bluuebunny/crossref_metadata_2025 huggingface dataset:
What underlying priority criteria influence which nursing activities get left unfinished? Findings from a national mixed methods study
Authors: Bassi Erika , Jones Terry L. , Chiappinotto Stefania , Tartaglini Daniela , Molin Alberto Dal , Palese Alvisa
Published: October 2024

Background: Priority setting is the act of classifying immediate actions versus what can be delayed until a later time; thus, some activities get left unfinished. Although several factors that increase or minimize the occurrence of unfinished nursing care (UNC) have been documented, the reasons why nurses decide to provide one intervention instead of another are still under-investigated. Expanding the knowledge regarding priority criteria adopted by nurses may help nurse managers provide support to clinical nurses and address and develop their competencies to set priorities, with the ultimate intent to minimize UNC episodes.
Methods: A mixed methods sequential explanatory design according to the Good Reporting of A Mixed Methods Study was conducted. The quantitative phase consisted of a national survey of 15 hospitals, 110 units, and 1,977 nurses invited to fill in the Unfinished Nursing Care Survey (from 1 ‘never unfinished’ to 5 ‘always unfinished’). A subsequent qualitative phase involved focus groups with nurses identified from hospitals with high, medium, and low UNC occurrence, which were revealed in the quantitative phase. A joint technique displayed where qualitative findings were used to explain which UNC patterns were adopted.
Results: A total of 1,400 nurses (70.8%) reported UNC ranging from 1.92 out of 5 (SD = 0.31) to 2.48 (SD = 0.32). Four priority criteria emerged: (1) “addressing biomedical needs”; (2) “physician expectations come first”; (3) “signing for/audited activities”; and (4) “it depends; there are absolute and relative priorities”. Data integration showed a thematic association that confirmed prioritization criteria underlying the pattern of UNC coherent with the elements of care mostly withheld in daily practice by nurses.
Conclusions: Overall, two priority criteria were based on biomedical patient needs and physician-centric workflow expectations: one pertained to organizational expectations and rules, and only one pertained to nursing as a discipline. Nurse managers are in the best position to foster organizational excellence not only by addressing the underlying causes of time scarcity and UNC, but also by creating supportive work environments that empower nurses to prioritize activities linked with the scope of their discipline.
Association between the use of proton pump inhibitors and osteoporosis/fracture: nested case-control studies using a national health screening cohort
Authors: Youk Hyun , Lee Hee Young , Lee Eun Young , Kim Yoon Ji , Park Ji Yeong , Choi Hyo Geun , Kim Hyun Sik , Lee Jung Woo
Published: October 2024

Proton pump inhibitors (PPIs) are widely used to treat acid-related disorders. However, PPI use may be associated with an increased risk of osteoporosis and fractures. Therefore, this study aimed to investigate the association between PPI use and the risk of osteoporosis and fractures using national data. Two nested case-control studies were conducted using nationwide population cohort data. The first study included patients with osteoporosis and controls while the second included patients with fractures and controls. Associations between PPI use and the risk of osteoporosis and fractures were analyzed using propensity score overlap-weighted odds ratios (ORs). The results showed that current PPI use was associated with a higher risk of osteoporosis than non-use (overlap-weighted OR = 37.4, 95% confidence interval: 33.3–42.1, P < 0.001). This association was stronger with a longer duration of PPI use. Similar associations were observed for distal radius, hip, and spinal fractures in the patient group. However, no significant associations were observed between PPI use and fractures in the PPI-treated group. Here, PPI use was associated with a higher risk of osteoporosis and fractures, particularly with a longer duration of use. Therefore, clinicians should consider the potential risks associated with PPIs when prescribing them to patients with acid-related disorders.
Cytochromes b5 Occurrence in Viruses Belonging to the Order Megavirales
Authors: Lamb David Christopher , Goldstone Jared , Belhaouari Djamal Brahim , Andréani Julien , Farooqi Ayesha , Allen Michael , Kelly Steven , Scola Bernard La , Stegeman John
Published: October 2024

Cytochrome b5 is a small electron transport protein that is found in animals, plants, fungi and photosynthetic proteobacteria where it plays key metabolic roles in energy production, lipid and sterol biosynthesis and cytochrome P450 biochemistry. Previously it was shown that a gene encoding a soluble and functional cytochrome b5 protein was encoded in the large double stranded DNA virus OtV2 that infects the unicellular marine green alga Ostreococcus tauri, the smallest free-living eukaryote described to-date. This single gene represented a unique finding in the virosphere. We now report that genes for soluble and membrane-bound cytochromes b5 also occur in giant viruses in the proposed order Megavirales, particularly the AT-rich Mimiviridae and Tupanviruses. Conversely, other members of the Megaviralestaxa such as the GC-rich Pandoraviridae have not been found to encode cytochrome b5 as yet. Megaviruses encoding cytochrome b5 have been isolated from the deep ocean, from freshwater and terrestrial sources, as well as from human patients. Giant virus cytochrome b5 proteins share high sequence identity with one another (45-95% depending on group) but no more than 25% identity with the cytochrome b5 gene product we identified in Acanthamoeba castellanii, an amoeba host for many giant viruses. Thus, the origin of the unique cytochrome b5 genes in giant viruses remainsunknown. Examination of viral cytochrome b5 primary amino acid sequences revealed that some have either a N- or C-terminal transmembrane anchor, whilst others lack a membrane anchor and are thus predicted to be soluble proteins. This cytochrome b5 topography suggests adapted biochemical functions in those viruses. Our findings raise questions regarding the evolution and diversity of cytochrome b5 proteins in nature, adding to questions about the origin of viral haemoproteins in general.
Predictive Model of Sleep Disorders in Pregnant Women Using Machine Learning and SHAP Analysis
Authors: Liu Can , Lin Yuan , Wang Lu , Li Hongyu , Li Ye , Yang Deguang , Wang Chunyan , Yu Zexin , Wang Hao , Du Yunyun , Guan Suzhen
Published: October 2024

Background
Sleep disorders in pregnant women are common and can adversely affect maternal and infant health. We aimed to develop a reliable machine learning (ML) model for early prediction of sleep disorders during pregnancy to inform interventions.
Methods
We analyzed data from 1,681 pregnant women in western China. Logistic regression and LASSO regression were used to identify key predictors of sleep disorders. Eight ML algorithms were compared, with LightGBM selected for its superior predictive performance. SHAP analysis was employed to interpret the model and assess the impact of risk factors.
Results
Seven significant predictors were identified: age, morning sickness, pregnancy intention, pre-pregnancy health, underlying diseases, anxiety, and depression. LightGBM demonstrated the best performance with an AUC of 0.687, accuracy of 0.670, and specificity of 0.764. The SHAP values revealed that these factors are associated with a positive influence on the model's risk score predictions.
Conclusion
Our LightGBM model, with its high accuracy and interpretability, can effectively predict sleep disorders in pregnant women, potentially aiding in the development of targeted interventions to improve maternal and infant health.
Research on dynamic distributed flow shop dynamic scheduling based on LSTM-PPO
Authors: Rao Chuchu , LI Renwang , Lan Yeshen , Chen Junxian
Published: October 2024

Aiming at the Dynamic Distributed Flow Shop Scheduling Problem (DDFSP), a scheduling solution method combining a Long short-term memory (LSTM) network with a Proximal Policy Optimization(PPO) algorithm is proposed. To solve the scheduling confusion caused by many uncertain factors in the scheduling process. By learning and analyzing a large amount of data in the dynamic distributed workshop system, the approximate optimal solution is obtained by integrating the time sequence feature extraction capability of the LSTM network and the optimization efficiency of the PPO algorithm, to realize more intelligent and flexible scheduling decision-making, improve production efficiency and process optimization level, and verified by experiment and simulation. The results show that this method can improve production efficiency and resource utilization, and has the potential for cost control.
Cardiomyocyte-enriched USP20 ameliorates pathological cardiac hypertrophy by targeting STAT3-CARM1 axis
Authors: Yin Deling , Zhong Lingfeng , Dai Shanshan , Yu Fan , Shi Guo-Ping , Gong Qinyan , Zhang Yucong , Duan Jingsi , Lou Zhengyin , Tang Zhixuan , Gong Fuzhe , Chen Derong , Hou Liya , Chen Jinghai , Wang Jian-An
Published: October 2024

Pathological cardiac hypertrophy can lead to heart failure. The molecular mechanisms underlying pathological cardiac hypertrophy remain undefined. This study aimed to examine the role and molecular mechanisms of a deubiquitinating enzyme (DUB), ubiquitin-specific protease 20 (USP20) in cardiac hypertrophy. Hypertrophic hearts were conducted for RNA-sequencing to screen the expression profiles of DUBs. Cardiomyocyte-specific USP20 knockout and overexpression mouse models were generated to explore its function. Co-immunoprecipitation coupled with liquid chromatography-mass spectrometry/mass spectrometry were performed to screen potential USP20 substrates. Cleavage under targets and tagmentation assay with high-throughput sequencing was utilized to identify the potential downstream targets of STAT3. We identified cardiomyocyte-enriched USP20 is downregulated in cardiac hypertrophy. Cardiomyocyte-specific USP20 deficiency exacerbated cardiac hypertrophy induced by Angiotensin II and transverse aortic constriction, whereas cardiomyocyte-specific USP20 overexpression ameliorated the phenotype. We further identified STAT3 is a substrate of USP20 during cardiac hypertrophy through direct binding with DUSP2 domain. Mechanistically, USP20 removes K63 ubiquitin chains from STAT3 at the K177 site via its H645 active site, reducing STAT3 phosphorylation and nuclear translocation. This prevents STAT3 from binding to the coactivator-associated arginine methyltransferase 1 (CARM1) promoter, thereby promoting CARM1 transcription and improving cardiac hypertrophy. Importantly, we discover with STAT3 inhibitor stattic that STAT3 is a key substrate through which USP20 exerts its therapeutic effect on cardiac hypertrophy. These results elucidate a critical role for a novel USP20/STAT3/CARM1 axis in cardiomyocytes and an exciting new avenue study for therapies to treat cardiac hypertrophy.
Hemoptysis in a Complex Case: Unraveling Underlying Factors
Authors: Kang Jianxiong , Zhang Weihao , Wang Mu , Hua Peiyan , Wang Bin
Published: October 2024

Case presentation: A middle-aged female patient underwent right upper and middle lobe lung resection surgery seven years ago and has since experienced intermittent hemoptysis symptoms. Following chest examinations at our hospital, the patient was diagnosed with surgical ligation of the pulmonary artery. Concurrently, the patient has pulmonary aspergillosis, pulmonary tuberculosis, and bronchiectasis. Sequentially, the patient underwent bronchoscopy and percutaneous arterial embolization treatments at our hospital, but there was no improvement. Ultimately, surgical intervention was chosen. The mechanisms by which bronchial arteries, non-bronchial systemic arteries (NBSA), pulmonary aspergillosis, and pulmonary tuberculosis induce hemoptysis, along with strategies to address blood supply to the remaining lung post-pulmonary artery ligation, merit in-depth investigation. Conclusions: We deem this case exceptionally rare and of considerable research value; therefore, we conducted a thorough analysis and report.
Comparative Effectiveness of Bubble versus Ventilator-Derived Nasal Continuous Positive Airway Pressure on the Management of Transient Tachypnoea of the Newborn: A Retrospective Cohort Study in a Tertiary Care Hospital
Authors: TUTAK Ercan , ÇELİK Zeynep TUTAR
Published: October 2024

Background
Transient Tachypnoea of the Newborn (TTN) is a common cause of neonatal respiratory distress, often requiring respiratory support with Continuous Positive Airway Pressure (CPAP). This study compares the effectiveness of Bubble CPAP (BCPAP) and Ventilator-derived CPAP (VCPAP) in reducing NICU admissions in late preterm and term neonates with TTN.
Materials and Methods
This retrospective cohort study analysed 144 neonates born at or beyond 34 weeks' gestation with TTN who received either BCPAP (n = 70) or VCPAP (n = 74) in the delivery room. Outcomes included NICU admissions, length of hospital stay, intubation rates, surfactant use, and complications.
Results
There were no significant differences between the groups in NICU admissions (p > 0.05), hospital stay, intubation rates, or surfactant use. No cases of sepsis, necrotizing enterocolitis, or pneumothorax were observed.
Conclusion
Both BCPAP and VCPAP were equally effective in managing TTN, with no notable difference in clinical outcomes or safety. Further prospective studies are required to validate these findings.
Digital Economy, Logistics Development and the Increase of Farmers’ Income: An Empirical Analysis Based on the Eastern Economic Region of China
Authors: Miao Xiaohong , Li Zhongbin , Ning Manxiu , Xu Anxin , Wu Zhilong
Published: October 2024

In the context of China’s “Rural revitalization via digital commerce”, the study explored the impact of the digital economy on farmers’ income and the path mechanism of logistics development in it. Based on the panel data of 71 cities in the Eastern Economic Region of China from 2013 to 2021, this paper calculated the level of the digital economy and used the level of logistics development as a moderating variable. Then using the basic transmission mechanism and the heterogeneous transmission mechanism to empirically analyse the impact of the digital economy on the income of farmers, exploring the non-linear link between the digital economy and farmers’ income. The analysis showed that: (1) the development of digital economy has a significant positive impact on farmers’ income. (2) the impact of the digital economy on the advancement of logistics development, showed a delayed phenomenon. (3) the digital economy’s indirect effect on farmers’ income growth also showed a lag. In this way, this study verified the practical significance of “Rural revitalization via digital commerce”, and put forward the corresponding recommendations for promoting the development of the digital economy and rural logistics.
Fasting and Diabetes: An Interventional Approach to Enhance Knowledge and Self-Care during Ramadan
Authors: Firdausa Sarah , Syahrizal Dedy , Rachmah Rachmah , Suhanda Rachmad , Zulkarnain Zulkarnain , Adewiah Siti , Munirwan Haris , Meutia Firdalena , Vonna Azizah , Suryawati Suryawati , Zufry Hendra , Ekadamayanti Agustia Sukri , Sucipto Krishna W , Ardiani Deasy , Suryantoro Satriyo Dwi , Maulana Hanapi , Ghufran Ghufran
Published: October 2024

Background. The aim of this study was to assess the impact of educational interventions on the knowledge and self-care practices of diabetes patients who fast during Ramadan. People diagnosed with type 2 diabetes were selected from outpatient clinic at Dr. Zainoel Abidin Hospital. Educational intervention was delivered before and during Ramadan. Disease knowledge and self-care practices were assessed by using Diabetes Knowledge Questionnaire and Diabetes Self-Management Questionnaire. Chi-square test was used to analyse the changes before and after educational intervention.
Results. There were 186 diabetes patients involved in this study with average age of 59.77 ± 9.64 years, body mass index was overweight at 24.78 ± 3.62 kg/m2 and poor HbA1c at 9.21 ± 2.62 %. The DKQ scores spotted a substantial improvement, with a vast majority (92.47%) achieving the good knowledge category compared to the previous percentage of 30.65%. There was also a significant change in DMSQ scores before and after the educational intervention. Pre-intervention, 83.87% of DMSQ scores were optimal self-care practice, while 16.13% were suboptimal. After intervention, it changed significantly, with 94.08% of those characterized as having optimal self-care habits. Three items of DMSQ subscales showed significant changes which were eating behavior (p 0.046), medication taking (p 0.001), and glucose monitoring (p 0.001).
Conclusion. The study suggests that the educational intervention effectively improved both the knowledge and self-care practices of diabetes patients, as evidenced by the significant positive changes in knowledge and self-practice scores. This implies the potential for such interventions to contribute positively to the management and overall well-being of individuals with diabetes.
Evaluating treatment outcome of Glioblastoma with Stupp’s regimen: an experienced in single Institute
Authors: Van Dang Nguyen , Thu Nhung Nguyen Thi , Huy Phan Nguyen , Thi Hang Nguyen , Cam Thanh Do
Published: October 2024

Background
The current conventional treatment approach for newly diagnosed GBM entails the complete removal of the tumor, followed by the implementation of Stupp's procedure. We assessed the results of Stupp's treatment protocol and examined certain prognostic markers associated with survival, which could offer empirical evidence in the treatment of GBM.
Methods
A total of 64 patients diagnosed with newly developed glioblastoma underwent treatment with irradiation and TMZ at VNCH from January 2020 to September 2022. The study provided information on the demographic and clinical features of the patients, as well as their overall survival (OS) and progression-free survival (PFS) outcomes. The analysis of survival and related variables involved the utilization of Kaplan-Meier curves, Cox regression, and the log-rank test.
Results
The retrospective analysis comprised 64 participants. The vast majority patients were in favorable performance status. The median OS and PFS were 24.33 and 9.39 months, respectively. Factors as female patients, GTR/STR, time to start RT within 8 weeks postoperative, no progressive disease after CCRT, no dexamethasone required and Ki67 level below 15% experienced increased OS. RegardingPFS, characteristics such as age < 40 years old, GTR/STR and no disease progression following CCRT were substantially related with improved survival. Nearly half of patients received TMZ 50mg/m2 in combination with Bevacizumab following the initial progressive illness.
Conclusion
Multidisciplinary collaboration, as well as advancements in diagnostic and customized treatment strategies, are critical in the treatment of GBM patients. In actual life, completing the entire Stupp's protocolsignificantly improves GBM survival.
Nutritional composition, mineral profile and phytochemical content of new and established cultivars of chickpea as effected by cropping year
Authors: . Prashansa , Kumar Rajendra , Yadav Neelam
Published: October 2024

The study investigates the proximate composition, non-nutrient phenols, as well as mineral profile of various chickpea cultivars. Eight cultivars, comprising four desi (BG-3062, BG-20211, BG-1053, and K-850) and four kabuli (BG-3022, BG-2024, BG-1103, BG-1108) varieties, were analyzed. The proximate composition of chickpea was assessed by AOAC method and values depicted that all cultivars had appreciable amount of protein. However, there was significant difference in protein (19.13% - 25.36%) between cultivars. The non-nutrient analysis showed total phenolic content (TPC)ranged from 101- 276 mg GAE/100g and total flavonoid content (TFC) from 0.100-0.173 mg/g. Phytate content varied between 579-891.6 mg/100g. Phenol and phytate content were higher in desi cultivars than kabuli. Mineral analysis of chickpea was done by ICP-OES method and result highlighted significant differences in calcium, chromium, and other essential minerals. Newer cultivars BG-20211 had highest iron content as well as good amount of zinc hence can be screened out for this quality. The study also compared nutritional profile of four established cultivars of chickpea over a 10 years (2009 and 2019) cropping interval. There were significant changes in protein and mineral content in established chickpea cultivars in both cropping years; whereas TPC content was in the same order of magnitude. A significant increase in phytate content was reported in the year 2019 in three out of four established cultivars. The findings suggest that these chickpea cultivars possess diverse nutritional properties and has significant impact of climate change. This emphasizes the need of targeted breeding and agricultural practices to enhance chickpea quality.
Diagnostic Accuracy of Combined T2-weighted MR Imaging and H1MR Spectroscopy for Prostate Cancer Detection
Authors: Idrees Ibrahim Nasir
Published: October 2024

Background
The primary objective was to evaluate the diagnostic accuracy of combining T2-weighted MR imaging and H1MR Spectroscopy in detecting prostate cancer, with histopathology serving as the reference standard.
Methods
The study included 125 male patients aged 44–78, who presented with clinical suspicion of prostate cancer (e.g., gland asymmetry, nodule, induration, adhesion, or palpable seminal vesicles). Patients with previous surgeries, hormonal or radiation therapy, or a biopsy within the last 12 weeks were excluded. MR imaging and H1MR Spectroscopy were conducted using a 1.5 Tesla scanner, and histopathology was used as the gold standard.
Results
The mean patient age was 63.17 ± 8.47 years. Of the 125 patients, 54 were true positives, 7 were false positives, 49 were true negatives, and 15 were false negatives. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 78.26%, 87.5%, 88.52%, 76.56%, and 82.4%, respectively.
Conclusion
The combination of T2-weighted MR imaging and H1MR Spectroscopy demonstrates high diagnostic accuracy in detecting prostate cancer. This technique, pending further validation, may serve as a reliable non-invasive diagnostic method in clinical practice.
Establishment of gender related 99th percentile values for cardiac troponin-T among young and middle-aged adult Egyptians
Authors: Tork Ahmed , Labib Mohamed , Rabea Abeer , Ali Abeer
Published: October 2024

Background
Cardiac troponins are the preferred biomarkers for the diagnosis of acute myocardial infarction (AMI). The stable nature of cardiac troponin T (cTnT) in the circulation and the worldwide available single standardized assay make it a more precise biomarker of AMI. The manufacturer’s proposed upper reference limit (URL) for the high sensitive (hs)-cTnT assay does not take into consideration patients’ gender, age or race. The study aimed at establishing and comparing gender-specific upper reference limit for cardiac troponin-T among apparently healthy young adult Egyptians.
Subjects and methods
240 adult Egyptians (120 males and 120 females) participated in this study. Serum cTnT was determined using a commercially available hs-cTnT electrochemiluminescent immunoassay. The gender related 99th percentile values were then calculated to represent the URLs for cTnT according to the CLSI and IFCC approved guidelines.
Results
Serum cTnT was significantly higher in males compared to females (p < 0.001). The 99th percentile URL for cTnT in females (12.58 ng/L) was lower than that of males (19.55 ng/L). Upon dividing them according to an age cutoff value of 36 years, serum cTnT level was significantly lower among those aged < 36 years old (n = 119) compared to those aged 36 years old or more (n = 121) (p < 0.001), with a proposed 99th percentile URL after including outliers of 18.1 ng/L for the former and 16.42 ng/L for the latter, while after excluding outliers the URL was 10.0 ng/L for the former and 12.6 ng/L for the latter. Moreover, a significantly higher serum cTnT value among males compared to females was only noticed in those aged less than 36 years old (p = 0.001).
Conclusion:
An adult patient in early diagnosis of AMI by increasing both assay’s specificity among adult The use of age and gender specific 99th percentile value as an URL of hs-cTnT assay would benefit males (decreasing over-diagnosis) and assay’s sensitivity among adult females (decreasing under-diagnosis).
Incorporation of different particle-size peanut shell powder in wheat flour: effect on the dough and cookie characteristics
Authors: ALKIŞ Ülgen İlknur KONAK , EREM Fundagül
Published: October 2024

Peanuts are the most produced and processed industrial crops worldwide. Therefore, a considerable amount of waste is generated during its processing. In this study, the effect of peanut shells ground to different sizes (212, 500, and 800 µm) on the physical, chemical, techno-functional, and textural properties of cookies was investigated. The hardness of the dough increased and the stickiness and the dough strength decreased as the particle size decreased; however, no significant differences were observed in the textural parameters between the doughs obtained with 500 µm and 800 µm aperture-sized peanut shell powder. The addition of peanut shells to cookies was found to increase the crude fiber content by 85-100-fold, the total phenolic content by 1.5-1.8-fold, and the antioxidant activity by 2-2.4-fold. The incorporation of peanut shell powder in cookies decreased the thickness by 8–15% but increased the spread ratio by 18–33% compared to the control cookies. The hardness and the fracturability of cookies decreased by about 27–47% and 1–5%, respectively, as the particle size of peanut shell powder increased. The results suggest that peanut shells could be a noteworthy source of fiber and phenolic compounds in functional cookie production.
Impact of Lower Limb Muscle Strength and Power Asymmetry on Multidirectional Speed in Female Soccer Players
Authors: Skalski Dariusz , Prończuk Magdalena , Łośinska Kinga , Spieszny Michał , Kostrzewa Maciej , Aschenbrenner Piotr , Maszczyk Adam
Published: October 2024

The aim of the present study was to examine and determine the impact of asymmetry of muscle strength and power between the right and left lower limbs on running speed with changes of direction (multidirectional speed) in female football players. 20 right-footed elite female soccer players from the Ekstraliga participated in the study. Statistical analysis indicates that in running speed with change of direction in the 505 Right and 505 Left tests (group criterion: MVSLJ), players in the group with higher asymmetry (G2) achieved higher change-of-direction running speeds than those in the group with lower asymmetry (G1). A one-way ANOVA of running speeds between groups G1 and G2 (group criterion: PPLP) indicate statistically significant differences in running speed between groups in the Zigzag and 505 Right tests. Players in the group with higher asymmetry (G2) ran faster in the change-of-direction sections of the 505 Right. Based on the results collected during the study on the impact of differences in strength and power between the lower limbs on change-of-direction sprint speed in professional female soccer players, it was observed that players with smaller asymmetry achieved lower change-of-direction running speeds than those with greater asymmetry. Moreover, all observed significant differences in running speed tests between the analyzed groups were significantly correlated with the percentage differences in lower limb power within these groups.
Primary Klebsiella pneumoniae in Lumbar Spine: Case Report and Literature Review
Authors: Liu Wenying , Wang Yafang , Shi Juanhong , Dong Guixia
Published: October 2024

Background:
Klebsiella pneumoniae infections are predominantly observed in respiratory medicine, but their manifestation in the spine is exceedingly rare. Such infections can be easily manifestation as spinal tuberculosis or other similar infections, resulting in non-standardized treatments and an increased risk of adverse drug reactions. This study aims to explore the standardization and safety of early diagnosis and treatment of Klebsiella pneumoniae infections in the spine.
Case presentation:
We report the case of a 38-year-old female who presented with an acute onset of lower back pain. Initially diagnosed with spinal tuberculosis at a local community hospital, she was treated with anti-tuberculosis medications, which failed to alleviate her symptoms. Upon re-evaluation with enhanced MRI and additional laboratory tests, a core needle biopsy (CNB) was performed under local anesthesia, confirming Klebsiella pneumoniae as the causative pathogen. Following appropriate antibiotic treatment, the patient's pain symptoms significantly improved. Follow-up lumbar MRI indicated the complete resolution of vertebral and paravertebral abscesses. During a one-year follow-up period, the patient experienced no further complications and successfully conceived, delivering a healthy male infant.
Conclusions:
This case report highlights the rarity and significance of primary Klebsiella pneumoniae infections in the lumbar spine, emphasizing the need for heightened awareness among clinicians. Despite its infrequency, K. pneumoniae should be considered in differential diagnoses for spinal infections, particularly when tuberculosis is suspected. Early and accurate diagnosis through techniques such as core needle biopsy is crucial for effective management. Our findings suggest that tailored antibiotic therapy, combined with diligent long-term follow-up using MRI, can lead to successful outcomes and minimize the risk of recurrence. Given the challenges posed by potential drug resistance and the complexity of spinal infections, further research is essential to establish standardized treatment protocols and improve patient care in this domain.
A phase 2 randomized, placebo-controlled trial of inulin for the prevention of gut pathogen colonization and infection in the intensive care unit
Authors: Park Heekuk , Lynch Elissa , Tillman Alice , Lewis Kristen , Jin Zhezhen , Uhlemann Anne-Catrin , Abrams Julian A. , Freedberg Daniel E.
Published: October 2024

Objective
Patients admitted to the intensive care unit (ICU) often have gut colonization with pathogenic bacteria and such colonization is associated with increased risk for death and infection. We conducted a trial to determine whether a prebiotic would improve the gut microbiome to decrease gut pathogen colonization and decrease downstream risk for infection among newly admitted medical ICU patients.
Design
Randomized, double-blind, placebo-controlled trial with two prebiotic dose arms.
Setting
Two medical ICUs at a single center.
Patients
Adults who were admitted to the medical ICU for sepsis and were receiving broad-spectrum antibiotics.
Intervention
Participants were randomized 1:1:1 to placebo, inulin 16 grams/day, or inulin 32 grams/day for seven days.
Measurements and main results
The trial primary outcome was a surrogate measure for gut colonization resistance, namely the within-individual change from ICU admission to Day 3 in the relative abundance of short chain fatty acid (SCFA)-producing bacteria based on rectal swabs. Ninety participants were analyzed, including 30 in each study group. There was no difference between study groups in the relative abundance of SCFA-producing bacteria from ICU admission to ICU Day 3 (placebo: 0.0% change, IQR -8·0% to +7·4% vs. combined inulin: 0·0% change, IQR -10·1% to +4·8%; p=0·91). At end-of-treatment on ICU Day 7, inulin did not affect SCFA-producer levels, microbiome diversity, or rates of gut colonization with pathogenic bacteria. After 30 days of clinical follow-up, inulin did not affect rates of death or clinical infection. Patients who died or developed culture-proven infections had lower relative abundance of SCFA-producing bacteria at ICU admission compared to those who did not (p=0.03).
Conclusions
Prebiotic fiber had minimal impact on the gut microbiome in the ICU and did not improve clinical outcomes. Microbiome restitution therapies may face significant challenges in the ICU.
Trial registration: Clinicaltrials.gov: NCT03865706. Registered 10/14/19
Barriers and Enablers for Generative Artificial Intelligence in Clinical Psychology: A Qualitative Study Based on the COM-B and Theoretical Domains Framework (TDF) models.
Authors: Tambo Daniel de la Fuente , Moreno Sara Iglesias , Ruiz Manuel Armayones
Published: October 2024

Background: This study investigated the perceptions of care psychologists regarding the adoption of generative artificial intelligence (GenAI) in therapeutic practice. A qualitative method is used, relying on the Theoretical Domains Framework (TDF) and the COM-B model to analyse both perceived factors such as rejection (barriers) and factors that promote acceptance (facilitators) of GenAI.
Methods: A thematic qualitative study design was adopted, and semistructured and in-depth interviews were conducted with 14 private care psychologists. The interviews focused on TDF domains to identify barriers and enablers. All the interviews were recorded and transcribed. The data were analysed via a thematic approach, with the identified topics associated with the TDF and COM-B components.
Results: Twenty-three factors were identified that influenced the decision to accept or reject GenAI in therapy, with 14 factors acting as barriers and 9 acting as facilitators. These factors are classified within the TDF domains. Highlighted barriers included a lack of understanding of AI and concerns about the confidentiality and privacy of information shared in therapy, whereas the main facilitators were training in AI skills and the possibility of having a digital assistant.
Conclusion: This study reveals the need for greater understanding of training in AI among psychologists. The acceptance of AI varies depending on the training and experience of professionals; some show concern for the future of their profession, whereas others highlight that it is an opportunity to improve interventions. Information privacy concerns are significant and have been identified as key factors for enabling AI deployment.
Secure Mobile Authentication With Blockchain Utilizing Ecc, Zkps, and Post- Quantum Cryptography
Authors: COSKUN Vedat , AJLOUNI Naim , Busra OZDENIZCI
Published: October 2024

The increasing reliance on smartphones for sensitive transactions has underscored the urgent need for robust authentication methods in mobile applications, especially in sectors such as finance and legal services. Traditional authentication mechanisms frequently fail to meet high-security standards due to inadequate integration of advanced biometric credentials. This paper presents a Blockchain-based Triple-Layer Authentication (TLA) system that enhances mobile security by integrating PIN/passwords, one-time passwords (OTPs), and biometric data through advanced cryptographic techniques, including Elliptic Curve Cryptography (ECC), Zero-Knowledge Proofs (ZKPs), and Post-Quantum Cryptography. By employing Distributed Ledger Technology (DLT) for the secure storage of encrypted user credentials, the TLA system not only improves security but also safeguards user privacy. The model addresses the key elements of knowledge, possession, and inherent user traits, significantly strengthening user authentication. A thorough complexity analysis indicates that ECC is optimal for mobile environments due to its low computational overhead, while the shuffling mechanism operates with a complexity of \(\:O\left(n\:log\:n\right)\), making it feasible for mobile devices. Additionally, Non-Interactive Zero-Knowledge Proofs (NIZK’s) and Bulletproofs ensure efficient ZKP processes, and while Post-Quantum ZKPs offer necessary future-proofing against quantum threats, they may require further optimization for practical use on mobile platforms. The implementation of the TLA model demonstrates its effectiveness and reliability in enhancing mobile service security through comprehensive testing and validation in real-world scenarios. This study provides a comparative analysis with existing solutions and identifies avenues for future improvements, establishing the TLA model as a robust and innovative approach to contemporary authentication challenges in the digital landscape.
Molecular Epidemiological Studies of pfmdr-1 Gene in Plasmodium falciparum Among Undergraduates in A Private University in Lagos State
Authors: Ibrahim Azeez G , Bassey Omolola , Adebayo Dorcas , Esther Nwaoha
Published: October 2024

Background
The prevalence of Plasmodium falciparum-resistant parasites remains one of the major challenges to malaria control and eradication in sub-Saharan Africa. Monitoring the molecular markers that confer resistance to various antimalarial drugs is important for tracking the prevalence of resistant parasites and optimizing the therapeutic longevity of current drugs. Morbidity and mortality among students remain quite high despite the availability of malaria management strategies. Therefore, the aim of this study is to determine the prevalence of malaria with its possible risk factors and the presence of pfmdr-1 genes and the drugs in which the mutant allele combinations N86Y, Y184F, S1034C and N1042D are sensitive to among undergraduates in Anchor University.
Method
Dried blood spots (DBS) were collected from 340 students after testing for the presence of Plasmodium falciparum parasites using RDT kits (On-site Rambo Rapid Detection Kit). The spots were subjected to DNA extraction. The extracted product was then amplified using the Nested PCR and the amplicons was runs on the gel to identify the presence and genotype of gene mutations base pairs. The data was analyzed using the SPSS versions 27 Software.
Results
The prevalence of malaria in this study was 20.59%. Female students that participated in the study showed higher percentage of malaria than the male, 75.7% and 24.3% respectively. Malaria was also reported in all age groups but the infection rate was highest in the 16–20 age groups (82.9%). 70.88% of the populations studied don’t make use of mosquito nets, and 28.24% don’t use insecticide. Among the P. falciparum positive patients, it was also observed that those who indulge in self-medication and those who didn’t complete their malaria-drugs dosage, presented a higher percentage of those positive for malaria. 66.67% of the population size uses drug combinations of Arthemether and Lumefantrine.
Conclusion
No mutant allele combinations of the molecular marker of pfmdr1 gene among the participants with P. falciparum was detected in the study.
Impact of the use of cost-effectiveness analysis (CEA) on patient access to innovative medicines for cancer and rare diseases: A comparison of CEA versus non-CEA markets
Authors: Katsikostas-Michopoulos George , Alleman Cathelijne , Azough Ali , Hickson Stacey , Griffin Adrian , Rollmann Danielle , McKendrick Jan
Published: October 2024

Background
Although previous studies have examined approaches to health technology assessment (HTA) and different resulting levels of patient access across individual markets, data focusing on the use of cost-effectiveness analysis (CEA) versus other primary approaches to value assessment (e.g., based on relative clinical effectiveness) were previously lacking in the published literature. This study aimed to identify how the use of CEA impacted national-level patient access decisions for innovative medicines.
Methods
National-level patient access decisions in 10 markets with established systems (CEA: Australia, Canada, England, Scotland, Sweden; non-CEA: France, Germany, Italy, Spain, United States [US]) were assessed for all first indications of oncology and orphan drugs with initial European Medicines Agency regulatory approval between 2016 and 2019, and all subsequent indications approved to December 2021. Corresponding US, Australian, and Canadian approvals for the respective drugs were also included. To ensure consistency across markets, a patient access decision was defined as the first applicable national-level access outcome decision recommending some positive level of patient access (either full access or restricted access) or the final negative recommendation (no access).
Results
The sample included 129 unique drug/indication pairs (70 individual drugs). Overall, 862 patient access decisions were identified. The number of patient access decisions was markedly higher in non-CEA (n = 510) than CEA markets (n = 352). The total number and proportion of full patient access decisions was also higher in non-CEA (n = 335 [65.7%]) than CEA (n = 124, [35.2%]) markets, with restricted patient access decisions more common in CEA (n = 150 [42.6%]) than non-CEA (n = 113 [22.2%]) markets. The types of patient access decisions (i.e., no vs. full vs. restricted vs. no access) also varied across agencies, even within CEA and non-CEA markets.
Conclusions
National-level positive patient access decisions for innovative oncology and orphan medicines were more limited in markets that primarily use CEA in value assessments than in those that do not. Patient access restrictions beyond the regulatory label were also applied more often in CEA than non-CEA markets at the national level, recognizing that additional (and heterogeneous) barriers that impact ultimate patient access may occur downstream of the national decision in some markets.
Synchronous Oral Heterotopic Gastrointestinal Cyst and Oral Squamous Cell Carcinoma: First Case Report
Authors: Silva Caroline Alfaia , Rosa Túlio Silva , Ribeiro Lidiane de Paula , Reinheimer Angélica , Rivero Elena Riet Correa , Modolo Filipe , Gondak Rogério Oliveira , Albuquerque-Júnior Ricardo Luiz Cavalcanti
Published: October 2024

Background.
Synchronous lesions in the oral cavity are uncommon and present diagnostic challenges, particularly when a benign lesion coexists with a malignancy. Heterotopic gastrointestinal cyst of the oral cavity (HGIC), typically seen in pediatric patients, contains ectopic gastrointestinal tissue and is rarely found in adults. This report describes a case of a HGIC in an adult patient concomitant with oral squamous cell carcinoma (OSCC), which is believed to be the first report of this unique entity.
Methods and results.
A 62-year-old man presented with an ulcerated lesion on the right floor of the mouth. An incisional biopsy was performed, and the pathology revealed that it was an HGIC with a pathological cavity lined by tall columnar epithelial cells with basally displaced nuclei and apical microvilli (brush border), synchronous with an SCC exhibiting a proliferation of epidermoid cells with moderate cellular atypia, pleomorphism, and nuclear hyperchromatism. The patient is currently undergoing regular follow-up, with further evaluations planned to monitor local disease control and prevent potential complications.
Conclusion.
Early and accurate identification of coexisting lesions may be crucial for effective clinical management and a broader understanding of the pathogenesis of these conditions.
Transient, Turbulent Hall Currents in the Sunlit Terrestrial Ionosphere
Authors: Ivarsen Magnus , Jin Yaqi , Huyghebaert Devin , Miyashita Yukinaga , St.-Maurice Jean-Pierre , Hussey Glenn , McWilliams Kathryn , Kasahara Satoshi , Sibeck David , Song Kaili , Jayachandran P , Dan Billett , Clausen Lasse , Yokota Shoichiro , Miyoshi Yoshizumi , Kasahara Yoshiya , Shinohara Iku , Matsuoka Ayako
Published: October 2024

The `cusp' emerges from a direct coupling between Earth's ionosphere and the solar wind, and the dynamic auroras found in the cusp-region have long been taken to reflect the time-history of pulsed magnetic reconnection between Earth's magnetic field and that of the Sun. However, the prevailing explanation is challenged by observations of chorus wave-driven energetic particle precipitation on closed magnetic field lines, which excited strong modulations to the ionospheric electric field. Intense Hall current channels formed along the open-closed field-line boundary, triggering the Farley-Buneman instability and the consequent proliferation of intense meter-scale turbulent waves in the bottomside ionosphere. The finding is unearthed using data mining techniques applied to a large database of coherent scatter radar echoes from small-scale ionospheric plasma turbulence. The emerging radar tracking technique allows for the ionospheric electric field to be monitored over time. Further evidence in favour of our explanation is found with ground-based observations of magnetospheric plasma convection and GPS scintillations, as well as in situ observations from a weather satellite and an inner-magnetosphere spacecraft. Our results suggest that during geomagnetic storms the electrodynamics of the cusp-region can at times be driven by wave-particle interactions in the dayside magnetosphere instead of the solar wind.
Trends in the Concurrent Use of Illicit Drugs and Interacting Medications Among Adults in the United States
Authors: Qato Dima Mazen , Ozenberger Katharine
Published: October 2024

Introduction: The concurrent use of illicit drugs and prescription medications with potential drug-drug interactions (DDIs) significantly increases the risk of adverse events, including unintentional overdose. This study investigates trends in the concurrent use of illicit drugs such as cannabis, heroin, cocaine, and methamphetamine (HCM) and interacting prescription medications among U.S. adults from 2013 to 2018.
Methods: Data were collected from the National Health and Nutrition Examination Survey (NHANES) for adults aged 18-59 years (N=10,321). Concurrent use was defined as the use of at least one illicit drug with one interacting prescription medication within the prior 30 days. Micromedex was used to identify medications having a contraindicated, major or moderate drug-drug interaction with illicit drugs.
Result: The prevalence of concurrent use of illicit drugs and prescription medications increased from 5.1% to 9.8% between 2013 and 2018 (P=0.004). The concurrent use of illicit drugs with at least one interacting medication did not significantly change during this period and affected 3.1% of US adults in 2017-2018. Nearly one in five (18.4% [95% CI, 15.6%-21.6%]) adults that use cannabis and one in four (26.6% [95% CI, 19.4%-35.4%]) adults that use HCM used at least one interacting medication. Central nervous system depressants were the most common interacting medication among adults that used cannabis. Antidepressants, proton pump inhibitors, and opioid analgesics were the most common among adults that used HCM.
Discussion and Conclusion: The rising trend in the concurrent use of illicit drugs and interacting medications poses a significant risk for overdose. More than 1 in 30 US adults, aged 18-59 years, concurrently used either cannabis or HCM with an interacting medication is at risk of a unintentional drug overdose. National efforts to improve the safe use of prescriptions among people that use illicit drugs should address potential drug-drug interactions.
Simplified LSL-Net architecture for Unmanned Aerial Vehicles detection in real-time
Authors: Camacho-Gonzalez Francisco David , Garcia-Rojas Nestor Andres , Martínez-Trinidad José Francisco , Carrasco-Ochoa Jesús Ariel
Published: October 2024

In this paper, we propose a simplified architecture based on LSL-Net for detecting unmanned aerial vehicles, this architecture integrates the ability to track and detect them, based on convolutional neural networks. The biggest challenge is the creation of a model that allows us to have good results without the need for large computational resources, in addition to this we must take into account the scarcity of training images for drone detection. To address this problem, we developed simplified LSL-Net architecture using dilated convolutions that allows us to reach our objective. Finally, our proposed architecture integrates the detection and tracking of drones. Experiments show that our architecture performs well with limited resources, achieving an accuracy of 97\% in training and in the detection of new elements.