bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Expression of Inflammatory Cytokines and Discogenic Neck Pain
Authors: Kang Xinjian , Qian Man , Qin Tao , Liu Mingli , Xu Haiwei , Xu Baoshan
Published: December 2023

Objective

Although neck pain has become a serious economic and social problem worldwide, the etiology remains poorly understood. The aim of current study is to explore the possible pathogenesis of discogenic neck pain by analyzing the relationship between inflammatory cytokines and discogenic neck pain and provide a valuable reference for the prevention and treatment of discogenic neck pain.

Methods

A total of 111 cervical disc samples were collected between October 1, 2021, and October 1, 2022: 38 samples from the discogenic neck pain group, 41 samples from the symptomatic control group, and 32 samples from the normal control group. The concentration of nitric oxide (NO), interleukin (IL)‐1, interleukin (IL)‐6, and tumor necrosis factor alpha (TNF‐α) was determined using the enzyme‐linked immunosorbent assay in each sample, and the degeneration degree of the target discs were evaluated using T2‐weighted sagittal magnetic resonance imaging (MRI) according to the Miyazaki disc degeneration grading system. Whether the differences among the three groups were statistically significant was tested using one‐way analysis of variance and an unpaired t‐test, respectively.

Results

The differences of the baseline characteristics were not statistically significant between the discogenic neck pain group and the symptomatic control group (p > 0.05). The expression of inflammatory cytokines in disc samples from the discogenic neck pain group (NO: 9.89 ± 1.75, IL‐1β: 10.74 ± 1.92, IL‐6:31.65 ± 2.46, and TNF‐α: 5.96 ± 1.91) was increased in comparison with the disc samples from both the symptomatic control group (NO: 7.15 ± 2.78, IL‐1β: 8.03 ± 1.87, IL‐6: 25.79 ± 2.12, and TNF‐α: 4.18 ± 2.87) and the normal control group (NO: 6.11 ± 1.37, IL‐1β: 5.84 ± 2.25, IL‐6: 20.65 ± 1.26, and TNF‐α: 2.05 ± 0.58). The differences were statistically significant (p < 0.001). Further, there were no statistical differences in the degree of degeneration between discogenic neck pain group and symptomatic control group.

Conclusions

The increased expression of inflammatory cytokines in diseased cervical intervertebral discs might play a key role in the pathogenesis of discogenic neck pain. Although inflammation is involved in intervertebral disc degeneration, there is no linear positive correlation between the concentration of inflammatory cytokines and the degree of disc degeneration.
Administrative responses to democratic backsliding: When is bureaucratic resistance justified?
Authors: Bauer Michael W.
Published: December 2023

Populist, illiberal, or outright autocratic movements threaten democracies worldwide, particularly when such extreme political forces gain control of executive power. For public administration illiberal backsliders in government pose a dilemma. Trained on instrumental values and expected to implement neutrally the political choices of their elected superiors, bureaucrats lack orientation of how to act in situations when obeying their own government may mean becoming an accomplice to democratic regression. Against this background, this article maps the dubious demands of backsliders in government as well as the potential reactions of bureaucrats to them. Public administration thinking is subsequently examined with a view to showing how administrative resistance to democratic backsliding could be normatively justified. Finally, the article provides practical recommendations to enhance the resilience of democratic public administration in the face of illiberal challenges.
Predicting competitive integrated employment outcomes of Asian American vocational rehabilitation Clients: A national study
Authors: Kaya Cahit , Chun Jina , Torres Ayse , Chen Roy K.
Published: December 2023

Purpose

The current study investigated the relationships between demographic variables, cash benefits, vocational rehabilitation (VR) services, and employment outcomes of Asian Americans VR clients.

Methods

The data were extracted from the most recent Rehabilitation Service Administration database (RSA‐911). Among 17,278 case services records, 5784 clients met the inclusion criteria. Chi‐square automatic interaction detector and logistic regression analyses were employed to investigate the employment outcomes.

Results

The results indicated that Asian American clients who have completed a bachelor's degree or more do not receive disability‐related benefits, and those who received more VR services were more likely to achieve competitive integrated employment (CIE). In addition, VR counseling and job placement services were significant predictors of employment outcomes.

Conclusions

These findings provide valuable insights into the factors influencing CIE among Asian American VR clients with disabilities. The results further underscore the importance of VR professionals possessing cultural competence to effectively serve a diverse clientele.
Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini
Authors: Kerschberger Bernhard , Vambe Debrah , Schomaker Michael , Mabhena Edwin , Daka Michelle , Dlamini Themba , Ngwenya Siphiwe , Mamba Bheki , Nxumalo Bongekile , Sibanda Joyce , Dube Sisi , Dlamini Lindiwe Mdluli , Mukooza Esther , Ellman Tom , Ciglenecki Iza
Published: December 2023

Objectives

Despite declining TB notifications in Southern Africa, TB‐related deaths remain high. We describe patient‐ and population‐level trends in TB‐related deaths in Eswatini over a period of 11 years.

Methods

Patient‐level (retrospective cohort, from 2009 to 2019) and population‐level (ecological analysis, 2009–2017) predictors and rates of TB‐related deaths were analysed in HIV‐negative and HIV‐coinfected first‐line TB treatment cases and the population of the Shiselweni region. Patient‐level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient‐level and population‐level predictors of deaths.

Results

Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV‐negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV‐status. The treatment case fatality ratio remained above 10% in most years. At patient‐level, fatality risk was higher in PLHIV (aRR 1.74, 1.51–2.02), and for older age and extra‐pulmonary TB irrespective of HIV‐status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18–1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47–1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB‐LAM testing (aRR 0.65, 0.35–0.90). At population‐level, mortality rates decreased 6.4‐fold (−147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (−826/100,000 vs. HIV‐negative: −23/100,000), the relative population‐level mortality risk remained higher in PLHIV (aRR 4.68, 3.25–6.72) compared to the HIV‐negative population.

Conclusions

TB‐related mortality rapidly decreased at population‐level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.
Silica and barium: Comparison of microscopic appearance and characterization of effects of silica on cytomorphology
Authors: Cagle Laura A. , Fry Michael M. , Wesley Kenneth B. , Beatty Sarah S. K.
Published: December 2023

Background

Silica from plastic red top sample collection tubes and barium cause recognized artifacts in slide preparations for microscopic examination.

Objectives

The objectives of this study were to evaluate and directly compare the microscopic appearance of silica and barium particles and various slide preparation techniques (e.g., use of coverslips, oil immersion, and different stains). A secondary objective of this study was to evaluate the effects of silica particles on cellular morphology after mechanical trauma with cytocentrifugation.

Methods

Fluid samples (deionized water, pleural effusion, peritoneal effusion, cerebrospinal fluid, and urine) were collected and evaluated in silica‐ and non‐silica‐containing tubes. Barium was added to silica and non‐silica samples. Direct and cytocentrifuge preparations were compared to evaluate the effect of silica particles on cellular morphology. Preparations were stained with Wright–Giemsa, rhodizonic acid disodium salt, Alizarin Red, Grocott's methenamine silver, and Prussian blue.

Results

Silica and barium particles were identifiable via light microscopy with and without polarized light, although silica particles diminished with immersion oil. Barium particles retained their structure and diminished less under oil. Cytoseal mounting medium for coverslip placement resulted in diminished refractility of silica and some barium particles. Silica particles with mechanical interaction during cytocentrifugation resulted in disrupted cellular morphology with many lysed cells. Silica and barium particles were negative for all special stains tested.

Conclusions

Silica from plastic red top tubes adversely affects cell morphology in cytocentrifuge preparations, potentially affecting manual differential cell counts and compromising diagnostic interpretation. Samples intended for microscopic evaluation should not be collected in silica‐containing tubes.
Industrial Research Laboratory Organization
Authors: Mees C. E. K.
Published: December 2023

The great value of scientific research, both to the industries and the nation at large, is now generally recognized. The industrial research laboratory is an important factor in maintaining the supremacy of an industry, and its success depends to a considerable degree upon its relation to the other departments of the company with which it is associated. In this paper these statements are discussed, and the author presents his views regarding the establishment and function of industrial laboratories, giving in connection with the latter three annular diagrams. The form and operating costs of industrial laboratories are also discussed.
Standards of Carburetor Performance
Authors: Berry O. C.
Published: December 2023

The type of test which a carburetor is most frequently given to establish its merit or lack of merit is carried out in the following manner: An engine in good mechanical condition is tested, using a carburetor which bears a high reputation. These tests are then repeated, using the new carburetor, and its merits are thus reported in terms of the comparative performances of the engine. The results of these tests are valuable and convincing, and while they will always be the final criterion of carburetor performance, they fall a little short of the ideal in that they fail to show the reasons for the differences. Several writers have recently pointed this out and suggested that the performance of a carburetor should also be expressed in terms of its ability to perform those functions which are essential to proper carburation. In order to do this it will be necessary to determine these essentials. Each function must then be studied to see when and how it operates, its comparative importance, and the conditions for the best results. This is a difficult task, but its accomplishment should prove of great benefit. In this paper a list of the essential factors, as now understood, has accordingly been made. Some experimental data are also presented which it is hoped will help to establish some of the standards of performance. These data cover the following points:

(a) The efficiency and power capacity of an engine as affected by the richness of the mixture

(b) The effect of the speed of an engine upon its mixture requirements

(c) The effect of the torque produced by the engine upon its mixture requirements

(d) The effect of the dryness of the mixture upon the mixture requirements, power and efficiency of the engine:

1 The heat for drying the mixture coming from the sensible heat in the air

2 The heat for drying the mixture coming from a “hot spot” in the intake manifold.

Further research is now under way which is expected to throw light on other phases of the problem.
The Design of Riveted Butt Joints
Authors: Adler Alphonse A.
Published: December 2023

In this paper Schwedler’s graphical method of designing riveted joints is analytically treated by the author, who states the fundamental assumptions employed and submits brief evidence for their justification.

A general equation is derived to determine the pitch in any row, and another to determine the efficiency in ideal cases. The design of cover plates is also considered.

Actual joints are calculated, using commercial dimensions, and the close agreement found between the ideal and calculated efficiencies seems to indicate that the scheme of analysis is consistent. The design of a quadruple-riveted joint furnishes the data for the single-, double- and triple-riveted joints by simply omitting the extra rows of rivets.
Common Errors in Designing and Machining Bearings
Authors: Bierbaum Christopher H.
Published: December 2023

After presenting ten principles relating to the design, construction and operation of journal bearings, based on what is now known concerning the laws of lubrication, the author discusses among other things oil grooves and their proper distribution, the disadvantages of tight-fitting bushings, proper methods of finishing brasses to provide for expansion when running, and proper methods of clamping bearings during tooling. He then takes up the matter of the tools employed in machining bearings and shows by numerous photomicrographs of finished surfaces the importance of using sharp tools with the proper rake in order that the crystalline structure of the surface material of the bearing may not be so crushed and compacted that it will fail to function as a normal bearing alloy.
The Hvid Engine and its Relation to the Fuel Problem
Authors: Blakely E. B.
Published: December 2023

This paper describes a type of engine, the Hvid, which, it is claimed, has all the advantages and none of the disadvantages of the so-called Diesel type, and which is being produced in units as small as 1½ hp. It can be started cold, has no complicated air-compressor system, and is so economical that it can compete with gasoline engines of the same size. The author outlines the operation of the engine, describing in detail the suction, compression, power and exhaust strokes and presenting a series of indicator cards. Fuel consumption is shown by means of curves obtained as the results of tests performed. The paper concludes with a discussion of the heat balance and torque characteristics of the engine. It is not claimed that this motor has reached its ultimate state of development, but rather that it possesses certain characteristics which, in the author’s opinion, ought to attract many internal-combustion engineers by the possibilities they hold out of helping to solve some of the country’s fuel problems.
Modern Electric Furnace Practice as Related to Foundries in Particular
Authors: Moore W. E.
Published: December 2023

Since 1913 the number of electric furnaces employed in the steel industry in the United States and Canada has risen from 19 to 335, practically all of which are of the arc type.

After first giving particulars regarding the operation of acid and basic furnaces, the author enumerates the superior properties which have created the present demand for electric steel. He then points out the advantages of the electric furnace over the open-hearth furnaces in steel melting and states the features of the various classes of arc furnaces which have made that type practically supreme in its field.

Following this the crucible and converter processes are briefly described and it is shown how the acid type of furnace is the best for foundry work.

Comparative operating costs of producing liquid steel by the converter and electric-furnace processes are then given, which bring out the marked economy of the latter. The paper concludes with notes on the employment of the electric furnace in malleable-iron foundries and on the selection of the most suitable type of furnace for a given installation.
Thread Forms for Worms and Hobs
Authors: Waterman B. F.
Published: December 2023

The use of worm gearing is steadily increasing, and accompanying this increase, perhaps the cause of it, is a corresponding increase in efficiency and durability which is the result of a better understanding of both the theoretical and mechanical problems. This paper points out some of the problems involved and some of the mechanical difficulties in the use of worm gearing, for failure to take these problems and difficulties into consideration in the past has often led to the discrediting of this form of drive. It also suggests methods for bringing about a uniform and satisfactory practice in worm gearing.
Design of Porous Partition Elastomer Substrates for the Island–Bridge Structures in Stretchable Inorganic Electronics
Authors: Gao Hongwei , Li Jiaxin , Wang Zihao , Xue Zhaoguo , Meng Xianhong
Published: December 2023

Stretchable inorganic electronics have been of growing interest over the past decades due to their various attractive potential applications. The island–bridge structure is the most widely used structural design, where rigid inorganic devices (islands) and interconnects (bridges) are attached to an elastomer substrate, and large deformations in the structure are accommodated by the large stretchability of the interconnects and the elastomer underneath them. Due to the large modulus mismatch of more than five orders of magnitude between the rigid island and elastomer substrate, there is a severe stress and strain concentration at the interface between the island and the substrate during large deformations, which may cause the interface fracture and delamination. In this work, the analytical solution of the interfacial shear and peel stress between the island and the substrate is derived to reveal the mechanism of interface fracture and agrees well with finite element analysis (FEA) results. A simple porous partition substrate design strategy is proposed to alleviate this stress and strain concentration at the boundary of the interface, where the porous region can undergo larger deformation due to the reduced stiffness of the material. FEA obtains the key parameters affecting the pore layout. The digital image correlation (DIC) experiment verifies the design strategy. The results show that, compared to the solid substrate, the porous partition substrate strategy can significantly reduce the maximum normal strain of the substrate around the island, thus effectively reducing the risk of structural interface failure.
Accounting for Machine Learning Prediction Errors in Design
Authors: Du Xiaoping
Published: December 2023

Machine learning is gaining prominence in mechanical design, offering cost-effective surrogate models to replace computationally expensive models. Nevertheless, concerns persist regarding the accuracy of these models, especially when applied to safety-critical products. To address this challenge, this study investigates methods to account for model prediction errors by incorporating epistemic uncertainty within surrogate models while managing aleatory uncertainty in input variables. The paper clarifies key aspects of modeling coupled epistemic and aleatory uncertainty when using surrogate models derived from noise-free training data. Specifically, the study concentrates on quantifying the impacts of coupled uncertainty in mechanical design through the development of numerical methods based on the concept of the most probable point. This method is particularly relevant for mechanical component design, where failure prevention holds paramount importance, and the probability of failure is low. It is applicable to design problems characterized by probability distributions governing aleatory and epistemic uncertainties in model inputs and predictions. The proposed method is demonstrated using shaft and beam designs as two illustrative examples. The results demonstrate the method's effectiveness in quantifying and mitigating the influence of coupled uncertainty in the design process.
A Continuously Variable Transmission-Based Variable Stiffness Actuator for pHRI: Design Optimization and Performance Verification
Authors: Mobedi Emir , Can Dede Mehmet İsmet
Published: December 2023

Physical human–robot interfaces (pHRIs) enabled the robots to work alongside the human workers complying with the regulations set for physical human–robot interaction systems. A variety of actuation systems named variable stiffness/impedance actuators (VSAs) are configured to be used in these systems’ design. Recently, we introduced a new continuously variable transmission (CVT) mechanism as an alternative solution in configuring VSAs for pHRI. The optimization of this CVT has significant importance to enhance its application area and to detect the limitations of the system. Thus, in this paper, we present a design optimization approach (an adjustment strategy) for this system based on the design goals, desired force, and minimization of the size of the system. To implement such design goals, the static force analysis of the CVT is performed and validated. Furthermore, the fabrication of the optimized prototype is presented, and the experimental verification is performed considering the requirements of VSAs: independent position and stiffness variation, and shock absorbing. Finally, the system is calibrated to display 6 N continuous output force throughout its transmission variation range.
Fouling and Corrosion Control Technologies for Waste-to-Energy Boilers
Authors: Goff Stephen , Danielsen Asger
Published: December 2023

There are more than 1600 waste-to-energy (WTE) plants worldwide, processing over 200 million tons of waste per year and recovering energy for power generation and heating applications. Many of these plants operate with quite old or even outdated equipment. As these plants age, the waste disposal capacity and energy recovery are at risk, necessitating technologies to improve their performance, reduce operating and maintenance costs, and maintain high reliability. This potential for improved performance is important and, in many cases, more economical and sustainable than the construction of new WTE facilities.
The Role of Fuel and Energy Recovery From Non-recyclable Materials in Circular/low Carbon Economy Policies
Authors: Bourtsalas A.C. (Thanos)
Published: December 2023

Circular economy (CE) and low-carbon economy (LCE) are the policies adopted as a response to the unsustainable use of natural resources. However, the role of fuel or energy recovery from non-recyclable materials (waste to energy or WTE; materials which otherwise are landfilled) in CE and LCE policies is often questioned, mainly due to considerations on the environmental and economic impacts of the processes. This paper is divided into two parts. The first part is associated with an evaluation of primary industrial data to compare the environmental and economic aspects of six advanced Mechanical Biological Treatment (MBT; called ‘dirty’ Materials Recovery Facilities in the US) facilities in Europe, some of which included the use of non-recyclable materials in the energy/cement sectors. The second part relates to a holistic assessment of the management of waste products in the US by evaluating the potential contribution of such products to the U.S. energy grid and assessing the opportunity to substitute fossil fuels, both for electricity and residential heat production. From this analysis, it can be concluded that WTE can be the final disposal step for non-recyclable materials and serve as a transition step to a more circular/sustainable development path, depending on where cities are at the start.
Observation of interplay between phonon chirality and electronic band topology
Authors: Hernandez Felix G. G. , Baydin Andrey , Chaudhary Swati , Tay Fuyang , Katayama Ikufumi , Takeda Jun , Nojiri Hiroyuki , Okazaki Anderson K. , Rappl Paulo H. O. , Abramof Eduardo , Rodriguez-Vega Martin , Fiete Gregory A. , Kono Junichiro
Published: December 2023

The recently demonstrated chiral modes of lattice motion carry angular momentum and therefore directly couple to magnetic fields. Notably, their magnetic moments are predicted to be strongly influenced by electronic contributions. Here, we have studied the magnetic response of transverse optical phonons in a set of Pb

1−
x

Sn

x

Te films, which is a topological crystalline insulator for
x
> 0.32 and has a ferroelectric transition at an
x
-dependent critical temperature. Polarization-dependent terahertz magnetospectroscopy measurements revealed Zeeman splittings and diamagnetic shifts, demonstrating a large phonon magnetic moment. Films in the topological phase exhibited phonon magnetic moment values that were larger than those in the topologically trivial samples by two orders of magnitude. Furthermore, the sign of the effective phonon
g
-factor was opposite in the two phases, a signature of the topological transition according to our model. These results strongly indicate the existence of interplay between the magnetic properties of chiral phonons and the topology of the electronic band structure.
Acquisition of suppressive function by conventional T cells limits antitumor immunity upon T
reg
depletion
Authors: Whiteside Sarah K. , Grant Francis M. , Alvisi Giorgia , Clarke James , Tang Leqi , Imianowski Charlotte J. , Zhang Baojie , Evans Alexander C. , Wesolowski Alexander J. , Conti Alberto G. , Yang Jie , Lauder Sarah N. , Clement Mathew , Humphreys Ian R. , Dooley James , Burton Oliver , Liston Adrian , Alloisio Marco , Voulaz Emanuele , Langhorne Jean , Okkenhaug Klaus , Lugli Enrico , Roychoudhuri Rahul
Published: December 2023

Regulatory T (T
reg
) cells contribute to immune homeostasis but suppress immune responses to cancer. Strategies to disrupt T
reg
cell–mediated cancer immunosuppression have been met with limited clinical success, but the underlying mechanisms for treatment failure are poorly understood. By modeling T
reg
cell–targeted immunotherapy in mice, we find that CD4
+
Foxp3
−
conventional T (T
conv
) cells acquire suppressive function upon depletion of Foxp3
+
T
reg
cells, limiting therapeutic efficacy. Foxp3
−
T
conv
cells within tumors adopt a T
reg
cell–like transcriptional profile upon ablation of T
reg
cells and acquire the ability to suppress T cell activation and proliferation ex vivo. Suppressive activity is enriched among CD4
+
T
conv
cells marked by expression of C-C motif receptor 8 (CCR8), which are found in mouse and human tumors. Upon T
reg
cell depletion, CCR8
+
T
conv
cells undergo systemic and intratumoral activation and expansion, and mediate IL-10–dependent suppression of antitumor immunity. Consequently, conditional deletion of
Il10
within T cells augments antitumor immunity upon T
reg
cell depletion in mice, and antibody blockade of IL-10 signaling synergizes with T
reg
cell depletion to overcome treatment resistance. These findings reveal a secondary layer of immunosuppression by T
conv
cells released upon therapeutic T
reg
cell depletion and suggest that broader consideration of suppressive function within the T cell lineage is required for development of effective T
reg
cell–targeted therapies.
Advances in the cellular biology, biochemistry, and molecular biology of acidocalcisomes
Authors: Docampo Roberto
Published: December 2023

Acidocalcisomes are organelles conserved during evolution and closely related to the so-called volutin granules of bacteria and archaea, to the acidocalcisome-like vacuoles of yeasts, and to the lysosome-related organelles of animal species. All these organelles have in common their acidity and high content of polyphosphate and calcium. They are characterized by a variety of functions from storage of phosphorus and calcium to roles in Ca
2+
signaling, osmoregulation, blood coagulation, and inflammation. They interact with other organelles through membrane contact sites or by fusion, and have several enzymes, pumps, transporters, and channels.
Complete m6A and m4C methylomes for group B streptococcal clinical isolates CJB111, A909, COH1, and NEM316
Authors: Manzer Haider S. , Doran Kelly S.
Published: December 2023

Group B
Streptococcus
(GBS) is known to colonize the female reproductive tract and causes adverse pregnancy outcomes and neonatal disease. DNA methylation is a common mechanism for both phage defense and transcriptional regulation. Here, we report the m6A and m4C methylomes of four clinical GBS isolates, CJB111, A909, COH1, and NEM316.
Antipsychotic quetiapine alters the mouse fecal resistome by impacting antibiotic efflux, cell membrane, and cell wall synthesis genes
Authors: Kyono Yasuhiro , Magboo Jonathan D. , Daley Elizabeth A. , Flowers Stephanie A.
Published: December 2023

The understanding of the antimicrobial activities of non-antibiotic pharmaceuticals is evolving, with growing interest in their implications for antimicrobial resistance (AMR) in gut bacteria. Quetiapine, a frequently prescribed second-generation antipsychotic (SGA), is relevant in this context. While previous studies indicate quetiapine’s role in AMR development
in vitro
, the specific mechanisms and impacts remain undefined. We aim to elucidate quetiapine’s effects on the gut resistome in C57BL/6NHsd male and female mice. Over 12 weeks, mice received quetiapine in their drinking water. We longitudinally analyzed the fecal resistome, contrasting it with a control group receiving regular water. Recognizing AMR genes’ minute presence in metagenomes, we adopted a hybrid capture method to examine AMR genes’ longitudinal trends, correlating them with 16S ribosomal RNA (16S rRNA) sequencing data and validating with qPCR. We also evaluated the minimal inhibitory concentrations for
Escherichia coli
exposed to quetiapine
in vitro
and
Escherichia
species cultured from experimental mouse stool. Quetiapine exposure led to a pronounced increase in the relative abundance of certain AMR gene families within the mouse fecal resistome, notably those linked to antibiotic efflux, phosphoethanolamine transferases, and undecaprenyl pyrophosphate-related proteins.
Escherichia
isolates from quetiapine-exposed mice showed significantly reduced colistin sensitivity compared to isolates from control mice. Our findings mark the first evidence that quetiapine, and potentially other SGAs, may influence AMR evolution in complex
in vivo
microbial communities. This highlights the need for continued investigation into how medications impact the gut resistome, guiding improved clinical practices and antimicrobial stewardship.

IMPORTANCE

This study significantly contributes to our understanding of how certain medications can unintentionally contribute to a major global health issue, i.e., antibiotic resistance. Quetiapine, a widely used antipsychotic medication, was found to increase key resistance mechanisms of gut bacteria to antibiotics in mice. Specifically, these data suggest that quetiapine may target elements of the bacterial cell membrane. If similar effects are found in humans, this medicine could unexpectedly make it harder to treat certain infections. This research emphasizes the importance of being mindful about not just antibiotics themselves, but also about other medications that could inadvertently contribute to this problem. Ultimately, these findings underline the necessity for more in-depth research on the broader impact of pharmaceuticals.
Effect of the Tool Path on Hardness Uniformity in an Annular Zone of X20Cr13 Steel Surface-Hardened by Friction Stir Processing
Authors: Kuznetsov V. P. , Skorobogatov A. S. , Kolubaev E. A. , Dmitriev A. I. , Smolin I. Yu. , Voropaev V. V. , Vorontsov I. A.
Published: December 2023

This paper presents the numerical and experimental results of hardening of an annular zone on the flat surface of an X20Cr13 steel specimen by friction stir processing (FSP) with a WC-Co hard alloy tool moving along circular and fan-shaped paths. A finite element model of the process is proposed for predicting the temperature distribution through the width and depth of the annular zone for the considered tool paths and for detecting the reverse tempering regions. The influence of the paths of a cylindrical friction stir tool with a flat end on microhardness distribution in the surface layer of the hardened zone was studied experimentally. It was shown that FSP along the fan-shaped path provides uniform hardening of the annular zone, while processing along the circular trajectory leads to softening of the material in the regions where the friction tracks overlap. The uniformity of surface hardness in the friction stir processed annular zone of X20Cr13 steel was evaluated by calculating the “covering uniformity” (CU) index proposed by Campana. The hardening behavior is in full agreement with the results of finite element simulation of the FSP process. Hardness measurements and microstructural studies showed that the fan-shaped tool path provides surface layer hardening to a depth of 400 μm with the CU index ranging from 0.78 to 1.00. In the case of the circular path, the CU index ranges from 0.48 to 0.72 at the same depth. The proposed research methods can be applied to evaluate the FSP efficiency when using other workpiece and tool materials.
Geospatial mapping of 2-hour access to timely essential surgery in the Philippines
Authors: Lim Xuxin , Ayyappan Madhumitha , Zaw Ma Wai Wai , Mandyam Nikita Kanumoory , Chia Hui Xiang , Lucero-Prisno Don Eliseo
Published: December 2023

Objectives

Timely access to safe and affordable surgery is essential for universal health coverage. To date, there are no studies evaluating 2-hour access to Bellwether procedures (caesarean section, laparotomy, open fracture management) in the Philippines. The objectives of this study were to measure the proportion of the population able to reach a Bellwether hospital within 2 hours in the Philippines and to identify areas in the country with the most surgically underserved populations.

Methods

All public hospitals with Bellwether capacities were identified from the Philippines Ministry of Health website. The service area tool in ArcGIS Pro was used to determine the population within a 2-hour drive time of a Bellwether facility. Finally, suitability modelling was conducted to identify potential future sites for a surgical facility that targets the most underserved regions in the Philippines.

Results

428 Bellwether capable hospitals were identified. 85.1% of the population lived within 2 hours of one of these facilities. However, 6 regions had less than 80% of its population living within 2 hours of a Bellwether capable facility: Bicol, Eastern Visayas, Zamboanga, Autonomous region of Muslim Mindanao, Caraga and Mimaropa. Suitability analysis identified four regions—Caraga, Mimaropa, Calabarzon and Zamboanga—as ideal locations to build a new hospital with surgical capacity to improve access rates.

Conclusion

85.1% of the population of the Philippines are able to reach Bellwether capable hospitals within 2 hours, with regional disparities in terms of access rates. However, other factors such as weather, traffic conditions, financial access, availability of 24-hour surgical services and access to motorised vehicles should also be taken into consideration, as they also affect actual access rates.
Inhaled beclomethasone in the treatment of early COVID-19: a double-blind, placebo-controlled, randomised, hospital-based trial in Sri Lanka
Authors: Mettananda Chamila , Peiris Chathura , Abeyrathna Dharani , Gunasekara Aloka , Egodage Thimira , Dantanarayana Channaka , Pathmeswaran Arunasalam , Ranasinha Channa
Published: December 2023

Objectives

To study if early initiation of inhaled beclomethasone 1200 mcg in patients with asymptomatic, mild or moderate COVID-19 reduces disease progression to severe COVID-19.

Design

Double-blinded, parallel-groups, randomised, placebo-controlled trial.

Setting

A hospital-based study in Sri Lanka.

Participants

Adults with asymptomatic, mild or moderate COVID-19, presenting within the first 7 days of symptom onset or laboratory diagnosis of COVID-19, admitted to a COVID-19 intermediate treatment centre in Sri Lanka between July and November 2021.

Interventions

All participants received inhaled beclomethasone 600 mcg or placebo two times per day, for 10 days from onset of symptoms/COVID-19 test becoming positive if asymptomatic or until reaching primary endpoint, whichever is earlier.

Primary outcome measure

Progression of asymptomatic, mild or moderate COVID-19 to severe COVID-19.

Secondary outcome measures

The number of days with a temperature of 38°C or more and the time to self-reported clinical recovery.

Results

A total of 385 participants were randomised to receive beclomethasone(n=193) or placebo(n=192) stratified by age (≤60 or >60 years) and sex. One participant from each arm withdrew from the study. All participants were included in final analysis. Primary outcome occurred in 24 participants in the beclomethasone group and 26 participants in the placebo group (RR 0.90 ; p=0.763). The median time for self-reported clinical recovery in all participants was 5 days (95% CI 3 to 7) in the beclomethasone group and 5 days (95% CI 3 to 8) in the placebo group (p=0.5). The median time for self-reported clinical recovery in patients with moderate COVID-19 was 5 days (95% CI 3 to 7) in the beclomethasone group and 6 days (95% CI 4 to 9) in the placebo group (p=0.05). There were no adverse events.

Conclusions

Early initiation of inhaled beclomethasone in patients with asymptomatic, mild or moderate COVID-19 did not reduce disease progression to severe COVID-19.

Trial registration number

Sri Lanka Clinical Trials Registry; SLCTR/2021/017.
Study protocol for a single-blind, parallel-group, randomised, controlled non-inferiority trial of 4-day intensive versus standard cognitive behavioural therapy for adults with obsessive–compulsive disorder
Authors: Ivanova Ekaterina , Fondberg Robin , Flygare Oskar , Sannemalm Max , Asplund Sofia , Dahlén Sofia , Sampaio Filipa , Andersson Erik , Mataix-Cols David , Ivanov Volen Z , Rück Christian
Published: December 2023

Introduction

Individual cognitive behavioural therapy (CBT) with exposure and response prevention is an effective treatment for obsessive–compulsive disorder (OCD). However, individual CBT is costly and time-consuming, requiring weekly therapy sessions for 3–4 months. A 4-day intensive version of CBT for OCD delivered in group format has been recently developed in Norway (Bergen 4-day treatment, B4DT). B4DT has shown promising results in several uncontrolled and one small, randomised trial, but its non-inferiority to the gold standard treatment has not been established.

Methods and analysis

This single-blind, randomised controlled trial including 120 patients (60 per arm) will compare B4DT to individual CBT. The primary outcome is the blind assessor-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We hypothesise that B4DT will be non-inferior to gold standard CBT 15 weeks after treatment start. The non-inferiority margin is set at four points on the Y-BOCS. Secondary outcomes include time to treatment response, cost-effectiveness, response and remission rates, drop-out rates and adverse events.

Ethics and dissemination

This study has been approved by the Swedish Ethical Review Authority. Hypotheses were specified and analysis code published before data collection started. Results from all analyses will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials and Consolidated Health Economic Evaluation Reporting Standards irrespective of outcome.

Trial registration number

NCT05608278.
Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database
Authors: Tang Lian-Sha , Zhou Yu-Wen , Wang Jia-Ling , Zhang Guo-Xu , Xu Chen-Hao , Liu Ji-Yan , Qiu Meng
Published: December 2023

Objectives

Carcinosarcoma (CS) is a rare and biphasic malignancy characterised by a highly invasive biological nature and poor prognosis. This study explored the epidemiology, site-specific characteristics and survival outcome of CS.

Design

We conducted a retrospective study in the Surveillance, Epidemiology and End Results (SEER) database (1975–2018) for primary CS.

Setting and participants

SEER database includes publicly available information from regional and state cancer registries in the US centres. A total of 5042 CS patients were identified. We selected the top five anatomic CS (uterus, double adnexa, lung, bladder and breast) patients for further analysis.

Primary outcome measures

Incidence was estimated by geographical region, age, sex, race, stage and primary site. Trends were calculated using joinpoint regression. The cancer-specific survival (CSS) rate and initial treatment were summarised.

Results

Nearly 80% of CS occurred in the uterus and double adnexa, followed by lung, bladder and breast. The elderly and black population presented the highest age-adjusted rate of CS. The rates of distant metastasis in CS progressively increased from 1989 to 2018. Atlanta was the area with the highest incidence at 0.7 per 100 000. Pulmonary and bladder CS more frequently occurred in men and were diagnosed with regional stage. Distant metastasis was mostly found in ovary/fallopian tube CS. Radiotherapy was more commonly applied in uterine CS, while adnexa CS cases were more likely to receive chemotherapy. Multiple treatments were more used in breast CS. Pulmonary CS seemed to suffer worse CSS (median: 9.92 months), for which radiotherapy might not provide survival benefits (HR 0.60, 95% CI 0.42 to 0.86). Compared with the common histological types in each site, CS had the shortest survival.

Conclusions

CS has unique clinical features in each primary site. Substantial prognosis variances exist based on tumour locations. The aggressive course is the common feature in CS at all sites.
Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals: a qualitative descriptive study
Authors: Duncan Edward , Alexander Lyndsay , Cowie Julie , Love Alison , Morris Jacqui H , Moss Rachel , Ormerod Jane , Preston Jenny , Shim Joanna , Stage Emma , Tooman Tricia , Cooper Kay
Published: December 2023

Objectives

This study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.

Design

We used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)) and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads).

Setting

Four NHS Scotland territorial health boards.

Participants

51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews).

Results

Three key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management and (3) strengths and limitations of existing Long COVID rehabilitation services.

Conclusions

Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.
Use of the positive deviance approach for healthcare system service improvement: a scoping review protocol
Authors: Kassie Ayelign Mengesha , Eakin Elizabeth , Abate Biruk Beletew , Endalamaw Aklilu , Zewdie Anteneh , Wolka Eskinder , Assefa Yibeltal
Published: December 2023

Introduction

Healthcare systems are currently facing challenges in enhancing access and improving the quality of healthcare services around the world, and one of the innovative strategies that have been used to address such challenges is the positive deviance (PD) approach. The approach assumes that identifying, examining, understanding and disseminating solutions to problems that are already available within the community and organisations including the healthcare system can help in bringing improvements at scale. However, to the best of the researcher’s knowledge, there is no scoping review, that is, conducted to map and synthesise the available evidence on the use of the PD approach for healthcare system service improvements. Hence, this scoping review aims to map and synthesise resources on the methodologies and reported outcomes and identify gaps and potentials regarding the use of the PD approach in the healthcare system.

Methods and analysis

Articles will be searched and retrieved in research databases such as PubMed, Embase and Scopus. Retrieved articles will be screened independently for inclusion through a title and, or abstract review. Then, articles that passed the title and abstract review will be screened by reading the full texts. A descriptive mapping and synthesis of the literature will be employed to present data using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist and data will be presented in text, figure and table formats.

Ethics and dissemination

The results of this scoping review will be published in peer-reviewed reputable international journals. Furthermore, it will also be disseminated through conference presentations, and popular press to the wider community. However, formal ethical approval is not required as primary data will not be collected.
Measuring practice preference variation for quality improvement: development of the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT)
Authors: Whitesel Emily , Healy Helen , Mao Wenyang , Pursley DeWayne M , Zupancic John , Gupta Munish
Published: December 2023

Background

Understanding behavioural psychology and the human side of change are guiding principles for quality improvement (QI). Tools to measure these to guide improvement efforts are lacking.

Methods

We created a clinical vignette-based survey to measure provider preferences for respiratory care in the neonatal intensive care unit. Fourteen vignettes were included, each vignette offering two reasonable practice choices. Responses were based on a 5-point Likert scale, ranging from neutral to strong preference for either choice. The survey was completed by physicians, nurses, advanced practice providers and respiratory therapists in 2017 and again in 2019. Net preference was measured as the median value of responses, and agreement was measured as the SD of responses. Net preference and agreement were assessed for all responses, by discipline, and by year.

Results

Response rates were 51% of all staff in 2017 and 57% in 2019. Vignettes asking about non-invasive respiratory support showed more defined net preferences and higher agreement between years, coinciding with QI efforts and guideline implementation in this area during the interval time. Results on other areas of practice were consistent between years. Discipline comparisons showed nurses and physicians agreed the least often. Six response patterns were identified, ranging from net preference and high agreement to no net preference and low agreement.

Conclusion

We propose this survey, called the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool, is a novel method for measurement of hospital unit psychology and culture. Demonstrated improvement where QI efforts were focused and consistency in results in other areas support the validity of this tool. Measuring the human side of change may impact QI efforts.