bluuebunny/crossref_metadata_2025 huggingface dataset:
The promotion of homebased physical activity for people with lung cancer and cachexia, a qualitative study of healthcare professionals, patients and carers
Authors: Gale Nichola , Hopkinson Jane , Wasley David , Byrne Anthony
Published: April 2023

Purpose

There is some evidence of the benefits of physical activity (PA) in patients with lung cancer; however, there is a lack of understanding of acceptable PA for patients with established cachexia and how to facilitate sustainable behaviour change to promote PA. Therefore, this study explored the views of healthcare professionals (HP), patients with lung cancer and cachexia, and their carers on preferences for, barriers and facilitators of homebased PA.

Methods

This qualitative study involved ten telephone interviews with HPs and face-to-face interviews with seven patients with lung cancer and cachexia and their carers. Interviews were transcribed and analysed thematically. The Capability, Opportunity, Motivation and Behaviour (COM-B) model was used as a framework for the thematic cross-group analysis.

Results

The types of homebased PA suggested by patients with lung cancer and cachexia (n = 7), their carers (n = 7) and HPs (n = 10) were functional, flexible, individualised and initially of short duration and low intensity. PA was influenced by themes within physical and psychological Capability, physical and social Opportunities as well as automatic and reflective Motivation.

Conclusion

Based on a behaviour change theory, principles to promote homebased PA were developed. These principles need to be integrated into tools to promote PA in people with lung cancer and weight loss.

Implications for Cancer Survivors

The application of the proposed principles by clinicians will promote physical activity, enhancing the function and wellbeing of patients with lung cancer and reducing burden on carers.
The Decision Problem for Effective Procedures
Authors: Salmón Nathan
Published: April 2023

The “somewhat vague, intuitive” notion from computability theory of an effective procedure (method) or algorithm can be fairly precisely defined even if it is not sufficiently formal and precise to belong to mathematics proper (in a narrow sense)—and even if (as many have asserted) for that reason the Church–Turing thesis is unprovable. It is proved logically that the class of effective procedures is not decidable, i.e., that there is no effective procedure for ascertaining whether a given procedure is effective. This result is proved directly from the notion itself of an effective procedure, without reliance on any (partly) mathematical lemma, conjecture, or thesis invoking recursiveness or Turing-computability. In fact, there is no reliance on anything very mathematical. The proof does not even appeal to a precise definition of ‘effective procedure’. Instead, it relies solely and entirely on a basic grasp of the intuitive notion of an effective procedure. Though the result that effectiveness is undecidable is not surprising, it is also not without significance. It has the consequence, for example, that the solution to a decision problem, if it is to be complete, must be accompanied by a separate argument that the proposed ascertainment procedure invariably terminates with the correct verdict.
On the Influence of Precipitation on the Dynamic Strain Aging in Mg-2%Nd
Authors: Garcés Gerardo , Pérez Pablo , Medina Judit , Barea Rafael , Gómez Adrián , García Javier , Adeva Paloma
Published: April 2023

The Mg-2%Nd alloy, thermally treated at 520°C and quenched, exhibits plastic instabilities at intermediate temperatures between 100°C and 300°C when it is compressively tested because of the dynamic strain aging phenomenon caused by the presence of neodymium atoms in solid solution. During compression tests, there is a competition between the precipitation of Mg-Nd particles and the DSA phenomenon, which depends largely on the test temperature. Thus, below 200°C, the formation of neodymium-rich precipitates is slow, and the interaction is insignificant. Under these conditions, the alloy exhibits a normal behavior of the DSA, i.e., the critical strain decreases with the increase in the test temperature. However, for test temperatures > 200°C, the formation of neodymium-rich precipitates is faster and the evolution of the critical strain with temperature is inverted because of the decrease of neodymium in solid solution.
Deleted in lymphocytic leukemia 2 (DLEU2): a possible biomarker that holds promise for future diagnosis and treatment of cancer
Authors: Qu Xue , Cao Yu-xia , Xing Yuan-xin , Liu Qi , Li Huan-jie , Yang Wei-hua , Wang Ban-qin , Han Shu-yi , Wang Yun-shan
Published: April 2023

The mechanism of deleted in lymphocytic leukemia 2 (DLEU2)-long non-coding RNA in tumors has become a major point of interest in recent research related to the occurrence and development of a variety of tumors. Recent studies have shown that the long non-coding RNA DLEU2 (lncRNA-DLEU2) can cause abnormal gene or protein expression by acting on downstream targets in cancers. At present, most lncRNA-DLEU2 play the role of oncogenes in different tumors, which are mostly associated with tumor characteristics, such as proliferation, migration, invasion, and apoptosis. The data thus far show that because lncRNA-DLEU2 plays an important role in most tumors, targeting abnormal lncRNA-DLEU2 may be an effective treatment strategy for early diagnosis and improving the prognosis of patients. In this review, we integrated lncRNA-DLEU2 expression in tumors, its biological functions, molecular mechanisms, and the utility of DLEU2 as an effective diagnostic and prognostic marker of tumors. This study aimed to provide a potential direction for the diagnosis, prognosis, and treatment of tumors using lncRNA-DLEU2 as a biomarker and therapeutic target.
The influence of the mass on the finish time in skeleton and luge competitions, and the fairness of rules and regulations
Authors: Fuss Franz Konstantin
Published: April 2023

In gravity-powered sports, more mass at the same drag area results in a shorter finish time. Based on the body mass data and the finish times of the Skeleton and Luge competitions at the 2018 Winter Olympics, this study investigated the fairness of rules, by establishing trends between finish time and body mass or simulated system mass. A glide model served for the assessment of the sensitivity of mass, drag area and coefficient of friction, and for determining how much mass were required to tie with the next higher rank of the first four athletes of each competition. The rules of Skeleton and Luge competitions permit the use of ballast mass as a function of the athletes’ body mass, but the reference mass was up to 10 kg too low. When correlating the finish time with the body mass, all trends were significant (p ≤ 0.032; α = 0.05) which indicated that the finish times were mass dependent. Correlating the finish time with the simulated system mass reveals the same result except for the men’s Luge competition. The sensitivity analysis showed that 15% change of an input parameter resulted in about 1% change of the finish time. Despite the low sensitivity, the masses required to tie with the next highest rank ranged from 0.02 to 20 kg, with a median of 0.7 kg. The skeleton rules were improved in 2020 which now provide equal conditions across a wide range of body masses; however, the current Luge rules still disadvantage lighter athletes even when using the permitted ballast mass.
A review of key terminology and definitions used for birth defects globally
Authors: Malherbe HL , Modell B , Blencowe H , Strong KL , Aldous C
Published: April 2023

Birth defects, also known as congenital disorders, are a significant health issue impacting at least five million births annually worldwide. For policymakers to mount a relevant healthcare response to care for those affected, the burden of disease of these conditions must be quantified. Estimates of the contribution of birth defects to under-5 child mortality and morbidity are generated by several groups globally. These estimates often differ, causing confusion for policymakers. While some differences may be attributed to the data sources and methods used, much is due to a lack of clarity in the terminology used for the group of disorders classed as “congenital”. This study aimed to gain insight into the diversity of terms and definitions for birth defects, including those used routinely by relevant international/national organisations and in the peer-reviewed literature. This two-part study included (1) scoping review of peer-reviewed literature to identify terms and definitions in use for birth defects and (2) review of key websites and grey literature to identify terms and definitions used. The results of this study indicate a wide variety of terms being used, often interchangeably and undefined, in peer-reviewed publications, on institutional websites and related literature. This suggests a lack of clarity related to terminology and sets the scene for further discussion, recommending that the community of practice working on birth defects comes to a consensus on standard terminology and definitions for global uptake and implementation. Such standardisation will facilitate a common understanding of the burden of these disorders globally, regionally and within countries so that action can be taken to support affected children and their families.
Captive Offshoring, Innovation and Market Diffusion: Evidence from the Swedish Community Innovation Survey
Authors: Schubert Torben
Published: April 2023

Although the effects of captive offshoring on firm innovation have increasingly become a subject of study, the literature did so far not distinguish between the effects on introducing innovation as opposed to the effects their market diffusion. This distinction is important. By integrating insights from the innovation diffusion literature, we argue that the effects of captive offshoring on home base innovation are likely to differ between the generation and the diffusion phases. Using a matched employer-employee panel dataset drawn from consecutive waves of the Swedish Community Innovation Survey (CIS) between 2009 and 2015, it is shown that captive offshoring, as measured by the share of employees at foreign locations, has an inverted u-shape effect on innovation propensity (with positive effects for the average firm). In contrast, employment offshoring does not, on average, affect the rate of diffusion as measured by the share of turnover from new products. For firms with more novel product innovations, the effects are even negative.
Quality assessment of non-roof harvested rainwater in industrial layouts of Enugu, South East Nigeria
Authors: Okudo Calistus C. , Ekere Nwachukwu R. , Okoye Chukwuma O. B.
Published: April 2023

Non-roof harvested rainwater was studied in Enugu industrial layouts of Emene and Iva Valley to determine the quality of the water. The determination was based on physicochemical parameters and concentration of 7 heavy metals, namely copper (Cu), chromium (Cr), nickel (Ni), manganese (Mn), zinc (Zn), lead (Pb) and cadmium (Cd). The physicochemical parameters of the rainwater: pH, colour, turbidity, total dissolved solids, conductivity were determined using Hanna water quality checker, and the anions nitrate, sulphate, chloride and phosphate were analysed in accordance to standard methods. The concentrations of Cu, Cr, Ni, Mn, Zn, Pb and Cd were determined using FS240 Agilent Atomic Absorption Spectrophotometer. The mean values (mg/l) of the metals: Cu, Cr, Ni, Mn, Zn, Pb and Cd in Emene sample are as follows: 0.12 ± 0.01, 0.10 ± 0.02, 0.37 ± 0.02, 0.03 ± 0.01, 0.15 ± 0.01, 0.58 ± 0.11 and 0.17 ± 0.07, while Iva Valley sample recorded 0.08 ± 0.01, 0.04 ± 0.01, 0.82 ± 0.06, 0.09 ± 0.02, 0.26 ± 0.01, 0.48 ± 0.04 and 0.31 ± 0.08, respectively. Some of these values are within or above the standard limit of World Health Organization (WHO) and Nigeria Standard for Drinking Water Quality (NSDWQ). It is important to note that these metals are toxic, persistence and have the potential to bioaccumulate. Therefore, non-roof harvested rainwater is not ready to consume water without some form of treatment. Monitoring, treatment and awareness on the harvesting and use of rainwater should be emphasized.
Outcomes of surgical treatment of diverticular abscesses after failure of antibiotic therapy
Authors: Arezzo Alberto , Nicotera Antonella , Bonomo Luca Domenico , Olandese Francesco , Veglia Simona , Ferguglia Alice , Pentassuglia Giuseppe , Mingrone Giuseppe , Morino Mario
Published: April 2023

Management of diverticular abscess (DA) is still controversial. Antibiotic therapy is indicated in abscesses ≤ 4 cm, while percutaneous drainage/surgery in abscesses > 4 cm. The study aims to assess the role of antibiotics and surgical treatments in patients affected by DA. We retrospectively analyzed 100 consecutive patients with DA between 2013 and 2020, with a minimum follow-up of 12 months. They were divided into two groups depending on abscess size ≤ or > 4 cm (group 1 and group 2, respectively). All patients were initially treated with intravenous antibiotics. Surgery was considered in patients with generalized peritonitis at admission or after the failure of antibiotic therapy. The primary endpoint was to compare recurrence rates for antibiotics and surgery. The secondary endpoint was to assess the failure rate of each antibiotic regimen resulting in surgery. In group 1, 31 (72.1%) patients were conservatively treated and 12 (27.9%) underwent surgery. In group 2, percentages were respectively 50.9% (29 patients) and 49.1% (28 patients). We observed 4 recurrences in group 1 and 6 in group 2. Recurrence required surgery in 3 patients/group. We administered amoxicillin-clavulanic acid to 74 patients, piperacillin-tazobactam to 14 patients and ciprofloxacin + metronidazole to 12 patients. All patients referred to surgery had been previously treated with amoxicillin-Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation clavulanic acid. No percutaneous drainage was performed in a hundred consecutive patients. Surgical treatment was associated with a lower risk of recurrence in patients with abscess > 4 cm, compared to antibiotics. Amoxicillin-clavulanic acid was associated with a higher therapeutic failure rate than piperacillin-tazobactam/ciprofloxacin + metronidazole.
Health monitoring of ultra high fiber performance reinforced concrete communication tower using machine learning algorithms
Authors: Saleem Sarah , Hejazi Farzad , Ostovar Nima
Published: April 2023

Within the last decades, the needed for communication towers has accelerated with the requirements for effective communication, especially for radio, radar, and television. The complexity configuration of the tower and limit access to the structure body especially inner part of the tower with hollow section is led the health monitoring of tower as the main challenging issue to maintenance during its function. The change of natural frequencies can be considered as one of the prevalent damage detection methods in structural assessment procedures. Therefore, the main aim of present research is to develop health monitoring system for Ultra High Fiber Performance Reinforced Concrete (UHPFRC) communication tower based on frequency domain response. Since the frequency data of tower is mostly noisy and interpreting of frequency in different modes in variant case of tower damage. The hybrid algorithm based on the Adaboost, Bagging and RUSBoost algorithms are implemented to identify the damage in the UHPFRC communication tower using frequency domain data. The training samples for the algorithm are obtained from a finite element simulation and full-scale experiment testing is also performed to generate the testing samples. The finite element simulation dynamic frequency results are verified through conducting a full-scale experimental test on 30 m height UHPFRC communication tower. For this propose, frequency Response Functions (FRF’s), for healthy and damaged structures were obtained by exciting of tower by an impact hammer and the acceleration response recorded by three accelerometers sensors attached in suitable positions. The developed hybrid algorithm to identifying the damage is tested and verified by considering the part of tower segments 2–3 and conducting experimental testing on the healthy structure as well as a damaged structure which caused using dynamic actuator. The testing results proved the accuracy of the developed optimized hybrid algorithm to identify damage in the tower structure in variant condition.
Schistosomiasis in Europe
Authors: Gabrielli Albis Francesco , Garba Djirmay Amadou
Published: April 2023

Purposeof Review

The purpose of this review is to provide an overview of the burden of schistosomiasis in the European continent. It discusses three subjects: the endemic forms of non-human schistosomiasis in Europe; the introduction of transmission of human schistosomiasis into Europe; and the occurrence of imported cases of human schistosomiasis.

Recent Findings

Europe is not endemic for human schistosomiasis; nevertheless, it is affected by the disease in multiple ways, although the magnitude of the burden remains elusive because of gaps in surveillance and reporting.

Schistosomiasis is a global neglected disease prevalent in tropical and subtropical areas. As of 2022, it is estimated that 251 million people require preventive chemotherapy for schistosomiasis, 90% of whom live in Africa. In Europe, human schistosomiasis is frequently detected in migrants from endemic countries who reach the continent. Additionally, outbreaks due to local transmission can sporadically occur following the introduction of schistosomes in one of the many freshwater bodies in southern Europe where competent snail hosts are found. Finally, human cercarial dermatitis is frequently occurring in Europe, because of the presence of avian schistosomiasis in several countries across the continent. A stronger epidemiological surveillance and reporting system, coupled with more surveys on humans and snails, can contribute to better assess and characterize the burden of schistosomiasis in Europe.
Trimester-specific reference intervals for thyroid function parameters in pregnant Caucasian women using Roche platforms: a prospective study
Authors: Dorizzi R. M. , Spiazzi G. , Rolli N. , Maltoni P. , Mingolla L. , Sgarzani C. , Torello M. , Tosi F. , Bonin C. , Moghetti P.
Published: April 2023

Background

Standard thyroid function parameters reference intervals (RI) are unsuitable during pregnancy, potentially resulting in incongruous treatments that may cause adverse effects on pregnancy outcomes. We aimed at defining trimester-specific TSH, FT4 and FT3 RI, using samples longitudinally collected from healthy Caucasian women.

Materials and methods

Blood samples from 150 healthy Caucasian women, who had a physiological gestation and a healthy newborn at term, were collected in each trimester and at around six months post-partum. They showed mild iodine deficiency. After excluding women with overt TSH abnormalities (> 10 mU/L) and/or TPO antibodies, data from 139 pregnant women were analyzed by means of widely used Roche platforms, and TSH, FT4 and FT3 trimester-specific RI were calculated. Post-partum data were available for 55 subjects.

Results

Serum TSH RI were 0.34–3.81 mU/L in the first trimester, and changed slightly to 0.68–4.07 U/L and 0.63–4.00 mU/L in the second and third trimester, respectively. Conversely, both FT4 and FT3 concentrations progressively decreased during pregnancy, the median values in the third trimester being 14.8% and 13.2% lower, respectively, than in the first trimester. Thyroid function parameters in the first trimester were similar to those measured after the end of pregnancy.

Conclusions

This study calculates trimester-specific RI for thyroid function parameters in pregnancy, and proposes the reference limits that should be adopted when using Roche platforms in Caucasian women.
Habitat Suitability Models of a Critically Endangered Cold-water Coral, Isidella Elongata, in the Mallorca Channel
Authors: Standaert Ward , Puerta Patricia , Mastrototaro Francesco , Palomino Desirée , Aguilar Ricardo , Ramiro-Sánchez Berta , Vázquez Juan-Tomás , Guillamón Olga Sánchez , Marin Pilar , Blanco Jorge , Orejas Covadonga
Published: April 2023

The bamboo coral Isidella elongata is often associated with a diverse community, including commercial fish species, playing an important role in the deep-sea Mediterranean as a biodiversity hotspot. There has been a drastic decrease of the populations of this species since the twentieth century, mainly related to impacts of fishing, leading to its inclusion in the Barcelona Convention and the list of Mediterranean vulnerable marine ecosystems. However, the knowledge on its local scale distribution is still very limited. In this study, habitat suitability models were performed based on a dense population of I. elongata, located in the Mallorca Channel (western Mediterranean), to contribute to fill this knowledge gap. Generalized additive models, Maximum entropy models and Random Forest were combined into an ensemble model. Models showed that habitat is most suitable on smooth plains surrounding the seamounts of Ses Olives and Ausiàs March present in the study area. Furthermore, two models out of three showed a preference of the coral for flat areas. The predictions of the habitat suitability models presented in this study can be useful to design protection measures for this critically endangered species to contribute to the species’ and deep-sea fisheries management.
A green strategy for porous biochar fabrication with superior capacity for peroxydisulfate activation to degrade sulfadiazine: the cooperative role of C-sp3 and specific surface area
Authors: Wang Shulian , Huang Yan , Ma Shuanglong , Zhan Sihui , Wang Jingzhen , Gao Boqiang , Tang Xiaodan , Zhu Qiuhui , Xu Shengjun , Zhuang Xuliang
Published: April 2023

Metal-free porous biochars are popularly utilized as catalysts for peroxydisulfate (PDS) activation. The enhancement effect of PDS activation of porous biochars fabricated by employing both hard template and alkali metal activating agent has not been explored completely. In addition, the role of the inherent carbon defect in PDS activation has not been clearly elucidated. Hence, a series of carbonaceous catalysts were fabricated using a sole template (KCl), a sole activating agent (Na2S2O3) or a combination of template and activating agent (KCl/Na2S2O3, KCl/KHCO3, KCl/NaHCO3, and KCl/Na2C2O4), to systematically investigate the effect of specific surface area (SSA) and intrinsic defect of porous biochar on its PDS activation ability. The biochar synthesized by KCl and Na2S2O3 (SK-C) exhibited the optimum degradation performance. The SK-C was found to possess an interconnected hollow cage with three-dimensional mesh structure showing the largest surface area, pore volume and C-sp3 edge  defect content among all the catalysts, which explained its paramount catalytic ability. The SSA and C-sp3 content together can determine the catalytic performance in a quantitative relationship. The single electron transfer pathway from SDZ to inner-sphere bound SK-C/PDS* was the protagonist of pollutant oxidation. The degradation intermediates were detected and recognized and their toxicities were evaluated. This study for the first time comprehensively identified the synergistic effect between the SSA and inherent defects on improving the catalytic performance of biochar for PDS activation to removal contaminants.

Graphical Abstract
Porous Zirconia Blocks Embedded with Platelet Rich Fibrin for Enhanced Bone Healing: Mechanical and Morphological Assessment
Authors: Sampaio Nuno , Noronha Oliveira Miguel , Carvalho Oscar , Manzanares-Céspedes Maria Cristina , Silva Filipe , Henriques Bruno , Souza Júlio C. M.
Published: April 2023

Extensive bone defects can not be repaired with traditional porous blocks composed of graft ceramics concerning the low strength of the materials. In this way, zirconia porous blocks become alternative bone graft material for repairing of extensive bone sites considering their physical properties. The main aim of this study was to evaluate the compressive strength and morphological aspects of porous zirconia blocks embedded with platelet rich fibrin for enhanced bone healing. Porous blocks composed of yttria-stabilized zirconia polycrystals (Y-TZP) were manufactured by the replica method using a polyurethane sponge. Specimens were submitted to a heat treatment at 1 °C/min up to 1500 °C for 120 min. Half of specimens were embedded with an injectable platelet rich fibrin (i-PRF). On i-PRF, harvested blood was immediately centrifuged by using a high-quality table centrifuge at 2700 rpm (408 g) and at room temperature for 3 min. Random specimens were prepared for morphological analyses by optical and scanning electron microscopy. Groups of specimens were mechanically assessed by compressive strength and nano-indentation tests. Porous structures composed of (Y-TZP) revealed high strength values even though interconnected pores had large dimensions. The size of pores was proper for cell migration, bone ingrowth, and angiogenesis. The incorporation of platelet rich fibrin promoted an increase in compressive strength of the porous YTZP structure. However, a decrease in strength of the porous structures was noted with the increase of number and size of pores. Fragile porous zirconia blocks can reveal an adequate strength for surgical handling and tissue healing at extensive bone repair. Also, the incorporation of further bioactive absorbable materials such as platelet rich fibrin increases the strength of the porous structures. The combination of zirconia porous blocks and platelet rich fibrin can enhance the bone healing leading to low risks of clinical issues.

Graphical Abstract
Science and sequestration for sustainability: more green space; more carbon free earth
Authors: Malik Tariq H.
Published: April 2023

While science and technology are increasing globally, environmental quality is degrading. Ideally, the increase in science productivity should decrease carbon emission; instead, carbon emissions have rapidly increased, fuelling the vicious cycle. This essay tackles this dilemma with three points based on descriptive evidence. The first point reveals that the science output has increased, carbon emissions have amplified, and agricultural productivity has decreased. The second point explicates the potential causes, showing that forest erosion has reduced the green space in the world. The erosion of green space in the world has an adverse correlation with carbon emissions and low agricultural productivity. Although science generates innovative technologies to reduce carbon emissions, which is a product of the far future, the already emitted carbon requires immediate attention and solution. We propose greening the land (foresting) can sequester carbons (Sequestration: the process of green plans absorbing carbon and producing oxygen into the atmosphere), which has multiple merits. Greening space sequesters carbon in the air and increases oxygen for sustainability, and tree plantation can produce commercial products—wood in construction and usage in an institutionalised market. The free market has neglected the depleting forests and green spaces worldwide and the institutionalised market (for example, a% of the wood in the house construction should replace steel/concrete). This institutionalised supply and demand have the potential to transform the vicious cycle into a virtuous cycle. Hence, this essay addresses these three points to highlight that the current state of affairs is not working, shrinking forest/green space reflects underlying causes, and it requires an institutionalised market solution for the input and output of foresting.
Arterial Occlusion Effectiveness of Space Blanket‒Improvised Tourniquets for the Remote Setting
Authors: Salchner Hannah , Isser Markus , Banyai Lukas , Schachner Thomas , Wiedermann Franz J. , Lederer Wolfgang
Published: April 2023

Introduction

Control of severe extremity hemorrhage by tourniquet can save lives. In remote areas or in mass casualty incidents with multiple severely bleeding victims, lack of conventional tourniquets may make it necessary to improvise tourniquets.

Methods

Occlusion of the radial artery and delayed onset of capillary refill time resulting from windlass-type tourniquets were experimentally investigated by comparing a commercial tourniquet and a space blanket‒improvised tourniquet with a carabiner as a rod. This observational study was conducted on healthy volunteers in optimal application circumstances.

Results

Operator-applied Combat Application Tourniquets were deployed more swiftly (27 s, 95% CI: 25.7–30.2 vs 94 s, 95% CI: 81.7–114.4) and achieved 100% complete radial occlusion compared with improvised tourniquets, as assessed by Doppler sonography ( P<0.001). When space blanket‒improvised tourniquets were used, traces of radial perfusion persisted in 48% of the applications. In Combat Application Tourniquets, capillary refill times were significantly delayed (7 s, 95% CI: 6.0–8.2 vs 5 s, 95% CI: 3.9–6.3) compared with those when using improvised tourniquets ( P=0.013).

Conclusions

Improvised tourniquets should be considered only in dire circumstances with uncontrolled extremity hemorrhage and when no commercial tourniquets are available. Complete arterial occlusion was achieved in only half of the applications using a space blanket‒improvised tourniquet when a carabiner was used as a windlass rod. The speed of application was inferior to that for Combat Application Tourniquets. Similar to Combat Action Tourniquets, the correct assembly and application of space blanket‒improvised tourniquets on upper and lower extremities have to be trained. Trial registration: ClinicalTrials.gov identifier: BASG No.: 13370800/15451670
Providing value to patients and providers via a pediatric statewide antibiogram in South Carolina
Authors: Bailey Pamela , Antosz Kayla , Daniels Robert , Gainey Andrew B. , Burch Anna Kathryn
Published: April 2023

Objective:

Antimicrobial stewardship has special challenges in particular populations and facilities, including pediatrics. We sought to augment the information available to antimicrobial stewardship programs (ASPs) by created a cumulative statewide antibiogram for neonatal and pediatric populations.

Methods:

In the Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), we created statewide antibiograms, including a separate antibiogram accounting for the pediatric and neonatal intensive care unit (NICU) populations. We collated data from the 4 pediatric and 3 NICU facilities in the state to provide a cumulative statewide antibiogram.

Results:

Methicillin-susceptible Staphylococcus aureus was more prevalent than methicillin-resistant Staphylococcus aureus. Pseudomonas aeruginosa, Citrobacter koserii, and Acinetobacter baumannii were isolated in only 1 NICU.

Conclusions:

These antibiograms should improve empiric prescribing in both the inpatient and outpatient setting, providing data in some areas that historically do not have pediatric antibiogram to inform prescribing. The antibiogram alone is not sufficient independently to improve prescribing but is one important aspect of stewardship in the pediatric population of South Carolina.
2 A CTS Team Approach to Topological Data Analysis of Electronic Health Records for Subtyping and Clinical Outcomes Prediction in Patients with COVID-19
Authors: Skaf Yara , Dasa Osama , Brunson Jason Cory , Pearson Thomas , Laubenbacher Reinhard
Published: April 2023

OBJECTIVES/GOALS: Analysis and modeling of large, complex clinical data remain challenging despite modern advances in biomedical informatics. We aim to explore the potential of topological data analysis (TDA) to address such challenges in the context of COVID-19 outcomes using electronic health records (EHRs). METHODS/STUDY POPULATION: In this work, we develop TDA approaches to characterize subtypes and predict outcomes in patients with COVID-19 infection. First, data for >70,000 COVID-19 patients were extracted from the OneFlorida EHR database. Next, enhancements to the TDA algorithm Mapper were designed and implemented to adapt the technique to this type of data. Clinical variables, including patient demographics, vital signs, and lab values, were then used as input to conduct a population-level exploratory analysis with an emphasis on identifying phenotypic subtypes at increased risk of adverse outcomes such as major adverse cardiovascular events (MACE), mechanical ventilation, and death. RESULTS/ANTICIPATED RESULTS: Preliminary Mapper experiments have produced visual representations of the COVID-19 patient population that are well-suited to exploratory analysis. Such visualizations facilitate easy identification of phenotypic subnetworks that differ from the general population in terms of baseline variables or clinical outcomes. In this and subsequent work, we aim to fully characterize and quantify differences between these subnetworks to identify factors that may confer increased risk (or protection from) adverse outcomes. We also plan to validate and rigorously compare the efficacy of this TDA-based approach to common alternatives such as clustering, principal component analysis, and machine learning. DISCUSSION/SIGNIFICANCE: This work demonstrates the potential utility of TDA for the characterization of complex biomedical data. Mapper provides a novel means of exploring EHR data, which are otherwise difficult to visualize and can aid in identifying or characterizing patient subtypes in diseases such as COVID-19.
6 An Interdisciplinary Approach to Studying the Mitochondrial Toxicity of Prenatal PAH Exposure
Authors: McLarnan Sarah , Kupsco Allison , Bloomquist Tessa , DeSantis Kathryn , Herbstman Julie , Pearson Brandon
Published: April 2023

OBJECTIVES/GOALS: This study models a framework for integrating epidemiological and experimental approaches to investigate the effect of prenatal polycyclic aromatic hydrocarbon (PAH) exposure on mitochondrial function (mtDNAcn, superoxide production and membrane potential) as a potential mechanism of toxicity. METHODS/STUDY POPULATION: The epidemiological aim of this study characterizes mitochondrial outcomes in samples of umbilical cord tissue and blood from two Manhattan based birth cohorts. Prenatal PAH exposure is quantified using silicone wristbands worn for 48 hours during the third trimester of pregnancy. Experimentally, we are applying a PAH mixture designed to emulate the exposure profile of the human cohorts to mouse preimplantation embryos on various dosing schedules and quantifying the same mitochondrial outcomes. mtDNAcn is quantified using rtPCR while superoxide production and membrane potential are measured using fluorescence microscopy. The goal of this study design is to leverage the strengths of each approach to draw more robust conclusions than could be derived from either alone. RESULTS/ANTICIPATED RESULTS: Preliminary results of this study have found associations between higher levels of PAH exposure and increased mitochondrial superoxide production and hyperpolarization of the mitochondrial membrane potential in mouse preimplantation embryos. We anticipate these findings to persist across dosing schedules. We furthermore expect a decrease in mtDNAcn in association with higher PAH exposure in umbilical cord tissue samples and decreased mtDNAcn with exposure to the PAH mixture in mouse embryos. DISCUSSION/SIGNIFICANCE: Characterizing the effect of prenatal PAH exposure on the mitochondria is a critical step in understanding the mechanisms that underlie the toxicity of this exposure. By employing a similar exposure mixture and mitochondrial outcomes across epidemiological and experimental approaches, we offer a model of true interdisciplinary research design.
7 Association of Non-Alcoholic Fatty Liver Disease (NAFLD) with Mild Cognitive Impairment (MCI) in Aging Hispanics
Authors: Miranda-Enchautegui Antonio , Amaya-Ardila Claudia , Santiago-Rivera Loscar , Wojna Valerie , Sepulveda-Rivera Vanessa
Published: April 2023

OBJECTIVES/GOALS: Non-alcoholic fatty liver disease increases with aging and may be associated with MCI. Thus, adults >65 years with NAFLD have a greater risk of MCI. Our objective is to associate NAFLD with MCI and, therefore, optimize the management of MCI through prevention strategies and early interventions. METHODS/STUDY POPULATION: We will recruit 100 patients >65 of all sexes from the GI and Geriatrics clinics of the University of Puerto Rico (UPR). NAFLD prevalence in aging adults will be estimated via ICD-10 codes and definition will be liver fat accumulation or steatosis (AASLD) without secondary causes. We will exclude patients RESULTS/ANTICIPATED RESULTS: We expect to find a higher NAFLD prevalence in aging adults >65 years old compared to younger ones. Furthermore, we aim to elucidate an association of NAFLD with MCI in aging adults. Besides, as the literature has shown, we anticipate that the main cognitive domains affected by NAFLD will be the visuospatial and executive functions. As the population ages, this study will help identify future targets for early interventions in people diagnosed with NAFLD that could have a greater risk for cognitive impairment. DISCUSSION/SIGNIFICANCE: To our knowledge, no study has determined the association of NAFLD with MCI in Hispanics >65 in PR. Raising awareness of NAFLD as a possible treatable or preventable risk factor for MCI by screening NAFLD patients for MCI may improve not only their global health but their quality of life as well.
8 BERD Challenges and opportunities in the new translational science landscape
Authors: Sabo Roy T. , Bean Melanie , Harris Lauren D.
Published: April 2023

OBJECTIVES/GOALS: The goal of this presentation is to highlight the role of and challenges to the Biostatistics, Epidemiology and Research Design (BERD) Core as it transitions into (i) the resources and services module (ii) and also possibly a regional center of translational science. METHODS/STUDY POPULATION: BERD cores play key roles in translational research missions, often in the form of long-term collaborative relationships focusing on project conception and design, interim monitoring and review, analysis and dissemination. The resources and services module encourages consolidation of all resources and services under the single modular umbrella, which can pose challenges to BERD autonomy and function. CTSAs transitioning from local to regional centers can also threaten to overwhelm BERD workloads and resources. Our CTSA planned an outsource-insource model to make the BERD a central feature of the new module and transplant its functionality to partner institutions. RESULTS/ANTICIPATED RESULTS: The team has planned a centralized, web-based entry-point for both self-guided inquiry and electronic requests of all resources and services, which aides project database creation and provides notification for review. The review process adds two new approval types: guided assistance to help navigate connections to relevant resources, and triaged referrals to training modules for remediation and skills development. Our BERD has added a Consulting Laboratory for projects of sufficient but non-priority merit that would otherwise be waitlisted, and established connections with regional partner institutions to whom they can refer investigators. DISCUSSION/SIGNIFICANCE: We have consolidated all resources and services into a single, accessible location, emphasizing tailored guidance to maximize limited resources. We also planned a transportable regional model that accounts for local resources and capacity to keep from overstretching the BERD and other hubs.
9 Cardio-Omentopexy to Reduce Myocardial Scarring and Promote Regeneration
Authors: Stachnik Stephen , Parsell Dawn , Forbess Joseph , Deatrick Kristopher
Published: April 2023

OBJECTIVES/GOALS: While the current management of single ventricle repairs has drastically prolonged life expectancy, the repair fails over time primarily through pathologic inflammation and fibrosis. Our goal is to demonstrate that cardio-omentopexy can decrease inflammation and fibrosis in swine after cryoinjury. METHODS/STUDY POPULATION: A cryoinjury is created using a liquid nitrogen cooled probe to the right ventricle of 20kg swine. In half the groups the omentum is attached to the heart over the area of the injury. The swine are recovered and monitored for 4 or 8 weeks at which time they are euthanized. The injured area is evaluated via histological and immunohistochemical testing for markers of inflammation and scarring including collagen type, scar area, macrophage activity. RESULTS/ANTICIPATED RESULTS: We anticipate that the addition of omentopexy to cryoinjury will decrease scar area, fibrosis and markers of chronic inflammation. Additionally, we expect an increase in myocytes in the area of injury. We expect that this will occur through the anti-inflammatory and protective mechanism of the omentum. DISCUSSION/SIGNIFICANCE: Cardio-omentopexy, if able to decrease fibrosis and preserve myocytes, may provide a useful adjunct to the treatment of single ventricle repair by prolonging the longevity of the repair. Additionally, as these repairs often require a ventriculotomy, decreasing the operative scar may preserve myocardial function.
15 COVID-19 and Moroccan nursing students: A multicenter cross-sectional survey on their related knowledge, attitudes and practices
Authors: Khudur Khulud Elnur , Khudur Khulud , Fakhri Nada , Jallal Manar , Belabbes Sanaa , Kaddar Rochdi , Oubaasri Ahmed , Elhadraoui Najia , Abdallahi Ndjoubnane Mohammed , Hassani Wafaa Al , Nejjari Chakib , Belouali Radouane , Khalis Mohamed
Published: April 2023

OBJECTIVES/GOALS: The purpose of our study was to assess the knowledge, attitudes and practices of nursing students during the COVID-19 pandemic. METHODS/STUDY POPULATION: Data were collected using an online questionnaire consisted of demographic characteristics and 24 items about COVID-19-related knowledge, attitudes and practices. RESULTS/ANTICIPATED RESULTS: A total of 1,216 nursing students participated in this study. About 82% of the participants reported that the COVID-19 virus spreads via respiratory droplets of infected individuals. The most clinical symptoms of COVID-19 correctly identified by participants were fever (97.6%), dry cough (92.4%), dyspnoea (82%) and fatigue (74.9%). More than 56.6% of the participants were afraid of being affected by COVID-19. Almost all participants reported that they avoid crowded places frequently. About 93.4% of the participants declared frequently wearing face mask when leaving home, and 85.5% maintained social distancing frequently. However, only 47.4% reported that they frequently washed their hands. About 51% stated that coronavirus outbreak has considerably changed their daily routines. DISCUSSION/SIGNIFICANCE: Sensitization and education campaigns are needed to improve their preventative practices, such as hand hygiene and wearing face mask. In addition, it may be of importance to incorporate competences into curricula to improve knowledge, attitudes and practices of future health professionals and to prepare them for emergencies and outbreaks.
16 Cross-ancestry analysis of preeclampsia identifies novel maternal susceptibility loci
Authors: Greene Catherine A. , Jasper Elizabeth A. , Hellwege Jacklyn , Verma Shefali S. , Xiao Brenda , Edwards Todd , Velez Edwards Digna R.
Published: April 2023

OBJECTIVES/GOALS: Preeclampsia (PE) is a hypertensive disorder of pregnancy, affecting 5 - 7% of pregnancies worldwide. A major cause of morbidity and mortality, PE is also associated with subsequent adverse health outcomes, including long-term increased risk of cardiovascular disease. The genetics conferring increased risk for PE are incompletely understood. METHODS/STUDY POPULATION: We performed a cross-ancestry, fixed-effects meta-analysis, incorporating both published and unpublished genome-wide association study (GWAS) summary statistics. In addition to publicly available summary statistics from two prior studies, we generated GWAS data from three electronic health record biobanks (BioVU, eMERGE, and PMBB). In total, we utilized data from 359,378 individuals (4,411 cases and 354,967 controls). Leveraging this large-scale biobank data importantly allows for detection of complex factors contributing to the diverse etiology of PE. Cases across cohorts were defined using PE-specific ICD-9/ICD-10 codes and phecodes. Cohorts included pregnant individuals of self-identified non-Hispanic Black, non-Hispanic White, and East Asian ancestry. RESULTS/ANTICIPATED RESULTS: 2 of 20,204,625 loci achieved genome-wide significance (p < 5 × 10–8) when minor allele frequency was limited to common variants (>0.01). The most significant locus was rs138180605 (p = 1.77 × 10–8), located in an intergenic region between FGFR2 and ATE1, both previously associated with breast cancer. The other significant locus was rs137895377 (p = 2.33 × 10–8), located in an intronic region of PLEKHO1. Another 225 loci achieved suggestive significance (p < 1 × 10–5). 203 loci could be mapped to 109 unique genes, some previously associated with related phenotypes such as hypertension. Next steps will focus on functional analyses, including genetically predicted gene expression incorporating placental tissue, followed by construction of a PE polygenic risk score to demonstrate predictive utility of results. DISCUSSION/SIGNIFICANCE: This work has contributed to the limited body of knowledge surrounding maternal genetic susceptibility to PE by identifying several loci warranting further investigation. Further work will expand on these results to improve understanding of genetic factors and clarify clinical risk of disease.
20 Discovery of Novel African American Genetic Risk Factors for Breast Cancer by Analyzing Whole Genome Sequencing Data of the Alabama Hereditary Cancer Cohort
Authors: LoBue Troy , Stallworth Betsy , Glover Sheniqua , Mcneely Isaac , Merner Nancy
Published: April 2023

OBJECTIVES/GOALS: My research aims to discover African American breast cancer genetic risk factors. Interested in genetic predisposition, I search for inherited variants that could explain why African American women are disparately diagnosed at younger ages and with aggressive subtypes compared to other ethnicities. METHODS/STUDY POPULATION: Our study cohort, the Alabama Hereditary Cancer Cohort (AHCC), consists of African Americans that have had a breast cancer diagnosis indicative of hereditary breast cancer. Whole genome sequencing is conducted for AHCC breast cancer cases. Hypothesizing that African American-specific protein-truncating variants explain inherited risk, our control cohort consists of whole exome sequencing data of (~2500) African Americans from the Type 2 Diabetes Exome Sequencing Project on dbGAP. Single variant and gene-based association tests are being conducted to identify risk variants/genes. Prime editing is conducted to introduce risk variants into cancer cell lines for functional analyses. RESULTS/ANTICIPATED RESULTS: Preliminary studies, involving 60 breast cancer cases, have already revealed multiple African American-specific genetic variants in the nuclear and mitochondrial genome that are statistically linked to breast cancer risk. We are in the process of increasing our breast cancer sample size, aiming for significantly higher confidence. Prime editing for selected novel variants has begun in breast cancer cell lines. Functional assays will then be carried out to observe differences in cell proliferation, cell migration, and spheroid formation in the genetically edited compared to unedited cell lines. DISCUSSION/SIGNIFICANCE: African Americans are underrepresented in breast cancer research. This study reduces research participation gaps and identifies genetic risk variants, leading to better risk assessments and screening methods. Such discoveries can also lead to new therapeutic targets, reducing breast cancer deaths.