular remodeling, endothelialization, and aneurysm healing following endovascular treatment are poorly understood. The current study aims to explore circulating miRNA as a treatment and outcome-associated biomarkers in patients undergoing endovascular treatment.

Methods

Patients undergoing endovascular interventions for unruptured intracranial aneurysms, using either flow diverter placement or coil embolization, were enrolled. Blood samples were collected before the intervention and during a follow-up period between 6 and 18 months. Total mRNA/miRNA was isolated from plasma, followed by RNA-seq analysis. Gene Ontology analysis was used to identify pathways linked to altered miRNA expression.

Results

Twenty-three patients participated, with 13 (56.5%) undergoing flow diversion and 10 (43.5%) coil embolization. The median follow-up sample collection time was 10.70 months (SEM ± 1.32). No significant differences in angiographic occlusion were noted between intervention groups. Differentially expressed miRNAs were not identified between groups at baseline. However, at follow-up, 39 miRNAs were upregulated and 41 were downregulated, independent of intervention. Notably, three miRNAs (miR-4746-5p, miR-4685-3p, and miR-490-3p) were downregulated in the flow diversion group compared to the coil embolization group. Bioinformatics analysis revealed associations with upregulated fluid shear stress, p53, adherens junction pathways, along with downregulated apoptosis pathways.

Conclusions

This study suggests that fluid shear stress and apoptosis may influence aneurysm healing or thromboembolic events in flow diverter-treated patients. Further research is warranted to elucidate the functional significance of these findings in treatment outcomes, providing valuable insights for improved patient care in intracranial aneurysm management.
“A Beauty Full of Healing”: Black Aesthetics as Methodology
Authors: Abdi Kaha
Published: November 2024

Sylvia Wynter calls for a rethinking of the aesthetics since our current system of knowledge, which is rooted in a positivist, biocentric framework, fails to recognize storytelling as an essential aspect of humanness. Similarly, bell hooks reminds us to  see, not only through sight, but in a metaphysical way that heightens our awareness and understanding – expanding our ability to engage with reality through all of our senses. Thus, this paper explores the ways in which Black aesthetics serve as method-making practices in order to reclaim the imagination from modern thinking, particularly given that the narrative of modernity has been partially constructed on the myth that Black peoples lack culture, or, alternatively, that their cultural practices are primitive and monolithic. By asserting Blackness as a situating force, Black cultural practices underscore the agentic capacity of Black peoples to create and define their own realities, rather than being merely subjects of observation. What methods do we use, then, that can faithfully portray the subtleties of Black life?
Empowering junior doctors: A study on the feasibility and efficacy of ultrasound AAA screening in rural Australia
Authors: Koo Mei Ping Melody , Bookun Hansraj Riteesh
Published: November 2024

Purposes

Abdominal Aortic Aneurysm (AAA) screening via ultrasound in Caucasian males aged 65 and older has proven cost-effective in metropolitan areas. Evidence suggests that with adequate training, individuals without prior sonography experience can achieve accurate aortic measurements. This study evaluates the capability of junior doctors, after brief training, to conduct reliable AAA ultrasound screenings in a rural hospital setting, addressing the gap in speciality surgical services.

Methods

Three junior doctors participated in a 2-hour practical ultrasound training, subsequently performing scans on both inpatients and community volunteers at a regional hospital. The analysis focused on measurement discrepancies within a 5 mm clinically acceptable difference, scanning efficiency, and aneurysm detection accuracy.

Results

A total of 71 participants were included. Among the screenings, 81.7% fell within the clinically acceptable discrepancy range, with 72.7% accuracy in inpatient scans and 95.5% in volunteer scans. Measurement reproducibility improved significantly with the standardisation of ultrasound techniques, and there was excellent agreement among operators in detecting aneurysms. Notably, scanning efficiency improved from the inpatient group to the volunteer group with statistical significance.

Conclusions

Junior doctors demonstrated the ability to efficiently and reproducibly measure the infrarenal aortic diameter at a level comparable to experienced sonographers after only 2 hours of training. A single day of supervised practice is recommended to ensure standardised ultrasound technique. This approach offers a practical, cost-effective supplement to specialist radiology services in rural areas, enhancing access to critical screening procedures without proposing the replacement of professional sonographers.
Enhancing turbine blade durability: Evaluating protective ceramic coatings for Ti6Al4V alloy
Authors: Khai Xin Lee , Johari Nur Dalilah , Kamarudin Maslinda , Nosbi Norlin , Yusof Abdul Hakim Mohd , Wan Ali Wan Fahmin Faiz
Published: November 2024

Ti64 turbine blades face extreme conditions during solid particle erosion, accelerating the erosive and corrosive processes. Hard-coating materials such as DLC, AlTiN, TiSiN, AlCrN, and AlTiCN have been introduced through physical vapor deposition to enhance the turbine blade characteristics and increase the component lifespan. The results showed preferential orientations of (002) and (022) in coating crystallization with DLC exhibiting the highest compressive residual stress. DLC and AlTiCN coatings demonstrated fewer macroparticles and white spots, correlating with a lower coefficient of friction (COF) and surface roughness. The wear analysis revealed that DLC had the lowest COF and wear rate, followed by AlTiCN. Electrochemical tests indicated DLC's superior corrosion resistance of DLC. Although the properties of AlTiCN are comparable, DLC has emerged as the most promising coating material for achieving high erosion particle resistance in Ti64 turbine blades.
Bowstringing of the extensor digitorum: clinical and biomechanical results using an ankle extensor retinaculum graft
Authors: Durand Sébastien , Mercier Julie , Joseph Samuel
Published: November 2024

We report a case of extensor digitorum bowstringing after complete rupture of the extensor retinaculum treated successfully with an ankle extensor retinaculum graft. Reconstruction of structure, form and mechanical properties of the extensor retinaculum is possible owing to the histological similarity of anatomical pulleys throughout the body.

Level of evidence: V
Enhancement structural and signaling microenvironment of artificial tumor extracellular matrix for enhanced drug screening
Authors: Liu Xingxing , Ren Yueying , Fu Sijia , Jiao Yongjie , Chen Xinan , Wang Fujun , Wang Lu , Hu Mengbo , Li Chaojing
Published: November 2024

Bioscaffolds with characteristics of the tumor microenvironment is an important substrate to support the formation of multicellular tumor spheroids (MCTS). Conventional biomaterials promote MCTS formation using tumor extracellular matrix (ECM) components and exogenous growth factors, but lack individualized tumor cell niche construction which may restricts cell biology and drug discovery research. Herein, an ECM mimicked fiber composite dual-network hydrogel (FCDNG) was constructed. The 3D nanofibrous framework was introduced into the hydrogel by a “dispersion-swelling” method and an alginate/platelet-rich plasma (PRP) dual-network hydrogel was constructed by a simple “one-step” activation process. The scaffold can well control the physicochemical conditions that mimic the ECM structure and biomimetic mechanical properties. The fibrin formed by PRP can promote tumor cell proliferation, angiogenesis and cancer stem cell enrichment. Meanwhile, FCDNG has suitable degradation properties to meet the matrix remodeling requirements during the formation of MCTS. Tumor cells cultured in FCDNG had enhanced tumor stemness, proliferation, and resistance to chemotherapeutic agents, and thus providing an effective strategy for clinical drug evaluation.
Methods, techniques and practices for research on poor consumers: A state of the art and a vade-mecum
Authors: Rousselet Evelyne , Bonnemaizon Audrey
Published: November 2024

Marketing research targeting poor consumers has been developing recently. The specific characteristics of these consumers make it difficult to conduct empirical research. This difficulty has raised the question of how to adapt the methods and techniques usually used in marketing. This article provides a multidisciplinary review of the difficulties encountered in addressing people living in poverty and enables researchers to assess this population and anticipate their needs. In addition, based on a literature review of the methods used in 83 empirical marketing studies published between 1990 and 2021, our study provides researchers with a vade-mecum to guide them in their choice of research design. Concrete and detailed recommendations are provided to facilitate their involvement in the field of poor consumers.
Exploring the influential factors and improvement strategies for digital information literacy among the elderly: An analysis based on integrated learning algorithms
Authors: Kong Haiyan , Wang Xinyu
Published: November 2024

Objective

Despite previous research identifying factors such as age, education level, income, and interest in technology that influence digital literacy among the elderly, this study attempts to use machine learning algorithms, especially ensemble learning algorithms, to predict and identify the key factors that affect the digital information literacy of the elderly, so as to propose effective strategies to improve the elderly's ability to utilize digital information and better integrate into the digital society.

Methods

This study used primary data on older adults from the Digital Divide Survey 2022 conducted by the Korea National Information Society Agency. A predictive model was built, and 15 variables that were highly important in predicting digital information literacy were identified. Prediction accuracy was assessed using an ensemble of algorithms including Random Forest, LGBM, XGBoost, AdaBoost, and CatBoost.

Results

The study found that in addition to demographic factors and personal technology use ability factors, relationship support factors and social digital environment factors are also important predictors of digital information literacy for the elderly. Among different predictive models, the CatBoost model, based on boosting ensemble, exhibited the highest predictive accuracy at 86.2%, followed by Random Forest (85.5%), LGBM (85.2%), XGBoost (84.5%), and AdaBoost (83.8%). The predictive accuracies of these models were higher than those of traditional machine learning models, indicating the effectiveness of ensemble learning algorithms in predicting digital information literacy among the elderly.

Conclusions

The academic significance of this study lies in the application of artificial intelligence technologies to the social sciences, specifically demonstrating the effectiveness of ensemble learning algorithms in predicting factors influencing the digital literacy levels of the elderly. This approach provides a novel and powerful tool for addressing complex social issues. The practical significance lies in the proposed strategies for improving the digital literacy of the elderly based on the research results, including education and training, social relationship support, social participation, technical support, and policy formulation, aiming to help the elderly better adapt to the digital environment, narrow the digital divide, and enhance the elderly's sense of participation and happiness in the digital society.
Efficacy of a culturally tailored mobile health lifestyle intervention on cardiovascular health among African Americans with preexisting risk factors: The FAITH! Trial
Authors: Lalika Mathias , Jenkins Sarah , Hayes Sharonne N , Jones Clarence , Burke Lora E , Cooper Lisa A , Patten Christi A , Brewer LaPrincess C
Published: November 2024

Background

African Americans have a higher prevalence of cardiovascular risk factors, leading to higher cardiovascular disease mortality than White adults. Our culturally tailored mobile health (mHealth) lifestyle intervention ( FAITH! App) has previously demonstrated efficacy in promoting ideal cardiovascular health in African Americans.

Methods

We conducted a secondary analysis from a cluster randomized controlled trial among African-Americans from 16 churches in Minnesota that compared the FAITH! App to a delayed intervention control group. A subgroup of participants with ≥ 1 diagnosis of overweight/obesity, hyperlipidemia, hypertension, or diabetes was examined. The primary outcome was a change in LS7 score—a measure of cardiovascular health ranging from poor to ideal (range 0–14 points)—at 6-months post-intervention.

Results

The analysis included 49 participants (intervention group: n = 20; mean age 58.8 years, 75% female; control group: n = 29, mean age 52.5 years, 76% female) with no significant baseline differences in cardiovascular risk factors. Compared to the control group, the intervention group showed a greater increase in LS7 score across all cardiovascular risk factors at 6-months post-intervention, with statistically significant differences among those with overweight/obesity (intervention effect 1.77, p < 0.0001) and 2+ or 3+ cardiovascular risk factors (1.00, p = 0.03; 1.09, p = 0.04). The intervention group demonstrated a higher increase in the percentage of participants with intermediate or ideal LS7 scores than the control group, although these differences were not statistically significant.

Conclusions

Our culturally tailored mHealth lifestyle intervention was associated with significant increases in LS7 scores among African Americans with preexisting cardiovascular risk factors, suggesting its efficacy in improving cardiovascular health among this population.
Machine learning models for predicting return to sports after anterior cruciate ligament reconstruction: Physical performance in early rehabilitation
Authors: Hwang Ui-jae , Kim Jin-seong , Kim Keong-yoon , Chung Kyu-sung
Published: November 2024

Objective

Return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) is a crucial surgical success measure. In this study, we aimed to identify the best-performing machine learning models for predicting RTS at 12 months post-ACLR, based on physical performance variables at 3 months post-ACLR.

Methods

This case-control study included 102 patients who had undergone ACLR. The physical performance variables measured 3 months post-ACLR included the Biodex balance system, Y-balance test, and isokinetic muscle strength test. The RTS outcomes measured at 12 months post-ACLR included the single-leg hop test, single-leg vertical jump test, and Tegner activity score. Six machine learning algorithms were trained and validated using these data.

Results

Random forest models in the test set best predicted the RTS success based on the single-leg hop test (area under the curve [AUC], 0.952) and Tegner activity score (AUC, 0.949). Gradient boosting models in the test set best predicted the RTS based on the single-leg vertical jump test (AUC, 0.868).

Conclusion

Modifiable factors should be considered in the early rehabilitation stage after ACLR to enhance the possibility of a successful RTS.
Association Between COVID-19 Risk Perceptions and Economic Expectations During the Pandemic in South Korea
Authors: Kim Jun Hyung , Kim Jin-Hwan , Lee Jong Jae , Jang Deok Hyun , Jang Won Mo
Published: November 2024

Risk perceptions of the COVID-19 pandemic changed economic expectations and shaped individuals’ consumption and investment choices, thereby worsening its economic and social damage. This study investigated the associations between COVID-19 risk perceptions and economic expectations using a South Korean dataset collected during the pandemic. The results of a logistic regression conducted on 1,001 participants revealed that greater pandemic risk perceptions were significantly associated with negative economic expectations at both the national and the household levels. Affective risk perception had a large and significant negative association with all four types of economic expectations, whereas cognitive risk perception had a significant negative association only with households’ economic expectations. The association was greater for the perception that the economy would “get better” than for “get worse” or “remain the same,” indicating COVID-19 may have reduced individuals’ optimistic economic expectations. COVID-19’s economic damage may last beyond the pandemic, as individuals adjust their economic expectations.
Clinical Characteristics and Valve Lesions in Rheumatic Heart Disease Among Children at Hiwot Fana Comprehensive Specialized Hospital: A Comparative Study of Newly Diagnosed and Known Cases
Authors: Libe Temesgen Teferi , Kelil Yunus Edris , Tegene Samrawit Abebaw , Hassen Faisel Abdi , Mesfin Kibrom Hailemariam
Published: November 2024

Background. Rheumatic heart disease remains a significant health burden in resource-limited settings. This study investigated the clinical characteristics and valve lesion patterns of RHD in children from Eastern Ethiopia, comparing newly diagnosed and known RHD patients. Objective. This study aimed to characterize the clinical features and valve lesion patterns in children with Rheumatic heart disease and provide a comparative analysis between newly diagnosed and known cases. Methods. A hospital-based cross-sectional study was conducted at Hiwot Fana Comprehensive Specialized Hospital from January 1 to December 31, 2021. A total of 39 children with RHD were included, with data collected from medical records, clinical assessments, and echocardiographic evaluations. Descriptive statistics and chi-square tests were used for analysis. Results. Among the 39 children studied, 25 were newly diagnosed and 14 were known RHD cases. The majority were female (71.8%). The median age was 10 years. Shortness of breath (53.9%) and cough (38.5%) were the most common presenting complaints. Only 14.3% of known RHD patients were adherent to secondary prophylaxis. Severe acute malnutrition and severe anemia were the most common comorbidities. Class IV heart failure was present in 89.7% of the patients. Echocardiographic findings revealed that all patients had mitral valve involvement, with mitral regurgitation (94.9%) being the most frequent. Conclusion. This study revealed that rheumatic diseases in children in Eastern Ethiopia present at advanced stages. Low adherence to secondary prophylaxis and high rates of severe heart failure highlights the consequences of delayed diagnosis and management. These findings underscore the urgent need for better healthcare infrastructure, enhanced prevention programs, and improved strategies to increase prophylaxis adherence to prevent disease progression and improve outcomes for affected children.
The future of negotiations under the climate change COP (Conference of the Parties): Implementation is not enough
Authors: Depledge Joanna
Published: November 2024

Ever since the adoption of the Paris Agreement's rulebook, the United Nations (UN) climate regime has been in an implementation phase. Patchy and weak implementation of the Paris Agreement obligations, however, has led to calls for the Conference of the Parties (COP) to take a more active role in promoting delivery. However, the COP's scope for action is constrained by its limited mandate and unwieldy process. There are potential ways around these constraints, such as leveraging the authority of COP Presidents, reforming the COP, or setting up ‘climate clubs’ outside the COP. However, given that global emissions continue to rise, and ambition also remains insufficient, this commentary argues for a more radical approach: introducing a voting rule, and negotiation under the COP of new optional legal agreements on specific emission sectors and sources.
Modified Slow-Strain-Rate Tensile Testing Method for Evaluation of Room-temperature Hydrogen Embrittlement Susceptibility and Its Application to 23Cr2Ni4MoV Steel
Authors: Lv Sanshu , Chen Xuedong , Fan Zhichao , Zhou Yu , Yang Hao , Zhang Qiang , Chi Mingjian , Li Yue
Published: November 2024

To evaluate the room-temperature hydrogen embrittlement susceptibility (HES) of high-pressure hydrogen storage vessels, a modified slow-strain-rate tensile (MSSRT) testing method was proposed for effectively aligning with their actual operating conditions. The effectiveness of the MSSRT testing method in evaluating the room-temperature HES of steels under high pressure was validated by comparing the results obtained using the conventional slow strain rate tensile (SSRT) and proposed MSSRT testing methods for 30CrMo steel, which is widely used for manufacturing high-pressure hydrogen storage vessels. The tensile properties and fracture morphologies of 23Cr2Ni4MoV steel were then examined using the MSSRT testing method under 35 MPa hydrogen and nitrogen at room temperature. Results indicate that 35 MPa hydrogen exerted a marginal effect on the tensile properties of 23Cr2Ni4MoV steel at room temperature when considering the MSSRT testing method; moreover, the test specimen basically exhibited macroscopic ductile fracture. Furthermore, obvious surface cracking was observed on the fractured specimen tested under hydrogen, whereas surface cracking was not observed on the fractured specimen tested under nitrogen. Hence, the relative reduction of area and surface cracking are necessary criteria for evaluating the room-temperature HES of steels using the MSSRT testing method. Overall, 23Cr2Ni4MoV steel might be unsuitable for manufacturing high-pressure hydrogen storage vessels.
A dispensable SepIVA orthologue in Streptomyces venezuelae is associated with polar growth and not cell division
Authors: Sen Beer Chakra , Mavi Parminder Singh , Irazoki Oihane , Datta Susmita , Kaiser Sebastian , Cava Felipe , Flärdh Klas
Published: November 2024

Background

SepIVA has been reported to be an essential septation factor in Mycolicibacterium smegmatis and Mycobacterium tuberculosis. It is a coiled-coil protein with similarity to DivIVA, a protein necessary for polar growth in members of the phylum Actinomycetota. Orthologues of SepIVA are broadly distributed among actinomycetes, including in Streptomyces spp.

Results

To clarify the role of SepIVA and its potential involvement in cell division in streptomycetes, we generated sepIVA deletion mutants in Streptomyces venezuelae and found that sepIVA is dispensable for growth, cell division and sporulation. Further, mNeonGreen-SepIVA fusion protein did not localize at division septa, and we found no evidence of involvement of SepIVA in cell division. Instead, mNeonGreen-SepIVA was accumulated at the tips of growing vegetative hyphae in ways reminiscent of the apical localization of polarisome components like DivIVA. Bacterial two-hybrid system analyses revealed an interaction between SepIVA and DivIVA. The results indicate that SepIVA is associated with polar growth. However, no phenotypic effects of sepIVA deletion could be detected, and no evidence was observed of redundancy with the other DivIVA-like coiled-coil proteins Scy and FilP that are also associated with apical growth in streptomycetes.

Conclusions

We conclude that S. venezuelae SepIVA, in contrast to the situation in mycobacteria, is dispensable for growth and viability. The results suggest that it is associated with polar growth rather than septum formation.
Prospective multicenter study of camrelizumab in real-world settings for asian patients with esophageal squamous cell carcinoma
Authors: Li Tingting , Dai Yaqing , Fu Xiaobin , Cai Qunrong , Ke Dongmei , Yao Qiwei , Li Jiancheng
Published: November 2024

Background

In this study, we aimed to evaluate the real-world efficacy and safety of camrelizumab and identify clinicolaboratory factors that predict treatment outcomes in patients with unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC) receiving camrelizumab.

Methods

Herein, 174 patients with unresectable advanced, recurrent, or metastatic ESCC treated with camrelizumab monotherapy (n = 30), camrelizumab + chemotherapy (CT; n = 91), and camrelizumab + radiotherapy (RT; n = 53) between October 1, 2019 and October 1, 2022 were included.

Results

The median follow-up time was 20 months (range, 1–34 months). The median progression-free survival (PFS) and overall survival (OS) of the whole cohort were 8 months [95% confidence interval (CI), 6.5–9.5 months] and 14 months (95% CI, 11.2–16.8 months), respectively. After multivariate analysis, receiving > 4 cycles of camrelizumab was identified as an independent predictor of better PFS [hazard ratio (HR), 0.56; 95% CI, 0.38–0.827; P = 0.004] and OS (HR, 0.532; 95% CI, 0.341–0.83; P = 0.005). An intermediate-to-poor lung immune prognostic index (LIPI) was identified as an independent predictor of worse PFS (HR, 1.505; 95% CI, 1.032–2.196; P = 0.034) and OS (HR, 1.657; 95% CI, 1.094–2.51; P = 0.017). The disease control rate of patients in the camrelizumab monotherapy group, camrelizumab + CT group, and camrelizumab + RT group was 92.3% (95% CI, 74.9–99.1%), 90.6% (95% CI, 82.3–95.9%), and 96.1% (95% CI, 86.8–99.5%), respectively. The treatment-related adverse events (AEs) of grade 3 or higher were reported in 67 patients (38.5%). The most common treatment-related AEs were decreased neutrophil count (23.0%), decreased white blood cell count (19.5%), anemia (7.5%), and pneumonitis (4.6%). One patient (0.6%) died from a treatment-related AE of immune checkpoint inhibitor-induced myocarditis.

Conclusion

Camrelizumab was safe and effective as both monotherapy and part of a combination therapy. Longer PFS and OS were associated with receiving > 4 cycles of camrelizumab and having a good LIPI. LIPI can be used as a prognostic biomarker for ESCC patients receiving camrelizumab + RT.

Trial registration

ClinicalTrial.gov Identifier: CHICTR2000039499. Registered: 19th October 2020.
Evaluation of the therapeutic relevance of architectural aspects in child and adolescent psychiatric institutions from the perspective of architects and senior physicians
Authors: Fornefeld Dustin , Schmoll-Klute Fabian , Halswick Daniel , Schmidt Peter , Scheiderer Marie-Léne , Reuter Lynn , Brockmann Katharina , Pfersich Anna , Fricke Oliver
Published: November 2024

Objective

The concept of “Healing Architecture” addresses the relevance of design and architectural issues on the outcome of medical and therapeutic treatment in hospitals. The questionnaire ARCHI was developed to record data on the opinion of different groups of users on the architectural design of their therapeutic environment in departments of child and adolescent psychiatry.

Method

A Questionnaire-based cross-sectional study was conducted in two phases between 2020 and 2022 using ARCHI to gather the perspectives of senior physicians and architects on the significance of architectural design in German child and adolescent psychiatric facilities.

Results

In the survey of the senior physicians, 49 heads of child and adolescents psychiatric departments initiated the survey, and 73.5% (n = 36) of them completed the questionnaire in its entirety. During the survey for the architect-specific, 145 individuals commenced the survey, and 60.7% of them completed the questionnaire (n = 88). Significant differences between architects and senior physicians became visible for four of the 93 items, namely “environment of the hospital”, “structure of building”, “labelling of floors” and “visible cleanliness”.

Conclusions

Although senior physicians and architects were characterized by the same opinions on the relevance of architectural design on therapeutic issues for the major part of issues, differences could be obtained for several aspects which are important for the architectural planning of new departments and hospitals. It remains open why both professional groups had different point of views on these four aspects of hospital design which should be clarified to improve the process of hospital development in the future.
Community utilization of a co-created COVID-19 testing program in a US/Mexico border community
Authors: Reyes Breanna J. , Calvillo Stephenie Tinoco , Escoto Arleth A. , Lomeli Angel , Burola Maria Linda , Gay Luis , Cohen Ariel , Villegas Isabel , Salgin Linda , Cain Kelli L. , Pilz Dylan , Watson Paul , Oswald Bill , Arevalo Cesar , Sanchez Jessica , Richardson Marjorie , Nelson Jennifer , Villanueva Pricilla , McGaugh Garrett , Zaslavsky Ilya , Tukey Robert H. , Stadnick Nicole A. , Rabin Borsika A. , Laurent Louise C. , Seifert Marva
Published: November 2024

Background

The COVID-19 pandemic exposed several health disparities experienced by underserved and Latino/a communities, including inequitable access to COVID-19 testing.

Objective and Goals

To describe the utilization of a community-driven and culturally-tailored testing model on COVID-19 testing in an underserved Latino/a community in San Diego.

Methods

The Community-driven Optimization of COVID-19 testing to Reach and Engage Underserved Areas for Testing Equity (CO-CREATE) project implemented a community co-designed COVID-19 testing program in partnership with a Federally Qualified Health Center in a US/Mexico border community.

Results

Between May 2021 and March 2023, 24, 422 COVID-19 PCR tests were administered to 13,253 individuals, among whom 93% percent identified as Latino/a, 57% spoke Spanish in the home, and 38% resided in our target community adjacent to the US/Mexico border, San Ysidro. Based on a subset of available county testing data, CO-CREATE accounted for nearly 12% of all COVID-19 tests reported for San Ysidro residents. Over the course of the project, we estimated that nearly 17% of all San Ysidro residents were tested for COVID-19 through the CO-CREATE project.

Conclusion

These findings highlight the success and reach of this culturally responsive and community co-designed COVID-19 testing program, within a Latino/a border community. Future public health interventions should focus on identifying testing barriers and design appropriate strategies to ensure equitable access to resources and testing uptake for all community members.
From infected to recovered: the mediating role of sleep quality between self-compassion, social support and COVID-19 psychosomatic symptoms
Authors: Chen Outong , Guan Fang , Zhan Chengqing , Li Ying
Published: November 2024

Background

Recent research has shown significant individual differences in COVID-19 psychosomatic symptoms. However, there has been a lack of studies investigating the influence of physical and psychological factors on these symptoms and their underlying mechanisms. This study aims to fill this gap by investigating the predictive role of self-compassion and social support on COVID-19 psychosomatic symptoms, as well as the potential mediating role of sleep quality.

Methods

Data were collected from 636 participants infected with COVID-19 during the early post-pandemic reopening phase in China. The measurement tools used in the current study included the Self-Compassion Scale, the Perceived Social Support Scale, Self-Rating Scale of Sleep, and a COVID-19 Psychosomatic Symptom Diary.

Results

A structural equation model revealed that: (1) social support directly predicts COVID-19 psychosomatic symptoms; (2) sleep quality fully mediates the relationship between self-compassion and COVID-19 psychosomatic symptoms; and (3) sleep quality partially mediates the relationship between social support and COVID-19 psychosomatic symptoms.

Conclusions

These findings not only confirm previous research but also provide new insights into the intricate interplay between psychological and physical factors and their influence on COVID-19 psychosomatic symptoms. The implications of these findings may inform the development of targeted rehabilitation programs in the post-pandemic era of the “new normal”.

Clinical trial number

Not applicable.
Spatiotemporal characterization of extracellular matrix maturation in human artificial stromal-epithelial tissue substitutes
Authors: Ávila-Fernández Paula , Etayo-Escanilla Miguel , Sánchez-Porras David , Fernández-Valadés Ricardo , Campos Fernando , Garzón Ingrid , Carriel Víctor , Alaminos Miguel , García-García Óscar Darío , Chato-Astrain Jesús
Published: November 2024

Background

Tissue engineering techniques offer new strategies to understand complex processes in a controlled and reproducible system. In this study, we generated bilayered human tissue substitutes consisting of a cellular connective tissue with a suprajacent epithelium (full-thickness stromal-epithelial substitutes or SESS) and human tissue substitutes with an epithelial layer generated on top of an acellular biomaterial (epithelial substitutes or ESS). Both types of artificial tissues were studied at sequential time periods to analyze the maturation process of the extracellular matrix.

Results

Regarding epithelial layer, ESS cells showed active proliferation, positive expression of cytokeratin 5, and low expression of differentiation markers, whereas SESS epithelium showed higher differentiation levels, with a progressive positive expression of cytokeratin 10 and claudin. Stromal cells in SESS tended to accumulate and actively synthetize extracellular matrix components such as collagens and proteoglycans in the stromal area in direct contact with the epithelium (zone 1), whereas these components were very scarce in ESS. Regarding the basement membrane, ESS showed a partially differentiated structure containing fibronectin-1 and perlecan. However, SESS showed higher basement membrane differentiation, with positive expression of fibronectin 1, perlecan, nidogen 1, chondroitin-6-sulfate proteoglycans, agrin, and collagens types IV and VII, although this structure was negative for lumican. Finally, both ESS and SESS proved to be useful tools for studying metabolic pathway regulation, revealing differential activation and upregulation of the transforming growth factor-β pathway in ESS and SESS.

Conclusions

These results confirm the relevance of epithelial-stromal interaction for extracellular matrix development and differentiation, especially regarding basement membrane components, and suggest the usefulness of bilayered artificial tissue substitutes to reproduce ex vivo the extracellular matrix maturation and development process of human tissues.

Graphical Abstract
Improving hospital care for people who use drugs: deliberative process development of a clinical guideline for opioid withdrawal management
Authors: Wickremsinhe Marisha , Holland Adam , Scott Jenny , Gittins Rosalind , Brown Michael , Noctor Adrian ‘Bean’ , Lewer Dan , Hope Vivian , Eastwood Niamh , Harris Magdalena
Published: November 2024

Background

Management of opioid withdrawal in hospital settings is crucial to improve treatment completion and health outcomes among patients who use opioids, such as heroin. Evidence-based clinical guidelines can support responsive provision of opioid substitution therapy (OST). In England there is no standardised application of guidance for substance dependence management across National Health Service (NHS) Hospitals. A recent review of NHS hospital policies identified varying approaches to managing opioid withdrawal and procedural barriers to timely medication.

Objective

To develop a clinical guideline for opioid withdrawal management in acute NHS hospital trusts to be tested and evaluated as part of the iHOST (Improving Hospital Opioid Substitution Therapy) research intervention.

Methods

We undertook a deliberative guideline development process. The University London College Hospital (UCLH) substance dependence guideline was used as a template, with key points of revision informed by evidence review, consultations with hospital staff and people with opioid dependence. A multidisciplinary working group deliberated evidence statements to develop recommendations. These were reviewed by an oversight committee comprising representatives from key stakeholder organisations. The team authored the guideline with iterative review by the oversight committee, key stakeholders and UCLH clinical governance committees.

Results

Deliberation focused on three key domains: (1) identifying opioid dependence and promptly continuing existing OST prescriptions; (2) initiating or re-titrating OST; (3) ensuring safety and continuity of care at discharge. Changes to the UCLH guideline included removal of mandatory urine drug testing prior to OST; increasing initial methadone titration dose; and provision for a higher day-one titration dose when specific safety criteria are met. A new titration schedule for sublingual buprenorphine was incorporated. Discharge planning to ensure continuity of community care and reduce risk of opioid overdose was emphasised, with allowance for bridging prescriptions of OST and naloxone provision on hospital discharge.

Conclusion

The iHOST clinical guideline aims to remove procedural barriers to opioid withdrawal management for hospital inpatients. It is intended to be implemented by other NHS hospitals, which could improve access to OST and reduce discrepancies in treatment access and completion.

Study registration

ISRCTN47320412 https://doi.org/10.1186/ISRCTN47320412.
First-in-human trial using mixed-reality visualization for patient setup during breast or chest wall radiotherapy
Authors: Johnson Perry B. , Bradley Julie , Lampotang Samsun , Jackson Amanda , Lizdas David , Johnson William , Brooks Eric , Vega Raymond B. Mailhot , Mendenhall Nancy
Published: November 2024

Background

The purpose of this study is to assess the feasibility of mixed-reality (MixR) visualization for patient setup in breast and chest wall radiotherapy (RT) by performing a first-in-human clinical trial comparing MixR with a 3-point alignment.

Methods

IRB approval was granted for a study incorporating MixR during the setup process for patients undergoing proton (n = 10) or photon (n = 8) RT to the breast or chest wall. For each patient, MixR was utilized for five fractions and compared against another five fractions using 3-point alignment. During fractions with MixR, the patient was aligned by at least one therapist wearing a HoloLens 2 device who was able to guide the process by simultaneously and directly viewing the patient and a hologram of the patient’s surface derived from their simulation CT scan. Alignment accuracy was quantified with cone-beam CT (CBCT) for photon treatments and CBCT plus kV/kV imaging for proton treatments. Registration time was tracked throughout the setup process as well as the amount of image guidance (IGRT) utilized for final alignment.

Results

In the proton cohort, the mean 3D shift was 0.96 cm using 3-point alignment and 1.18 cm using MixR. An equivalence test indicated that the difference in registration accuracy between the two techniques was less than 0.5 cm. In the photon cohort, the mean 3D shift was 1.18 cm using 3-point alignment and 1.00 cm using MixR. An equivalence test indicated that the difference in registration accuracy was less than 0.3 cm. Minor differences were seen in registration time and the amount of IGRT utilization.

Conclusions

MixR for patient setup for breast cancer RT is possible at the level of accuracy and efficiency provided by a 3-point alignment. Further developments in marker tracking, feedback, and a better understanding of the perceptual challenges of MixR are needed to achieve a similar level of accuracy as provided by modern surface-guided radiotherapy (SGRT) systems.

Trial registration

ClinicalTrials.gov, UFHPTI 2015-BR05: Improving Breast Radiotherapy Setup and Delivery Using Mixed-Reality Visualization, NCT05178927.
The NACA score predicts mortality in polytrauma patients before hospital admission: a registry-based study
Authors: Fiore Paolo Ivan , Monteleone Andrea Stefano , Müller Jochen , Filardo Giuseppe , Candrian Christian , Riegger Martin
Published: November 2024

Background

The early assessment of the severity of polytrauma patients is key for their optimal management. The aim of this study was to investigate the discriminative performance of the NACA score in a large dataset by stratifying the severity of polytraumatized patients in correlation to injury severity score (ISS), Glasgow Coma Scale (GCS), and mortality.

Methods

This study on the Swiss Trauma Registry investigated 2239 polytraumatized patient (54.3 ± 22.8 years) enrolled from 2015 to 2023: 0.5% were NACA 3, 76.7% NACA 4, 21.4% NACA 5, and 1.4% NACA 6. The NACA predictive value of patients’ mortality was investigated, as well as the correlation of ISS and GCS scores, and other factors influencing patients’ survival at discharge and after 28 days.

Results

In NACA 4 and 5 the survival rate during hospitalization was 97.7% and 82.5%, respectively, and 28-day mortality 3.5% and 23.5%, respectively (p < 0.0005). NACA correlated with GCS in the prehospital phase and in the emergency room (p < 0.0005), as well as with ISS (p < 0.0005). NACA 4 and 5 presented different injury patterns (fall < 3 m vs vehicle accident) with NACA 5 requiring more CPR and intubation (p < 0.001, p < 0.0005). The ROC AUC analysis showed the prehospital NACA and GCS values as the strongest variables predicting patients’ survival.

Conclusions

This study provides valuable evidence supporting the effectiveness of the NACA score in assessing the severity of polytrauma patients in both the pre-ER and ER condition. Considering the statistical significant correlation with the GCS and with the ISS, NACA is a valid score for assessing polytrauma patients.