bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of blood meals from stable flies to evaluate the bovine leukemia virus infection status in cattle herds: a pilot study
Authors: Shimizu Kaori , Mori Chikahiro , Okada Ayaka , Inoshima Yasuo
Published: October 2024

The incidence of enzootic bovine leukosis (EBL), a type of B-cell lymphoma, is increasing in Japan. EBL is caused by bovine leukemia virus (BLV; Retroviridae, Deltaretrovirus bovleu) infection and is diagnosed by detecting antibodies against BLV in milk and blood or BLV DNA in blood. We assessed the feasibility of using stable flies ( Stomoxys calcitrans) as a sampling tool to assess BLV infection status in cattle herds. First, we collected blood from 3 cattle herds and, based on the measurement of BLV–proviral load (PVL) by quantitative real-time PCR (qPCR), identified 1) a BLV-free herd, 2) a herd with a low prevalence of BLV-infected cattle and low PVL, and 3) a herd wherein half of the cattle were BLV-infected with low-to-high PVLs. Next, we collected stable flies from the 3 herds, extracted DNA from their blood meals, analyzed it for BLV DNA, and measured the BLV PVL. Cattle DNA and BLV DNA, but not other mammalian DNA, were successfully detected by digestion of the flies. Based on fly blood meal qPCR, we identified one herd as BLV-free and the other 2 herds as having <50% prevalence of BLV-infected cattle with low PVLs. Our fly results were not consistent with preliminary BLV-PVL measurements on cattle blood. Our pilot study indicated that, to assess the feasibility of a stable fly blood meal test as an alternative technique for evaluating BLV infection status in dairy and beef cattle, additional investigations involving more cattle herds and stable flies are needed.
Making Conscientious Decisions: Engaging in Venous Leg Ulcer Self-Management Following Nurse-Led Patient Education
Authors: Bobbink Paul , Gschwind Géraldine , Larkin Philip , Probst Sebastian
Published: October 2024

Venous leg ulcers (VLUs) provoke multiple symptoms and impact individuals and society as a whole. Their treatment and prevention strategies require individual’s involvement in self-management strategies. Insufficient knowledge with regard to prevention, management, and treatment has been identified as a critical factor related to VLUs and their recurrence. Therapeutic patient education (TPE) proposed as part of a management strategy for this population provides unclear benefits regarding wounds healing or prevention of recurrence. The aim of the study was to develop a theory explaining how individuals with a VLU experience an individualized nurse-led TPE program regarding self-management strategies. The constructivist approach of Charmaz to the grounded theory method was used to develop the theory. A total of 26 individuals contributed to the co-construction of the theory through face-to-face or telephone semi-structured interviews. Data analysis and data collection occurs simultaneously with a comparative process to reveal the conceptual categories, apply theoretical sampling, and define theoretical saturation. The theory of “Conscientiously Engaging in Self-Management” was co-constructed with the participants encapsulating four categories: “Being influenced by my own story,” “Being personally informed,” “Making conscientious decisions to engage in self-adapted management strategies,” and “Integrating a conscientious way of living.” This theory highlights individuals’ voices and stories toward their journey of VLU self-management taking contextual factors into consideration. This new theory offers new knowledge about implementation of self-management strategies for individuals living with a VLU and will inform clinical practice and contribute to the development of targeted interventions.
Knowledge of Palliative Care in Men and Women Diagnosed With Metastatic Breast Cancer
Authors: Robles-Rodriguez Evelyn , Weinmann Ashley , Grana Generosa , Carter Teralyn , Jerome-D’Emilia Bonnie
Published: October 2024

Purpose

The purpose of this study was to evaluate knowledge of Palliative Care (PC) and the impact of systemic and patient-related factors on the use of PC in a diverse population of men and women diagnosed with metastatic breast cancer.

Methodology

A telephone administered survey was used with patients receiving treatment at a Cancer Center in an urban area of the Northeast US. Descriptive statistics and chi square analysis were used.

Findings

Of the 101 participants, 44% had no knowledge of PC and only 21.78% indicated that they were receiving palliative care. Participants who reported being followed by palliative care were less likely to have been treated in the emergency department in the past year ( P = 0.003) or to have been hospitalized ( P = 0.042). However, when asked about symptom burden, using the Edmonton Symptom Assessment Scale, patients who reported being followed by PC were more likely to report severe pain as compared to patients not receiving PC ( P < 0.001). There were no associations found between race/ethnicity or social determinants of health and knowledge of PC or receipt of services.

