bluuebunny/crossref_metadata_2025 huggingface dataset:
Combining Wearable Technology and Telehealth Counseling for Rehabilitation After Lumbar Spine Surgery: Feasibility and Acceptability of a Physical Activity Intervention
Authors: Master Hiral , Coronado Rogelio A , Whitaker Sarah , Block Shannon , Vanston Susan W , Pennings Jacquelyn S , Gupta Rishabh , Robinette Payton , Stephens Byron , Abtahi Amir , Schwarz Jacob , Archer Kristin R
Published: July 2023

Objective

The purpose of this study was to examine the feasibility and acceptability of a wearable device and telehealth counseling physical activity intervention early after lumbar spine surgery.

Methods

Sixteen patients were randomized to an 8-session physical activity intervention or to usual postoperative care after surgery. The intervention included a wearable device (ie, Fitbit) and telehealth counseling by a licensed physical therapist. The feasibility of study procedures was assessed through recruitment, randomization, retention, and participation rates. Acceptability was assessed through a satisfaction survey and median within-participant change in objective physical activity (steps per day and time spent in moderate-to-vigorous physical activity [MVPA]) and patient-reported outcomes.

Results

Of 64 participants who were eligible, recruitment and randomization rates were 41 and 62%, respectively. Retention for objective physical activity and patient-reported outcomes was 94 and 100%, respectively, at 6-month follow-up. Seven (88%) participants in the intervention group completed all telehealth sessions, and 6 (75%) met step goals over the 8 sessions. All participants in the intervention group found the wearable device and telehealth counseling to be helpful and reported it much or somewhat more important than other postoperative services. Median within-participant change for steps per day improved from baseline (preoperative) to 6 months after surgery for both the intervention (1070) and usual care (679) groups, while MVPA only improved for the intervention group (2.2. minutes per day). Improvements in back and leg pain and disability were noted for both groups. No adverse events were reported in the study.

Conclusion

Combining wearable technology and telehealth counseling is a feasible approach to promote the physical activity during the early postoperative period after spine surgery. Future randomized controlled trials are needed to investigate the efficacy of leveraging wearables and telehealth during postoperative rehabilitation.

Impact

This study has implications for the clinical dissemination of physical activity strategies in the rehabilitation setting.
Pontine Waves Accompanied by Short Hippocampal Sharp Wave-Ripples During Non-rapid Eye Movement Sleep
Authors: Tsunematsu Tomomi , Matsumoto Sumire , Merkler Mirna , Sakata Shuzo
Published: July 2023

Ponto-geniculo-occipital or pontine (P) waves have long been recognized as an electrophysiological signature of rapid eye movement (REM) sleep. However, P-waves can be observed not just during REM sleep, but also during non-REM (NREM) sleep. Recent studies have uncovered that P-waves are functionally coupled with hippocampal sharp wave ripples (SWRs) during NREM sleep. However, it remains unclear to what extent P-waves during NREM sleep share their characteristics with P-waves during REM sleep and how the functional coupling to P-waves modulates SWRs. Here, we address these issues by performing multiple types of electrophysiological recordings and fiber photometry in both sexes of mice. P-waves during NREM sleep share their waveform shapes and local neural ensemble dynamics at a short (~100 milliseconds) timescale with their REM sleep counterparts. However, the dynamics of mesopontine cholinergic neurons are distinct at a longer (~10 seconds) timescale: although P-waves are accompanied by cholinergic transients, the cholinergic tone gradually reduces before P-wave genesis during NREM sleep. While P-waves are coupled to hippocampal theta rhythms during REM sleep, P-waves during NREM sleep are accompanied by a rapid reduction in hippocampal ripple power. SWRs coupled with P-waves are short-lived and hippocampal neural firing is also reduced after P-waves. These results demonstrate that P-waves are part of coordinated sleep-related activity by functionally coupling with hippocampal ensembles in a state-dependent manner.
Eye-mask and earplugs compared with sleep advice leaflet to improve night sleep duration in pregnancy: a randomized controlled trial
Authors: Gan Farah , Sooriappragasarao Muginrarao , Sulaiman Sofiah , Razali Nuguelis , Hong Jesrine Gek Shan , Tan Peng Chiong
Published: July 2023

Study Objectives

To evaluate at-home use of eye-mask and earplugs (EMEP) versus sleep hygiene advice leaflet (AL) on actigraphy-derived night sleep duration in sleep-deprived pregnant women.

Methods

A randomized controlled trial was conducted in the antenatal clinic of University Malaya Medical Centre from June 2021 to June 2022. Women at 34–36 weeks gestation with self-reported night sleep duration ≤6 hours were recruited. Participants wore an actigraphy device at night for seven consecutive nights (Observation/Baseline week). Only women whose actigraphy-derived night sleep duration was confirmed to be ≤360 minutes were randomized to use EMEP or AL. Actigraphy was continued for another week (Intervention week). Primary outcome was change in actigraphy-derived night sleep duration from observation to intervention week across trial arms. Secondary outcomes include participants’ sleep quality, labor, and neonatal outcome. Comparisons were by Student t-test, Mann–Whitney U test, and chi-square test.

Results

A total of 210 women were randomized: 105 each to EMEP and AL. The increase in night sleep duration over baseline was significantly longer with both EMEP (mean ± SD) 23 ± 41 minutes, p < .001, and AL 10 ± 35 minutes, p = .007. Night sleep duration was longer by 12.9 (95% CI = 2.2 to 23.7) minutes, p = .019 with EMEP over AL. Sleep quality (Global Pittsburgh Sleep Quality Index score) was significantly improved with EMEP (mean ± SD) −2.0 ± 2.5, p < .001, but not with AL −0.3 ± 2.2, p = .246. Labor and neonatal outcomes were not significantly different.

Conclusion

EMEP significantly lengthened night sleep duration in sleep-deprived women in late pregnancy and is superior to AL.

Clinical Trial Information

“Use of eye masks and earplugs compared with standard advice to improve sleep in pregnancy”. https://doi.org/10.1186/ISRCTN19061849. Registered with ISRCTN on 07 May 2021, trial identification number: ISRCTN19061849.
Psychological Distress after inpatient non-cardiac Surgery
Authors: Gandotra Sakshi , Daza Julian F. , Diep Calvin , Mitani Aya A. , Ladha Karim S. , Wijeysundera Duminda N. ,   on behalf of the METS Study Investigators
Published: July 2023

Objective:

Describe the incidence and natural progression of psychological distress after major surgery.

Summary Background:

The recovery process following surgery imposes physical and mental burdens that put patients at risk of psychological distress. Understanding the natural course of psychological distress after surgery is critical to supporting timely and tailored management of high-risk individuals.

Methods:

We conducted a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) multicentre cohort study (Canada, Australia, New Zealand, UK). METS recruited adult participants (≥40 y) undergoing elective inpatient non-cardiac surgery and followed them for one year. The primary outcome was the severity of psychological distress measured using the anxiety-depression item of EQ-5D-3L. We used cumulative link mixed models to characterize the time trajectory of psychological distress among relevant patient subgroups. We also explored potential predictors of severe and/or worsened psychological distress at one year using multivariable logistic regression models.

Results:

Of 1,546 participants, moderate-to-severe psychological distress was reported by 32.6% of participants before surgery, 27.3% at 30 days after surgery, and 26.2% at 1 year after surgery. Psychological distress appeared to improve over time among females (OR 0.80, 95% CI 0.65–0.95) and patients undergoing orthopedic procedures (OR 0.73, 95% CI 0.55–0.91), but not among males (OR 0.87, 95% CI 0.87–1.07) or patients undergoing non-orthopedic procedures (0.95, 95% CI 0.87–1.04). Among the average middle-aged adult, there were no time-related changes (OR 0.94, 97% CI 0.75–1.13) whereas the young-old (OR 0.89, 95% CI 0.79–0.99) and middle-old (OR 0.87, 95% CI 0.73–1.01) had small improvements. Predictors of severe and/or worsened psychological distress at one year were younger age, poor self-reported functional capacity, smoking history, and undergoing open surgery.

Conclusion:

One-third of adults experience moderate to severe psychological distress before major elective non-cardiac surgery. This distress tends to persist or worsen over time among select patient subgroups.
Multiple mechanisms of linezolid resistance in Staphylococcus haemolyticus detected by whole-genome sequencing
Authors: Manoharan Meerabai , Sawant Ajit Ramesh , Prashanth K. , Sistla Sujatha
Published: July 2023

Introduction. Linezolid is an effective therapeutic option for treating severe infections caused by multidrug-resistant Gram-positive organisms. Several mechanisms have been reported to be responsible for resistance to this antibiotic.

Hypothesis or Gap Statement. Although several mechanisms of linezolid resistance have been reported in

Staphylococcus haemolyticus

, the prevalence and potential for horizontal transfer of resistance genes have not been fully characterized, particularly among

S. haemolyticus

isolates from India.

Aim. To perform whole-genome sequencing (WGS) of linezolid-resistant

S. haemolyticus

isolates to characterize the resistance mechanisms.

Methodology. WGS was performed for 16 linezolid-resistant

S. haemolyticus

isolates to check for the presence of cfr, optrA and poxtA genes and mutations in 23S rRNA and ribosomal proteins (L3, L4 and L22) that are possible mechanisms implicated in linezolid resistance. Sequence types were identified using MLST finder. The minimum inhibitory concentration (MIC) of linezolid was determined using the E-test method. Polymerase chain reaction (PCR) was carried out for the detection of the cfr gene.

Results. The study documented three different mechanisms of linezolid resistance in

S. haemolyticus

. Thirteen of the 16 isolates were phenotypically resistant to linezolid, of which 12 were positive for the cfr gene. The G2603T mutation in 23S rRNA was found in the majority of the isolates (n=13). Ten isolates had the R138V mutation in L3 ribosomal protein. Twelve isolates with the cfr gene in combination with either G2603T or R138V mutations displayed extremely high MIC values. Surprisingly, three phenotypically sensitive isolates were found to be positive for the cfr gene but negative for other resistance mechanisms. Importantly, in almost half of the isolates the cfr gene was present on a plasmid. ST3 and ST1 were found to be the predominant sequence types.

Conclusion. All phenotypically resistant isolates exhibited two or three linezolid resistance mechanisms. The cfr gene was found on plasmids in many isolates, demonstrating its potential for horizontal transfer to more pathogenic organisms.
The impact of fentanyl on DUIDs and traffic fatalities: Blood and oral fluid data
Authors: Harper Curt E. , Mata Dani C. , Lee Dayong
Published: July 2023

Fentanyl has emerged as the most prolific drug in the ongoing opioid epidemic and has greatly impacted traffic safety in recent years. This study aimed to evaluate fentanyl prevalence and concentrations in blood and oral fluid in driving under the influence of drugs (DUID) cases in three different regions (i.e., Alabama, Orange County, CA, and Houston, TX) from 2017 to 2022. Furthermore, traffic fatalities were evaluated for Alabama and Orange County, CA. Fentanyl positivity in DUID and traffic fatalities increased for most years in this study. In Alabama, the prevalence of fentanyl DUID cases increased 4‐fold in 2022 compared to 2017. Orange County's increase from 2017 to 2022 was 14‐fold. In Houston, the increase was approximately 2‐fold from 2019 to 2022. The greatest increase for all laboratories coincided with the start of the COVID‐19 pandemic. In 2022, the median fentanyl DUID blood concentrations were 4.7, 11, and 4.7 ng/mL in Alabama, Orange County, and Houston, respectively. Most fentanyl cases were polydrug cases (≥90%). Methamphetamine, THC, and alprazolam were the most frequently detected drugs in combination with fentanyl. Alabama has collected oral fluid and blood in DUID cases since 2018. The detection of fentanyl in oral fluid was comparable to blood. However, 59% and 8.7% of fentanyl‐positive cases had concentrations of >20 ng/mL in oral fluid and blood, respectively. Therefore, oral fluid as an alternative or supplemental specimen to blood is an attractive approach for fentanyl in DUID cases. This study contributes to understanding recent fentanyl trends and their impact on traffic safety.
Anal cancer: a 20‐year retrospective study from Australia
Authors: Wong Jean , Allwright Maggie , Hruby George , Roberts Jennifer M. , Carr Andrew , Jin Fengyi , Gett Rohan , Meagher Alan P. , Hillman Richard
Published: July 2023

Backgrounds

Anal cancer is an uncommon condition, occurring at higher rates in specific subpopulations. Clinical experience is limited and substantial changes have recently occurred in our understanding of this condition. We, therefore, set out to characterize patients presenting with anal cancer and investigate whether there have been any changes over the past 20 years.

Methods

Retrospective audit of cases identified from pathology and clinical databases during the period 1 January 2000 to 31 December 2019.

Results

Two hundred and sixteen patients had anal squamous cell carcinomas, comprising 160 (74%) males and 56 (26%) females. Mean age at initial diagnosis was 55.1 ± 11.20 for males and 60.6 ± 15.18 for females (P = 0.02). At initial diagnosis, HIV‐positive cases were significantly younger than HIV negative cases (mean 52.2 ± 9.35 vs. 62.8 ± 11.61, P < 0.001); 46% of cases were classified as intra‐anal, 29% perianal and 25% both; 52% were > 2 cm at diagnosis. At presentation, intra‐anal cases were larger and more advanced than perianal cases (P = 0.049). Compared with the period 2000–2009, anal cancers presented more commonly in 2010–2019 (148 vs. 76), were more likely to occur in HIV‐negative people and to be diagnosed at a similar stage.

Conclusion

The number of anal cancer cases almost doubled over the study period and people living with HIV presented 10 years younger than others. Perianal cases presented earlier than those originating in intra‐anal locations. Together with the large size at diagnosis, this suggests the potential value of screening, particularly for intra‐anal cancers in those at high risk.
The history of Danish neuroscience
Authors: Paulson Olaf B. , Schousboe Arne , Hultborn Hans
Published: July 2023

The history of Danish neuroscience starts with an account of impressive contributions made at the 17th century. Thomas Bartholin was the first Danish neuroscientist, and his disciple Nicolaus Steno became internationally one of the most prominent neuroscientists in this period. From the start, Danish neuroscience was linked to clinical disciplines. This continued in the 19th and first half of the 20th centuries with new initiatives linking basic neuroscience to clinical neurology and psychiatry in the same scientific environment. Subsequently, from the middle of the 20th century, basic neuroscience was developing rapidly within the preclinical university sector. Clinical neuroscience continued and was even reinforced during this period with important translational research and a close co‐operation between basic and clinical neuroscience. To distinguish ‘history’ from ‘present time’ is not easy, as many historical events continue in present time. Therefore, we decided to consider ‘History’ as new major scientific developments in Denmark, which were launched before the end of the 20th century. With this aim, scientists mentioned will have been born, with a few exceptions, no later than the early 1960s. However, we often refer to more recent publications in documenting the developments of initiatives launched before the end of the last century. In addition, several scientists have moved to Denmark after the beginning of the present century, and they certainly are contributing to the present status of Danish neuroscience—but, again, this is not the History of Danish neuroscience.
Gluten subfractions of wheat storage proteins are affected by high night temperature during grain formation
Authors: Parveen Shamima , Sharma Poornima , Kaushik Megha , Divte Pandurang R. , Mandal Pranab Kumar , Jain Neelu , Anand Anjali
Published: July 2023

Gluten (gliadin + glutenin) protein in wheat flour is affected by high temperature (day and/or night) resulting in undesirable consequences on dough quality. A study was conducted with early and late‐maturing wheat genotypes, to assess the spatial (superior‐ central and inferior‐ apical and basal spikelets) variation in the composition of gluten subfractions in the developing ear under high night temperature (HNT). We hypothesised that protein content in the superior and inferior grains may show a differential quantitative and qualitative response to HNT. HNT resulted in a significant increase in protein content which exhibited a strong (r = −0.44*) negative correlation with sedimentation volume (SV) that determines baking quality. The late‐maturity genotypes were more responsive to HNT with changes in ω‐5 and γ gliadin subfractions of both superior and inferior spikelets, though a consistent trend was not established. The proportion of high molecular weight (HMW) glutenins increased, whereas low molecular weight (LMW) glutenins reduced in most of the genotypes under HNT. Both HMW and LMW glutenins revealed significant positive (r = 0.43* and r = 0.81***, respectively) correlation with SV. The expression analysis of genes for gluten subfractions showed a significant decrease in transcript abundance of α, ω‐5, γ, HMW, and LMW fractions under HNT.
Families in quarantine: COVID‐19 pandemic effects on the work and home lives of women and their daughters
Authors: Coyle Emily F. , Fulcher Megan , Baker Konner , Fredrickson Craig N.
Published: July 2023

The onset of the COVID‐19 pandemic in March 2020 disrupted the lives of millions of US families, with rising unemployment and initial lockdowns forcing nationwide school and daycare closures. These abrupt changes impacted women in particular, shifting how families navigated roles. Even pre‐pandemic, US women were responsible for the majority of household labor and childcare, and daughters bore greater chore responsibility than sons. We surveyed 280 families early in the pandemic (Spring 2020) and another 199 families more than a year later (Summer 2021) about pre‐pandemic versus current work‐family conflict (WFC), division of labor and schooling, and children's daily activities. Early on, mothers reported increased WFC (especially family impacting work), mothers assumed primary responsibility for children's education at home, and daughters spent more time doing chores and educating siblings. One year in, WFC remained high but mother's stress was lower, parents reported working less from home, and children largely returned to face‐to‐face schooling. Yet, children, especially daughters, actually spent more time caring for siblings than early in the pandemic, though less time on chores overall. We conclude that policies that support families such as paid family leave and subsidized childcare are needed to right the gender inequalities exacerbated by the pandemic.
Cardiac resynchronization therapy for patients with heart failure and nonspecific intraventricular conduction delay
Authors: Cao Zezhong , Chen Xinmin , Su Lan , Hou Xiaofeng
Published: July 2023

The efficacy of cardiac resynchronization therapy (CRT) in heart failure patients with left bundle branch block (LBBB) is well established with Class I or IIa recommendation according to 2021 ESC Guidelines on cardiac pacing and CRT, whereas non‐LBBB morphology is less recommended. There is insufficient evidence that proves patients with NICD could benefit from CRT. As patients with NICD are characterized by heterogeneity, the effect of CRT on these patients is still controversial. Although the proportion of NICD in the population is lower than that of LBBB patients, it is still worth investigating the effects of CRT on patients with NICD in an era of His‐Purkinje conduction system pacing (HPCSP).
A qualitative study of school nurses’ moral distress related to COVID‐19
Authors: Baker Christina , Jones Jacqueline , Weiss Charlotte R. , Harpin Scott B.
Published: July 2023

Objective

To understand school nurses' perceptions and experiences of moral distress related to COVID‐19 case management in the school systems.

Design

A descriptive qualitative study guided by Braun and Clarke's reflexive thematic analysis.

Sample

Twelve school nurses practicing in Colorado from December 2021 to January 2022.

Measurements

Semi‐structured interviews about school nurses’ experiences of COVID‐19. Investigators utilized an iterative reflexive thematic analysis process engaging the participants' and researchers' subjective experiences.

Results

Four themes were created: (1) keeping kids and the community safe, (2) caught in the middle of the “tug of war” between health and politics, (3) distress amid an ocean of COVID‐19 uncertainty, and (4) visibility as a bright spot shining through the COVID‐19 cloud.

Conclusions

Two research questions examined school nurses’ experiences of moral distress and their role and scope of practice that affected their relationships in the educational and public health systems. The results of this study confirm the important role of school nurses and interprofessional case management in school environments in the fight against infectious diseases and pandemics. Building stronger relationships between school nurses and public health is imperative for future collaborative and cohesive public health responses to pandemics.
Total Loss of Feedwater Analysis of Pressurized Water Reactor Using RELAP5
Authors: Prošek Andrej
Published: July 2023

In Europe, the design extension conditions (DEC) were introduced after the Fukushima Dai-ichi accident as preferred method for giving due consideration to the complex sequences and severe accidents without including them in the design basis conditions. The objective of the study is to determine available elapsed time before core uncovery and needed DEC safety features for total loss of all feedwater (TLOFW) in a two-loop pressurized water reactor. RELAP5/MOD3.3 computer code has been used for calculations. The initiating event for TLOFW is multiple failures in which, in addition to the loss of main feedwater, the auxiliary feedwater is also lost. The scenarios without DEC safety features and the scenarios with DEC safety feature assumed have been simulated. The results showed that after TLOFW event initiation, it is very important to trip the reactor as soon as possible. In case of loss of offsite power, the reactor coolant pumps stop, and the reactor very quickly trips on low reactor coolant pump flow. When normal operation systems are assumed, the reactor trip occurs on low-low steam generator narrow level few tens of seconds after accident initiation, resulting in less time available before core uncovery occurence. The results for TLOFW scenarios with normal operation systems and DEC safety features assumed demonstrated that secondary side bleed and feed can prevent core uncovery in case when no operator actions are credited in the first 30 min of event. When primary side bleed and feed is used, less time is available for operator actions.
Transcriptome architecture of the three main lineages of agrobacteria
Authors: Waldburger Lucas , Thompson Mitchell G. , Weisberg Alexandra J. , Lee Namil , Chang Jeff H. , Keasling Jay D. , Shih Patrick M.
Published: July 2023

Agrobacteria are a diverse, polyphyletic group of prokaryotes with multipartite genomes capable of transferring DNA into the genomes of host plants, making them an essential tool in plant biotechnology. Despite their utility in plant transformation, genome-wide transcriptional regulation is not well understood across the three main lineages of agrobacteria. Transcription start sites (TSSs) are a necessary component of gene expression and regulation. In this study, we used differential RNA-seq and a TSS identification algorithm optimized on manually annotated TSS, then validated with existing TSS to identify thousands of TSS with nucleotide resolution for representatives of each lineage. We extend upon the 356 TSSs previously reported in
Agrobacterium fabrum
C58 by identifying 1,916 TSSs. In addition, we completed genomes and phenotyping of
Rhizobium rhizogenes
C16/80 and
Allorhizobium vitis
T60/94, identifying 2,650 and 2,432 TSSs, respectively. Parameter optimization was crucial for an accurate, high-resolution view of genome and transcriptional dynamics, highlighting the importance of algorithm optimization in genome-wide TSS identification and genomics at large. The optimized algorithm reduced the number of TSSs identified internal and antisense to the coding sequence on average by 90.5% and 91.9%, respectively. Comparison of TSS conservation between orthologs of the three lineages revealed differences in cell cycle regulation of
ctrA
as well as divergence of transcriptional regulation of chemotaxis-related genes when grown in conditions that simulate the plant environment. These results provide a framework to elucidate the mechanistic basis and evolution of pathology across the three main lineages of agrobacteria.

IMPORTANCE

Transcription start sites (TSSs) are fundamental for understanding gene expression and regulation. Agrobacteria, a group of prokaryotes with the ability to transfer DNA into the genomes of host plants, are widely used in plant biotechnology. However, the genome-wide transcriptional regulation of agrobacteria is not well understood, especially in less-studied lineages. Differential RNA-seq and an optimized algorithm enabled identification of thousands of TSSs with nucleotide resolution for representatives of each lineage. The results of this study provide a framework for elucidating the mechanistic basis and evolution of pathology across the three main lineages of agrobacteria. The optimized algorithm also highlights the importance of parameter optimization in genome-wide TSS identification and genomics at large.
The inclusion of diagnostics in national health insurance schemes in Cambodia, India, Indonesia, Nepal, Pakistan, Philippines and Viet Nam
Authors: Bigio Jacob , Hannay Emma , Pai Madhukar , Alisjahbana Bachti , Das Rishav , Huynh Huy Ba , Khan Uzma , Mortera Lalaine , Nguyen Thu Anh , Safdar Muhammad Aamir , Shrestha Suvesh , Venkat Raman A , Verma Sharat Chandra , Yellappa Vijayashree , Srivastava Divya
Published: July 2023

The Lancet Commission on Diagnostics highlighted a huge gap in access to diagnostic testing even for basic tests, particularly at the primary care level, and emphasised the need for countries to include diagnostics as part of their universal health coverage benefits packages. Despite the poor state of diagnostic-related services in low-income and middle-income countries (LMICs), little is known about the extent to which diagnostics are included in the health benefit packages. We conducted an analysis of seven Asian LMICs—Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Viet Nam—to understand this issue. We conducted a targeted review of relevant literature and applied a health financing framework to analyse the benefit packages available in each government-sponsored scheme. We found considerable heterogeneity in country approaches to diagnostics. Of the seven countries, only India has developed a national essential diagnostics list. No country presented a clear policy rationale on the inclusion of diagnostics in their scheme and the level of detail on the specific diagnostics which are covered under the schemes was also generally lacking. Government-sponsored insurance expansion in the eligible populations has reduced the out-of-pocket health payment burden in many of the countries but overall, there is a lack of access, availability and affordability for diagnostic-related services.
Amber photobiomodulation versus tranexamic acid for the treatment of melasma: protocol for a double-blind, randomised controlled trial
Authors: Galache Thais Rodrigues , Galache Marcelo , Sena Michelle Mota , Pavani Christiane
Published: July 2023

Introduction

Photobiomodulation (PBM) has been suggested as an alternative treatment for melasma.In vitrostudies have shown PBM with amber light inhibits the tyrosinase enzyme, induces autophagy and reduces the melanin content, but randomised controlled clinical trials are still needed. This study aims to evaluate the efficacy of amber PBM (590 nm) in the treatment of melasma compared with liposomal tranexamic acid.

Methods and analysis

This study is a controlled, randomised, double-blind, non-inferiority trial. This study will be performed in two centres (Universidade Nove de Julho Facility, Campus Vergueiro, and Galache Odontology Clinic, São Caetano do Sul, both in São Paulo State, Brazil). The sample (54 participants) will be divided into two groups in a 1:1 ratio; one group will receive active PBM and a placebo cosmetic and the other will receiveshamPBM and liposomal tranexamic acid. Women presenting facial melasma, aged 35–50 years, with skin phototypes II–IV, will be eligible for inclusion. Women who use oral contraceptives, intrauterine devices, hormone replacement or photosensitive drugs, those with autoimmune disease and those who have undergone facial treatments in the last 3 months will be excluded from the study. The participants will receive PBM weekly for 12 weeks and will use the cosmetic two times per day at home during this period. The severity of melasma will be evaluated through the Melasma Area and Severity Index (MASI) as the primary outcome; pigmentation of the epidermis evaluated by corneomelametry, the photographic records, the global diagnosis of the face and the quality-of-life questionnaire (Brazilian Portuguese version of the Melasma Quality of Life Questionnaire) will assessed as secondary outcomes. All assessments will be made before starting the study (week 0), mid-study at 6 weeks and at the completion of treatment (week 12). MASI will also be evaluated during follow-up (weeks 16 and 20). The data will be analysed based on the intention-to-treat analysis using a generalised mixed model, and α <0.05 will be considered statistically significant.

Ethics and dissemination

The protocol was approved by the Research Ethics Committee of Universidade Nove de Julho (5 332 384). All participants will fill out the patient informed consent form. The results obtained in this trial will be presented at conferences and submitted for publication.

Trial registration number

ClinicalTrials.gov Registry (NCT05326997).
Conformally covariant differential symmetry breaking operators for a vector bundle of rank 3 on S3
Authors: Pérez-Valdés Víctor
Published: July 2023

We construct and give a complete classification of all the differential symmetry breaking operators [Formula: see text], between the spaces of smooth sections of a vector bundle of rank [Formula: see text] over the [Formula: see text]-sphere [Formula: see text], and a line bundle over the [Formula: see text]-sphere [Formula: see text]. In particular, we give necessary and sufficient conditions on the tuple of parameters [Formula: see text] for which these operators exist.
Reconstructing the parameter space of nonanalytical cosmological fixed points
Authors: García-Serna Santiago , Orjuela-Quintana J. Bayron , Valenzuela-Toledo César A. , Durán Hernán Ocampo
Published: July 2023

Dynamical system theory is a widely used technique in the analysis of cosmological models. Within this framework, the equations describing the dynamics of a model are recast in terms of dimensionless variables, which evolve according to a set of autonomous first-order differential equations. The fixed points of this autonomous set encode the asymptotic evolution of the model. Usually, these points can be written as analytical expressions for the variables in terms of the parameters of the model, which allows a complete characterization of the corresponding parameter space. However, a thoroughly analytical treatment is impossible in some cases. In this work, we give an example of a dark energy model, a scalar field coupled to a vector field in an anisotropic background, where not all the fixed points can be analytically found. Then, we put forward a general scheme that provides a numerical description of the parameter space. This allows us to find interesting accelerated attractors of the system with no analytical representation. This work may serve as a template for the numerical analysis of highly complicated dynamical systems.
Luminescence Performance of Mn4+ Activated BaLa2Al2O7 Phosphors
Authors: Gu Xuan , Sun Xiao-Yu , He Zheng
Published: July 2023

Mn4+ doped BaLa2Al2O7 phosphors were developed after a sintering process at 1400 °C for 3 h. The phase and luminescence performance of them were researched. The XRD patterns confirm single phase of the Mn4+ doped BaLa2Al2O7 phosphors. Upon the UV light excitation, the Mn4+ doped BaLa2Al2O7 phosphors emit strong deep-red emission. The concentration-dependence emission spectra demonstrate that the critical concentration for Mn4+ ion in BaLa2Al2O7 host is 0.006. On the basis of the temperature-dependence emission spectra, the activation energy for Mn4+ has been calculated as 0.292 eV, which suggests excellent thermostability of the Mn4+ activated BaLa2Al2O7 phosphors.
Contrast-Induced Encephalopathy: A Rare Complication in a Patient on Peritoneal Dialysis with Several Risk Factors
Authors: Milan Manani Sabrina , Mattiotti Maria , Marcello Matteo , Virzì Grazia Maria , Gnappi Maddalena , Marturano Davide , Tantillo Ilaria , Ronco Claudio , Zanella Monica
Published: July 2023

Major adverse renal and cardiovascular events are reported for high-risk patients undergoing intra-arterial procedures, even if performed with iso-osmolar contrast media (CM). We report a case of contrast-induced encephalopathy (CIE) in a peritoneal dialysis (PD) patient, affected by diabetes, hypertension, and chronic heart failure. A 78-year-old PD patient (diuresis 1,000 mL) underwent a percutaneous angioplasty of the carotid. Immediately after the exam, he developed mental confusion and aphasia. Encephalic computed tomography scan and magnetic resonance imaging excluded ischemia or hemorrhage, but both showed cerebral edema; EEG showed right hemisphere abnormalities, sequelae of recent ischemia. Mannitol and steroids were administered to reduce edema, and additional PD exchange was performed with depurative aim. Within 2 days the patient completely recovered. CIE mimics severe neurological diseases, and it should be considered as differential diagnosis if symptoms come out soon after intra-arterial administration of CM, especially in high-risk patients. Our patient suffered from diabetes, chronic kidney disease, hypertension, chronic heart failure, which are possible contributing factors to the development of CIE. Moreover, this clinical scenario is noteworthy because the development in a patient who underwent PD had never been described before.
Rationale and Design of NEUTRALIZE-AKI: A Multicenter, Randomized, Controlled, Pivotal Study to Assess the Safety and Efficacy of a Selective Cytopheretic Device in Patients with Acute Kidney Injury Requiring Continuous Kidney Replacement Therapy
Authors: Yessayan Lenar , Humes H. David , Scribe Emily C. , Iyer Sai Prasad N. , Chung Kevin K.
Published: July 2023

Introduction: NEUTRALIZE-AKI is a pivotal study to evaluate the safety and effectiveness of the selective cytopheretic device (SCD) in adult patients with acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT). Methods/Design: This is a two-arm, randomized, open-label, controlled multi-center pivotal US study which will enroll 200 adult patients (age 18–80 years) in the intensive care unit with acute kidney injury requiring CKRT and at least one additional organ failure across 30 clinical centers. Eligible patients will be randomized to CKRT plus SCD therapy versus CKRT alone. Therapy will be administered for up to 10 days, with the hypothesis that the CKRT plus SCD group will demonstrate a lower mortality rate or better rate of renal recovery than the CKRT alone group by day 90. The primary outcome is a composite of dialysis dependence or all-cause mortality at day 90. Conclusion: The SCD is a cell-directed extracorporeal therapy that targets and deactivates pro-inflammatory neutrophils and monocytes, with evidence of efficacy across a variety of critically ill patient populations. Knowledge and experience from many of those studies and other AKI trials were incorporated into the design of this pivotal study, with the aim to investigate the role of effector cell immunomodulation in the intervention of AKI.
Causal discovery approach with reinforcement learning for risk factors of type II diabetes mellitus
Authors: Gao Xiu-E. , Hu Jian-Gang , Chen Bo , Wang Yun-Ming , zhou Sheng-Bin
Published: July 2023

Background

Statistical correlation analysis is currently the most typically used approach for investigating the risk factors of type 2 diabetes mellitus (T2DM). However, this approach does not readily reveal the causal relationships between risk factors and rarely describes the causal relationships visually.

Results

Considering the superiority of reinforcement learning in prediction, a causal discovery approach with reinforcement learning for T2DM risk factors is proposed herein. First, a reinforcement learning model is constructed for T2DM risk factors. Second, the process involved in the causal discovery method for T2DM risk factors is detailed. Finally, several experiments are designed based on diabetes datasets and used to verify the proposed approach.

Conclusions

The experimental results show that the proposed approach improves the accuracy of causality mining between T2DM risk factors and provides new evidence to researchers engaged in T2DM prevention and treatment research.
Analysis of female pre-clinical students’ readiness, academic performance and satisfaction in online learning: an assessment of quality for curriculum revision and future implementation
Authors: Ganesh Kavitha , Rashid Najwa Abdur , Hasnaoui Raja El , Assiri Rasha , Cordero Mary Anne W.
Published: July 2023

Background

The acceptance of online courses by medical and dental students, especially during the coronavirus disease 2019 crisis, is substantial, as reported in various studies. However, the unfavourable online learning experiences of the students during the pandemic were also highlighted. As the teaching-learning process is returning to the “new normal,“ it is necessary to identify online learning domains implemented during the pandemic crisis that may be applied in pre-clinical courses in the future.

Methods

A validated Student Online Learning Readiness questionnaire assessed pre-clinical students’ online learning competence. Students’ academic performance in face-to-face post-pandemic was compared with their performance in online settings during the pandemic crisis. Students’ satisfaction with online learning was evaluated using a self-made survey questionnaire. Descriptive statistics, the t-test, and multiple regression analysis were used to analyze the data gathered with a p-value ≤ 0.05 considered statistically significant.

Results

Except for social skills with classmates and groupmates, in which 47.5% of respondents indicated unreadiness, most students were prepared for online learning. Theory-wise, online learners outperformed traditional learners, but the difference was insignificant. In contrast, students’ practical skills in face-to-face modality are significantly higher (p = 0.029). Students rated their satisfaction with online learning higher for interactions with instructors and staff and lower for interactions with classmates and group mates and skill acquisition.

Conclusion

Providing high-quality pre-clinical online teaching was achieved for theoretical components but not practical skills acquisition. Students’ social engagement with peers is one of the key elements crucial to online learning success. Academic leaders and curriculum developers must recognize potential gaps as they transition to online learning.
New paradigms in research on Dirofilaria immitis
Authors: Geary Timothy G.
Published: July 2023

Background

Since the advent of ivermectin (along with melarsomine and doxycycline), heartworm has come to be viewed as a solved problem in veterinary medicine, diminishing investment into non-clinical research on Dirofilaria immitis. However, heartworm infections continue to pose problems for practitioners and their patients and seem to be increasing in frequency and geographic distribution. Resistance to preventative therapies (macrocyclic lactones) complicates the picture. The use of chemotherapy for other kinds of pathogens has benefitted enormously from research into the basic biology of the pathogen and on the host-pathogen interface. A lack of basic information on heartworms as parasites and how they interact with permissive and non-permissive hosts greatly limits the ability to discover new ways to prevent and treat heartworm disease. Recent advances in technical platforms will help overcome the intrinsic barriers that hamper research on D. immitis, most notably, the need for experimentally infected dogs to maintain the life cycle and provide material for experiments. Impressive achievements in the development of laboratory animal models for D. immitis will enhance efforts to discover new drugs for prevention or treatment, to characterize new diagnostic biomarkers and to identify key parasite-derived molecules that are essential for survival in permissive hosts, providing a rational basis for vaccine discovery. A ‘genomics toolbox’ for D. immitis could enable unprecedented insight into the negotiations between host and parasite that enable survival in a permissive host. The more we know about the pathogen and how it manipulates its host, the better able we will be to protect companion animals far into the future.

