bluuebunny/crossref_metadata_2025 huggingface dataset:
A self-fulfilling prophecy? Constructions of youth-as-troublemakers in UN DDR processes
Authors: Cho Jacqui
Published: March 2024

Youth as a category that informs international interventions in conflict-affected settings has gained currency in the past decade. This article traces the rising rhetoric of youth in UN Disarmament, Demobilization and Reintegration (DDR) discourse and demonstrates how changes in its dominant representations have implications beyond the matter of semantics. Drawing on post-structuralist traditions, the article highlights how the DDR discourse delineates problems through particular framings that call forth certain solutions, which in turn reinforce the very (mis)understandings that underlie the interventions. A case study from the Central African Republic illustrates how the hegemonic representation of youth-as-troublemakers in UN documents, together with a compelling narrative that naturalized the link between youth, unemployment and violence, made possible and conferred legitimacy to the proliferation of projects with an overwhelming economic focus. The article discusses how the resource landscape, such as opportunities to unlock earmarked funding, incentivizes the reproduction of certain constructions of youth that align with today’s policy panic around violent extremism. In so doing, it puts into question the instrumental approach towards discourse by pointing to surprising ways in which discourses become appropriated by both international peacebuilders and the ‘subjects’ of these interventions.
Cost-benefit Analysis of Adopting Blockchain Technology in the Radiology Unit of a District Hospital
Authors: Apipi Munir , Abdul Rasid Siti Zaleha , Basiruddin Rohaida
Published: March 2024

Background

Blockchain technology has better security and immutable features, which are beneficial for healthcare data management. Decentralisation data management allows better sharing of medical images between units and departments.

Objectives

The objectives of this study were to determine the cost of adopting the blockchain-based system for medical images and the cost-benefit analysis for five years of adoption of this technology at a district hospital in Malaysia.

Methodology

Data regarding the yearly costs and workload for 2016 until 2018 were collected from a district hospital in Malaysia. The cost of blockchain implementation was obtained from a company that developed this technology. The cost-benefit analysis was done using the capital budgeting method for five years of this technology adoption. Sensitivity analysis was done to assess uncertainty conditions during this adoption.

Results

The total yearly cost of Radiology Unit for 2018 was MYR490,168.96. The cost for adopting blockchain technology was MYR80,000 for the software, MYR115,000 for upgrading the assets and yearly maintenance cost was MYR16,000. The total present value of net benefits for five years of technology adoption was MYR865,295.01. Sensitivity analysis shows that consumables cost-saving is the most sensitive variable. Most pessimistic situation analyses showed positive net benefits.

Conclusion

The adoption of blockchain technology in managing medical images offers numerous benefits to public hospitals in Malaysia. Investment in this technology can provide a good return to the organisation.
Chronic Liver Disease and Promising Therapeutic Strategy: A Concise Review
Authors: Yu Han , Wang Zhijun , Zhao Gang
Published: March 2024

Background

Chronic liver dysfunction (CLD) is a significant global health issue; alcohol use, obesity, drugs, and antibiotic and viral infections contribute to its development. However, changes in gut microbiota composition, primarily as people grow older, can also play a role in initiating and progressing liver dysfunction.

Purpose

This review summarizes the altered gut microbiota–mediated chronic liver dysfunction and promising therapeutic strategies for NAFLD, ALD, NASH, and liver cirrhosis.

Discussion on the chronic liver disease and its therapeutic aspects

The gut microbiota influences physiological processes, including immune system regulation, by promoting the production of pro-inflammatory markers and elevating the expression of toll-like receptors (TLRs) on hepatocytes, metabolisms of bile acids and choline, alteration in saturated aliphatic organic acid (SCFA) production, and food absorption. These alterations increase intestinal permeability, chronic inflammation, and liver dysfunction. Dysbiosis triggers inflammatory pathways, oxidative stress, and the production of toxic compounds that damage liver cells and promote chronic liver diseases such as alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and cirrhosis. Age-related changes in gut motility, secretory function, and immunological function can further decline beneficial bacterial diversity and abundance and shifts in pathogenic bacterial species’ relative abundance.

Conclusion

Dysbiosis resulting from these age-related changes may contribute to the development of CLD. Numerous therapeutic approaches are available to restore the altered gut microbiota and reduce the risk of chronic liver dysfunction.
Using Evidence-based Scientific Research to Influence Dietary Behavioral Change: Taking a Look in the Mirror
Authors: Bueno de Mesquita Clifton P. , Vimercati Molano Ylenia , Vimercati Lara , de Mesquita P. Jacob Bueno
Published: March 2024

