bluuebunny/crossref_metadata_2025 huggingface dataset:
Does outpatient mutual‐aid reduce oncology patients' utilization of inpatient services?—An empirical study of outpatient mutual‐aid policy in Wuhan, China
Authors: Jiang Junnan , Zhang Zhibing , Bingbing Tuo
Published: October 2024

Background

The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual‐aid policy which had led to a change in the costs associated with outpatient treatment from being fully self‐paid by the patient to being partially self‐paid.

Purpose

This study aimed to assess the impact of the outpatient mutual‐aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare.

Methods

24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy.

Results

The findings was that the implementation of the outpatient mutual‐aid would result in a reduction of 1.2 days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent.

Conclusions

Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.
Assessment of anxiety in parents of children undergoing tonsillectomy under general anaesthesia: A cross‐sectional study
Authors: Siddiqui Khalid Maudood , Khan Zohair Ahmed , Yousuf Muhammad Saad , Ali Muhammad Asghar
Published: October 2024

Background and Aims

Surgery in the pediatric age group entails a significant amount of anxiety for parents. Due to anxiety, parents are unable to take care of their children, which could affect the child's well‐being and contributes to poor outcomes. The primary objective of this study is to determine the frequency of preoperative anxiety in parents before the surgery of their children.

Methods

It is a cross‐sectional descriptive study that included either parent of 147 children of American Society of Anaesthesiology (ASA) I & II, aged 1–12 years undergoing tonsillectomy over the period of 1 year. Each parent's demographic data were recorded and requested to answer a proforma containing the Amsterdam Preoperative Anxiety Information Scale (APAIS) for assessing anxiety on a 5‐point Likert scale. Median interquartile range (IQR), and frequency (%) were used to report the normal, skewed, and categorical variables. APAIS anxiety and information scores were compared by using either the Mann–Whitney U‐test or the Kruskal–Wallis test. Furthermore, anxiety scores were grouped (present/absent) with a cut‐off score of 11 for the presence of anxiety, and multivariate logistic regression was performed to explore the relationship between potential risk factors and the parent's anxiety.

Results

Overall, anxiety was present in 59 (40.1%) respondents with 20 (33.9%) being fathers and 39 (66.1%) mothers. The median (IQR) for APAIS anxiety and information score were 9 ± 5 and 5 ± 2, respectively. Higher median anxiety scores were observed statistically significant in children under 5 years old, mother respondents, mothers aged 35 or younger, fathers under 40, and mothers with graduate or higher education (p < 0.05). Father respondents (AOR = 0.3, 95% CI = 0.1–0.8, p = 0.01), and mother's education less than graduation (AOR = 0.2, 95% CI = 0.1–0.6, p = 0.006) were also found to be statistically significant predictors.

Conclusion

There is a significant prevalence of anxiety in parents of children who underwent surgery under general anaesthesia, and mothers have showed significantly higher anxiety levels than fathers.
A narrative review of magnetic resonance imaging findings in pediatric idiopathic intracranial hypertension
Authors: Sheibani Abdolreza , Hashemi Narges , Beizaei Behnam , Tavakkolizadeh Nahid , Shoja Ahmad , Karimabadi Neda , Mirakhorli Houshang , Hasanabadi Parsa , Payandeh Asma , Hassannejad Ehsan
Published: October 2024

Background and Aims

Idiopathic intracranial hypertension (IIH) is a rare neurological disorder in the pediatric population which is defined as an increase in intracranial pressure (ICP) without the presence of brain parenchymal lesions, hydrocephalus, or central nervous system infection. In this study, we have determined the magnetic resonance imaging (MRI) findings in IIH patients.

Methods

A comprehensive literature search was conducted using the electronic databases including Web of Sciences, Scopus, and Pubmed to identify suitable and relevant articles using keyword search methods. The search included keywords such as “idiopathic intracranial hypertension,” “pseudotumor cerebri,” “MRI,” and “pediatrics.” The search was limited to the available publications up to January 2024.

Results

MRI plays a crucial role in diagnosing IIH by excluding secondary causes and revealing neuroimaging findings associated with elevated ICP. Despite fewer studies in children compared to adults, MRI serves as a cornerstone in identifying traditional neuroradiological markers such as empty sella turcica, posterior globe flattening, optic nerve tortuosity, optic nerve sheath distension, and transverse venous sinus stenosis. Additional subtle markers include increased Meckel's cave length, cerebellar tonsillar herniation, and slit‐like ventricles, although these are less reliable. Diffusion‐weighted imaging does not typically show cerebral ADC value changes indicative of cerebral edema in pediatric IIH.