Graphical Abstract
Anti-carbamylated protein antibodies in systemic sclerosis
Authors: Liem Sophie I. E. , Hoekstra E. M. , Levarht E. W. Nivine , Dorjee Annemarie L. , Scherer Hans U. , Toes René E. M. , Huizinga Tom W. J. , de Vries-Bouwstra Jeska K. , Fehres Cynthia M.
Published: July 2023

Background

To investigate the presence of different isotypes of anti-carbamylated protein (CarP) antibodies in systemic sclerosis (SSc) patients and its association with skin involvement.

Methods

Sera of 194 SSc patients from the Leiden CCISS cohort, fulfilling ACR/EULAR 2013 criteria and a clinical diagnosis of SSc, 83 patients with other connective tissue diseases/Raynaud’s Phenomenon, 24 rheumatoid arthritis patients and 98 age and sex-matched healthy controls were tested for the presence of anti-CarP IgG, IgA and IgM, determined by ELISA. Clinical characteristics, that were evaluated in SSc patients, included age, anti-topoisomerase antibodies (ATA), anti-centromere antibodies (ACA) and modified Rodnan Skin Score (mRSS).

Results

The SSc patients were 55 (SD:13) years and 155 (80%) were female. Forty-four (23%) patients tested positive for ATA, and 80 (42%) ACA. The median mRSS was 2 (range: 0; 47).

Prevalence of anti-CarP IgG was higher in SSc patients than in healthy controls (8% vs 3%, p = 0.007. Prevalence of anti-CarP IgA and IgM and levels of anti-CarP isotypes were comparable between SSc patients and healthy controls.

Fifteen (8%) SSc patients tested positive for anti-CarP IgG, 16 (8%) for anti-CarP IgA, and 36 (19%) for anti-CarP IgM. There were no significant correlations between age and levels of anti-CarP isotypes. No correlation between anti-CarP IgG levels and mRSS was found (r = 0.141, p = 0.049), nor for anti-CarP IgM and IgA levels. Anti-CarP IgA levels were higher in ATA compared to ACA positive SSc patients (ATA: 616 aU/ml [359; 1103]; ACA: 424 aU/ml [300; 673], p = 0.015).

Conclusion

SSc patients can test positive for Anti-CarP IgG, IgA and IgM. We do not observe a relevant clinical association between anti-CarP antibody response and skin involvement in SSc.
Long-term planning and development for urban and regional inclusion, safety, resilience, and sustainability. Insights from Singapore
Authors: Kempton Yelena , Salvati Luca , Vardopoulos Ioannis
Published: July 2023

Today, Singapore is a thriving city-state representing a growth of almost eighty percent since 1990. A feasible combination of state authorities’ planning, policy implementation, public-private partnerships, and international assistance has led to the city-state’s development and sustainability. Urban economics fl uctuations, demographic shifts, environment degradation reaching to irreversible points, among others, are expected to challenge the future of cities the next 50 years. Thus, it is considered essential to plan ahead for sustainability and resource management. This study delves into the broad policies and practices that have contributed to Singapore’s success story while also getting into recent years’ specifi cs and modern technologies of sustainable planning and development. Adopting a case study of Singapore long-term, or constant, re-development, fi ndings contribute to the enhancement of the existing body of knowledge in the fi eld of sustainable planning and can benefi t those interested in understanding from a policy and operational standpoint. The Singapore example illustrates that technocratic competence in design, planning, and implementation is a fundamental requirement for the long-term world-wide sustainability scheme expressed by the UN Sustainable Development Goals.
Correlation between anti-hypertensive drugs and disease progression among moderate, severe, and critically ill COVID-19 patients in the second referral hospital in Surabaya: A retrospective cohort study
Authors: Suryantoro Satriyo Dwi , Thaha Mochammad , Hayati Mutiara Rizky , Yusuf Mochammad , Pikir Budi Susetyo , Susilo Hendri
Published: July 2023

Background: Hypertension, as the comorbidity accompanying COVID-19, is related to angiotensin-converting enzyme 2 receptor (ACE-2R) and endothelial dysregulation which have an important role in blood pressure regulation. Other anti-hypertensive agents are believed to trigger the hyperinflammation process. We aimed to figure out the association between the use of anti-hypertensive drugs and the disease progression of COVID-19 patients.  

Methods: This study is an observational cohort study among COVID-19 adult patients from moderate to critically ill admitted to Universitas Airlangga Hospital (UAH) Surabaya with history of hypertension and receiving anti-hypertensive drugs.  

Results: Patients receiving beta blockers only had a longer length of stay than angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ACEI/ARB) or calcium channel blockers alone (17, 13.36, and 13.73 respectively), had the higher rate of intensive care unit (ICU) admission than ACEi/ARB (p 0.04), and had the highest mortality rate (54.55%). There were no significant differences in length of stay, ICU admission, mortality rate, and days of death among the single, double, and triple anti-hypertensive groups. The mortality rate in groups taking ACEi/ARB was lower than other combination.  

Conclusions: Hypertension can increase the severity of COVID-19. The use of ACEI/ARBs in ACE-2 receptor regulation which is thought to aggravate the condition of COVID-19 patients has not yet been proven. This is consistent with findings in other anti-hypertensive groups.