Science can provide accurate information to society to inform decision-making and behavior. One contemporary topic in which the science is very clear, yet behavioral change has lagged, is climate change mitigation. Climate change scientists use evidence-based research to advocate to the public to adopt emission-reducing behaviors in various sectors such as transportation and food. However, scientists themselves often do not change their own behaviors according to the scientific consensus. We present a case study of a group of natural sciences PhD students, who, when presented with evidence and an opportunity for a behavioral change with implications for climate change mitigation, demonstrated defensive reactions that would undoubtedly frustrate these same scientists if they were doing public outreach about their own work. Our goal is to raise awareness that we scientists do not always practice what we preach but could perhaps overcome this by understanding the defense mechanisms that impede meaningful change.
Spillover–Crossover Effect of Work–Family Interface: A Systematic Review
Authors: Ratnaningsih Ika Zenita , Idris Mohd Awang
Published: March 2024

Work and family are essential aspects of adulthood, exerting a substantial impact on well-being and satisfaction. Work–family conflict refers to conflicts that originate at work and then affect family life and vice versa. Higher levels of stress, the emergence of physical and mental health issues, detrimental effects on family relationships, and poorer life satisfaction are a few outcomes that may have an influence on both individuals and other family members. Work–family conflict can have a socioeconomic impact on broader public health, as it may result in poor job performance and high absenteeism rates at work. This current study aims to identify the mechanisms of spillover–crossover within the work–family interferences. Using a systematic literature review from 57 articles collected from three prestigious databases: Scopus, Web of Science, and PsycINFO, the study found that direct crossover is the predominant form of transmission. However, the crossover phenomenon is not only found in marital relationships but includes interactions between parents-children, superiors-subordinates, and employees-customers. This systematic literature review advances a novel framework by synthesizing these findings, thereby promoting a comprehensive understanding of the spillover–crossover effects of work–family conflict. In turn, this understanding can serve as the basis for the formulation of workplace policies, offering a promising path forward for both individuals and society.
The Positive Relational Couples Therapy Model: A Group Therapeutic Approach for LGBTQIA+ Military Couples
Authors: Morris Crystal , Wright Galaxina , Herbert Léa
Published: March 2024

Given the history of discrimination and increased mental health risks surrounding LGBTQIA+ service members, group counseling is a practical approach for practitioners to mitigate effects in a therapeutic setting. This article synthesizes the Positive Relational Couples Therapy (PRCT) model, incorporating concepts of the Multicultural and Social Justice Counseling Competencies (MSJCC), Relational-Cultural Theory (RCT), the PERMA model, and Gottman's Method Couples Therapy as a group process to provide a conceptual framework. An outline of the PRCT model and case illustration are provided for practitioners for group counseling with LGBTQIA+ military couples. Practical group considerations and implications for this work are discussed.
Institutional Courage in the College Context: A Mixed-Methods Analysis of Campus Victim Advocate Perceptions and Experiences
Authors: Nightingale Sarah D. , Cousineau Shannon
Published: March 2024

How institutions of higher education respond to campus sexual assault impacts the well-being and academic success of student survivors. Researchers at the Center for Institutional Courage developed an 11-step framework for campuses to respond to sexual assault in a manner that minimizes harm. This mixed-methods study uses the framework to understand college victim advocate perceptions of campus response to sexual assault. Results from a national survey and four focus groups found that advocates identify courageous response efforts as strong relationships across campus units, availability of trauma-informed services, and when resources were available to meet students’ direct needs. The critical role of leadership throughout the framework was also identified. Implications for policy and practice are discussed.
Comparative study of dexamethasone premedication regimens with docetaxel chemotherapy in early HER-2 positive breast cancer: A safety net hospital experience
Authors: Hager Avery , Kondle Shreya , Agarwal Amulya , Chintapenta Monica , Horadam Rochelle , Sadeghi Navid , Syed Samira
Published: March 2024

Introduction

Docetaxel can cause fluid retention reactions (FRRs) and hypersensitivity reactions (HSRs). The manufacturer recommends a multi-day oral dexamethasone premedication to prevent these toxicities, but steroid related side effects and regimen compliance remain a concern. This study aimed to determine if modified dexamethasone premedication regimens resulted in differences in HSRs or FRRs to docetaxel. We also examined side effects of dexamethasone and delays in chemotherapy.

Methods

A retrospective chart review was conducted on 82 early breast cancer patients treated with docetaxel. Three steroid regimens were examined: IV 20 mg single-dose dexamethasone, or IV 12 mg dexamethasone with either dexamethasone 8 mg BID for three days starting the day before chemotherapy or dexamethasone 4 mg BID for three days following chemotherapy. Adverse effects, delays in chemotherapy, and reasons for delays in chemotherapy were recorded.

Results

The incidence and severity of FRRs and HSRs was low, with less than 10% incidence of HSRs or FRRs in any group. Delays were most common in the group receiving dexamethasone 8 mg BID for 3 days starting the day before chemotherapy (63.3%) ( p < 0.05) and were most commonly due to patient noncompliance (26%).

