bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery
Authors: Mielewczyk Frances J , Boyle Elaine M
Published: July 2023

Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.

A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.

This review suggests that parents’ preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians’ opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.

This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
Malaysian burden of disease: years of life lost due to premature deaths
Authors: Khaw Wan-Fei , Chan Yee Mang , Nasaruddin Nur Hamizah , Alias Nazirah , Tan LeeAnn , Ganapathy Shubash Shander
Published: July 2023

Background

In Malaysia, the previous mortality burden has been a significant concern, particularly due to the high prevalence of noncommunicable diseases (NCDs) as the leading cause of death. Estimates of mortality are key indicators for monitoring population health and determining priorities in health policies and health planning. The aim of this study was to estimate the disease burden attributed to 113 major diseases and injuries in Malaysia in 2018 using years of life lost (YLL) method.

Methods

This study included all deaths that occurred in Malaysia in 2018. The YLL was derived by adding the number of deaths from 113 specific diseases and multiplying it by the remaining life expectancy for that age and sex group. Data on life expectancy and mortality were collected from the Department of Statistics Malaysia.

Results

In 2018, there were 3.5 million YLL in Malaysia. Group II (NCDs) caused 72.2% of total YLL. Ischaemic heart disease was the leading cause of premature mortality among Malaysians (17.7%), followed by lower respiratory infections (9.7%), road traffic injuries (8.7%), cerebrovascular disease (stroke) (8.0%), and diabetes mellitus (3.9%).

Conclusions

NCDs are a significant health concern in Malaysia and are the primary contributor to the overall burden of disease. These results are important in guiding the national health systems on how to design and implement effective interventions for NCDs, as well as how to prioritise and allocate healthcare resources. Key strategies to consider include implementing health promotion campaigns, adopting integrated care models, and implementing policy and regulatory measures. These approaches aim to enhance health outcomes and the managements of NCDs in Malaysia.
Does intramedullary nail have advantages over dynamic hip screw for the treatment of AO/OTA31A1-A3? A meta-analysis
Authors: Yu Fei , Tang Yang-Wei , Wang Ju , Lin Zhi-Cheng , Liu Yu-Bin
Published: July 2023

Background

Hip fractures are still unsolved problems nowadays. We evaluated the functional outcomes and complications in the treatment of hip fractures (AO/OTA31A1-A3) to find potential difference and risk between intramedullary nail (IMN) and dynamic hip screw (DHS).

Method

We searched PubMed, Embase, Cochrane library up to 19 June 2023 and retrieved any studies comparing IMN and DHS in treatment of Hip fractures. The main outcomes and complications were extracted from the included studies. The fixed-effect model was selected to pool the data for homogeneous studies (I2 < 50%). Otherwise, the random effects model was selected (heterogeneity, I2 > 50%). The analysis of sensitivity and subgroup was performed to explore the homogeneous studies among studies. The p-value of less than 0.05 was considered statistically significant.

Results

30 RCT studies were included in this meta-analysis. There were significant difference of in the items of blood loss, screening time, femoral neck shortening, non-union, and femoral fractures (p < 0.05). Significant difference was found in the parameter of open reduction of fracture after sensitive analysis (p < 0.05). No significant difference was found in the parameter of Mobility Score at the last follow-up after sensitive analysis (p ≥ 0.05). There was no significant difference in the parameters of open reduction of fracture, required blood transfusion, mean surgical time, hospital stays, time to healing, mean Harris Hip Score, infection, cut out, poor reduction, breakage of implant, failure of fixation, reoperation, and systemic complications of chest infection, decubital ulcer, urinary tract infection and persistent pain in the hip (p ≥ 0.05).

Conclusions

Our meta-analysis revealed that hip fractures treated with IMN have merits with lower rate of blood loss, femoral neck shortening and non-union; shortcoming of increased risk of femoral fractures. It is suggested that special attention should be paid to the risk of femoral fracture when intramedullary nail was inserted in the intraoperative.
Anticancer properties of red beetroot hydro-alcoholic extract and its main constituent; betanin on colorectal cancer cell lines
Authors: Saber Amir , Abedimanesh Nasim , Somi Mohammad-Hossein , Khosroushahi Ahmad Yari , Moradi Shima
Published: July 2023

Colorectal cancer (CRC) is the third most common type of cancer worldwide. Red beetroot (Beta vulgaris) contains Betanin as its major betacyanin, possessing wide proapoptotic effects. This study aimed to investigate the anticancer and pro-papoptotic effects of beetroot hydro-alcoholic extract (BHE) and betanin, on colorectal cancer cell lines. BHE and betanin were used to treat Caco-2 and HT-29 colorectal cancer cells. MTT assay, DAPI staining, and FACS-flow cytometry tests were used to determine the half-maximal inhibitory concentration (IC50) and apoptosis-inducing evaluations. Intended genes were assessed by real-time polymerase chain reaction (RT-PCR). The IC50 for HT-29 and Caco-2 cell lines were 92 μg/mL, 107 μg/mL for BHE, and 64 μg/mL, 90 μg/mL for betanin at 48 h, respectively. BHE and betanin significantly inhibited the growth of both cancer cell lines time and dose-dependently. DAPI staining and flow cytometry results revealed significant apoptosis symptoms in treated cancerous cell lines. The expression level of proapoptotic genes (BAD, Caspase-3, Caspase-8, Caspase-9, and Fas-R) in treated HT-29 and Caco-2 cells was higher than in untreated and normal cells. In contrast, the anti-apoptotic gene (Bcl-2) was significantly downregulated. BHE and betanin effectively inhibited cancer cell proliferation and induced apoptosis via the modification of effective genes.
The effect of training medical students in the community area in the midst of the Covid-19 pandemic in China: a community-based study
Authors: Li Ying , Pan YiYang , Ding XiWen , Aierken Ayizuhere , Jiang Wei
Published: July 2023

Background

Community practice training is an important part of education in medicine, public health, social medicine, and other disciplines. The objective of this study is to explore the effect and importance of the community practice of Master of Public Health graduates on community residents’ health during the Coronavirus Disease 2019 pandemic.

Methods

This study used a pretest-posttest design. A total of 152 participants with age ≥ 60 years were selected using a multistage sampling method from Hangzhou in China. Baseline and endline data were collected using structured questionnaires by face-to-face interviews. All psychological and behavioral measurements were performed using standardized instruments and showed good reliability and validity. A total of 147 participants were included in the analysis. The chi-square and rank sum tests were used to compare the difference between baseline and endline for categorical variables. Binary logistic regression analysis was used to evaluate the association between community practice training and changes in psychology and behavior.

Results

The result of chi-square test revealed a statistically significant difference in participants’ eating habits from baseline to endline. Participants reported that the self-perceived health status was different between endline and baseline by the rank sum test. The results of logistic regression analysis showed that community practice training was significantly associated with increased self-efficacy scores, cognitive function and eating habits, with odd ratios of 1.08, 0.90 and 1.93, respectively.

Conclusions

Community practice training was associated with changes in health behavior and psychology of community residents. Our results suggested enhanced community practice training for students under the Master of Public Health program.
Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
Authors: Baek Ae-Rin , Hong Sang-Bum , Bae Soohyun , Park Hye Kyeong , Kim Changhwan , Lee Hyun-Kyung , Cho Woo Hyun , Kim Jin Hyoung , Chang Youjin , Lee Heung Bum , Gil Hyun-Il , Shin Beomsu , Yoo Kwang Ha , Moon Jae Young , Oh Jee Youn , Min Kyung Hoon , Jeon Kyeongman , Baek Moon Seong ,   and the Korean HAP/VAP Study Group
Published: July 2023

Background

Although the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.

Methods

This multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.

Results

Of 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).

Conclusions

After the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed.
Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial
Authors: Térémetz Maxime , Hamdoun Sonia , Colle Florence , Gerardin Eloïse , Desvilles Claire , Carment Loïc , Charron Sylvain , Cuenca Macarena , Calvet David , Baron Jean-Claude , Turc Guillaume , Maier Marc A. , Rosso Charlotte , Mas Jean-Louis , Lindberg Påvel G.
Published: July 2023

Objective

To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke.

Methods

A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after–before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation.

Results

BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2–7] vs 4[2–7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[− 1–7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs − 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2–0.8 vs 0.2/0.1–0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015).

Conclusions

Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial.

Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered)
Cytomegalovirus drug resistance mutations in transplant recipients with suspected resistance
Authors: Recio Vanessa , González Irene , Tarragó David
Published: July 2023

Resistant CMV infections are challenging complications after SOT and HSCT. Prompt recognition of ARMs is imperative for appropriate therapy. 108 plasma samples from 96 CMV + transplant recipients with suspected resistance were analysed in CNM in a retrospective nationwide study from January 2018 to July 2022 for resistance genotyping. ARMs in UL97 and UL54 were found in 26.87% (18/67) and 10.60% (7/66) of patients, respectively. Patients’ ARM distribution in UL97 was as follows: L595S n = 3; L595S/M460I n = 1; L595S/N510S n = 1; L595W n = 1; C603W n = 4; A594V n = 3; A594E n = 1; C607Y n = 1; L397R/T409M/H411L/M460I n = 1; L397I n = 1; H520Q n = 1; four patients showed ARMs in UL54 as well (F412C n = 1; T503I n = 2; P522S n = 1), whereas three patients exhibited ARMs in UL54 only (L501I/T503I/L516R/A834P n = 1; A987G n = 2). L516R in UL54 and L397R/I and H411L in UL97 have been found for the first time in a clinical sample. L595S/W was the most prevalent ARM found to lend resistance to GCV. In UL54 all ARMs lent resistance to GCV and CDV. In addition, A834P, found in one patient, also lent resistance to FOS. CMV load did not differ significantly in patients with or without ARMs, and no differences were found either between patients with ARMs in UL97 or in UL97 and UL54. Despite extensive use of classical antivirals for the treatment of CMV infection after HSCT and SOT, ARMs occurred mainly in viral UL97 kinase, which suggests that CDV and mostly FOS continue to be useful alternatives to nucleoside analogues after genotypic detection of ARMs.
Aged mesenchymal stem cells and inflammation: from pathology to potential therapeutic strategies
Authors: Yang Xue , Wang Ying , Rovella Valentina , Candi Eleonora , Jia Wei , Bernassola Francesca , Bove Pierluigi , Piacentini Mauro , Scimeca Manuel , Sica Giuseppe , Tisone Giuseppe , Mauriello Alessandro , Wei Lixin , Melino Gerry , Shi Yufang
Published: July 2023

Natural ageing of organisms and corresponding age-related diseases result mainly from stem cell ageing and “inflammaging”. Mesenchymal stem cells (MSCs) exhibit very high immune-regulating capacity and are promising candidates for immune-related disease treatment. However, the effect of MSC application is not satisfactory for some patients, especially in elderly individuals. With ageing, MSCs undergo many changes, including altered cell population reduction and differentiation ability, reduced migratory and homing capacity and, most important, defective immunosuppression. It is necessary to explore the relationship between the “inflammaging” and aged MSCs to prevent age-related diseases and increase the therapeutic effects of MSCs. In this review, we discuss changes in naturally ageing MSCs mainly from an inflammation perspective and propose some ideas for rejuvenating aged MSCs in future treatments.
Why do older adults decline participation in research? Results from two deprescribing clinical trials
Authors: Strayer Thomas E. , Hollingsworth Emily K. , Shah Avantika S. , Vasilevskis Eduard E. , Simmons Sandra F. , Mixon Amanda S.
Published: July 2023

Background

Heterogenous older adult populations are underrepresented in clinical trials, and their participation is necessary for interventions that directly target them. The purpose of this study was to evaluate reasons why hospitalized older adults declined participation in two deprescribing clinical trials.

Methods

We report enrollment data from two deprescribing trials, Shed-MEDS (non-Veterans) and VA DROP (Veterans). For both trials, inclusion criteria required participants to be hospitalized, age 50 or older, English-speaking, and taking five or more home medications. Eligible patients were approached for enrollment while hospitalized. When an eligible patient or surrogate declined participation, the reason(s) were recorded and subsequently analyzed inductively to develop themes, and a chi-square test was used for comparison (of themes between Veterans and non-Veterans).

Results

Across both trials, 1226 patients (545 non-Veterans and 681 Veterans) declined enrollment and provided reasons, which were condensed into three themes: (1) feeling overwhelmed by their current health status, (2) lack of interest or mistrust of research, and (3) hesitancy to participate in a deprescribing study. A greater proportion of Veterans expressed a lack of interest or mistrust in research (42% vs 26%, chi-square value = 36.72, p < .001), whereas a greater proportion of non-Veterans expressed feeling overwhelmed by their current health status (54% vs 35%, chi-square value = 42.8 p < 0.001). Across both trials, similar proportion of patients expressed hesitancy to participate in a deprescribing study, with no significant difference between Veterans and non-Veterans (23% and 21%).

Conclusions

Understanding the reasons older adults decline participation can inform future strategies to engage this multimorbid population.
Failure of diltiazem to prevent 1:1 conduction of atrial flutter: a case report
Authors: Tiver K. D. , Martin D. K. , Quah J. , Lahiri A. , Ganesan A. N.
Published: July 2023

Background

Atrial flutter with 1:1 conduction to the ventricles is a dangerous cardiac arrhythmia. Contemporary guidelines recommend atrioventricular nodal blocking agents should be co-administered with class 1C anti-arrhythmics, as prophylaxis against 1:1 flutter. No guidance is provided on the type or strength of atrioventricular nodal blockade required, and in practice, these agents are frequently prescribed at low dose, or even omitted, due to their side effect profile.

Case presentation

A 62 year old Caucasian man with a history of paroxysmal atrial fibrillation treated with flecainide, presented with atrial flutter with 1:1 conduction to the ventricles and was cardioverted. Diltiazem was added to prevent this complication and he again presented with atrial flutter with 1:1 conduction to the ventricles, despite prophylaxis with coadministration of diltiazem.

Conclusions

This case report demonstrates failure of diltiazem to prevent 1:1 flutter in a patient chronically treated with flecainide for paroxysmal atrial fibrillation.
Bladder carcinosarcoma treated by cystectomy and adjuvant chemotherapy with good outcomes: a case report
Authors: Kouhen Fadila , Dahbi Zineb , Afif Mohammed , Chihabeddine Meriem , Errafiy Nadia , Oqbani Kenza , Omor Youssef , Elhossini Amal
Published: July 2023

Background

Primary carcinosarcoma of the bladder is a rare and highly aggressive tumor, representing less than 1% of all bladder neoplasms. There is no specific treatment guideline has for carcinosarcoma of the bladder, and majority of published patients was treated exclusively by surgery.

Case presentation

We report a case of 65-year-old Moroccan man, presented with macroscopic hematuria, pollakiuria and painful urination. Histological analysis showed a biphasic epithelial and mesenchymal proliferation, with invasion of lamina propria and muscularis, compatible with diagnosis of bladder carcinosarcoma. The patient was treated with cystectomy and adjuvant chemotherapy based on gemcitabin-cisplatin, 18 months after treatment, patient still free of recurrence.

Conclusion

Carcinosarcoma of the urinary bladder is a rare and aggressive tumor regardless treatment. A multidisciplinary management based on radical cystectomy and combined adjuvant treatments can improve prognosis. In this work, we suggest to propose adjuvant chemotherapy whenever possible.
Effects of a Low-Carbohydrate-High-Protein Pre-Exercise Meal in Type 1 Diabetes—a Randomized Crossover Trial
Authors: Kristensen Kasper B , Ranjan Ajenthen G , McCarthy Olivia M , Holst Jens J , Bracken Richard M , Nørgaard Kirsten , Schmidt Signe
Published: July 2023

Context

Current guidelines for exercise-related glucose management focus on reducing bolus and/or basal insulin doses and considering carbohydrate intake. Yet far less attention has been paid to the potential role of other macronutrients alongside carbohydrates on glucose dynamics around exercise.

Objective

To investigate the effects of a low-carbohydrate-high-protein (LCHP) compared with a high-carbohydrate-low-protein (HCLP) pre-exercise meal on the metabolic, hormonal, and physiological responses to exercise in adults with insulin pump–treated type 1 diabetes.

Methods

Fourteen adults (11 women, 3 men) with insulin pump–treated type 1 diabetes (median [range] HbA1c of 50 [43-59] mmol/mol (6.7% [6.1%-7.5%]), age of 49 [25-65] years, and body mass index of 24.0 [19.3-27.1] kg/m2) completed an unblinded, 2-arm, randomized, crossover study. Participants ingested isocaloric meals that were either LCHP (carbohydrate 21%, protein 52%, fat 27%) or HCLP (carbohydrate 52%, protein 21%, fat 27%) 90 minutes prior to undertaking 45 minutes of cycling at moderate intensity. Meal insulin bolus was dosed according to meal carbohydrate content but reduced by 25%. Basal insulin rates were reduced by 35% from meal ingestion to end of exercise.

Results

Around exercise the coefficient of variability was lower during LCHP (LCHP: 14.5 ± 5.3 vs HCLP: 24.9 ± 7.7%, P = .001). Over exercise, LCHP was associated with a lesser drop (LCHP: Δ−1.49 ± 1.89 vs HCLP: Δ−3.78 ± 1.95 mmol/L, P = .001). Mean insulin concentration was 30% lower during exercise for LCHP compared with HCLP (LCHP: 25.5 ± 11.0 vs HCLP: 36.5 ± 15.9 mU/L, P < .001).

Conclusion

Ingesting a LCHP pre-exercise meal lowered plasma glucose variability around exercise and diminished the drop in plasma glucose over exercise.
ZnUMBA – a live imaging method to detect local barrier breaches
Authors: Higashi Tomohito , Stephenson Rachel E. , Schwayer Cornelia , Huljev Karla , Higashi Atsuko Y. , Heisenberg Carl-Philipp , Chiba Hideki , Miller Ann L.
Published: July 2023

Epithelial barrier function is commonly analyzed using transepithelial electrical resistance, which measures ion flux across a monolayer, or by adding traceable macromolecules and monitoring their passage across the monolayer. Although these methods measure changes in global barrier function, they lack the sensitivity needed to detect local or transient barrier breaches, and they do not reveal the location of barrier leaks. Therefore, we previously developed a method that we named the zinc-based ultrasensitive microscopic barrier assay (ZnUMBA), which overcomes these limitations, allowing for detection of local tight junction leaks with high spatiotemporal resolution. Here, we present expanded applications for ZnUMBA. ZnUMBA can be used in Xenopus embryos to measure the dynamics of barrier restoration and actin accumulation following laser injury. ZnUMBA can also be effectively utilized in developing zebrafish embryos as well as cultured monolayers of Madin–Darby canine kidney (MDCK) II epithelial cells. ZnUMBA is a powerful and flexible method that, with minimal optimization, can be applied to multiple systems to measure dynamic changes in barrier function with spatiotemporal precision.
Risk-Adapted Intraoperative Radiation Therapy (IORT) for Breast Cancer: A Novel Analysis
Authors: Silverstein Melvin J. , Kim Brian , Lin Kevin , Lloyd Shane , Snyder Lincoln , Khan Sadia , Kramme Katherine , Chen Peter
Published: July 2023

Background

Randomized trials have shown that risk-adapted intraoperative radiation therapy (IORT) after breast-conserving surgery for low-risk breast cancer patients is a safe alternative to whole-breast radiation therapy (WBRT). The risk-adapted strategy allows additional WBRT for predefined high-risk pathologic characteristics discovered on final histopathology. The greater the percentage of patients receiving WBRT, the lower the recurrence rate. The risk-adapted strategy, although important and necessary, can make IORT appear better than it actually is.

Methods

Risk-adapted IORT was used to treat 1600 breast cancers. They were analyzed by the intention-to-treat method and per protocol to better understand the contribution of IORT with and without additional whole-breast treatment. Any ipsilateral breast tumor event was considered a local recurrence.

Results

During a median follow-up period of 63 months, local recurrence differed significantly between the patients who received local treatment and those who received whole-breast treatment. For 1393 patients the treatment was local treatment alone. These patients experienced 79 local recurrences and a 5-year local recurrence probability of 5.95 %. For 207 patients with high-risk final histopathology, additional whole-breast treatment was administered. They experienced two local recurrences and a 5-year local recurrence probability of 0.5 % (p = 0.0009).

Conclusions

Whole-breast treatment works well at reducing local recurrence, and it is a totally acceptable and necessary addition to IORT as part of a risk-adapted program. However, the more whole-breast treatment that is given, the more it dilutes the original plan of simplifying local treatment and the less we understand exactly what IORT contributes to local control as a stand-alone treatment.
Hilbert and Poincaré problems for semi-linear equations in rectifiable domains
Authors: Ryazanov Vladimir
Published: July 2023

The study of the boundary value problem with arbitrary
measurable data originated in the dissertation of Luzin where
he investigated the Dirichlet problem for harmonic functions in the unit
disk.
Recently, in \cite{R7}, we studied the Hilbert, Poincaré and Neumann
boundary value problems with arbitrary measurable data for
generalized analytic and generalized harmonic functions and provided
applications to relevant problems in mathematical physics.
The present paper is devoted to the study of the boundary value
problem with arbitrary measurable boundary data in a domain with
rectifiable boundary corresponding to semi-linear equation with
suitable nonlinear source. We construct a completely continuous
operator and generate nonclassical solutions to the Hilbert and
Poincaré boundary value problems with arbitrary measurable data for
Vekua type and Poisson equations, respectively. Based on that, we
prove the existence of solutions of the Hilbert boundary value
problem for the nonlinear Vekua type equation with arbitrary
measurable data in a domain with rectifiable boundary.
It is necessary to point out that our approach differs from the
classical variational approach in PDE as it is based on the
geometric interpretation of boundary values as angular (along
non-tangential paths) limits.
The latter makes it possible to also obtain a theorem on the
boundary value problem for directional derivatives,
and, in
particular, of the Neumann problem with arbitrary measurable
data for the Poisson equation with nonlinear sources in any Jordan
domain with rectifiable boundary.
As a result we arrive at applications to some problems of
mathematical physics.
Organizing Data Analytics
Authors: Alonso Ricardo , Câmara Odilon
Published: July 2023

