bluuebunny/crossref_metadata_2025 huggingface dataset:
Using QI to develop a sustainable method for titrating taxane infusions to reduce hypersensitivity reactions
Authors: Jabaley Terri , Menon Susanne , Bagley Janet , Tuskan Jacqueline , Mazzola Emanuele , Costa Jennifer , Rompelman Garrett , Servant Jennifer , Corbett Megan , Lynch Donna-Marie
Published: October 2024

Objective

To develop a sustainable three-step method for titrating first and second taxane exposures through integration of best practices in patient and environmental safety; and to evaluate the impact on immediate hypersensitivity rates.

Methods

A quality improvement study was initiated at a large, NCI-designated comprehensive cancer center in the U.S. to determine a sustainable method of slow, upward titration for reducing taxane-related hypersensitivity reactions. Multidisciplinary collaboration led to the incorporation of best practices for safe preparation and administration of high risk, hazardous drugs. Retrospective data from the electronic health records of 690 patients who received 1221 taxane doses were analyzed. Non-titrated infusions were compared with infusions titrated using a method initially tested for efficacy; and infusions titrated using a method revised for greater compliance with safety standards. Two-sided Fisher's exact tests at a 0.1 level of significance were used to detect differences in the rate of HSR between the three groups.

Results

A method of taxane titration that incorporated standardized, preprogrammed infusion rates and tubing primed with inert IV fluid showed a significant reduction in HSR incidence in comparison to non-titrated infusions (6% v. 19%, P = 0.001) and a similar decrease in the rate of HSR (6%) to the initial method previously studied (7%) (P = 0.659) which was not sustainable due to patient and environmental safety concerns.

Conclusions

A three-step titration method using standardized, preprogrammed infusion rates and tubing primed with inert IV fluid reduced taxane-related HSRs and was adopted as sustainable practice in ambulatory cancer care.
A coated hypotrochoidal compressible liquid inclusion neutral to a hydrostatic stress field after relaxation by interface slip and diffusion
Authors: Wang Xu , Schiavone Peter
Published: October 2024

We study the steady-state response of a three-phase composite composed of an internal hypotrochoidal compressible liquid inclusion, an intermediate isotropic elastic coating and an outer isotropic elastic matrix with simultaneous interface slip and diffusion occurring on the solid–solid interface when the matrix is subjected to a uniform hydrostatic stress field. We design a neutral coated hypotrochoidal liquid inclusion that does not disturb the prescribed uniform hydrostatic stress field in the surrounding matrix. The neutrality is achieved when the plane-strain bulk modulus or the compressibility of the elastic matrix is determined by solving a system of simultaneous linear algebraic equations for given geometric and material parameters of the coated liquid inclusion.
Hospital-Based Preparedness Measures for CBRNE Disasters: A Systematic Review
Authors: Qzih Eman S , Ahmad Muayyad M
Published: October 2024

Chemical, Biological, Radiological or Nuclear and Explosive (CBRNe) disasters have historically caused significant fatalities and posed global threats. The inadequate preparedness of hospital equipment for CBRNe incidents underscores the urgent need for hospitals to modernize and standardize their equipment to effectively manage these high-risk situations. The purpose of this systematic review was to examine hospital-based preparedness measures for CBRNe incidents. The PRISMA guidelines were followed for this review. A comprehensive search of English-language peer-reviewed literature from January 2010 to 2023 was conducted, identifying 2191 items from PubMed, ScienceDirect, EBSCO, and Google Scholar. The modified ROBINS-I instrument was used to assess bias, ensuring the reliability and validity of the studies. Data synthesis was conducted jointly by both authors. After eliminating duplicates and reviewing abstracts, 124 studies remained. Upon full-text examination, only 20 studies met the criteria for inclusion in this review. The review identified three key interrelated domains of preparedness: personal, technological, and structural measures. Most studies emphasized decontamination, Personal Protective Equipment (PPE), and detection, while the management of deceased bodies, transportation, and Points of Dispensing (PODs) were largely overlooked. These findings may assist hospital administrators and policymakers in enhancing their facilities’ readiness for CBRNe emergencies.
Primary Hyperparathyroidism With Undetectable Intact Parathyroid Hormone
Authors: Song Zhixing , McMullin Jessica , Huls Forest , Rosenthal Richard , Bantu Sravani , Wu Christopher , Chen Herbert , Lindeman Brenessa
Published: October 2024

Hypercalcemia can result from either hyperparathyroidism or non-parathyroid conditions. When hypercalcemia is accompanied by undetectable parathyroid hormone (PTH) levels, hyperparathyroidism is rarely considered the diagnosis. Herein, we report the case of a 65-year-old Caucasian woman referred to our hospital for further evaluation of hypercalcemia. Her symptoms included fatigue and brain fog, with undetectable PTH levels. A comprehensive workup, including a series of laboratory and imaging tests, excluded common non-parathyroid causes such as malignancy and familial hypocalciuric hypercalcemia. Ultrasound identified a likely enlarged parathyroid gland, which was further confirmed by a sestamibi scan. After 2 weeks of cinacalcet treatment, the patient’s calcium levels decreased, indicating the parathyroid gland as the likely source of hypercalcemia. Parathyroidectomy was subsequently performed, revealing a 1927 mg adenoma. Postoperatively, the patient’s calcium levels normalized, PTH levels became detectable within the normal range, and her symptoms resolved, with a marked improvement in energy. This case demonstrates that primary hyperparathyroidism can present with hypercalcemia and undetectable PTH. A genetic mutation in the PTH gene within the adenoma may explain the undetectable PTH levels preoperatively.
Critical data studies meets discard studies: Waste data reflectivity in digital urban waste tracking system
Authors: Strzelecka Celina
Published: October 2024

The article critically examines the implementation and impact of the Digital Urban Waste Tracking System (DUWTS), a ‘smart’ waste management technology deployed in several towns in Poland to enhance urban waste segregation practices. By integrating critical discard studies with critical data studies, the article introduces the concept of ‘waste data reflectivity’ to investigate how data representation in DUWTS influences perceptions and responsibilities within waste management. The study highlights how DUWTS employs advanced dataveillance technologies to monitor waste disposal, creating distorted reflections that obscure the complexities of municipal waste management. These distortions are analyzed through the metaphorical lenses of three mirrors – concave, kaleidoscopic, and ceiling – which reveal the illusory effects on municipalities, waste disposal companies, and residents. Additionally, the article discusses how DUWTS exemplifies ‘technologies of (un)knowing’, which systematically obscure or misrepresent waste management issues, leading to the marginalization of true responsibilities and challenges. The findings demonstrate that while DUWTS represents a technological advancement, it can also perpetuate the existing challenges in waste management by masking the true nature of waste issues and obscuring the responsibilities of different stakeholders. The article concludes by emphasizing the socio-technological consequences of such systems and the importance of a critical analysis in evaluating the effectiveness and ethics of data-driven waste management technologies.
Heat transfer performance optimization of turbine blade internal cooling channel with pin-fins and recessed-extruded endwalls
Authors: Do Khanh-Duy Cong , Chung Duy-Hung , Plourde Frédéric , Duong Viet-Dung , Pham Gia-Diem , Dinh Cong-Truong
Published: October 2024

This paper involves implementing and optimizing a novel recessed-extruded endwall design for a rectangular cooling channel equipped with pin-fins. The study encompasses an in-depth exploration of the flow dynamics, pondering the generation and sustenance of vortices within the channel, using Reynolds-averaged Navier-Stokes analysis. The study delves into the evaluation of heat transfer characteristics, considering crucial parameters such as Nusselt number, friction factor, and overall heat transfer performance. These attributes are contrasted with the corresponding values observed in cases featuring flat endwalls, concerning Reynolds numbers spanning from 7400 to 36,000. A parametric study of the channel with recessed-extruded endwalls is conducted, aiming to comprehend the influence of geometric factors on channel heat transfer. A single-objective optimization process focusing on enhancing heat transfer effectiveness, quantified through the heat transfer efficiency index (HTEI), is conducted with three design variables. The results indicate that the new endwall configuration significantly enlarges the high heat transfer areas near the pin-fins compared to the flat endwall across all Reynolds numbers. This novel endwall design substantially elevates the heat transfer levels adjacent to the pin-fins, showcasing an impressive 62.4% increase in HTEI at Re = 21,500 compared to the flat endwall, with a protrusion height of 2.5% of the channel height. Furthermore, by increasing the height, the recessed-extruded endwall configuration can achieve a remarkable 91.1% increase in HTEI compared to the flat endwall. This achievement is reached with a protrusion height equivalent to 5% of the channel height at Re = 7400. Through design optimization using the radial basis neural network (RBNN) surrogate model and particle swarm optimization (PSO) technique, the HTEI of the recessed-extruded endwall design shows enhancements of 91.7% and 18.0% compared with the flat endwall and reference designs, respectively, at a Reynolds number of 21,500. The present work demonstrates the potential for enhancing the heat transfer of pin-fins channels by improving endwall design.
Optimization of the full-load combustion schemes of n-butanol/biodiesel reactivity-controlled compression ignition (RCCI) toward high-efficiency and low-emission engines
Authors: Cai Yikang , Jia Ming , Li Yaopeng , Li Haoran , Liu Zihe , Ding Rui , Lu Xingcai
Published: October 2024

Biodiesel and n-butanol, as popular alternative fuels, can be used in advanced reactivity-controlled compression ignition (RCCI) engines for efficient and clean combustion. However, the complex interactions between n-butanol and biodiesel, as well as the best combustion schemes at different loads, remain poorly understood. Given this, the objective of this paper is to identify optimal fuel organizations for n-butanol/biodiesel RCCI engines across different load scenarios by combining engine simulation with a global optimization algorithm, explore the potential synergies of control parameters, and analyze microscopic dual-fuel interactions based on the integrated average reaction path analysis. Results show that the optimal scheme at low load employs almost homogeneous fuel-air mixtures at elevated temperature atmosphere above 390 K, with n-butanol energy share exceeding 96% and optimal biodiesel injection timing between −70 and −50 °CA. Higher n-butanol ratio coupled with increased intake temperature improves engine performance. For mid load, biodiesel injection timing is retarded to −55 to −30 °CA, and biodiesel proportion is increased to introduce reactivity stratification, while maintaining its energy share below 20% to mitigate NOx emissions. Notably, biodiesel density is identified as the primary physical property influencing NOx formation. At high load, a split combustion scheme involving premixing and subsequent diffusion combustion is optimal. The physical effects of n-butanol addition minimally impact the low-temperature ignition of biodiesel, while its chemical effects significantly defer the low-temperature reactivity. The reaction path analysis reveals that n-butanol competes with biodiesel for OH radical consumption, with a large proportion of OH and HO2 consumed in the cyclic reactions of nC4H9OH and nC4H8OH. Adjusting the reactivity stratification affects the reaction state of n-butanol entrained by the biodiesel jets. Higher reactivity gradient intensifies biodiesel reactions to induce the pyrolysis of the involved n-butanol through nC4H8OH => 2C2H4 + OH, therefore resulting in more staged heat release.
Supporting delivery of remote pulmonary rehabilitation across different healthcare contexts: A multi-national study
Authors: Cox Narelle S , Rawlings Sarah , Lannin Natasha A , Candy Sarah , Bhatt Surya P , Babu Abraham Samuel , Holland Anne E
Published: October 2024

Purpose: This study aimed to understand factors that health professionals, from a variety of healthcare contexts and countries, believed support remote delivery of pulmonary rehabilitation (PR); and to develop a targeted intervention to support implementation of remote PR. Methods: A 3-phase participatory action-research process was employed, across three study hubs in three countries (NZ, India, USA), representing diverse healthcare delivery contexts. Phase 1 employed focus groups of health professionals working in PR; data were analysed qualitatively with transcripts coded against two implementation frameworks (Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR)). Findings informed development of an online toolbox to support delivery of remote PR (Phase 2), which was evaluated using semi-structured interviews (Phase 3). Results: 20 health professionals participated across all study phases. Factors considered to influence implementation of remote PR were consistent across diverse healthcare contexts and related to staffing availability, skills and confidence, and equipment and technology accessibility. An online toolbox provided support for enhancing knowledge and confidence, but was not able to address all implementation barriers. Discussion: Key factors to support clinicians deliver remote PR are common across different healthcare contexts, suggesting broader telerehabilitation implementation strategies may be applicable across healthcare environments.
Does the Combined Arteritis Damage Score (CARDS) in the Diagnosis of Takayasu Arteritis Predict Prognosis and Need for Biologic Therapy?
Authors: Deniz Rabia , Güzelbey Tevfik , Tanrıkulu Merve , Bes Cemal
Published: October 2024

Background

We aimed to investigate the prognostic value of the combined arteritis damage score (CARDS) in Takayasu arteritis (TAK) patients to predict the need for biologic treatment at diagnosis and the possible contribution of wall thickness (WT).

Materials and Methods

Blind evaluation of MRA/CTA at the time of diagnosis was performed by a reader rheumatologist (RR) and an interventional radiologist (RIR). The CARDS damage score for 21 arterial regions was assessed as normal, mild or moderate/severe stenosis, occclusion or aneursym/dilatation. Additionally, WT was scored for all regions as present or absent. A modified CARDS (mCARDS) was calculated as the sum of CARDS and the number of WT areas.

Results

According to follow-up treatment, 10 patients with non-biologic treatment (non-BT) (F/M:8/2, median age 37.5 years) and 15 patients with biologic treatment (BT) (F/M:13/2, median age 30 years) were included. Indian Takatasu Arteritis Score (ITAS), CRP, and ESR levels were similar in both groups. CARDS (1.4 (0-7.2) vs 4.5 (.6-19), P: .003), WT (1.5 (0-8) vs 7 (1-21), P < .001), and mCARDS (4 (0-14.2) vs 11.4 (1.6-40), P < .001) scores were significantly higher in the BT group compared to nonBT group. Cohen’s kappa coefficient between RR and RIR for WT was .99 with 99.6% aggrement, and CARDS was .98 with 99.6% agreement. The AUC values for CARDS, WT, and mCARDS scores were .748 (.605-.892), .837 (.723-.950), and .847 (.735-.958), respectively, and P value was <.0001.

Conclusions

The prediction of prognosis and biologic treatment need at TAK diagnosis using non-invasive angiographic images can improve outcomes and prompt closer follow-up. The combination of CARDS and WT as mCARDS achieved the highest sensitivity and specificity, and all scores appear useful for predicting prognosis.
Augmented Reality Implementation in Minimally Invasive Surgery for Future Application in Pulmonary Surgery: A Systematic Review
Authors: Doornbos Marie-Claire J. , Peek Jette J. , Maat Alexander P. W. M. , Ruurda Jelle P. , De Backer Pieter , Cornelissen Bart M. W. , Mahtab Edris A. F. , Sadeghi Amir H. , Kluin Jolanda
Published: October 2024

Objective

This systematic review investigates of Augmented Reality (AR) systems used in minimally invasive surgery of deformable organs, focusing on initial registration, dynamic tracking, and visualization. The objective is to acquire a comprehensive understanding of the current knowledge, applications, and challenges associated with current AR-techniques, aiming to leverage these insights for developing a dedicated AR pulmonary Video or Robotic Assisted Thoracic Surgery (VATS/RATS) workflow.

Methods

A systematic search was conducted within Embase, Medline (Ovid) and Web of Science on April 16, 2024, following the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). The search focused on intraoperative AR applications and intraoperative navigational purposes for deformable organs. Quality assessment was performed and studies were categorized according to initial registration and dynamic tracking methods.

Results

33 articles were included, of which one involved pulmonary surgery. Studies used both manual and (semi-) automatic registration methods, established through anatomical landmark-based, fiducial-based, or surface-based techniques. Diverse outcome measures were considered, including surgical outcomes and registration accuracy. The majority of studies that reached an registration accuracy below 5 mm applied surface-based registration.

Conclusions

AR can potentially aid surgeons with real-time navigation and decision making during anatomically complex minimally invasive procedures. Future research for pulmonary applications should focus on exploring surface-based registration methods, considering their non-invasive, marker-less nature, and promising accuracy. Additionally, vascular-labeling-based methods are worth exploring, given the importance and relative stability of broncho-vascular anatomy in pulmonary VATS/RATS. Assessing clinical feasibility of these approaches is crucial, particularly concerning registration accuracy and potential impact on surgical outcomes.
KLF1 Activates RAC3 to Mediate Fatty Acid Synthesis and Enhance Cisplatin Resistance in Bladder Cancer Cells
Authors: Song Lide , Xu Qi , Chen Rong , Sun Wanghong , Zhan Jianfei
Published: October 2024

While cisplatin remains a frontline treatment for bladder cancer (BCa), the onset of resistance greatly hampers its effectiveness. RAC3 is closely linked to chemoresistance in cancer cells, but its specific role in cisplatin resistance within BCa is still elusive. RAC3 expression in BCa was analyzed using bioinformatics and quantitative polymerase chain reaction (qPCR). The gene set enrichment analysis (GSEA) identified RAC3-enriched pathways and the correlation between RAC3 and fatty acid synthase (FASN), a gene involved in fatty acid synthesis. Potential upstream transcription factors of RAC3 were predicted and their interaction with RAC3 was confirmed via dual-luciferase and chromatin immunoprecipitation (ChIP) assays. T24/DDP, a cisplatin-resistant BCa cell line, was established to probe into the regulatory role of RAC3 in cisplatin resistance. Cell proliferation was evaluated by colony formation and the IC50 values after cisplatin treatment were determined using cell counting kit-8 (CCK-8). The levels of free fatty acids and triglycerides (TGs), as well as the expression of DGAT2 and FASN proteins, were measured to gauge the extent of fatty acid synthesis in cells. Elevated expression of RAC3 was observed in BCa and the cisplatin-resistant BCa cells (T24/DDP). The knockdown of RAC3 within T24/DDP cells was demonstrated to counteract cisplatin resistance. Subsequent analyses identified RAC3 as being notably enriched in the fatty acid synthesis pathway, with Kruppel-like factor 1 (KLF1) emerging as a key upstream regulator. The overexpression of RAC3 was correlated with increased cisplatin resistance in T24/DDP cells, an effect that was mitigated by the addition of the FASN inhibitor, Orlistat. Furthermore, the downregulation of KLF1 suppressed RAC3 expression, disrupted fatty acid synthesis, and attenuated cisplatin resistance in T24/DDP cells. Conversely, the co-overexpression of RAC3 counteracted the effects conferred by KLF1 knockdown. Our study has validated that KLF1 activates RAC3 to mediate fatty acid synthesis and promote cisplatin resistance in BCa, suggesting the KLF1/RAC3 axis as a potential target for combating cisplatin-resistant BCa.
Cucurbita Pepo L. Seed Oil Modulates Dyslipidemia and Neuronal Dysfunction in Tramadol-Induced Toxicity in Wistar Albino Rats
Authors: Ekpono Ezebuilo Ugbala , Aja Patrick Maduabuchi , Ibiam Udu Ama , Agu Peter Chinedu , Eze Ejike Daniel , Afodun Adam Moyosore , Okoye Osita Gabriel , Ifie Josiah Eseoghene , Atoki Ayomide Victor
Published: October 2024

Objective: The modulating effects of Cucurbita pepo seed oil (CPSO) on dyslipidemia and neuronal dysfunction in tramadol toxicity were studied.

Methods: Fifty-six albino rats were divided into seven groups of eight rats each after a 2-week acclimatization period. All animals had unrestricted access to water and feed, and treatments were administered orally once daily for 42 days. Glutamate dehydrogenase and glutaminase activities were assessed using brain homogenate, while lipid profiles were analyzed in serum samples.

Results: Tramadol toxicity was evidenced by significant ( P < 0.05) increases in brain glutamate dehydrogenase along with significant ( P < 0.05) decreases in the activities of glutaminase in the group administered only tramadol. Also, serum levels of total cholesterol, LDL-C and triglycerides also increased significantly ( P < 0.05) following administration of tramadol with decreased level of HDL-C ( P < 0.05). However, treatment with CPSO significantly restored the activities and levels of the altered biochemical parameters in a dose-dependent manner. The results of the biochemical investigation using the lipid profile and the enzymes of glutamate metabolism were corroborated by the results obtained from the histopathological examination of the brain.

Conclusion: The results of this study therefore suggest that tramadol-induced dyslipidemia and neuronal dysfunction be managed and prevented by the administration of Cucurbita pepo seed oil.
Adsorption Behavior of Methylene Blue Onto Activated Coconut Shells: Kinetic, Thermodynamic, Mechanism and Regeneration of the Adsorbent
Authors: Abbas Moussa , Trari Mohamed
Published: October 2024

Adsorption techniques are widely used to remove some classes of pollutants from waters, especially those which are not easily biodegradable. The removal of Methylene blue (MB), as a pollutant, from waste waters of textile, paper, printing and other industries has been addressed by the researchers. The aim of this study is to eliminate MB by Activated Coconut Shells (ACS) produced at low cost by adsorption in batch mode. The ACS was characterized by the FTIR spectroscopy and point of zero charge (pHpzc: 5.06). Some examined factors were found to have significant impacts on the MB uptake of ACS like the initial dye concentration Co (40-120 mg/L), solution pH (2-8), ACS dose (1-12 g/L), agitation speed (50-500 r/min), particles size (1.0-1.2 mm) and temperature (298-333 K). The best capacity was found at pH 6 with an adsorbent dose 8 g/L, an agitation speed 200 r/min and a contact time of 60 min. Modeling Kinetics and Isotherms shows that the pseudo-second-order kinetic model with R2 (0.935 -0.998) and Langmuir adsorption isotherm model provide better fitness to the experimental data with the maximum adsorption capacity of 30.30 mg/g at 25°C. The separation factor RL (0.933-0.541) in the concentration range studied (10-120 mg/L) shows a favorable adsorption. The isotherms at different temperatures have been used for the determination of the free energy ΔG° (198-9.72 kJ/mol); enthalpy ΔH° (82.082 kJ/mol) and entropy ΔSo (245.689 J/K mol) to predict the nature of MB adsorption process. The positive values of (ΔGo) and (ΔHo) indicate a non-spontaneous and endothermic MB adsorption with a chemisorption. The adsorbent elaborated from Coconut Shells was found to efficient and suitable for the removal of MB dye from aqueous solutions, due to its availability, low cost preparation and good uptake capacity.
Recognition of dural to pial supply in high-grade dural arteriovenous fistula: A technical note
Authors: Miyake Shigeta , Kee Tze Phei , Radovanovic Ivan , Terbrugge Karel , Krings Timo , Hendriks Eef Jacobus
Published: October 2024

High-grade dural arteriovenous fistulas (DAVFs) are known to demonstrate classical dural supply and can demonstrate pre-existing dural supply and ‘pure’ arterial supply from pial branches. The latter two are examples of congenital versus acquired pial to dural shunting, respectively. We describe the recognition of dural to pial supply during combined transarterial and transvenous embolization of a high-grade DAVF with holocephalic venous reflux, stressing the importance of careful assessment of this condition with micro catheter injections.
Beyond conventional imaging: A systematic review and meta-analysis assessing the impact of computed tomography perfusion on ischemic stroke outcomes in the late window
Authors: Elsherif Salah , Legere Brittney , Mohamed Ahmed , Saqqur Razan , Fatima Nida , Saqqur Maher , Shuaib Ashfaq
Published: October 2024

Background:

Non-contrast cranial computed tomography (NCCT) and CT angiogram (CTA) have become essential for endovascular treatment (EVT) in acute stroke. Patient selection may improve when CT perfusion (CTP) imaging is also added for patient selection. We aimed to analyze the effects of implementing CTP in acute ischemic stroke (AIS) patients’ treatment to assess whether stroke outcomes differ in the late window.

Methods:

We searched the PubMed, Embase, and Web of Sciences databases to obtain articles related to CTA and CTP in EVT. Collected patient data were split into two groups: the CTP and control (NCCT + CTA) cohorts. Primary outcomes evaluated were modified Rankin Scale (mRS) scores, symptomatic intracranial hemorrhages (sICHs), mortality, and successful recanalization.

Results:

There were 14 studies with 5809 total patients in the final analysis: 2602 received CTP and 3202 were in the control group. CTP/CTA patients showed significantly lower rates of 90-day stroke-related mortality (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.60–0.87, p < 0.01) and significantly higher successful recanalization (OR = 1.42, 95% CI = 1.06–1.94, p < 0.01) compared with CTA-only patients. Analysis of other outcomes including functional independence (mRS = 0–2), critical times, and intracranial hemorrhages was non-significant ( p > 0.05).

Conclusion:

The study highlights the usefulness of CTP-guided therapy as a supplementary tool in EVT selection in the late window. Although the addition of CTP resulted in lower mortality, the favorable outcomes did not improve. Further evidence is required to establish a clearer understanding of the potential advantages or limitations of incorporating CTP in stroke imaging.
Comparison of the effect of different doses of phenylephrine infusion on the prevention of hypotension in the elderly under spinal anaesthesia in orthopaedic surgery
Authors: Golmohammadi Mitra , Sane Shahryar , Kadhum Wesam R. , Hjazi Ahmed , N. Fenjan Mohammed , Mahmoudifar Farnaz , Kazemi haki Behzad , Soodagar Eskandarabadi Mehri , Ghavipanjeh Rezaiy Somayeh
Published: October 2024

Background:

Considering the vasopressor drug categories and doses that can be used for elderly patients following hypotension are few, the present trial aimed to compare the effect of different doses of phenylephrine infusion on the prevention of hypotension in elderly patients undergoing orthopaedic lower extremities surgery.

Methods:

This randomised, double-blind prospective clinical trial was conducted by including 60 elderly patients older than 60 years and classified as American Society of Anesthesiology class I and II who were candidates for femur fracture fixation surgery. White and black cards randomly allocated patients to: group A (25µg/kg/h phenylephrine) or group B (35µg/kg/h phenylephrine).

Results:

At the T3-T7 time points, group A’s systolic and diastolic blood pressure was significantly higher than in group B’s (p < 0.05). However, after 27 minutes (T0-T7) of phenylephrine infusion, statistical analysis showed no significant difference between the two groups regarding blood pressure (T8-Tend). The frequency of bradycardia and reactive hypertension in group B were significantly higher than in group A (p = 0.02) and (p = 0.03), respectively. There was no significant difference between the bleeding loss, blood transfusion and crystalloid volume in both groups (p > 0.05).

Conclusion:

Our trial illustrated that high-dose phenylephrine infusion could not assure haemodynamic stability and may cause some side effects.
The incidence of vasculitides in Israel from 2007 to 2021 and during the COVID-19 pandemic
Authors: Zeller Lior , Ben David Ran , Novack Lena , Abuhasira Ran , Abu-Shakra Mahmoud , Miskin Yuval , Sagy Iftach
Published: October 2024

Background:

The incidence of various types of vasculitis conditions over time, specifically during coronavirus disease 2019 (COVID-19), is unknown.

Objectives:

We aimed to assess recent trends in vasculitides and the effect of the COVID-19 pandemic on these trends.

Design:

We conducted a retrospective analysis of Israel’s largest Health Maintenance Organization, which covers over 4.7 million patients and represents 55% of the country.

Methods:

We calculated the age- and sex-adjusted incidence of giant cell arteritis (GCA), Takayasu, ANCA-associated vasculitis (AAV), IgA vasculitis, cryoglobulinemia, and Behcet’s disease (BD) during 2007–2021. We analyzed associations of COVID-19 with the incidence of each of the examined conditions.

Results:

During 2007–2021, the adjusted annual incidence decreased from 7.9 (95% confidence interval (CI) 3.5–17.9) to 1.5 (95% CI 0.7–3.6) per 100,000 for GCA, from 5.2 (95% CI 2.7–11.1) to 1.5 (95% CI 0.7–3.3) per million for IgA vasculitis, and from 6.3 (95% CI 3.0–13.5) to 1.0 (0.5–2.5) per 100,000 for BD. The relative risks for these conditions decreased: 0.92 (95% CI 0.91–0.93), 0.93 (95% CI 0.89–0.98), and 0.90 (95% CI 0.85–0.94), respectively. The incidences of Takayasu, AAV, and cryoglobulinemia remained unchanged. The COVID-19 pandemic was not associated with changes in the incidence of any examined vasculitides.

Conclusion:

The incidences of GCA, IgA vasculitis, and BD decreased substantially in Israel during 15 years and were unaffected by the COVID-19 pandemic. Future studies should focus on possible environmental contributions to these findings.
The theory of democratic integration
Authors: Hoeksma Jaap
Published: October 2024

The outcome of the 2024 European Parliament elections highlights the need for the EU to underpin its functioning as a European democracy with a proper political theory. This article introduces the theory of democratic integration as a political philosophy of the EU. It aims to provide the EU with a philosophical foundation by analysing its evolution as a deviation from the Westphalian system of international relations and its doctrine of absolute sovereignty. The article finds that the EU is succeeding in creating a new democratic home for its citizens and its member states. In times of increasing support for parties which promote national sovereignty as the recipe for the future and which consequently call for the dismantling of the European Parliament and the deconstruction of EU democracy, the theory will empower the Union to defend its constitutional achievements and prevent it from backsliding into an undemocratic organisation of illiberal states.
HINDERING POLICY CHANGE: Under What Conditions Have Marriage Equality Policies Been Hampered in Latin America?
Authors: Alza Barco Carlos
Published: October 2024

Since 1993, over a hundred bills have been submitted to National Congresses in Latin America, proposing a shift from restrictive to permissive marriage equality or same sex partnerships regulations. Only five of 19 countries have approved legal changes, and five have done so in courts. Extant research has focused on the explanatory factors of the positive policy changes, but few studies have examined cases of hampered policies. This article aims to identify under what conditions marriage equality, as a moral policy, has stalled in Latin America. It contributes to our understanding of policy non-decisions by offering a cross-national analysis and overcoming the limitations of “mirror” strategies that explain negative cases solely by the absence of factors associated with positive change. It highlights the importance of studying conditions conjunctionally. High levels of religiosity can significantly influence political decisions and may obfuscate religious cleavages, as left-wing parties also engage in moral discourse.
High-Frequency 10-kHz Spinal Cord Stimulation Provides Long-term (24-Month) Improvements in Diabetes-Related Pain and Quality of Life for Patients with Painful Diabetic Neuropathy
Authors: Petersen Erika A. , Stauss Thomas G. , Scowcroft James A. , Jaasma Michael J. , Edgar Deborah R. , White Judith L. , Sills Shawn M. , Amirdelfan Kasra , Guirguis Maged N. , Xu Jijun , Yu Cong , Nairizi Ali , Patterson Denis G. , Creamer Michael J. , Galan Vincent , Bundschu Richard H. , Mehta Neel D. , Sayed Dawood , Lad Shivanand P. , DiBenedetto David J. , Sethi Khalid A. , Goree Johnathan H. , Bennett Matthew T. , Harrison Nathan J. , Israel Atef F. , Chang Paul , Wu Paul W. , Argoff Charles E. , Nasr Christian E. , Taylor Rod S. , Caraway David L. , Mekhail Nagy A.
Published: October 2024

Background:

The SENZA-PDN study evaluated high-frequency 10-kHz spinal cord stimulation (SCS) for the treatment of painful diabetic neuropathy (PDN). Over 24 months, 10-kHz SCS provided sustained pain relief and improved health-related quality of life. This report presents additional outcomes from the SENZA-PDN study, focusing on diabetes-related pain and quality of life outcomes.

Methods:

The SENZA-PDN study randomized 216 participants with refractory PDN to receive either conventional medical management (CMM) or 10-kHz SCS plus CMM (10-kHz SCS + CMM), allowing crossover after six months if pain relief was insufficient. Postimplantation assessments at 24 months were completed by 142 participants with a permanent 10-kHz SCS implant, comprising 84 initial and 58 crossover recipients. Measures included the Brief Pain Inventory for Diabetic Peripheral Neuropathy (BPI-DPN), Diabetes-Related Quality of Life (DQOL), Global Assessment of Functioning (GAF), and treatment satisfaction.

Results:

Over 24 months, 10-kHz SCS treatment significantly reduced pain severity by 66.9% ( P < .001; BPI-DPN) and pain interference with mood and daily activities by 65.8% ( P < .001; BPI-DPN). Significant improvements were also observed in overall DQOL score ( P < .001) and GAF score ( P < .001), and 91.5% of participants reported satisfaction with treatment.

Conclusions:

High-frequency 10-kHz SCS significantly decreased pain severity and provided additional clinically meaningful improvements in DQOL and overall functioning for patients with PDN. The robust and sustained benefits over 24 months, coupled with high participant satisfaction, highlight that 10-kHz SCS is an efficacious and comprehensive therapy for patients with PDN.
Excessive or sustained endoplasmic reticulum stress: one of the culprits of adipocyte dysfunction in obesity
Authors: Jiang Yu , Guo Jia-Qi , Wu Ya , Zheng Peng , Wang Shao-Fan , Yang Meng-Chen , Ma Gen-Shan , Yao Yu-Yu
Published: October 2024

As the prevalence of obesity continues to rise globally, the research on adipocytes has attracted more and more attention. In the presence of nutrient overload, adipocytes are exposed to pressures such as hypoxia, inflammation, mechanical stress, metabolite, and oxidative stress that can lead to organelle dysfunction. Endoplasmic reticulum (ER) is a vital organelle for sensing cellular pressure, and its homeostasis is essential for maintaining adipocyte function. Under conditions of excess nutrition, ER stress (ERS) will be triggered by the gathering of abnormally folded proteins in the ER lumen, resulting in the activation of a signaling response known as the unfolded protein responses (UPRs), which is a response system to relieve ERS and restore ER homeostasis. However, if the UPRs fail to rescue ER homeostasis, ERS will activate pathways to damage cells. Studies have shown a role for disturbed activation of adipocyte ERS in the pathophysiology of obesity and its complications. Prolonged or excessive ERS in adipocytes can aggravate lipolysis, insulin resistance, and apoptosis and affect the bioactive molecule production. In addition, ERS also impacts the expression of some important genes. In view of the fact that ERS influences adipocyte function through various mechanisms, targeting ERS may be a viable strategy to treat obesity. This article summarizes the effects of ERS on adipocytes during obesity.
Preparing for aging: Understanding middle-aged user acceptance of AI chatbots through the technology acceptance model
Authors: Wang Aoqi , Zhou You , Ma Haoming , Tang Xingyi , Li Sijia , Pei Runyuan , Piao Meihua
Published: October 2024

Background

Preparing for aging with personalized technology is crucial due to the growing elderly population. Artificial Intelligence (AI), notably AI chatbots in healthcare, has transformed technology by simulating human-like conversations. Research on middle-aged adults’ acceptance of AI chatbots is limited. Assessing middle-aged individuals’ intentions to use AI is vital for enhancing AI competency among the elderly and guiding future interventions.

Objective

This study aims to explore the acceptance of middle-aged individuals toward AI chatbots and influencing factors and verify the usability of Technology Acceptance Model 2 (TAM2) in the use of AI technology in middle-aged people, also to inspire the design of future intelligent systems and online interventions for improving the health and well-being of the aging population.

Methods

A cross-sectional design and snowball sampling method were utilized to conduct an online questionnaire survey among middle-aged adults. The questionnaire was compiled based on TAM2 and was created using the online survey platform. SPSS 26.0 software was used for statistical analysis.

Results

A total of 259 valid questionnaires were included in the final data analysis. The study reported the Cronbach's α of 0.94 for the questionnaire. We found that perceived ease of use, subjective norm, and user image significantly influence users’ intention to use AI chatbots. Notably, perceived usefulness emerged as a complete mediator in the relationship between subjective norm and intention to use, highlighting its central role in shaping user perceptions. The study also revealed a moderate acceptance level among middle-aged adults, emphasizing the need for targeted interventions.

Conclusions

This study emphasized the importance of customizing AI technology to improve its adoption among middle-aged adults, providing valuable guidance for developers and policymakers. The findings indicated the need for effective aging preparation that includes technological competency, suggesting that future planning should encompass comprehensive preparations for aging to enhance AI competency among the middle-aged population.
Digital health literacy: A concept analysis
Authors: Ban Suyeon , Kim Yirang , Seomun GyeongAe
Published: October 2024

Objective

To elucidate the concept of digital health literacy by delineating its primary dimensions, origins and effects. Through this clarification, we seek to augment our understanding of the contemporary use of the concept of digital health literacy.

Methods

Rodgers's concept analysis was employed to investigate digital health literacy as a context-influenced concept evolving with technological progress. Six databases (PubMed, Embase, CINAHL, RISS, KISS and DBpia) and Google Scholar were searched from 2006 to 2023, focusing on the terms ‘digital health literacy’, ‘eHealth literacy’ and ‘mHealth literacy’. Of 2,819 papers, 32 were included in the analysis to identify the conceptual structure of digital health literacy.

Results

The conceptual structure of digital health literacy was identified, and its evolution was traced. Currently, the four critical attributes are (a) goal-driven regulation, (b) information processing, (c) communication and (d) utilisation. Functional literacy, prior health knowledge and experience, and access to technology are antecedents, while positive health outcomes, increased perceived control and enhanced health-related quality of life emerged as consequences. Additionally, the concept was influenced by multilevel contextual factors.

Conclusions

By enhancing our understanding of digital health literacy; standardising its terminology; and exploring the interactions among its antecedents, consequences and influencing factors, this study aims to reduce health disparities and promote equitable health in the digital era. The results of this foundational work, which establishes a basis for future research and policy development, provide clear pathways for developing targeted interventions and measurement tools of digital health literacy, ultimately contributing to better health practices.
Engaging with artificial intelligence in mammography screening: Swedish breast radiologists’ views on trust, information and expertise
Authors: Högberg Charlotte , Larsson Stefan , Lång Kristina
Published: October 2024

Objectives

Lack of trust and transparency is stressed as a challenge for clinical implementation of artificial intelligence (AI). In breast cancer screening, AI-supported reading shows promising results but more research is needed on how medical experts, which are facing the integration of AI into their work, reason about trust and information needs. From a sociotechnical information practice perspective, we add to this knowledge by a Swedish case study. This study aims to: (1) clarify Swedish breast radiologists’ views on trust, information and expertise pertaining to AI in mammography screening and (2) analytically address ideas about medical professionals’ critical engagement with AI and motivations for trust in AI.

Method

An online survey was distributed to Swedish breast radiologists. Survey responses were analysed by descriptive statistical method, correlation analysis and qualitative content analysis. The results were used as foundation for analysing trust and information as parts of critical engagements with AI.

Results

Of the Swedish breast radiologists ( n = 105), 47 answered the survey (response rate = 44.8%). 53.2% ( n = 25) of the respondents would to a high/somewhat high degree trust AI assessments. To a great extent, additional information would support the respondents’ trust evaluations. What type of critical engagement medical professionals are expected to perform on AI as decision support remains unclear.

Conclusions

There is a demand for enhanced information, explainability and transparency of AI-supported mammography. Further discussion and agreement are needed considering what the desired goals for trust in AI should be and how it relates to medical professionals’ critical evaluation of AI-made claims in medical decision support.
Enhancing the prediction of the invasiveness of pulmonary adenocarcinomas presenting as pure ground-glass nodules: Integrating intratumor heterogeneity score with clinical-radiological features via machine learning in a multicenter study
Authors: Zheng Hong , Chen Wei , Qi Wanyin , Liu Haibo , Zuo Zhichao
Published: October 2024

Objective

The invasiveness of lung adenocarcinoma significantly impacts clinical decision-making. However, assessing this invasiveness preoperatively, especially when it manifests as pure ground-glass nodules (pGGN) on CT scans, poses challenges. This study aims to quantify intratumor heterogeneity (ITH) and determine whether the ITH score can enhance the accuracy of invasiveness predictions.

Methods

A total of 524 patients with lung adenocarcinomas presenting as pGGN were enrolled in the study, with 177 (33.78%) receiving a pathologic diagnosis of invasiveness. Four diagnostic approaches were developed to predict the invasiveness of lung adenocarcinoma presenting as pGGN: (1) conventional lesion size, (2) ITH score, (3) clinical-radiological features (ClinRad), and (4) integration of the ITH score with ClinRad. ClinRad alone or in combination with the ITH score served as the input for 11 machine learning approaches. The trained models were evaluated in an independent validation cohort, and the area under the curve (AUC) was calculated to assess classification performance.

Results

The conventional lesion size showed the lowest performance, with an AUC of 0.826 (95% confidence interval [CI]: 0.758–0.894), while the ITH score outperformed it with an AUC of 0.846 (95% CI: 0.787–0.905). The CatBoost model performed best when the ITH score and ClinRad were both used as input features, leading to the development of an ITH-ClinRad-guided CatBoost classifier. CatBoost also excelled with ClinRad alone, resulting in a ClinRad-guided CatBoost classifier with an AUC of 0.830 (95% CI: 0.764–0.896), surpassed by the ITH-ClinRad-guided CatBoost classifier with an AUC of 0.871 (95% CI: 0.818–0.924).

Conclusion

The ITH-ClinRad-guided CatBoost classifier emerges as a promising tool with significant potential to revolutionize the management of lung adenocarcinomas presenting as pGGNs.
School Counselors’ Experiences of Induction and Mentoring
Authors: Kitching Emily , Mullen Patrick R. , Chae Nancy , Backer Adrienne
Published: October 2024

We analyzed data from a national sample to explore whether school counselors participated in induction programs and mentoring and how that participation impacted burnout and work engagement. Results indicated that, although school counselors often had mentors, most did not participate in induction programs. Both work engagement and burnout improved when participants engaged in induction programs and mentoring. We discuss the implication of these findings for practice and future research.