Conclusion

A single dose of intravenous dexamethasone alone or followed by lower doses of oral dexamethasone may improve patient compliance and avoid delays in chemotherapy, without an increase in docetaxel toxicity.
Wilderness Medical Society Clinical Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness: 2024 Update
Authors: Paterson Ryan , Drake Brandy , Tabin Geoffrey , Cushing Tracy
Published: March 2024

A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded based on the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians.
Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update
Authors: Eifling Kurt P. , Gaudio Flavio G. , Dumke Charles , Lipman Grant S. , Otten Edward M. , Martin August D. , Grissom Colin K.
Published: March 2024

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33–S46.
Association Between Multiple Single Nucleotide Polymorphisms in Folate Metabolism Pathway and Breast Cancer Risk in Georgian Women: A Case-Control Study
Authors: Ahmadi Saba , Surmava Sandro , Kvaratskhelia Davit , Gogolashvili Ana , Kvaratskhelia Eka , Abzianidze Elene , Kankava Ketevani
Published: March 2024

Background:

The folate metabolism pathway plays an integral part in DNA synthesis, methylation, and repair. Methylenetetrahydrofolate reductase (MTHFR) and methylenetetrahydrofolate dehydrogenase (MTHFD1) are both enzymes that are involved in this pathway, and the single nucleotide polymorphisms (SNPs) in genes coding for them have modulatory effects on DNA expression. This study aimed to investigate the relationship between MTHFR C677T (rs1801133) and MTHFD1 G1958A (rs2236225) polymorphisms and the risk of developing breast cancer in Georgian women.

Methods:

A case-control study was performed examining the MTHFR C677T and MTHFD1 G1958A SNP in breast cancer–confirmed cases and healthy matched controls. Real time-polymerase chain reaction (PCR) was used to genotype SNPs. The case individuals’ pathology reports were obtained following surgeries for cancer characteristic data. Statistical analysis was performed to investigate the significance of the acquired data.

Results:

Statistical analysis of MTHFR C677T SNP revealed that the CT genotype increased the risk of breast cancer by 2.17 folds in the over-dominant model. Statistical analysis of MTHFD1 G1958A SNP showed that the GA genotype increased the risk of breast cancer by 4.12 folds in the codominant model and 2.41 folds in the over-dominant model. No statistically significant link was found between genotypes and lymph node status, however, patients with the CT genotype had higher percentages of proliferative activity.

Conclusions:

Breast cancer seems to have a statistically significant association with the CT genotype in MTHFR C677T and the GA genotype in MTHFD1 G1958A in Georgian women.
Increased levels of circulating soluble CD226 in multiple sclerosis
Authors: Kari Saniya , Bucciarelli Florence , Angles Thibault , Oster Anne-Cecile , Cauboue Pauline , Laviolette Karl , Mougenot Madeline , Morandi Elena , Bernard Isabelle , Pignolet Beatrice , Bost Chloé , Thomas Joelle , Nogueira Leonor , Saoudi Abdelhadi , Liblau Roland , Astier Anne L
Published: March 2024

Background:

The glycoprotein CD226 plays a key role in regulating immune cell function. Soluble CD226 (sCD226) is increased in sera of patients with several chronic inflammatory diseases but its levels in neuroinflammatory diseases such as multiple sclerosis (MS) are unknown.

Objective:

To investigate the presence and functional implications of sCD226 in persons with multiple sclerosis (pwMS) and other neurological diseases.

Methods:

The mechanisms of sCD226 production were first investigated by analyzing CD226 surface expression levels and supernatants of CD3/CD226-coactivated T cells. The role of sCD226 on dendritic cell maturation was evaluated. The concentration of sCD226 in the sera from healthy donors (HD), pwMS, neuromyelitis optica (NMO), and Alzheimer’s disease (AD) was measured.

Results:

CD3/CD226-costimulation induced CD226 shedding. Addition of sCD226 to dendritic cells during their maturation led to an increased production of the pro-inflammatory cytokine interleukin (IL)-23. We observed a significant increase in sCD226 in sera from pwMS and NMO compared to HD and AD. In MS, levels were increased in both relapsing–remitting multiple sclerosis (RRMS) and secondary-progressive multiple sclerosis (SPMS) compared to clinically isolated syndrome (CIS).

Conclusion:

Our data suggest that T-cell activation leads to release of sCD226 that could promote inflammation and raises the possibility of using sCD226 as a biomarker for neuroinflammation.
Neoehrlichiosis associated with ocrelizumab in a patient with multiple sclerosis: A case report
Authors: Afzal Raja Majid , Romme Christensen Jeppe , Gynthersen Rosa Maja Møhring , Lebech Anne-Mette , Blinkenberg Morten , Mens Helene
Published: March 2024

Objective:

To describe a case of neoehrlichiosis, an emerging opportunistic tick-borne infection, in a patient with multiple sclerosis (MS) treated with ocrelizumab.

Methods:

This is a case study.

Results:

Our patient developed clinical infection over several months while on ocrelizumab and was ultimately diagnosed with neoehrlichiosis, caused by the bacteria Neoehrlichia mikurensis. Resolution of symptoms began within a few days after the initiation of antibiotic treatment.

Conclusion:

We describe the first probable case of ocrelizumab-associated neoehrlichiosis in a patient with MS. Clinicians should be aware of this potentially debilitating and life-threatening infection in patients receiving CD20-depleting therapy.
Efficacy of telerehabilitation in patients with nonspecific neck pain: A meta-analysis
Authors: Zou Hui , Lu Zhoupeng , Zhao Peng , Wang Jialin , Wang Ruirui
Published: March 2024

Introduction

At a rate of more than 30% annually, neck pain is a very prevalent musculoskeletal ailment that is second only to low back pain as the most common cause of disability. Most occurrences of neck pain are nonspecific. Telerehabilitation is regarded as a potentially effective healthcare approach in this setting. This review aims to evaluate how a telerehabilitation-based intervention affected individuals with nonspecific neck pain (NNP) in terms of pain and disability.

Methods

PubMed, Web of Science, Scopus, Embase, MEDLINE, Cochrane library, ClinicalTrials.gov, CNKI, and WanFang were consulted from inception to September 2023, with the inclusion of randomized controlled trials only. The experimental data were meta-analyzed using RevMan 5.3.

Results

The meta-analysis contained eight studies; there was no significant difference in pain improvement in patients with NNP by telerehabilitation compared to conventional care (SMD = −0.10, 95% CI: −0.48 to 0.28), but there was a significant effect on disability improvement (SMD = −0.41, 95% CI: −0.78 to −0.03). Telerehabilitation demonstrated more significant improvements in pain (SMD = −1.16, 95% CI: −1.99 to −0.32) and disability (MD = −3.78, 95% CI: −5.29 to −2.27) compared to minimal or no intervention.

Discussion

This study emphasizes the potential benefits of employing telerehabilitation in patients with NNP, especially in reducing pain intensity and improving disability. But additional study is required to fully grasp the potential of telerehabilitation in this field.
Contemporary visions of the next apocalypse: Climate change and artificial intelligence
Authors: Mascareño Aldo
Published: March 2024

The ancient Greco-Roman and Judeo-Christian traditions are the main sources of the eschatological compositions of the apocalypse. Through the combination of various symbolic elements and a prefigured narrative, apocalyptic visions offer a script that can be applied in diverse historical situations to deal with the uncertainty of the present, to justify political action and to allocate resources. In contemporary society, the high complexity and significance of the socio-natural and socio-technical operations in the domains of climate change and artificial intelligence create a fertile ground for the proliferation of apocalyptic eschatologies. The analysis shows that while the use of the apocalyptic script indeed motivates action in the present to avoid a future posited as unavoidable, it also generates strong moral and political distinctions that emphasize a unilateral projection of the future and undervalue alternative possibilities. The article concludes that apocalyptic eschatology promotes a ritualistic action in the present that evades the explanation of the complex causalities underlying climate change and artificial intelligence. The magnetism of the apocalyptic narrative lies in its ability to motivate action based on a recognizable architecture, but in doing so, it precludes alternative future options.
A new deformable self-clinching fastener
Authors: Pragana João PM , Sampaio Rui FV , Clara Ricardo G , Bragança Ivo MF , Silva Carlos MA , Martins Paulo AF
Published: March 2024

This work proposes a novel deformable self-clinching fastener for producing hidden lap joints suitable for both structural and electric power distribution applications. The fastener, characterized by an axisymmetric concave shape, is employed to fabricate hybrid busbar joints between electrically conductive strips of different materials and thicknesses. The self-clinching process with the new deformable fastener involves machining dovetail holes in both conductors and applying a squeezing force to the fastener to create a form-closed mechanical joint. The work encompasses both experimental investigations and numerical modeling using finite element analysis and is carried out on unit cells made from aluminum and copper conductors, which are representative of the joining process. The investigation evaluates force requirements, conducts destructive testing, and performs thermo-electric characterization of the new joints to conclude on the suitability of the new deformable self-clinching fastener for electric power distribution applications. Results indicate that while copper fasteners necessitate greater squeezing forces, they offer superior mechanical and thermo-electrical performance compared to aluminum fasteners in hybrid busbar joints.
Automatic smooth map generation of internal combustion engines via local-global model based calibration technique
Authors: Soltanalizadeh Samaneh , Esfahanian Vahid , Haeri Yazdi Mohammad Reza , Nejat Mohammad
Published: March 2024