We develop a theory of credible skepticism in organizations to explain the main tradeoffs in organizing data generation, analysis, and reporting. In our designer-agent-principal game, the designer selects the information privately observed by the agent who can misreport it at a cost, whereas the principal can audit the report. We study three organizational levers: tampering prevention, tampering detection, and the allocation of the experimental-design task. We show that motivating informative experimentation while discouraging misreporting are often conflicting organizational goals. To incentivize experimentation, the principal foregoes a flawless tampering detection/prevention system and separates the tasks of experimental design and analysis.

This paper was accepted by Alfonso Gambardella, business strategy.

Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2023.00207 .
Long-term Survival after Femoral Anterior Rotational Osteotomy for Late-onset Legg-Calvé-Perthes Disease: A Case Report with 27-year Follow-up ?
Authors: Ikegami Akira , Oka Yoshinobu , Yamazoe Shoichi , Takahashi Kenji
Published: July 2023

Introduction: The purpose of treatment for Legg-Calvé-Perthes disease (LCPD) is to regain the sphericity of the femoral head in childhood and prevent degenerative changes in adulthood. Due to the largely unsatisfactory results of conservative treatment for late-onset LCPD (i.e. patient age >9 years.), surgery is generally indicated. Various surgeries have been applied and the reported short-term results are generally good. However, few reports have described the long-term (approximately 30 years) outcomes of femoral anterior rotational osteotomy (ARO). We herein report the long-term results of late-onset LCPD treated by femoral ARO. Case Report: This report describes a boy and a girl with LCPD who underwent surgical treatment at the ages of 12 and 11 years, respectively. Conservative treatment with a brace had initially been applied, but the patients subsequently developed hinge abduction; therefore, we performed femoral ARO. Five-year postoperatively, the patients’ Stulberg classification was Class II and Class III, respectively. The clinical results were satisfactory after 27 years of follow-up. Slight anterior residual deformity was seen, but there were no degenerative changes. Conclusion: In patients with hinge abduction, it is difficult to achieve good containment by conservative treatment, and even by surgical treatment, degenerative changes can occur in the early post-operative period. In severe cases of late-onset LCPD, a femoral ARO is performed, effectively transferring the viable posterior area of the femoral head onto the weight-bearing area. Maintaining good sphericity of the femoral head helps to prevent degenerative change and leads good long-term results. Both patients described in this report were asymptomatic and did not show any signs of degenerative change upon final examination. We did, however, confirm that the anterior head-neck junction exhibited residual deformity. ARO is a proven effective option for treating late-onset severe LCPD. Keywords: Legg-calvé-perthes disease, anterior rotational osteotomy, hinge abduction, late onset.
Ultrasound-guided Percutaneous Lavage as Treatment for Pellegrini-Stieda Syndrome with Suspected Same Patho-mechanism as Rotator Cuff Syndrome: A Case Report
Authors: Rizky Dio Asgira , Lee Kevin , Sulaeman Wendell Sebastian , Butarbutar John Christian Parsaoran , Suginawan Earlene Tasya
Published: July 2023

Introduction: Pellegrini-Stieda syndrome is described as pain and restriction at the range of motion caused by calcification in the medial collateral ligament (MCL) around the knee with the recognized radiographic findings of the lesion in the affected site. The pathomechanism of Pellegrini-Stieda is suspected to be similar as calcification of the rotator cuff that is thought to be reactive calcification followed by resorption and tendon remodeling involving four phases (pre-calcific, formative, resorptive, and healing) without any trauma history. Since the calcium deposit in the rotator cuff has been well managed by percutaneous lavage, in this case report, we assumed that the pathomechanism of Pellegrini-Stieda Syndrome is similar to calcification of the rotator cuff, thus can be treated with the same principle using ultrasound-guided percutaneous lavage (UGPL). Objective: The aim of the study was to discuss UGPL as management for Pellegrini-Stieda with suspected similar pathomechanism to rotator cuff calcification. Case Report: A 52-year-old woman came to the outpatient clinic with a week of severe pain in her right knee. The patient had difficulty walking due to stiffness and pain that is aggravated by moving her knee. Radiographic examination confirmed calcified lesions located within the MCL on the right knee. In consideration of the acute pain, we opted to perform UGPL procedure. Follow-ups were done 1 week and 1 month after the procedure. The patient reported no pain when walking and bending her knee during the follow-up examination and there was no complication noted. Overall, she was very satisfied with the result. We also interviewed her for the lower extremity functional scale Score which the patient gave 64 points and 72 points out of 80 for week 1 and 1 month, respectively, indicating favorable results. Conclusion: Based on our case, UGPL can be an option for treating Pellegrini-Stieda Syndrome because it produces the same result as UGPL on rotator cuff calcification. Surgery should be the last resort if this procedure fails. Future high-quality randomized controlled trials were required to determine the reliability of this method. Keywords: Pellegrini-stieda, pellegrini-stieda syndrome, ultrasound-guided percutaneous lavage.
Realization of an optical nanostructure 4×1  multiplexer based on metal-insulator-metal plasmonic waveguides
Authors: Abdulwahid Saif H. , Wadday Ahmed Ghanim , Ali Faris Mohammed , Hamza Bashar J. , Al-Shamani Ali Najah
Published: July 2023

The optical multiplexer was created at a nanoscale plasmonic structure
utilizing the finite element method (FEM) with COMSOL version 5.5
software to enable maximum light confinement, high-speed optical
systems, and a tiny structure. The metal-insulator-metal technology at
a nanoscale dimension is used for creating the 4×1 multiplexer. In this design, the
transmission threshold (Tthreshold) is selected to be 100% for
separating between logic “1” and logic “0” at a 1310 nm
operating wavelength. The modulation depth (MD), contrast ratio (CR),
and insertion loss (IL) characteristics were explained to evaluate the
performance of the multiplexer. The CR has 3.48 dB, the MD
offers an ideal performance with 95.28 %, and the IL has
3.31 dB.
Phase retrieval using Gaussian basis functions
Authors: Bahk Seung-Whan
Published: July 2023

A wavefront map of arbitrary aperture can be represented by a sum of Gaussian basis functions. Its performance is compared here to other representation methods such as orthonormal polynomials and Fourier modes. Gaussian basis functions can be applied to phase retrieval of high-frequency wavefront maps. Experiments show good agreement with direct measurements by a wavefront sensor. Optimum measurement conditions are discussed based on the statistics of wavefront properties.
Magneto-optical engineering by plasmonic and dielectric metasurfaces in a CoFeB perforated microstructure
Authors: Shnan N. S. , Roostaei N. , Hamidi S. M.
Published: July 2023

We have investigated theoretically and experimentally the effect of plasmonic and all-dielectric metasurfaces on the magneto-optical response of the 2D periodic structure. For this purpose, we fabricate polydimethylsiloxane-based 2D microstructures. So, we coated them with a gold layer and a TiO2 dielectric layer as plasmonic and dielectric metasurfaces, respectively, CoFeB as the prominent magneto-optical thin films. We record the spectral magneto-optical longitudinal Kerr effect under 40 mT, and the spectrometer’s response in all visible regions. Our results show that the electric and magnetic dipole moments enhance the magneto-optical response by factors of one and two in two closer channels in 650 and 660 nm in an all-dielectric structure, respectively. The plasmonic hot spot-based magneto-optical enhancement is also confirmed in two other media with an enhancement factor of two.
Wide bandwidth THz emission based on two color chirped laser plasma interaction
Authors: Saeed Masoud , Khorsandi Alireza
Published: July 2023

This study examined the impact of chirping the input pulses on the amplification of a wide bandwidth THz wave emitted from a plasma slab within a range of input wavelengths from 800 nm to 3.9 µm. It was found that in a normal case of interaction when the injected pulses are highly chirped, flowerthorn-like fluctuations raised in the transverse current density of the plasma, and a THz emission with a higher amplitude within a wide band of 50 THz could be reached. Employing the cross-focusing scheme, the amplitude of the THz wave at 3.9 µm is further enhanced to about 43 times the ones obtained at 800 nm when the two-color pulses are weakly chirped down to 3 × 10−4 rad/s2. A significant increase of 233 times received in THz radiation when a weakly-chirped regime of delayed cross-focusing interaction is established and the intensity of the delayed pulse is increased to 1015 W/cm2, beyond the ionization threshold of Argon gas. The profile change of the fundamental and its second-harmonic waves indicated that a flat-top form is capable of enhancing the THz amplitude approximately by 8 times compared to the case when an ordinary Gaussian profile is used. The obtained results have confirmed that a combination of the type of interaction, chirp value, and the profile of inputs is crucial for enlarging the THz magnitude and domain.
Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approach
Authors: Okiah Lindah , Olowo Samuel , Iramiot Stanely J. , Nekaka Rebecca , Ssenyonga Lydia V. N.
Published: July 2023

Introduction

Epilepsy has been found to affect caregivers’ quality of life, lifestyle, psychological health, social well-being, and working time. Caregivers in Uganda as in the rest of the world are important in assisting a person with epilepsy in complying with medical directions and are actively involved in communicating with healthcare professionals. Little is known about the lived experiences of caregivers of persons afflicted with epilepsy in Uganda. The purpose of this study was to determine the lived experiences of caregivers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital, eastern Uganda.

Methods and materials

The caregivers’ lived experiences were elicited directly from them and their health workers who work with them in the care of the patients. Forty participants which consisted of 30 caregivers and 10 key informant health workers were selected for the study through purposive sampling. Face-to-face in-depth interviews with an unstructured interview guide were conducted to gather participants’ information. The principal investigator conceptualized the interview guide, the guide was then reviewed by co-investigators, and revised and approved as the final data collection instrument after an extensive and comprehensive literature review. The interview guide comprised two sections; the first section comprised the questions that elicited the participants’ social-demographic information. The second section comprised questions that explored caregivers’ experiences of persons afflicted with epilepsy. Notations were taken and a digital recorder was used purposely for audio recordings. All interviews lasted for an hour and were audio-recorded with the participant’s consent. An inductive thematic analysis was employed and adopted to identify the patterns emerging from the texts.

Results

The caregivers majorly perceived epilepsy as a burden. Four main themes were revealed from the analysis and these are: psychological burdens which included, worries about the future of the patient, being looked down upon; social burdens which entailed, affected public relations, feelings of stigma; an economic burden which included interference with the source of income, affected productivity at work; and physical burdens which included, Feelings of uneasiness and disrupted sleep among others.

Conclusion

The caregivers majorly perceived epilepsy as a serious burden. This burden can be psychological, social, economic, and physical. Therefore, services and plans targeting patients with epilepsy need to consider the burden that caregivers encounter to comprehensively manage epilepsy.
Determinants of undernutrition and overnutrition among reproductive-age women in Bangladesh: Trend analysis using spatial modeling
Authors: Vatsa Richa , Ghimire Umesh , Yasmin Khaleda , Hasan Farhana Jesmine
Published: July 2023

Background

Bangladesh is facing a dual burden of malnutrition, with high rates of undernutrition and increasing rates of overnutrition. The complex scenario of malnutrition in Bangladesh varies across different regions, making it a challenging public health concern to address.

Objectives

This study analyzes the spatial and temporal dependence of underweight and overweight Bangladeshi women of reproductive age.

Methods

Nationally representative cross-sectional data from the Bangladesh Demographic and Health Surveys in 2014 and 2017–18 were utilized to study the changes in weight status in 15–49-year-old women who were either underweight or overweight. A Bayesian geo-additive regression model was used to account for non-linear and linear effects of continuous and categorical covariates and to incorporate spatial effects of geographical divisions.

Results

The prevalence of overweight or obese women in rural, city corporations, and other urban areas increased significantly over the four years from 2014 to 2017–18. Women in the categories ‘richer’ and ‘richest’ were more likely to be overweight or obese. Women from Sylhet were more likely to be underweight in both survey years; however, the spatial effects were significant for underweight women in Mymensingh for the year 2017–18. Women in Rajshahi and Khulna were more likely to be overweight or obese in 2014, and women from Barishal and Chittagong were more likely to be overweight in the year 2017–18.

Conclusions

Underweight and overweight statuses in women vary unevenly across Bangladesh, with a substantially higher prevalence of overweight or obese women in more urbanized areas. The growing burden of overweight and obesity among Bangladeshi women should be addressed with interventions aimed at those in the reproductive age group.
Improving continence management for people with dementia in the community in Aotearoa, New Zealand: Protocol for a mixed methods study
Authors: Burholt Vanessa , Peri Kathryn , Awatere Sharon , Balmer Deborah , Cheung Gary , Daltrey Julie , Fearn Jaime , Gibson Rosemary , Kerse Ngaire , Lawrence Anna Michele , Moeke-Maxwell Tess , Munro Erica , Orton Yasmin , Pillai Avinesh , Riki Arapera , Williams Lisa Ann
Published: July 2023

Background

The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions.

Methods and analysis

A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers’ study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources.