bluuebunny/crossref_metadata_2025 huggingface dataset:
Leveraging multisectoral approach to understand the determinants of childhood stunting in Rwanda: a systematic review and meta-analysis
Authors: Kalinda Chester , Qambayot Maria Albin , Ishimwe Sage Marie C. , Regnier Denis , Bazimya Darius , Uwizeyimana Theogene , Desie Samson , Rudert Christiane , Gebremariam Alemayehu , Brennan Elizabeth , Karumba Silver , Wong Rex , Bekele Abebe
Published: January 2024

Background

Addressing childhood stunting is a priority and an important step in the attainment of Global Nutrition Targets for 2025 and Sustainable Development Goals (SDGs). In Rwanda, the prevalence of child stunting remains high despite concerted efforts to reduce it.

Methods

Utilizing the United Nations International Children’s Emergency Fund (UNICEF) framework on maternal and child nutrition, this study systematically evaluated the determinants of child stunting in Rwanda and identified available gaps. Twenty-five peer-reviewed papers and five Demographic and Health Surveys (DHS) reports were included in the final selection of our review, which allowed us to identify determinants such as governance and norms including wealth index, marital status, and maternal education, while underlying determinants were maternal health and nutrition factors, early initiation of breastfeeding, water treatment and sanitation, and immediate factors included infections.

Results

A total of 75% of the overall inequality in stunting was due to the difference in the social determinants of stunting between poor and nonpoor households. Maternal education (17%) and intergenerational transfer (31%) accounted for most of the inequalities in stunting, and an increase in gross domestic product per capita contributed to a reduction in its prevalence. There is a paucity of information on the impact of sociocultural norms, early life exposures, maternal health and nutrition, and Rwandan topography.

Conclusion

The findings of this study suggest that improving women’s status, particularly maternal education and health; access to improved water, sanitation, and hygiene-related factors; and the socioeconomic status of communities, especially those in rural areas, will lay a sound foundation for reducing stunting among under-5 children.
Edge-cloud computing cooperation detection of dust concentration for risk warning research
Authors: Su Qiao , Wang Hongsu , Zhao Haiyang , Chu Yan , Li Jie , Lyu Xuan , Li Zijuan
Published: January 2024

An edge-cloud computing collaborative dust concentration detection architecture is proposed for real-time operation of intelligent algorithms to reduce the warning delay. And, an end-to-end three-channel convolutional neural network (E2E-SCNN) method is proposed in the paper to facilitate intelligent monitoring and management of dust concentration in tobacco production workshops. This model, which includes three sub-networks-a local feature branch, a global feature branch, and a spatial feature branch, learns the detail texture, overall layout, and spatial distribution information of the input image respectively. A fusion of the three complementary features is performed at the end of the network for the final dust concentration regression prediction. The design, when compared with the single network structure that directly regresses the entire image, is shown to more fully represent the overall information of the image and enhance monitoring performance. A richly annotated image dataset of tobacco production workshops is constructed to verify the effectiveness of the proposed method. The prediction error of E2E-SCNN is compared with existing image estimation algorithms, dual-channel networks, and other methods on this dataset using indicators such as Mean Absolute Error (MAE) and $${R}^{2}$$

R

2

. It is shown by the results that excellent performance is achieved by the E2E-SCNN algorithm, significantly surpassing other comparison methods. The paper demonstrates that the accuracy and robustness of dust concentration prediction can be greatly improved by using a three-channel convolutional neural network spatial information monitoring framework. This achievement provides an effective means for dust supervision and governance during the tobacco production process and offers a technical route that can be referred to for image analysis tasks in other similar fields.
Improving the quality of antenatal screening and early intervention for alcohol and other drug use: protocol for a multi-stage approach to systems reform
Authors: Stevens Matthew W. R. , Cooper Megan , Cusack Lynette , Ali Robert L. , Briley Annette L.
Published: January 2024

Background

Alcohol, tobacco and illicit drug use during pregnancy can cause significant harm to women and their developing fetuses. Despite recommendations for abstinence during pregnancy, some women continue to use, making screening for substance use during antenatal clinic attendances an important strategy for reducing risk. This study aims to improve the rates of screening and intervention for substance use among pregnant women, including appropriate referral for those who may be substance-dependent. The protocol outlined here focuses on a multi-stage implementation study.

Methods

This study will occur in four phases. Phase 1 will identify a baseline rate of screening and subsequent care at the antenatal clinics of two, South Australian hospital-based maternity services, through a retrospective case note audit. Rates of self-reported substance use identified in the case notes will also be compared against representative data from Adelaide Primary Health Network to establish rates of over or underreporting. Phase 2 will involve an online Training Needs Analysis of midwifery staff working at those services, to assess their knowledge, attitudes, beliefs, and commitment to the care of women who use substances during pregnancy. Phase 3 will involve a training package for all midwifery staff at those services, focused on routine screening for substance use, and how to provide appropriate care. Outcome measures from phase 2 will be reassessed during phase 3 and any changes since training will be evaluated. Phase 4 will then repeat phase 1 to compare the changes in rates of both screening and any associated intervention before and after training.

Discussion

From a public health perspective, this project has the potential to make a significant impact on reducing risk of harm from substance use disorders among pregnant women, and contribute to better health outcomes for their children.

Trial registration: This trial has been pre-registered under the Open Science Framework. Registration: https://doi.org/10.17605/OSF.IO/73FDZ.
Digital transformation of the promotion of educational services of Kazakhstani universities
Authors: Zarubina Venera , Zarubin Mikhail , Yessenkulova Zhaukhar , Salimbayeva Rassima , Satbaeva Gulbarshyn
Published: January 2024

Digital channels have become the modern priority channels for promoting educational services. Integration into the international educational space, changes in the priority of communication channels, and digital transformation have led to the need to rethink existing approaches to the digital promotion of educational services of Kazakhstani universities. Particular interest in modernizing the promotion of educational services is caused by the fact that representatives of the new generation, Generation Z, are now becoming consumers of educational services. The basis of this study was the analysis of digital promotion channels as the main source of information and value, the needs of generation Z, who are now becoming the main consumers of the services of universities, including those in Kazakhstan. The purpose of the study is to determine the priorities for the digital promotion of educational services, to build a model for the digital promotion of university educational services, taking into account the needs of key consumers—generation Z, digital channels, and educational programs of the university. Hypothesis: priorities for digital promotion of educational services of universities should be differentiated depending on the popularity and technical parameters of the sites. The web resources similarweb.com, pagespeed.web.dev, wordstat.yandex.ru, sitechecker.pro were used as analysis tools. A correlation analysis of queries on university websites and the core values of generation Z was carried out. The closeness of the pairwise correlation between the total number of visits and website performance, search engine optimization, recommendations, and special features was determined. Based on the research, a model for promoting the university’s educational services has been structured, highlighting key components: educational programs, digital technologies, and the values of generation Z.
Survival and treatment in older patients with ewing sarcoma: an analysis of the national cancer database
Authors: Braaten Marco , Braaten Jacob , Chaddha Jasleen , Hu Robert , Lanoue Connor , Silberstein Peter , Tauseef Abubakar , Asghar Noureen , Mirza Mohsin
Published: January 2024

Background

Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.

Methods

This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Propensity score 1:1 matching was performed according to sex and race. Univariate and multivariate logistic regression was performed to generate odds ratios (OR) and a Multivariate Cox regression model was used to generate a hazard ratio (HR) for patients over 40. Kaplan–Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM statistics version 27.0 was used. p < 0.05 was used to indicate statistical significance.

Results

EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 44.6% for older patients vs. 61.8% for younger patients (p < 0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 1.96; p < 0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.1% vs 8.9%; p < 0.05) and cranium (5.3% vs. 2.9%; p < 0.05) and had a higher rate of axial tumors (31.6% vs. 18.5%; p < 0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (36.7 days vs. 24.8 days; p < 0.05) and were less likely to receive adjuvant chemotherapy (93.4% vs. 97.9%; p < 0.05).

Conclusion

An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.
Refining mutanome-based individualised immunotherapy of melanoma using artificial intelligence
Authors: Zakariya Farida , Salem Fatma K. , Alamrain Abdulwhhab Abu , Sanker Vivek , Abdelazeem Zainab G. , Hosameldin Mohamed , Tan Joecelyn Kirani , Howard Rachel , Huang Helen , Awuah Wireko Andrew
Published: January 2024

Using the particular nature of melanoma mutanomes to develop medicines that activate the immune system against specific mutations is a game changer in immunotherapy individualisation. It offers a viable solution to the recent rise in resistance to accessible immunotherapy alternatives, with some patients demonstrating innate resistance to these drugs despite past sensitisation to these agents. However, various obstacles stand in the way of this method, most notably the practicality of sequencing each patient's mutanome, selecting immunotherapy targets, and manufacturing specific medications on a large scale. With the robustness and advancement in research techniques, artificial intelligence (AI) is a potential tool that can help refine the mutanome-based immunotherapy for melanoma. Mutanome-based techniques are being employed in the development of immune-stimulating vaccines, improving current options such as adoptive cell treatment, and simplifying immunotherapy responses. Although the use of AI in these approaches is limited by data paucity, cost implications, flaws in AI inference capabilities, and the incapacity of AI to apply data to a broad population, its potential for improving immunotherapy is limitless. Thus, in-depth research on how AI might help the individualisation of immunotherapy utilising knowledge of mutanomes is critical, and this should be at the forefront of melanoma management.
Smallholder aquaculture diversifies livelihoods and diets thus improving food security status: evidence from northern Zambia
Authors: Kaminski Alexander M. , Cole Steven M. , Johnson Jacob , Thilsted Shakuntala H. , Lundeba Mary , Genschick Sven , Little David C.
Published: January 2024

Background

Much has been made of the potential for aquaculture to improve rural livelihoods and food and nutrition security in Africa, though little evidence exists to back such claims. This study, conducted in northern Zambia, assessed the benefits of adopting aquaculture by comparing a sample of households with (n = 177) and without fishponds (n = 174).

Results

On-farm food production was assessed by summing all crop and livestock activities and calculating a production diversity score (PDS) of key food groups. Aquaculture households had greater crop diversification and were more associated with key nutritious foods grown on the farm, possibly due to additional water irrigation capabilities. A greater diversity of cultivated crops led to better household dietary diversity scores (HDDS). We further assessed the frequency of consumption of 53 food items (including 30 fish species) over a period of 4 weeks via a Food Frequency Questionnaire (FFQ). Using the Simpson’s Index, aquaculture households had greater diversity and evenness in the distribution of foods and fish species consumed, particularly for foods grown on the farm. Using livelihood and dietary factors in a multilevel probit regression on the Household Food Insecurity Access Scale (HFIAS), we found that adopting aquaculture gave households almost two times more likelihood of improving their food security status. Households could further improve their food security outcomes by growing and consuming certain vegetables, especially those that could be integrated along pond dykes.

Conclusions

The study suggests three clear pathways to food security. (1) Increasing wealth and income from the sale of fish and integrated vegetables and/or crops, which can be used to purchase a diversity of foods. (2) Increasing food and nutrition security via the direct consumption of fish and vegetables grown on the farm. (3) Improving irrigation capabilities in integrated aquaculture–agriculture systems that has direct impact on pathways 1 and 2. Aquaculture should be promoted in the region for its crop diversification and food security benefits, so long as it fits the local farming system and livelihood context. Moving away from productivist approaches to nutrition-sensitive aquaculture widens the scope of uncovering the many benefits of pond farming in smallholder systems.
A novel high accuracy finite-difference time-domain method
Authors: Sekido Harune , Umeda Takayuki
Published: January 2024

The finite-difference time-domain (FDTD) method is widely used for numerical simulations of electromagnetic waves and acoustic waves. It is known, however, that the Courant condition is restricted in higher dimensions and with higher order differences in space. Although it is possible to relax the Courant condition by utilizing the third-degree difference in space, there remains a large anisotropy in the numerical dispersion at large Courant numbers. This study aims to reduce the anisotropy in the numerical dispersion and relax the Courant condition simultaneously. A new third-degree difference operator including the Laplacian is introduced to the time-development equations of FDTD(2,4) with second- and fourth-order accuracies. The present numerical simulations have demonstrated that numerical oscillations due to the anisotropic dispersion relation are reduced with the new operator.

Graphical Abstract
Experimental assessment and prediction of design parameter influences on a specific vacuum-based granular gripper
Authors: Wacker Christian , Dierks Niklas , Kwade Arno , Dröder Klaus
Published: January 2024

Innovative soft robotic grippers, such as granular grippers, enable the automated handling of a wide spectrum of different geometries, increasing the flexibility and robustness of industrial production systems. Granular grippers vary in their design as well as in their configuration, which affects the specific characteristics and capabilities regarding grippable objects. Relevant aspects are the selection of granulates and membranes, as they affect the deformability. This influences the achievable gripping forces, which vary with the gripped objects geometry. On the basis of experimental studies, the modeling of interpolations as well as through experimental validations, the present research investigates the influences of different configurations on the achievable gripping forces for a specific concept of an innovative vacuum-based granular gripper. Specifically, the focus lies on design as well as configuration parameters, which could influence the achievable gripping force. Influencing parameters are determined based on a literature review of similar gripping concepts. Various adjustment possibilities are identified, such as materials of granulates or membranes. The possible configuration options are experimentally analyzed with a one-factor-at-a-time approach. The possibility of modelling the effects of their interrelations on the achievable gripping force is examined with approaches for linear models and compared to interpolations based on Machine Learning. Especially the granulate filling level and the membrane configuration exhibit the largest influences, which were best predicted with the approach based on artificial neural networks. A selection of an optimized gripper configuration for a specified object set as well as possible further developments such as a continuous expandability of the approaches and integrations with simulations are discussed. As a result of these analyses, this research provides methodologies for an optimized selection of a gripper configuration for an improved object-specific achievable gripping force and allows for more efficient handling processes with the examined type of vacuum-based granular gripper.
Production of the PET radionuclide 61Cu via the 62Ni(p,2n)61Cu nuclear reaction
Authors: Brühlmann Santiago Andrés , Walther Martin , Kopka Klaus , Kreller Martin
Published: January 2024

Background

There are only a handful of true theranostic matched pairs, and in particular the theranostic radiocopper trio 61Cu, 64Cu and 67Cu, for diagnosis and therapy respectively, is a very attractive candidate. In fact, the alternative of two imaging radionuclides with different half-lives is a clear advantage over other theranostic pairs, since it offers a better matching for the tracer biological and radionuclide physical half-lives. Due to the high availability of 64Cu, its translation into the clinic is being successfully carried out, giving the example of the FDA approved radiopharmaceutical Detectnet (copper Cu 64 dotatate injection). However, a shorter-lived PET radionuclide such as 61Cu may as well be beneficial.

Results

Proton irradiation of enriched 62Ni electrodeposited targets with a compact cyclotron produced the desired radionuclide via the 62Ni(p,2n)61Cu nuclear reaction, leading to 61Cu activities of up to 20 GBq at end of bombardment and 8 GBq at end of purification. Furthermore, two purification methods are compared leading to comparable results regarding separation yield and product purity. Following the radiochemical separation, quality assessment of this product [61Cu]CuCl2 solution proved radionuclidic purities (RNP) over 99.6% and apparent molar activities (AMA) of 260 GBq/µmol with the 1,4,8,11-tetraazacyclotetradecane-1,4,8,11-tetraacetic acid (TETA) chelator, end of purification corrected.

Conclusions

In the current article a comprehensive novel production method for the PET radionuclide 61Cu is presented, providing an alternative to the most popular production routes. Characterization of the [61Cu]CuCl2 product showed both high RNP as well as high AMA, proving that the produced activity presented high quality regarding radiolabeling up to 9 h after end of purification. Furthermore, production scalability could be easily achieved by increasing the irradiation time.

Graphical abstract
Ultra-low reflection electromagnetic interference shielding nanofiber film with effective solar harvesting and self-cleaning
Authors: Lyu Bin , Wang Yunchuan , Gao Dangge , Guo Shihao , Zhou Yingying , Ma Jianzhong
Published: January 2024

It is urgent to develop low-reflection electromagnetic interference shielding material to shield electromagnetic waves (EMW) and reduce their secondary radiation pollution. Herein, an electromagnetic interference shielding nanofiber film is composed of ZnO and carbon nanofiber (CNF) via electrospinning and carbonization approachs, and subsequently coating perfuorooctyltriethoxysilane as a protective layer. On the one hand, ZnO coated by porous carbon, which is derived from ZIF-8, endows the nanofiber film low reflection property through optimizing impedance matching between free space and the nanofiber film. On the other hand, the nanofiber film possesses high electromagnetic interference shielding efficiency, which is beneficial by excellent electrical conductivity of CNF derived from waste leather scraps. Furthermore, the nanofiber film involves abundant interface, which contributes to high interfacial polarization loss. Thus, the nanofiber film with a thickness of 250 μm has electrical conductivity of 53 S/m and shielding efficiency of 50 dB. The reflection coefficient of the nanofiber film is inferior to 0.4 indicates that most of EMW are absorbed inside the materials and the nanofiber film is effective in reducing secondary radiation contamination of electromagnetic waves. Fortunately, the nanofiber film exhibits outstanding solar harvesting performance (106 ℃ at 1 sun density) and good self-cleaning performance, which ensure that the nanofiber film can work in harsh environments. This work supplies a credible reference for fabricating low-reflection electromagnetic shielding nanofiber film to reduce secondary radiation pollution and facilitates the upcycling of waste leather scraps.

Graphic abstract
Surmounting photon limits and motion artifacts for biological dynamics imaging via dual-perspective self-supervised learning
Authors: Shen Binglin , Luo Chenggui , Pang Wen , Jiang Yajing , Wu Wenbo , Hu Rui , Qu Junle , Gu Bobo , Liu Liwei
Published: January 2024

Visualizing rapid biological dynamics like neuronal signaling and microvascular flow is crucial yet challenging due to photon noise and motion artifacts. Here we present a deep learning framework for enhancing the spatiotemporal relations of optical microscopy data. Our approach leverages correlations of mirrored perspectives from conjugated scan paths, training a model to suppress noise and motion blur by restoring degraded spatial features. Quantitative validation on vibrational calcium imaging validates significant gains in spatiotemporal correlation (2.2×), signal-to-noise ratio (9–12 dB), structural similarity (6.6×), and motion tolerance compared to raw data. We further apply the framework to diverse in vivo experiments from mouse cerebral hemodynamics to zebrafish cardiac dynamics. This approach enables the clear visualization of the rapid nutrient flow (30 mm/s) in microcirculation and the systolic and diastolic processes of heartbeat (2.7 cycle/s), as well as cellular and vascular structure in deep cortex. Unlike techniques relying on temporal correlations, learning inherent spatial priors avoids motion-induced artifacts. This self-supervised strategy flexibly enhances live microscopy under photon-limited and motion-prone regimes.
Unlocking the power of precision medicine: exploring the role of biomarkers in cancer management
Authors: Gadade Dipak D. , Jha Hariom , Kumar Chetan , Khan Farzan
Published: January 2024

Background

Personalized or Precision medicine (PM) is a promising approach for the cancer treatment that tailors treatment to a patient's characteristics. Biomarkers are crucial for identifying the patients who are expected to derive greatest advantage from targeted therapy.

Main body

Here, various biomarkers, including genetic, epigenetic, protein, and metabolites, and their clinical significance, are discussed. The review provides insights into the use of biomarkers and their clinical significance in cancer treatment. There are several hurdles in use of PM in oncology, such as the complexity of tumor biology and heterogeneity, limited availability of biomarkers, high cost of targeted therapies, resistance to targeted therapies, and ethical and social issues.

Conclusion

The biomarkers play a crucial diagnostic role in the treatment of cancer. The review also acknowledges the challenges and limitations of personalized medicine which, if resolved, can be helpful in the management of cancer.
Incorporating LGBT+ mental health into psychiatric residency and training: perspectives from the Philippines
Authors: Alibudbud Rowalt
Published: January 2024

The Philippine Mental Health Act upholds the rights and inclusivity of all people, regardless of gender and sexual orientation, within mental health services and programmes. Nevertheless, a noteworthy challenge lies in the inadequate attention given to the needs of LGBT+ individuals within the medical and health professions education in the country. Therefore, it is imperative to integrate LGBT+ mental health into psychiatric residency training. To address this gap, this paper proposes the inclusion of concepts relevant to LGBT+ mental health, including minority stress, intersectionality, identity concealment and LGBT+-affirming practices, to enhance the understanding and response to the needs of LGBT+ Filipinos.
Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records
Authors: López-Díaz Álvaro , Palermo-Zeballos Fernanda Jazmín , Gutierrez-Rojas Luis , Alameda Luis , Gotor-Sánchez-Luengo Francisco , Garrido-Torres Nathalia , Métrailler Johann , Alerci Livia , Bonnarel Vincent , Cano-Domínguez Pablo , Avanesi-Molina Elma , Soto-Ontoso Miguel , Torrecilla-Olavarrieta Rocio , Muñoz-Manchado Leticia Irene , Torres-Hernández Pedro , González-Higueras Fermín , Prados-Ojeda Juan Luis , Herrera-Cortés Mario , Meca-García José Miguel , Gordillo-Urbano Rafael Manuel , Sánchez-Robles Cristina , Delgado-Durán Tomás , Soriano-Peña María Felipa , Golay Philippe , Conus Philippe , Crespo-Facorro Benedicto , Ruiz-Veguilla Miguel
Published: January 2024

Background

There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.

Aims

This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).

Method

A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.

Results

The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.

Conclusions

The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
Emerging Insights in Small-Cell Carcinoma of the Genitourinary Tract: From Diagnosis to Novel Therapeutic Horizons
Authors: Liao Ross S. , Ruan Hui Ting , Jang Albert , Huynh Melissa , Nadal Rios Rosa , Hoffman-Censits Jean H. , Wei Shuanzeng , Mian Omar Y. , Barata Pedro C.
Published: January 2024

Small-cell carcinomas (SCCs) of the genitourinary (GU) tract are rare malignancies with high metastatic potential. The most common primary sites are the bladder and prostate, but case reports of primary SCC of the kidney, ureter, and urethra also exist. The majority of patients present with gross hematuria, irritative or obstructive urinary symptoms, and symptoms of locoregionally advanced or metastatic disease at initial presentation. SCC of the bladder presents with nodal or metastatic involvement in the majority of cases and requires the use of platinum-based chemotherapy in combination with surgery and/or radiation. SCC of the prostate is most commonly seen in the metastatic castrate-resistant setting, and aggressive variant disease presents with a greater propensity for visceral metastases, osteolytic lesions, and relatively low serum prostate-specific antigen for volume of disease burden. Multiple retrospective and prospective randomized studies support the use of a multimodal approach combining platinum-based systemic therapy regimens with radiation and/or surgery for localized disease. This evidence-based strategy is reflected in multiple consensus guidelines. Emerging data suggest that small-cell bladder and prostate cancers transdifferentiate from a common progenitor of conventional urothelial bladder carcinoma and prostatic acinar adenocarcinoma, respectively. Areas of active basic research include efforts to identify the key genetic and epigenetic drivers involved in the emergence of small cell cancers to exploit them for novel therapies. Here, we review these efforts, discuss diagnosis and currently supported management strategies, and summarize ongoing clinical trials evaluating novel therapies to treat this rare, aggressive GU cancer.
Adverse Events of Peripherally Administered Norepinephrine During Surgery: A Prospective Multicenter Study
Authors: Christensen Jens , Andersson Elisabeth , Sjöberg Fredric , Hellgren Elisabeth , Harbut Piotr , Harbut Joanna , Sjövall Fredrik , von Bruhn Gufler Christian , Mårtensson Johan , Rubenson Wahlin Rebecka , Joelsson-Alm Eva , Cronhjort Maria
Published: January 2024

BACKGROUND:

Perioperative treatment of hypotension by intravenous administration of norepinephrine in a peripheral vein can lead to adverse events, for example, tissue necrosis. However, the incidence and severity of adverse events during perioperative administration are unknown.

METHODS:

This was a prospective observational study conducted at 3 Swedish hospitals from 2019 to 2022. A total of 1004 patients undergoing surgery, who met the criteria for perioperative peripheral norepinephrine administration, were included. The infusion site was inspected regularly. If swelling or paleness of skin was detected, the infusion site was changed to a different peripheral line. Systolic blood pressure and pulse frequency were monitored during the infusion time and defined as adverse events at >220 mm Hg and <40 beats•min–1. In case of adverse events, patients were observed for up to 48 hours. The primary outcome was prevalence of extravasation, defined as swelling around the infusion site. Secondary outcomes were all types of adverse events and associations between predefined clinical variables and risk of adverse events.

RESULTS:

We observed 2.3% (95% confidence interval [CI], 1.4%–3.2%) extravasation of infusion and 0.9% (95% CI, 0.4%–1.7%) bradycardia. No cases of tissue necrosis or severe hypertension were detected. All adverse events had dissipated spontaneously within 48 hours. Proximal catheter placement was associated with more adverse events.

CONCLUSIONS:

Extravasation of peripherally administrated norepinephrine in the perioperative period occurred at similar rates as in previous studies in critically ill patients. In our setting, where we regularly inspected the infusion site and shifted site in case of swelling or paleness of skin, we observed no case of severe adverse events. Given that severe adverse events were absent, the potential benefit of this preventive approach requires confirmation in a larger population.
Short-Term High-Intensity Rowing Ergometry Training Improves Rowing Performance Equally in Healthy Weight and Obese Adolescents
Authors: WALTERS GRACE , DRING KARAH J. , NEVILL BENJAMIN A. , COOPER SIMON B. , NEVILL ALAN M. , NEVILL MARY E. , MORRIS JOHN G.
Published: January 2024

Purpose

Childhood obesity is a major health concern and physical activity is commonly proposed as an intervention strategy to combat the increasing prevalence of overweight and obesity in young people. The aim of this study was to examine the effect of high-intensity, supervised, rowing ergometer training on maximal and submaximal rowing performance in healthy weight and centrally obese adolescents (12–13 yr).

Methods

Participants were randomized to either 6 wk of supervised rowing ergometry, comprising of 2 sessions per week with each session comprising of 2 × 3-min bouts of high-intensity rowing ergometry (n = 57), or a control group who continued with their habitual activities (n = 45). At baseline and follow-up, rowing performance was assessed via a submaximal test and a 3-min maximal test.

Results

Six weeks of rowing ergometer training significantly improved maximal exercise performance; total distance rowed in a 3-min maximal effort improved by 19.7 m (2.7%) (time × group, P = 0.018) and produced a significant reduction in perceived effort in response to a set submaximal load (60 W) (time × group, P = 0.040). At baseline total distance rowed during the 3-min maximal test was significantly affected by body mass (main effect of body mass, P = 0.002), whereby a higher body mass was associated with enhanced rowing performance. However, the pattern of change over time was not different between healthy weight and centrally obese adolescents (time × group × waist centile, P = 0.577).

Conclusions

A 6-wk high-intensity rowing ergometry training intervention improved maximal rowing performance. This improvement was similar in healthy weight versus overweight and obese adolescents; yet overall overweight and obese adolescents had superior rowing performance compared to their healthy weight counterparts, suggesting that rowing may be an attractive exercise modality for interventions in overweight and obese young people.
Postconcussion Moderate to Vigorous Physical Activity Predicts Anxiety Severity among Adolescent Athletes
Authors: SMULLIGAN KATHERINE L. , WINGERSON MATHEW J. , MAGLIATO SAMANTHA N. , RADEMACHER JACOB G. , WILSON JULIE C. , HOWELL DAVID R.
Published: January 2024

Purpose

This study aimed to examine how moderate-to-vigorous physical activity (MVPA) during concussion recovery influences self-reported anxiety symptoms at follow-up assessment. We hypothesized that more MVPA after concussion would be associated with lower anxiety rating at follow-up.

Methods

We performed a prospective study of participants aged 13–18 yr initially assessed within 14 d of diagnosed concussion. Participants rated concussion symptoms using the Post-Concussion Symptom Inventory and were provided a wrist-worn actigraphy device to track activity for 1 wk after assessment. At follow-up assessment, participants rated anxiety symptoms using the four-question Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety subscale. Each question ranged from 1 (never) to 5 (almost always), with an overall score range of 4–20. For univariable analysis, we calculated correlation coefficients between MVPA and PROMIS anxiety subscale scores. We then created a multiple linear regression model with follow-up PROMIS anxiety subscale score as the outcome and MVPA, sex, initial symptom severity, and preconcussion anxiety as predictors.

Results

We enrolled and initially tested 55 participants, and 48 were included in the final analysis (age, 14.6±2.7 yr; 56% female; initial assessment, 7.3± 3.1 d; follow-up assessment, 42.0±29.7 d). We observed an inverse and low correlation between MVPA and follow-up PROMIS anxiety subscale T-scores (r = −0.30, P = 0.04). Multivariable regression results indicated that MVPA (β = −5.30; 95% confidence interval (CI), −10.58 to −0.01), initial Post-Concussion Symptom Inventory score (β = 0.11; 95% CI, 0.03 to 0.19), and preconcussion anxiety (β = 5.56; 95% CI, 0.12 to 11.0), but not sex (β = −2.60; 95% CI, −7.14, to 1.94), were associated with follow-up PROMIS anxiety subscale T-scores.

Conclusions

After adjusting for covariates, more MVPA early after concussion predicted lower PROMIS anxiety subscale scores at follow-up. Although initial concussion symptom severity and preconcussion anxiety were also associated with follow-up PROMIS anxiety subscale score, MVPA represents a modifiable factor that may contribute to lower anxiety symptoms.
Low Energy Availability Followed by Optimal Energy Availability Does Not Benefit Performance in Trained Females
Authors: OXFELDT MIKKEL , MARSI DANIEL , CHRISTENSEN PETER M. , ANDERSEN OLE EMIL , JOHANSEN FRANK TED , BANGSHAAB MAJ , RISIKESAN JEYANTHINI , JEPPESEN JAN S. , HELLSTEN YLVA , PHILLIPS STUART M. , MELIN ANNA K. , ØRTENBLAD NIELS , HANSEN METTE
Published: January 2024

Purpose

Short periods of reduced energy availability are commonly undertaken by athletes to decrease body mass, possibly improve the power-to-mass ratio, and enhance physical performance. Our primary aim was to investigate the impact of 10 d of low energy availability (LEA) followed by 2 d of optimal energy availability (OEA) on physical performance parameters in trained females. Second, physiological markers at the whole-body and molecular level related to performance were evaluated.

Methods

Thirty young trained eumenorrheic females were matched in pairs based on training history and randomized to a 10-d intervention period of LEA (25 kcal·fat-free mass (FFM)−1·d−1) or OEA (50 kcal·FFM−1·d−1) along with supervised exercise training. Before the intervention, participants underwent a 5-d run-in period with OEA + supervised exercise training. After the LEA intervention, 2 d of recovery with OEA was completed. Participants underwent muscle biopsies, blood sampling, physical performance tests, body composition measurements, and resting metabolic rate measurements. A linear mixed model was used with group and time as fixed effects and subject as random effects.

Results

Compared with OEA, LEA resulted in reduced body mass, muscle glycogen content, repeated sprint ability, 4-min time-trial performance, and rate of force development of the knee extensors (absolute values;P< 0.05). Two days of recovery restored 4-min time-trial performance and partly restored repeated sprint ability, but performance remained inferior to the OEA group. When the performance data were expressed relative to body mass, LEA did not enhance performance.

Conclusions

Ten days of LEA resulted in impaired performance (absolute values), with concomitant reductions in muscle glycogen. Two days of recovery with OEA partially restored these impairments, although physical performance (absolute values) was still inferior to being in OEA. Our findings do not support the thesis that LEA giving rise to small reductions in body mass improves the power-to-mass ratio and thus increases physical performance.
A prolonged wait: The impact of COVID-19 on elective surgeries in India, a prospective study
Authors: Islam Heraa , Muhammed Mohsin Nazeer , Kapoor Aditi , Ehsan Muhammed , Shankar Gowri , Agrawal Raadhika
Published: January 2024

Background The continuing Coronavirus Disease 2019 (COVID-19) pandemic has had a massive impact on healthcare systems all around the globe. There is no exception in the demographics of elective surgery also. Like any other medical professionals, surgeons and post-graduates are redirected to the management of patients with COVID-19. The purpose of this study is to determine how the COVID-19 pandemic affected elective surgeries, surgeon skills, and post-graduate training. Methods This prospective study was done among 320 participants through a 15-question online cross-sectional survey sent primarily to surgeons practicing in six states of India that were most affected by the pandemic according to recent statistics and also to surgeons in other states via email or other online messaging services carried out from June 2021 to July 2021. Results 320 surgeons participated from various states in India. Overall, 59.7% of those participants who agreed that there was a reduction in bed availability, 70.4% of those participants who agreed that there was a shortage of oxygen, 78.8% of those participants who agreed that there was a shortage of PPE kits, 60.7% of those participants who agreed that there was a delay in procurement of surgical implants and 64% of participants also agreed that the COVID-19 pandemic had affected the post-graduate teaching program. Conclusions All these factors showed significant p-values with statistical significance, thereby indicating the impact of the COVID-19 pandemic on the healthcare system and healthcare delivery. The pandemic also had a significant impact on post-graduate training.
The problematic space between art, ambition, and gameplay: The Medium and the issues concerning difficult subject matter and gameplay in games
Authors: Marak Katarzyna , Markocki Miłosz , Chmielewski Krzysztof , Brzostek Dariusz
Published: January 2024

This article identifies and examines a couple of selected issues regarding speculative digital games which endeavor to deal with serious subject matter. Due to the fact that speculative games are exceptionally well suited for symbolic representation of sensitive topics, they allow their creators to conceive ambitious projects that aspire to be great works of audiovisual art. However, because game texts belong to a very specific medium, it is not always possible to realize this ambition in the context of gameplay. For reasons of space and focus this article uses one particular game, The Medium (2021), to serve as the primary example of how the problems which occur in the process of combining specific, engaging gameplay with serious, sensitive subject matter, lead to situations in which a game can fail to fulfill the player’s expectations. By analyzing the structure, gameplay, and storytelling tools employed in The Medium, the article places emphasis on the significance of the possible tensions between the intention of the designers of the game experience and the experiences, ideas, and interpretations the players themselves bring to the game text.
Focus particles and focus domain in Hindi – A comparison with Japanese toritateshi particles –
Authors: Chauhan Anubhuti , Numata Yoshiko
Published: January 2024

This study analyses focus particles in Hindi by investigating the relationship between focus particle position, the focalized constituent, and the focus domain. Contrasting the focus patterns in Hindi with Japanese reveals that Hindi not only allows cases where the focus particle attaches to the focalized constituent, but also cases where it attaches to a sub-constituent within the focalized constituent. However, unlike Japanese, it does not allow cases where the focus particle appears on an element outside the focalized constituent. Based on our observation that the focus particle either attaches to the focalized constituent that corresponds to the focus domain or appears on the leftmost element within the focus domain, we claim that Hindi focus particles function as markers of the domain initial position.
E-learning modules to improve clinical reasoning and practice: a prospective comparative study
Authors: Stollar Fabiola , Cerutti Bernard , Aujesky Susanne , Scherly Daniel , Nendaz Mathieu , Galetto-Lacour Annick
Published: January 2024

Background Controversy remains about whether e-learning can improve clinical competences. Our study aimed to compare the effects of e-learning versus traditional education on medical students' reasoning and how they applied their knowledge to clinical competences, assess factors associated with e-learning that might influence exam scores, and evaluate medical students' satisfaction with these two learning methods. Methods Prospective study of 299 medical students in two fourth-year pediatric clerkship cohorts (2016–17 and 2017–18) in Switzerland. Results We found no evidence of a difference in students' reasoning or how they applied their knowledge to competences in clinical case resolution, whether they had followed e-learning modules or attended traditional lectures. The number of quizzes taken and being female were factors associated with better scores. Even though overall satisfaction with the two learning methods was similar, students claimed that they learned more in e-learning than in traditional lectures and that e-learning explained learning objectives better. Conclusions E-learning could be used as a supplement or alternative to traditional face-to-face medical teaching methods without compromising teaching quality. E-learning modules should be better integrated into medical students' curricula but avoid the risk of curriculum overload, especially in case of repeated COVID-like context.