The addition of new sensors and actuators to the engine, to reduce fuel consumption and emissions besides improving the engine operation, complicates the control commands stored in the engine control unit (ECU). Substitution of mechanical actuators with electronic ones increases the engine’s degrees of freedom and the number of control parameters, which results in the increased engine calibration time and cost. The aim of this paper is to take advantage of optimization techniques to achieve optimal values of control parameters in a fast and automated way. In this regard, it requires replacing the real engine with the virtual model and implementing the model-based calibration by coupling the virtual engine model with optimization algorithms. In this study, deep neural network (DNN) modeling and genetic algorithm (GA, NSGA-II) optimization are used for model-based calibration. The effect of all input control parameters, including ignition angle, continuously variable valve timing, etc., on all output control parameters including, brake-specific fuel consumption, emissions level, knock limit, combustion stability, etc., are investigated simultaneously by a valid global model, which is a remarkable achievement in the model-based calibration. Dynamic lag of some actuators delays the execution of control commands sent from ECU. To avoid abrupt variations in the actuators values, smoothness of the engine maps is considered in the calibration process. To reduce fuel consumption, decrease emission levels and attain smooth maps, the calibration of control parameters is performed by local-multi-objective optimization and global-single-objective optimization. Local-global model-based calibration presented in this study reduces 3.7% of the brake-specific fuel consumption and 7%–10% of emissions level at breakpoints of the engine map compared to manual calibration. In addition, the calibration time and costs while producing better engine performance can be reduced by automating the calibration process. Finally, calibrated maps are stored as a lookup table (LUT) in ECU. Generating an optimal lookup table involves the pre-calculation of several points that cover the calculation domain and allow the interpolation for other points. Selecting the optimal points for exact calculation is of great importance in the size and accuracy of LUT. In this study, an optimization tool is also presented to generate accurate and efficient LUT.
The CO2 corrosion behaviour of 25Mn2 and 2Cr steels under certain downhole condition
Authors: Yuling Zhang , Qingchao Tian , Xuyan Deng , Xu Xiao , Guofu Wang
Published: March 2024

An economical 2Cr steel tubing was prepared for application in a certain downhole corrosion condition, and the CO2 corrosion behaviour was investigated by employing the 25Mn2 steel for comparative study. The corrosion films of the two steels under different corrosion conditions were analysed by optical microscope, scanning electron microscope (SEM), energy dispersive spectrometer (EDS) and X-ray diffraction (XRD). It is revealed that the corrosion rate of 25Mn2 steel at static solution is about 2.5 times higher than that at the dynamic solution with the flow velocity of 1 m/s, while the corrosion rate of 2Cr steel keeps almost the same. It is found that both steels show two layers of corrosion film at static corrosion, and the corrosion film is mainly composed of FeCO3, α-FeOOH and dotted Fe3C in the inner layer. It is inferred that carbon pickup phenomenon observed in the corrosion film is attributed to the formation of FeCO3, as well as may also be due to phenomenologically the reaction of Fe3C with carbonic acid.
Analysis of Beibu Gulf tidal zone exposure on properties of carbon steel
Authors: Yu Peng , Liao Jianhui , Zhou Yitong , He Sheng
Published: March 2024

Marine tidal zone is a corrosive environment that has a negative impact on carbon steel. This research investigates the change of mechanical properties and corrosion behaviour of carbon steel specimens subjected to field exposure test and simulation test for 12 and 6 months, respectively. The corrosion behaviour of carbon steel exposed to real marine tidal zone and simulation environment was discussed through morphological observation and corrosion kinetics analysis, in order to reveal the essential reason for the degradation of its mechanical properties. Then the tensile test was performed on the corroded specimens and true stress–strain curves were obtained. In addition, regression equations were derived for the mechanical properties as a function of the degree of corrosion degradation and a constitutive model with time factor for corroded carbon steel is proposed.
Comparative study on mechanism of DC and AC current on corrosion of copper–aluminium composites
Authors: Cheng Yulin , Zhang Yifan , Li Zhengyuan , Tang Xinyue , Yuan Xiaoguang
Published: March 2024

In this study, corrosion behaviours accelerated by neutral salt spray were thoroughly investigated on copper–aluminium composites with 3 wt% concentration NaCl for 72 h under DC and AC current respectively. The similarities and differences of the corrosion mechanism of the copper–aluminium composite under the two kinds of current were analysed by weight loss analysis, scanning electron microscopy, energy-dispersive X-ray spectroscopy and electrochemical detection methods. It can be concluded that there are two opposing influences of the current on the corrosive effects, including acceleration by the impressed current and inhibition by the heating effect. Of these, the inhibition effect on corrosion is more obvious, as the thermal effect of DC current is greater under the same current value. It is worth noting that the directional migration of ions caused by DC current will affect the degree of corrosion and the composition of the corrosion products on the surfaces of both sides of the samples, which is a unique characteristic not seen with AC current.
Rulemakers’ Professional Experience and Rulemaking Efficiency in U.S. Federal Agencies
Authors: Liu Huchen
Published: March 2024

