bluuebunny/crossref_metadata_2025 huggingface dataset:
A Cross‐Sectional Survey of Anesthesiologists' Awareness Toward Traumatic Dental Injuries During General Anesthesia in Syrian Arab Republic
Authors: Al‐Shiekh Mohammed N. , Altinawi Mohamed K. , Darwish Bana , Alzoubi Hasan
Published: November 2024

Background

Traumatic dental injuries with tracheal intubation during general anesthesia are considered one of the most common complications. It is also the primary reason for malpractice legal claims against anesthesiologists according to insurance companies. There is much information regarding the incidence, consequences, and risk factors of traumatic dental injuries during general anesthesia. This study aimed to assess the awareness (knowledge, practice, and attitude) of anesthetists regarding peri‐anesthetic traumatic dental injuries and discuss measures to reduce the risk regarding peri‐anesthetic traumatic dental injuries.

Materials and Methods

Sixty seven anesthetists participated in this cross‐sectional survey between January 2023 and July 2023, which was carried out in the Syrian Arab Republic. The questionnaire was generated using Google Forms and sent individually, as the researcher (MNA) was accompanied by all included anesthesiologists while filling out all the questionnaire paragraphs to answer any questions. The Fisher exact test and Pearson's Chi‐squared test were used to analyze the results.

Results

The dental trauma caused by the anesthetists during their professional careers was 38.8%, and none of them were exposed to any legal claim. 77.6% of the anesthetists thought that avulsed permanent teeth could be replanted, 46.2% believed that the procedure must be done in < 30 min, and 84.6% thought they could not do it themselves and would send the patient to a dentist after the procedure. More than half of respondents (63.5%) indicated that the sterile saline solution was the best storage medium for avulsed teeth. Furthermore, 74.6% of anesthetists stated that emergency intubations are related to more traumatic dental injuries in comparison with elective intubation and about 62% were aware of the importance of mouthguard. However, nearly 57% complained about the shortage of knowledge related to the oral cavity and its special structure.

Conclusions

Syrian anesthetists have limited awareness (knowledge, practice, and attitude) of traumatic dental injury classification, prevention, and management. More information and training are still needed about factors used within clinical dentistry.
Simplified Composite Restorations for Fractured Young Incisors: A Clinical Review
Authors: Çehreli Zafer C.
Published: November 2024

Tooth fractures are a common consequence of dental trauma in young patients, requiring prompt and effective restorative interventions that ensure both functional integrity and esthetic appeal. Although resin stratification (layering) is the gold standard for achieving life‐like restoration of fractured teeth, many clinicians find it technically challenging due to the time and effort required for precise shade matching, concealing the fracture line, and accurate placement of resin composite layers with different levels of opacity. The more recent generation of monoshade composites, with their ability to adapt to various tooth shades, reduce the complexity of multi‐layer restorations, and improve chairside efficiency. Additionally, the composite cutback technique has gained attention as an effective method for restoring fractured teeth in young patients. This method combines the benefits of monoshade composites and the precision of simple additional layering to enhance both the esthetic and functional outcomes of the restorations. This mini‐review provides a comprehensive analysis of the composite cutback technique, the role of monoshade composites, and their clinical application in the restoration of fractured young teeth.
Future‐Proofing Dentistry: A Qualitative Exploration of COVID‐19 Responses in UK Dental Schools
Authors: Vernon Jon J. , Vinall‐Collier Karen , Csikar Julia , Emms George , Lancaster Paula E. , Nattress Brian R. , Wood David J.
Published: November 2024

Introduction

The COVID‐19 pandemic had extensive influence on dental education. UK dental schools were compelled to respond with substantial adaptations to clinical training approaches and environments to mitigate educational impact.

Materials and Methods

The Surveying Pandemic Education Response in Higher Education Dental Schools (SPEARHEAD) study aimed to retrospectively evaluate the diverse responses of UK dental schools to the COVID‐19 pandemic. All UK dental schools were invited to participate in semi‐structured interviews to ascertain institutional responses, with transcripts subjected to thematic framework analysis.

Results and Discussion

Ten UK dental schools contributed to the study and three main themes were identified: student education, environment, and procedures and equipment. The most common approach to student education was the reduction of student numbers in clinical areas; however, this increased supervisory demands. While there was widespread acknowledgement of the need for enhanced ventilation, implementing the necessary modifications was frequently constrained by building configurations and financial implications. Numerous procedural adjustments were implemented, accompanied by widespread adoption of enhanced personal protective equipment. Fallow periods were common, although differing durations underscored the need for data‐driven guidance. Many schools transitioned towards electric speed‐controlled handpieces, but the need to reflect real‐world scenarios often led to a reversion to air turbines.

Conclusion

UK dental schools showed initiative, resilience, and ingenuity in safeguarding students from enduring irretrievable educational setbacks amidst the challenges posed by the COVID‐19 pandemic. Validating a data‐driven strategy for addressing future threats would facilitate a unified response, minimising the educational repercussions and bolstering the resilience of dental training.
Performance of a Generative Pre‐Trained Transformer in Generating Scientific Abstracts in Dentistry: A Comparative Observational Study
Authors: Alencar‐Palha Caio , Ocampo Thais , Silva Thaisa Pinheiro , Neves Frederico Sampaio , Oliveira Matheus L.
Published: November 2024

Objectives

To evaluate the performance of a Generative Pre‐trained Transformer (GPT) in generating scientific abstracts in dentistry.

Methods

Ten scientific articles in dental radiology had their original abstracts collected, while another 10 articles had their methodology and results added to a ChatGPT prompt to generate an abstract. All abstracts were randomised and compiled into a single file for subsequent assessment. Five evaluators classified whether the abstract was generated by a human using a 5‐point scale and provided justifications within seven aspects: formatting, information accuracy, orthography, punctuation, terminology, text fluency, and writing style. Furthermore, an online GPT detector provided “Human Score” values, and a plagiarism detector assessed similarity with existing literature.

Results

Sensitivity values for detecting human writing ranged from 0.20 to 0.70, with a mean of 0.58; specificity values ranged from 0.40 to 0.90, with a mean of 0.62; and accuracy values ranged from 0.50 to 0.80, with a mean of 0.60. Orthography and Punctuation were the most indicated aspects for the abstract generated by ChatGPT. The GPT detector revealed confidence levels for a “Human Score” of 16.9% for the AI‐generated texts and plagiarism levels averaging 35%.

Conclusion

The GPT exhibited commendable performance in generating scientific abstracts when evaluated by humans, as the generated abstracts were indistinguishable from those generated by humans. When evaluated by an online GPT detector, the use of GPT became apparent.
Multilevel Analysis of MYC and BCL2 Aberrations in Diffuse Large B‐Cell Lymphoma: Identifying a High‐Risk Patient Subgroup Across Cell‐of‐Origin Using Targeted Sequencing
Authors: Vimalathas Gayaththri , Lang Cecilie Steensboe , Green Tina Marie , Møller Michael Boe , Nyvold Charlotte Guldborg , Hansen Marcus Høy , Larsen Thomas Stauffer
Published: November 2024

Introduction

Diffuse large B‐cell lymphoma (DLBCL) exhibits striking clinical and biological heterogeneity. Recent studies have identified new subgroups within germinal center B‐cell like (GCB) DLBCL, associated with inferior prognosis, irrespective of MYC and BCL2 translocations. We explored the existence of such a DLBCL high‐risk subgroup, based on multilevel aberrations, especially focusing on MYC and BCL2.

Methods

Tissue samples from 111 DLBCL patients were sequenced with a 90‐gene lymphoma panel, followed by integrative analyses combining sequencing data, immunohistochemistry, fluorescent in situ hybridization, and clinical data.

Results

We identified a high‐risk subgroup in DLBCL defined by: dual immunohistochemical MYC and BCL2 expression (DEL), concurrent MYC and BCL2 translocations (DHL‐BCL2), mutations in MYC, CXCR4, or both, and/or BCL2 amplification. The high‐risk subgroup constituted 41% of the cohort and included DHL‐BCL2, DEL, a GCB subgroup likely representing the recently described GCB subgroups, and a subset of non‐GCB patients. In multivariate analysis, high‐risk features provided independent predictive value from age and IPI. The 5‐year overall survival was 36% in high‐risk patients, compared to 76% in non‐high‐risk patients.

Conclusion

We identified a distinct high‐risk DLBCL subgroup, characterized by MYC and BCL2 aberrations, beyond conventional DHL‐BCL2 and DEL, and irrespective of cell‐of‐origin, thereby expanding the poor‐prognosis group.
Serum neurofilament light chain predicts disease severity in axonal variants of acute immune neuropathies: A retrospective monocentric cohort study
Authors: Afzali Ali Maisam , Vosko Milan , Reinhardt Nya , Zinevych Iaroslav , Gmeiner Vincent , Korn Thomas , Gasperi Christiane , Berthele Achim , Feneberg Emily , Hemmer Bernhard
Published: November 2024

Background and purpose

The purpose was to explore the prognostic utility of neurofilament light chain (NfL) in patients with immune‐mediated polyradiculoneuropathies (IMPs).

Methods

This retrospective monocentric study analysed serum and cerebrospinal fluid samples from patients diagnosed with IMP collected prior to treatment initiation. NfL concentrations were correlated with clinical outcomes, including F score and hospitalization duration.

Results

Amongst 115 IMP patients tested, baseline cerebrospinal fluid and serum NfL (sNfL) concentrations were higher in acute inflammatory axonal polyradiculoneuropathy (AIAP) than other IMP variants. In the AIAP cohort, a positive correlation was observed between baseline sNfL concentrations, F score and hospitalization duration. Multivariate linear regression analysis further supported the predictive relationship between elevated baseline sNfL concentrations and clinical outcomes. Using receiver operating characteristic analysis, a cut‐off value for sNfL of 351 pg/mL was found to predict an F score >3 in AIAP with a sensitivity of 40% and specificity of 81.8%. AIAP patients with sNfL concentrations above this threshold required longer hospitalization (extended by 15 days).

Discussion

Our findings highlight the potential of baseline sNfL as an effective marker for distinguishing between IMP variants and predicting the prognosis of AIAP. Further validation may facilitate translation of sNfL into clinical practice, potentially identifying high‐risk patients for tailored treatment approaches.
Bank Financial Distress and Stock Price Crashes: A Quasi‐Experimental Approach
Authors: Biswas Priti , Maitra Debasish , Mukherjee Sayantan
Published: November 2024

Using 118,292 US bank‐month observations, we examine the effects of short‐term changes in bank's financial distress on stock price crash risk. There is a significant positive association between short‐term changes in distress on stock price crash risk. The results remain consistent across alternative measures of distress and crash risk. We confirm robustness by employing additional tests for reverse causality and propensity score matching. We find opacity, proxied by discretionary loan‐loss provisions to be a potential channel through which increase in distress affects future crash risk. Our study underscores the critical association between increasing financial distress, loan‐loss reporting, and crash risk.
Too Hot to Handle: A Meta‐Analytical Review of the Thermal Tolerance and Adaptive Capacity of North American Sturgeon
Authors: Dichiera Angelina M. , Earhart Madison L. , Bugg William S. , Brauner Colin J. , Schulte Patricia M.
Published: November 2024

Understanding how ectotherms may fare with rising global temperatures and more frequent heatwaves is especially concerning for species already considered at‐risk, such as long‐lived, late‐maturing sturgeon. There have been concerted efforts to collect data on the movement behavior and thermal physiology of North American sturgeon to enhance conservation efforts; thus, we sought to synthesize these data to understand how sturgeon respond to thermal stress and what capacity they have to acclimate and adapt to warming. Here, we combined a systematic literature review and meta‐analysis, integrating field‐based observations (distribution and spawning) and laboratory‐based experiments (survival, activity, growth, metabolism, and upper thermal limits) for large‐scale insights to understand the vulnerability of North American sturgeon to rising global temperatures. We summarized the preferred thermal habitat and thermal limits of sturgeon in their natural environment and using meta‐analytical techniques, quantified the effect of prolonged temperature change on sturgeon whole‐animal physiology and acute upper thermal limits. While acclimation did not have significant effects on physiological rates or survival overall, there were positive trends of activity and metabolism in young‐of‐the‐year sturgeons, likely offset by negative trends of survival in early life. Notably, North American sturgeon have a greater capacity for thermal tolerance plasticity than other fishes, increasing upper thermal limits by 0.56°C per 1°C change in acclimation temperature. But with limited laboratory‐based studies, more research is needed to understand if this is a sturgeon trait, or perhaps that of basal fishes in general. Importantly, with these data gaps, the fate of sturgeon remains uncertain as climate change intensifies, and physiological impacts across life stages likely limit ecological success.
Soil pH Determines Nitrogen Effects on Methane Emissions From Rice Paddies
Authors: Tang Junqi , Qian Haoyu , Zhu Xiangcheng , Liu Zhuoshu , Kuzyakov Yakov , Zou Jianwen , Wang Jinyang , Xu Qiang , Li Ganghua , Liu Zhenghui , Wang Songhan , Zhang Weijian , Zhang Jun , Huang Shan , Ding Yanfeng , van Groenigen Kees Jan , Jiang Yu
Published: November 2024

Rice paddies account for approximately 9% of human‐induced methane (CH4) emissions. Nitrogen (N) fertilization affects CH4 emissions from paddy soils through several mechanisms, leading to conflicting results in field experiments. The primary drivers of these N‐related effects remain unclear and the contribution of N fertilization to CH4 emissions from the rice paddies has not yet been quantified for global area. This uncertainty contributes to significant challenges in projecting global CH4 emissions and hinders the development of effective local mitigation strategies. Here, we show through a meta‐analysis and experiments that the impact of N fertilization on CH4 emissions from rice paddies can be largely predicted by soil pH. Specifically, N fertilization stimulates CH4 emissions most strongly in acidic soils by accelerating organic matter decomposition and increasing the activities of methanogens. Accounting for the interactions between soil pH and N fertilization, we estimate that N fertilization has raised current area‐scaled and yield‐scaled CH4 emissions across the total global paddy area by 52% and 8.2%, respectively. Our results emphasize the importance of alleviating soil acidification and sound N management practices to mitigate global warming.
UKHCDO gene therapy taskforce: Guidance for implementation of haemophilia gene therapy into routine clinical practice for adults
Authors: Chowdary Pratima , Duran Beatriz , Batty Paul , Lowe Gillian , Jones April , Pollard Debra , Boyce Sara , Motwani Jayashree , Amirloo Bahareh , Musgrave Kathryn , Hopper David , Classey Stephen , Whitaker Sarah , Dunn Nicola , Bowyer Annette , Shapiro Susan
Published: November 2024

Introduction

2022 was a landmark year with two adeno‐associated viral vectors (AAVs) receiving conditional marketing authorization from EMA for the treatment of persons with severe haemophilia A and severe to moderately severe haemophilia B and a third in 2024. Gene therapy is a transformative, irreversible treatment with long‐lasting effects, necessitating development of new clinical pathways to ensure optimal outcomes.

Aim

To develop a consensus framework and service specification for delivery of AAV gene therapy for haemophilia in adults within the UK using the hub‐and‐spoke model proposed by the European Association of Haemophilia and Allied Disorders and the European Haemophilia Consortium.

Methods

The UK Haemophilia Centre Doctors Organisation (UKHCDO) set up a working party to develop expert consensus guidance, working with NHS England to ensure alignment with NHS England commissioning and the national service specification.

Results

These guidelines detail the patient pathway, counselling and governance requirements for the hub‐and‐spoke model. The national service specification requires the hub site to manage governance for AAV‐based gene therapy. Proposed regional and national multidisciplinary teams will harmonize clinical practices incorporating expertise from various specialities and professional groups. Key requirements identified include standardized documentation and multidisciplinary collaboration. Nationally agreed patient information and counselling checklists will streamline the informed consent process and facilitate data collection for long‐term safety and efficacy monitoring.

Conclusion

These guidelines provide a structured framework for the delivery of liver‐directed gene therapy. Whilst specific to the United Kingdom they provide a framework for the implementation of gene therapy in other countries for haemophilia and other monogenic disorders.
‘The Letter Says I May or May Not Be Eligible… It Is a Big Doubt and Frustrating:’ A Qualitative Study on Barriers and Facilitators to Children's Oral Healthcare From the Perspective of Karen Refugee Parents in Victoria
Authors: Balla Sudheer Babu , Tadakamadla Jyothi , Tadakamadla Santosh Kumar
Published: November 2024

Background

Australia has a longstanding tradition of resettling refugees and individuals in humanitarian need. Among these, the Karen community from Southeast Asia is rapidly growing in Australia. The absence of data on the barriers they face in accessing dental services is concerning. This study explores the barriers and facilitators Karen refugees encounter when seeking oral healthcare for their children in Australia, aiming to understand their experiences.

Methods

Using a qualitative research design with a phenomenological approach, we conducted semi‐structured interviews with 23 parents (17 females and 6 males) who had been in Australia for 1–17 years. Each interview, lasting between 35 and 60 min, was audio‐recorded and transcribed verbatim. The transcripts were thematically analysed through an inductive, data‐driven approach, focusing on open coding and participant‐based meanings.

Findings

Nine main themes were identified. At the individual level, cultural practices, parental behaviours and perceptions were the primary barriers. At the organisational level, long waiting lists in the public dental system were significant barriers. Additionally, a lack of knowledge about financial benefits and government support for children's dental care deterred refugees from seeking dental services. The results also highlighted the strengths of support networks, free dental care for children and school‐based dental care programmes. Parents reported experiences of inadequate oral healthcare, citing issues such as insufficient cultural sensitivity training among dental service providers, interpreter problems and shortages. These experiences revealed gaps in the provision of oral healthcare services.

Conclusion

When designing tailored oral health promotion programs, all stakeholders must consider the lived experiences of refugees as valuable sources of information.

Patient or Public Contribution

The authors thank the parents and carers from the Karen refugee community for sharing their experiences with the oral healthcare of their children. Recruitment was facilitated by the Karen Organisation of Bendigo and Bendigo Community Health Services. An interpreter from the Karen refugee community assisted in all the interviews.
Diagnostic features in paediatric MDS‐EB with UBTF‐internal tandem duplication: defining a unique subgroup
Authors: Schwarz‐Furlan Stephan , Gengler Carole , Yoshimi‐Noellke Ayami , Piontek Guido , Schneider‐Kimoto Yuki , Schmugge Markus , Thiede Christian , Niemeyer Charlotte M. , Erlacher Miriam , Rudelius Martina
Published: November 2024

Aim

Tandem‐duplications of the UBTF gene (UBTF‐TDs) have recently been identified as a new genetic driver in young individuals with acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS). Disease in these newly defined subgroups is characterized by poor response to standard intensive chemotherapy and inferior survival of the affected patients. However, a thorough analysis of bone marrow histomorphology of UBTF‐mutated neoplasia has not been undertaken thus far.

Methods and results

In this retrospective study, we investigated the characteristic histopathological features of a cohort comprising 14 paediatric MDS patients with an excess of blasts (MDS‐EB) and UBTF‐TD. Bone marrow biopsies from these patients revealed hypercellularity and severe dysplasia across all three haematopoietic lineages. In particular, a marked hyperplastic megakaryopoiesis characterized by the presence of frequent micromegakaryocytes and a high number of monolobulated cells forming small clusters was observed. Additionally, erythropoiesis was left‐shifted, with numerous blastoid precursors. The granulopoietic precursors displayed prominent UBTF‐positive nucleoli.

Conclusion

The unique combination of these histomorphological features strongly suggests a possible UBTF aberration. It will allow initiating the appropriate genetic testing to confirm the presence of UBTF‐TD and identify potential additional genetic alterations. Such molecular profiling will not only contribute to a better understanding of the disease mechanism, but also facilitate more rational treatment approaches for these high‐risk paediatric MDS patients.
Getting to the Point: Examining Associations Between Adult Interactional Strategies and Infant Gestures
Authors: Romano Mollie , Lloyd Blair P. , Lucca Kelsey , Eugenio Johanna
Published: November 2024

The developmental importance of infant gesture use is well established, yet few investigations examine what adults can do to facilitate infant gestures. We used an event lag with pauses sequential analysis to generate an index of association between each adult interactional strategy and deictic infant gesture during ten‐minute play interactions with 27 typically developing infants (11–25 months) and trained interventionists. We ran correlations to examine potential relationships between the sequential associations, child age, and language scores. Results indicated modeling gestures with a short phrase increased the momentary likelihood of infant gestures overall and points specifically, whereas modeling short phrases without gestures decreased the momentary likelihood of any infant gesture.
Impact of high‐temperature sintering on SiO2−LiO2−Al2O3−K2O−P2O5${\rm SiO}_2{-}{\rm LiO}_2{-}{\rm Al}_2{\rm O}_3{-}{\rm K}_2{\rm O}{-}{\rm P}_2{\rm O}_5$ glass ceramics with ZrO2${\rm ZrO}_2$ and Y2O3${\rm Y}_2{\rm O}_3$ additives
Authors: Kazi Gulsan Ara Sathi , Billah Areef , Takahashi Azusa , Tanno Ko , Hayama Natsuko , Ahmmad Bashir
Published: November 2024

The influence of multi‐step sintering at high temperatures was used to meticulously characterize the crystallization, mechanical, and optical properties of a glass system with the addition of and . The research began with a novel base glass composition of 3.8 wt% , 4.2 wt% , 4.5 wt% , 35 wt% , and 2.5 wt% , to which 47 wt% and 3 wt% added. The initial glass powder was sintered in two steps at low temperatures. Either 500 for 10 min or 500 for 10 min then a raise to 650 for 20 min was used in the first step. Then, the second step of sintering was done at 850. Finally, after the pellet preparation, final calcination was conducted at 1450. The resulting microstructure was a composite material with various grain components embedded within a glass matrix. The low first sintering temperature triggered the optimum crystal growth, and after the final calcination process, a new glass‐ceramic named – was synthesized. The synthesized ceramics demonstrated strong diametral tensile strength and excellent Vickers micro‐hardness values, a remarkable refractive index, and optical band gaps larger than 3.1 eV. Consequently, the process of multi‐step sintering at high temperatures clenches the impending manufacture of a novel composite ceramic having remarkable hardness and good optical properties that encourage several biological, technological, and industrial applications.
Eye Movement Modelling Examples as Cues to Guide Attention and Improve Learning in Short or Long Animations
Authors: Wang Fuxing , Leng Xiaoxue , Kuang Ziyi , Zhao Tingting
Published: November 2024

Background

Both eye movement modelling examples (EMMEs) and cues guide attention and improve learning in multimedia learning environments. EMME can act as a special form of cue. However, no studies have directly examined whether EMME would be superior to visual cues.

Objective

The study was to investigate whether there were advantages of EMME over cues on visual attention, learning outcomes and subjective perception in a multimedia environment.

Method

In Experiment 1, 67 college students were randomly assigned to the EMME group, cue group and control group and learned from animations explaining the synaptic transmission. In Experiment 2, we replicated Experiment 1 using longer learning material. Seventy‐one college students were randomly assigned to three groups (EMME, cue and control) and learned from animations explaining the process of cell division.

Results and Conclusions

In Experiment 1, results indicated both EMMEs and cues guide attention and facilitate learning. Regarding learning outcomes and subjective perception, learners did not benefit more from EMMEs than cues. Eye movement indicators showed that EMMEs were better than cues. In Experiment 2, results were consistent with Experiment 1.

Implications

This study is the first to compare EMMEs and cues. We found that EMMEs and cues were equivalent in producing effects on learning outcomes and subjective perception. EMMEs were superior to cues in guiding attention and conveying strategies, as indicated by eye movements. Both theoretical and practical implications could be drawn.
Immune checkpoint inhibitor‐induced pancreatic enzyme elevation in melanoma patients: Incidence, management and therapy—A multicentre analysis
Authors: Brandlmaier M. , Hoellwerth M. , Silly T. , Hoeller C. , Koch L. , Richtig E. , Binder K. , Lange‐Asschenfeldt B. , Barta M. , Schmid‐Simbeck M. , Froehlich F. , Dummer R. , Muigg L. , Hitzl W. , Koelblinger P.
Published: November 2024

Background

Immune checkpoint inhibitors (ICI) are considered standard‐of‐care in the systemic treatment of melanoma. However, management of certain ICI‐associated adverse events (AE) can be challenging. Incidence, course and management of immune checkpoint inhibitor‐induced pancreatic injury (ICIPI) are not well‐documented and specific diagnostic and therapeutic algorithms are lacking. Current management includes serological monitoring of pancreatic enzymes, radiographic imaging and corticosteroid or further immunosuppressive treatment. Objectives: Based on previous data regarding adjuvant ICI treatment, we suspected that elevation of pancreatic enzymes may occur more frequently than reported while the clinical relevance of—particularly asymptomatic—ICIPI is still unclear.

Methods

A collaboration of eight Austrian and Swiss dermato‐oncology centres was established to retrospectively analyse a large cohort of ICI‐treated patients regarding incidence and management of ICIPI. Additionally, a questionnaire‐based survey concerning ICIPI‐management was conducted.

Results

Among 1516 melanoma patients receiving ICI therapy, 204 patients exhibited ≥CTCAE II° lipase elevation. Of these patients, 41 (20.1%) had symptoms suggestive of pancreatitis. Immunotherapy was interrupted or discontinued due to pancreatic AE in almost half of the patients. Systemic corticosteroids were administered in 103 patients (50.5%), with higher doses reported in symptomatic cases. Six per cent of asymptomatic patients had radiographically proven pancreatitis. Maximum lipase elevation was >5xULN in all of these patients.

Conclusion

Routine lipase monitoring was conducted in all participating centres, although not recommended in respective guidelines. Elevation of serum lipase was observed more frequently than recently reported. Although radiographic findings indicating pancreatitis were rare in asymptomatic patients, ICI treatment was frequently paused or discontinued and systemic steroids were administered. To reduce the existing uncertainty in routine clinical practice reflected by our findings, we provide an algorithm to guide the monitoring and management of potential pancreatic adverse events. Lipase measurement should be limited to symptomatic patients and/or those with radiographic findings indicative of pancreatic injury.
Evaluating family‐centred care at BC Children's Hospital: Healthcare providers' perspectives
Authors: Kolar Tessa , Cook Courtney B. , Cooper Anthony , Blydt‐Hansen Tom , Connolly Mary B. , Boelman Cyrus , Chhina Harpreet , Datta Anita , Demos Michelle , Hildebrand Kyla J. , Selby Kathryn , Shen Ye , Wenderfer Scott E. ,   GenCOUNSEL Study, Elliott Alison M.
Published: November 2024

Background

Family‐centred care (FCC) emphasizes a partnership approach to care between healthcare providers (HCPs), patients, and families. FCC provides significant benefits to both children and families; however, challenges exist in implementing FCC into practice. This study aimed to explore HCPs' FCC behaviours in multidisciplinary specialty clinics at a tertiary pediatric health care center in Canada.

Methods

A demographic survey and the Measure of Processes of Care for Service Providers (MPOC‐SP) questionnaire was administered to HCPs in five specialty clinics: orthopaedics, neurology, multi‐organ transplant, immunology, and nephrology. Survey data were summarized using descriptive statistics. The association between possible predictor variables (ethnicity, gender, years in clinical practice) and MPOC‐SP scores were analysed by analysis of variance (ANOVA) followed by post‐hoc Tukey's test. Differences in scores across professional disciplines were analysed by multivariate analysis of variance (MANOVA) followed by ANOVA. Items rated lower (1–4 out of 7 by >33% of participants) were identified as potential areas for improvement.

Results

HCPs (N = 77) from all five clinics rated the MPOC‐SP domain ‘Treating People Respectfully’ the highest (mean 6.00 ± 0.59) and ‘Providing General Information’ the lowest (mean 4.56 ± 1.27). HCPs with 5–10 years of experience had higher scores across all domains compared to HCPs with <5 years and >10 years of experience. There were no significant differences in scores based on ethnicity, gender, and professional discipline. Items rated lower (1–4 out of 7 by >33% of participants) involved providing general information and emotional support to families.

Conclusions

Providing general information and emotional support to patients and families are areas for improvement for all specialty clinics surveyed. Given genetic counsellors (GCs) expertise in education and counselling, GC integration in these clinics is one way in which FCC can be improved. Our study also shows that years of work experience influences HCPs' capacity to provide FCC.
Multivariate Brain Tumor Detection in 3D‐MRI Images Using Optimised Segmentation and Unified Classification Model
Authors: Anitha V.
Published: November 2024

Aims and Objectives

3D Magnetic Resonance Imaging (3D‐MRI) analysis of brain tumours is an important tool for gathering information needed for diagnosis and disease therapy planning. However, during the brain tumor segmentation process existing techniques have segmentation error while identifying tumor location and extended tumor regions due to improper extraction of initial contour points and overlapping tissue intensity distributions.

Methods

Hence a novel Duo‐step optimised Pyramidal SegNet has been proposed in which multiscale contrast convolutional attention module improve contrast and the tumor edge has been extracted based on location and tumor extension using Duo‐step darning needle optimisation that set initial contour points and pyramidal level set segmentation with ancillary Sobel edge operator extract the tumour region from all 2D MRI image slices without having overlapped tissue intensity distributions thereby effectively minimises segmentation error. Furthermore, during the classification of segmented tumor region based on its type, irregular planimetric volume and low interrater concordance of multivariate brain tumors reduce the detection rate due to neglecting the extraction of contextual and symmetric features. Hence 3D brain Unified NN has been proposed in which adaptive multi‐layer deep unified encoder module extract 3D contextual and symmetric features by measuring the difference from the observed region and contralateral region and the multivariate brain tumors are classified with boosted Sparse Categorical Cross entropy loss calculation to demonstrate high detection rate.

Results and Conclusion

The results obtained for the BraTS2020 and Brain Tumor Detection 2020 data sets showed that the proposed model outperforms existing techniques with excellent precision of 97%, 97.5%, recall of 99%, 97.8%, and accuracy of 95.7%, 98.4%, respectively.
Effect of vitamin D, omega‐3 supplementation, or a home exercise program on muscle mass and sarcopenia: DO‐HEALTH trial
Authors: Eggimann Anna K. , de Godoi Rezende Costa Molino Caroline , Freystaetter Gregor , Vellas Bruno , Kanis John A. , Rizzoli René , Kressig Reto W. , Armbrecht Gabriele , Da Silva José A. P. , Dawson‐Hughes Bess , Lang Wei , Gagesch Michael , Egli Andreas , Bischoff‐Ferrari Heike A.
Published: November 2024

Background

We aimed to investigate the effect of daily supplemental vitamin D, omega‐3s, and a thrice‐weekly home exercise program, alone or in combination, on change of appendicular lean muscle mass index (ALMI) and incident sarcopenia in older adults.

Methods

This is a secondary endpoint analysis of a 3‐year randomized, double‐blind, placebo‐controlled trial with a 2 × 2 × 2 factorial design among 2157 community‐dwelling, healthy adults aged 70 + years, from 2012 to 2018 (DO‐HEALTH). Participants were randomized to 2000 IU/d vitamin D and/or 1 g/d marine omega‐3s and/or exercise. Change in ALMI over 3 years was calculated in all participants who underwent dual energy X‐ray absorptiometry (DXA) (n = 1495) using mixed effect models. Incident sarcopenia was analyzed based on the Sarcopenia Definitions and Outcomes Consortium in all non‐sarcopenic participants (n = 1940).

Results

Among 1495 participants (mean age 74.9 (sd 4.4); 63.3% were women; 80.5% were at least moderately physically active at baseline) mean gait speed at baseline was 1.2 m/s (sd 0.3), mean ALMI at baseline was 6.65 (SD 0.95) in women, and 8.01 (SD 0.88) kg/m2 in men. At year 3, average change of ALMI was −0.09 (sd 0.34) kg/m2 (−1.35%) in women and − 0.17 (sd 0.33) kg/m2 (−2.0%) in men. None of the treatments individually or in combination had a benefit on ALMI change compared to control over 3 years, with omega‐3s showing a small protective effect on ALMI at year 1 only (−0.021 vs. no‐omega‐3s −0.066 kg/m2, p = 0.001). Of 1940 non‐sarcopenic participants at baseline, 88 (4.5%) developed incident sarcopenia over 3 years. None of the treatments individually or in combination reduced the odds of incident sarcopenia compared with placebo.

Conclusion

Among healthy, physically active older adults, ALMI and incidence of sarcopenia were not improved by treatment of daily 2000 IU vitamin D, daily 1 g omega‐3s, or a simple home exercise program compared with control over 3 years.
The tip of the iceberg: A call to improve medical director presence, time, and training in US nursing facilities
Authors: Zwahlen Denise , Luxenberg Jay
Published: November 2024

See related article by Goldwein et al. in this issue.
The “nature” and “nurture” of product lifetimes in dynamic stock modeling
Authors: Krych Kamila , Müller Daniel B. , Pettersen Johan B.
Published: November 2024

Product life extension is often portrayed as one of the pillars of the circular economy since longer lifetimes slow down material turnover rates and thus decrease resource use and associated emissions. Strategies for product longevity can involve addressing the product “nature” (inherent product durability) or “nurture” (external factors). Yet, in most dynamic material flow analysis (dMFA) studies, lifetime is an intrinsic property of the cohort assigned “at birth,” so “nurture” strategies such as repair or reuse cannot be explicitly considered. Here, we introduce a Python‐based tool for comprehensive modeling of lifetime changes in dMFA, including three dimensions of lifetime: age, period (time), and cohort. The tool employs the hazard function, which directly links the outflow to the preceding year's stock, allowing for differentiating the influence of product nature and nurture on lifetimes. The tool supports dynamic stock and flow calculations and is compatible with ODYM, a commonly used dMFA framework. We apply the tool to a case study on dishwashers in Norway to illustrate nature‐ and nurture‐focused lifetime extension strategies. The framework enables linking product lifespans with events such as economic crises and pandemics. It can serve to model life extension scenarios in dMFA that (i) extend the lifetime not only of the new products entering use but also of the products already in use, thus achieving faster effects; and (ii) expand the group of potential stakeholders beyond producers and designers to, for example, consumers, repairers, and resellers. This article met the requirements for a gold‐gold JIE data openness badge described at http://jie.click/badges.
Contact Metamorphism of Pelitic Rocks Constrains the Depth of Emplacement of the Re di Castello Intrusion (Adamello Batholith, Italy)
Authors: Cesare Bernardo , Bartoli Omar , Brack Peter , Moranduzzo Giorgio , Randazzo Arianna , Iaccarino Salvatore , Santello Lisa
Published: November 2024

Re di Castello is the southernmost unit of the composite Adamello batholith (central Alps, Italy). It was emplaced between 43 and 40 Ma, yet its depth of emplacement is not well constrained. We have studied the contact metamorphism of pelitic country rocks in two localities: the upper Caffaro Valley and the Borzago Valley in the southern and the northern sub‐units of the Re di Castello, respectively. In the Caffaro Valley, the country rocks comprise the Triassic sedimentary Lozio Shale, a carbon‐rich slate–siltstone, which was intruded by quartz‐dioritic magma. Near the contact, the hornfelses display the mineralogical assemblage Kfs‐Crd‐Bt‐Ms‐Pl‐Qz‐Gr, with rare fibrolitic sillimanite in a single sample. Andalusite was never observed throughout the aureole at this locality. In the Borzago Valley, contact metamorphism developed on schists of the pre‐Permian basement with a Variscan, regional metamorphic overprint. The sequence of contact metamorphic mineral assemblages progresses from And‐Bt‐bearing parageneses to the Sil‐Crd‐Bt‐Kfs‐Ms‐Pl‐Qz that characterizes peak conditions, at which incipient melting is also observed. K‐feldspar forms slightly upgrade the first appearance of sillimanite. For samples at both localities, thermodynamic modelling in the NCKFMASHT system failed at predicting a stability field for the sequences of mineral assemblages developed during contact metamorphism. Also the Ti‐in biotite thermometer did not constrain temperatures adequately. The P–T conditions at the thermal peak were thus evaluated by an alternative bathograd‐like approach, considering phase relationships in the simplified NKASH‐C system. To form sillimanite only as product of the incomplete Ms‐Qz breakdown—divariant for the presence of Na in Ms and Kfs and shifted to lower temperature due to the presence of graphite (in the Lozio Shale)—an isobaric path typical of contact metamophism must have crossed above the Msss‐Qz‐Kfsss‐Sil‐And‐fluid invariant point. This constrains an emplacement pressure >3.3 kbar in the Caffaro Valley, and >3.2 kbar in the Borzago Valley. Concerning temperature, the same univariant point also constrains the minimum temperature in the Caffaro Valley as >615°C–620°C, consistent with results of RSCM thermometry on graphite from the Lozio Shale. The evidence of incipient melting in some samples from the Borzago Valley indicates higher temperatures, probably approaching 670°C, near the contact to the intrusion. Assuming an average crust density of 2.7 g cm−3, the estimated pressures correspond to a minimum paleo‐depth of emplacement of about 12 km. These depths are somewhat greater than normally considered and should be regarded as revised constraints on models of the emplacement dynamics of the Adamello batholith and on paleogeographic reconstructions of this part of the Southalpine domain.
Dermal Filler‐Induced Alopecia: A Case Report and Literature Review
Authors: Albargawi Salma , Nagshabandi Khalid Nabil , Shadid Asem
Published: November 2024

Background

Dermal filler‐induced alopecia is a rare yet significant complication of aesthetic procedures primarily associated with vascular occlusion and subsequent tissue ischemia. Hyaluronic acid (HA) fillers, though widely used for facial rejuvenation, can lead to adverse outcomes such as skin necrosis and hair loss, particularly in high‐risk areas like the temples and glabella.

Objective

This case report aims to highlight the clinical presentation, diagnostic approach, and multidisciplinary management of filler‐induced alopecia, contributing to the existing literature with a comprehensive review of previously reported cases.

Method

A 21‐year‐old female presented with localized skin necrosis and alopecia four days after receiving 7 mL of HA filler injections in the temples, tear trough, and eyebrow glabella regions. Trichoscopy revealed follicular dropout and white dots, consistent with ischemic hair loss. Treatment included hyaluronidase injections (1500 units), intralesional corticosteroids, topical minoxidil, and CO2 laser therapy. Over 1 year of follow‐up, the patient achieved complete hair regrowth and resolution of facial scarring.

Results

Only 16 cases of filler‐induced alopecia have been documented, predominantly involving HA fillers. This case underscores the importance of early recognition and intervention with hyaluronidase to mitigate ischemic damage. The multidisciplinary management approach employed here demonstrates the potential for full cosmetic recovery.

Conclusion

Filler‐induced alopecia, though rare, necessitates heightened awareness among dermatologists and aesthetic practitioners. Adhering to recommended injection techniques and dosages, alongside the judicious use of ultrasound guidance, can minimize risks and improve patient safety.
Heat Treatment of Saliva to Reduce Infectious Disease Contamination Does Not Impact the Analysis of Melatonin by Radioimmunoassay
Authors: Salkeld Mark D. , Kennaway David J.
Published: November 2024

The determination of melatonin levels in saliva represents one of the key methods for assessing the timing of the central circadian clock in humans, both in research and clinical settings. Melatonin levels in saliva are typically determined in a laboratory setting by RIA or enzyme‐linked immunosorbent assay and the emergence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) presented a serious challenge to the routine, safe assessment of melatonin in saliva samples. However, SARS‐CoV‐2 present in biological fluids can be inactivated by exposure to temperatures of at least 55–60°C for 30 min and the aim of this study was to assess the validity of applying a pretreatment heating step to saliva samples being prepared for melatonin determination using the Novolytix Radioimmunoassay (RK‐DSM2). 40 archived saliva samples collected under a Dim Light Melatonin Onset sampling protocol were thawed and aliquoted into three identical groups—Controls (no pretreatment), 56°C pre‐assay heat‐treatment (30 min), and 70°C pre‐assay heat‐treatment (30 min). Melatonin concentrations in samples that were heated to 56°C for 30 min before assaying showed close agreement with the untreated controls, with the Pearson's correlation coefficient between the two sets of samples of 0.99 (p < 0.0001) and the slope of the Deming regression analysis close to 1.0 (Y = 1.04X + 0.168). When saliva samples were pretreated to 70°C for 30 min before assaying, the subsequent melatonin determinations were still strongly correlated with the untreated controls (Pearsons correlation coefficient = 0.97 (p < 0.0001), however melatonin concentrations were consistently overestimated when compared to the untreated controls with Deming regression slope of Y = 1.26X + 0.241. These results indicate that a 56°C pretreatment step is suitable for inclusion in standard operating protocols for melatonin determinations using the Novolytix RIA, as a way of effectively minimizing the potential for accidental pathogen exposure while handling saliva samples.
Genotyping and drug susceptibility profiling of Prototheca sp. strains isolated from cases of protothecosis in dogs
Authors: Proskurnicka Angelika , Iskra Mateusz , Wronka Sylwia , Bakuła Zofia , Danesi Patrizia , de Farias Marconi Rodrigues , Ramos Portilho Fábio Vinícius , Garcia Ribeiro Márcio , Rösler Uwe , Kano Rui , Malik Richard , Jagielski Tomasz
Published: November 2024

Background

Protothecosis in dogs is a rare, yet emerging disease, distinguished by its often‐aggressive clinical course and high fatality rate. Our study was conducted to enhance treatment protocols for affected dogs by better understanding the genetic diversity and drug resistance patterns of Prototheca species.

Objectives

To identify species and drug susceptibility profiles of an international collection of 28 Prototheca strains isolated from cases of protothecosis in dogs.

Animals

None.

Methods

Retrospective study. Species‐level identification was made for isolates from 28 dogs in 6 countries by molecular typing with the partial cytb gene as a marker. For the determination of minimum inhibitory concentrations (MICs) and minimum algicidal concentrations (MACs), the Clinical Laboratory Standards Institute (CLSI) protocol (M27‐A3) was used.

Results

Prototheca bovis was the most prevalent species, accounting for 75% (21/28) of the cases, followed by P. wickerhamii (18%; 5/28) and P. ciferrii (7%; 2/28). Of the 6 drugs tested, efinaconazole (EFZ) was the most potent in vitro, with its median MIC and MAC values equal to 0.125 mg/L. The lowest activity was found for fluconazole (FLU), with MIC and MAC medians of 48 mg/L and 64 mg/L, respectively.

Conclusions and Clinical Importance

Our study identifies P. bovis as the species that most frequently causes protothecosis in dogs, which suggests the possibility of cross‐species infection from other animals, especially cows. Additionally, it indicates that EFZ could be used in the treatment of infection in the colon.