Conclusions

This sample of men and women diagnosed with metastatic breast cancer and being treated in a Cancer Center had limited knowledge and exposure to Palliative Care services across race and ethnicity. While no specific disparity was noted, the utilization of PC was low. Whether a function of a lack of referrals or patient preference, an effort should be made to increase PC referrals for all patients diagnosed with cancer.
Does Prosocial Automation Increase Driver’s Well-being?
Authors: Kim Sooyeon , Mehrotra Shashank , Akash Kumar , Misu Teruhisa , Lee John D.
Published: October 2024

As societies transition to hybrid mobility systems, interactions between automated vehicles (AVs) and human users in public spaces become more complex, highlighting the critical role of prosocial behaviors. These behaviors are essential for the seamless operation of interdependent transportation networks, helping to address integration challenges of AVs with human-operated vehicles and enhancing well-being by creating more efficient, less stressful, and inclusive environments. This study explores the impact of receiving prosocial behaviors on the cognition, riding performance, and well-being of micromobility users in simulated urban traffic scenarios. Using a mixed-method design, the research contrasts two types of social interactions—prosocial and asocial—across three temporal conditions: relaxed, neutral, and urgent. The Structural Equation Modeling underscored the intricate relationships between prosocial behaviors, satisfaction, cognition, riding performance, and well-being. Incorporating social factors into driving systems could enhance safety and improve urban mobility solutions.
The Impact of Soundscapes on Healthcare Teams: A Literature Review
Authors: Hummel Kenton , Lowndes Bethany R. , Ryherd Erica , Kennel Victoria
Published: October 2024

Healthcare teams often work in complex systems where soundscapes include numerous noise sources and levels which could impact teamwork. While studies have analyzed the impact of sound on patients, articles describing clinician and clinical team experience are relatively sparse. The purpose of this literature review was to determine what is currently known about soundscapes and their impact on teamwork and team performance in hospital-based healthcare settings. Eleven studies met the inclusion criteria. The Input-Process-Output framework and SEIPS 2.0 model guided our review and categorization of the included studies. The work environments studied included the operating room (OR), perioperative area, and a simulation. Noise input was grouped by existing noise, music or controlled sound conditions, and communication wearables during clinical or simulated tasks. Nine of the 11 articles studied the impact sound environment on team communication and three articles measured other team processes. The findings from this review assessed both existing and experimental noise conditions discovering associations with team performance processes and outcomes. Overall, previous studies have found that noise can impact individuals and elements of teamwork, especially communication. Future research is needed to develop best practices and innovative solutions supporting a positive soundscape for teamwork.
Comparative analysis of compartment-specific immunothrombotic biomarker profiles in bronchoalveolar lavage fluid and serum of patients with pneumonia-related acute respiratory distress syndrome: A preliminary cross-sectional study
Authors: Zong Xiaolong , Wang Xuechao , Liu Yaru , Wang Xiao , Li Duanyang , Zhou Zhiqing , Li Zhenyu
Published: October 2024

Immunothrombosis has emerged as a potential mechanistic link underlying the development and progression of acute respiratory distress syndrome (ARDS), but understanding its specific profile in patients, both locally and systemically, is limited. The objective of this study was to characterize and compare the immunothrombotic signatures in patients diagnosed with pneumonia-related ARDS (p-ARDS) at both the pulmonary and systemic levels and to evaluate their clinical relevance. The study included 23 consecutive patients diagnosed with p-ARDS admitted to the intensive care unit at a tertiary university hospital from July 2022 to May 2023, alongside 40 concurrently hospitalized patients with common pneumonia as controls. Paired bronchoalveolar lavage fluid (BALF) and serum samples were collected from the participants for the analysis of 15 biomarkers to assess and quantify the pulmonary and systemic immunothrombotic signatures. The study results revealed significant pulmonary inflammation and systemic endothelial injury in p-ARDS patients compared to pneumonia controls. These observations were maintained after adjustment for severity of illness (Acute Physiology and Chronic Health Evaluation II scores). In terms of clinical relevance, inflammatory biomarkers (interleukin [IL]-6, IL-8) in BALF were found to correlate with PaO2/FiO2 ratio, while serum levels of a disintegrin and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS-13) and thrombomodulin showed associations with Sequential Organ Failure Assessment and Disseminated Intravascular Coagulation scores. In conclusion, this preliminary investigation identified compartment-specific variations in the immunothrombotic signature between patients with p-ARDS and those with pneumonia alone, with inflammatory responses predominantly localized in the alveolar compartments and coagulation/endothelial injury biomarkers more pronounced in peripheral blood.
Plucking Heartstrings: Guqin, Aesthetic Attunement, and TCM Music Therapy
Authors: Huang Wenlei , Yang Jie
Published: October 2024

In the Chinese cultural context, music is deeply intertwined with the human heart and plays a central role in both healing and governance. Guqin, an ancient Chinese zither, exemplifies holistic care throughout history, embodying heart-based empathy and resonance. This study draws on insights from traditional Chinese medicine (TCM), classic philosophy, literature, and aesthetics to trace a lineage of thinking that continues to inform contemporary music therapy. We examine the Chinese notion of xin/heart and the interdependent self, and how music facilitates individuals’ aesthetic attunement toward the natural and social orders. Our approach transcends limitations of Euro-American psychological paradigms centered on the psyche, by adopting a holistic perspective that emphasizes the interconnectedness of the heart, the body, and the cosmos. We argue for the necessity of moving beyond reductive biomedical treatment models to explore alternative ways of living and alternative care that highlight relational, moral, and aesthetic approaches to well-being.
A Randomized, Double-Blind, Controlled Trial to Assess the Effects of Lactoferrin at Two Doses vs. Active Control on Immunological and Safety Parameters in Healthy Adults
Authors: Peterson Ross D. , Guarneiri Liana L. , Adams Caryn G. , Wilcox Meredith L. , Clark Anthony J. , Rudemiller Nathan P. , Maki Kevin C. , Malinczak Carrie-Anne
Published: October 2024

