bluuebunny/crossref_metadata_2025 huggingface dataset:
Type 2 diabetes and chronic kidney disease as long‐term predictors of cardiovascular events in patients with coronary artery disease
Authors: Schnetzer Laura , Leiherer Andreas , Festa Andreas , Mündlein Axel , Plattner Thomas , Mayer Gert , Saely Christoph , Drexel Heinz
Published: December 2024

Background

Both chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) confer a high risk of cardiovascular disease and mortality. These entities frequently coincide. The separate and joint impact of CKD and T2DM on the risk of major cardiovascular events (MACE) and survival is unclear.

Methods

In this prospective cohort study, patients with angiographically proven coronary artery disease were investigated according to their CKD and T2DM status (T2DM−/CKD−, T2DM+/CKD−, T2DM−/CKD+, T2DM+/CKD+) and followed for up to 18 years.

Results

A total of 1441 patients were included in the study of whom 39% experienced MACE (T2DM−/CKD−: 31%, T2DM+/CKD−: 43%, T2DM−/CKD+: 53%, T2DM+/CKD+: 61%) and 53% died. A log‐rank test revealed significant differences between the event‐free time period of the four groups (χ2 (3) = 112.57, p < 0.001). The presence of T2DM and CKD was associated with a 2.72‐fold increase [1.98–3.73] in MACE compared to patients who suffered from neither condition (p < 0.001). T2DM alone led to a 1.37‐fold increase [1.1–1.7], (p = 0.004), CKD alone to a 1.71‐fold increase [1.31–2.25], (p < 0.001).

Conclusion

T2DM and CKD in patients with coronary artery disease are mutually independent predictors of cardiovascular events. Patients with both CKD and T2DM are at an extremely high risk for cardiovascular events.
Patterns of parental conflict after separation: Links with the Dark Triad
Authors: Reim Julia , Amberg Stefanie , Zimmermann Janin , Lux Ulrike , Walper Sabine
Published: December 2024

Objective

The aim of this study was to uncover patterns of parental postseparation conflict and to investigate possible links to the personality factors of the Dark Triad (i.e., Machiavellianism, narcissism, and psychopathy).

Background

Studies revealed different postseparation coparenting patterns that explain why some parents face long‐lasting conflicts after separation. However, the role of legal disputes and links to parental personality traits have mostly been neglected so far.

Method

The analyses included 486 separated parents from the German Family Panel “pairfam” in year 2020–2021. We aimed to identify postseparation patterns of conflict, including coparenting and legal conflict, by using latent profile analysis. Possible links between latent profiles and the Dark Triad were assessed.

Results

Three postseparation conflict profiles were found: a cooperative, a parallel‐derogating, and a conflictual profile. Links between these profiles and the Dark Triad could be found for narcissism, with membership to the conflictual profile being more likely with higher narcissism values.

Conclusion

The findings show that a significant proportion of separated families is affected by postseparation conflict and that parents' personality plays a role here.

Implications

The results indicate that interventions targeting families affected by postseparation conflict should take parental personality traits into account.
Global Meta‐Analysis of Individual and Combined Nitrogen Inhibitors: Enhancing Plant Productivity and Reducing Environmental Losses
Authors: Wang Wenyu , Li Yaqun , Wang Wei , Ding Keren , Zhang Kun , Zhang Yulan , Liu Kai , Li Jingyuan , Li Dongwei , Lian Ruiyuan , Li Daijia , Gu Jian , Li Jie
Published: December 2024

Nitrogen (N) transformation inhibitors have been widely recognized as a promising strategy to enhance crop productivity and mitigate N losses. However, the effectiveness of individual or combined inhibitors can vary significantly across different agroecosystems. Using meta‐analysis and cost–benefit analysis (CBA), we synthesized findings from 41 peer‐reviewed studies (285 observations) globally to evaluate the efficacy of urease inhibitors (UIs), nitrification inhibitors (NIs), and combined inhibitors (UINIs). We assessed their influence on soil inorganic N transformations, greenhouse gas emissions, and crop productivity across diverse climates, soil types, cropping systems, and fertilization practices. Our results indicated that combined UINIs were the most efficient, increasing crop yields by 5% and mitigating gaseous emissions by 51% compared to UIs or NIs alone. UINIs achieved these benefits by enhancing crop ammonium (NH4+) availability through regulating urea hydrolysis and prolonging NH4+ retention by suppressing nitrification in the soil. The CBA revealed that the overall economic benefits of UINIs application outweighed the costs, resulting in a net monetary benefit of $23.36 ha−1, equivalent to a 6.4% increase in revenue. Both meta‐regression and random forest analyses suggested that UINIs performance was strongly influenced by factors such as N application rate, organic matter content, and soil pH. Notably, more substantial responses were observed in fine‐textured soils and/or crops exposed to high N fertilization rates. Acidic soils (pH < 6.5) exhibited the largest effect sizes, with increased crop productivity and reduced NH3 volatilization due to specific inhibitory interactions. In conclusion, these findings highlight UINIs beneficial impacts on crop productivity and environmental conservation, achieving a “win‐win” scenario by addressing various N‐loss challenges while enhancing economic outcomes. Further exploration and optimization of the interaction between climate, soil, plant, and management systems and the use of appropriate inhibitors are crucial for maximizing their positive impact on global climate and reaping corresponding economic benefits.
Exploring Mindset Profiles and Their Associations With Enjoyment, Ideal Self, Grit, and Achievement Among Chinese Adolescent Language Learners: A Latent Profile Analysis
Authors: Eerdemutu Liu , Sachurina Bai , Wang Junju
Published: December 2024

Mindset plays a crucial role in the learning process and outcomes. However, its impact on language learning remains underexplored. This study, grounded in the mindset theory, investigates the mindset profiles of language learners and their effects on language learning, with a focus on emotions (enjoyment), motivation (ideal self), personality traits (i.e., grit), and achievement. Data were collected via a composite questionnaire from 660 Chinese high school English as foreign language learners. Latent profile analysis identified three language mindset profiles: growth, mixed, and fixed. The majority of students were categorized under the mixed mindset profile. Students in the growth mindset profile showed the highest levels of enjoyment and ideal self, followed by those in the mixed and fixed mindset profiles. Additionally, those in the growth mindset profile demonstrated higher grit (perseverance of effort and consistency of interest) and achievement (self‐perceived and actual) compared to the mixed and fixed profiles, with no significant differences between the latter two groups. These findings highlight the importance of fostering a growth mindset in language learners and provide pedagogical implications for enhancing language learning and outcomes.
The Relationship Between University Students' Use of Social Networks and Their Political Knowledge and Activity
Authors: Li Jian , Wang Zhaojie , Zhao Shubin
Published: December 2024

Background

In today's high‐tech society, the relationship between social networks and the formation of political orientation and socio‐political activity within the student environment has become a key subject of research.

Objectives

The aim of this article is to investigate the correlations between the influence of various social media platforms, the level of political orientation and the degree of socio‐political engagement among university students.

Methods

A cross‐sectional design was employed to understand the influence of social networks on political orientation and socio‐political activity and socio‐political activity. Political orientation and socio‐political activity tests were applied to provide objective data for further analysis. The research findings indicate an equally positive correlation between Facebook and Instagram with students' levels of political orientation and socio‐political activity, whereas a weaker correlation was observed with TikTok.

Results and Conclusions

Prospects for future research may include a more profound analysis of the relationships between types of content and political orientation and socio‐political activity, as well as the study of the dynamics of changes in the influence of social networks at different stages of education and personality development.
Association between obstructive sleep apnea syndrome and type1/type2 diabetes mellitus: A systematic review and meta‐analysis
Authors: Huang Huiling , Chen Zhang
Published: December 2024

Introduction

Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway, along with hypoxemia, microarousals, and sleep fragmentation. Compelling evidence has clarified a bidirectional correlation between OSA and diabetes mellitus (DM). This paper was to assess the link between OSA and DM via meta‐analysis, consisting of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Materials and Methods

Four databases (PubMed, Cochrane Library, Embase, and CNKI) were screened from inception to March 2024 for observational studies of OSA and DM, including case–control studies and cohort studies. Bidirectional associations between OSA and DM were analyzed, consisting of T1DM and T2DM. Random‐effect models were employed to determine the pooled odds ratio (OR) and 95% confidence intervals (CIs) to compare prevalence. Traditional subgroup analyses were implemented. Review Manager 5.3 and Stata 16.0 were utilized for data analyses.

Results

Thirty‐five studies were enrolled, including 12 prospective cohort studies, 4 retrospective cohort studies, and 19 case–control studies. DM prevalence was notably higher in OSA patients than in non‐OSA patients (OR: 2.29, 95% CI: 1.93–2.72), and OSA prevalence was notably higher in DM patients than in non‐DM patients (OR: 2.12, 95% CI: 1.73–2.60). Subgroup analysis uncovered that DM prevalence in the OSA population was more significant in the group <50 years (OR: 3.28, 95% CI: 2.20–4.89) and slightly decreased in the group >50 years (OR: 1.82, 95% CI: 1.38–2.40).

Conclusions

The meta‐analysis reveals a bidirectional link between OSA and DM.
Long‐Term Performance and Safety of a Superficial HA Filler With Tri‐Hyal Technology on Different Facial Zones: Forehead, Cheeks, Crow's Feet, and Upper Lips
Authors: Cartier Hugues , Deutsch Jean‐Jacques , Braccini Frederic , Garcia Philippe , Ehlinger Agnès , David Michel , Loreto Frederic , Benadiba Laurent , Grand‐Vincent Anne , Mathey Elena Rumyantseva , Nadra Karim , Fanian Ferial
Published: December 2024

Background

The function of injectable hyaluronic acid‐based fillers is to smooth dermal wrinkles formed during aging. The aim of this study is to evaluate the performance and safety of a dermal filler after its commercialization.

Methods

In this context, an 18‐month prospective randomized single‐blind study for the efficacy and safety of ART FILLER Fine Lines (AFFL) was performed on the forehead, the upper lip, the cheek folds, and the crow's feet. The efficacy, the longevity, and the safety were evaluated after a single filler injection without any re‐touch injection. The persistence of the correction was evaluated at 3, 6, 9, 12, 15, and 18 months.

Results

The observations performed on 196 subjects enrolled showed that AFFL injections induced a significant improvement in wrinkle correction for all the assessed areas. These effects were significant as soon as 3 weeks after injection and remained significant until 18 months. Furthermore, injections of AFFL were well tolerated and no severe event was recorded. The minor reported reactions were resolved within 3 weeks.

Conclusion

AFFL with Tri‐Hyal technology is suitable and well tolerated for the treatment of superficial wrinkles without any irregularity or Tyndall effect and showed a prolonged efficacy for at least 18 months.
The use of a percutaneous cystostomy tube as an adjunctive treatment option for dogs with idiopathic functional outflow tract obstruction
Authors: Greenfield Zoe P. , Berent Allyson C. , Weisse Chick W.
Published: December 2024

Background

Functional outflow tract obstruction (FOO) remains a challenging disease to manage in male dogs. Cystostomy tubes have been used to relieve urethral obstruction while allowing time to achieve effective medical management, avoiding the need for emergency visits and repeat urinary catheterizations.

Objectives

To describe a series of dogs with FOO and categorize the most successful management strategies including medical management alone or with the support of cystostomy tubes for urinary diversion.

Animals

Twelve client‐owned dogs with FOO were included.

Methods

Medical records of dogs presented from August 2012 to September 2021 with a presumptive diagnosis of FOO were retrospectively reviewed and findings recorded.

Results

Seven dogs were managed with a cystostomy tube and 5/7 (71%) had a good‐excellent outcome. Five dogs were managed without a tube and 1/5 (20%) had a good outcome. Eight dogs were refractory to medical management; 5 managed with a cystostomy tube and 3/5 (60%) had a good‐excellent outcome; 3 managed without a cystostomy tube and 0/3 had a good or excellent outcome. Overall, dogs with cystostomy tubes had better outcomes but also had mild, moderate, and severe complications (100%, 71%, and 71%, respectively) reported.

Conclusions and Clinical Importance

Most dogs that received a percutaneous cystostomy tube as part of their management plan had a good to excellent outcome, particularly when compared to those that did not, despite the high rate of tube‐related complications. Percutaneous cystostomy tubes could be considered early during management for FOO to improve overall outcomes.
Biomechanical Evaluation of Clival Screw Fixation for Occipitocervical Instablity: A Finite Element Analysis
Authors: Lin Weipeng , Zheng Jianying , Zhang Meichao , Xu Panjie , Xiao Hang , Ji Wei
Published: December 2024

Objective

The clivus is trapezoidal in shape with uneven bone structure, the optimal number and position of screws for clival fixation are not clear. Therefore, this study aims to explore the optimization clival screw fixation method for occipitocervical instability using finite element analysis.

Methods

Seven finite element models were developed to evaluate biomechanical properties of clival screw fixation for treating occipitocervical stability, including (i) one clival screw fixation A1 and A2 models; (ii) two clival screws fixation B1 and B2 models; (iii) three clival screws fixation C1 and C2 models; (iv) four clival screws fixation D1 model. Loads of 1.5 Nm were applied to the model fRoM different directions to induce flexion, extension, lateral bending, and axial rotation movements.

Results

The regular triangle C1 type three clival screws fixation exhibited great stability, with RoM of 4.20° in flexion, 5.80° in extension, 0.85° in lateral bending, and 1.60° in axial rotation. The peak stress on the internal fixation devices were relatively low, with maximum screw stress of 194 MPa in flexion, 276 MPa in extension, 180 MPa in lateral bending, and 213 MPa in axial rotation; the maximum plate stress were 126, 554, 426, and 378 MPa, respectively. The areas with higher stress were mainly concentrated at the robust neck section of the plate.

Conclusion

The triangular configuration of three clival screws fixation represented the optimized anterior occipitocervical fixation method through the clivus, offering superior biomechanical stability, lower stress on the devices and dispersed stress distribution in the occipitocervical region.
Ecological Restoration of Inland Aquaculture in Land‐Locked Europe: The Role of Semi‐Intensive Fishponds and Multitrophic Technologies in Transforming Food Systems
Authors: Roy Koushik , Verdegem Marc C. J. , Mraz Jan
Published: December 2024

Pond aquaculture and water protection in Europe suffer from conflicts, whereas multitrophic freshwater aquaculture technologies face hardships with over‐regulations in Europe. As such, inland freshwater aquaculture in land‐locked Europe has not given its contribution or echoed its importance in regional food system dialogues. The emphasis on marine cages and RAS‐based aquaculture is enormous. Almost if they are the only viable way to carry the future European aquaculture forward. In this scoping review, we have hypothesized that semi‐intensive fishponds and freshwater multitrophic aquaculture could be an overlooked component in the European food system. The analysis we present reviewed: (1) current positioning of inland freshwater aquaculture in European food system; (2) European fishponds' current positioning within food system and inland freshwater aquaculture; (3) way forward for semi‐intensive European fishponds through ecological pond nutrition research; (4) ecological technologies for realizing ‘net zero’ aquatic foods in land‐locked Europe; (5) risks and potential for making the transition. We conclude ample circular technologies and nature‐based solutions in pond and multitrophic freshwater aquaculture in land‐locked Europe. They have the potential to transform food systems locally with low‐impact aquatic food. European inland freshwater aquaculture may be a sleeping giant among EU's planetary healthy diet ambitions. As an example, 0.25 million hectares available Central Eastern European fishponds have the potential to ecologically substitute 1 billion marine fish oil capsules (EPA + DHA in 1 kt marine fish oil) and 11.9 kt of casein (leucine from 0.45 billion litres milk) equivalents, fulfilling singlehandedly annual leucine or EPA + DHA requirements of 1.2–3 million adults.
Powerful Sounds of Prayer. Christianity and Electricity in Northern Malawi
Authors: Cichocki Piotr
Published: December 2024

The Christianity in Northern Region of Malawi serves as an illustrative case study where technological objects affect religious practices. To elucidate the role of material objects in the constitution of the religious world, the article discusses the example of electricity as a key infrastructure and its role in bridging the modern material world with the colonization of religious practices. Within this analyze, religiosity is conceived not merely as a system of symbols but rather in terms of holistic, embodied, yet institutionalized practices. The pivotal role played by electric musical instruments concerns the establishment of a centralized public sphere closely intertwined with a Christianization project and technological advancements. Electronic keyboards operate within a religiously significant electrical infrastructure, which is intricately interwoven with political and religious ideologies, embodiment, and subjectivity. The electronic sound becomes agents of profound influence, imbuing religious musical experience with the affect of civilization. This transformative impact, however, also underscores the historical marginalization and suppression of indigenous drumming traditions, initially by early missionaries, and later by institutionalized Christian churches. The historical relation between electricity, embodied affect, and religion are exemplified by two case studies: the history of the industrial Presbyterian mission of Livingstonia and the adoption of electric instruments by Katawa Singers and other local gospel choirs. Paradoxically, the development of electrical infrastructures obscures significant asymmetries within the religious socio‐spiritual world. In the Northern Region, other spiritual practices rooted in ancestral reverence and traditional healing modalities construct an antagonistic yet interconnected network that is overshadowed by the mediated public sphere shaped by technical developments.
BIL7 enhances plant growth by regulating the transcription factor BIL1/BZR1 during brassinosteroid signaling‡
Authors: Miyaji Tomoko , Yamagami Ayumi , Nakamura Yusuke , Nishida Kaisei , Tachibana Ryo , Surina Surina , Fujioka Shozo , Garcia‐Hourquet Mariano , Mora‐García Santiago , Nosaki Shohei , Miyakawa Takuya , Tanokura Masaru , Matsui Minami , Osada Hiroyuki , Shinozaki Kazuo , Asami Tadao , Nakano Takeshi
Published: December 2024

Brassinosteroids (BRs) are plant steroid hormones that regulate plant development and environmental responses. BIL1/BZR1, a master transcription factor that regulates approximately 3000 genes in the BR signaling pathway, is transported to the nucleus from the cytosol in response to BR signaling; however, the molecular mechanism underlying this process is unknown. Here, we identify a novel BR signaling factor, BIL7, that enhances plant growth and positively regulates the nuclear accumulation of BIL1/BZR1 in Arabidopsis thaliana. BIL7‐overexpressing plants were resistant to the BR biosynthesis inhibitor Brz and taller than wild‐type (WT) plants were due to increased cell division. BIL7 is mainly localized to the plasma membrane, but during the early stages of cell growth, it was also localized to the nucleus. BIL7 was directly phosphorylated by the kinase BIN2, and nuclear localization of BIL7 was enhanced by the BIN2 inhibitor bikinin. BIL7 was found to bind to BIL1/BZR1, and nuclear accumulation of BIL1/BZR1 was strongly enhanced by BIL7 overexpression. Finally, double overexpression of BIL1/BZR1 and BIL7 led to greatly elongated hypocotyls in the presence of Brz. These findings suggest that BIL7 mediates nuclear accumulation of BIL1/BZR1, which activates inflorescence elongation in plants via BR signaling.
Corticolimbic structures activation during preparation and execution of respiratory manoeuvres in voluntary olfactory sampling: An intracranial EEG study
Authors: Granget Jules , Niérat Marie Cécile , Lehongre Katia , Lambrecq Virginie , Frazzini Valerio , Navarro Vincent , Buonviso Nathalie , Similowski Thomas
Published: December 2024

Volitional respiratory manoeuvres such as sniffing and apnoea play a key role in the active olfactory exploration of the environment. Their impairment by neurodegenerative processes could thus impair olfactory abilities with the ensuing impact on quality of life. Functional brain imaging studies have identified brain networks engaged in sniffing and voluntary apnoea, comprising the primary motor and somatosensory cortices, the insula, the anterior cingulate cortex and the amygdala. The temporal organization and the oscillatory activities of these networks are not known. To elucidate these aspects, we recorded intracranial electroencephalograms in six patients during voluntary sniffs and short apnoeas (12 s). The preparation phase of both manoeuvres involved increased alpha and theta activity in the posterior insula, amygdala and temporal regions, with a specific preparatory activity in the parahippocampus for the short apnoeas and the hippocampus for sniff. Subsequently, it narrowed to the superior and median temporal areas, immediately after the manoeuvres. During short apnoeas, a particular dynamic was observed, consisting of a rapid decline in alpha and theta activity followed by a slow recovery and increase. Volitional respiratory manoeuvres involved in olfactory control involve corticolimbic structures in both a preparatory and executive manner. Further studies are needed to determine whether diseases altering deep brain structures can disrupt these mechanisms and if such disruption contributes to the corresponding olfactory deficits.

image

Key points

Both sniff manoeuvres and short apnoeas are associated with oscillatory activity predominantly in low‐frequency bands (alpha and theta).

Preparation of sniff manoeuvres and short apnoeas involve activities in low‐frequency bands in the posterior insula and temporal regions that extend to amygdala during the execution of both manoeuvres.

During short apnoeas, activities in low‐frequency bands initially decline before continuously increasing until the apnoeas end.
Experiencias de un grupo de pacientes con la alimentación recibida durante su estancia hospitalaria en Medellín, en el año 2023
Authors: Correa Arenas Katherine
Published: December 2024

Introducción: la alimentación en el entorno hospitalario es fundamental para la satisfacción y el bienestar del paciente. Entender cómo los pacientes perciben la calidad de la alimentación que reciben durante su estancia hospitalaria es esencial para mejorar los servicios de salud, lo que justifica la necesidad de explorar este aspecto. Objetivo: comprender las experiencias de los pacientes en torno a la alimentación que reciben en su estancia hospitalaria y cómo perciben su calidad. Metodología: estudio cualitativo ligado al paradigma interpretativo, que utilizó como enfoque la fenomenología interpretativa. Se realizaron 10 entrevistas semiestructuradas a adultos en un rango de edades entre 19 y 74 años, hospitalizados en una IPS de alta complejidad de la ciudad de Medellín en el año 2023. Resultados: al evaluar la “calidad” de la alimentación brindada a los pacientes durante su estancia hospitalaria, se destacan una serie de atributos que los participantes consideran importantes, tales como el sabor, el olor, la presentación y la temperatura de las preparaciones suministradas. Además, los pacientes consideran que tener en cuenta su opinión en el proceso de alimentación es importante para mejorar el servicio. Conclusión: la presente investigación destaca la importancia de la alimentación en el entorno hospitalario como un componente esencial para la satisfacción y bienestar del paciente. Los hallazgos demuestran que aspectos como el sabor, la presentación y la variedad, además de las experiencias previas y la adaptación a las preferencias individuales, influyen en la percepción de calidad del servicio de alimentación recibido por los pacientes.
Métodos en la elaboración del análisis de situación de salud ASIS en América Latina y el Caribe
Authors: Ruiz Taborda Juan Paulo , Otálvaro-Castro Gabriel Jaime , Agudelo García Héctor Byron , Rodríguez Ospina Fabio León
Published: December 2024

Introducción: Los análisis de situación de salud (ASIS) permiten describir y explicar los perfiles de salud/enfermedad de una población y las condiciones en que las personas viven y trabajan. Sin embargo, persisten retos en cuanto a la integralidad en sus diferentes fases de implementación. Objetivo: describir los métodos utilizados en las diferentes etapas del diseño de los ASIS de América latina.  Métodos: análisis de contenido de diferentes ASIS oficiales y guías para su elaboración de los países de América Latina disponibles en la web. Resultados: la participación comunitaria se identificó en el 63% de las guías analizadas. Las principales fuentes cuantitativas de información sobre determinantes sociales fueron fuentes secundarias gubernamental (96%), seguido de fuentes primarias locales (36%). las principales fuentes de información sobre condiciones de salud fueron las fuentes secundarias institucionales (100%), seguidas de las fuentes primarias locales (57%). El análisis más allá de lo descriptivo (en términos estadísticos) se identificó en el 29% de los casos Por su parte las fuentes cualitativas se utilizaron en el 54% de las guías, cobrando gran importancia en áreas pequeñas y de difícil acceso. Dentro de las guías revisadas se encontró que 15 países (62%) incorporan la priorización y el 37.5% utiliza diferentes alternativas para comunicar los resultados Conclusión: es necesario que se hagan nuevas investigaciones que permitan abrir el debate sobre la renovación de las guías y orientaciones metodológicas para la elaboración de los ASIS tomando en cuenta los principales experiencias, avances y críticas de los ASIS en América Latina.
Metodologías Lean en salud. Propuesta de mapa analítico-conceptual para sistematizar su impacto y resultados
Authors: Danet Alina , Pérez Lázaro Juan José
Published: December 2024

Objetivo: Diseñar una propuesta teórico-metodológica para sistematizar los resultados del uso de metodologías Lean en salud y aplicar dicho modelo en el ámbito sanitario occidental.  Metodología: Se diseñó una herramienta teórico-metodológica que combina los sistemas de indicadores del modelo de Donabedian, el Sistema Nacional de Salud y el modelo de Atención Sanitaria Basada en el Valor. El mapa analítico-conceptual creado se aplicó en una revisión sistemática de estudios empíricos cuantitativos y mixtos publicados en los últimos cinco años sobre el impacto de Lean en salud. Resultados: Los 33 estudios analizados, principalmente diseños cuantitativos pre-post, describen y evalúan el impacto de diversas intervenciones Lean (flujo de valor, ciclo PDSA/PDCA, Lean Six Sigma y eventos Kaizen) orientadas a mejorar la eficiencia y la calidad asistencial. La mayoría de los estudios se concentran en contextos hospitalarios (quirófanos, cuidados intensivos y farmacia) y en mediciones centradas en el eje organizacional (oferta de servicios, accesibilidad, gestión del tiempo y organización del trabajo, reducción de costos, eficiencia y seguridad), con menor atención a los aspectos centrados en el valor para los pacientes (resultados en salud, satisfacción y efectos a largo plazo). Conclusiones: El análisis estructurado basado en el mapa analítico-conceptual permitió dimensionar los resultados de Lean en salud, identificar las áreas de gestión y calidad con mayor aplicación e impacto Lean, y señalar la necesidad de ampliar las investigaciones en torno al valor para los pacientes.
O serviço residencial terapêutico como protagonista no cuidado em liberdade: avanços e desafios das políticas de Minas Gerais
Authors: Ferreira de Souza André Vitor , de Jesus Freitas Isabelle , Salluz Mattos Pereira Lírica , Vasconcelos Alcântara Amanda
Published: December 2024

O serviço residencial terapêutico (SRT) é uma casa presente na comunidade, destinada ao cuidado de pessoas com transtornos mentais egressas de hospitais psiquiátricos e de custódia que permaneceram nestes por longo período e possuem vínculos sociofamiliares rotos. Realizamos levantamento das legislações do estado de Minas Gerais com o objetivo de analisar as que subsidiaram o fomento dos SRTs existentes e quais são os avanços e desafios dessa política. Trata-se de artigo de revisão de literatura realizado por meio do portal “Pesquisa legislativa” do Poder Executivo de Minas Gerais, utilizando-se das palavras-chave “serviços residenciais terapêuticos”, “serviço residencial terapêutico”, “desospitalização”, “serviços substitutivos” e “desinstitucionalização”. Foram identificadas 307 legislações e incluídas 4 no estudo entre 1995 e 2022. Identificou-se que as normativas seguiram uma linearidade, a partir da incorporação de novas regras e parâmetros, e da caracterização do serviço, não havendo mudanças significativas no que tange aos elementos já postos. Assim, é necessário amplo debate com gestores municipais e estaduais quanto ao fortalecimento da Rede de Atenção Psicossocial para a reinserção social dos usuários que ainda estão em hospitais psiquiátricos do Estado, visando ao cuidado em liberdade.
Rheological and Electro-Pitting Performance of Electric Vehicle Motor Greases With Various Nanoparticle Greases
Authors: Janik Jack R. , Saha Sudip , Jackson Robert L. , Mills German
Published: December 2024

As the performance and efficiency requirements of electric vehicles (EVs) continue to expand, the demand for advanced driveline lubricants has grown exponentially. Unlike traditional internal combustion engine (ICE) vehicles, EVs experience unique challenges, including increased acceleration and deceleration rates, immediate torque delivery, higher operating speeds, and elevated drivetrain temperatures. Moreover, EV lubricants must endure exposure to damaging bearing currents, which can lead to morphological damage on bearing surfaces, such as electrical pitting. Addressing these challenges is critical to ensuring the longevity and reliability of EV components. This study aims to explore and validate innovative lubricant solutions tailored explicitly for EV applications. This work provides experimental validation of the capabilities of silver (Ag) and different concentrations of magnetic iron-oxide nanoparticles (NPs) in reducing damage through reciprocating rolling ball-on-disk tests. Additionally, an electrically conductive carbon black lithium-thickened grease was tested under comparable conditions. The significance of this research lies in its potential to revolutionize the EV lubricant industry by offering a robust solution to a prevalent problem. Successful implementation of nanoparticle-enhanced lubricants could lead to increased durability and efficiency of EV drivetrains, reducing maintenance costs and improving overall vehicle performance. This advancement aligns with the evolving demands of the EV market and sets a new standard for lubricant technology in electrified mobility.
Quantifying interpretation reproducibility in Vision Transformer models with TAVAC
Authors: Zhao Yue , Agyemang Dylan , Liu Yang , Mahoney Matt , Li Sheng
Published: December 2024

Deep learning algorithms can extract meaningful diagnostic features from biomedical images, promising improved patient care in digital pathology. Vision Transformer (ViT) models capture long-range spatial relationships and offer robust prediction power and better interpretability for image classification tasks than convolutional neural network models. However, limited annotated biomedical imaging datasets can cause ViT models to overfit, leading to false predictions due to random noise. To address this, we introduce Training Attention and Validation Attention Consistency (TAVAC), a metric for evaluating ViT model overfitting and quantifying interpretation reproducibility. By comparing high-attention regions between training and testing, we tested TAVAC on four public image classification datasets and two independent breast cancer histological image datasets. Overfitted models showed significantly lower TAVAC scores. TAVAC also distinguishes off-target from on-target attentions and measures interpretation generalization at a fine-grained cellular level. Beyond diagnostics, TAVAC enhances interpretative reproducibility in basic research, revealing critical spatial patterns and cellular structures of biomedical and other general nonbiomedical images.
Single-cell profiling of the amphioxus digestive tract reveals conservation of endocrine cells in chordates
Authors: Dai Yichen , Pan Rongrong , Pan Qi , Wu Xiaotong , Cai Zexin , Fu Yongheng , Shi Chenggang , Sheng Yuyu , Li Jingjing , Lin Zhe , Liu Gaoming , Zhu Pingfen , Li Meng , Li Guang , Zhou Xuming
Published: December 2024

Despite their pivotal role, the evolutionary origins of vertebrate digestive systems remain enigmatic. We explored the cellular characteristics of the amphioxus (
Branchiostoma floridae
) digestive tract, a model for the presumed primitive chordate digestive system, using bulk tissue companioned with single-cell RNA sequencing. Our findings reveal segmentation and a rich diversity of cell clusters, and we highlight the presence of epithelial-like, ciliated cells in the amphioxus midgut and describe three types of endocrine-like cells that secrete insulin-like, glucagon-like, and somatostatin-like peptides. Furthermore,
Pdx
,
Ilp1
,
Ilp2
, and
Ilpr
knockout amphioxus lines revealed that, in amphioxus,
Pdx
does not influence
Ilp
expression. We also unravel similarity between amphioxus Ilp1 and vertebrate insulin-like growth factor 1 (Igf1) in terms of predicted structure, effects on body growth and amino acid metabolism, and interactions with Igf-binding proteins. These findings indicate that the evolutionary alterations involving the regulatory influence of Pdx over
insulin
gene expression could have been instrumental in the development of the vertebrate digestive system.
Tracking of spaceflight-induced bone remodeling reveals a limited time frame for recovery of resorption sites in humans
Authors: Walle Matthias , Gabel Leigh , Whittier Danielle E. , Liphardt Anna-Maria , Hulme Paul A. , Heer Martina , Zwart Sara R. , Smith Scott M. , Sibonga Jean D. , Boyd Steven K.
Published: December 2024

Mechanical unloading causes bone loss, but it remains unclear whether disuse-induced changes to bone microstructure are permanent or can be recovered upon reloading. We examined bone loss and recovery in 17 astronauts using time-lapsed high-resolution peripheral quantitative computed tomography and biochemical markers to determine whether disuse-induced changes are permanent. During 6 months in microgravity, resorption was threefold higher than formation. Upon return to Earth, targeted bone formation occurred in high mechanical strain areas, with 31.8% of bone formed in the first 6 months after flight at sites resorbed during spaceflight, significantly higher than the 2.7% observed 6 to 12 months after return. Limited bone recovery at resorption sites after 6 months on Earth indicates a restricted window for reactivating bone remodeling factors in humans. Incomplete skeletal recovery may arise from these arrested remodeling sites, representing potential targets for new interventions, thus providing means to counteract this long-term health risk for astronauts.
Limits to timescale dependence in erosion rates: Quantifying glacial and fluvial erosion across timescales
Authors: Wilner Joel A. , Nordin Bailey J , Getraer Alexander , Gregoire Rowan M. , Krishna Mansa , Li Jiawen , Pickell Derek J. , Rogers Emma R. , McDannell Kalin T. , Palucis Marisa C. , Keller C.
Published: December 2024

Earth’s topography and climate result from the competition between uplift and erosion, but it has been debated whether rivers or glaciers are more effective erosional agents. We present a global compilation of fluvial and glacial erosion rates alongside simple numerical experiments, which show that the “Sadler effect,” wherein geological rates show an inverse relationship with measurement timescale, comprises three distinct effects: a measurement thickness bias, a bias of erosion and redeposition, and a bias introduced by not observing quiescent intervals. Furthermore, we find that, globally, average glacial erosion rates exceed fluvial erosion rates through time by an order of magnitude, and that this difference cannot be explained by Sadlerian biases or by variations in hillslope, precipitation, or latitude. These findings support observations of increased erosion rates following Cenozoic cooling and glaciation, and reveal the importance of glacial erosion over millennial to orogenic timescales.
Rapid water drainage on human eyelashes of a hydrophobic
Brachistochrone
fiber array
Authors: Zhou Shan , Chen Fenglin , Cheng Ziyang , Gao Can , He Zengyi , Wang Shutao , Jiang Lei , Dai Haoyu , Dong Zhichao
Published: December 2024

Numerous organisms exploit asymmetrical capillary forces generated by unique fiber or asymmetrical tapered structures to rapidly eliminate undesired liquid for survival in moist or rainy habitats. Human eyelashes, the primary protector of eyes, use a yet-to-be-fully-understood mechanism to efficiently transfer incoming liquid for vision safeguarding. Here, we elucidate that human eyelashes featuring a hydrophobic curved flexible fiber array with surface micro-ratchet and macro-curvature approximating the
Brachistochrone
is adept at directionally and rapidly expelling incoming liquid to maintain clear vision. These structural attributes are sequentially used for liquid drainage, starting from anisotropic retention via micro-ratchet, followed by the elastic expulsion among deflected hydrophobic flexible fiber arrays and culminating in the fastest sliding off along a
Brachistochrone
path, which together reduce the contact time by about 20% of that on rigid linear slopes. Investigating the intricate relationship between multistructure and draining efficiency of human eyelashes may inspire the design of advanced liquid-repelling edges on outdoor devices to maintain dryness.
A wearable triboelectric impedance tomography system for noninvasive and dynamic imaging of biological tissues
Authors: Yang Peng , Liu Zhaoqi , Qin Siyao , Hu Jun , Yuan Songmei , Wang Zhong Lin , Chen Xiangyu
Published: December 2024

Tissue imaging is usually captured by hospital-based nuclear magnetic resonance. Here, we present a wearable triboelectric impedance tomography (TIT) system for noninvasive imaging of various biological tissues. The imaging mechanism relies on the obtained impedance information from the different soft human tissues. A high-precision signal source is designed on the basis of a composite triboelectric nanogenerator, which exhibits a minimal total harmonic distortion of 0.03% and a peak output signal-to-noise ratio up to 120 decibels. The current density injected into human skin is around 79.58 milliamperes per square meter, far below the safety threshold for medical devices. The TIT system achieves time-resolved tomography of human limbs’ soft tissues, and many appealing functions can be realized by using this wearable system, including the observation of muscle movement, the motion intention recognition, and the identification of pathological changes of soft tissue. Hence, this TIT system with excellent biocompatibility can be integrated with various devices, such as medical-assistive exoskeletons and smart protective suit.
Extrasinusoidal macrophages are a distinct subset of immunologically active dural macrophages
Authors: Amann Lukas , Fell Amelie , Monaco Gianni , Sankowski Roman , Wu Huang Zie Quann , Jordão Marta Joana Costa , Borst Katharina , Fliegauf Maximilian , Masuda Takahiro , Ardura-Fabregat Alberto , Paterson Neil , Nent Elisa , Cook James , Staszewski Ori , Mossad Omar , Falk Thorsten , Louveau Antoine , Smirnov Igor , Kipnis Jonathan , Lämmermann Tim , Prinz Marco
Published: December 2024

Although macrophages in the meningeal compartments of the central nervous system (CNS) have been comprehensively characterized under steady state, studying their contribution to physiological and pathological processes has been hindered by the lack of specific targeting tools in vivo. Recent findings have shown that the dural sinus and its adjacent lymphatic vessels act as a neuroimmune interface. However, the cellular and functional heterogeneity of extrasinusoidal dural macrophages outside this immune hub is not fully understood. Therefore, we comprehensively characterized these cells using single-cell transcriptomics, fate mapping, confocal imaging, clonal analysis, and transgenic mouse lines. Extrasinusoidal dural macrophages were distinct from leptomeningeal and CNS parenchymal macrophages in terms of their origin, expansion kinetics, and transcriptional profiles. During autoimmune neuroinflammation, extrasinusoidal dural macrophages performed efferocytosis of apoptotic granulocytes. Our results highlight a previously unappreciated myeloid cell diversity and provide insights into the brain’s innate immune system.
Meeting report: Hidden links in autoimmunity
Authors: Guerau-de-Arellano Mireia , Morris Margaret A. , Sherman Matthew A. , Esch Thomas R.
Published: December 2024

A NIAID-sponsored workshop was held in September 2024, where challenges to understanding common mechanisms in autoimmune disease were discussed as opportunities to advance research.
Mitigating genetic instability caused by the excision activity of the
phi
C31 integrase in
Streptomyces
Authors: Duan Yadan , Liu Zhangliang , Huang Xiaofang , Xu Lu , Wang Xianxue , Liu Hao , Xie Zhoujie
Published: December 2024

Over the past three decades, the integrase (Int) from
Streptomyces
phage
phi
C31 has become a valuable genome engineering tool across various species.
phi
C31 Int was thought to mediate unidirectional site-specific integration (
attP
×
attB
to
attL
and
attR
) in the absence of the phage-encoded recombination directionality factor (RDF). However, we have shown in this study that Int can also catalyze reverse excision (
attL
×
attR
to
attP
and
attB
) at low frequencies in
Streptomyces lividans
and
Escherichia coli
, causing genetic instability in engineered strains. To address this issue, we developed a two-plasmid co-conjugation (TPC) system. This system consists of an
attP
-containing integration vector and an Int expression suicide plasmid, both carrying
oriT
to facilitate efficient conjugation transfer from
E. coli
to
Streptomyces
. Using the TPC system, genetically stable integrants free of Int can be generated quickly and easily. The indigoidine-producing strains generated by the TPC system exhibited higher genetic stability and production efficiency compared to the indigoidine-producing strain generated by the conventional integration system, further demonstrating the utility of the TPC system in the field of biotechnology. We anticipate that the strategies presented here will be widely adopted for stable genetic engineering of industrial microbes using phage integrase-based integration systems.

IMPORTANCE

Large serine recombinases (LSRs), including the bacteriophage
phi
C31 integrase, were previously thought to allow only unidirectional site-specific integration (
attP
×
attB
to
attL
and attR). Our study is the first to show that the
phi
C31 integrase can also catalyze a low-efficiency reverse excision reaction in
Streptomyces
and
E. coli
without the involvement of the phage-encoded recombination directionality factor (RDF). The genetic instability caused by the low
in vivo
excisionase activity of the
phi
C31 integrase is a major challenge for biotechnological applications. Our study addresses this issue by developing a two-plasmid co-conjugation (TPC) system that facilitates the construction of Int-deficient genomic engineering strains. The Int-deficient integrants produced by this TPC system exhibit strong genetic stability for introduced genes and maintain stable production traits even in the absence of selection pressure, making them highly valuable for industrial applications.