bluuebunny/crossref_metadata_2025 huggingface dataset:
L3 Vehicles are becoming a Reality: Important Human Factors Consideration for the Viability of Conditional Automation
Authors: Yu Denny , Nasir Mansoor , Pitts Brandon J. , Shutko John , Bao Shan , Monk Chris
Published: October 2023

As of early 2023, only a limited number of Society of Automotive Engineers (SAE) Level 3 (L3) automated driving systems are available on the market, and they are primarily offered by luxury vehicle brands. SAE L3 automated driving systems are classified as conditional automation (CA), meaning that the vehicle can undertake some well-defined driving tasks under specific conditions, but the driver must be ready to assume control of the vehicle when prompted by the system. It is anticipated that an increasing number of L3 CA systems will be introduced on public roads in the next few years. However, L3 systems pose unique Human Factors (HF) challenges that require thoughtful consideration to ensure that production systems are feasible without compromising driver or road safety. This panel discussion brings together HF researchers and practitioners with expertise in human behavior and usability design for automotive applications to discuss and delineate key issues specifically related to L3 systems, as well as potential approaches to tackle these issues.
Reveal, Inspect, Adapt: Bridging the Gap Between Teamwork Theory and Practice in Corporate IT Projects
Authors: Turner Carl W.
Published: October 2023

This paper presents a rationale for establishing collaboration between corporate IT projects and those conducting empirical research on teamwork. A review of teamwork research reveals gaps in many teamwork models: the influence of context of performance, the mechanisms of team development over time, and data generated by practitioners in naturalistic settings. The paper describes the Scrum framework for executing projects in IT departments in terms of input artifacts, output artifacts, team processes, and the role of organizational context. Given the lack of quantitative project outputs, the method describes how Thematic Analysis and qualitative research are needed to convert project outputs to insights on team processes. This method of conducting research on team performance aligns closely with the Macroergonomics framework for research and its attention to team, task, context, and study with practitioners in naturalistic settings.
Enhanced Bidirectional Gamma-band Granger Prediction in Fast Compared to Slow Performers in a 3-stimulus Oddball Task
Authors: Rhodes L. Jack , Borghetti Lorraine , Morris Megan B.
Published: October 2023

We used Granger prediction (GP) to assay fatigue effects in a 3-stimulus oddball task requiring context-sensitive proactive control to evaluate top-down frontal-parietal and bottom-up parietal-frontal gamma-band connectivity across two time windows - an earlier window associated with sensory processing and a later window associated with high level cognition. Results indicated frontal-parietal GP enhancement in better performers, though more so in the early versus later window. No differences emerged in parietal-frontal connectivity. Findings suggest observed differences are driven largely by early top-down frontal-parietal network activity. The observed pattern corresponds to connectivity in previous work, suggesting gamma-band GP could be a generalized indicator of central control and related motivational factors.
Drivers’ Responses to Stopped and Slowed Lead Vehicles During Nighttime
Authors: Oliver Myriam , DeLucia Patricia R. , Jupe Jason , Dudley LeGrand , Weaver Bradley W.
Published: October 2023

We previously showed that, in daytime, drivers responded to stopped and slow-moving lead vehicles gradually, rather than suddenly when optical expansion rate reached .006 rad/s. Here we examined whether this occurs in (simulated) nighttime driving. We recorded expansion rate and lead vehicle’s time on screen at six driver inputs (from early- release accelerator to late- slam on brakes) to stopped and slow-moving vehicles. Two groups of participants responded differently to slowmoving vehicles; one group released the accelerator, and one group applied unanticipated-level braking. Responses to stopped vehicles occurred when expansion rate reached .005 rad/s, close to the .006 rad/s reported for immediate hazard perception. Time on screen was longer in daytime than nighttime for slow-moving vehicles for later inputs, suggesting that daytime drivers see the vehicle sooner and better estimate how much time they have to respond. Effects of cell phone conversation and expectancy were not significant.
Predicting Driver Takeover Decisions in Conditionally Automated Vehicles with a Gaze-based Deep Learning Model
Authors: Gupta Shantanu , Tan Xiaomei , Zhang Yiqi
Published: October 2023

This study proposes a novel methodology for modeling driver takeover behavior in conditionally automated vehicles (AVs) when exiting a freeway using deep learning (DL) network architectures. While previous research has focused on modeling takeover time in emergency scenarios, which require quick responses, these models may not be applicable to scheduled, non-time-critical takeovers. In such situations, drivers may employ varying strategies and take longer to resume control of the vehicle when there is no time pressure. To address this problem, a deep learning architecture based on a convolutional neural network (CNN) was implemented to predict drivers’ takeover behaviors in scheduled takeovers. The model was trained on drivers’ driving data and eye gaze with varying time windows, facilitating an analysis of drivers’ takeover decisions to various takeover request designs. The model achieved good performance metrics, with an F1 Score of 0.993, a recall of 0.996, and a precision of 0.991. The application of these models holds substantial potential for refining the design of the human-machine interface, specifically in calibrating the takeover request (ToR) lead time, thereby promoting safe freeway exiting takeovers in conditionally AVs.
Training Effectiveness Evaluation: Frameworks and Considerations for Flightcrew Training Review & Approval
Authors: Sonnenfeld Nathan A. , Nguyen Blake , Alonso Alex , Jentsch Florian
Published: October 2023

The use of systematic training effectiveness evaluation (TEE) in flightcrew training provides training practitioners with methods to assess the validity and efficacy of specific curricula or training methods for set goals and objectives and deeper insight into the processes and systems used. As discussed in our extended abstract, there are various frameworks used to assess training effectiveness, but there have been few systematic comparisons of these TEE frameworks and little consensus as to which frameworks should be applied for the evaluation of modern training configurations. This poster will overview lessons learned from our comparison of various traditional, factors-based, and systematic frameworks and their respective qualities and limitations. We will provide a series of practical suggestions for the flightcrew training community and outline a baseline of the outcomes and factors to be considered when conducting a TEE in the flightcrew training domain, highlighting future directions for TEE research and practice.
A New Framework for an Old Idea: Overhauling Reliability to Meet Current and Future Needs
Authors: Cotter Jenna E. , Atchley Andrew , Barr Hannah M. , Weger Kristin , Mesmer Bryan , Menon Vineetha , Gholston Sampson , Tenhundfeld Nathan L.
Published: October 2023

The concept of reliability is widely recognized across various academic disciplines. However, the conventional understanding of reliability varies by discipline, does not adequately address the intricate and ever-changing environments, and fails to account for the dynamic interactions between humans and artificial intelligence (AI) systems. To address these gaps, a new framework is proposed for considering reliability that accounts for performance on both supraordinate and subordinate objectives. By framing reliability in such a manner, the evaluation of systems can become more precise and research involving human-machine interactions can gain greater clarity. This is crucial for product designers and evaluators working to develop systems that meet end-use goals and comply with regulations. Researchers and practitioners alike need to rethink reliability in the context of AI systems, and this article proposes a new framework for understanding reliability.
Improving Patient Safety Event Report Classification with Machine Learning and Contextual Text Representation
Authors: Chen Hongbo , Cohen Eldan , Wilson Dulaney , Alfted Myrtede
Published: October 2023

Adverse events caused by medical errors pose a significant threat to patient safety, with estimates of 251,454 deaths and a cost of $17.1 billion to the healthcare system annually in the United States. Patient safety event (PSE) reports play a vital role in identifying measures to prevent adverse events, but their utility is dependent on the accurate classification of PSE reports. Recent studies have used static natural language processing (NLP) and machine learning (ML) techniques to automate PSE report classification. However, the use of static NLP has limitations in differentiating the meaning of words in disparate contexts, which can lead to inferior classification results. Thus, this study proposes to utilize contextual text representation produced from neural NLP methods to improve the accuracy of PSE report classification. The results suggest that the contextual text representation can further improve the performance of PSE classifiers. The best-performing classifier, a support vector machine trained with contextual text representation (Roberta-base) reaches an accuracy of 0.75 and a ROCAUC score of 0.94, surpassing all ML classifiers trained with static text representations. Furthermore, the confusion matrix of the best classifier exposes latent deficiencies in the PSE reports' classification taxonomy, such as the multi-class nature of PSE and conceptually related event types. The study's findings can save time for PSE reclassification, enhance the learning capabilities of the reporting system, ultimately improve patient safety
A Longitudinal Assessment of Sleep in Surface Warfare Officers During Training and Fleet Assignments: Preliminary Results
Authors: Lewis Shattuck Nita , Matsangas Panagiotis
Published: October 2023

Several previous studies have assessed fatigue on USN warships, especially of enlisted Sailors. Our study, however, is focused explicitly on Surface Warfare Officers (SWOs) (N=34) during training and after returning to the fleet. The average daily sleep duration was 6.83±0.44 hours (62% of the SWOs sleeping <7 hours/day). The average daily sleep duration was higher when SWOs were in training compared to their fleet assignment (p=0.068). SWOs slept 0.82 hours/day more on weekends compared to weekdays in fleet settings and 0.42 hours/day when in training. Sleep efficiency during the major sleep episodes was lower in fleet settings (p<0.001), heart rate was higher (p=0.020), and HRV was lower (p<0.001). These preliminary results suggest that chronic sleep deprivation is prevalent in SWOs, especially in fleet settings. The depressed HRV during fleet assignments may be explained by the high stress levels during these periods in conjunction with the increased sleep deprivation.
Applying the sidekick principles to the prototyping of human-machine teaming in collection planning
Authors: Born Werner , Bruni Sylvain , Detzler Lam , Yerdon Valarie
Published: October 2023

Collection planning for multi-domain operations is a complex task that is heavily manual, resource-intensive, and sub-optimally setup for collaboration. To solve these gaps and leverage advances in Artificial Intelligence and Machine Learning, which suggest that those are resolvable, our team employed the sidekick principles for human-machine teaming to design and prototype COGSWORTH, a system for Collection Optimization and Generation Synchronized with Optempo Reasoning Tailored to Humans. COGSWORTH is envisioned as a cognitive assistant to help collection planners. We report here on (1) our application of the sidekick principles to the prototyping of COGSWORTH, (2) how the sidekick principles are tangibly reflected in prototype artifacts, and (3) lessons learned and practical takeaways that may inform other researchers and practitioners in the human-machine teaming field.
Back Rest Angle Influence on Nap Quality and Comfort
Authors: Vink P. , Singh U. , Smulders M. , Vledder G. , Yao X. , Song Y.
Published: October 2023

The sleep quality and (dis)comfort sitting upright was studied among 40 participants who took a nap at home. They were asked to take a nap at 17:00h on three consecutive days. The backrest had to be at a different angle every day: upright, reclined and more reclined. They were asked to record the backrest angle of the three positions and report the length of the sleep, the sleep quality, comfort and discomfort and influence of other factors each during each nap. From the 120 cases (3 conditions, 40 participants), the cases where participants were not able to sleep had an average backrest angle of 110°, which was significantly different from the cases where participants were able to sleep, who had an average backrest angle of 118°. The scores in the more upright position (<110°) resulted in significantly more discomfort and a lower sleep quality than in the reclined positions (>123°). As the conditions were arranged by the participants, there was much variation in outcomes. Therefore, future research under more standardised conditions is recommended.
The need for specificity in uncertainty communication is further supported: Preliminary evidence from eye tracking
Authors: McGarry Shannon P. D. , Brown Noelle L. , Drollinger Sabrina M. , Neilson Brittany N. , Foroughi Cyrus K. , Sibley Ciara M. , Coyne Joseph T.
Published: October 2023

Automation transparency is understudied in environments with varied automation reliability. We previously found uncertainty communication, a form of automation transparency, led to nuanced and unintentional performance outcomes in this type of environment. To better understand these outcomes, participants’ monitoring policies of automation were studied via a preliminary eye tracking analysis. In a simulated multi-UAV mission, 272 Naval Aviation trainees monitored three automated systems that were identical in function, but differed in reliability. Halfway through the experiment, uncertainty communication about the least reliable system was delivered as a chat message. Performance improvements coincided with a monitoring policy that had larger dwell times overall and one where the proportion of visual attention towards the automated system mentioned in the uncertainty communication increased upon its delivery. Overall, examining participant monitoring policies helped explain other performance outcomes and bolstered our previous conclusion: effective uncertainty communication requires maximum specificity.
Validating a Task Complexity Framework for Studies of Uncertainty Visualization
Authors: Newton Olivia B. , Fiore Stephen M. , Song Jihye
Published: October 2023

In this study, we validate and extend previous theoretical and empirical work on the design of visualizations to support decision makers using interfaces with high levels of information density and evolving constraints. Prior research proposed and validated a theoretical framework of task complexity to facilitate the systematic evaluation of uncertainty visualizations for these contexts. We adopted this approach to the evaluation of visualizations of uncertainty, displaying hurricane visualizations on a map rather than abstract symbols on a grid, manipulating the dispersion of visualizations, and varying an additional visuospatial element––visualization orientation––to improve the ecological validity of the experimental task. The results of this study provide evidence for the utility of a task complexity framework for research on the visualization efficacy.
Assessing Different Methods for Detection of Distracted Driving
Authors: Woods Amber N. , Reagan Ian J. , Monfort Samuel S. , Cicchino Jessica B.
Published: October 2023

Roadside observations provide insight into the prevalence of distracted driving on American roadways. Traditional observational studies require the use of observers stationed on the roadside who manually annotate the behavior of passing drivers, while camera-based methods allow researchers to code distracted driving from photos without an observer on the scene. The current study compared the accuracy of a traditional in-person roadside observer with a camera-based method in identifying driver distraction. Both methods distinguished cellphone distractions from other behaviors with high accuracy, although the in-person observer performed slightly better than the camera-based method across most specific behaviors. This study demonstrates that both in-person and camera-based observations are reasonably accurate approaches for measuring the prevalence of cellphone distractions on the road. Camera-based methods may provide an advantage to in-person observers by enabling observations on roadways where it is not feasible to station a human observer.
Evaluating the Consistency of Cooperative Video Games in Inducing Teamwork Behaviors
Authors: Farah Yvonne A. , Banuelos-Moriel Antonio , Dorneich Michael C.
Published: October 2023

Teamwork assessment requires research environments that replicate the task complexity and induce challenges and uncertainty. Gamified environments are gaining attention as suitable environments for teamwork assessment, where teaming behaviors can be quantified. However, further research is needed to establish the relationship between gaming mechanics and teaming competencies. This work aims to assess the consistency of video games in inducing teaming behaviors. Five video games were analyzed through coding behaviors and cooperative features from gameplay streams. Results show that the selected games induce similar behavioral profiles of percentages of teaming competencies. These games have similar design characteristics, including performance environments and game loops. Design suggestions reflect potential associations between the analyzed game mechanics and the resulting behavioral profiles. The resulting teamwork profiles can be targeted through the simulation cooperative genre, therefore providing a design tool for teamwork testbed designers to induce teamwork distributions of interest.
L858R-K860I Doublet Mutation of EGFR gene in Non-Small Cell Lung Carcinoma: Cause of a False Negative Call for L858R on Initial Companion Diagnostic Test
Authors: Mehta Anurag , Diwan Himanshi , Nathany Shrinidhi , Mattoo Sakshi , Kumar Dushyant , Panigrahi Manoj Kumar
Published: October 2023

With the advent of targeted therapy in non-small cell lung carcinoma (NSCLC), biomarker detection has become standard practice. US Food and Drug Administration (FDA) has approved a few companion diagnostics as single gene assays to find these driver mutations. We report a case of NSCLC where initial molecular tests to detect epidermal growth factor receptor ( EGFR)- sensitizing mutations by an FDA-approved assay (Cobas® EGFR Mutation Test v2) failed to identify the common EGFR mutation L858R. However, the latter was picked up on subsequent next-generation sequencing (NGS). Interestingly an additional single nucleotide variant K860I was also observed in the cis configuration. The false-negative result for L858R was assumed to be caused by the abrogation of complementarity for the probe binding site on the amplicon generated. The concurrent occurrence of L858R and K860I will not be detectable by Cobas® EGFR Mutation Test v2 (FDA-approved companion diagnostic) despite its real-world intra and inter-laboratory studies demonstrating high accuracy.
Self-regulatory coping among community dwelling older adults with multiple chronic conditions
Authors: Bankole Ayomide Okanlawon , Gill Sara L. , McSharry Jenny , White Carole L. , Aniemeke Chidinma , Wallington Sherrie Flynt , Addo-Mensah Dorothy Ewurabena , Braden Carrie Jo
Published: October 2023

Objectives

Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC.

Methods

A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study.

Results

Three themes were developed from the analysis: (1) “I don’t think about it unless something happens": coping in the absence of a health event, (2) "doing what I am supposed to do”: coping during a health event, and (3) “How do I know if what I did works?”: appraisal of coping success.

Discussion

Self-regulatory coping was influenced by individual beliefs and experiences ( illness representations), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.
Accessibility to the faculty of educational studies building at the University of Education, Winneba: Experience of two wheelchair users
Authors: Abu–Sadat Rabbi
Published: October 2023

This study focused on how two students with physical disabilities who are wheelchair users perceive accessibility to the Faculty of Educational Studies building at the University of Education, Winneba, and how they feel the challenges that come with access should be addressed. Data were gathered through in-depth interviews with two out of the six undergraduate students who are wheelchair users using a semi-structured guide. The respondents were chosen on the criteria that they had spent longer years on the block in comparison to other wheelchair users, and those with physical disabilities who are not wheelchair users in first and second years were excluded on that criteria. All audio-recorded interviews were transcribed verbatim and analysed thematically, using narrative themes with alphabets (A and B) attached for identification of responses from the two respondents. The findings showed that students who are wheelchairs users had difficulties accessing the faculty block due to the non-availability of an elevator and a ramp for wheelchair users. The study recommends that the management of the University, the office of Dean of faculty and the Resource Centre for Students with Special needs should act to ensure the block is made accessible for all learners.
Mechanism of RhoA regulating benign prostatic hyperplasia: RhoA-ROCK-β-catenin signaling axis and static & dynamic dual roles
Authors: Shan Shidong , Su Min , Li Yan , Wang Zhen , Liu Daoquan , Zhou Yongying , Fu Xun , Yang Shu , Zhang Junchao , Qiu Jizhang , Liu Huan , Zeng Guang , Chen Ping , Wang Xinghuan , DiSanto Michael E. , Guo Yuming , Zhang Xinhua
Published: October 2023

Background

The pathogenesis of benign prostatic hyperplasia (BPH) has not been fully elucidated. Ras homology family member A (RhoA) plays an important role in regulating cell cytoskeleton, growth and fibrosis. The role of RhoA in BPH remains unclear.

Methods

This study aimed to clarify the expression, functional activity and mechanism of RhoA in BPH. Human prostate tissues, human prostate cell lines, BPH rat model were used. Cell models of RhoA knockdown and overexpression were generated. Immunofluorescence staining, quantitative real time PCR (qRT-PCR), Western blotting, cell counting kit-8 (CCK-8), flow cytometry, phalloidine staining, organ bath study, gel contraction assay, protein stability analysis, isolation and extraction of nuclear protein and cytoplasmic protein were performed.

Results

In this study we found that RhoA was localized in prostate stroma and epithelial compartments and was up-regulated in both BPH patients and BPH rats. Functionally, RhoA knockdown induced cell apoptosis and inhibited cell proliferation, fibrosis, epithelial-mesenchymal transformation (EMT) and contraction. Consistently, overexpression of RhoA reversed all aforementioned processes. More importantly, we found that β-catenin and the downstream of Wnt/β-catenin signaling, including C-MYC, Survivin and Snail were up-regulated in BPH rats. Downregulation of RhoA significantly reduced the expression of these proteins. Rho kinase inhibitor Y-27632 also down-regulated β-catenin protein in a concentration-dependent manner. However, overexpression of β-catenin did not affect RhoA-ROCK levels, suggesting that β-catenin was the downstream of RhoA-ROCK regulation. Further data suggested that RhoA increased nuclear translocation of β-catenin and up-regulated β-catenin expression by inhibiting its proteasomal degradation, thereby activating Wnt/β-catenin signaling. Overexpression of β-catenin partially reversed the changes in cell growth, fibrosis and EMT except cell contraction caused by RhoA downregulation. Finally, Y-27632 partially reversed prostatic hyperplasia in vivo, further suggesting the potential of RhoA-ROCK signaling in BPH treatment.

Conclusion

Our novel data demonstrated that RhoA regulated both static and dynamic factors of BPH, RhoA-ROCK-β-catenin signaling axis played an important role in the development of BPH and might provide more possibilities for the formulation of subsequent clinical treatment strategies.
Profiling risk factors for separation of infection complications in patients with gastrointestinal and nodal diffuse large B-cell lymphoma
Authors: Xue Min , Gao Zhenzhen , Yan Miaolong , Bao Yi
Published: October 2023

Objective

To identify risk factors for infection complications in patients with gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) and nodal DLBCL (N-DLBCL) during treatment, respectively.

Methods

Total 51 GI-DLBCL patients and 80 N-DLBCL patients were included after retrieving clinical data from a single medical center in the past ten years. Logistic regression analysis was utilized to analyze patients’ data, including baseline demographics, treatments and laboratory values, to determine independent risk factors of infection in these patients.

Results

Total 28 of 51 patients (54.9%) in the GI-DLBCL group and 52 of 80 patients (65%) in the N-DLBCL group were observed infection events during treatment. A multivariate logistic regression model revealed that Ann-arbor stage IV (P = 0.034; odds ratio [OR]: 10.635; 95% confidence interval [CI]: 1.152-142.712), extra-nodal lesions ≥ 2 (P = 0.041; OR: 23.116; 95%CI: 1.144-466.949) and high serum lactate dehydrogenase (LDH) at the time of diagnosis (LDH > 252U/L; P = 0.033; OR: 6.058; 95%CI: 1.159–31.659) were independent risk factors for the development of infection in patients with GI-DLBCL after systemic treatment. In the N-DLBCL group, high serum C-reactive protein (CRP) (P = 0.027; OR: 1.104; 95%CI: 1.011–1.204) and a low platelet count (P = 0.041; OR: 0.991; 95%CI: 0.982-1.000) at routine blood tests just before infection occurred were identified as significant risk factors related to infection events during treatment.

Conclusions

Discordant independent risk factors induced infection may be present during the treatment in patients with GI-DLBCL and N-DLBCL. Close monitoring these risk factors is likely an effective strategy to prevent microbial infections in these patients.
Long-term trends of nasopharyngeal carcinoma mortality in China from 2006 to 2020 by region and sex: an age-period-cohort analysis
Authors: Guo Xinru , Cui Jiameng , Yuan Xin , Gao Zibo , Yu Ge , Wu Hao , Kou Changgui
Published: October 2023

Background

China has a high mortality from nasopharyngeal carcinoma (NPC). The NPC mortality trends in China from 2006 to 2020 were described and analyzed to understand its epidemiological characteristics by region and sex and to explore age, period, and cohort effects.

Methods

This study utilized NPC mortality data from the China Health Statistical Yearbook. A joinpoint regression model was used to fit the standardized NPC mortality and age-specific mortality. The age-period-cohort model was applied to investigate age, period, and cohort effects on NPC mortality risk.

Results

The results showed that the NPC mortality rate in China has been declining steadily. From 2006 to 2020, the standardized NPC mortality rate in most age groups showed a significant downward trend. The annual percentage change was smaller in rural areas than in urban areas. The mortality risks of rural males and rural females from 2016 to 2020 were 1.139 times and 1.080 times those from 2011 to 2015, respectively. Both urban males born in 1984–1988 and rural males born in 1979–1983 exhibited an increasing trend in NPC mortality risk.

Conclusions

Our study confirmed the effectiveness of NPC prevention and treatment strategies in China from 2006 to 2020. However, it underscored the urgent need for targeted interventions in rural areas to further reduce NPC mortality rates.
Using novel porous metal pillars for tibial bone defects in primary total knee arthroplasty
Authors: Tang Qiheng , Guo Shaoyi , Deng Wang , Zhou Yixin
Published: October 2023

Background

The optimal method to treat tibial bone defects during primary total knee arthroplasty (TKA) is still unclear. A novel technique of porous metal pillar augmentation has been applied recently. This study aimed to assess the short-term outcomes of primary TKA with the use of novel porous metal pillars for tibial bone defects.

Methods

A total of 24 cases (22 patients) of primary TKA between January 2019 and December 2020 using porous metal pillars for tibial bone defects were reviewed. Clinical results were evaluated using the Knee Society knee score (KSKS) and function score (KSFS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). Hip-knee-ankle angle (HKAA), femorotibial angle (FTA), and radiolucent lines were assessed radiologically.

Results

The median follow-up period was 36.0 months (interquartile range: 31–37 months). The KSKS, KSFS, WOMAC score, and ROM improved significantly at the final follow-up assessment compared with the preoperative evaluation. Both of the HKAA and FTA were corrected after surgery. Only one knee had a nonprogressive radiolucent line at the bone-cement interface. No radiolucent lines were detected around the pillar in any of the cases. There were no cases of prosthesis loosening and revision.

Conclusions

The use of novel porous metal pillars yielded satisfactory clinical outcomes and reliable radiological evidence of fixation in this study with a minimum 2-year follow-up. Porous metal pillar augmentation can be considered as a valuable and easy-to-use method for the management of tibial bone defects in primary TKA.
What do medical students and their clinical preceptors understand by primary health care in South Africa? A qualitative study
Authors: Mabuza Langalibalele Honey , Moshabela Mosa
Published: October 2023

Background

The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient’s first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools.

Methods

A qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4–6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software.

Results

Four themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient’s first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC.

Conclusions

Medical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC.
The effect of a simulation-based training program in basic life support on the knowledge of Palestinian nurses: a quasi-experimental study in governmental hospitals
Authors: Fahajan Yousef , Emad Osama J. , Albelbeisi Ahmed Hassan , Albelbeisi Ali , Shnena Yasmin Abu , Khader Ayda , Kakemam Edris
Published: October 2023

Background

Basic Life Support (BLS) plays an important role in increasing the survival rate of hospitalized heart attack patients. There are no previous studies on the effect of BLS training among Palestinian nurses. This study aimed to evaluate the effect of simulation-based BLS training program on nurses’ knowledge Palestinian nurses at governmental hospitals.

Methods

A quasi-experimental, pre & post-test design was used. 700 nurses were recruited proportionally using a simple random sampling method among 2980 nurses from 13 public hospitals in the Gaza Strip. This study was conducted from June to August 2022. A practical BLS test consisting of 10 multiple-choice questions according to American Heart Association guidelines (2020) was collected and sociodemographic characteristics. SPSS software, version 24 was used for the statistical analysis. Descriptive statistics and weighted mean were used. T-Test and One-way analysis of variance (ANOVA) were applied to determine differences in means among groups.

Results

Most of the participating nurses (55.7%) were male, while (44.3%) were female. The majority of nurses (84.4%) are under 40 years of age. The weighted mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was (6.16 ± 1.97). After applying conventional BLS training, the weighted mean scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The study revealed that the nurses’ knowledge increased after applying simulation-based training program. The mean of knowledge scores was statistically significant between the pre and post-test on the basis of the current work hospital (P-value < 0.001).

Conclusion

This study affords significant evidence of the positive effects of the BLS training program in improving nurses’ knowledge; we recommend advanced BLS training for all healthcare providers, doctors, and nurses working in hospitals and healthcare centers. Nursing managers can implement systematic strategies to enhance nurses’ knowledge and practice in BLS to target low-scoring Governorates.
Intermittent hypoxia therapy ameliorates beta-amyloid pathology via TFEB-mediated autophagy in murine Alzheimer's disease
Authors: Wang Xueting , Xie Yuqi , Chen Guijuan , Lu Yapeng , Wang Dan , Zhu Li
Published: October 2023

Background

Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder. Impaired autophagy in plaque-associated microglia (PAM) has been reported to accelerate amyloid plaque deposition and cognitive impairment in AD pathogenesis. Recent evidence suggests that the transcription factor EB (TFEB)-mediated activation of the autophagy–lysosomal pathway is a promising treatment approach for AD. Moreover, the complementary therapy of intermittent hypoxia therapy (IHT) has been shown to upregulate autophagy and impart beneficial effects in patients with AD. However, the effect of IHT on PAM remains unknown.

Methods

8-Month-old APP/PS1 mice were treated with IHT for 28 days. Spatial learning memory capacity and anxiety in mice were investigated. AD pathology was determined by the quantity of nerve fibers and synapses density, numbers of microglia and neurons, Aβ plaque deposition, pro-inflammatory factors, and the content of Aβ in the brain. TFEB-mediated autophagy was determined by western blot and qRT-PCR. Primary microglia were treated with oligomeric Aβ 1–42 (oAβ) combined with IHT for mechanism exploration. Differential genes were screened by RNA-seq. Autophagic degradation process of intracellular oAβ was traced by immunofluorescence.