Recombinant human lactoferrin (rhLF) is of commercial interest for immune support as a food ingredient. The objective was to evaluate the immunogenicity/alloimmunization potential of Helaina rhLF (effera™) from K. phaffii over a 28-day period compared to bovine LF (bLF). Study 1 was a randomized, double-blind, parallel arm, controlled trial where 66 healthy adults were randomly allocated to 1 of 3 groups: high-dose rhLF (3.4 g/d), low-dose rhLF (0.34 g/d), or bLF (3.4 g/d). Participants completed a 28-day supplementation period with follow-up visits on Days 28, 56, and 84. Study 2 was a 12-week observational study with no intervention that enrolled 24 healthy adults. In both studies, serum was obtained for analysis of anti-LF antibody levels as the primary endpoint. In Study 1, change from baseline to Day 56 in serum anti-bLF antibodies in the bLF group (least squares geometric mean and 95% confidence interval for the post/pre ratio: 3.01; 2.08, 4.35) was greater than the changes in serum anti-hLF antibodies in the low-dose rhLF (1.07; 0.77, 1.49; P < 0.001) and high-dose rhLF (1.02; 0.62, 1.70; P < 0.001) groups. The rhLF groups had similar changes to the observational study, indicating no change in anti-hLF antibodies and no evidence of alloimmunization following ingestion. Changes in safety outcomes were similar between groups and within normal ranges. These results show that under the conditions of the protocol, no increased anti-hLF antibodies or adverse events were identified following ingestion of effera™ as a food ingredient at an intake level up to 3.4 g/d in healthy adults (clinicaltrials.gov: NCT06012669).
Positive Behavioral Interventions and Supports and Substance Misuse in Secondary Schools
Authors: Austin Sean C. , Hammond Mark A. , Seeley John R.
Published: October 2024

Amid a proliferation of highly potent opioids, school systems have sought to invest in programs for preventing substance misuse. School teams often prioritize early screening and intervention to prevent student substance misuse; however, given the limited resources of many schools, it is crucial to understand the extent to which commonly available data and existing frameworks are relevant for prevention efforts. In this study, we examined (a) how commonly available data on substance misuse (office discipline referrals [ODRs]) relate to self-reported substance misuse and (b) how positive behavioral interventions and supports (PBIS) implementation across tiers relates to these substance-related outcomes. We found that self-reported substance misuse is significantly related to substance-related ODRs, but that self-report rates are much higher than ODR rates. We also found that Tier 2 PBIS implementation was associated with significantly lower rates of both self-reported substance misuse and substance-related ODRs. These findings suggest that aspects of PBIS implementation could be beneficial in preventing substance misuse, but more research is needed to understand what specific school-based practices best address these student behavioral health needs.
Comparative performance of video-otoscopy and CT in the diagnosis of external ear disease in cats
Authors: Gracz Magdalena , Vandenabeele Sophie , Rodrigues Tania N , Duchateau Luc , Saunders Jimmy H , Stock Emmelie
Published: October 2024

Objectives

The aim of the study was to compare CT with video-otoscopy for detecting external ear canal masses in cats and to describe CT features of feline external ear disease.

Methods

This retrospective study evaluated the external ear canals of cats that underwent both CT and video-otoscopy. Two blinded observers reviewed the CT scans and their findings were compared with video-otoscopy results evaluated by one blinded observer.

Results

Of the 32 examined ears, 13 had an external ear canal mass detected by both CT and video-otoscopy. No false positives were identified. All 19 ears without masses were correctly identified as true negatives, resulting in perfect agreement for mass detection (kappa = 1.000). On histopathology, 9/13 masses were diagnosed as polyps, 1/13 masses was diagnosed as carcinoma, 2/13 did not undergo histopathology and 1/13 masses seen on video-otoscopy was diagnosed as otitis externa with granulomatous tissue formation. Of the 16 cats examined, 12 had a mass in the external ear canal diagnosed by video-otoscopy: six domestic shorthairs, five Maine Coons and one Oriental Shorthair cat. Of these cats, 11 had a unilateral mass and one had a bilateral mass. There was very low agreement between CT and video-otoscopy for ear canal wall enhancement and erythema (kappa = 0.033), as well as for ear canal thickening and stenosis (weighted kappa = 0.056). There was no significant difference between chronic and non-chronic clinical signs in terms of the presence of ear canal wall mineralisation ( P = 0.223).