I explore the potential impact of rulemakers’ professional experience on the efficiency of rulemaking by U.S. federal agencies. I highlight two types of professional experience rulemakers may have—inside experience gathered by working in the federal government, if not the same agency, and outside experience gained before entering the civil service or between stints in government. I discuss several plausible mechanisms through which inside and outside experience may affect rulemaking efficiency. Using data combining rulemakers’ career backgrounds with rulemaking life-cycles from 1999 to 2023, I show that outside experience, and not inside experience, is associated with two measures of rulemaking efficiency: a higher likelihood for proposed rules to be promulgated as final and a lower likelihood of unanticipated events—extensions of public comment periods, other delays to the rulemaking timetable, and the withdrawal of rules already issued.
The Influence of Honey and Hydrogel Products Therapy on Healing Time in Diabetic Foot
Authors: Searan Wael Mahmoud , Abdalqader Mohammed A. , Al-Goshae Husmi Ahmed , Nor Hamdan Mohammed , Al-Shubrumi Hamad Saleh , Badahdah Hani
Published: March 2024

Background

Diabetic foot ulcer is a serious and common complication of diabetes that often leads to significant morbidity and even amputation if not properly treated. Current treatment options, such as wound dressing, have limitations in promoting efficient healing. There is a need for effective interventions that can expedite the healing process and enhance the time required for complete healing.

Methodology

This prospective single-blinded randomized control trial studied diabetic mellitus type 2 patients with ulcer in their second-degree feet from February 2019 to February 2023 in the Diabetic Foot Center, King Fahad Specialist Hospital Al Qassim-KSA.

Results

This study involved 120 patients with a mean age of 59.64 ± 10.21. And 63% to 52.5% of them were males and 57% to 47.5% were females. The mean healing time was about 12.76 ± 4.08 days. Cases were divided into 4 equal groups with altered treatment procedures: honey alone, hydrogel alone, honey, and hydrogel combination alternately (3 intervention groups), and fucidin ointment or cream alone (1 control group), with 30 participants in each group. We revealed that the mean healing times for honey alone, hydrogel alone, and honey and hydrogel alternately were 12.20, 13.97, and 10.83 days, respectively. While it was 14.03 days in the control Fucidin ointment or cream [significantly P < .05 ( P = .004)].

Conclusion

From the findings of the present study, we noticed that faster healing time among diabetic foot cases could be accomplished by treatment with a combination of honey and hydrogel alternately. Therefore, this therapy is effective in reducing the risk of diabetic foot ulcers.
RxBERT: Enhancing drug labeling text mining and analysis with AI language modeling
Authors: Wu Leihong , Gray Magnus , Dang Oanh , Xu Joshua , Fang Hong , Tong Weida
Published: March 2024

The US drug labeling document contains essential information on drug efficacy and safety, making it a crucial regulatory resource for Food and Drug Administration (FDA) drug reviewers. Due to its extensive volume and the presence of free-text, conventional text mining analysis have encountered challenges in processing these data. Recent advances in artificial intelligence (AI) for natural language processing (NLP) have provided an unprecedented opportunity to identify key information from drug labeling, thereby enhancing safety reviews and support for regulatory decisions. We developed RxBERT, a Bidirectional Encoder Representations from Transformers (BERT) model pretrained on FDA human prescription drug labeling documents for an enhanced application of drug labeling documents in both research and drug review. RxBERT was derived from BioBERT with further training on human prescription drug labeling documents. RxBERT was demonstrated in several tasks using regulatory datasets, including those involved in the National Institutes of Technology Text Analysis Challenge Dataset (NIST TAC dataset), the FDA Adverse Drug Event Evaluation Dataset (ADE Eval dataset), and the classification of texts from submission packages into labeling sections (US Drug Labeling dataset). For all these tasks, RxBERT reached 86.5 F1-scores in both TAC and ADE Eval classification, respectively, and prediction accuracy of 87% for the US Drug Labeling dataset. Overall, RxBERT was shown to be as competitive or have better performance compared to other NLP approaches such as BERT, BioBERT, etc. In summary, we developed RxBERT, a transformer-based model specific for drug labeling that outperformed the original BERT model. RxBERT has the potential to be used to assist research scientists and FDA reviewers to better process and utilize drug labeling information toward the advancement of drug effectiveness and safety for public health. This proof-of-concept study also demonstrated a potential pathway to customized large language models (LLMs) tailored to the sensitive regulatory documents for internal application.
The Janus face of antipsychotics in glial cells: Focus on glioprotection
Authors: Schmitz Izaviany , da Silva Amanda , Bobermin Larissa Daniele , Gonçalves Carlos-Alberto , Steiner Johann , Quincozes-Santos André
Published: March 2024