Conclusion

MRI findings provide valuable non‐invasive diagnostic indicators that facilitate early detection, clinical management, and potential surgical intervention in pediatric IIH. The reliability of these MRI markers underscores their importance in clinical practice.
Identification of diagnostic candidate genes in COVID‐19 patients with sepsis
Authors: Li Jiuang , Pu Shiqian , Shu Lei , Guo Mingjun , He Zhihui
Published: October 2024

Purpose

Coronavirus Disease 2019 (COVID‐19) and sepsis are closely related. This study aims to identify pivotal diagnostic candidate genes in COVID‐19 patients with sepsis.

Patients and Methods

We obtained a COVID‐19 data set and a sepsis data set from the Gene Expression Omnibus (GEO) database. Identification of differentially expressed genes (DEGs) and module genes using the Linear Models for Microarray Data (LIMMA) and weighted gene co‐expression network analysis (WGCNA), functional enrichment analysis, protein–protein interaction (PPI) network construction, and machine learning algorithms (least absolute shrinkage and selection operator (LASSO) regression and Random Forest (RF)) were used to identify candidate hub genes for the diagnosis of COVID‐19 patients with sepsis. Receiver operating characteristic (ROC) curves were developed to assess the diagnostic value. Finally, the data set GSE28750 was used to verify the core genes and analyze the immune infiltration.

Results

The COVID‐19 data set contained 3,438 DEGs， and 595 common genes were screened in sepsis. sepsis DEGs were mainly enriched in immune regulation. The intersection of DEGs for COVID‐19 and core genes for sepsis was 329, which were also mainly enriched in the immune system. After developing the PPI network, 17 node genes were filtered and thirteen candidate hub genes were selected for diagnostic value evaluation using machine learning. All thirteen candidate hub genes have diagnostic value, and 8 genes with an Area Under the Curve (AUC) greater than 0.9 were selected as diagnostic genes.

Conclusion

Five core genes (CD3D, IL2RB, KLRC, CD5, and HLA‐DQA1) associated with immune infiltration were identified to evaluate their diagnostic utility COVID‐19 patients with sepsis. This finding contributes to the identification of potential peripheral blood diagnostic candidate genes for COVID‐19 patients with sepsis.
Legislative developments in personal insolvency in China’s mainland: A comparative analysis of regional practices in China’s mainland, Hong Kong, and Taiwan Region
Authors: Liu Pin
Published: October 2024

With the ongoing implementation of personal insolvency practices in China’s mainland, the realization of a nationwide personal insolvency system in China’s mainland no longer appears distant. In the design of specific personal insolvency schemes, key elements to consider are establishing entry criteria, assessing the integrity of debtors, determining the duration of the discharge examination period, setting the length of the blocking period for subsequent insolvencies. Additionally, the availability of a simplified procedure for personal insolvency should also be considered. By analysing 12 official documents from regional practices in China's mainland and comparing them with corresponding regulations in Taiwan Region ("Taiwan") and Hong Kong, we can draw valuable experiences and identify shortcomings. This effort aims to lay the foundation for a unified personal insolvency system in the future of China’s mainland.
Development and validation of a lung cancer polygenic risk score incorporating susceptibility variants for risk factors
Authors: Ma Zhimin , Zhu Zhaopeng , Pang Guanlian , Gong Feilong , Gao Jiaxin , Ge Wenjing , Wang Guoqing , Zhu Mingxuan , Gong Linnan , Li Qiao , Ji Chen , Fu Yating , Jin Chen , Ma Hongxia , Ji Yong , Zhu Meng
Published: October 2024

Incorporating susceptibility genetic variants of risk factors has been reported to enhance the risk prediction of polygenic risk score (PRS). However, it remains unclear whether this approach is effective for lung cancer. Hence, we aimed to construct a meta polygenic risk score (metaPRS) of lung cancer and assess its prediction of lung cancer risk and implication for risk stratification. Here, a total of 2180 genetic variants were used to develop nine PRSs for lung cancer, three PRSs for different histopathologic subtypes, and 17 PRSs for lung cancer‐related risk factors, respectively. These PRSs were then integrated into a metaPRS for lung cancer using the elastic‐net Cox regression model in the UK Biobank (N = 442,508). Furthermore, the predictive effects of the metaPRS were assessed in the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial (N = 108,665). The metaPRS was associated with lung cancer risk with a hazard ratio of 1.33 (95% confidence interval: 1.27–1.39) per standard deviation increased. The metaPRS showed the highest C‐index (0.580) compared with the previous nine PRSs (C‐index: 0.513–0.564) in PLCO. Besides, smokers in the intermediate risk group predicted by the clinical risk model (1.34%–1.51%) with the intermediate‐high genetic risk had a 6‐year average absolute lung cancer risk that exceeded the clinical risk model threshold (≥1.51%). The addition of metaPRS to the clinical risk model showed continuous net reclassification improvement (continuous NRI = 6.50%) in PLCO. These findings suggest the metaPRS can improve the predictive efficiency of lung cancer compared with the previous PRSs and refine risk stratification for lung cancer.
Uterine rupture following prostaglandins use in second trimester medical abortion: Fact or fiction? A systematic review
Authors: Malvasi Antonio , Tinelli Andrea , Mulone Vanessa , Cicinelli Ettore , Vitagliano Amerigo , Damiani Gianluca Raffaello , Baldini Giorgio Maria , Dellino Miriam , D'Amato Antonio , Vimercati Antonella
Published: October 2024

Background

Prostaglandins (PGs) have emerged as key drugs in second trimester medical abortion (STMA) and are currently a cornerstone in obstetric practice. Nevertheless, the application of PGs, integral to labor and abortion procedures, is not risk‐free, and has been associated with several complications, particularly maternal fever and uterine rupture (UR).

Objectives

The main outcome of the present systematic review was to assess the safety of PGs use in STMA, particularly in scarred uterus (SC).

Search Strategy

The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We performed a comprehensive systematic review by searching multiple databases, including MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database, and the research registers of Web of Science during the years 1990–2022.

Selection Criteria

Only articles regarding cases of UR occurred after the use of PGs for STMA were included in the article. We excluded papers regarding UR during first trimester abortion induction of labor or pregnancy or unrelated to PGs use for STMA. Risk of bias was assessed employing a modified version of the “Newcastle‐Ottawa Scale” (NOS).

Data Collection and Analysis

A total of 178 studies were initially identified as potentially meeting the criteria for inclusion in the review. After full text evaluation, 110 other articles were excluded and 67 studies that suited the inclusion criteria were included. A total of 19 of the included studies were judged to have a high risk of bias. Given the heterogeneous nature of the findings, we opted for a narrative synthesis of the results.

Main Results and Conclusions

PGs appear to be an effective pharmacologic tool for STMA; however, their use is not entirely risk‐free. STMA requires well‐equipped obstetric centers with skilled clinicians and surgeons prepared for emergencies. Ultrasonographic scans should be routinely performed during STMA management, since a UR can also be silent during the induction of labor. Intrapartum transabdominal, transperineal, and transvaginal ultrasound may have the diagnostic potential to early recognize this obstetric emergency, to facilitate rapid medical and surgical treatment, improving the outcome.
Adolescents' offline and online social support: A study on latent groups and their relationship with mental health
Authors: Zhou Ziyao , Cheng Qijin , Ma Yujun
Published: October 2024

Introduction

The internet has become a common space for adolescents to connect with others and find information. However, it remains unclear whether online encounters can serve as new sources of social support for Chinese adolescents. The present study aimed to identify distinct patterns in Chinese adolescents’ social support from both offline and online sources and to examine how these patterns relate to individual and family factors and adolescents’ mental health conditions.

Methods

Data were obtained from a cross‐sectional survey of 1031 Chinese adolescents (47.1% female, mean age = 13.67) in Foshan, Guangdong province. Latent profile analysis was performed with Mplus. Associations between the identified classes and auxiliary variables were examined with the “R3STEP” procedure and the DCON command in Mplus.

Results

We identified four groups. Three groups showed consistent patterns in terms of receiving social support from offline and online sources, namely, the high support group (24.8%), moderate support group (43.8%), and low support group (15.3%), respectively. The fourth group received a moderate level of offline but low level of online support (16%), named the moderate offline‐low online support group. The groups differed in individual and family characteristics. Higher support was associated with higher life satisfaction, lower depression, and social anxiety, but also higher problematic internet use. Overall, the moderate offline‐low online support group showed better mental health than the other groups.

Conclusions

Our study extends social support research by revealing heterogeneity in adolescents’ social support patterns. The findings encourage a balanced use of offline and online support.
Evaluation of Health Associations With Height‐Normalised Abdominal Body Composition Indices: A Single‐Centre Cross‐Sectional Study
Authors: Liu Yupeng , He Hangqian , Qian Keyu , Huang Yufeng , Ao Xuemei , Shi Xudong , Ruan Binye , Xue Ru , Fu Xiaoyi , Wang Shuran
Published: October 2024

Background

Traditional metrics such as body mass index (BMI) and waist circumference (WC) fail to accurately assess the health outcomes associated with abdominal adiposity, because they neglect the intricacies of adipose tissue distribution. Notably, the variability in body composition scaled to height remains underexplored in Chinese demographics. This study introduces height‐normalised indices of abdominal adiposity using computed tomography (CT) scans and further assesses their associations with various health outcomes.

Methods

In a large, diverse Chinese population (n = 1054 healthy individuals; n = 1159 with dyslipidemia; n = 803 with diabetes; n = 1289 with cardio‐cerebrovascular diseases; n = 1108 with cancers; and n = 509 with abnormal bone mas), abdominal CT scans were performed and allometric growth model analyses were used to derive height‐normalised indices (body composition/heightβ). Logistic regression models assessed the associations between these indices and health outcomes.

Results

Distinct scaling powers were observed for visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total abdominal adipose tissue (TAT), as well as for sagittal diameter (SAD), with marked sex differences. Powers for VAT were 1.786 ± 1.270 for males and 1.274 ± 0.692 for females. Powers for SAT were 2.266 ± 0.856 for males and 1.656 ± 0.497 for females. Powers for TAT were 2.141 ± 0.967 for males and 1.438 ± 0.489 for females. Powers for SAD were 0.646 ± 0.217 for males and 0.678 ± 0.141 for females. After controlling for age, BMI and WC, VAT/heightβ, TAT/heightβ and SAD/heightβ retained their significantly positive associations with the odds of health outcomes, whereas SAT/heightβ did not.

Conclusions

Our findings endorse the clinical utility of height‐normalised indices, particularly VAT/heightβ, TAT/heightβ and SAD/heightβ, in health outcomes assessment. These indices, grounded in robust empirical data, underscore the necessity of a nuanced approach in obesity‐related health evaluations, advocating for a departure from conventional methods like BMI.
Fusion of Color Correction and HSV Segmentation Techniques for Automated Segmentation of Acute Lymphoblastic Leukemia
Authors: Al‐Tahhan F. E. , Omar Emam
Published: October 2024

This article presents an enhanced segmentation methodology for the accurate detection of acute lymphoblastic leukemia (ALL) in blood smear images. The proposed approach integrates color correction techniques with HSV color space segmentation to improve white blood cell analysis. Our method addresses common challenges in microscopic image processing, including sensor nonlinearity, uneven illumination, and color distortions. The key objectives of this study are to develop a robust preprocessing pipeline that normalizes blood smear images for consistent analysis, implement an HSV‐based segmentation technique optimized for leukocyte detection, and validate the method's effectiveness across various ALL subtypes using clinical samples. The proposed technique was evaluated using real‐world blood smear samples from ALL patients. Quantitative analysis demonstrates significant improvements in segmentation accuracy compared to traditional methods. Our approach shows strong capability in reliably detecting and segmenting ALL subtypes, offering the potential for enhanced diagnostic support in clinical settings.
Use of the pectoralis minor and coracoacromial ligament for a biplanar coracoclavicular and acromioclavicular reconstruction: A cadaveric feasibility study
Authors: Cartaya Marco A. , Vargas Jorge M.
Published: October 2024

Purpose

The aim of this study was to evaluate the feasibility of a novel technique that focuses on vertical and horizontal stabilization of the acromioclavicular joint using two local autologous grafts, the pectoralis minor (Pm) and the coracoacromial ligament (CAL).

Methods

Ten fresh‐frozen shoulder cadaveric pieces were dissected. Length and width of the Pm and CAL were measured in their anatomical position and anatomical variants were noted. The Pm tendon was harvested at the myothendinous junction keeping the insertion at the coracoid process. The CAL was detached from the coracoid process keeping the acromial insertion. The free limbs of both grafts were prepared with the Krackow technique and the Arthrex SpeedWhip technique, respectively. The primary coracoclavicular reduction and fixation were with the button system or with two subcoracoid ultrahigh‐strength suture cerclage through and around the clavicle. The Pm graft was fixed inside a clavicular tunnel by a cortical button and the CAL was transferred and fixed to the lateral clavicle using a knotless anchor or intramedullary when lateral clavicle resection was performed.

Results

The median length of the Pm was 50 mm (interquartile range [IQR]: 50–54), and the median length of the CAL was 36.5 mm (IQR 34–40) which decreased by 15% and 23% once were prepared with the Krackow and Arthrex SpeedWhip techniques to 44.5 mm (IQR: 30–65) and 30 mm (IQR: 22–32), respectively. The diameter of the prepared Pm graft was 5 mm (IQR: 4.5–6) and the CAL graft 5.5 mm (5–6). All grafts were able to reach the fixation points. The procedure was feasible in 100% of the cases.

Conclusion

A biplanar reconstruction using autologous Pm and CAL appears feasible in restoring the acromioclavicular joint stability.

Level of Evidence

Level IV. Basic science, anatomy, cadaveric dissection
Comparable long‐term functional outcomes of subvastus and medial parapatellar approach in total knee arthroplasty: A 10‐year follow‐up study
Authors: Hosseini‐Monfared Pooya , Mirahmadi Alireza , Amiri Shayan , Minaie Reza , Ghafouri Mohammad Hossein , Kazemi Seyed Morteza
Published: October 2024

Background

Surgeons usually use the medial parapatellar or subvastus approaches for total knee arthroplasty (TKA). The subvastus approach is rapidly gaining recognition to reduce damage to the extensional mechanism and recover faster after surgery. This study compares the long‐term outcomes of the conventional medial parapatellar and subvastus approaches in primary TKA during a minimum 10‐year follow‐up.

Methods

In a retrospective longitudinal follow‐up study from 2008 to 2013, 60 eligible patients for primary TKA were included. The patients were divided into two groups: one undergoing TKA with the subvastus approach (n = 30) and the other with the conventional medial parapatellar approach (n = 30). Postoperatively, the patients were followed up for 10–15 years. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Visual Analogue Scale index for pain.

Results

The time required to perform an active straight leg raise (SLR) was significantly shorter in the subvastus group (p < 0.001) at early postoperation evaluation. Patients in the subvastus group had lower pain and better knee functional scores at the one‐year follow‐up (p < 0.05). There was no difference between the two groups regarding duration of hospitalisation, blood loss, operation time, length of the scar, and postoperative complications. Both approaches had similar long‐term results regarding pain and functional scores of WOMAC (6.2 ± 1.2 vs. 6.3 ± 1.3, p‐value = 0.69) and KSS scores (93.1 ± 6.8 vs. 95.0 ± 3.2, p‐value = 0.42).

Conclusion

The subvastus approach was associated with a shorter time to achieve active SLR, higher functional scores, and better pain relief at early postoperative evaluations. However, both techniques had similar long‐term outcomes in terms of pain and functional scores, as measured by the WOMAC and KSS scales.

Level of Evidence

II
Genotypes of carboxypeptidase A1 and gamma‐glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of intraductal papillary mucinous neoplasm in Japan
Authors: Agawa Shuhei , Futagami Seiji , Nakamura Ken , Habiro Mayu , Kawawa Rie , Shinagawa Yuto , Motomiya Rina , Kirita Kumiko , Akimoto Teppei , Onda Takeshi , Tanabe Tomohide , Ueki Nobue , Honda Kazufumi , Gwee Kok‐Ann , Iwakiri Katsuhiko
Published: October 2024

Background and Aim

This study aimed to clarify whether several single‐nucleotide polymorphisms (SNPs)‐related chronic pancreatitis such as carboxypeptidase A1 (CPA1), carboxypeptidase B1 (CPB1), Gamma‐glutamyltransferase 1 (GGT1), G‐protein‐coupled receptor Class C Group 6 Member A (GPRC6A), and serine protease inhibitor, Kazal type 1 (SPINK‐1) genotypes were associated with clinical characteristics of patients with intraductal papillary mucinous neoplasm (IPMN) and worrisome features of IPMN.

Methods

We enrolled 100 patients with IPMN and 116 patients as a control. Serum p‐amylase, lipase, trypsin, phospholipase A2 (PLA2), and elastase‐1 levels were measured. An Olympus EUS (GF‐UCT 260) was used to perform endosonography in 100 patients with IPMN. Total EUS score was evaluated using endosonography. DNA was isolated from the duodenal tissue using a commercial system and polymerase chain reaction (PCR) was performed on 7500 Fast PCR System.

Results

There were no associations between glucose tolerances, lipid levels and genotypes of CPA1, GGT1, GPRC6A, and SPINK‐1 in patients with IPMN. CPA1 genotype was significantly associated with the pathophysiology of IPMN. Then, GGT1 genotype was also significantly associated with EUS total score and the size of cyst more than 20 mm and more than 30 mm as one of worrisome features of IPMN.

Conclusion

Genotypes of carboxypeptidase A1 and gamma‐glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of IPMN.
On graphs for which large books are Ramsey good
Authors: Liu Meng , Li Yusheng
Published: October 2024

Let be a graph and a connected graph. Then is said to be ‐good if the Ramsey number is equal to the general lower bound , where and are the chromatic number and the chromatic surplus of , respectively. For a fixed graph with and , it is shown that if , then large are ‐good if and only if is a subgraph of for some , where is a matching of edges. We also give conditions for with respect to ‐goodness of large .
Prevalence and co‐occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low‐ and middle‐income countries: a cross‐sectional study
Authors: Parcesepe Angela M. , Stockton Melissa , Bernard Charlotte , Kanguya Tukiya , Kwobah Edith Kamaru , Lopez Alvaro , Murenzi Gad , Ross Jeremy , Minga Albert , Maruri Fernanda , Tlali Mpho , Goodrich Suzanne , Perazzo Hugo , Musabyimana Françoise , Nimkar Smita , Lancaster Kathryn , Consortium IeDEA
Published: October 2024

Introduction

Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co‐occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co‐occurrence of MSDs among ageing PWH remains limited, particularly in low‐ and middle‐income countries (LMICs).

Methods

We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co‐occurrence of unhealthy alcohol use (AUDIT‐C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ‐9 ≥10), anxiety (GAD‐7 ≥10) and post‐traumatic stress disorder (PTSD) (PCL‐5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio‐demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use.

Results

Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men.

Conclusions

Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi‐focus mental health treatment approaches in HIV care settings should be examined.
Evaluation of Microbial Phospholipase and Lipase Activity Through the Chromatographic Analysis of Crude, Degummed, and Transesterified Soybean Oil for Biodiesel Production
Authors: Eddehech Ahlem , Tropea Alessia , Rigano Francesca , Donnarumma Danilo , Ben Abdallah Emna , Cacciola Francesco , Mondello Luigi , Zarai Zied
Published: October 2024

The present study aimed at synthesizing fatty acid methyl esters in a combined enzymatic method by applying degumming and transesterification of soybean oil. A soluble lipase from Serratia sp. W3 and a recombinant phosphatidylcholine‐preferring phospholipase C (PC‐PLC) from Bacillus thuringiensis were used in a consecutive manner for phosphorus removal and conversion into methyl esters. By applying 1% of recombinant PC‐PLC almost 83% of phosphorus was removed (final content of 21.01 mg/kg). Moreover, a sensitive and selective high‐performance liquid chromatography method coupled to tandem mass spectrometry was applied to obtain a comprehensive lipid profile for the simultaneous evaluation of phospholipids removal and diacylglycerol (DAG) increase. A significant increase for all the monitored DAG species, up to 138.42%, was observed by using the enzymatic degumming, in comparison to the crude sample, resulting in an increased oil yield. Serratia sp. W3 lipase was identified as a suitable biocatalyst for biodiesel production, converting efficiently the acylglycerols. The results regarding the physical‐chemical characteristics show that the cetane level, density and pour point of the obtained biodiesel are close to current regulation requirements. These findings highlight the potential of a two‐step process implementation, based on the combination of lipase and phospholipase, as a suitable alternative for biodiesel production.
Missed Adjuvant Therapy in Human Papillomavirus Positive Oropharyngeal Squamous Cell Carcinoma
Authors: Huang Lily , Patel Aman M. , Haleem Afash , Brant Jason A. , Maxwell Russell , Brody Robert M. , Carey Ryan M.
Published: October 2024

Objective

Investigate missed adjuvant therapy and associated disparities in overall survival (OS) for human papillomavirus‐associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC).

Methods

The 2010–2017 National Cancer Database was queried for patients with surgically resected HPV+ OPSCC. Indications for adjuvant radiotherapy (aRT) included pT3‐4 classification, pN2‐3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins (PSM). Indication(s) for adjuvant chemoradiotherapy (aCRT) included pENE and/or PSM. Multivariable logistic and Cox regression models were implemented.

Results

Of 5297 patients satisfying inclusion criteria, 4288 had indication(s) for aRT; 775 did not receive any adjuvant therapy and were considered as missing aRT. A total of 2234 patients had indication(s) for aCRT. Of these, 1383 (61.9%) received aCRT, 555 (24.8%) patients received aRT alone and were considered as having missed aCRT, and 296 (13.2%) did not receive any adjuvant therapy. Missed aRT and missed aCRT were each associated with age, treatment facility type, pN classification, and surgical margin status (p < 0.015). Among patients with indication(s) for aRT alone, OS of those receiving no adjuvant therapy, aRT alone, and aCRT was 90.0%, 94.8%, and 93.4%, respectively (p = 0.080). Among patients with indication(s) for aCRT, those receiving aRT alone and aCRT had similar OS (89.0% vs. 86.6%, p = 0.357) which was superior to receiving no adjuvant therapy (74.9%, p < 0.001). These patterns in OS persisted on multivariable Cox regression.

Conclusion

Among patients with HPV+ OPSCC and indication(s) for aRT, missed aRT was not associated with worse OS. For patients with indication(s) for aCRT, aRT alone was associated with similar OS as aCRT.

Level of Evidence

3 Laryngoscope, 135:729–740, 2025
Farmland Degradation in the Czech Republic: Drivers and Barriers of Mitigation Strategies in Agricultural Soils
Authors: Cechura Lukas , Ullah Ayat , Bajan Bartłomiej , Bavorová Miroslava
Published: October 2024

In line with Sustainable Development Goal (SDG) 15.3, which aims to restore degraded land and soil, and the priorities of the Common Agriculture Policy (CAP) to mitigate environmental issues caused by intensive agriculture, understanding the factors influencing farmers' adoption of soil conservation practices (SCPs) is crucial. However, there is still a limited understanding of these specific factors, particularly in the context of the Czech Republic. This study investigates the perceptions and determinants influencing the adoption of SCPs among farmers in the Czech Republic. We analyzed 358 randomly selected farm households using probit and multivariate probit models. Our results show that a significant number of farmers perceive soil degradation as an important problem, attributing it to factors such as low soil nutrient content, declining soil humus, water and wind erosion. The results of our analysis showed positive associations for perceived effectiveness and profitability, indicating that farmers tend to adopt practices such as minimum tillage, mulching, mixed cropping, cover cropping, and continuous soil cover when these methods are perceived to be effective and profitable. Conversely, negative associations are found for perceptions of soil degradation and education, suggesting potential barriers to adoption with higher levels of perceived soil degradation and education. The study also highlights the complex interplay of information sources on adoption, with both positive and negative trends. In light of these findings, we propose recommendations, including that awareness campaigns should be tailored to address perceptions of soil degradation, and that the use of peer networks and information dissemination from research institutions can bridge the gap between scientific recommendations and on‐farm practices. Policy makers and agricultural extension services should work together to develop targeted strategies that take into account regional differences in the factors influencing adoption and ultimately promote widespread adoption of SCPs.
Pore Structures in Detritusphere of Soils Under Switchgrass and Restored Prairie Vegetation Community
Authors: Lee Jin Ho , Geers‐Lucas Maik , Guber Andrey K. , Kravchenko Alexandra N.
Published: October 2024

Root detritusphere, that is, the soil in the vicinity of decomposing root residues, plays an important role in soil microbial activity and C sequestration. Pore structure (size distributions and connectivity of soil pores) in the detritusphere serves as a major driver for these processes and, in turn, is influenced by the physical characteristics of both soil and roots. This study compared pore structure characteristics in the root detritusphere of soils of contrasting texture and mineralogy subjected to > 6 years of contrasting vegetation: monoculture switchgrass and polyculture prairie systems. Soil samples were collected from five experimental sites in the US Midwest representing three soil types. Soil texture and mineralogy were measured using a hydrometer and x‐ray powder diffraction, respectively. The intact cores were scanned with x‐ray computed micro‐tomography to identify visible soil pores, biopores, and particulate organic matter (POM). We specifically focused on pore structure within the detritusphere around the POM of root origin. Results showed that the detritusphere of coarser textured soils, characterized by high sand and quartz contents, had lower porosity in the vicinity of POM compared with finer textured soils. POM vicinities in finer textured soils had high proportions of large (> 300 μm diameter) pores, and their pores were better connected than in the coarser soils. Lower porosity in the outer (> 1 mm) parts of the detritusphere of switchgrass than of prairie suggested soil compaction by roots, with the effect especially pronounced in the coarser soils. The results demonstrated that soil texture and mineralogy played a major, while vegetation played a more modest, role in defining the pore structure in the root detritusphere.
Outpatient management of pediatric epistaxis: A cost analysis and clinical model
Authors: Lee Joshua A. , Puchi Christopher , Billings Kathleen R. , Lavin Jennifer M. , Hazkani Inbal , Glennon Carole , Thompson Dana M. , Maddalozzo John
Published: October 2024

Objective(s)

Pediatric epistaxis is a common, often non‐operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers.

Methods

Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed.

Results

In total, 122 patients were included for analysis. Over a follow‐up duration of 20.5 months (IQR 8–36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution (n = 122). Refractory epistaxis was associated with a family history of coagulopathy (p = .007), daily epistaxis episodes (p = .043), and anemia (p <.001). Average direct hospital costs associated with nasal cautery were $187 for in‐office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in‐office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work‐up was $576.

Conclusion

Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care.

Level of Evidence: 4.
Challenges and Opportunities of Stretchable Electroluminescent Devices and Displays
Authors: Zhang Hao‐Yang , Jia Shi‐Xin , Yin Da , Feng Jing
Published: October 2024

Stretchable electroluminescent (EL) devices have been studied for more than 10 years, and their EL and mechanical performance, such as brightness, efficiency, stretchability, and stretching stability show significant improvement. Stretchable display is considered to be the most promising next‐generation display technology, which has broad application prospects in various emerging fields, such as deformable displays, electronic skins, and biomedical devices, and it attracts much attention from worldwide manufacturers. However, no commercial application cases for stretchable displays are reported to date. There are many reasons for this situation, including deficient device performance, immature preparation process, and diversiform device structures and materials. On the other hand, although researchers devise a number of possible applications for stretchable EL devices, it is still controversial what unique and interesting functions stretchable displays can play in these scenarios, and whether they can be replaced by flexible, bendable, and rollable devices with better EL and mechanical performance. Therefore, the future of stretchable displays is full of both opportunities and challenges. In response to the above concerns, this review summarizes the characteristics, problems, and possible solutions of various types of stretchable EL devices, aiming to promote their development and application.
Effect of Temperature and Oxygen Concentration on Corrosion of J55 Steel in an O2/CO2 Environment
Authors: Ma Haozhe , Yu Xiaohong , Jia Xiaolan , Yu Haobo
Published: October 2024

The corrosion product competition and transformation process of J55 under an O2/CO2 environment in the temperature range of 50–350°C and 0–1 MPa oxygen partial pressure range, respectively, were studied using electrochemical and surface analysis techniques as well as thermodynamic calculations to determine its corrosion rate change law and pitting corrosion phenomenon. This study demonstrates that the uniform corrosion rate of J55 with increasing temperature shows a trend of first increasing, then decreasing, and finally increasing. The transformation of its corrosion products, from FeCO3 into Fe3O4, is consistent with the altering corrosion rate law with increasing temperatures. J55 corrodes faster at 350°C as the O2 partial pressure increases. When the O2 partial pressure is low, the predominant kind of corrosion product that is obtained is FeCO3; when the O2 partial pressure exceeds 0.2 MPa, all corrosion products are transformed into iron oxides. As the oxygen partial pressure increases, J55's corrosion product film becomes increasingly less protective of the substrate, making the substance more vulnerable to corrosion reactions.
Adding a constant and an axiom to a doctrine
Authors: Guffanti Francesca
Published: October 2024

We study the meaning of “adding a constant to a language” for any doctrine, and “adding an axiom to a theory” for a primary doctrine, by showing how these are actually two instances of the same construction. We prove their universal properties, and how these constructions are compatible with additional structure on the doctrine. Existence of Kleisli object for comonads in the 2‐category of indexed poset is proved in order to build these constructions.
Curves on Brill–Noether special K3 surfaces
Authors: Haburcak Richard
Published: October 2024

Mukai showed that projective models of Brill–Noether general polarized K3 surfaces of genus 6–10 and 12 are obtained as linear sections of projective homogeneous varieties, and that their hyperplane sections are Brill–Noether general curves. In general, the question, raised by Knutsen, and attributed to Mukai, of whether the Brill–Noether generality of any polarized K3 surface is equivalent to the Brill–Noether generality of smooth curves in the linear system , is still open. Using Lazarsfeld–Mukai bundle techniques, we answer this question in the affirmative for polarized K3 surfaces of genus , which provides a new and unified proof even in the genera where Mukai models exist.
Enhancing Cough Motor Learning in Parkinson's Disease Through Variable Practice During Skill Training
Authors: Borders James C. , Villarreal‐Cavazos Katya , Huber Jessica E. , Quinn Lori , Keller Bryan , Troche Michelle S.
Published: October 2024

Background

When re‐learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasible and efficacious to improve cough strength; however, previous studies have used the same practice target during training.

Objectives

Our goal was to examine the impact of CST with variable practice on motor performance, motor learning, and respiratory system adaptations.

Method

The study was a prospective three‐visit single group design. Twenty individuals with Parkinson's disease (PD) and concomitant dysphagia and dystussia completed two sessions of CST involving three randomized practice targets. Cough, lung volume, and airway clearance outcomes were assessed before and after treatment sessions with long‐term retention evaluated after 1 month.

Results

Peak expiratory flow rate improved after CST with variable practice for voluntary single (β = 0.35 L/s) and sequential (β = 0.22 L/s) cough, which were maintained after 1 month without treatment. The ability to expel material from the upper airway demonstrated a small magnitude of improvement (β = −1.87%). During CST, participants altered lung volume based on the treatment target and lung volume decreased during reflex cough after completing CST.

Conclusions

Individuals with PD demonstrated improvements in several aspects of motor learning after two sessions of CST with variable practice. Increasing lung volume may not be an implicit strategy to upregulate voluntary cough strength in this treatment paradigm. The findings support the need for larger investigations exploring the potential benefits of this CST approach.
Interdisciplinary Consensus in Evaluating the Severity Subscale of the Original and Revised Toronto Western Spasmodic Torticollis Rating Scale Through Video‐Based Assessment: An Inter‐Rater Reliability Study
Authors: Kassaye Shimelis Girma , De Pauw Joke , De Waele Ségolène , De Hertogh Willem , Gudina Esayas Kebede , Crosiers David
Published: October 2024

Background

Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) is widely employed for cervical dystonia (CD) evaluation.

Objective

To assess the inter‐rater reliability of the severity subscale of the original and revised TWSTRS using video recordings.

Methods

Three raters, a PhD student with a nursing degree, a physiotherapist specialized in CD, and a neurologist‐in‐training independently rated all videos. The inter‐rater reliability was assessed with the intra‐class correlation coefficient (ICC).

Results

The total severity score of both tools demonstrated a good inter‐rater reliability (ICC = 0.87 to 0.88). The inter‐rater reliability of individual sub‐items varied from poor (ICC = 0.29) to excellent (ICC = 0.9).

Conclusions

The total severity score of both TWSTRS showed good inter‐rater reliability in a multidisciplinary team, indicating their applicability for online patients’ assessment. We recommend using the total subscale for outcome comparison. Furthermore, there is a need for more accurate definitions of duration factor and shoulder elevation.