bluuebunny/crossref_metadata_2025 huggingface dataset:
Logística reversa de resíduos sólidos na construção civil
Authors: Mendes Sunamita Pereira , Lima Diogo Pedreira
Published: May 2022

Estima-se que mais de 50% dos resíduos sólidos gerados pela atividade humana são provenientes da construção civil, onde 98% poderiam ser reciclados. Levando em consideração esses dados, a Resolução CONAMA 307/2002 determina para o gerenciamento adequados dos resíduos da construção civil (RCC), além de em 2010 ter sido publicada a Política Nacional de Resíduos Sólios, determinando a logística reversa. Frente ao exposto, a presenta pesquisa objetiva verificar a aplicação da logística reversa na construção civil no Brasil, através de dados publicados em outros artigos, realizando uma revisão de literatura integrativa. Trata-se de uma revisão de literatura integrativa, do tipo descritiva-exploratória e abordagem qualitativa, por meio de uma pesquisa bibliográfica, referente à logística reversa na construção civil, realizada através do Google Acadêmico, com publicações entre 2020 e 2021. Foram selecionados 13 artigos para a construção da pesquisa, sendo estudos realizados ao longo de todo o território nacional. Embora haja estudos que demonstram bons resultados, todos possuem alguma falha, seja por parte das empresas geradoras de RCC, seja por parte dos órgãos públicos para fiscalização. Nenhum estudo compre todas as determinações da Resolução CONAMA 307/2002 e a PNRS. Há uma necessidade de as empresas implantarem o Programa de Gerenciamento De Resíduos Sólidos da Construção Civil (PGRCC) na construção civil, além de uma necessidade de as prefeituras buscarem realizar corretamente a fiscalização das empresas. Onde deve-se buscar aplicar multas às empresas que não se adequam às normas vigentes, para que assim, a logística reversa consiga ser aplicada no Brasil.
Análise de patologias em galpão construído com estrutura metálica: estudo de caso em fazenda de Brasnorte (MT)
Authors: Barbosa Jonathan Lima , Valin Júnior Marcos de Oliveira , Salvioni Henrique Goes , Franco Fernada Miguel
Published: May 2022

Este trabalho tem como objetivo apresentar um estudo de identificação de patologias apresentadas em um galpão metálico em uma fazenda no município de Brasnorte - MT. Grandes fazendas produtoras de grãos necessitam de um setor para manutenção de maquinários e locação destes, tais máquinas de grande porte exigem estruturas com pé direito elevado, grandes vãos, que resistam a ações dos ventos, peso próprio e momentos solicitantes. Em galpões de fazendas, além das intempéries, destaca-se que a manutenção de máquinas e equipamentos podem gerar resíduos como graxa, óleos, além do uso de insumos agrícolas como os fertilizantes e defensivos agrícolas podem contribuir para a formação de patologias. Foi observado corrosão nos pilares da estrutura metálica que está em contato direto com o solo, sendo está uma região de plantio, há grande presença de substâncias no solo que podem ter uma característica corrosiva como fertilizantes e defensivos, que tendem a aumentar o pH do solo gerando assim um meio agressivo a substâncias metálicas. Outra patologia apresentada foi na treliça metálica do galpão em verificou-se uma deformação no banzo superior por não seguir o detalhamento do projeto. Concluiu-se que os problemas ocorreram por falhas na execução. A execução do serviço de montagem em locais distantes como em fazendas no interior do estado deve ter controle extremamente rigoroso, seguindo os projetos e os detalhes previstos, tal como se a obra fosse executada na cidade. Não pode ser admitido execução com adaptações feitas no próprio local da execução por profissionais não habilitados, ou mesmo pelo proprietário.
Elaboração dos mapas de suscetibilidade dos solos de Pombos (PE) aplicando o geoprocessamento com software QGIS
Authors: Santos Valéria Elayne Carvalho dos , Pereira Guilherme Fernando Cavalcanti , Medeiros Iálysson da Silva , Santos Martha Maria Bezerra
Published: May 2022

Devido ao crescimento tecnológico e populacional é possível notar uma maior ocupação do solo. Visto que essa apropriação é feita, por muitas vezes, sema a projeção e com manejos de infertilidade, é necessário um maior detalhamento do terreno para fins construtivos, no qual são realizados mapeamentos geológicos-geotécnicos que permitem a elaboração de cartas de suscetibilidade do solo. Assim, este trabalho visa analisar a sensibilidade do solo do Município de Pombos-PE em relação a problemas geotécnicos por cartas de suscetibilidade, tendo como base os parâmetros pedológicos da região. Inicialmente, foi feito um levantamento dos dados geográficos do solo da cidade de Pombos – PE, para que em seguida fossem montadas as cartas de suscetibilidade e classificação quanto a sensibilidade do solo em baixa, média e alta, utilizando o método de Amorim (2004). Com isso, o território em estudo apresentou uma baixa suscetibilidade de ocorrência de solos expansivos, 1,43% de média suscetibilidade a solos colapsíveis, 22,09% de alta suscetibilidade a solos dispersivos e erosivos e 10,49% de alta suscetibilidade a solos moles. De posse dos dados, conclui-se que é possível mapear de forma eficaz, com poucos recursos e temas, a suscetibilidade dos solos relativos a problemas geotécnicos por meio do software QGIS v. 3.18.2.
Economic Evaluation Engine (E3) technical manual
Authors: Kneifel Joshua , Webb David , Donmoyer Luke , Kim Tasha
Published: May 2022

The Engineering Laboratory (EL) of the National Institute of Standards and Technology (NIST) has developed a variety of tools that provide some level of economic analysis, many of which have been developed by EL s Applied Economics Office (AEO). AEO-developed tools range across topic areas and economic metrics. Each tool is targeting government agencies and organizations that fall under NIST s mission. Stakeholders need different levels of details and functionality because of the diverse backgrounds across stakeholders. As a result, AEO has developed these software tools in a one-off approach on an as needed basis. As a result, each software has its own unique set of code even though these tools have some key underlying components that are common across tools, including methodology documented in standards. To improve the efficiency of the tools developed by AEO and its stakeholders, AEO has developed an economic service/engine with an associated Application Programming Interface (API) that provides consistent, standardized, transparent, reproducible economic analysis calculations should be developed, maintained, and made publicly available for internal and external researchers, analysts, and software developers called the Economic Evaluation Engine (E3). E3 provides economic evaluation capabilities based on ASTM building economic standards including life-cycle cost analysis, benefit-cost analysis, profit maximization / cost-minimization, and risk-cost analysis. E3 could be leveraged by NIST as well as other federal agencies and national laboratories, state and local governments, academia, and the private sector to improve their tool development by using a federally developed and validated calculations to provide standard-consistent analysis. E3 is publicly accessible on a NIST server as well as on GitHub for anyone to use for economic analysis, whether it s through a basic script calling on the E3 API, online interface that connects to the E3 API, or an executable program that is built on E3 s capabilities. Additionally, users of E3 could provide expansions to the capabilities by developing the code and submitting it to NIST for review and incorporation. This technical manual describes E3, including the underlying standards on which its based, the data flow through the tool, details on the code libraries, classes, and file structure, development tools used, guidance on how to use the tool, limitations, planned release, and the development of its future capabilities.
Application Instructions to Ministry of Education University-Industry Collaborative Education Program 2022
Authors:   Creative Publishing Co., Limited, LI Changkui
Published: May 2022

This article introduces the participation conditions, application precautions and time arrangement of the Ministry of Education's industry-university cooperative education project 2022.
South Africa regains polio-free status: Processes involved and lessons learnt
Authors:   Department of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa, Nyasulu J C Y ,   AFRIQUIP, Health Systems Strengthening, Johannesburg, South Africa, Maphoto R ,   Child, Youth and School Health, National Department of Health, Pretoria, South Africa, Kamupira M G S ,   World Health Organization, Pretoria, South Africa, Msomi N ,   Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
Published: May 2022

The World Health Organization recommends continuous immunisation coverage and polio surveillance standards for countries to sustain a polio-free status. We highlight experiences and lessons learnt by South Africa (SA) in losing – and subsequently regaining – its polio-free status. Following some decline in achieving acute flaccid paralysis surveillance and immunisation coverage targets, SA had its polio-free status withdrawn in 2017. Existing gaps were addressed and the polio-free status was regained in 2019. Lessons learnt from this experience include reaffirming the importance of continued commitment to polio eradication efforts, strengthening health systems through quality improvement projects, ensuring accountability in supervision, and monitoring of polio-related indicators. Consistent political commitment, collaboration and accountability are critical in sustaining the country’s health programmes, including maintaining a polio-free status and closing identified gaps.
Why Are We Waiting?
Authors: Stern Nicholas
Published: May 2022

An urgent case for climate change action that forcefully sets out, in economic, ethical, and political terms, the dangers of delay and the benefits of action.

The risks of climate change are potentially immense. The benefits of taking action are also clear: we can see that economic development, reduced emissions, and creative adaptation go hand in hand. A committed and strong low-carbon transition could trigger a new wave of economic and technological transformation and investment, a new era of global and sustainable prosperity. Why, then, are we waiting? In this book, Nicholas Stern explains why, notwithstanding the great attractions of a new path, it has been so difficult to tackle climate change effectively. He makes a compelling case for climate action now and sets out the forms that action should take.

Stern argues that the risks and costs of climate change are worse than estimated in the landmark Stern Review in 2006—and far worse than implied by standard economic models. He reminds us that we have a choice. We can rely on past technologies, methods, and institutions—or we can embrace change, innovation, and international collaboration. The first might bring us some short-term growth but would lead eventually to chaos, conflict, and destruction. The second could bring about better lives for all and growth that is sustainable over the long term, and help win the battle against worldwide poverty. The science warns of the dangers of neglect; the economics and technology show what we can do and the great benefits that will follow; an examination of the ethics points strongly to a moral imperative for action. Why are we waiting?
Locally developed models improve the accuracy of remotely assessed metrics as a rapid tool to classify sandy beach morphodynamics
Authors: Checon Helio Herminio , Shah Esmaeili Yasmina , Corte Guilherme N. , Malinconico Nicole , Turra Alexander
Published: May 2022

Classification of beaches into morphodynamic states is a common approach in sandy beach studies, due to the influence of natural variables in ecological patterns and processes. The use of remote sensing for identifying beach type and monitoring changes has been commonly applied through multiple methods, which often involve expensive equipment and software processing of images. A previous study on the South African Coast developed a method to classify beaches using conditional tree inferences, based on beach morphological features estimated from public available satellite images, without the need for remote sensing processing, which allowed for a large-scale characterization. However, since the validation of this method has not been tested in other regions, its potential uses as a trans-scalar tool or dependence from local calibrations has not been evaluated. Here, we tested the validity of this method using a 200-km stretch of the Brazilian coast, encompassing a wide gradient of morphodynamic conditions. We also compared this locally derived model with the results that would be generated using the cut-off values established in the previous study. To this end, 87 beach sites were remotely assessed using an accessible software (i.e., Google Earth) and sampled for an in-situ environmental characterization and beach type classification. These sites were used to derive the predictive model of beach morphodynamics from the remotely assessed metrics, using conditional inference trees. An additional 77 beach sites, with a previously known morphodynamic type, were also remotely evaluated to test the model accuracy. Intertidal width and exposure degree were the only variables selected in the model to classify beach type, with an accuracy higher than 90% through different metrics of model validation. The only limitation was the inability in separating beach types in the reflective end of the morphodynamic continuum. Our results corroborated the usefulness of this method, highlighting the importance of a locally developed model, which substantially increased the accuracy. Although the use of more sophisticated remote sensing approaches should be preferred to assess coastal dynamics or detailed morphodynamic features (e.g., nearshore bars), the method used here provides an accessible and accurate approach to classify beach into major states at large spatial scales. As beach type can be used as a surrogate for biodiversity, environmental sensitivity and touristic preferences, the method may aid management in the identification of priority areas for conservation.
Forecasting effects of transport infrastructure on endangered tigers: a tool for conservation planning
Authors: Carter Neil H. , Pradhan Narendra , Hengaju Krishna , Sonawane Chinmay , Sage Abigail H. , Grimm Volker
Published: May 2022

The rapid development of transport infrastructure is a major threat to endangered species worldwide. Roads and railways can increase animal mortality, fragment habitats, and exacerbate other threats to biodiversity. Predictive models that forecast the future impacts to endangered species can guide land-use planning in ways that proactively reduce the negative effects of transport infrastructure. Agent-based models are well suited for predictive scenario testing, yet their application to endangered species conservation is rare. Here, we developed a spatially explicit, agent-based model to forecast the effects of transport infrastructure on an isolated tiger (Panthera tigris) population in Nepal’s Chitwan National Park—a global biodiversity hotspot. Specifically, our model evaluated the independent and interactive effects of two mechanisms by which transport infrastructure may affect tigers: (a) increasing tiger mortality, e.g., via collisions with vehicles, and (b) depleting prey near infrastructure. We projected potential impacts on tiger population dynamics based on the: (i) existing transportation network in and near the park, and (ii) the inclusion of a proposed railway intersecting through the park’s buffer zone. Our model predicted that existing roads would kill 46 tigers over 20 years via increased mortality, and reduced the adult tiger population by 39% (133 to 81). Adding the proposed railway directly killed 10 more tigers over those 20 years; deaths that reduced the overall tiger population by 30 more individuals (81 to 51). Road-induced mortality also decreased the proportion of time a tiger occupied a given site by 5 years in the 20-year simulation. Interestingly, we found that transportation-induced depletion of prey decreased tiger occupancy by nearly 20% in sites close to roads and the railway, thereby reducing tiger exposure to transportation-induced mortality. The results of our model constitute a strong argument for taking into account prey distributions into the planning of roads and railways. Our model can promote tiger-friendly transportation development, for example, by improving Environmental Impact Assessments, identifying “no go” zones where transport infrastructure should be prohibited, and recommending alternative placement of roads and railways.
Morbidity and Mortality Profile among Low Birth Weight Neonates- A Cross-sectional Study from Jalandhar, India
Authors: Singh Balbir , Singh Jatinder , Singh Jaskaran , Kaur Manmeet , Kohli Raaghvi , Chawla Garima , Sonakshi .
Published: May 2022

Introduction: World Health Organisation (WHO) has defined Low Birth Weight (LBW) as weight at birth of fewer than 2,500 grams in the first hour of delivery. This practical cut-off for international comparison is based on epidemiological observations that infants weighing less than 2,500 gm are approximately 20 times more likely to die than babies with a normal birth weight. LBW is closely associated with neonatal and infant mortality and morbidity and stifled growth and cognitive development of children. Aim: To know the aetiological profile and outcome of admitted Low birth weight babies in Neonatal Intensive Care Unit (NICU). Materials and Methods: The present study was hospital based retrospective study conducted on 610 neonates admitted in NICU at a teaching hospital, Punjab Institute of Medical Sciences, Jalandhar, from January 2019 to December 2019. Neonate with birth weight less than 2500 gm and less than 28 days old were included in the study. The total subjects were divided into three groups- Group 1: Extremely Low Birth Weight (ELBW) <1000 gm; Group 2: Very Low Birth Weight (VLBW): 1000- <1500 gm; Group 3: Low Birth Weight (LBW): 1500-<2500 gm. All the babies were investigated and managed as per standard hospital protocol. Data recorded were: demographic profile, aetiology, morbidity and mortality among LBW babies. Data was analysed using Statistical Package for Social Sciences(SPSS) version 21.0 using standard statistical tests. Results: Total number of LBW babies registered in the study was 610. Among them, weight of 72 (11.8%) of neonates were <1000 g (Group 1), 208 (34.1%) were weighed 1000-<1500 g (Group 2) and 330 (54.1%) were weighed between 1500-<2500 g (Group 3). The mortality rate was 3.77%. The major causes of admission observed in neonates were sepsis (45.2%), hyperbilirubinemia (29.5%), apnoea (24.2%), hypoglycaemia (21.9%) and respiratory distress (17.2%). Highest mortality was observed amongst cases with Extremely Low Birth Weight (ELBW) (p<0.01). Two neonates out of total subjects 19 (3.1%) diagnosed with necrotising enterocolitis (NEC) succumbed to death, both belonging to group 1. Conclusion: The leading cause of morbidity and mortality in LBW babies were sepsis and Necrotising Enterocolitis (NEC) so we need to address this problem more effectively.
Analysis of Five Years Data of Special Newborn Care Unit in a Rural Medical College: Scope for Improvement in Neonatal Mortality and Morbidity
Authors: Khuntdar Bidyut Kumar , Mondal Sumon , Mudi Umesh , Mohanta Mahesh Prasad
Published: May 2022

Introduction: Neonatal mortality is the most important contributor towards infant mortality. Special Newborn Care Units (SNCUs) are part of the facility based newborn care of National Health Mission (NHM) and cornerstones for reducing neonatal mortality. Aim: To study the mortality and morbidity data of a tertiary care SNCU of rural tribal Eastern India and find out the focus area for improvement. Materials and Methods: This was a retrospective observational study carried out on 19397 babies admitted in the SNCU of Midnapore Medical College, Midnapore, West Bengal, India, from February 2016 to January 2021. Data were collected from the SNCU admission register and computerised reporting data of SNCU. In this study, five years admission and mortality data of the SNCU was analysed. Results: There were 67729 live births during the period between February 2016 and January 2021, out of which 8627 were admitted to the SNCU (inborn). There were 1195 deaths among the inborn babies, thus the mortality rate was13.8%. The number of outborn babies admitted during the study period was 10770, out of which 1357 babies died, thus the mortality rate was 12.6%. There was significantly higher mortality among inborn babies than outborn babies (13.8% vs. 12.6%). The major causes of admissions in the SNCU were prematurity (n=10167, 52.5%), Low Birth Weight (LBW) (n=11519, 59.3%), jaundice (n=4692, 24.19%), Hypoxic Ischaemic Encephalopathy (HIE) (n=4278, 22%) and sepsis (n=2161, 11.14%). The main causes of mortality were HIE (n=766, 30%), and sepsis (n=709, 27.78%), followed by respiratory distress syndrome (n=162, 6.3%), congenital malformations (n=77, 3%), and meconium aspiration syndrome (n=37, 1.45%). Conclusion: Prematurity and LBW were the major causes of morbidity and mortality. Sepsis and HIE were the major direct causes of mortality. Hence to reduce neonatal morbidity and mortality focus should be on preventing the above causes.
Cross Sectional Study on Awareness About Eye Banking in Moradabad (India)
Authors: Chaudhary Archana , Paul Maitri , Khurana Ashi , Chauhan Lokesh
Published: May 2022

Purpose:

There has been a shortage of transplantable corneal tissue in developing countries. Assessing awareness about eye banking would help us in making effective strategies to overcome this.

Methods:

A cross-sectional descriptive study was conducted using a standard pretested closed-ended structured questionnaire. Survey interview was conducted by an independent trained interviewer. Questionnaire had eighteen questions to assess awareness (6 questions), knowledge (6 questions) and process (6 questions) of eye donation.

Results:

A total of 396 individuals of more than 18 years participated in this survey. A total of 269 (67.9%) participants were aware that eyes can be donated and 156 (39.4%) participants agreed to donate their eyes after their death. Of all, 251 (63.4%) were aware that family consent is needed for eye donation and 172 (43.4%) participants thought that one needs to come to an eye hospital for eye donation. Only 82 (20.7%) participants know an eye bank facility in their nearby area. Of all, 86 (21.7%) participants believed that eyes can be donated by a living person and 24 (6.1%) believed that they need to pay for eye donation.

Conclusion:

Majority of participants know that eyes can be donated. However a low percentage of them agreed to donate their eyes after death. Awareness was low in terms of knowledge and process of eye banking. To increase awareness, innovative community based strategies to be implemented in the study area which ultimately increase cornea retrieval.
Effects Of Long-Term Use of Topical Antiglaucoma Drugs on Ocular Surface: A Cross Sectional Study
Authors: Richhariya Aparajita , Sahai Anshu , Shamshad Mohammad Abid , Kumar Pukhrambam Ratan , Ansari Maryem
Published: May 2022

Purpose:

Glaucoma is a chronic progressive disease and a major risk factor for blindness. This study aimed to evaluate the long-term effects of topical antiglaucoma drugs on ocular surface.

Methods:

This was a cross-sectional study, which included patients with glaucoma who had been taking one/two/three topical drugs (minimum 3 months) and control group of newly diagnosed glaucoma (10 months). The patients were divided into test groups A1 (timolol 0.5%/ briminodine 0.1%/ bimatoprost 0.01%), A2 (dual combination of any of the above drugs), A3 (triple combination) and control. Schirmer-I, tear film breakup time (TBUT), rose bengal, conjunctival impression cytology and ocular surface disease index (OSDI) scores were evaluated.

Results:

A total of 164 patients were enrolled and divided into groups A1, A2, A3 and control, respectively. There was a significant difference in Schirmer’s test (mm) results between the groups (15.06, 13.77, 11.24 and 21.26 in A1, A2, A3 and control, respectively; p<0.001). The mean TBUT (seconds) was 9.84, 8.25, 5.29 and 12.33 in A1, A2, A3 in control group, respectively (p<0.001 timolol 0.5% plus briminodine 0.1% plus bimatoprost 0.01%). Abnormal rose bengal was higher in A2 and A3 than A1 (3.94, 5.92 and 2.55, respectively; p<0.001). The mean conjunctival impression cytology grades were more severe in subgroups A1 (1.83), A2 (1.70) and A3 (2.74) than control group (0.96). The mean OSDI scores were significantly (p<0.001) higher in A2 (34.62) and A3 (49.63) than A1 (25.93).

Conclusion:

Topical antiglaucoma drugs caused OSD on long term use. The severity of OSD was higher in multiple drug combinations in comparison to single drug.
Stage 3 Retinopathy of Prematurity in a Child with Lipemia Retinalis
Authors: Verma Ritesh , Rathi Manisha , Sachdeva Sumit , Phogat Jitender , Lochab Sakshi
Published: May 2022

We report a case of four month old child with low birth weight presenting with raised serum triglyceride (2793mg/dl) and serum cholesterol levels (1200mg/dl) with zone 2 stage 3 retinopathy of prematurity with lipemia retinalis. Though the regression of lipemia retinalis has been reported but there are no guidelines regarding treatment of ROP in such cases as this is an unusual finding.
Cryopreserved Amniotic Membrane in The Management of Persistent Epithelial Defect
Authors: Garg Rajiv , Madan Siddharth
Published: May 2022

Amniotic membrane has anti-inflammatory, anti-scarring and anti-angiogenic properties. Preclinical and clinical evidence support the successful use of cryopreserved amniotic membrane in treating corneal epithelial defects and ulcers caused by neurotrophic keratitis and the ulcers which are unresponsive to prior treatment. The case describes one such use of amniotic membrane in the treatment of a persistent epithelial defect.
Corneal Laceration Repair!
Authors: Jain Prateek , Pattnaik Anshuman
Published: May 2022

Ocular trauma is an emergency which should be addressed immediately. Injury to cornea is a preventable cause of blindness. A meticulous corneal tear repair is essential for optimal visual outcome. This photo essay aims to brief postgraduate residents with an insight on principles of full thickness corneal tear repair. Two cases of severe penetrating corneal injury are presented here who were operated with satisfactory restoration of ocular integrity
Ocular Effects of Systemic Medications
Authors: Divya Jain
Published: May 2022

Systemic medications can give rise to ocular toxicity due to rich ocular blood supply and small ocular mass. These side effects can range from dry eye, keratitis, corneal deposits, glaucoma, cataract to blinding complications as a result of retinal toxicity and optic neuropathy. This review focuses on commonly used drugs, their ocular side effects, some newer drugs and their toxicity. Baseline examination and follow up at regular intervals is necessary for timely recognition of toxicity and discontinuation of these side effects. Recommendations for monitoring for medications with frequent and/ or severe adverse ocular effects are discussed.
Anti VEFG Agents In Retinal Diseases
Authors: Chawla Khushboo
Published: May 2022

Anti-vascular endothelial growth factor (Anti VEGF) agents are emerging as the most vital tool in the prevention of blindness due to ocular neovascularization in modern medicine. VEGFs are glycoproteins specific to endothelial cells, acting as key regulators of angiogenesis, vasculogenesis, and increasing vascular permeability. These are indicated in conditions such as diabetic macular edema (DME), vascular occlusions (RVO), Retinopathy of prematurity (ROP), neovascular age-related macular degeneration (nAMD), etc. The cost effect, need for frequent dosage, and side effects of increased IOP, infection, and cataract adds to the economic and disease burden. The newer research is now focused beyond anti-VEGF such as Angiopoietin and tyrosine kinase for vasculogenesis. This article reviews various anti-VEGF and angiogenic agents available in clinical practices.
New Persistent Opioid Use After Surgery
Authors: Bologheanu Razvan , Bilir Aylin , Kapral Lorenz , Gruber Felix , Kimberger Oliver
Published: February 2025

Importance

New persistent opioid use after surgery is contributing to the opioid crisis affecting the US, and interventions to limit postoperative opioid prescriptions have been proposed to mitigate the opioid-related health care burden. Limited information is available regarding the incidence of new persistent use after surgery in other countries.

Objective

To determine the incidence of new persistent opioid use and to evaluate factors associated with its risk after surgery in Austria.

Design, Setting, and Participants

This retrospective, population-based cohort study used administrative data from the national Austrian social insurance database for adult patients undergoing surgery between January 1, 2016, and December 31, 2021. Exclusion criteria were incomplete exposure or outcome data, early postoperative death, and ongoing opioid use at the time of surgery. Data were analyzed from September 2023 to August 2024.

Exposures

General, gynecological, urological, orthopedic, and cardiac surgery.

Main Outcomes and Measures

The primary study outcome was the incidence of new persistent opioid use up to 6 months after surgery in the Austrian population; the factors associated with use, including patient factors and surgical procedures, were analyzed. A logistic regression model was used to evaluate the association between the primary outcome and the independent variables after controlling for multicollinearity.

Results

Among 559 096 patients undergoing 642 857 surgical procedures (median [IQR] age, 60 [48-71] years; 318 391 male patients [49.5%]), new persistent opioid use was documented in 10 810 cases (1.7%) overall, and the rates ranged from 0.3% for appendectomy (130 cases per 40 565 procedures) to 0.7% for abdominal surgery (2198 cases per 335 034 procedures) to 6.8% for spinal surgery (3495 cases per 51 348 procedures). The median (IQR) daily opioid dose in oral morphine equivalents was 7.4 (4.1-14.9) mg. Specific procedures, including spinal surgery (odds ratio [OR], 5.36; 95% CI, 5.04-5.69) and arthroplasty (OR, 1.57; 95% CI, 1.48-1.67), and patient characteristics, such as previous opioid use that was discontinued before surgery (OR, 3.06; 95% CI, 2.93-3.19) and the frequency of previously filled opioid prescriptions (OR, 16.49; 95% CI, 13.63-19.95), were associated with new persistent opioid use.

Conclusions and Relevance

In Austria, the incidence of new persistent opioid use after surgery is lower than that in North America, but the factors associated with risk are similar. These findings suggest the need for studies comparing pain management strategies, as well as systemic and organizational factors, that contribute to the development of new persistent opioid use after surgery in North American and European health care systems, where less evidence about new persistent opioid use has been available.
Inequities in the Application of Behavioral Flags for Hospitalized Pediatric Patients
Authors: Edwell April , Huang Jia Xin , Bongiovanni Tasce , Pantell Matthew
Published: February 2025

Importance

Behavioral flags in the electronic health record (EHR) may introduce bias and perpetuate structural racism and discrimination. Descriptions of differences in the way that markers of behavioral risk are communicated will help clarify the inequities that pediatric patients and their families experience in the hospital.

Objective

To assess whether racially and socioeconomically marginalized pediatric patients and families are more likely than their counterparts to be assigned a behavioral flag in their EHR.

Design, Setting, and Participants

This retrospective cohort study used EHR data for pediatric patients (aged <18 years) hospitalized from June 2012 to July 2021 across care settings at the University of California, San Francisco health care facilities, an academic quaternary care hospital system that includes 2 pediatric inpatient facilities. The analysis was completed from December 29, 2022, to November 22, 2024.

Main Outcome and Measures

The primary outcome of interest was any of the following behavioral flags placed in a patient’s EHR: witnessed substance abuse, history of inappropriate behavior, security, violent behavior, dismissal from practice, and child protective services (CPS) hold. The primary variables were patients’ race, ethnicity, insurance status, and primary language.

Results

Of 55 865 pediatric encounters (52.2% among males; median patient age at the first encounter, 3 years [IQR, 0-12 years]), 236 (0.4%) had behavioral flags. Compared with encounters among patients who identified as White, encounters among patients who identified as Black or African American were more likely to have a behavioral flag (incidence rate ratio [IRR], 2.07; 95% CI, 1.32-3.25). Behavioral flags were also more likely among encounters of individuals with government insurance compared with those with private insurance (IRR, 2.60; 95% CI, 1.85-3.65). Black or African American patients younger than 1 year (IRR, 3.53; 95% CI, 1.80-6.91) and aged 1 to 7 years (IRR, 2.87; 95% CI, 1.34-6.15) had a higher likelihood of flag placement compared with their White counterparts.

Conclusions and Relevance

This cohort study found significant inequities in incidence of behavioral flags in the EHR among racially and socioeconomically marginalized pediatric patients. This finding was most pronounced for Black or African American patients younger than 8 years, suggesting that this phenomenon may be a response to Black families rather than specific patient behavior.
Beaded Bubbles in the Eye After Vitrectomy and Gas Fill
Authors: Zhang Yanyan , Gong Yan , Yi Quanyong
Published: February 2025

This case report discusses the appearance of beaded bubbles after C3F8 gas fill in a patient who underwent vitrectomy for proliferative diabetic retinopathy.
Sexual Harassment in Ophthalmology
Authors: Killeen Olivia J. , Ding Leona , Enyedi Laura , Sun Grace , Cabrera Michelle T.
Published: February 2025

Importance

High rates of sexual harassment were reported among ophthalmologists who responded to a survey in 2018. A comparison with the rates in 2023 seems warranted following increased initiatives to combat sexual harassment.

Objectives

To compare the rates and characteristics of sexual harassment in ophthalmology from survey respondents in 2018 and 2023 and to investigate rates of gender discrimination among the 2023 respondents.

Design, Setting, and Participants

In this cross-sectional, observational survey study, the survey was administered anonymously using Google Forms through the Women in Ophthalmology email blast list from August 25 to September 25, 2023. Primarily female ophthalmologists or ophthalmology trainees were surveyed in the United States and Canada. The study was determined to be exempt by the University of Washington institutional review board because it involved an anonymous, low-risk survey of adults. Participants provided consent electronically.

Main Outcomes and Measures

Rates of sexual harassment in ophthalmology, number of occurrences in the past 5 years, and gender discrimination. Rates were compared between the 2018 and 2023 surveys.

Results

Of 1051 emails sent, 692 (65.8%) were opened, and of those opened, 289 of 692 eligible participants (41.8%) responded, so that the respondents represented 289 (27.5%) of the 1051 emails sent. Among the 288 survey participants who provided gender data, there were 282 women (97.9%), 3 men (1.0%), 1 nonbinary or third gender participant (0.3%), and 2 other participants (ie, they preferred not to say or preferred to self-describe) (0.6%), with 113 (39.2%) aged 31 to 40 years. Of the 289 survey respondents in 2023, 172 (59.5%) experienced sexual harassment in ophthalmology compared with 265 of 447 (59.3%) surveyed in 2018 (difference, 0.2%; 95% CI, −7.0% to 7.5%; P = .95). Also, of the 172 respondents in 2023 who reported experiencing sexual harassment, 107 (62.2%) experienced it within the past 5 years compared with 125 of 265 respondents (47.2%) who reported experiencing it in 2018 (difference, 15.0%; 95% CI, 5.5%-24.2%; P < .001). In 2023, 41 of 170 respondents (24.1%) reported their most severe experience to an authority compared with 40 of 265 (15.1%) in 2018 (difference, 9.0%; 95% CI, 1.3%-16.8%; P = .02). Of 287 survey respondents in 2023, 244 (85.0%) experienced gender discrimination.

Conclusions and Relevance

In this survey study, the rates of sexual harassment among respondents remained high 5 years after a survey on sexual harassment in ophthalmology, with higher frequency of recent experiences and continued low reporting rates. With other forms of gender discrimination also highly prevalent among respondents, these results support pursuit of validated strategies to foster a culture of zero tolerance toward harassment and discrimination.
Integration of single‐cell and bulk RNA‐sequencing data reveals the prognostic potential of epithelial gene markers for prostate cancer
Authors: Mou Zhuofan , Harries Lorna W.
Published: February 2025

Prognostic transcriptomic signatures for prostate cancer (PCa) often overlook the cellular origin of expression changes, an important consideration given the heterogeneity of the disorder. Current clinicopathological factors inadequately predict biochemical recurrence, a critical indicator guiding post‐treatment strategies following radical prostatectomy. To address this, we conducted a meta‐analysis of four large‐scale PCa datasets and found 33 previously reported PCa‐associated genes to be consistently up‐regulated in prostate tumours. By analysing single‐cell RNA‐sequencing data, we found these genes predominantly as markers in epithelial cells. Subsequently, we applied 97 advanced machine‐learning algorithms across five PCa cohorts and developed an 11‐gene epithelial expression signature. This signature robustly predicted biochemical recurrence‐free survival (BCRFS) and stratified patients into distinct risk categories, with high‐risk patients showing worse survival and altered immune cell populations. The signature outperformed traditional clinical parameters in larger cohorts and was overall superior to published PCa signatures for BCRFS. By analysing peripheral blood data, four of our signature genes showed potential as biomarkers for radiation response in patients with localised cancer and effectively stratified castration‐resistant patients for overall survival. In conclusion, this study developed a novel epithelial gene‐expression signature that enhanced BCRFS prediction and enabled effective risk stratification compared to existing clinical‐ and gene‐expression‐derived prognostic tools. Furthermore, a set of genes from the signature demonstrated potential utility in peripheral blood, a tissue amenable to minimally invasive sampling in a primary care setting, offering significant prognostic value for PCa patients without requiring a tumour biopsy.
Optimized Heterostructures by Preferred Crystal Orientation for Ultrafast Sodium Storage
Authors: Zhang Man , Wang Shunchao , Zhu Jing , Zheng Fenghua , Jiang Yongjie , Hu Sijiang , Li Yahao , Huang Youguo , Pan Qichang , Wang Hongqiang , Ou Xing , Li Qingyu
Published: February 2025

Accelerating the Na+ diffusion kinetics and enhancing the structural stability in sulfide‐based anodes by structural engineering is an extremely effective strategy for improving sodium storage performance. Herein, an optimized Co9S8/MoS2 heterojunction with preferred crystal orientation is delicately designed and successfully fabricated. Distinguish from the conventional heterostructure with anisotropic distribution, the preferred crystal orientation with isotropic structure can provide a rapid Na+‐diffusion pathway and regulate Na+‐concentration to promote its uniform distribution. Furthermore, it simultaneously realizes the even dispersion of inner stress and acquire the structural stability during the discharge/charge processes. Additionally, the abundant heterointerfaces with one direction effectively improve the charge transfer and reduce the Na+‐diffusion distance, ensuring the boosted reaction kinetic. As expected, ascribing to the synergetic effect, the Co9S8/MoS2 presents excellent ultra‐high rate performance and long‐term cycling stability for sodium ion batteries. Specifically, a high capacity of 492.1 mAh g−1 is maintained over 2000 cycles at 2.0 A g−1, and an ultrahigh capacity of 504 mAh g−1 is achieved even at ultrahigh rate of 15.0 A g−1. Moreover, the assembled NVP@C//Co9S8/MoS2 full‐cell can achieve excellent cycling performance, delivering a high capacity of 318 mAh g−1 over 500 cycles at 1.0 A g−1.
AKT1 Phosphorylates FDX1 to Promote Cuproptosis Resistance in Triple‐Negative Breast Cancer
Authors: Sun Zicheng , Xu Huazhen , Lu Guanming , Yang Ciqiu , Gao Xinya , Zhang Jing , Liu Xin , Chen Yongcheng , Wang Kun , Guo Jianping , Li Jie
Published: February 2025

Cuproptosis, a recently defined copper‐dependent cell death pathway, remains largely unexplored in tumor therapies, particularly in breast cancer. This study demonstrates that triple‐negative breast cancer (TNBC) bears a relatively elevated copper levels and exhibits resistance to cuproptosis. Mechanistically, copper activates the AKT signaling pathway, which inhibits ferredoxin‐1 (FDX1), a key regulator of cuproptosis. AKT1‐mediated FDX1 phosphorylation not only abrogates FDX1‐induced cuproptosis and aerobic respiration but also promotes glycolysis. Consequently, the combination of AKT1 inhibitors and the copper ionophores synergistically alleviate TNBC tumorigenesis both in vitro and in vivo. In summary, the findings reveal a crucial mechanism underlying TNBC resistance to cuproptosis and suggest a potential therapeutic approach for TNBC.
Applying Ultrasound to Mechanically and Noninvasively Sensitize Prostate Tumors to TRAIL‐Mediated Apoptosis
Authors: Fabiano Abigail R. , Newman Malachy W. , Dombroski Jenna A. , Rowland Schyler J. , Knoblauch Samantha V. , Kusunose Jiro , Gibson‐Corley Katherine N. , Kaufman Benjamin G. , Ren Liqin , Caskey Charles F. , King Michael R.
Published: February 2025

Non‐surgical and safe prostate cancer (PCa) therapies are in demand. Soluble tumor necrosis factor (TNF‐α) related apoptosis inducing ligand (TRAIL), a cancer‐specific drug, shows preclinical efficacy but has a short circulation half‐life. This research has shown that physiological fluid shear stress activates mechanosensitive ion channels (MSCs), such as Piezo1, enhancing TRAIL‐mediated apoptosis in cancer cells. Herein, noninvasive, focal ultrasound (FUS) is implemented to augment the pro‐apoptotic effects of TRAIL. Using thermally safe FUS parameters, it is observed that TRAIL sensitivity increases with higher FUS pressure in PCa cells, mediated by Piezo1. This is confirmed by examining the effects of calcium chelation, MSC inhibitors, and PIEZO knockdown. In vivo, a multi‐dose study with 10 min FUS exposure shows that 0 and 4‐h intervals between TRAIL and FUS significantly reduce tumor burden, with an increase in apoptosis evident by enhanced cleaved‐caspase 3 expression. This mechanotherapy offers a clinically translatable approach by utilizing widely available FUS technology, applicable to treat additional cancer types.
Disruption of the eEF1A1/ARID3A/PKC‐δ Complex by Neferine Inhibits Macrophage Glycolytic Reprogramming in Atherosclerosis
Authors: Xie Baoping , Tian Li‐Wen , Liu Chenxu , Li Jiahua , Tian Xiaoyu , Zhang Rong , Zhang Fan , Liu Zhongqiu , Cheng Yuanyuan
Published: February 2025

Glycolytic reprogramming of macrophages is a decisive factor in atherosclerosis (AS) plaque formation. Eukaryotic elongation factor 1A1 (eEF1A1) plays an important role in protein synthesis, ubiquitination degradation, and nuclear translocation. However, the potential function of eEF1A1 in AS has not yet been fully understood. Here, the natural small molecule neferine (Nef), which targets eEF1A1 to suppress macrophage glycolytic reprogramming is discovered. In this work, chemical genetics and non‐modified target confirmation assays are used to confirm that eEF1A1 is a direct target of Nef. Mechanically, Nef disrupted the formation of the eEF1A1/ARID3A/PKC‐δ complex, inhibits phosphorylation of ARID3A at Thr491, and consequently prevents its nuclear translocation. Meanwhile, it is verified that ARID3A is a transcriptional regulator of enolase 2 (ENO2), an important enzyme in the glycolytic process. Nef suppresses ENO2 transcription activation by affecting ARID3A binding to the promoter region of ENO2, which results in macrophage glycolytic reprogramming inhibition and transformation of macrophages from M1 to M2. Collectively, these findings provide an attractive future direction for AS therapy by inhibiting ARID3A/ENO2‐mediated macrophage glycolytic reprogramming by targeting eEF1A1.
Expanding the Phenotypic Spectrum of HNRNPU‐Related Disorder, Documenting the First Familial Presentation and Comprehensive Review
Authors: Hodgson A. K. O. , Baxandall L. , Aiyedun D. , Li A. , Au P. Y. B. , Bain J. M. , Gillentine M. A. , Goel H. , Kline A. D. , Ricupero C. L. , Sánchez‐Carpintero R. , Seward E. P. , Sidlow R. , Wilson S. A. , Balasubramanian M.
Published: February 2025

HNRNPU‐related neurodevelopmental disorder (HNRNPU‐NDD) is caused by pathogenic and likely pathogenic variants in HNRNPU. With increasing accessibility to advanced genetic investigations, children presenting with developmental delay and intellectual disability will often undergo genomic testing; hence, the number of patients found to be affected by HNRNPU‐NDD is increasing. We document a cohort of 17 previously unpublished patients with HNRNPU variants, including the first familial case, building on those previously published by our group. A comprehensive literature review was performed, identifying previously published patients and phenotypes for comparison. Eighty‐four patients have been published in previous studies with pathogenic variants in HNRNPU with the following phenotypes: Global developmental delay, moderate to severe intellectual disability, early‐onset seizures, and dysmorphic features. In addition to these phenotypes previously described, we have recognized ophthalmic abnormalities, cardiac abnormalities, and short stature in our cohort. We provide information on patients with a milder phenotype, enhancing our knowledge of phenotypic variability in HNRNPU‐NDD.
Iridium‐Catalyzed Asymmetric Allylic Alkylation of Boron Enolates to Construct Acyclic All‐Carbon Quaternary Stereocenters
Authors: Yang Liu , Yang Mengzhi , Wang Zhenchao , Zhao Wanxiang
Published: February 2025

Enolates are ubiquitous intermediates in organic synthesis. Among them, boron enolates exhibit distinctive reactivity patterns and selectivities due to the presence of a boron atom, making their synthesis highly attractive. Although methods for accessing ketone‐ or ester‐derived boron enolates are well‐developed, much less progress has been made in the development of aldehyde‐derived boron enolates due to aldehydes' high tendency toward self‐condensation. Therefore, the practical applications of aldehyde‐derived boron enolates are significantly hindered. We present herein an efficient method for the preparation of aldehyde‐derived boron enolates via the 1,2‐hydroboration of ketenes with boranes, avoiding the use of acidic R2BCl/R2BOTf and bases and leading to improved functional group tolerance. Utilizing this convenient protocol, we developed an Ir‐catalyzed asymmetric allylic alkylation of boron enolates, yielding a wide array of chiral aldehydes bearing acyclic all‐carbon quaternary centers with high chemo‐, regio‐, and enantioselectivity, which are prevalent in various natural products and bioactive molecules. The synthetic utility and practicality of this method are demonstrated through gram‐scale reactions and asymmetric syntheses of the ent‐5HT1A antagonist as well as biological activity studies in inhibiting the growth of plant pathogens.