Results

In this study, we found that IHT ameliorated cognitive function by attenuating neuronal loss and axonal injury in an AD animal model (APP/PS1 mice) with beta-amyloid (Aβ) pathology. In addition, IHT-mediated neuronal protection was associated with reduced Aβ accumulation and plaque formation. Using an in vitro PAM model, we further confirmed that IHT upregulated autophagy-related proteins, thereby promoting the Aβ autophagic degradation by PAM. Mechanistically, IHT facilitated the nuclear localization of TFEB in PAM, with TFEB activity showing a positive correlation with Aβ degradation by PAM in vivo and in vitro. In addition, IHT-induced TFEB activation was associated with the inhibition of the AKT–MAPK–mTOR pathway.

Conclusions

These results suggest that IHT alleviates neuronal damage and neuroinflammation via the upregulation of TFEB-dependent Aβ clearance by PAM, leading to improved learning and memory in AD mice. Therefore, IHT may be a promising non-pharmacologic therapy in complementary medicine against AD.

Graphical Abstract
Saharan dust induces NLRP3-dependent inflammatory cytokines in an alveolar air-liquid interface co-culture model
Authors: Bredeck Gerrit , Dobner Jochen , Stahlmecke Burkhard , Fomba Khanneh Wadinga , Herrmann Hartmut , Rossi Andrea , Schins Roel P. F.
Published: October 2023

Background

Epidemiological studies have related desert dust events to increased respiratory morbidity and mortality. Although the Sahara is the largest source of desert dust, Saharan dust (SD) has been barely examined in toxicological studies. Here, we aimed to assess the NLRP3 inflammasome-caspase-1-pathway-dependent pro-inflammatory potency of SD in comparison to crystalline silica (DQ12 quartz) in an advanced air-liquid interface (ALI) co-culture model. Therefore, we exposed ALI co-cultures of alveolar epithelial A549 cells and macrophage-like differentiated THP-1 cells to 10, 21, and 31 µg/cm² SD and DQ12 for 24 h using a Vitrocell Cloud system. Additionally, we exposed ALI co-cultures containing caspase (CASP)1−/− and NLRP3−/− THP-1 cells to SD.

Results

Characterization of nebulized DQ12 and SD revealed that over 90% of agglomerates of both dusts were smaller than 2.5 μm. Characterization of the ALI co-culture model revealed that it produced surfactant protein C and that THP-1 cells remained viable at the ALI. Moreover, wild type, CASP1−/−, and NLRP3−/− THP-1 cells had comparable levels of the surface receptors cluster of differentiation 14 (CD14), toll-like receptor 2 (TLR2), and TLR4. Exposing ALI co-cultures to non-cytotoxic doses of DQ12 and SD did not induce oxidative stress marker gene expression. SD but not DQ12 upregulated gene expressions of interleukin 1 Beta (IL1B), IL6, and IL8 as well as releases of IL-1β, IL-6, IL-8, and tumor necrosis factor α (TNFα). Exposing wild type, CASP1−/−, and NLRP3−/− co-cultures to SD induced IL1B gene expression in all co-cultures whereas IL-1β release was only induced in wild type co-cultures. In CASP1−/− and NLRP3−/− co-cultures, IL-6, IL-8, and TNFα releases were also reduced.

Conclusions

Since surfactants can decrease the toxicity of poorly soluble particles, the higher potency of SD than DQ12 in this surfactant-producing ALI model emphasizes the importance of readily soluble SD components such as microbial compounds. The higher potency of SD than DQ12 also renders SD a potential alternative particulate positive control for studies addressing acute inflammatory effects. The high pro-inflammatory potency depending on NLRP3, CASP-1, and IL-1β suggests that SD causes acute lung injury which may explain desert dust event-related increased respiratory morbidity and mortality.
Pure platelet-rich plasma promotes semaphorin-3A expression: a novel insight to ameliorate intervertebral disk degeneration in vitro
Authors: Huang Jie , Lian Shi-lin , Han Jia-heng , Lu Zheng-cao , Ding Yu
Published: October 2023

Introduction

Intervertebral disk degeneration (IVDD) can be effectively treated using platelet-rich plasma (PRP). While the exact process is fully understood, it is believed that using pure PRP (P-PRP) without leukocytes is a better option for preventing IVDD. Semaphorin-3A (Sema3A), an inhibitor of angiogenesis and innervation, is essential for preserving IVDD’s homeostasis. Whether PRP prevents IVDD by modifying Sema3A has yet to receive much research. This work aims to clarify how P-PRP affects Sema3A when IVDD develops in vitro.

Methods

Nucleus pulposus cells (NPCs) isolated from 8-week-old male Sprague-Dawley rats were exposed to 10 ng/ml IL-1β and then treated with P-PRP or leukocyte platelet-rich plasma (L-PRP) in vitro, followed by measuring cell proliferation, apoptosis and microstructures, inflammatory gene and Sema3A expression, as well as anabolic and catabolic protein expression by immunostaining, quantitative real-time polymerase chain reaction (qPCR), western blot, and enzyme-linked immunosorbent assay (ELISA).