Conclusions and relevance

There is high agreement between video-otoscopy and CT in detecting external ear canal masses in cats. However, there is very low agreement between CT and video-otoscopy for ear canal wall enhancement, erythema, thickening and stenosis. The presence of external ear canal mineralisation did not correlate with the chronicity of clinical signs.
Motivational profiles in instrumental music learning: Perspectives on self-determination theory
Authors: Wieser Martin , Müller Florian H.
Published: October 2024

This study examined the motivation of child and adolescent music students to learn instruments in five Austrian music schools using a person-centered approach. Drawing on self-determination theory, two autonomous and controlled forms of motivational regulation were surveyed. The results of a cluster analysis ( N = 616) were used to construct four motivational profiles: one autonomously motivated type (high quality), one overall highly motivated type (high quantity), one moderately autonomously motivated type (low quality), and one type with poor quantity motivation. The clusters showed differences in the support required to meet music students’ basic psychological needs in music lessons, which are essential determinants in the development of autonomous motivation, in the individual activity preferences associated with playing an instrument, and in the tendency to stop playing an instrument. No differences were found between the instrument groups and gender. This study provides theoretical and practical implications of a person-centered approach to music-related motivation research.
Memoirs of impossible identities: Exploring biographical narratives of gay ex-Jehovah’s witnesses
Authors: Greenough Chris
Published: October 2024

This article offers a critical examination of Jehovah’s Witnesses’ positionality on homosexuality. After making the case for engaging with memoir literature, the article analyses two narratives that depict the experiences of gay former Jehovah’s Witnesses: Paul Mendez’s Rainbow Milk (2020) and Daniel Allen Cox’s I Felt The End Before It Came (2023). The critical discussion of narratives and meta-narratives interrogate the social world behind the Witnesses, as well as the relationships between the enactment of their beliefs in relation to LGBTQ+ identities. The resultant thematic analysis explores the following issues: disfellowshipping, identity negotiation, sex work and education.
Embedding employability into curriculum design: The impact of education 4.0
Authors: Koseda Ellie , Cohen Ivan K. , Cooper Jasmine , McIntosh Bryan
Published: October 2024

In recent years, there has been a change in the objectives of Higher Education (HE): the inclusion of employability. The successful inclusion of employability as a goal of HE requires a change to the sector’s teaching, learning and assessment (TLA) methods, which ought to be part of an HEI’s strategy. In particular, there needs to be an emphasis on adjustments to both curriculum design and modes of assessment, both for the inclusion of employability and also in preparation for digital transformation (Education 4.0) as well as internationalisation. Any HEI development plan should acknowledge the importance of employability. To meet national standards and keep up with evolving trends in the job market, every programme needs to equip students with the necessary skills, knowledge, and experience to succeed in their future careers. Every institution is obligated to provide opportunities for students from all backgrounds and capabilities to learn about work.
Like Shooting Phish in a Barrel: Cue Utilization and Cognitive Reflection Aid Performance in Controlled, but Not Naturalistic Phishing Tasks
Authors: Morrison Ben W. , Graf Emmilly , Bayl-Smith Piers , Wiggins Mark W.
Published: October 2024

The study tested the role of cue utilization and cognitive reflection tendencies in email users’ phishing decision capabilities in both controlled and naturalistic settings. 94 university students completed measures of their phishing cue utilization and cognitive reflection, a phishing decision task, and a naturalistic simulated phishing campaign, in which they were sent simulated phishing emails to their personal inboxes. For the phishing decision task, results revealed that participants with lower cognitive reflection tendencies were more likely to misclassify genuine emails as phishing, compared to participants with higher cognitive reflection. Further, participants with higher cognitive reflection and lower cue utilization took the most time to diagnose emails, but participants low in both cue utilization and cognitive reflection demonstrated the shortest response latencies. These findings suggest that greater cognitive reflection can offset lower levels of cue utilization. For the naturalistic simulation, neither cue utilization nor cognitive reflection predicted an increased propensity to interact with a suspicious email. This result highlights a potential gap between phishing investigations conducted in controlled and naturalistic settings. The implications extend to future research, emphasizing the need for studies that employ naturalistic methodologies to better understand and address phishing threats in real-world environments.
A Study of Sperm DNA Damage Mechanism Based on miRNA Sequencing
Authors: Liu Feng , Ma Miaomiao , Li Luyu , Zhang Yongtao , Shang Yihan , Yuan Quan , Ju Baojun , Wang Zulong
Published: October 2024

To analyze the differential expression profiles of microRNAs (miRNAs) in spermatozoa of patients with sperm DNA damage and to investigate the role of miRNAs in sperm DNA damage. Male infertility patients with sperm DNA damage who attended the First Affiliated Hospital of Henan University of Chinese Medicine from October 2023 to December 2023 were selected and included in this study as a case group. Fertile healthy men who were seen at the health check-up center during the same period and diagnosed by examination were also included as a control group. Sperm miRNA expression was detected in patients with sperm DNA damage (case group, n = 5) and healthy medical check-ups (control group, n = 5) using high-throughput sequencing technology. The differentially expressed miRNAs between the two groups were bioinformatically analyzed to explore the main biological functions of the target genes. We found that 63 miRNAs were significantly changed in the spermatozoa of patients with sperm DNA damage,|log2 (foldchange)| ≥ 1, p < .05. Gene Ontology (GO) enrichment analysis indicated that these differential miRNAs might be involved in developmental process, anatomical structure development, cellular macromolecule metabolic process, multicellular organism development, system development, and so on. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that that they mainly affect the PI3K-AKT signaling pathway. The present study suggests that the altered expression of miR-1255a, miR-921, and miR-3156-5p may play an important role in the sperm DNA damage process, and the mechanism may involve the phosphatidylinositol-3'-kinase-AKT (PI3K-AKT) signaling pathway.
‘I am Pleased to Share my Thoughts and Opinions’- Including Marginalised People with Disabilities in Inclusive Qualitative Research in Bangladesh Through Creative, Relational Methodologies
Authors: Shaw Jackie , Wickenden Mary
Published: October 2024

The rhetoric of ‘nothing about us without us’, motivates much disability inclusive research, but meaningful participation of the most marginalised is still rare. There is a tendency to recruit only people with disabilities who are perceived as ‘easier to include’. We reflect critically on recent fieldwork in Bangladesh working with local and international NGOs on a disability inclusive employment project. We focus on inclusion of the most marginalised people with disabilities: those with complex communication, psychosocial, intellectual or multiple impairments, or those who face intersecting inequalities. During a two-stage process, we engaged with 4 small groups of people in 2 sites. The participants were involved in an adapted vocational training programme, and had either both visual and hearing impairments, or were economically disadvantaged young disabled women. We discuss how creative, inclusive, participatory methodologies were combined to explore participants’ experiences of pathways to work through learning a trade. We consider the ethical, methodological rationales for our research epistemologies; including development of local research teams’ and participants’ awareness, confidence and capacities; and what worked and didn’t to enable or constrain inclusion and knowledge generation. We synthesise insights and recommendations about engagement/recruitment, situated ethics, accommodating individual needs, challenging assumptions, building communication capacities and group agency, maintaining inclusive interaction, multi-modal communication, using visual, tactile, narrative and creative methodologies, sequencing and layering methods, generating emotional knowledge, and collective analysis. We discuss the dynamic situated, emotional, interactional, and relational enablers of inclusion, and how participatory methodologies are applicable in research contexts to move beyond working with the ‘usual suspects’ to effectively engage people who are most often excluded.
Simulation and experimental analysis of fixed and rotating blades on the runner of Oryon Watermill applicable for head drops of the canal
Authors: Chaulagain Raj Kumar , Kalwar Akash , Khatiwada Purushottam
Published: October 2024

Numerous sites for watermills exist in the world with shallow heads and are possible for power generation either mechanical or electrical. The prime mover required for the energy generation from such sites is in the developing phase with efficient, minimum components, and low cost as a modular unit. The Oryon Watermill (OWM) is one of them developed by Deepwater Energy applicable to water current directly. The working of OWM is used differently on the head drop of the canal with fixed and rotating blades using the NACA 6516 series of airfoil shapes as the novelty of this research. The research covers the CFD simulations with ANSYS Fluent 19.0 of two runners, fabrication, and conduction of tests on-site with a head drop of 1.2 m. The major variable was the water flow rate for both runners with the design discharge of 0.09 m3/s. The analysis of results showed the runner with rotating lamellas performed with 9% and 40% higher efficiency from the simulation and experiment respectively compared to the fixed type. The efficiency achieved from the research is at a low range indicating the availability of large space for future study on performance improvement.
Predictive residual stress analysis in gear units: an artificial intelligence approach based on finite element data
Authors: Bayat Hamid Reza , Mustaq Bilawal , Vötterl Axel
Published: October 2024

Determining residual stresses is essential for ensuring the safety and longevity of gear components. Traditional methods, such as analytical, numerical, and experimental approaches, are often costly, time-consuming, and sometimes destructive. This study proposes a new method to predict residual stresses in gear units using artificial intelligence based on data from finite element analysis. To achieve this, a commercial finite element tool models the heat treatment and carburization processes, grounded in thermomechanical metallurgical physics. The residual stresses obtained from finite element analysis are then compared to the ones from experiment using deep hole drilling approach. This is followed by a sensitivity analysis. Next, a specific class of gearbox component geometries and the computed stress fields are utilized to train artificial neural networks. The performance of the artificial neural networks approach is compared to that of two different machine learning regression methods. It has been concluded that this technique successfully anticipates residual stresses in components with scaled geometries and similar heat treatment steps, outperforming the two regression models in accuracy and efficiency. Importantly, it achieves this with incomparable, significantly less computation time compared to standard finite element analysis.
Hand surgery in Vietnam: development, challenges and future directions
Authors: Nguyen Phi Duong , Nguyen Thai Van , Le Doan Van , Le Nhan Nghi Thanh
Published: October 2024

Hand surgery in Vietnam has evolved significantly, especially in cities like Ho Chi Minh City, Hanoi and Hue. Despite advancements, there remain challenges, including the lack of a unified national hand surgery society. This article highlights the contributions of key figures, advances and the future of the discipline in the country.
Robot-assisted percutaneous scaphoid fixation: patient-reported outcomes and learning curve at two centres
Authors: Yi Zhe , Qi Weiya , Lim Rebecca Qian Ru , Chen Wei , Chen Shanlin , Liu Bo
Published: October 2024

This study describes patient-reported outcomes of robot-assisted percutaneous scaphoid fracture fixation of 62 patients from two medical centres and the learning curve of this new technique. One attempt to place the guidewire was sufficient in 97% of cases. All fractures achieved radiographic union at a mean of 9 weeks. There were no complications observed. At a mean follow-up of 36 months (range 12–68 months), the mean patient-rated wrist evaluation (PRWE) was 2 (range 0–22) and the mean Mayo Wrist Score was 96 (range 70–100). After the initial ten to 20 cases, the learning phase was reasonably surmountable with a marked reduction of operative duration and improvement of the screw accuracy.

Level of evidence: IV
Total elbow allograft augmented with vascularized periosteal grafts for salvage of a failed distal humeral joint replacement for Ewing sarcoma reconstruction
Authors: Soldado Francisco , Gonzalez-Morgado Diego , Guillen-Distefano Juan Sebastian
Published: October 2024

Vascularized periosteal grafts have been used to promote bone union in massive bone defects. We present a child with a failed distal humeral joint replacement for Ewing sarcoma reconstruction, successfully treated with a total elbow allograft augmented by vascularized periosteal grafts.

Level of evidence: V
Assessment of suspected cancer
Authors: Ali Abdishakur Mohamed , Siddiqui Zubair Ahmed
Published: October 2024

Cancer is a major health challenge worldwide, with a significant impact on morbidity and mortality. Early detection and intervention are crucial for improving patient outcomes. GPs play a pivotal role in the early identification and management of suspected cancer. GPs are uniquely positioned to recognise early warning signs, initiate appropriate investigations, and facilitate timely referrals to specialists. This article aims to provide a comprehensive guide for GPs on the assessment of suspected cancer, focusing on common cancers and the National Institute for Health and Care Excellence guidelines. It outlines the general approach to cancer assessment, including identifying red flags, risk factors, and initial investigations. This guide aims to provide GPs with knowledge and tools to assess and manage patients with suspected cancer confidently, ensuring timely and appropriate care.
Assessing age-related risks of gastrointestinal pathologies: a comparative study of gastroscopy outcomes across decades
Authors: Nguyen Lac , Räsänen Noora , Berggren Filippa , Nieuwenhoven Michiel A. van
Published: October 2024

Background:

Esophagogastroduodenoscopy (EGD) is the gold standard method for diagnosing upper gastrointestinal (GI) pathology. Swedish guidelines recommend patients over 50 years with new-onset dyspeptic symptoms undergo direct gastroscopy to rule out malignancy. However, the incidence of dysplasia or cancer in patients aged 61–70 years remains unclear.

Objectives:

To investigate the referral factors and endoscopic findings in patients aged 61–70 years and compare the result with age groups 51–60 and 41–50 years from our previous studies to establish whether there is an age cutoff for upper GI cancer risk.

Design:

A retrospective observational study was conducted to evaluate EGD referrals and outcomes in patients aged 61–70 years.

Methods:

We analyzed EGD referrals for patients aged 61–70 years within Region Örebro County from January 2019–April 2020 to January 2022–2023. Clinical data, including symptoms, medications, and laboratory results, were collected from medical records. Statistical analysis, including odds ratios (OR) and positive predictive values (PPV), was conducted to evaluate pathological outcomes based on referral factors.

Results:

A total of 1003 referrals were analyzed. Statistically significant differences in pathological findings were observed between the 41–50 years reference group and the older groups (51–60 years: OR 2.08, p < 0.001; 61–70 years: OR 3.05, p < 0.001). However, no statistically significant difference in cancer incidence was found between the age groups.

Conclusion:

The most common pathological findings were benign, including hiatal hernia, gastroesophageal reflux disease/esophagitis, or gastritis. The incidence of cancer was low in all three groups. These results suggest that the “test-and-treat” strategy, currently recommended for patients under 50 years, may be appropriate for patients aged 51–70 years as well.

Trial registration:

NCT04585516.
Prediction of Incident Diabetic Retinopathy in Adults With Type 1 Diabetes Using Machine Learning Approach: An Exploratory Study
Authors: Montaser Eslam , Shah Viral N.
Published: October 2024

Background:

Early detection and intervention are crucial for preventing vision-threatening diabetic retinopathy (DR) in adults with type 1 diabetes (T1D). This exploratory study uses machine learning on continuous glucose monitoring (CGM) data to identify factors influencing DR and predict high-risk individuals for timely intervention.

Methods:

Between June 2018 and March 2022, adults with T1D with incident DR or no retinopathy (control) were identified. The CGM data were collected retrospectively for up to seven years before the date of defining incident DR or no retinopathy. A mixture of three machine learning algorithms was trained and evaluated in two different scenarios, using different glycemic features extracted from CGM traces (scenario 1), and the two principal components (two PCs; exposure to hyperglycemia and hypoglycemia risk) of those features (scenario 2). Classifiers were evaluated through 10-fold cross-validation using the receiver operating characteristic area under the curve (AUC-ROC) to select the best classification model.

Results:

The CGM data of 30 adults with incident DR (mean±SD age of 21.2±9.4 years, glycated hemoglobin [HbA1c] of 8.6%±1.0%, and body mass index [BMI] of 24.5±4.8 kg/m2) and 30 adults without DR (age of 41.8±14.7 years, HbA1c of 7.0%±0.9%, and BMI of 26.2±3.6 kg/m2) were included in this analysis. In scenario 2, classifiers outperformed scenario 1, resulting in an average AUC-ROC increase to 0.92 for two of three models, indicating that the two PCs captured vital classification data, representing the most discriminative aspects and enhancing model performance.

Conclusion:

Machine learning approaches using CGM data may have potential to aid in identifying adults with T1D at risk of DR.
Long-term risks of cardiovascular-specific mortality among myeloproliferative neoplasms patients
Authors: Tang Meiling , Chen Ying , Zhou Yanying , Zhuang Xinran , Fu Yuxin , Chen Jinzheng , Wei Rongfang , Chen Yan
Published: October 2024

Background:

The myeloproliferative neoplasm (MPN) is a heterogeneous group of clonal hyperplasia hematopoietic stem cell disorders, predominantly affecting middle-aged and elderly individuals, with a slow disease progression. With advancements in disease-related research, the survival rates of MPN patients have significantly improved. This research primarily focuses on cardiovascular disease mortality (CVM) and prognostic factors in MPN patients, aiming to provide clinicians with more comprehensive references.

Methods:

A total of 24,277 patients were included in the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative mortality was assessed using a competing risk model, univariate and multivariate regression analysis of cardiovascular disease (CVD) mortality risk factors, and a comparison of standardized mortality ratio (SMR) and general population CVM.

Results:

Among the 24,277 patients included in this study, a total of 8841 deaths occurred during the follow-up period, with 2429 attributed to CVD. Notably, the risk of CVM was found to be significantly higher in patients with MPNs compared to the general population. Furthermore, this risk increased over time. CVD emerged as the predominant cause of death among individuals aged over 80 years and younger patients exhibited a significantly elevated SMR. Additionally, age, race, marital status, and insurance status were identified as independent prognostic factors for CVM.

Conclusion:

The incidence of cardiovascular events in patients with MPNs is significantly higher compared to the general population. Early screening and assessment of cardiac health should be implemented in MPN patients to prevent the occurrence of cardiovascular events and enhance their prognosis.
Clinical features and treatment of newly diagnosed multiple myeloma with secondary myelofibrosis: a retrospective study
Authors: Xu Han , Xu Yujie , Wang Mengying , Mao Chunxia , Huang Junxia , Li Tianlan , Gao Yan , Liu Shanshan , Zhou Jingjing , Zhang Yi , Feng Xianqi
Published: October 2024

Background:

Secondary myelofibrosis (SMF) is characterized by the excessive deposition of fibrous tissue on top of the primary disease, often causing clinical manifestations to be overshadowed by the primary disease. Unfortunately, current staging systems do not incorporate myelofibrosis, leading to potential treatment delays for SMF.

Objectives:

To evaluate the prognosis of patients with multiple myeloma (MM) complicated with myelofibrosis

Design:

The study included the clinical data and treatment results of 208 newly diagnosed multiple myeloma (NDMM) patients who were treated in the Affiliated Hospital of Qingdao University from January 2014 to August 2020, and performed a retrospective analysis.

Methods:

All patients underwent bone marrow biopsy, and MF severity was classified into grades 0–3 according to the 2016 WHO criteria. Treatment efficacy was evaluated based on the International Myeloma Working Group (IMWG) standard and SPSS was used for analysis.

Results:

The MM patients without SMF exhibited better treatment response ( p < 0.05). Importantly, increasing degrees of myelofibrosis were associated with a significant reduction in median progression-free survival (PFS; p < 0.05). MM-SMF patients exhibited significantly shorter median PFS and overall survival (OS; p < 0.05). In the MM-SMF group, neutrophil–lymphocyte ratio >2.39, monocyte–lymphocyte ratio ⩽0.18, and platelet–lymphocyte ratio ⩽61.6 were associated with significantly reduced median PFS and OS ( p < 0.05). Notably, the use of bortezomib-based regimens did not significantly impact prognosis in MM-SMF patients, while lenalidomide-based regimens significantly extended median OS but did not significantly affect median PFS.

Conclusion:

Myelofibrosis emerges as an important prognostic indicator for predicting the survival outcomes of NDMM patients. In the era of new therapeutics, there is a pressing need to explore novel treatment strategies in order to improve the prognosis of patients with multiple myeloma complicated by myelofibrosis.
Disinformation and the Ghost of Margaret Sanger
Authors: Whitmarsh Sarah
Published: October 2024

This study sought to investigate the prominence of U.S. birth control pioneer and eugenicist Margaret Sanger in social media discourse through a critical disinformation studies lens. Using computational and qualitative analysis techniques, 60 months of public Facebook posts and Google search data were analyzed to explore the scope, reach, and engagement with messages that reference Sanger and examine how injustice frames utilizing Sanger’s historical ties to eugenics are being used today to misinform and disinform on abortion and other issues. Injustice frames featuring Sanger were deployed to portray abortion as a method for Black genocide; vilify feminism as racist, anti-woman, and anti-motherhood; and depict the Black Lives Matter social justice movement and cancel culture as hypocritical. This analysis also captured a moment in time when Sanger’s legacy was being reconsidered by Planned Parenthood, the organization she founded, indicating that a long-sought-after reckoning with the racist roots of the early birth control movement in the United States may be underway—with both predictable and unpredictable rippling effects in disinformative spaces.
Identification and Analysis of Key Factors Affecting Digital Transformation of Small and Medium-Sized Manufacturing Enterprises
Authors: Chen Qingmei , Lyu Xiaoyong , Chen Jingjing
Published: October 2024

The digital transformation of small and medium-sized manufacturing enterprises is influenced by various factors, and the relationship between them is not yet clear. Studying the factors that affect the digital transformation of small and medium-sized enterprises can promote the digital transformation process of small and medium-sized manufacturing enterprises. On the basis of summarizing literature and expert recommendations, this study identified the influencing factors in the digital transformation process of small and medium-sized manufacturing enterprises, and analyzed the key influencing factors using a combined method of DEMATEL-ISM-MICMAC (Decision-Making Test and Evaluation Laboratory-Interpretive Structural Model-Matrices Impacts Croises-Multiplication Appliance Classement). Research has found that digital policies, market demand, business model innovation, third-party data-driven services, and the digital foundation of enterprises are key factors in the process of digital transformation. In addition, the causal factors in the DEMATEL method, the essential factors in the ISM method analysis, and the independent factors in the MICMAC technique analysis can mutually support and complement each other. This study enriches the methodology for studying the factors of digital transformation and provides reference for the digital transformation of small and medium-sized manufacturing enterprises and government policy formulation.
Enhancement of Marina Service Quality of Yacht Tourism in Taiwan: A Euclidean Distance of Importance-Performance Analysis
Authors: Wang Hui-Chiao , Lirn Taih-Cherng
Published: October 2024

In spite of COVID-19 struck tourism industry, the trend of yachting tourism is steadily increasing and provides a way for the tourism industry to resume after the epidemic. Marinas, a vital component of yachting tourism, deeply effects the yacht owners’ satisfactions and the coastal destinations attraction. Since the marina industry in Taiwan is still in its early stages, this study aims to identify ideal service quality standards to enhance competitiveness. With a limited cohort of 69 yacht owners in Taiwan possessing yachts exceeding 20 gross register tonnage (GRT), insights from our research, which engaged perspectives from 50 yacht owners, provide valuable understanding into their satisfaction regarding marina services in Taiwan. As the first study to explore key factors of marina service experience among yacht owners, this study applies importance-performance analysis (IPA) and Euclidean distance to provide the development strategy and improvement priority of Taiwan marina service. Overall, the result from improving IPA technique which adopted Euclidean distance reveal that yacht owners generally thought that the improvement priority of marina service quality is sewage, bilge water, and oil sludge treatment facilities, fueling facilities, high-voltage shore power facilities, land storage space. It is noteworthy that marina managers should embark on improving marina physical facilities as development strategy which highlight the performance of marina service quality for yacht owners and the improvement in those facilities can be developed to either increase the marina competition or to resume tourism industry.
Students’ Intention to Adopt E-learning Platform for College English Study: Mediating Effect of Satisfaction of Basic Psychological Needs
Authors: Deng Ping , Chen Bing , Zeng Wei , Fang Xinhua
Published: October 2024

E-learning platform (ELP) provides economic and efficient channels to share and learn knowledge online without time and location restrictions. Earlier studies have identified determinants that impact students’ intention to use new technologies in different learning contexts, yet few have tried to investigate the effect of students’ satisfaction of basic psychological needs during the adoption process. Based on the framework of UTAUT2, this study has tested the mediating role of satisfaction of basic psychological needs to better comprehend the relationships between the antecedents and intention. The partial least square structural equation modeling was used for data analysis, findings indicate that performance expectancy, learning value, hedonic motivation, and habit significantly impact students’ willingness to adopt ELP for college English study. As for the mediating effect of students’ satisfaction of basic psychological needs, it fully mediates the relationship between effort expectancy, facilitating conditions, and intention while partially mediating the relationship between performance expectancy, learning value, hedonic motivation, habit, and intention. The study aids in grasping the key factors to increase students’ adoption of ELP and offers recommendations to increase students’ participation, learning efficiency, and their satisfaction of basic psychological needs for competence, autonomy, and relatedness during college English study with ELP.