bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA Methylation, Inflammation, and Neurobehavior in Preterm Infants
Authors: Nist Marliese Dion , Pickler Rita H. , Shoben Abigail B. , Conley Yvette P.
Published: June 2024

Objectives: Inflammation contributes to disparate neurodevelopmental outcomes between preterm and term-born infants. In this context, DNA methylation may contribute to inflammation by affecting gene expression. Brain-derived neurotrophic factor ( BDNF) and nuclear factor-kappa-B-inhibitor alpha ( NFKBIA) are important genes for targeted DNA methylation analysis. The aims of this study were to (1) identify associations between inflammatory factors and BDNF and NFKBIA methylation , and (2) identify associations between BDNF and NFKBIA methylation and early neurobehavior in preterm infants. Methods: In a longitudinal cohort study of preterm infants born 28–31 weeks gestational age, blood samples were collected weekly for the quantification of inflammatory factors. We extracted DNA from saliva samples and quantified methylation of six BDNF cytosine-phosphate-guanine (CpG) sites and five NFKBIA CpG sites. Neurobehavior was assessed using the Neurobehavioral Assessment of the Preterm Infant. Results: Sixty-five infants were included in the analysis. In females, inflammatory factors were positively associated with BDNF methylation of most CpG sites. Interleukin-1 receptor antagonist was negatively associated with NFKBIA methylation at two CpG sites. In males, interleukin-6 was negatively associated with BDNF and NFKBIA methylation at most CpG sites. In females, BDNF methylation at two sites was inversely associated with motor performance. In males, NFKBIA methylation at one site was inversely associated with motor performance. Conclusion: This study provides evidence for the relationship between inflammation and neurobehavior in preterm infants, working mechanistically through DNA methylation. The finding of a difference between males and females suggests that female infants are potentially more vulnerable to inflammation and warrants future study.
Failure analysis and numerical simulation of the regulating valve with particle erosion and cavitation erosion in the black-water treatment system
Authors: Cui Bochao , Chen Ping , Liu Boshen , Zhao Yuanqi , Zheng Jiaqi
Published: June 2024

The black-water regulating valve is very easy to be damaged due to the erosion of the key components, such as valve spool and valve seat. This work presents the failure analysis of the spool and seat of regulating valve in the black-water treatment system. Scanning electron microscopy and X-ray energy-dispersive spectrometer were used to detect the morphology and chemical compositions of failure valve samples. The computational fluid dynamics method was also adopted to simulate the medium flow characteristics in black-water regulating valve. The results show that most erosion areas of the valve occur at the spool-seat throttle zone. The erosion profile is mainly manifested in plastic deformation pits, cutting abrasions, furrows, pinhole pits and impact pits. The particles and cavitation bubbles move toward the throttle zone driven by black-water medium, causing particles impact and bubbles collapse. The particle flow velocity in the throttle zone of the valve is between 50 and 175 m/s, while the maximum velocity can reach 175 m/s. The valve suffered severe particle erosion and cavitation erosion under the particle impact and bubble collapse, finally resulting in its failure.
Student-teachers’ professional agency development through ADDIE model of CALL teacher preparation
Authors: Meihami Hussein , Malmir Ali
Published: June 2024

Developing teachers’ professional agency through standard models of instructional designs is critical in helping them deal with the barriers in designing and implementing online learning environments. Therefore, the purpose of this study was to explore the role of an ADDIE (Analysis–Design–Development–Implementation–Evaluation) model of the computer-assisted language learning (CALL) teacher preparation program (TPP) in developing TEFL (teaching English as a foreign language) student-teachers’ professional agency (PA). We conducted an instrumental (exploratory) case study to explore the PA development of 18 TEFL student-teachers who took a CALL course that was designed based on ADDIE. The deductive thematic analysis of student-teachers’ autobiographical narratives, unstructured interviews, and course projects showed that each stage of ADDIE contributed to developing the dimensions of the PA. We concluded that the constructive role of the ADDIE model of CALL TPP in developing TEFL student-teachers’ PA might be due to ADDIE’s capability to construct a context for developing student-teachers’ dynamic capacity to tackle educational concerns and provide a context of playing different professional roles. The study bears implications for TEFL teacher educators to consider the action-based nature of PA when the ADDIE model is implemented.
Getting puzzled about puzzling: Doing my first exploratory practice on self-directed English language learning
Authors: Uştuk Özgehan
Published: June 2024

The Covid-19 pandemic required a transformation into innovative classroom pedagogies that expected language learners to become more active and shoulder more responsibilities than before. In this article, I report on my first experience of doing exploratory practice to examine online flipped classrooms used to develop English as a foreign language (EFL) students’ self-directed learning. In a classroom-based mixed-methods study, I examined and puzzled over classroom practices that may promote learners’ self-directed readiness in the context of a university-level writing class. The results indicated a significant increase in my students’ desire for learning and self-control. They also showed that learners need technical assistance and psychological support to increase their self-directed learning skills and become more self-directed and autonomous language learners. The article concludes with a critical reflection on my first exploratory practice endeavor and what the whole process of puzzling about my classroom activities has brought to my teaching practice.
Thinking with space invaders: ‘Freed slaves’, ‘asylum seekers’ and social wastelands
Authors: O’Connell Davidson Julia
Published: June 2024

This article uses Puwar’s concept of ‘space invaders’ as a lens to explore historical responses to people freed from slavery, and contemporary responses to people seeking asylum in the United Kingdom. This lens highlights the fact that in both cases, intense and violent fear was sparked by the idea of bodies that have come to be associated with particular spaces (the social space of slavery, the geographical space of the Global South) moving into spaces marked as belonging to others (propertied white men, ‘British people’). The article argues that this allows us to explain commonalities between two sets of discourses and practices adopted both in relation to emancipated people historically, and asylum seekers today. The first involves efforts to rid the body politic of ‘space invaders’ by physically transporting unwanted bodies elsewhere. The second set of practices, adopted in relation to those who cannot be physically removed, entails the creation of legal, social and spatial ‘no man’s lands’ or ‘wastelands’ that make it possible to hold these bodies simultaneously in and apart from society.
Reasoning More Efficiently with Primary Knowledge Despite Extraneous Cognitive Load
Authors: Lespiau Florence , Tricot André
Published: June 2024

Geary's evolutionary approach in educational psychology differentiates between primary (low cognitive costs and motivational advantage) and secondary knowledge (high cognitive costs and no motivational benefit). Although these features have been well demonstrated in previous work, the underlying mechanisms remain unclear. To investigate it, in a reasoning task, the present study varies (i) the content of the problems (primary knowledge vs. secondary; e.g., food vs. grammar rules), (ii) the intrinsic cognitive load (conflict or non-conflict syllogism, the former requiring more cognitive resources to be properly processed than the latter) and (iii) the extraneous cognitive load (via a Dot Memory Task with three modalities: low, medium and high cognitive load). Analyses assessed the influence of these variables on performance, problem solving speed and perceived cognitive load. Results confirmed the positive impact of primary knowledge on efficiency, particularly when intrinsic cognitive load was high. Surprisingly, the extraneous cognitive load did not influence the performance in secondary knowledge content but that in primary knowledge content: the higher the additional load was, the better the performance was, only for primary knowledge and especially for syllogisms with high intrinsic load. Findings support evolutionary theory as secondary knowledge would overload cognitive resources, preventing participants from allocating sufficient resources to solve problems. Primary knowledge would allow participants to process the additional load and to increase their performance despite this. This study also raises the hypothesis that a minimum cognitive load is necessary for participants to be invested in the task.
Interplay between representations, practices, and stigma variables towards people with intellectual disabilities among healthcare professionals: A cross-sectional study
Authors: LUCASSEN Laurie , RINALDI Romina , BATSELE Elise
Published: June 2024

Disparities in healthcare are observed among people with intellectual disabilities. They generally face stigmatisation and negative attitudes from healthcare professionals. The aim of this study is to investigate the link of diagnostic label and social distance on inclusive health representations and practices towards people with intellectual disabilities among healthcare professionals. We conducted an online survey of 163 healthcare professionals living in French-speaking Belgium. The results highlighted that the diagnostic label and a lower social distance predict better representations and practices in inclusive health. In addition, an analysis of mediation showed the mediating effect of social distance on the link between being in contact with people with intellectual disabilities (through employment) and better representations and practices in inclusive health. This study enabled us to assess the interplay between stigma variables and healthcare professionals’ representations and practices towards people with intellectual disabilities and to identify potential facilitators for promoting health equity.
Youth justice and social harm: Towards a ‘theory of the good’
Authors: Gray Patricia , Smith Roger
Published: June 2024

This article seeks to develop a distinctive conceptual framework for the purpose of (re)imagining progressive youth justice. We begin by utilising zemiological insights to relate the widely recognised impacts of neoliberalism to the social harms associated with the youth justice system. Then, drawing on a classification of children’s needs, informed by a ‘theory of the good’, and interrogating the idea of ‘utopia as method’, we move on to set out the guiding principles (‘archaeology’) and operational drivers (‘architecture’) which we believe provide an effective basis for the development of progressive forms of youth justice. We also acknowledge the value of several ‘noble attempts’ which go some way to achieving these objectives, despite limitations and systemic constraints.
Retrospective service evaluation of a specialist weaning unit
Authors: Finnerty John , Gill Sonya E , Alcock Emily , Johnson Eleanor , Flowers Emma , Price Jemma , Bentley Andrew , Felton Tim
Published: June 2024

Specialist weaning units (SWUs) aim to liberate patients with complex weaning failure from mechanical ventilation and facilitate their discharge from the ICU. This retrospective service evaluation reports the outcomes of a SWU at Wythenshawe Hospital, Manchester between 2017 and 2019. In total, 75.0% ( n = 33/44) of patients survived to hospital discharge. Of these patients, 72.7% ( n = 24/33) were self-ventilating. Overall, 1-year survival was 68.2% ( n = 30/44), whilst 5-year survival was 52.3% ( n = 23/44). Whilst this study is relatively small, these findings are encouraging and further support the case for SWUs.
Efficacy and NSAID-sparing effect of secukinumab 150 mg in ankylosing spondylitis: results from phase IV ASTRUM study
Authors: Kiltz Uta , Baraliakos Xenofon , Brandt-Jürgens Jan , Wagner Ulf , Lieb Sebastian , Sieder Christian , Mann Christian , Braun Jürgen
Published: June 2024

Background:

Radiographic axial spondyloarthritis (r-axSpA), formerly known as ankylosing spondylitis (AS), is a chronic, inflammatory rheumatic disease associated with symptoms such as inflammatory back pain, morning stiffness, and arthritis. First-line recommendations for patients with AS include treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) for reducing pain and stiffness.

Objectives:

The objective of our study is to evaluate the efficacy and short-term NSAID-sparing effect of secukinumab in patients with AS currently treated with NSAIDs.

Design:

We assessed the clinical Assessment of SpondyloArthritis International Society (ASAS20) response to secukinumab and evaluated the extent to which the use of concomitant NSAID can be reduced between weeks 4 and 12 in r-axSpA patients treated with secukinumab 150 mg compared with placebo.

Methods:

ASTRUM was a prospective 24-week randomized controlled trial of adult patients with active r-axSpA [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ⩾4] who had a documented inadequate response to ⩾2 NSAIDs. Patients were randomized (1:1:1) to initiate treatment with subcutaneous secukinumab 150 mg from either week 0 (group 1), week 4 (group 2), or week 16 (group 3). From week 4 onward, tapering of NSAIDs was allowed in all groups.

Results:

This study included 211 patients ( n = 71, 70, and 70 in groups 1, 2, and 3, respectively). ASAS20 response at week 12 for pooled groups 1 and 2 versus group 3 was 51.1% versus 44.3% ( p = 0.35). A higher proportion of patients in groups 1 and 2 achieved ASAS40 and BASDAI50 and showed improvements in other secondary clinical outcomes as compared to group 3 at week 16. More patients in groups 1 and 2 versus group 3 stopped their NSAID intake from baseline through week 16.

Conclusion:

Treatment with secukinumab improved clinical outcomes and showed a short-term NSAID-sparing effect in patients with r-axSpA, even though the primary endpoint was not met.

Trial registration:

ClinicalTrials.gov; NCT02763046, EudraCT 2015-004575-74.
Postprandial Glucose Control With Different Hybrid Closed-Loop Systems According to Type of Meal in Adults With Type 1 Diabetes
Authors: Scidà Giuseppe , Corrado Alessandra , Abuqwider Jumana , Lupoli Roberta , Rainone Carmen , Della Pepa Giuseppe , Masulli Maria , Annuzzi Giovanni , Bozzetto Lutgarda
Published: June 2024

Background:

Hybrid Closed-Loop Systems (HCLs) may not perform optimally on postprandial glucose control. We evaluated how first-generation and advanced HCLs manage meals varying in carbohydrates, fat, and protein.

Method:

According to a cross-sectional design, seven-day food records and HCLs reports from 120 adults with type 1 diabetes (MiniMed670G: n = 40, MiniMed780G: n = 49, Control-IQ [C-IQ]: n = 31) were analyzed. Breakfasts (n = 570), lunches (n = 658), and dinners (n = 619) were divided according to the median of their carbohydrate (g)/fat (g) plus protein (g) ratio (C/FP). After breakfast (4-hour), lunch (6-hour), and dinner (6-hour), continuous glucose monitoring (CGM) metrics and early and late glucose incremental area under the curves (iAUCs) and delivered insulin doses were evaluated. The association of C/FP and HCLs with postprandial glucose and insulin patterns was analyzed by univariate analysis of variance (ANOVA) with a two-factor design.

Results:

Postprandial glucose time-in-range 70 to 180 mg/dL was optimal after breakfast (78.3 ± 26.9%), lunch (72.7 ± 26.1%), and dinner (70.8 ± 27.3%), with no significant differences between HCLs. Independent of C/FP, late glucose-iAUC after lunch was significantly lower in C-IQ users than 670G and 780G ( P < .05), with no significant differences at breakfast and dinner. Postprandial insulin pattern (Ins3-6h minus Ins0-3h) differed by type of HCLs at lunch ( P = .026) and dinner ( P < .001), being the early insulin dose (Ins0-3h) higher than the late dose (Ins3-6h) in 670G and 780G users with an opposite pattern in C-IQ users.

Conclusions:

Independent of different proportions of dietary carbohydrates, fat, and protein, postprandial glucose response was similar in users of different HCLs, although obtained through different automatic insulin delivery patterns.
Genitourinary syndrome of menopause: Evaluation of symptoms, using a questionnaire, in a research setting, before and after treatment
Authors: Briggs Paula , Karavadra Babu , Wyatt James , Lane Steven , Hapangama Dharani K
Published: June 2024

Background

Genitourinary syndrome of menopause (GSM) is a common condition, yet there is no defined, objective, and reproducible intervention with which to make a diagnosis. There are many different treatment options available, but without the correct diagnosis, affected women are unable to access the right therapy. This paper reports on the questionnaire arm of the VAN study (VAginal Health – What’s Normal?) which aimed to evaluate the performance and acceptability of the methods of assessment of GSM, described below.

Objectives

To determine the value of the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women, in a prospective, observational, feasibility study.

Methods

60 women were recruited to the study (20 premenopausal, asymptomatic women (control group) and 40 peri- and postmenopausal, symptomatic women). All women had a baseline assessment, using three different interventions, in addition to the DIVA questionnaire and symptomatic women were offered treatment, followed by a second assessment undertaken at 16 weeks, using the same interventions. This paper focusses on the outcomes for the questionnaire and specifically on the paired data sets, before and after treatment.

Results

An improvement in the score for all four sections of DIVA (Activities of daily living, Emotions, Sexual Activity, and Feelings about yourself and your body (female embodiment)) was observed, following any treatment. Additional questions were added to DIVA, to assess patient preference in relation to the different diagnostic interventions. These included a speculum examination as part of the clinical assessment, a smear taken from the lateral vaginal wall to assess the vaginal maturation index, both undertaken by a clinician and a self-administered tampon to collect vaginal secretions, to determine the small molecule metabolite profile, using NMR spectroscopy, and to enable analysis of the vaginal microbiome. The medical standard tampon was the preferred intervention, before and after treatment, for women eligible for treatment.

Conclusion

The VAN study demonstrates that DIVA, a previously tested questionnaire, is an easily accessible intervention, to assess the impact of urogenital symptoms on quality-of-life indicators in women in the United Kingdom with GSM and that women prefer to use a tampon themselves, rather than have a clinician performed vaginal speculum examination or a vaginal smear.
Usability of an eHealth sleep education intervention for university students
Authors: Rosenberg Lindsay , Rigney Gabrielle , Jemcov Anastasija , van Voorst Derek , Corkum Penny
Published: June 2024

Background

It has been estimated that more than one-third of university students suffer from insomnia. Few accessible eHealth sleep education programmes exist for university students and of the ones that do exist, fewer were developed using a user-centred approach, which allows for student input to be systematically collected and utilized to provide students with a programme that they consider to be easy to use and implement and to be effective. Better Nights, Better Days-Youth ( BNBD-Youth) is a four-session eHealth sleep education programme designed for youth but previously only evaluated in younger adolescents (ages 14–18 years).

Aims

The purpose of this study is to evaluate the usability of the BNBD-Youth programme with university students using Morville's User Experience Honeycomb framework to determine if this programme would meet the needs of university students and if so what modifications would be needed.

Methods

Canadian undergraduate students ( n = 46) completed the BNBD-Youth programme. Students completed online usability questionnaires based on the seven dimensions of Morville's User Experience Honeycomb (i.e. useful, usable, valuable, credible, desirable, accessible and findable) after each session and after completion of the programme. Open- and closed-ended questions were used to obtain both quantitative and qualitative responses.

Results

Average quantitative ratings were positive across user experience dimensions, ranging from 3.43 to 4.46 (out of 5). Qualitative responses indicated overall positive experiences with the programme. The only constructive feedback that met the criteria for revising the programme was to include more interactive features in Session 4.

Conclusions

This study demonstrates that university students found BNBD-Youth to be a usable programme for older youth. Demonstrating usability is an essential step in developing a programme with a user-centred design that university students will want to use in the future. Once the BNBD-Youth programme is revised to create the BNBD-University ( BNBD-Uni) programme, additional usability and effectiveness testing will be conducted.
Effects of Practice Ownership and Integration of Health Services on Adherence to Diabetes Guidelines
Authors: Kostrubsky Nick , Harman Jeffrey S.
Published: June 2024

Objective:

There has been a trend toward hospital systems and insurers acquiring privately owned physician practices and subsequently converting them into vertically integrated practices. The purpose of this study is to observe whether this change in ownership of a medical practice influences adherence to clinical guidelines for the management of type 1 and type 2 diabetes.

Methods:

This is an observational study using pooled cross-sectional data (2014-2016 and 2018-2019) from the National Ambulatory Medical Care Survey, a nationally representative probability sample of US office-based physician visits. A total of 7499 chronic routine follow ups and preventative care visits to non-integrated (solo and group physician practices) and integrated practices were analyzed to see whether guideline concordant care was provided. Measures included 7 services that are recommended annually for individuals with type 1 and type 2 diabetes (HbA1c, lipid panel, serum creatinine, depression screening, influenza immunization, foot examination, and BMI).

Results:

Compared to non-integrated physician practices, vertically integrated practices had higher rates of hemoglobin A1C testing (odds ratio 1.58 [95% CI 1.07-2.33], P < .05), serum creatine testing (odds ratio 1.53 [95% CI 1.02-2.29], P < .05), foot examinations (odds ratio 2.03 [95% CI 0.98-4.22], P = .058), and BMI measuring (odds ratio 1.54 [95% CI 0.99-2.39], P = .054). There was no significant difference in lipid panel testing, depression screenings, or influenza immunizations.

Conclusions:

Our results show that integrated medical practices have a higher adherence to diabetes practice guidelines than non-integrated practices. However, rates of services provided regardless of ownership were low.
Perspectives of Hispanic Mothers on Social Support From Key Transition Stakeholders
Authors: Hawk Yeager Kristopher , Choiseul-Praslin Belkis , Deardorff Malarie E. , Argus-Calvo Beverley , Ordoñez Estefania
Published: June 2024

Parent involvement is foundational to the development of Individualized Education Programs (IEPs) for students with disabilities, including the transition component of the IEP. However, many culturally and linguistically diverse parents, including Hispanic mothers, report barriers to their participation in school-based transition planning, contributing to a sense of stress and alienation. We conducted semi-structured interviews with Hispanic mothers of high school students with disabilities ( n = 10) to better understand the way they receive or do not receive support from others involved in the transition. Our qualitative analysis resulted in six themes related to two main types of social support, action-facilitating and nurturant, which participants received from in-school professionals, out-of-school professionals, and family and friends. Findings suggest that participants received different forms of social support from key transition stakeholders, with professionals, most notably, providing limited nurturant support. We provide recommendations for transition teams to provide Hispanic mothers additional support via culturally responsive and empowering practices.
Consumer Ethnocentrism Research over Three Decades: A Bibliometric Analysis and Future Directions
Authors: Chahal Seema , Narwal Mahabir , Rozera Prinkle
Published: June 2024

Consumer ethnocentrism, a pivotal aspect influencing international marketing and consumer behaviour, has garnered considerable scholarly attention. However, a comprehensive understanding of its evolution and dynamics remains elusive. To address this gap and provide insights into the evolving landscape of consumer ethnocentrism research, this study conducts a robust bibliometric analysis spanning from 1989 to 2023. Focusing on the post-1989 period, when consumer ethnocentrism research gained momentum, the analysis aims to identify influential sources, journals and authors, analyse the conceptual structure and collaborative networks and trace the research’s evolution. The findings reveal a pronounced growth trajectory in research output, driven by collaborative efforts and interdisciplinary engagement. Developed nations such as the United States, Australia and the United Kingdom emerge as major contributors, while emerging themes like sustainability and perception gain prominence, reflecting evolving consumer attitudes and societal concerns. Thematic evolution analysis unveils shifting research priorities and emerging trends, highlighting the dynamic nature of consumer ethnocentrism research and its implications for global marketing strategies. Academia can leverage these insights to shape research agendas and pedagogical approaches, while the industry can refine market segmentation strategies and culturally sensitive marketing approaches. Future research avenues include exploring the impact of social media and advertising on consumer ethnocentrism and addressing emerging sustainability concerns, offering valuable guidance for scholars, policymakers and industry practitioners in shaping future research directions and strategic decision-making.
Optimizing Socket-Tunnel Position for Meniscal Allograft Transplantation Combined With ACL Reconstruction: A 3D Model Analysis
Authors: DeFroda Steven , Bourbon de Albuquerque João , Bezold Will , Cook Cristi R. , Nuelle Clayton W. , Stannard James P. , Cook James L.
Published: June 2024

Background:

Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure.

Purpose/Hypothesis:

The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles.

Study Design:

Descriptive laboratory study.

Methods:

A total of 27 artificial right tibias (3 per subgroup) were allocated to 9 experimental groups based on the inclination of the socket tunnels (55°, 60°, and 65°) created for simulating medial and lateral MAT and ACLR. Five standardized socket tunnels were created for each tibia using arthroscopic guides: one for the ACL tibial insertion and one for each meniscus root insertion. CT scans were performed for all specimens and sequentially processed using computer software to produce 3D models for quantitative assessment of socket-tunnel overlap risk. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests.

Results:

No subgroup consistently presented significantly safer distances than other subgroups for all distances measured. Three cases (11%) and 24 cases (~90%) of tunnel overlap occurred between the ACL tunnel and tunnels for medial and lateral MAT, respectively. Most socket-tunnel overlap (25 of 27; 92.6%) occurred between sockets at depths ranging between 6.3 and 10 mm from the articular surface. For ACLR and posterior root of the lateral meniscus setting, the guide set at 65° increased socket-tunnel distances.

Conclusion:

When combined ACLR and MAT using socket tunnels for graft fixation is performed, the highest risk for tibial socket-tunnel overlap involves the ACLR tibial socket and the lateral meniscus anterior root socket at a depth of 6 to 10 mm from the tibial articular surface.

Clinical Relevance:

Setting tibial guides at 65° to the tibial articular surface with the tunnel entry point anteromedial and socket aperture location within the designated anatomic “footprint” will minimize the risk for socket-tunnel overlap.
Use of High-Flow Nasal Cannulas in Saudi’s Neonatal Level III Intensive Care Units: A Nationwide Questionnaire Study
Authors: Algarni Saleh S. , Alshammari Khalid , Alkhalifah Meshal , Almutairi Waleed , Aljaidi Abdulrahman , Alruwaili Arwa , Alqarni Abdulkarim S , Alotaibi Tareq F , Alqahtani Mohammed M , Aljohani Hassan , Ismaeil Taha T , Alanazi Abdullah M M , Alghamdi Abdulrhman S , Alanazi Khaled , Alwadeai Khalid S , Siraj Rayan , Alanazi Turki M , Almudeer Ali , Ali Kamal , Alsaif Saif
Published: June 2024

Objective. To describe heated humidified high-flow nasal cannulas (HHHFNC) utilization in level III neonatal intensive care units (NICUs) in Saudi Arabia. Methods. A prospective cross-sectional study using an electronic web-based questionnaire. The survey targeted level III NICUs hospitals using HHHFNCs, covering HHHFNC availability, protocols, patient characteristics, and indications. It also collected opinions on the benefits of HHHFNCs compared to nasal continuous positive airway pressure (nCPAP). Results. Out of 47 government-level III neonatal intensive care units, 35 (74%) responded to the survey. Among the included units, 46% had guidelines for HHHFNC use. Additionally, 51% reported using HHHFNC in infants of all gestational ages. The primary indication for HHHFNC use was weaning off nCPAP (34%), with 60% of the respondents noting its advantages for kangaroo care and breastfeeding. Conclusion. HHHFNC are increasingly prevalent in NICUs in Saudi Arabia. However, there remain no clear policies or guidelines regarding their use in preterm infants.
Regional Variation in Entrepreneurial Attitude and Entrepreneurial Ecosystem
Authors: Paray Zahoor Ahmad , Dwivedi Amit Kumar , Sharma Anuja
Published: June 2024

The existing research demonstrates the presence of disparities in both individuals’ entrepreneurial attitudes (EAs) and the ecosystems within regions of different countries. However, most of these studies are based in Europe and the developed countries. Moreover, most of these studies use global entrepreneurship monitor (GEM) data to understand such differences. The current study collects data from five different Indian regions to understand the regional variations in an economically, culturally and geographically diverse country. Based on 11 different variables derived from the GEM questionnaire and other studies the current study wants to verify ‘perception differences for entrepreneurial attitude and entrepreneurial ecosystem in India’. One-way analysis of variance was used to verify possible mean differences among different regions of Jammu, Kashmir, Gujarat, Punjab and Karnataka. The study uses 407 student samples from various higher learning institutions in these regions. Results suggest that EA and entrepreneurial ecosystem (EE) significantly differ in the country’s northern, southern and western regions. This study brings into notice significant policy gaps and developments that affect the EE and the attitudes of the regional population. The research can be extended with newer regions and more extensive datasets to understand this phenomenon more clearly in the context of emerging and developing countries.
Medial-Sided Repair in Multi-Ligamentous Knee Injury
Authors: Patel Rohan R. , Green Joshua S. , Moran Jay , Santos Estevao , Medvecky Michael J.
Published: June 2024

Background:

Injuries to the medial structures of the knee are common in multi-ligamentous knee injuries (MLKIs), which account for 0.02% of orthopedic injuries each year. The most common medial structure involved is the superficial medial collateral ligament (sMCL) with possible additional injury to the posterior oblique ligament (POL) and deep medial collateral ligament (dMCL). There has been little evidence for the superior management of these structures regarding the use of repair or reconstruction to reproduce overall knee function. Although reconstruction may provide more valgus stability postoperatively, the use of sMCL repair over reconstruction may be superior at reestablishing native anatomic alignment and kinematic relationships of the knee while also preserving proprioception and providing similar valgus stability.

Indications:

Surgical repair of medial structures is typically indicated for third-degree injuries, bony avulsions, tibial plateau fracture, intra-articular entrapment of the end of the ligament (Stener-type lesions), or anteromedial stability. They are particularly indicated in the elite athlete who presents with excessive valgus laxity due to valgus knee loading, external rotation, or combined force vectors.

Technique Description:

This surgical technique video demonstrates an open, medial-sided femoral and tibial approach to repair proximal and distal medial knee structures in the setting of MLKIs using case examples of a Stener lesion and a combined sMCL, POL, and medial patellofemoral ligament tears.

Results:

Repair of sMCL injuries has been reported to show favorable healing, knee stability, and function.

Discussion/Conclusion:

The use of fixation of the sMCL to its anatomical attachment points offers similar valgus stability and improved functional and patient-reported outcomes when compared with sMCL reconstruction.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Fostamatinib effectiveness and safety for immune thrombocytopenia in clinical practice
Authors: González-López Tomás José , Bermejo-Vega Nuria , Cardesa-Cabrera Rocío , Martínez-Robles Violeta , Aguilar-Monserrate Gerardo , Pérez-Segura Gloria , Domingo Abel , Luis-Navarro Josefa , Lakhwani Sunil , Acedo Natalia , Lozano María Luisa , Bernat Silvia , Torres-Tienza Ana , Ruano Ana , Jarque Isidro , Galán Pilar , Benet Carmen , Marcellini Shally , Jimenez-Bárcenas Reyes , Martínez-Carballeira Daniel , De Miguel-Llorente Dunia , Perona-Blázquez Alvaro , Gonzalez-Gascón Isabel , Lopez-Ansoar Elsa , Alonso-Alonso José María , Bengochea-Casado María Luisa , Díaz-Gálvez Francisco Javier , Moretó Ana , Moreno-Jiménez Gemma , Hernández-Martin Roberto , de Cabo Erik , Dávila-Valls Julio , Cuesta Amalia , Pastoriza Carmen , Hermida-Fernández Gerardo Julio , García Covadonga , Pozas-Mañas Miguel Angel , Aguilar Carlos , Fernandez-Jimenez Dolores , Navas-Elorza Begoña , López-Santamaría Castro Carolina , Lorenzo Alvaro , Ortín Xavier , García Marta , Piernas Sonia , Díaz-Santa Johana , Soto Inmaculada , Provan Drew , García-Donas Gabaldón Gloria
Published: June 2024

Fostamatinib, a recently approved Syk inhibitor used in adult primary immune thrombocytopenia (ITP), has been shown to be safe and effective in this disorder. However, clinical trial results may not be similarly reproduced in clinical practice. Here, 138 patients with ITP (both primary and secondary) from 42 Spanish centers who had been treated with fostamatinib were evaluated prospectively and retrospectively. The median age of our cohort (55.8% women) was 66 years (interquartile range [IQR], 56-80). The median time since ITP diagnosis at fostamatinib initiation was 51 months (IQR, 10-166). The median number of therapies before fostamatinib initiation was 4 (IQR, 2-5), including eltrombopag (76.1%), romiplostim (57.2%), and IV immunoglobulins (44.2%). Fifty-eight patients (42.0%) had signs/symptoms of bleeding in the month before treatment initiation. Seventy-nine percent of patients responded to fostamatinib with 53.6% complete responses (platelet count > 100 × 109/L). Eighty-three patients (60.1%) received fostamatinib monotherapy, achieving a high response rate (85.4%). The proportion of time in response during the 27-month period examined was 83.3%. The median time to platelet response was 11 days (IQR, 7-21). Sixty-seven patients (48.5%) experienced adverse events, mainly grade 1 to 2; the commonest of which were diarrhea (n = 28) and hypertension (n = 21). One patient had deep venous thrombosis, and one patient developed acute myocardial infarction. Fostamatinib was shown to be effective with good safety profile in patients with primary and secondary ITP across a wide age spectrum in this real-world study.
Poor cardiac output reserve in pulmonary arterial hypertension is associated with right ventricular stiffness and impaired interventricular dependence
Authors: Cubero Salazar Ilton M. , Lancaster Andrew C. , Jani Vivek P. , Montovano Margaret J. , Kauffman Matthew , Weller Alexandra , Ambale-Venkatesh Bharath , Zimmerman Stefan L. , Simpson Catherine E. , Kolb Todd M. , Damico Rachel L. , Mathai Stephen C. , Mukherjee Monica , Tedford Ryan J. , Hassoun Paul M. , Hsu Steven
Published: June 2024

Background

Pulmonary arterial hypertension (PAH) is characterised by poor exercise tolerance. The contribution of right ventricular (RV) diastolic function to the augmentation of cardiac output during exercise is not known. This study leverages pressure–volume (P–V) loop analysis to characterise the impact of RV diastology on poor flow augmentation during exercise in PAH.

Methods

RVP–Vloops were measured in 41 PAH patients at rest and during supine bike exercise. Patients were stratified by median change in cardiac index (CI) during exercise into two groups: high and low CI reserve. Indices of diastolic function (end-diastolic elastance (Eed)) and ventricular interdependence (left ventricular transmural pressure (LVTMP)) were compared at matched exercise stages.

Results

Compared to patients with high CI reserve, those with low reserve exhibited lower exercise stroke volume (36versus49 mL·m−2; p=0.0001), with higher associated exercise afterload (effective arterial elastance (Ea) 1.76versus0.90 mmHg·mL−1; p<0.0001), RV stiffness (Eed0.68versus0.26 mmHg·mL−1; p=0.003) and right-sided pressures (right atrial pressure 14versus8 mmHg; p=0.002). Higher right-sided pressures led to significantly lower LV filling among the low CI reserve subjects (LVTMP −4.6versus3.2 mmHg; p=0.0001). Interestingly, low exercise flow reserve correlated significantly with high afterload and RV stiffness, but not with RV contractility nor RV–PA coupling.

Conclusions

Patients with poor exercise CI reserve exhibit poor exercise RV afterload, stiffness and right-sided filling pressures that depress LV filling and stroke work. High afterload and RV stiffness were the best correlates to low flow reserve in PAH. Exercise unmasked significant pathophysiological PAH differences unapparent at rest.
ERS statement on transition of care in childhood interstitial lung diseases
Authors: Pohunek Petr , Manali Effrosyni , Vijverberg Susanne , Carlens Julia , Chua Felix , Epaud Ralph , Gilbert Carlee , Griese Matthias , Karadag Bulent , Kerem Eitan , Koucký Václav , Nathan Nadia , Papiris Spyridon , Terheggen-Lagro Suzanne , Plch Lukáš , Torrent Vernetta Alba , Bush Andrew
Published: June 2024

Interstitial lung diseases (ILD) are a heterogeneous group of rare diffuse diseases affecting the lung parenchyma in children and adults. Childhood interstitial lung diseases (chILD) are often diagnosed at very young age, affect the developing lung, and can have different presentations and prognosis compared to adult forms of these diseases. In addition, chILD in many cases may apparently remit, and have a better response to therapy and better prognosis than adult ILD. Many affected children will reach adulthood with minimal activity or clinical remission of the disease. They need continuing care and follow-up from childhood to adulthood if the disease persists and progresses over time, but also if they are asymptomatic and in full remission. Therefore, for every chILD patient an active transition process from paediatric to adult care should be guaranteed. This European Respiratory Society (ERS) statement provides a review of the literature and current practice concerning transition of care in chILD. It draws on work in existing transition care programmes in other chronic respiratory diseases, disease-overarching transition-of-care programmes, evidence on the impact of these programmes on clinical outcomes, current evidence regarding long-term remission of chILD as well as the lack of harmonisation between the current adult ILD and chILD classifications impacting on transition of care. While the transition system is well established in several chronic diseases, such as cystic fibrosis or diabetes mellitus, we could not find sufficient published evidence on transition systems in chILD. This statement summarises current knowledge, but cannot yet provide evidence-based recommendations for clinical practice.
Clinical overview of the physiology and pathophysiology of pleural fluid movement: a narrative review
Authors: Ferreiro Lucía , Toubes María E. , Suárez-Antelo Juan , Rodríguez-Núñez Nuria , Valdés Luis
Published: June 2024

In physiological conditions, the pleural space couples the lung with the chest wall and contains a small amount of fluid in continuous turnover. The volume of pleural fluid is the result from the balance between the entry of fluid through the pleural capillaries and drainage by the lymphatics in the most dependent areas of the parietal pleura. Fluid filtration is governed by Starling forces, determined by the hydrostatic and oncotic pressures of the capillaries and the pleural space. The reabsorption rate is 28 times greater than the rate of pleural fluid production. The mesothelial layer of the inner lining of the pleural space is metabolically active and also plays a role in the production and reabsorption of pleural fluid.

Pleural effusion occurs when the balance between the amount of fluid that enters the pleural space and the amount that is reabsorbed is disrupted. Alterations in hydrostatic or oncotic pressure produce a transudate, but they do not cause any structural damage to the pleura. In contrast, disturbances in fluid flow (increased filtration or decreased reabsorption) produce an exudateviaseveral mechanisms that cause damage to pleural layers. Thus, cellular processes and the inflammatory and immune reactions they induce determine the composition of pleural fluid. Understanding the underlying pathophysiological processes of pleural effusion, especially cellular processes, can be useful in establishing its aetiology.
Highly controlled multiplex electrospinning
Authors: Gilfeather Isaac C. , Pearson-Nadal Harold W. , Andriolo Jessica M. , Skinner Jack L.
Published: June 2024

Applications of electrospinning (ES) range from fabrication of biomedical devices and tissue regeneration scaffolds to light manipulation and energy conversion, and even to deposition of materials that act as growth platforms for nanoscale catalysis. One major limitation to wide adoption of ES is stochastic fiber deposition resulting from the chaotic motion of the polymer stream as is approaches the deposition surface. In the past, fabrication of structures or materials with precisely determined mesoscale morphology has been accomplished through modification of electrode shape, use of multi-dimensional electrodes or pins, deposition onto weaving looms, hand-held electrospinning devices that allow the user to guide deposition, or electric field manipulation by lensing elements or apertures. In this work, we demonstrate an ES system that contains multiple high voltage power supplies that are independently controlled through a control algorithm implemented in LabVIEW. The end result is what we term “multiplex ES” where multiple independently controlled high-voltage signals are combined by the ES fiber to result in unique deposition control. COMSOL Multiphysics® software was used to model the electric field produced in this novel ES system. Using the multi-power supply system, we demonstrate fabrication of woven fiber materials that do not require complex deposition surfaces. Time-varied sinusoidal wave inputs were used to create electrospun torus shapes. The outer diameter of the tori was found, through parametric analysis, to be rather insensitive to frequency used during deposition, while inner diameter was inversely related to frequency, resulting in overall width of the tori increasing with frequency. Multiplex ES has a high-frequency cutoff based on the time response of the high voltage electrical circuit. These time constants were measured and minimized through the addition of parallel resistors that decreased impedance of the system and improved the high-frequency cutoff by up to 63%.
Genome mining of Lactiplantibacillus plantarum PA21: insights into its antimicrobial potential
Authors: Isaac Sharleen Livina , Abdul Malek Ahmad Zuhairi , Hazif Nurul Syafika , Roslan Farah Syahrain , Mohd Hashim Amalia , Song Adelene Ai-Lian , Abdul Rahim Raha , Wan Nur Ismah Wan Ahmad Kamil
Published: June 2024

Background

The dramatic increase of antimicrobial resistance in the healthcare realm has become inexorably linked to the abuse of antibiotics over the years. Therefore, this study seeks to identify potential postbiotic metabolites derived from lactic acid bacteria such as Lactiplantibacillus plantarum that could exhibit antimicrobial properties against multi-drug resistant pathogens.

Results

In the present work, the genome sequence of Lactiplantibacillus plantarum PA21 consisting of three contigs was assembled to a size of 3,218,706 bp. Phylogenomic analysis and average nucleotide identity (ANI) revealed L. plantarum PA21 is closely related to genomes isolated from diverse niches such as dairy products, food, and animals. Genome mining through the BAGEL4 and antiSMASH database revealed four bacteriocins in a single cluster and four regions of biosynthetic gene clusters responsible for the production of bioactive compounds. The potential probiotic genes indirectly responsible for postbiotic metabolites production were also identified. Additionally, in vitro studies showed that the L. plantarum PA21 cell-free supernatant exhibited antimicrobial activity against all nine methicillin-resistant Staphylococcus aureus (MRSA) and three out of 13 Klebsiella pneumoniae clinical isolates tested.

Conclusion

Results in this study demonstrates that L. plantarum PA21 postbiotic metabolites is a prolific source of antimicrobials against multi-drug resistant pathogens with potential antimicrobial properties.