Results

In comparison with L-PRP, P-PRP had a higher concentration of growth factors but a lower concentration of inflammatory substances. P-PRP increased the proliferation of NPCs, while IL-1 relieved the amount of apoptosis due to its intervention. Anabolic genes, aggrecan, and collagen II had higher expression levels. MMP-3 and ADAMTS-4, two catabolic or inflammatory genes, showed lower expression levels. Sema3A activity was enhanced after P-PRP injection, whereas CD31 and NF200 expression levels were suppressed.

Conclusions

P-PRP enhanced the performance of NPCs in IVDD by modifying the NF-κB signaling pathway and encouraging Sema3A expression, which may offer new therapy options for IVDD.

The translational potential of this article

The findings provide a new therapeutic target for the treatment of IVDD and show a novel light on the probable mechanism of PRP and the function of Sema3A in the progression of IVDD.
Bad research is not all bad
Authors: Hamilton Fergus , Arnold David , Lilford Richard
Published: October 2023

In this commentary, we discuss a recent article in Trials that raised concerns about the number of poorly performed randomised trials in the medical literature and discuss the trials literature more widely. Although we all aim for higher methodological standards in trials, we argue that (i) the idea that ‘most randomised trials are bad’, which the recent article concludes is an overly simplistic representation of the situation, and (ii) the suggestion that an increased focus on methodological review during trial development (e.g. ethical boards performing some assessment of the methodologists on a trial), while well meaning, may have negative unintended consequences. We therefore propose that (a) trials should be assessed on their merits and weaknesses, including an assessment of risk of bias but placing that in a wider context; (b) we should recognise that although the methodological conduct of trials is of utmost importance, interventions that aim to improve this could have unintended consequences—such as bureaucracy—that have an overall negative effect; and (c) we should therefore generate an evidence base for policy interventions to improve conduct of trials rather than applying arbitrary rules.
Trichinella spiralis excretory/secretory products from adult worms inhibit NETosis and regulate the production of cytokines from neutrophils
Authors: Wang Jing , Tang Bin , You Xihuo , Cai Xuepeng , Jia Wanzhong , Liu Xiaolei , Liu Mingyuan , Jin Xuemin , Ding Jing
Published: October 2023

Upon encountering exogenous pathogens, polymorphonucleocytes (PMNs) engage in various processes to destroy them, including releasing neutrophil extracellular traps (NETs) that trap pathogens and induce phagocytosis and cytokine production. Parasites have unique strategies with which to evade the host's immune response. However, the strategy employed by Trichinella spiralis in response to the reaction of PMNs has yet to be elucidated. This study explored the effect of excretory/secretory products (ESP) on three major functions: NETs, phagocytosis, and cytokine production. Specifically, PMNs were pre-treated with the ESP of 3-day-old adults and then stimulated with phorbol 12-myristate 13-acetate (PMA). We found that in PMNs pretreated with ESP, PMA-induced NET generation was suppressed by ESP. ROS production is a hallmark of PMA-induced NETosis. The LDH assay results showed that ESP inhibits NETs by suppressing ROS rather than promoting PMN death. Furthermore, ESP enhanced Escherichia coli engulfment by PMNs, improving overall phagocytic function. Finally, cytokine analysis revealed an increase in pro-inflammatory cytokine IL-1β, and other cytokines (IL-10, TNF-α), while IL-4 displayed a significant reduction. In conclusion, this study has unraveled T. spiralis' evasion and regulation mechanisms against innate immune cells, providing insights into parasite strategies to manipulate host immunity, potentially informing new treatments for NET-related autoimmune diseases.

Graphical Abstract
Co-expression of distinct L1 retrotransposon coiled coils can lead to their entanglement
Authors: Mizgier Nikola A. , Jones Charlie E. , Furano Anthony V.
Published: October 2023

L1 (LINE1) non-LTR retrotransposons are ubiquitous genomic parasites and the dominant transposable element in humans having generated about 40% of their genomic DNA during their ~ 100 million years (Myr) of activity in primates. L1 replicates in germ line cells and early embryos, causing genetic diversity and defects, but can be active in some somatic stem cells, tumors and during aging. L1 encodes two proteins essential for retrotransposition: ORF2p, a reverse transcriptase that contains an endonuclease domain, and ORF1p, a coiled coil mediated homo trimer, which functions as a nucleic acid chaperone. Both proteins contain highly conserved domains and preferentially bind their encoding transcript to form an L1 ribonucleoprotein (RNP), which mediates retrotransposition. However, the coiled coil has periodically undergone episodes of substantial amino acid replacement to the extent that a given L1 family can concurrently express multiple ORF1s that differ in the sequence of their coiled coils. Here we show that such distinct ORF1p sequences can become entangled forming heterotrimers when co-expressed from separate vectors and speculate on how coiled coil entanglement could affect coiled coil evolution.