Antipsychotics are commonly prescribed to treat several neuropsychiatric disorders, including schizophrenia, mania in bipolar disorder, autism spectrum disorder, delirium, and organic or secondary psychosis, for example, in dementias such as Alzheimer’s disease. There is evidence that typical antipsychotics such as haloperidol are more effective in reducing positive symptoms than negative symptoms and/or cognitive deficits. In contrast, atypical antipsychotic agents have gained popularity over typical antipsychotics, due to fewer extrapyramidal side effects and their theoretical efficacy in controlling both positive and negative symptoms. Although these therapies focus on neuron-based therapeutic schemes, glial cells have been recognized as important regulators of the pathophysiology of neuropsychiatric disorders, as well as targets to improve the efficacy of these drugs. Glial cells (astrocytes, oligodendrocytes, and microglia) are critical for the central nervous system in both physiological and pathological conditions. Astrocytes are the most abundant glial cells and play important roles in brain homeostasis, regulating neurotransmitter systems and gliotransmission, since they express a wide variety of functional receptors for different neurotransmitters. In addition, converging lines of evidence indicate that psychiatric disorders are commonly associated with the triad neuroinflammation, oxidative stress, and excitotoxicity, and that glial cells may contribute to the gliotoxicity process. Conversely, glioprotective molecules attenuate glial damage by generating specific responses that can protect glial cells themselves and/or neurons, resulting in improved central nervous system (CNS) functioning. In this regard, resveratrol is well-recognized as a glioprotective molecule, including in clinical studies of schizophrenia and autism. This review will provide a summary of the dual role of antipsychotics on neurochemical parameters associated with glial functions and will highlight the potential activity of glioprotective molecules to improve the action of antipsychotics.
Prevalence and Associated Clinical Characteristics of Walking-Related Motor, Cognitive, and Fatigability in Progressive Multiple Sclerosis: Baseline Results From the CogEx Study
Authors: Ramari Cintia , D’hooge Mieke , Dalgas Ulrik , Feinstein Anthony , Amato Maria Pia , Brichetto Giampaolo , Chataway Jeremy , Chiaravalloti Nancy D. , Cutter Gary R , DeLuca John , Farrell Rachel , Filippi Massimo , Freeman Jennifer , Inglese Matilde , Meza Cecilia , Motl Robert W. , Rocca Maria A , Sandroff Brian M. , Salter Amber , Kos Daphne , Feys Peter
Published: March 2024

Background:

People with progressive multiple sclerosis (PMS) present motor (eg, walking) and cognitive impairments, and report fatigue. Fatigue encompasses fatigability which is objectively measured by the capacity to sustain a motor or cognitive task.

Objective:

To investigate the prevalence of walking and cognitive fatigability (CF) and the associated clinical characteristics in a large sample of PMS patients.

Methods:

PMS patients (25-65 years old) were included from 11 sites (Europe and North America), having cognitive impairment (1.28 standard deviation below normative data for the symbol digit modality test [SDMT]). Walking fatigability (WF) was assessed using the distance walk index (DWI) and CF using the SDMT (scores from the last 30 seconds compared to the first 30 seconds). Additional measures were: cognitive assessment—Brief International Cognitive Assessment for multiple sclerosis (MS), cardiorespiratory fitness, 6-minute walk, physical activity, depressive symptoms, perceived fatigue—Modified Fatigue Impact Scale (MFIS), MS impact—MSIS-29, and walking ability.

Results:

Of 298 participants, 153 (51%) presented WF (DWI = −28.9 ± 22.1%) and 196 (66%) presented CF (−29.7 ± 15%). Clinical characteristics (EDSS, disease duration, and use of assistive device) were worse in patients with versus without WF. They also presented worse scores on MSIS-29 physical, MFIS total and physical and reduced physical capacity. CF patients scored better in the MSIS-29 physical and MFIS psychosocial, compared to non-CF group. Magnitude of CF and WF were not related.

Conclusions:

Half of the cognitively-impaired PMS population presented WF which was associated with higher disability, physical functions, and fatigue. There was a high prevalence of CF but without strong associations with clinical, cognitive, and physical functions.

Trial Registration Number:

The “CogEx-study,” www.clinicaltrial.gov identifier number: NCT03679468.
Tarsal Coalition: Surgical Management in the Young Athlete
Authors: Masquijo Javier , Turazza Florencia
Published: March 2024

Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.
Differences in outcome between left-sided and right-sided mechanical thrombectomy for acute ischemic stroke: A systematic review and meta-analysis
Authors: Ramzan Abdullah , Ghozy Sherief , Bilgin Cem , Rabinstein Alejandro A. , Kadirvel Ramanathan , Kallmes David F.
Published: March 2024

Background

Mechanical thrombectomy (MT) is a safe and effective treatment option for acute ischemic stroke due to large vessel occlusion. To investigate differences in outcomes between patients receiving left-sided and right-sided MT, we performed a systematic review and meta-analysis.

Methods

A systematic literature review was performed using Embase, PubMed, Scopus, and Web of Science databases. Additional literature was searched for manually. Studies reporting safety and efficacy metrics for MT were included. Data regarding the modified Rankin scale (mRS), thrombolysis in cerebral infarction (TICI), symptomatic intracranial hemorrhage (sICH), and 90-day mortality were included. A random-effects model was used to calculate pooled odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (CIs).

Results

The literature search yielded 13 reports consisting of 19 studies ranging from 98 to 5590 patients. Patients presenting with left-sided stroke had a National Institutes of health stroke scale score 2.89 greater than patients presenting with right-sided stroke (MD = 2.89; 95% CI = 2.09–3.68; P-value < 0.001). There were no differences between left-sided and right-sided MT patients for mRS 0–2 (OR = 0.94; 95% CI = 0.85–1.04; P-value = 0.224), TICI 2b–3 (OR = 1.05; 95% CI = 0.88–1.25; P-value = 0.598), sICH (OR = 0.83; 95% CI = 0.61–1.14; P-value = 0.255), or 90-day mortality (OR = 1.06; 95% CI = 0.84–1.33; P-value = 0.610).

Conclusions

There does not appear to be a difference in outcomes for patients undergoing left-sided or right-sided thrombectomy.
Clinical value of foot thermometry in patients with acute limb ischemia
Authors: Casian Dumitru , Predenciuc Alexandru , Culiuc Vasile
Published: March 2024

Objective

We hypothesized that the severity of foot poikilothermy can be used for better differentiation of grades of acute limb ischemia. Thus, the study aim was evaluation of the value of non-contact foot thermometry, performed using a low-cost infrared medical thermometer, as an adjunct for clinical diagnosis of immediately threatened acute limb ischemia.

Methods

It was a single-center observational prospective study performed over 3 years. Patients with acute limb ischemia of lower limbs grade I–IIB Rutherford treated with urgent revascularization were included. Grade of ischemia was determined independently by two experienced vascular surgeons. Thermometry of the ischemic foot was performed using a medical digital infrared non-contact thermometer (CK-T1501, Cooligg, China) with measuring accuracy of ±0.2°C. Temperature was measured in three points: the dorsal surface of the foot, plantar surface of the foot (both in the metatarsal region), and forehead. The maximal temperature gradient between patient’s forehead and foot (∆Tmax F-F) was calculated. Measurements were repeated 6–12 h after revascularization.

Results

A total of 147 patients were included. Only 3 (2%) patients presented rest pain without sensory loss and motor deficit, while the majority were diagnosed with mild (63/147, 42.8%) or moderate (27/147, 18.3%) motor deficit. The temperature of the ischemic foot varied from 20 to 36.1°C, while median value of the temperature was 26.7 [24.5–29.9] °C on the dorsal surface and 26.8 [24.5–29.6] °C on the plantar surface of the foot ( p = 0.85). Patients with Grade IIB ischemia had significantly lower dorsal foot temperature, plantar foot temperature, and larger ∆Tmax F-F than the patients with grades I–IIA: 25.1 [23.9–26.8] °C versus 29.9 [27.6–30.8] °C; 25.2 [23.8–27.5] °C versus 29.6 [28–31.1] °C; and 11.6 [9.7–12.8] °C versus 7.2 [6–9] °C ( p < 0.0001). Areas under ROC curve for diagnosis of Grade IIB ischemia were similar for dorsal foot temperature (0.82), plantar temperature (0.81), and ∆Tmax F-F (0.82). The best cutoff value by Youden was ≥9.5°C for ∆Tmax F-F, ≤26.8°C for dorsal, and ≤27.7°C for plantar temperature. Criterion ∆Tmax F-F offered the highest specificity of 86% (95%CI 74.2–93.7) and positive predictive value of 89.2% (95%CI 79.5–93.2), while plantar temperature offered sensitivity of 82.5% (95%CI 70.1–91.3) and negative predictive value of 69.1% (95%CI 57.6–83.2). In multivariate analysis including age, gender, and etiology of arterial occlusion, the criterion ∆Tmax F-F of ≥9.5°C was a unique variable significantly associated with risk of amputation (adjusted OR 2.6, 95%CI 1.2–5.9, p = 0.01).

Conclusion

Current study demonstrated that patients with immediately threatening ALI have significantly lower foot temperature than those with viable and marginally threatened limbs. Severe foot poikilothermy at admission is associated with poor outcomes of revascularization, mostly with limb loss.
Health providers’ reasons for participating in abortion care: A scoping review
Authors: Merner Bronwen , Haining Casey M , Willmott Lindy , Savulescu Julian , Keogh Louise A
Published: March 2024

Background:

There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links ‘conscience’ with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion.

Objective:

The study aimed to identify what is known about health providers’ reasons for participating in abortion provision.

Eligibility criteria:

Studies were eligible if they included health providers’ reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion.

Sources of evidence:

We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched.

Methods:

Dual screening was conducted of both title/abstract and full-text articles. Health providers’ reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data.

Results:

From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women’s choices and advocating for women’s rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%).

Conclusion:

Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women’s choices and rights; providing professional health care; and providing services that aligned with the provider’s own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience.