bluuebunny/crossref_metadata_2025 huggingface dataset:
Breaking down barriers: A qualitative study of the influence of clinical space design on teamwork
Authors: Allen Kara Jane , De Luca Lauren , Purdy Eve , Barrios Nova , Purdy Spencer , Szabo Rebecca A.
Published: December 2024

Background

Delivery of safe maternity care requires not only individual competence but collective team work, influenced by knowledge, team culture and physical working spaces. The ideal layout for a birthing unit is not known, but deliberate changes to the built environment can influence patient care.

Aims

To explore the impact of creation of an open ‘hub’ on maternity team culture in a tertiary birthing unit and how physical changes to the environment shape values and practice.

Materials and Methods

Semi‐structured interviews of members of the interprofessional team in a tertiary birth suite were performed and analysed using thematic analysis.

Results

Seventeen healthcare workers participated in interviews. Themes included: (i) enhanced psychological safety; (ii) impacts on teamwork; (iii) unintended consequences; and (iv) future directions for team cohesion and collaboration.

Conclusions

Changes to the built environment can impact team work. This qualitative study identified benefits and unintended consequences to removing a wall, creating a maternity hub. Individuals, departmental leadership, and hospital executives should consider how changes to the built environment can be an effective and efficient way to shape teamwork and organisational culture.
Institutionalizing Spending and Strategic Reviews: Supporting Effective Public Management
Authors: Shepherd Robert P. , Lindquist Evert A.
Published: December 2024

Canada has long been a leader in conducting episodic spending reviews to check public spending. However, it has fallen behind many other countries that have taken a more consistent approach relying to a much larger extent on strategic reviews that not only check spending, but also examine the links between spending and policy priorities. To bring greater coherence to review processes, we argue that an embedded system would greatly enhance decision‐makers' ability to make more informed budgetary choices that draw on reliable longitudinal data. There are many ways to organize reviews, and this article provides comparative international experience that could inform discussion on the rationale and benefits of an embedded review system that could be led by the Treasury Board Secretariat. We suggest that there may be a pathway to such implementation that must take into certain preconditions for success.
Loss of SMARCA4 induces sarcomatogenesis through epithelial–mesenchymal transition in ovarian carcinosarcoma
Authors: Katayama Yoshihiro , Iwasaki Takeshi , Yamamoto Takeo , Shimada Naomi , Nakashima Miya , Toya Masato , Narutomi Fumiya , Tomonaga Takumi , Kato Kiyoko , Oda Yoshinao
Published: December 2024

Ovarian carcinosarcoma (OCS) is a rare and aggressive tumor, and the development of its sarcomatous component is believed to be due to epithelial–mesenchymal transition (EMT). The SWIch/sucrose nonfermentable chromatin remodeling factor (CRF) is closely related to EMT; however, the relationship between CRF and EMT in OCS remains unclear. In this study, we analyzed the protein expression of CRFs, including ARID1A and SMARCA4, and their downstream mRNA expression in 28 OCS cases, two fallopian tube CS cases, and one peritoneal CS case. ARID1A and SMARCA4 exhibited a histological type‐specific loss of protein expression in 5 of 11 (45%) endometrioid cases and all 5 serous/homologous OCS cases, respectively. The mRNA analysis suggested that sarcomatogenesis is induced by the transforming growth factor‐β and Hippo signaling pathways, both of which regulate YAP1. Immunostaining for YAP1 suggested YAP1‐associated sarcomatogenesis in the CRF‐retained group, whereas YAP1‐unassociated sarcomatogenesis was suggested in the CRF‐reduced group. High‐grade serous carcinoma cell line experiments showed that the transcriptome of the SMARCA4‐knockdown group showed lower expression of the epithelial gene CDH1 and higher expression of mesenchymal genes such as VIM, ZEB1, and SNAI1 than the control group. Moreover, cell adhesion disappeared and cell morphology changed to a spindle shape, indicating sarcomatogenesis. In conclusion, this study reveals a mechanism for sarcoma development in OCS and provides novel therapeutic possibilities.
Prediction of Optimal Positive Airway Pressure in Chinese Patients With Obstructive Sleep Apnea
Authors: Pang Feng , Deng Wenmin , Huang Jingyan , Guo Yu , Lin Minmin , Zhang Xiangmin , Liu Jie
Published: December 2024

Purpose

Positive airway pressure (PAP) is the primary treatment for obstructive sleep apnea (OSA). This study aims to predict the optimal PAP pressure in Chinese OSA patients by their polysomnography (PSG) variables and demographic characteristics.

Methods

Patients with an apnea–hypopnea index (AHI) ≥ 15 times/h who received PAP therapy (residual AHI < 5 times/h) and underwent PSG were included in this study. Sex, age, body mass index (BMI), Epworth Sleepiness Scale (ESS), AHI, supine AHI, lowest oxygen saturation (LSaO2), percentage of total sleep time spent with SaO2 < 90% (CT90), and PAP pressure were recorded. PAP pressure and other variables were analyzed using univariate correlation and multivariate linear stepwise regression analysis.

Results

A total of 167 patients were enrolled, with 122 in the study group and 45 in the validation group. Univariate correlation analysis revealed a significant correlation between PAP pressure and age, BMI, ESS, AHI, supine AHI, LSaO2, and CT90. The multivariate linear regression analysis showed that PAP pressure was correlated with gender (b = 1.142, p = 0.032), age (b = −0.039, p = 0.005), AHI (b = 0.047, p = 0.000), and CT90 (b = 0.037, p = 0.000). The final PAP pressure prediction equation was PAPpre (cmH2O) = 8.548 + 1.142 × sex −0.039 × age + 0.047 × AHI + 0.037 × CT90 (R2 = 0.553) (male is defined as 0 and female as 1). This model accounts for 55.3% of the optimal pressure variance, and the area under the ROC curve of PAP prediction pressure is 0.7419.

Conclusion

PSG variables can be used to predict PAP pressure in Chinese OSA patients, but for some individuals, the prediction model is not very good. PAP is correlated with age, BMI, ESS, AHI, supine AHI, LSaO2, and percentage of total sleep time spent with SaO2 < 90% (CT90), which can be used to predict the optimal PAP pressure.
Hypoglycaemic stimulation of macrophage cytokine release is suppressed by AMP‐activated protein kinase activation
Authors: Zhang Jiping , Pollard Alice E. , Pearson Eleanor F. , Carling David , Viollet Benoit , Ellacott Kate L. J. , Beall Craig
Published: December 2024

Aims

Acute hypoglycaemia promotes pro‐inflammatory cytokine production, increasing the risk for cardiovascular events in diabetes. AMP‐activated protein kinase (AMPK) is regulated by and influences the production of pro‐inflammatory cytokines. We sought to examine the mechanistic role of AMPK in low glucose‐induced changes in the pro‐inflammatory cytokine macrophage migration inhibitory factor (MIF), which is elevated in people with diabetes.

Methods

Macrophage cell line Raw264.7 cells, primary macrophage bone marrow‐derived macrophages obtained from wild‐type mice or AMPK γ1 gain‐of‐function mice, were used, as were AMPKα1/α2 knockout mouse embryonic fibroblasts (MEFs). Allosteric AMPK activators PF‐06409577 and BI‐9774 were used in conjunction with inhibitor SBI‐0206965. We examined changes in protein phosphorylation/expression using western blotting and protein localisation using immunofluorescence. Metabolic function was assessed using extracellular flux analyses and luciferase‐based ATP assay. Cytokine release was quantified by enzyme‐linked immunosorbent assay (ELISA). Oxidative stress was detected using a fluorescence‐based reactive oxygen species (ROS) assay, and cell viability was examined using flow cytometry.

Results

Macrophages exposed to low glucose showed a transient and modest activation of AMPK and a metabolic shift towards increased oxidative phosphorylation. Moreover, low glucose increased oxidative stress and augmented the release of macrophage MIF. However, pharmacological activation of AMPK by PF‐06409577 and BI‐9774 attenuated low glucose‐induced MIF release, with a similar trend noted with genetic activation using AMPKγ1 gain‐of‐function (D316A) mice, which produced a mild effect on low glucose‐induced MIF release. Inhibition of NFĸB signalling diminished MIF release and AMPK activation modestly but significantly reduced low glucose‐induced nuclear translocation of NFĸB.

Conclusions

Taken together, these data indicate that pharmacological AMPK activation suppresses the release of MIF from macrophages caused by energy stress, suggesting that AMPK activation could be a useful strategy for mitigating hypoglycaemia‐induced inflammation.
Pre‐arrest atrial fibrillation and neurological recovery after cardiac arrest among hospitalized patients: A retrospective cohort study
Authors: Wang Chih‐Hung , Chen Yan‐Yu , Wu Meng‐Che , Ho Li‐Ting , Wu Cheng‐Yi , Tay Joyce , Lin Wei‐Han , Lin Jr‐Jiun , Yeh Huang‐Fu , Wu Yen‐Wen , Huang Chien‐Hua , Chen Wen‐Jone
Published: December 2024

Background

New‐onset atrial fibrillation (AF) is associated with an increased risk of stroke in hospitalized patients with severe sepsis. Post‐cardiac arrest patients experience conditions similar to sepsis. This study investigated whether pre‐arrest AF is associated with poor neurological recovery following in‐hospital cardiac arrest (IHCA).

Methods

This single‐centre retrospective study included patients experiencing IHCA between 2005 and 2020. Pre‐arrest electrocardiograms (ECGs) were reviewed, including twelve‐lead ECGs and ECG strips. New‐onset AF was defined as AF absent on electronic health records (EHRs, including admission diagnosis, past medical history and hospitalization notes) but present on pre‐arrest ECG. Without considering EHRs, AF‐presence was defined as AF present on pre‐arrest ECG.

Results

A total of 2466 patients were included, including 93 (3.8%) with new‐onset AF and 131 (5.3%) with evidence of AF on pre‐arrest ECG. The median age was 67.6 (interquartile range [IQR]: 22.3) years and the median CHA₂DS₂‐VASc score was 3.0 (IQR: 3.0). A total of 405 (16.4%) patients survived to hospital discharge, with 228 (9.2%) patients achieving favourable neurological recovery. Multivariable logistic regression analysis indicated that both new‐onset AF (odds ratio [OR]: .34, 95% confidence interval [CI]: .12–.94, p‐value: .04) and AF‐presence (OR: .35, 95% CI: .15–.85, p‐value: .02) were inversely associated with favourable neurological recovery in the primary and sensitivity analyses, respectively.

Conclusions

Pre‐arrest AF is a significant risk factor for poor neurological recovery following IHCA. Further research is needed to understand the underlying mechanisms, which could inform the development of strategies to improve outcomes in this patient subgroup.
Messages in the Medium: Modernism and Self‐Awareness in the Digital Age*
Authors: Schultz Annie R.
Published: December 2024

In this article, Annie Schultz argues that there are messages to be found in mediums. As an addition to media literacy education in the digital information era, Schultz joins in conversation with philosophers of education who have turned to aesthetics and visual culture studies as a way of interpreting digital misinformation. She suggests that themes in art and issues raised in art criticism provide tools for understanding critically how digital media impacts us aesthetically and affectively. Modernism, in particular, is a movement in art that offers interpretive tools for understanding how all the mediums of our information‐fueled world impinge on our lived experience. By attending to mediums, we can develop the self‐awareness necessary to understand critically how digital mediums influence how we make meaning.
What the Turtles Taught Us: Improving Migratory Outcomes for Eastern Long‐Necked Turtles Across Conservation Fences
Authors: Brewster Rob , Roncolato Francesca , Jameson Tom , Ferronato Bruno Oliveira , Dexter Nick , Macgregor Christopher , Maple Dion , Valentine Leonie E.
Published: December 2024

In Australia, conservation fences are widely used to enclose threatened native species in an area while excluding European Red Foxes (Vulpes vulpes) and Cats (Felis catus) that threaten them. However, conservation fences can have unintended negative consequences on other species within their vicinity, interrupting movement patterns and causing mortality via entrapment. A key component of conservation fence design should be the inclusion of structures to allow the transit of species negatively affected by fences, while maintaining an effective barrier to threats. In this study, we designed and tested a method to allow the movement of Eastern Long‐necked Turtles (Chelodina longicollis) through a ‘turtle tunnel’ under a conservation fence. This Australian freshwater turtle periodically migrates over land in response to changing weather conditions, wet‐dry cycles of wetlands, to nest, and to seek habitat and food resources. We tested the ability of wild‐caught Eastern Long‐necked Turtles to enter and traverse turtle tunnels in pen trials. We found that Turtles were able to navigate the turtle tunnels as intended, with 100% of individuals entering tunnels and 44% successfully traversing the tunnels during the timed trial. These results were used to inform the placement of nine turtle tunnels along a new conservation fence at Booderee National Park, Jervis Bay Territory, Australia. We monitored installed turtle tunnels at Jervis Bay for 6 months using a combination of camera traps and observational data collected during daily fence line checks. We found further evidence for the use of tunnels by Eastern Long‐necked Turtles and found that Foxes did not attempt to traverse tunnels. From our findings, we suggest that turtle tunnels be considered in the construction of conservation fences where they intersect with known areas of freshwater turtle migrations, but that further research is required to assess the long‐term effectiveness of the design as a wildlife transit device.
Neural substrates underlying distinct dual cognitive syndromes in Parkinson's disease
Authors: Yoshimura Kenji , Shima Atsushi , Kambe Daisuke , Furukawa Koji , Nishida Akira , Wada Ikko , Sakato Yusuke , Sakamaki‐Tsukita Haruhi , Terada Yuta , Yamakado Hodaka , Taruno Yosuke , Nakanishi Etsuro , Sawamura Masanori , Fujimoto Koji , Fushimi Yasutaka , Okada Tomohisa , Nakamoto Yuji , Hanakawa Takashi , Takahashi Ryosuke , Sawamoto Nobukatsu
Published: December 2024

Background

A dual‐syndrome hypothesis, which states the cognitive impairments in Parkinson's disease (PD) are attributable to frontostriatal dopaminergic dysregulation and cortical disturbance—each associated with attention/executive and memory/visuospatial dysfunction, respectively—has been widely accepted. This multisystem contribution also underlies highly heterogeneous progression rate to dementia.

Methods

Nondemented PD patients who underwent [123I]N‐ω‐fluoropropyl‐2β‐carbomethoxy‐3β‐(4‐iodophenyl) nortropane ([123I]FP‐CIT) SPECT and neuropsychological examinations were enrolled. Patients who agreed to participate and age‐ and sex‐matched healthy controls (HCs) also underwent 7‐T MRI. Patients were classified as cognitively normal (PD‐CN) or mild cognitive impairment (PD‐MCI) following the level II criteria of Movement Disorder Society Guideline.

Results

A total of 155 patients (PD‐CN/PD‐MCI 74/81) were enrolled, whereas 76 patients (PD‐CN/PD‐MCI 35/41) and 56 HCs underwent 7 T‐MRI. The caudate [123I]FP‐CIT uptake in PD was correlated with the performance of attention/working memory (trail‐making test [TMT]‐A and symbol digit modality test) and executive (TMT‐B) domains. In contrast, the regional cortical thickness in the left frontotemporal and right frontal lobes in PD was correlated with performance of memory (Hopkins verbal learning test‐revised delayed recall) and visuospatial (judgment of line orientation) domains. Moreover, compared to 37 HCs with a Montreal Cognitive Assessment score of >25, PD‐CN patients showed broad occipitoparietal cortical thinning.

Conclusions

We demonstrated distinctive impairments of dopaminergic frontostriatal deficits and cortical degeneration as neural bases for the dual‐syndrome hypothesis. Our findings suggest that occipitoparietal lobe thinning occurs at a cognitively normal stage, and additional frontotemporal lobe thinning underlies impairments in the memory and visuospatial domains at the PD‐MCI stage.
Levels and Spatial Patterns of Effective Population Sizes in the Southern Damselfly (Coenagrion mercuriale): On the Need to Carefully Interpret Single‐Point and Temporal Estimations to Set Conservation Guidelines
Authors: Lévêque Agathe , Duputié Anne , Vignon Vincent , Duez Fabien , Godé Cécile , Mazoyer Clément , Arnaud Jean‐François
Published: December 2024

The effective population size (Ne) is a key parameter in conservation and evolutionary biology, reflecting the strength of genetic drift and inbreeding. Although demographic estimations of Ne are logistically and time‐consuming, genetic methods have become more widely used due to increasing data availability. Nonetheless, accurately estimating Ne remains challenging, with few studies comparing Ne estimates across molecular markers types and estimators such as single‐sample methods based on linkage disequilibrium or sibship analyses versus methods based on temporal variance in allele frequencies. This study aims at bridging this gap by analysing single‐sample and temporally spaced populations in the southern damselfly (Coenagrion mercuriale), a bioindicator Odonata species of conservation concern found in southwestern Europe's freshwater stream networks. A total of 77 local populations were sampled from a semi‐urbanised area located in eastern France near Strasbourg city, yielding 2842 individuals that were genotyped with microsatellites and 958 of which were also genotyped for 2092 SNPs. Spatial genetic structure was stable over time, suggesting porosity between alternate‐year cohorts. When accounting for spatial genetic structure, single‐sample and temporal estimations of Ne were consistent for each set of molecular markers. Biologically meaningful results were obtained when the effect of migration was minimising by considering metapopulation Ne estimates based on the level of genetic differentiation and population boundaries. In terms of applied conservation and management, most depicted metapopulations displayed large Ne, indicating no immediate need for conservation measures to mitigate anthropogenic pressures, provided that a continuous suitable freshwater network is maintained. However, urbanisation negatively impacted Ne levels in populations close to Strasbourg city. Because Ne is used to inform conservation decisions, caution is crucial in interpreting Ne estimates, especially in continuously distributed populations undergoing migration. Altogether, our study highlights the challenge of obtaining robust Ne estimates and the necessity of careful interpretation to set relevant conservation guidelines.
Transglutaminase 2 is an RNA‐binding protein: experimental verification and characterisation of a novel transglutaminase feature
Authors: Csaholczi Bianka , Csuth Anna Renáta , Korponay‐Szabó Ilma Rita , Fésüs László , Király Róbert
Published: December 2024

Transglutaminase 2 (TG2) is a uniquely versatile protein with diverse catalytic activities, such as transglutaminase, protein disulfide isomerase, GTPase and protein kinase, and participates in several biological processes. According to information available in the RBP2GO database, TG2 can act as an RNA‐binding protein (RBP). RBPs participate in posttranscriptional gene expression regulation, therefore influencing the function of RNA, whereas RNA molecules can also modulate the biological activity of RBPs. The present study aimed to confirm this novel characteristic of TG2 in human umbilical cord vein endothelial cells (HUVEC), which physiologically express TG2. First, UV cross‐linked RNA–protein complexes were isolated from immortalised HUVECs using orthogonal organic phase separation. Compared with the RBP2GO database, mass spectrometry identified 392 potential RBPs, including TG2 and 20 previously undescribed, endothelium‐related RBPs. Recombinant human TG2 was also pulled down by magnetic bead‐immobilised total RNA from HUVEC. Complex formation between TG2 and a 43‐mer RNA molecule with a secondary structure as well as a homo‐oligomeric single‐stranded poly(dG), but not poly(dA), could be observed in magnetic RNA–protein pull‐down experiments. Experiments with TG2 inhibitors NC9 and GTPγS, which stabilise its open and closed conformation, respectively, revealed that the open conformation of the enzyme favoured RNA‐binding. Biolayer interferometry revealed a high binding affinity between TG2 and RNA with a KD value of 88 nm. Based on modelling and site‐directed mutagenesis studies, we propose that superficial residues on the catalytic core domain (173–177 amino acids), present in a hidden position in the closed TG2 conformation, are involved in RNA binding. The present study demonstrates the previously uncharacterised RNA‐binding ability of TG2, opening new avenues for understanding its multifunctionality.
Engagement With Professional Stakeholders in Healthcare Research—The Case of the Dementia PersonAlised Care Team (D‐PACT) Project in the United Kingdom
Authors: Hussain Basharat , Wheat Hannah , Oh Tomasina M. , Byng Richard
Published: December 2024

Introduction

In this viewpoint we highlight a gap in the literature relating to the involvement of professional stakeholders in healthcare evaluation research.

Method

Using the Dementia—PersonAlised Care Team (D‐PACT) project as an example, we illustrate how professional stakeholder work can serve various functions, from understanding commissioning and policy context to contributing to detail of intervention components.

Outcome

We argue that identifying these project‐specific functions can help researchers to effectively plan when, how and for whom they will engage in professional stakeholder work across the course of an evaluation. In addition, we call for further evidence‐based guidance and sufficient allocation of resources (provided by those funding research projects) to support effective stakeholder work.

Conclusion

Such support will not only enhance evaluation findings but also promote continued learning on best practice for professional stakeholder work.

Patient or Public Contribution

Public and patient involvement contributors were involved in the main D‐PACT study design, development of data collection tools and interpretation of study findings.
Examination of Multimedia Learning Principles in Augmented Reality and Virtual Reality Learning Environments
Authors: Çeken Burç , Taşkın Nazım
Published: December 2024

Background

Multimedia learning, encapsulating both visual and verbal information, has become pivotal in educational settings, with extensive research underscoring its influence. However, a notable research gap exists concerning the application and effectiveness of multimedia learning principles, precisely segmenting, pre‐training and modality, within emerging technologies like augmented reality (AR) and virtual reality (VR). This deficit, coupled with inconsistent findings in computer‐based learning studies and a lack of focus on intrinsic cognitive load and motivation in multimedia learning, motivates the current research.

Objectives

This research aims to provide insights by comparing the efficacy of these principles across different learning environments, including traditional, AR and VR.

Methods

Employing a 3 × 4 factorial design, this study involved 383 university students, randomly assigned to 12 treatment groups, to investigate multimedia learning principles in different environments. Participants engaged with learning materials on lightning formation and cell structure in various settings, including AR and VR, with data collected through multiple instruments, such as retention and transfer tests, and cognitive load and motivation questionnaires.

Results and Conclusions

Results reveal that AR environments significantly improved retention scores in cell structure compared to traditional methods but had no notable impact on lightning formation. The effectiveness of educational strategies, such as modality and segmenting, depends on the subject's complexity and the learning environment's specifics. Importantly, the study underscores the need to tailor educational techniques to the subject matter, learning environment and individual learner nuances to enhance learning efficacy.
The prognostic value of the systemic immunity–inflammation index for cardiovascular and all‐cause mortality in cardiovascular disease patients with diabetes or prediabetes
Authors: Long Zhengyi , Du Jingyun , Hu Jie , Xiao Yang , Hou Can
Published: December 2024

Background

The relationship between the systemic immune–inflammatory index (SII) and the prognosis of cardiovascular disease (CVD) patients with diabetes or prediabetes remains uncertain. This study investigated the association between baseline SII and all‐cause and cardiovascular mortality in American adults with CVD and diabetes or prediabetes.

Methods

Our survey included 4,060 adults with cardiovascular disease and diabetes or prediabetes from the National Health and Nutrition Examination Survey (1998–2020). Using restricted cubic splines (RCS) based on Cox regression models and a two‐piecewise Cox proportional hazards model for both sides of the inflection point, we elucidated the nonlinear relationship between baseline SII and mortality. Mediation analysis was used to explore the indirect impact of SII on mortality through eGFR.

Results

In the median 129 months of follow‐up, 620 people died from cardiovascular causes and 1,800 from all causes. In the CVD population with diabetes or prediabetes, SII showed a U‐shaped relationship with all‐cause mortality. The association between SII and CVD mortality was nonlinear and J‐shaped. Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between SII and both all‐cause and cardiovascular mortality by 9.4% and 6.9%, respectively.

Conclusions

SII revealed a U‐shaped relationship with all‐cause mortality (inflection point: lnSII = 6) and a J‐shaped association with CVD mortality (inflection point: lnSII = 5.73) in CVD patients with diabetes or prediabetes among American patients. Thus, assessing the SII index may offer valuable insights into risk assessment and prognosis in patients with CVD who are diabetic or prediabetic.
Guidance Documents for Off‐Label Drug Use Management for Chinese Health Care Institutions: A Scoping Review
Authors: Shi Changcheng , Yang Yingying , Wu Changling , Wang Limin , Dong Yehua , Qi Yajun , Hu Lingling , Chen Ling , Li Qingyu , Jiang Qianqian , Lin Nengming , Wang Gang
Published: December 2024

Background

Off‐label drug use (OLDU) is a common practice in health care institutions, and numerous guidance documents have been developed to guide the management of OLDU in China. This scoping review aims to compare these documents and identify existing issues.

Methods

PubMed, EMbase, three Chinese databases, the National Public Service Platform for Standards Information and the official websites of pharmaceutical‐related associations were searched to identify guidance documents relevant to the management of OLDU for Chinese health care institutions. We extracted and compared the recommended practices for various aspects of OLDU management, including management systems, organizational structure, prerequisites for OLDU, approval processes, evidence‐based evaluation, informed consent, and other related aspects.

Results

A total of 16 guidance documents were included, comprising 12 expert consensuses, 2 practice guidelines, and 2 group standards. Only six documents provide specific requirements for the establishment of management systems. Management of OLDU requires involvement from multiple departments or committees, yet only a few documents explicitly delineate the supervisory authority, and the responsibilities of the parties involved. These documents also show significant disparities in their approval process, evidence‐based evaluation, and informed consent recommendations. Furthermore, only a minority of the documents provide specific requirements for training and assessments focused on OLDU and improving adverse reaction monitoring.

Conclusion

These guidance documents differ significantly in their specific recommendations for the management of OLDU and lack sufficient emphasis on certain critical aspects. It may be beneficial for health administrative authorities to promote the development of unified national guidelines.
The efficacy of market timing and value creation
Authors: Lan Chunhua
Published: December 2024

In this article, I use a total timing measure that differentiates between cash‐flow timing and discount‐rate timing to assess value creation among actively managed US equity mutual funds. My findings indicate that some funds exhibit cash‐flow timing skills. Collectively, the top 20% of timing funds generate $3.4 billion annually in constant January 2000 dollars. Both sector rotation and individual stock selection contribute to executing timing techniques. Skilled timing funds shift their stockholdings toward cyclical sectors when anticipating positive changes in aggregate cash flows and toward defensive sectors when anticipating negative changes. Sector funds demonstrate similar cash‐flow timing skills through their individual stock bets.
Life Challenges and Quality of Life of People Living With Coeliac Disease: Time of Diagnosis Matters
Authors: Stroebele‐Benschop Nanette , Rau Christine J. , Dieze Anastasia , Bschaden Andreas
Published: December 2024

Background

Previous studies have examined the quality of life of patients with coeliac disease. There is a lack of understanding about potential changes in emotional responses and life challenges after diagnosis. This exploratory study aimed to evaluate the emotional impact, life challenges and quality of life in people living with coeliac disease in Germany.

Methods

An online survey was conducted among patients with coeliac disease to assess difficulties in implementing a gluten‐free diet in daily life activities, including food shopping and preparation, and eating away from home, as well as additional costs of time and money. Furthermore, the questionnaire assessed the time of diagnosis, emotions felt after diagnosis and today, compliance regarding the gluten‐free diet and sociodemographic data. Participants were recruited in 2022 via social media, newsletters and websites. Out of 1286 participants who had taken part in the survey, 766 met the inclusion criteria and were included in the data analysis.

Results

The majority of the respondents (aged 18–83 years) were female (93%) and almost 50% were diagnosed more than 5 years ago. Negative emotion ratings related to the disease were associated with age at the time of diagnosis and years passed since diagnosis. While compliance was high with 89% of respondents strictly adhering to the gluten‐free diet, patients with coeliac disease reported mainly life challenges in social situations involving food such as out‐of‐home consumption in restaurants, at work and while travelling. These challenges appear to persist over time.

Conclusions

Negative emotions and difficulties in implementing a gluten‐free diet are negatively impacting individuals with coeliac disease, particularly in the first months after diagnosis. Particularly adolescents and young adults appear to be negatively impacted. The study emphasises the need to improve the quality of life in all impacted areas through better guidance and improved training of health professionals as well as food providers outside of home and through psychological counselling in the first year of diagnosis to better help individuals improve their quality of life.
Factors Associated With Depression in Caregivers of Adults With Down Syndrome
Authors: Bodde Amy E. , Helsel Brian C. , Danon Jessica , Sherman Joseph , Rice Anna , Williams Kristine , Forseth Bethany , Donnelly Joseph E. , Ptomey Lauren T.
Published: December 2024

Background

Family caregivers of those with developmental disabilities have higher rates of depression and anxiety compared with caregivers of those without development disability. Few studies have examined factors that contribute to caregiver depression, including the appraisal of caregiving responsibilities and the physical fitness and daily function of the care recipient. The purpose of this study was to identify intrapersonal (caregiver) and interpersonal (care recipient) factors associated with depressive symptoms in caregivers of adults with Down syndrome (DS).

Methods

Twenty‐four adults with DS participating in a 12‐month physical activity trial completed physical fitness and function tests (VO2peak, hand grip strength, timed up and go, five times sit to stand) and activities of daily living (ADL) surveys at their baseline visit. Caregivers (n = 24) of the adults with DS completed surveys on caregiving distress, quality of life (QoL) and depressive symptoms. We evaluated the associations of these assessments on caregiver depressive symptoms using Mann–Whitney U tests and Spearman correlations.

Results

Adults with DS were 23 ± 7.5 years, 58% female; caregivers were 54 ± 10 years, 100% female, 96% family members. Caregiver depressive symptoms were significantly associated with caregiving distress (p = 0.024) and caregiving QoL (r = −0.58, p = 0.003). Hand grip strength of care recipients was inversely correlated with caregiver depressive symptoms (r = −0.45, p = 0.03), but other assessments of physical function and ADL were not associated with caregiver depressive symptoms.

Conclusions

Caregiver depressive symptoms were related to modifiable factors related to the caregiver and care recipient. Intervening to improve caregiving appraisal and functional strength of the care recipient may positively impact caregiver mental health.
Clinical Study of Intradermal Injection of Non‐Crosslinked Sodium Hyaluronate Combined With Human Epidermal Growth Factor in the Treatment of Skin Barrier Injury in Plateau Area
Authors: He Ao , Liu Boyan , Hua Yingjian , Gong Zhuo , Gan Fengshan , Zhou Qingzhu , Wang Songmei , Zhao Xian
Published: December 2024

Background

The Yunnan–Guizhou Plateau's high‐altitude setting is characterized by intense solar ultraviolet radiation, a significant environmental stressor that frequently leads to skin barrier damage. This damage presents clinically as erythema, itching, and desquamation, underscoring the need for effective reparative interventions.

Aims

The objective of this study was to assess the therapeutic efficacy of a novel treatment protocol that integrates non‐crosslinked hyaluronic acid (HA) injection with microneedle application of human epidermal growth factor (hEGF) for the restoration of skin barrier function in regions of high altitude.

Methods

Sixty female subjects exhibiting characteristic signs of skin barrier impairment were randomized into four cohorts: a control group and three experimental groups differentiated by hEGF concentration. The intervention comprised subdermal HA injection coupled with microneedle therapy. The VISIA digital skin analysis system was utilized to quantify skin barrier integrity, with assessments performed by a panel of dermatologists and through patient self‐evaluations at baseline and postintervention.

Results

A marked reduction in erythema and indices of skin barrier damage was observed in the experimental groups relative to the control. The cohort administered 10 000 IU hEGF exhibited the most pronounced restoration of skin barrier function, indicative of a dose‐dependent therapeutic response. The treatment demonstrated favorable tolerability without any reported adverse events.

Conclusions

The conjoint application of non‐crosslinked HA and hEGF presents as a potent therapeutic modality for the repair of the skin barrier in high‐altitude environments. Our findings indicate that an optimized concentration of hEGF is pivotal for achieving the most efficacious treatment outcomes.
Hepatitis B Patients' Adherence to Treatment in Relation to Knowledge, Attitudes, and Practices (KAP) in the West Bank, Palestine, 2022–2023
Authors: Sawalmeh Ayham , Johansson Emily White , Kostas Danis , Hjaijeh Dia'a
Published: December 2024

Hepatitis B is an infectious disease that inflicts high health and economic costs on the healthcare system. Poor adherence to treatment increases that cost. We aimed to assess the levels of knowledge, attitudes and practices (KAP) among patients in the West Bank, Palestine, and identify factors associated with good adherence. We conducted a cross‐sectional study surveying hepatitis B patients visiting primary healthcare during October 2022 until June 2023 using an interviewer‐administered questionnaire covering qualitative and quantitative aspects regarding hepatitis B. We considered adherence as good if participants received > 90% of their monthly prescription antiviral doses. Among 386 participants, the median age was 45 years (range 20–81); 80% had good adherence to treatment. Mean knowledge score was 11.4 (on a 13‐point scale), mean attitude score was 3.4 (on a 4‐point scale), mean practices score was 6 (on a 7‐point scale) and the mean overall KAP score was 21.8 (on a 24‐point scale). KAP components (Cronbach alpha = 0.820) were correlated with good adherence (p < 0.001). After adjustment for other factors, participants with good KAP scores had better adherence to treatment than those without (prevalence ratio: 1.41, 95% CI: 1.10–1.84, p‐value = 0.011). We recommend investment in education and awareness campaigns to improve adherence.
Cafeosite, Ca4Fe2+3Fe3+2□O6S4, a new meteoritic oxysulfide, a redox indicator of metamorphic alteration of carbonaceous asteroids
Authors: Ivanova Marina A. , Britvin Sergey N. , Gulyaeva Roza I. , Petrova Sofia A. , Zinovieva Nina G. , Kozlov Vladimir V. , Tyushnyakov Stanislav N. , Kasatkin Anatoly V.
Published: December 2024

A natural iron‐bearing oxysulfide, named сafeosite after its chemical composition, is a unique example of a mineral that simultaneously contains iron in three oxidation states: Fe3+, Fe2+, and intermediate between Fe2+ and Fe0 involved in metallic‐type FeFe bonding. Cafeosite was discovered in metamorphosed carbonaceous chondrite Dhofar 225, which is classified as CM‐anomalous but likely related to the CY (Yamato‐type) group. The mineral occurs as tiny anhedral grains that coalesce into irregular aggregates up to 20 μm, commonly encrusted by micrometer‐thick troilite or pyrrhotite rims. The grains are randomly disseminated within a chondrite matrix composed of thermally altered phyllosilicates. Associated accessory minerals are troilite, pyrrhotite, Fe‐rich, Al‐bearing olivine, unknown Al‐bearing Fe sulfide, Al‐rich chromite, kamacite, awaruite, pentlandite, escolaite, and perovskite. In reflected light, cafeosite is gray, with no internal reflections. Anisotropy is moderate, bireflectance in gray hues. Infrared microspectroscopy did not reveal any bands attributable to (OH)−, H2O or CO32− vibrations. Owing to the small grain size, the crystal structure of the mineral has been studied using synthetic analog, which was found to be isostructural with natural cafeosite based on electron backscatter diffraction (EBSD) data. Cafeosite is orthorhombic, space group Cmce (#64), a 17.4856(9), b 11.1516(5), c 11.1543(5) Å, V 2175.0(2) Å3, Z = 8, Dx = 4.11 g cm−3. The crystal structure has been solved and refined to R1 = 0.039 for 1105 unique reflections. Chemical composition of both natural and synthetic cafeosite corresponds to the formula Ca4Fe2+3Fe3+2(□1−xFex)O6S4 where (□1−xFex) denotes structural vacancy partially occupied by semimetallic‐type Fe (x = 0.2–0.3). The ideal endmember formula of the mineral is Ca4Fe2+3Fe3+2□O6S4. Cafeosite was likely formed from previously altered precursor material of Dhofar 225, which, like common CM chondrites, consisted of phyllosilicates, Ca‐bearing carbonates, tochilinite‐like sulfides–hydroxides and pyrrhotite. During thermal metamorphism at temperatures between 750 and 900°C, sulfides–hydroxides were partly sintered with calcined carbonates and iron oxides, resulting in cafeosite formation. Due to varying and redox‐dependent contents of Fe3+ and Fe2+, as well as the presence of metallic‐type Fe in the structure, cafeosite could be regarded as a single‐phase redox indicator alternative to the known triple‐phase buffers, for example, iron–magnetite–pyrrhotite (IM‐Po), iron–wüstite–pyrrhotite (IW‐Po) and magnetite–wüstite–pyrrhotite (MW‐Po) systems. Discovery of cafeosite provides insight into a previously obscured aspect of CY‐chondrite formation: the redox conditions of thermal metamorphism on carbonaceous asteroids.
Exploring the Decision Making of Women When Planning an Induction of Labor: A Multi‐Method Design
Authors: Sistanis Jasmine , Street Maryann , Nicholson Patricia
Published: December 2024

The aim of this study was to explore women's preferences and experiences of degree of control in decision making when planning an induction of labor (IOL). This multi‐method study was conducted using semi‐structured individual interviews and the completion of two Control Preferences Scales by eight postnatal women from a metropolitan health service in Melbourne, Australia. Four themes were generated from the interview data: “shared decision making”; “changing expectations”; “IOL experience”; and “informed consent.” Women's expectations of, and preferences for, an IOL changed during pregnancy and were influenced by their perception of risk to the fetus, indication for the procedure, and trust in clinicians. Information that was personalized to the woman to include practical aspects, risks, and alternative options was rarely provided. Overall, women reported that they did not experience the degree of control they preferred when planning an IOL. Clinician understanding of decision making preferences of women when planning an IOL can assist with care that is individualized and aligned to women's values, which is crucial to improving the quality of care provided.
Tachycardiomyopathy Treated With Ablation by Using 3D Mapping System in a Patient With Friedreich Ataxia
Authors: Hayıroğlu Mert İlker , Kalenderoğlu Koray , Gürkan Kadir
Published: December 2024

This case report presents the management of tachycardiomyopathy (TCM) in a patient with Friedreich ataxia, a hereditary disorder characterized by progressive neurodegeneration and associated cardiac complications. The patient exhibited severe tachycardia‐induced cardiac dysfunction, complicating the clinical picture due to the overlapping neurological symptoms of Friedreich ataxia. Utilizing a 3D mapping system, catheter ablation was performed to accurately identify and target the arrhythmogenic foci contributing to the patient's TCM. The procedure resulted in significant symptom relief and improvement in cardiac function, underscoring the potential benefits of advanced electrophysiological techniques in managing complex cases. This report highlights the importance of a multidisciplinary approach in diagnosing and treating cardiac manifestations in patients with Friedreich ataxia, as well as the efficacy of 3D mapping technology in guiding successful ablation therapies.
A Simple Way to Exclude a Lethal Complication Following Atrial Fibrillation Radiofrequency Ablation: A Case Report
Authors: Leventopoulos Georgios , Papageorgiou Angeliki , Perperis Angelos , Koniari Ioanna , Tsigkas Grigorios , Davlouros Periklis
Published: December 2024

Esophageal injury is a serious complication following atrial fibrillation catheter ablation procedures. It may manifest as atrio‐esophageal fistula, pericardio‐esophageal fistula (PEF), or restricted perforation, with high mortality rate if left unoperated. Chest computed tomography with intravenous contrast is the mainstay of diagnosis; however, a definite imaging diagnosis is often delayed and may worsen patient outcomes. This case demonstrates that pericardial fluid amylase detection may contribute to early differential diagnosis of PEF versus restricted esophageal perforation combined with inflammatory pericarditis, in patients with relevant symptoms who present with pericardial effusion and may guide either conservative–as our case–or surgical approach.
Abscisic Acid and Ethylene Antagonistically Regulate Root Endodermal Suberization to Mitigate Nonuniform Salt Stress in Cotton
Authors: Chen Yixin , Wang Cong , Tian Shijun , Yao Liying , Zhu Ningxin , Yang Xiubo , Bai Zhiying , Liu Liantao , Zhang Yongjiang , Sun Hongchun , Li Cundong , Zhang Ke
Published: December 2024

The heterogeneity of soil salinity is a critical attribute of saline agricultural environments, particularly for the physiological adaptability of cotton (Gossypium hirsutum L.) plants. However, the mechanisms by which cotton plants acclimate to heterogenous salinity remain poorly understood. To investigate the responses of cotton seedlings to nonuniform salinity, a split‐root system using germination paper was employed to replicate spatially variable salinity conditions within the root zone. The root endodermal barriers, consisting of the suberin lamellae and Casparian strip, were found to be enhanced in the roots on the saline side of this system relative to the nonsaline side, playing a crucial role in maintaining ion balance for cotton seedlings under heterogeneous salt environment. Ethylene levels were higher in roots on the nonsaline side, but significantly lower in roots on the saline side. Notably, abscisic acid (ABA) levels increased in roots on both sides. The delicate balance between ABA and ethylene can modify the root endodermal suberization, thereby regulating the adaptability of cotton seedlings to diverse salt environments.
Coupling Modelling and Experiments to Analyse Leaf Photosynthesis Under Far‐Red Light
Authors: Jans Tinko B. , Mossink Leon , Wassenaar Maarten , Wientjes Emilie , Driever Steven , Huber Martina , Pierik Ronald , de Boer Hugo J.
Published: December 2024

Leaf photosynthesis models are used extensively in photosynthesis research and are embedded in many larger scale models. Typical photosynthesis models simplify light intensity as the integrated intensity over the 400–700 nm waveband (photosynthetic active radiation, PAR). However, far‐red light (700–750 nm, FR) also drives photosynthesis when supplied in addition to light within the PAR spectrum. Currently, it is unknown how much far‐red light contributes to carbon assimilation under various spectral light conditions. We developed a combined experimental and computational method to quantify FR stimulation. Gas‐exchange parameters and incident light spectra were measured simultaneously and analysed with wavelength‐dependent modelling of light harvesting. Hereto, separate excitation of Photosystem I and Photosystem II was calculated from incident light spectra. The effect of FR supplementation on photosynthesis was subsequently modelled and expressed as a single parameter ρ. We tested our method on Solanum dulcamara, Lactuca sativa and Phaseolus vulgaris under various light conditions. Results show consistent ρ‐values across a range of FR levels. Our method provides an approach to consistently quantify the effect of FR stimulation on photosynthesis and harmonise the interpretation of photosynthesis measurements under different light regimes, for example in (experimental) setups with artificial FR supplementation or in canopies.