bluuebunny/crossref_metadata_2025 huggingface dataset:
The Essential Oil of Sclerorhachis leptoclada Rech.f.: Chemical Composition and Biological Activity
Authors: Shafaie Ebrahim , Taleghani Akram , Sahebkar Amirhossein , Eghbali Samira
Published: November 2023

Objective/Background: Sclerorhachis leptoclada Rech.f. belong to the Asteraceae family and is a very aromatic plant applied as a traditional herbal tea to treat digestive illnesses and also to flavor many food products. This study explored the chemical structure, antioxidant, and antibacterial actions of the essential oils (EOs) of S. leptoclada. Methods: The oil conformation was recognized using gas chromatography-mass spectrometry examination. 2,2-Diphenyl-1-picrylhydrazyl (DPPH) test was utilized to assess the antioxidant action of the EOs. In vitro antimicrobial action of the EOs of S. leptoclada was experienced against two Gram-positive ( Klebsiella pneumoniae, Staphylococcus aureus) and two Gram-negative ( Escherichia coli, Pseudomonas aeruginosa) bacteria by the broth microdilution technique. Results: The EOs of S. leptoclada involved a large number of monoterpenes. α-Terpineol (14.6%) and (E)-nerolidol (13.2%) were the key component of the oil. The IC50 value for antioxidant activity of EOs from S. leptoclada was 25.83 µg/mL. The results indicated a good antimicrobial action of S. leptoclada oil against Gram-positive compared with Gram-negative bacteria. Conclusion: The findings revealed a great number of monoterpenes and phenolic composites in S. leptoclada EO as well as the plant's antimicrobial and antioxidant activities.
In-House Virtual Surgery Planning and 3D Printing for Head and Neck Surgery With Free Software: Our Workflow
Authors: Gómez Vicenç J. , Martín-González Antonio , Zafra-Vallejo Víctor , Zubillaga-Rodríguez Ignacio , Fernández-García Antonio , Sánchez-Aniceto Gregorio
Published: November 2023

Study Design

This study explores the workflow of in-house computer-aided design/manufacturing (CAD/CAM) in head and neck oncologic surgery, focusing on 3D printing of biomodels and cutting guides.

Objective

We aim to describe a validated workflow for an in-house 3D Printing Department within a level III University Hospital of the Spanish Public Health System using free software.

Methods

Our study outlines a cost-effective and time-efficient workflow utilizing free software for 3D printing. We assess the feasibility of establishing an in-house department compared to outsourcing to the biomedical industry.

Results

The study demonstrates that creating an in-house 3D Printing Department in a hospital setting is a viable option. We discuss the advantages, including cost savings and reduced lead times, as well as the limitations of this approach.

Conclusions

In conclusion, establishing an in-house 3D Printing Department has the potential to significantly streamline complex head and neck oncologic surgery procedures. This approach can enhance accessibility to advanced CAD/CAM, making them more efficient and cost-effective within the healthcare system.
Braimah-Taiwo et al New Classification System and Treatment Algorithm of Mandibulo-Maxillary Synostosis Related to Noma. Field Experience From Noma Children Hospital Sokoto, Nigeria
Authors: Braimah Ramat Oyebunmi , