bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Professional Liability in Obstetrics and Gynecology: A Pilot Study of Criminal Proceedings in the Public Prosecutor’s Office at the Court of Rome
Authors: Bergamin Eva , Fiorillo Annamaria , Grassi Vincenzo M. , Lodise Maria , Vetrugno Giuseppe , De-Giorgio Fabio
Published: May 2023

Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- and Gynecology-related medical professional liability prosecutions within the General Register of Criminal Records of the Rome Public Prosecutor’s Office between the years 2000 and 2014. The number of prosecutions increased steadily in the years 2000–2005, with varying trends in the following years. A total of 727 healthcare professionals were involved in criminal charges, and most prosecuted crimes were related to Articles 590 and 589 of the Italian Penal Code, followed by violations of Article 17 of Law 194/78. In most cases, filing was requested and granted without opposition. In 95 cases, an expert witness was appointed by the Court, and in 68 cases, the technical consultants of the State Prosecutor found culpable conduct. Public hospitals, private nursing homes and outpatient clinics, or private practices were mostly involved; in 45% of the cases, the physicians were hospital employees. In this setting, Italy is prepared to introduce new measures and regulations to address the issues posed by defensive medicine and charges of professional liability for healthcare providers.
Undermine Sufferers’ Testimonies to Avoid Social Impacts of Pain
Authors: García-Rodríguez Mª Isabel , Biedma-Velázquez Lourdes , Serrano-del-Rosal Rafael
Published: May 2023

Pain is a subjective experience that is mediated by the social structure and by the contextual aspects of people in pain. From the point of view of those affected, a sociological analysis has been carried out of why society doubts pain and the impact that the lack of credibility has on people in pain. Qualitative methodology is used. In total, 19 semi-structured interviews have been conducted with men and women in pain. Research has shown that pain produces discredit in all dimensions of individual’s social life, from the most intimate to that related to healthcare and production. The lack of credibility takes the form of epistemic injustice, being a reaction produced from the social structure to avoid the impacts that pain could produce on the social system. Epistemic injustice affects anyone in pain, but the form it takes will be related to sufferer’s circumstances. Studying this topic is important because it shows the rigidity of expert systems to deal with some old and new situations related to pain. It also shows the frequent lack of fit between the systems and the sufferers. Finally, the article shows that to deal unfairly with the testimony of people in pain has negative consequences on the treatment of pain. A better understanding of these issues could improve the sufferers’ living conditions.
Collective Catering Activities and Official Controls: Dietary Promotion, Sustainability and Future Perspectives
Authors: Marcotrigiano Vincenzo , Stingi Giacomo Domenico , Nugnes Prudenza Tiziana , Mancano Sabrina , Lagreca Vita Maria , Tarricone Teresa , Salerno Gerardo , Pasquale Pietro , Marchet Paola , Sava Giovanni Andrea , Citiulo Alessandro , Tissi Monica , Oliva Stefania , Cinquetti Sandro , Napoli Christian
Published: May 2023

Ensuring safe meals with suitable hygienic-sanitary and nutritional features is an essential requirement to guarantee health in different settings. This study aims to evaluate the compliance of collective catering menus adopted in both school canteens and healthcare facilities in a regional area where specific guidelines have been issued, assessing many matters from food weight to single courses and from the use of wholegrain pasta and bread to the rotation of seasonal fruit and vegetables. Overall, 85 menus, edited by freelance professionals and endorsed by the Food Hygiene and Nutrition Service staff of the Local Health Authority, were assessed from 2018 to 2022, highlighting critical issues potentially attributable at a local level to the lack of complete knowledge of the existence of guidelines and official reference documents among nutrition professionals. Since the preliminary outcomes show non-compliance in both sectors investigated, it is essential to continue to strengthen the role of prevention departments entrusted with services dedicated to food and nutritional safety and promote joint official controls performed by healthcare workers and other professionals with different backgrounds in order to ensure safe food for the target population that use collective catering services. In school canteens and healthcare facilities, providing and administering food is an opportunity to promote health through a balanced diet and safe food and offers opportunities for the development of community well-being and the local economy in a sustainable manner, understood in economic, environmental and social terms.
Study of an Iron Age Gilded Silver Earring by XRF, SEM-EDS and Multifocus OM
Authors: Serrano Sofia , Rodrigues Alexandra , Silva Rui J. C. , Figueiredo Elin
Published: May 2023

The use of gold for artefact productions underwent substantial developments during Iron Age in western Europe, with the diversification of alloy compositions and the introduction of new technologies and aesthetics. This work presents a detailed study of a Late Iron Age earring from the western Iberian Peninsula and a discussion taking into consideration the alloys and technologies used at the time. The earring has a complex structure, composed of block- and strip-twisted wires and granulation. Characterization by multifocus optical microscopy, portable X-ray fluorescence spectrometry (pXRF), micro-XRF and scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS) were performed to obtain information on the chemical composition and manufacturing techniques. Results show that the earring was manufactured with wires and granules made of a silver-rich alloy, covered with a gold-rich layer 45 μm thick on average, which acted as an external coating making the entire earring resemble gold. This is a rare example of an Iron Age gilded earring, and its detailed study provides further information on the manufacturing solutions adopted by the Iron Age goldsmiths.
Quality of Olive Oil Obtained by Regulated Deficit Irrigation
Authors: García-Garví José Miguel , Noguera-Artiaga Luis , Hernández Francisca , Pérez-López Antonio José , Burgos-Hernández Armando , Carbonell-Barrachina Ángel A.
Published: May 2023

Olive oil is one of the basic products in the Mediterranean diet, and, due to its nutritional value, it is becoming more and more widespread in the world. Even though it has traditionally been a rainfed crop, farmers are currently transforming their plantations into super-high-density orchards to increase production. However, the increasingly acute drought in Mediterranean countries forces the establishment of water control mechanisms that allow restriction the contribution of water without undermining the properties of the products obtained. Under this concept, hydroSOS crops and products arose. This study aims to analyze the influence of the application of deficit irrigation on the olive oil obtained from the Arbequina and Arbosana varieties. The sensory parameters descriptive profile and consumers satisfaction degree were measured using trained and consumers’ panels, and the chemical parameters peroxide index, fatty acids, and volatile profile were analyzed using the methods from the International Olive Oil Council and gas chromatography. The experimental results showed that applying this type of irrigation leads to an oil that is more valued by consumers, with a higher concentration of aromatic compounds related with a greener aroma (hexanol, trans-2-hexen-1-ol, hexanal), a higher content of polyunsaturated fatty acids, and greater antioxidant capacity. Deficit irrigation strategies led to environmentally friendly olive oil with high acceptance by Spanish consumers.
Examination of Measured to Predicted Hydraulic Properties for Low Impact Development Substrates
Authors: Guram Satbir , Bashir Rashid
Published: May 2023

To counter the impacts of climate change and urbanization, engineers have developed ingenious solutions to reduce flooding and capture stormwater contaminants through the use of Low Impact Developments (LIDs). The soil is generally considered to be completely saturated when designing for the LIDs. However, this may not always be an accurate or realistic approach, as the soil could be variably unsaturated leading to inaccurate designs. To analyse the flow under variably unsaturated conditions, Richards’ equation can be used. To solve the Richards’ equation, two nonlinear hydraulic properties, namely soil water characteristic curve (SWCC) and the unsaturated hydraulic conductivity function are required. Laboratory and field measurements of unsaturated hydraulic properties are cumbersome, expensive and time- consuming. Pedotransfer functions (PTFs) estimate soil hydraulic properties using routinely measured soil properties. This paper presents a comparison between the direct measurement obtained through experimental procedures and the use of PTFs to estimate soil hydraulic properties for two green roof and three bioretention soil medias. Comparison between the measured and estimated soil hydraulic properties was accomplished using two different approaches. Statistical analyses and visual comparisons were used to compare the measured and estimated soil hydraulic properties. Additionally, numerical modelling to predict the water balance at the ground surface was conducted using the measured and estimated soil hydraulic properties. In some instances, the use of predicted hydraulic properties resulted in overestimation of the cumulative net infiltration of as much as 60 % for the green roof substrate, but was considered negligible for the bioretention substrate. Design performance criteria for green roof and bioretention facilities were examined using the measured and estimated soil hydraulic properties under extreme precipitation analysis. Results indicate that there is a high level of uncertainty when using PTFs for LID materials. A percent difference between the measured and predicted properties for the green roof peak time delay under a 2-year storm can be as much as 300%. For the bioretention design criteria of a 25-year storm, the surface runoff was overestimated by 14.7 cm and by 100% for the ponding time percent difference.
Centralized Intake Models and Recommendations for Their Use in Non-Acute Mental Health Services: A Scoping Review
Authors: Isaacs Anton , Bonsey Alistair , Couch Danielle
Published: May 2023

Centralized intake [CI] or single-entry models are utilized in health systems to facilitate service access by reducing waiting times. This scoping review aims to consolidate the Literature on CI service models to identify their characteristics and rationales for their use, as well as contexts in which they are used and challenges and benefits in implementing them. The review also aims to offer some lessons learned from the Literature and to make recommendations for its implementation in non-acute mental health services. The findings show that CI is mostly considered when there is increased demand for services and clients are required to navigate multiple services that operate individually. Successful models have meaningfully engaged all stakeholders from the outset and the telephone is the most common mode of intake. Recommendations are made for planning and preparation, for elements of the model, and for setting up the service network. When successfully implemented, CI has been shown to improve access and increase demand for services. However, if CI is not supported by a network of service providers who offer care that is acceptable to clients, the purpose of its implementation could be lost.
The Non-Linear Influence of Built Environment on the School Commuting Metro Ridership: The Case in Wuhan, China
Authors: Yan Jinming , Wan Qiuyu , Feng Jingyi , Wang Jianjun , Hu Yiwen , Yan Xuexin
Published: May 2023

Although many studies have investigated the non-linear relationship between the built environment and rail patronage, it remains unclear whether this influence is equally applicable to primary and secondary school students due to their physiological characteristics and cognitive limitations. This study applies the GBDT model to Wuhan student metro swipe data in order to investigate the relative importance and non-linear association of the built environment on the school-commuting metro ridership. The results show that the variable with the greatest predictive power is the number of living service facilities followed by the number of intersections, and the degree of land-use mixture. All of the built environment variables had non-linear associations with the school-commuting ridership, and the greatest attraction to the school-commuting metro ridership occurred when the number of living service facilities was 500, the number of intersections was 36, and the degree of land-use mixture was 0.8. These findings can help planners to prioritize land-use optimization and the effective range of land-use indicators when developing child-friendly rail transport policies.
In Vitro and In Vivo Therapeutic Potential of 6,6′-Dihydroxythiobinupharidine (DTBN) from Nuphar lutea on Cells and K18-hACE2 Mice Infected with SARS-CoV-2
Authors: Weiss Shay , Waidha Kamran , Rajendran Saravanakumar , Benharroch Daniel , Khalilia Jannat , Levy Haim , Bar-David Elad , Golan-Goldhirsh Avi , Gopas Jacob , Ben-Shmuel Amir
Published: May 2023

We have previously published research on the anti-viral properties of an alkaloid mixture extracted from Nuphar lutea, the major components of the partially purified mixture found by NMR analysis. These are mostly dimeric sesquiterpene thioalkaloids called thiobinupharidines and thiobinuphlutidines against the negative strand RNA measles virus (MV). We have previously reported that this extract inhibits the MV as well as its ability to downregulate several MV proteins in persistently MV-infected cells, especially the P (phospho)-protein. Based on our observation that the Nuphar extract is effective in vitro against the MV, and the immediate need that the coronavirus disease 2019 (COVID-19) pandemic created, we tested here the ability of 6,6′-dihydroxythiobinupharidine DTBN, an active small molecule, isolated from the Nuphar lutea extract, on COVID-19. As shown here, DTBN effectively inhibits SARS-CoV-2 production in Vero E6 cells at non-cytotoxic concentrations. The short-term daily administration of DTBN to infected mice delayed the occurrence of severe clinical outcomes, lowered virus levels in the lungs and improved survival with minimal changes in lung histology. The viral load on lungs was significantly reduced in the treated mice. DTBN is a pleiotropic small molecule with multiple targets. Its anti-inflammatory properties affect a variety of pathogens including SARS-CoV-2 as shown here. Its activity appears to target both pathogen specific (as suggested by docking analysis) as well as cellular proteins, such as NF-κB, PKCs, cathepsins and topoisomerase 2, that we have previously identified in our work. Thus, this combined double action of virus inhibition and anti-inflammatory activity may enhance the overall effectivity of DTBN. The promising results from this proof-of-concept in vitro and in vivo preclinical study should encourage future studies to optimize the use of DTBN and/or its molecular derivatives against this and other related viruses.
A Systematic Literature Review on Adaptive Supports in Serious Games for Programming
Authors: Toukiloglou Pavlos , Xinogalos Stelios
Published: May 2023

This paper reviews the research on adaptive serious games for programming regarding the implementation of their support systems. Serious games are designed to educate players in an entertaining and engaging manner. A key element in terms of meeting their educational goals is the presentation of the learning content through a support system. Recent developments in artificial intelligence, data analysis, and computing made the development of support systems that adapt to player individual characteristics possible. A systematic literature review is necessary to evaluate the efficiency of adaptive supports and examine the implementation approaches. This review identified 18 papers reporting evidence about the efficiency of the provided support and methods of development. A variety of techniques for presenting educational content was found, with text being the preferred type. Researchers employed data-driven approaches to model student knowledge levels and behavior such as Bayesian networks and questionnaires, with fuzzy logic being utilized most frequently. The efficiency of the supports, when compared with non-adaptive or traditional methods of teaching, was mostly positive, although this is not a decisive conclusion. Some papers did not provide empirical evidence or concluded no difference in efficiency. The limited number of articles in the field, together with the lack of a standard evaluation methodology, leads to the conclusion that further work needs to be carried out in the area.
Doping with Rare Earth Elements and Loading Cocatalysts to Improve the Solar Water Splitting Performance of BiVO4
Authors: Wang Meng , Wu Lan , Zhang Feng , Gao Lili , Geng Lei , Ge Jiabao , Tian Kaige , Chai Huan , Niu Huilin , Liu Yang , Jin Jun
Published: May 2023

BiVO4 is a highly promising material for Photoelectrochemical (PEC) water splitting photoanodes due to its narrow band gap value (~2.4 eV) and its ability to efficiently absorb visible light. However, the short hole migration distance, severe surface complexation, and low carrier separation efficiency limit its application. Therefore, in this paper, BiVO4 was modified by loading CoOOH cocatalyst on the rare earth element Nd-doped BiVO4 (Nd-BiVO4) photoanode. The physical characterization and electrochemical test results showed that Nd doping will cause lattice distortion of BiVO4 and introduce impurity energy levels to capture electrons to increase carrier concentration, thereby improving carrier separation efficiency. Further loading of surface CoOOH cocatalyst can accelerate charge separation and inhibit electron–hole recombination. Ultimately, the prepared target photoanode (CoOOH-Nd-BiVO4) exhibits an excellent photocurrent density (2.4 mAcm−2) at 1.23 V versus reversible hydrogen electrode potential (vs. RHE), which is 2.67 times higher than that of pure BiVO4 (0.9 mA cm−2), and the onset potential is negatively shifted by 214 mV. The formation of the internal energy states of rare earth metal elements can reduce the photoexcited electron–hole pair recombination, so as to achieve efficient photochemical water decomposition ability. CoOOH is an efficient and suitable oxygen evolution cocatalyst (OEC), and OEC decoration of BiVO4 surface is of great significance for inhibiting surface charge recombination. This work provides a new strategy for achieving effective PEC water oxidation of BiVO4.
Effective Phytosanitary Treatment for Export of Oriental Melons (Cucumis melo var L.) Using Ethyl Formate and Modified Atmosphere Packaging to Control Trialeurodes vaporariorum (Hemiptera: Aleyrodidae)
Authors: Kim Kyeongnam , Kim Dongbin , Kwon Tae Hyung , Lee Byung-Ho , Lee Sung-Eun
Published: May 2023

Trialeurodes vaporariorum (Hemiptera: Aleyrodidae), commonly known as greenhouse whitefly, is one of the main insect pests of Oriental melon (Cucumis melo var L.) in South Korea. T. vaporariorum is of concern as a quarantine pest for the exportation of C. melo in Southeast Asian countries. Due to future restrictions on the use of methyl bromide (MB) during quarantine, ethyl formate (EF) represents a potential alternative. In this study, we evaluated EF for its efficacy (probit-9 values) in enabling the export of Oriental melons. The probit-9 value of EF for controlling T. vaporariorum was 3.02 g·h/m3 after 2 h of fumigation. We also assessed the phytotoxicity of EF on melons when using modified atmosphere packaging (MAP) under low-temperature conditions, which is required for export and trade, to extend shelf-life. In scaled-up trials, we found 8 g/m3 EF for 2 h at 5 °C to be suitable as a new phytosanitary treatment against greenhouse whitefly for exported Oriental melons when using MAP. No phytotoxic damage was found 28 d after fumigation at 5 °C in terms of five quality parameters (firmness, sugar content, mass loss, color change, and external damage).
Specific Expression of Antimicrobial Peptides from the Black Soldier Fly in the Midgut of Silkworms (Bombyx mori) Regulates Silkworm Immunity
Authors: Deng Xuan , Liu Lianlian , Deng Jing , Zha Xingfu
Published: May 2023

Antimicrobial peptides are molecules with strong antimicrobial activity and are of substantial interest for the immunization of insects. As a type of dipteran insect that can turn organic waste into animal feed, the black soldier fly (BSF) can “turn waste into treasure”. In this study, we investigated the antimicrobial activity of the antimicrobial peptide genes, HiCG13551 and Hidiptericin-1, of BSF in silkworms, by overexpressing the genes specifically in the midgut. Changes in the mRNA levels of the transgenic silkworms after infection with Staphylococcus aureus were evaluated using transcriptome sequencing. The results showed that Hidiptericin-1 had stronger antimicrobial activity than HiCG13551. KEGG enrichment analysis showed that the differentially expressed genes in the transgenic overexpressed Hidiptericin-1 silkworm lines from the D9L strain were mainly enriched in the starch and sucrose metabolism, pantothenate and CoA biosynthesis, drug metabolism (other enzymes), biotin metabolism, platinum drug resistance, galactose metabolism, and pancreatic secretion pathways. In addition, immune-related genes were up-regulated in this transgenic silkworm strain. Our study may provide new insights for future immune studies on insects.
Knee Angle Generation with Walking Speed Adaptation Ability for a Powered Transfemoral Prosthetic Leg Prototype
Authors: Pranata I Wayan Dani , Nguyen Phuc Thanh-Thien , Su Kuo-Ho , Kuo Yu-Cheng , Kuo Chung-Hsien
Published: May 2023

This paper presents a microcontroller-based solution for generating real-time normal walking knee angle of a powered transfemoral prosthetic leg prototype. The proposed control algorithm was used to determine the prosthetic knee angle by utilizing seven hip angle movement features generated from only the inertia measurement unit (IMU) deployed on the prosthetic socket on the thigh of the same side. Then, a proportional–integral–derivative (PID) controller is developed to control the motor to reach the desired knee angle in real time. Furthermore, a novel parallel four-bar linkage-based master–slave validation framework combining a motion capture system was introduced to evaluate the performance of the knee angle generation on a speed-adjustable treadmill with able-bodied subjects. In the framework evaluation, 3 different walking speeds were applied to the treadmill to validate different speed adaptation capabilities of the prosthetic leg control system, precisely 50 cm/s, 60 cm/s, and 70 cm/s. Through the proposed 4-bar linkage framework, the prosthesis’s movement can simulate able-bodied subjects well with maximum RMSE never exceeding 0.27° in the swing flexion phase, 4.4° to 5.8° in the stance phase, and 1.953° to 13.466° in the swing extension phase. The treadmill results showed that the prosthetic leg is able to perform a normal walking gait following different walking speeds of the subject. Finally, a corridor walking experiment with a bypass adapter was successfully performed to examine the feasibility of real prosthetic walking situations.
Association of Renin-Angiotensin System Blockers with Survival in Patients on Maintenance Hemodialysis
Authors: Kang Seok Hui , Kim Bo Yeon , Son Eun Jung , Kim Gui Ok , Do Jun Young
Published: May 2023

Additional studies are needed to confirm whether the use of renin-angiotensin system blockers (RASBs) induces survival benefits in patients on hemodialysis (HD). This study aimed to evaluate patient survival with the use of RASBs in a large sample of maintenance HD patients. This study used data from the national HD quality assessment program and claim data from South Korea (n = 54,903). A patient using RASBs was defined as someone who had received more than one prescription during the 6 months of each HD quality assessment period. The patients were divided into three groups as follows: Group 1, no prescription for anti-hypertensive drugs; Group 2, prescription for anti-hypertensive drugs other than RASBs; and Group 3, prescription for RASBs. The five-year survival rates in Groups 1, 2, and 3 were 72.1%, 64.5%, and 66.6%, respectively (p < 0.001 for Group 1 vs. Group 2 or 3; p = 0.001 for Group 2 vs. Group 3). Group 1 had the highest patient survival rates among the three groups, and Group 3 had higher patient survival rates compared to Group 2. Group 3 had higher patient survival rates than Group 2; however, the difference in patient survival rates between Group 2 and Group 3 was relatively small. Multivariate Cox regression analyses showed similar trends as those of univariate analyses. The highest survival rates from our study were those of patients who had not used anti-hypertensive drugs. Between patients treated with RASBs and those with other anti-hypertensive drugs, patient survival rates were higher in patients treated with RASBs.
Microisolation of Spatially Characterized Single Populations of Neurons for RNA Sequencing from Mouse and Postmortem Human Brain Tissues
Authors: Alldred Melissa J. , Ginsberg Stephen D.
Published: May 2023

Single-cell and single-population RNA sequencing (RNA-seq) is a rapidly evolving new field of intense investigation. Recent studies indicate unique transcriptomic profiles are derived based on the spatial localization of neurons within circuits and regions. Individual neuronal subtypes can have vastly different transcriptomic fingerprints, well beyond the basic excitatory neuron and inhibitory neuron designations. To study single-population gene expression profiles of spatially characterized neurons, we have developed a methodology combining laser capture microdissection (LCM), RNA purification of single populations of neurons, and subsequent library preparation for downstream applications, including RNA-seq. LCM provides the benefit of isolating single neurons characterized by morphology or via transmitter-identified and/or receptor immunoreactivity and enables spatial localization within the sample. We utilize unfixed human postmortem and mouse brain tissue that is frozen to preserve RNA quality in order to isolate the desired neurons of interest. Microisolated neurons are then pooled for RNA purification utilizing as few as 250 individual neurons from a tissue section, precluding extraneous nonspecific tissue contaminants. Library preparation is performed from picogram RNA quantities extracted from LCM-captured neurons. Single-population RNA-seq analysis demonstrates that microisolated neurons from both postmortem human and mouse brain tissues are viable for transcriptomic profiling, including differential gene expression assessment and bioinformatic pathway inquiry.
Delayed Diagnosis of Congenital Myasthenic Syndromes Erroneously Interpreted as Mitochondrial Myopathies
Authors: Muñoz-García Mariana I. , Guerrero-Molina María Paz , de Fuenmayor-Fernández de la Hoz Carlos Pablo , Bermejo-Guerrero Laura , Arteche-López Ana , Hernández-Laín Aurelio , Martín Miguel A. , Domínguez-González Cristina
Published: May 2023

Background: Congenital myasthenic syndromes (CMSs) and primary mitochondrial myopathies (PMMs) can present with ptosis, external ophthalmoplegia, and limb weakness. Methods: Our method involved the description of three cases of CMS that were initially characterized as probable PMM. Results: All patients were male and presented with ptosis and/or external ophthalmoplegia at birth, with proximal muscle weakness and fatigue on physical exertion. After normal repetitive nerve stimulation (RNS) studies performed on facial muscles, a muscle biopsy (at a median age of 9) was performed to rule out congenital myopathies. In all three cases, the biopsy findings (COX-negative fibers or respiratory chain defects) pointed to PMM. They were referred to our neuromuscular unit in adulthood to establish a genetic diagnosis. However, at this time, fatigability was evident in the physical exams and RNS in the spinal accessory nerve showed a decremental response in all cases. Targeted genetic studies revealed pathogenic variants in the MUSK, DOK7, and RAPSN genes. The median diagnostic delay was 29 years. Treatment resulted in functional improvement in all cases. Conclusions: Early identification of CMS is essential as medical treatment can provide clear benefits. Its diagnosis can be challenging due to phenotypic overlap with other debilitating disorders. Thus, a high index of suspicion is necessary to guide the diagnostic strategy.
Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective
Authors: Yue John , Krishnan Nishanth , Andrews John , Semonche Alexa , Deng Hansen , Aabedi Alexander , Wang Albert , Caldwell David , Park Christine , Hirschhorn Melessa , Ghoussaini Kristen , Oh Taemin , Sun Peter
Published: May 2023

Background: Mild traumatic brain injury (MTBI) causes morbidity and disability worldwide. Pediatric patients are uniquely vulnerable due to developmental and psychosocial factors. Reduced healthcare access in rural/underserved communities impair management and outcome. A knowledge update relevant to current gaps in care is critically needed to develop targeted solutions. Methods: The National Library of Medicine PubMed database was queried using comprehensive search terms ((“mild traumatic brain injury” or “concussion”) and (“rural” or “low-income” or “underserved”) and (“pediatric” or “child/children”)) in the title, abstract, and Medical Subject Headings through December 2022. Fifteen articles on rural/underserved pediatric MTBI/concussion not covered in prior reviews were examined and organized into four topical categories: epidemiology, care practices, socioeconomic factors, and telehealth. Results: Incidences are higher for Individuals in rural regions, minorities, and those aged 0–4 years compared to their counterparts, and are increasing over time. Rural healthcare utilization rates generally exceed urban rates, and favor emergency departments (vs. primary care) for initial injury assessment. Management guidelines require customization to resource-constrained settings for implementation and adoption. Decreased community recognition of the seriousness of injury is a consensus challenge to care provision by clinicians. Low parental education and income were correlated with decreased MTBI knowledge and worse outcome. Telehealth protocols for triage/consultation and rehabilitation were feasible in improving care delivery to rural and remote settings. Conclusions: Pediatric MTBI/concussion patients in rural/underserved regions experience increased risks of injury, geographic and financial healthcare barriers, and poorer outcomes. Globally, under-reporting of injury has hindered epidemiological understanding. Ongoing MTBI education should be implemented for rural caregivers, schools, and low-income populations to improve community awareness. Telehealth can improve care delivery across acuity settings, and warrants judicious inclusion in triage and treatment protocols.
Plasma and Urinary Biomarkers Improve Prediction of Mortality through 1 Year in Intensive Care Patients: An Analysis from FROG-ICU
Authors: Davison Beth A. , Edwards Christopher , Cotter Gad , Kimmoun Antoine , Gayat Étienne , Latosinska Agnieszka , Mischak Harald , Takagi Koji , Deniau Benjamin , Picod Adrien , Mebazaa Alexandre
Published: May 2023

Background: This study aimed to assess the value of blood and urine biomarkers in addition to routine clinical variables in risk stratification of patients admitted to ICU. Methods: Multivariable prognostic models were developed in this post hoc analysis of the French and EuRopean Outcome ReGistry in Intensive Care Units study, a prospective observational study of patients admitted to ICUs. The study included 2087 patients consecutively admitted to the ICU who required invasive mechanical ventilation or a vasoactive agent for more than 24 h. The main outcome measures were in-ICU, in-hospital, and 1 year mortality. Results: Models including only SAPS II or APACHE II scores had c-indexes for in-hospital and 1 year mortality of 0.64 and 0.65, and 0.63 and 0.61, respectively. The c-indexes for a model including age and estimated glomerular filtration rate were higher at 0.69 and 0.67, respectively. Models utilizing available clinical variables increased the c-index for in-hospital and 1 year mortality to 0.80 and 0.76, respectively. The addition of biomarkers and urine proteomic markers increased c-indexes to 0.83 and 0.78. Conclusions: The commonly used scores for risk stratification in ICU patients did not perform well in this study. Models including clinical variables and biomarkers had significantly higher predictive values.
Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes
Authors: Tee Jia Wei , Bigdeli Amir K. , Thomas Benjamin , Falkner Florian , Didzun Oliver , Vollbach Felix H. , Kneser Ulrich , Gazyakan Emre
Published: May 2023

Background: Defects of the hand and foot often require an individualized reconstructive approach, due to their unique functional and aesthetic characteristics. Transferred tissues should be thin, pliable, and durable, with free fascial flaps meeting these requirements. This study aimed to evaluate the serratus fascia flap and the serratus carpaccio flap, which is a modification of the fascia flap, by including a thin muscle layer, with the goal of enhancing flap resilience and lowering morbidity rates. Methods: Between January 2000 and December 2017, 31 patients underwent microsurgical reconstruction of the hand or foot either by serratus fascia flap (fascia group) or serratus carpaccio flap (carpaccio group). The serratus fascia flaps were mainly harvested between 2000 and 2012, and the serratus carpaccio flaps between 2013 and 2017. Patient records were reviewed retrospectively, regarding demographics, complications, overall flap survival, additional revision surgeries, and surgical outcome. Categorical variables were compared using Fisher’s exact test and continuous data with the Mann–Whitney tests. Logistic regression was used to examine the correlation between comorbidities and postoperative complication rates. Differences were considered significant when p < 0.05. Results: The fascia group consisted of 17 patients and the carpaccio group of 14 patients. The average patient age in the fascia group was 39.2 ± 10.5 years, and it was 39.1 ± 14.7 years in the carpaccio group. Overall complication rates were significantly lower in the carpaccio group than in the fascia group (28.6% vs. 70.6%, p = 0.03). The rates of overall flap survival (85.7% in the carpaccio group vs. 74.5% in the fascia group, p = 0.66) and partial flap loss (14.3% in the carpaccio group vs. 47.1% in the fascia group, p = 0.07) did not differ significantly among both groups. One postoperative hematoma of the donor site requiring revision surgery was reported in the carpaccio group (7.1%, p = 0.45) while no donor-site morbidity was reported in the fascia group. Conclusions: Our findings indicate that the serratus carpaccio flap presents a promising alternative to the serratus fascia flap. This modification has proven to be effective in substantially reducing postoperative complications requiring additional surgical interventions. Therefore, the serratus carpaccio flap can be considered a dependable reconstructive option for addressing complex soft tissue defects of the hand and foot, with complication rates that are within an acceptable range.
Recent Advances in Dual Disorders (Addiction and Other Mental Disorders)
Authors: Torrens Marta , Adan Ana
Published: May 2023

In clinical mental health practice, the presence of Dual Disorders (DDs), defined as the comorbidity of at least one Substance Use Disorder (SUD) and another mental disorder in the same person [...]
Diagnosis and Management of Malnutrition in Patients with Heart Failure
Authors: Esteban-Fernández Alberto , Villar-Taibo Rocío , Alejo Mirian , Arroyo David , Bonilla Palomas Juan Luis , Cachero Montserrat , Joaquin Clara , Méndez Bailón Manuel , Pérez-Rivera José Ángel , Romero-Vigara Juan Carlos , Somoza Gema
Published: May 2023

Heart failure is a disease with an increasingly greater prevalence due to the aging population, the development of new drugs, and the organization of healthcare processes. Malnutrition has been identified as a poor prognostic factor in these patients, very often linked to frailty or to other comorbidities, meaning that early diagnosis and treatment are essential. This paper reviews some important aspects of the pathophysiology, detection, and management of malnutrition in patients with heart failure.
Inhaled Corticosteroids and Bronchiectasis: Friend or Foe?
Authors: Martinez-Garcia Miguel Angel
Published: May 2023

The three most common chronic inflammatory airway diseases are asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis [...]
Efficacy of Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair versus Sleeve–Fundoplication on Gastroesophageal Reflux Disease Resolution: Systematic Review and Meta-Analysis
Authors: Castagneto-Gissey Lidia , Russo Maria Francesca , D’Andrea Vito , Genco Alfredo , Casella Giovanni
Published: May 2023

(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric surgeons. While concomitant hiatal hernia repair (SG + HHR) has been proposed as a means of reducing the risk of GERD following SG with varying degrees of success, the addition of a fundoplication (SG + FP) has been suggested in recent years as a way to improve the lower esophageal sphincter’s competency. The aim of this study is to systematically review and meta-analyze the efficacy of SG + HHR versus SG + FP on GERD remission in patients with obesity. (2) Methods: A systematic review of the literature was conducted, and studies analyzing the effects of SG + HHR versus SG + FP on postoperative GERD were included. The methodological quality of included trials was evaluated. The primary outcome was postoperative GERD rate, erosive esophagitis, and 12-month weight loss. Secondary outcomes included postoperative complications and mortality. The PRISMA guidelines were used to carry out the present systematic review (PROSPERO Registration Number: CRD42023405600). (3) Results: Fifteen articles with a total of 1164 patients were included in the meta-analysis; 554 patients underwent SG + HHR while 610 underwent SG + FP. In the SG + HHR group, 58.5 ± 28.9% of subjects presented clinical GERD symptoms compared to 20.4 ± 17.5% postoperatively (p < 0.001). In the SG + FP group, 64.8 ± 39.4% were affected by GERD preoperatively compared to only 5 ± 8.1% postoperatively (p < 0.001). SG + FP patients had a significantly greater GERD remission compared to SG + HHR (p < 0.001). Weight loss was similar between groups (p = 0.125). The rate of leaks was 0.18% and 0.33% in the SG + HHR and SG + FP, respectively (p = 0.657), while perforations were significantly higher after SG + FP compared to the SG + HHR group (3.1% versus 0%, p = 0.002). The mortality rate was significantly greater in the SG + FP group (0.5% versus 0%, p = 0.002). (4) Conclusions: This study revealed that both SG with concomitant HHR and sleeve–fundoplication are effective in terms of reflux resolution and weight outcomes, with superiority of SG + FP in terms of GERD control, despite a greater overall complication rate. Both strategies can therefore be suggested as a suitable alternative variant to a conventional SG in subjects with obesity and concomitant hiatal hernia and/or GERD. Studies with extended follow-up and direct comparisons of these surgical approaches to conventional SG are warranted.
The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections
Authors: Ritter Einat , Shusterman Eden , Prozan Lior , Kehat Orli , Weiss Meilik Ahuva , Shibolet Oren , Ablin Jacob Nadav
Published: May 2023

Background: liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. Aims: we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). Methods: a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010–2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. Results: liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2–22), 3.45 (CI 1.7–7), 3.1 (CI 1.7–6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. Conclusion: liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests’ peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus.
Investigation of Water Absorption Properties of 2D Interwoven Kevlar–Jute Reinforced Hybrid Laminates
Authors: Raja Narayana Dilip , Anand Kumar Kammanni Veerabhadrappa , Salunkhe Sachin , Hussein Hussein Mohamed Abdelmoneam
Published: May 2023

The hygroscopic properties of natural fibers tend to degrade the mechanical properties of composite materials. It is essential to investigate the influence of water absorption behavior on the mechanical properties of hybrid composite materials. In this study, hybrid laminate materials consisting of two different reinforcement materials, i.e., Kevlar fibers and jute fibers in the same layer, are considered. Hybrid laminates that have four different weaving patterns: plain weave, basket weave, twill weave, and the satin weave, are tested for their water absorption characteristics. The jute fiber is a naturally extracted fiber that is subjected to chemical treatment. A comparison of mechanical properties before and after treatment of the jute fibers is carried out. Mechanical properties such as tensile strength, compressive strength, flexural strength, impact strength, and hardness are tested. It is found that the mechanical properties improved after the treatment of the jute fibers. The twill weave pattern exhibited negligible defects compared to its counterparts. Chemical treatment of the jute fibers enabled less water being absorbed into the hybrid laminate materials. Mechanical properties improved after using chemically treated jute fibers as the reinforcement material in the hybrid laminate materials. It is concluded that the twill weave pattern and chemical treatment of the natural fibers improved the mechanical properties of the hybrid laminate materials.
Optimization and Prediction of Process Parameters during Abrasive Water Jet Machining of Hybrid Rice Straw and Furcraea foetida Fiber Reinforced Polymer Composite
Authors: Madival Abhishek Sadananda , Doreswamy Deepak , Shetty Raviraj , Naik Nithesh , Gurupur Prakash Rao
Published: May 2023

In the last few decades, natural composite materials have been considered one of the highly sustainable ecological alternatives for reducing the consumption of synthetic materials. Today, research on natural fiber composites is the main thrust for their use in various industrial applications. Further, continuous research works are being carried out to utilize natural composites as an alternative to synthetic materials. However, the inhomogeneity of composites, delamination, fiber pullout, higher surface roughness (SR) and dimensional inaccuracy under traditional machining have led the attention towards non-traditional machining, such as abrasive water jet machining, to achieve high-quality components. Hence, in this study, an experimental analysis based on the design of experiments is conducted on the machinability of a hybrid rice straw/Furcraea foetida composite under abrasive water jet machining (AWJM). Further, the concentration of the rice straw and the AWJ process parameters are varied, and their effects on the quality of machining is evaluated. The experimental trials are designed based on the Taguchi L27 orthogonal array, followed by an analysis of variance (ANOVA). From extensive experimentations, the concentration of rice straw is observed to be the most contributing (93.5%) factor to the SR. The traverse speed (TS) shows the highest percentage contributions of 93.13%, 55.50 and 55.70% to the material removal rate (MRR) and the top (TKW) and bottom kerf widths (BKW), respectively. However, the interaction between the fiber concentration and traverse speed gives the maximum contribution (35.04%) to the kerf taper (KT). A second-order response surface model is generated to study the effects of the process parameters on the SR, MRR, TKW, BKW and KT in any experimental domain. Finally, the microstructural characteristics of the machined surfaces, such as micro-cracks, debonding, and fiber pullout, are discussed.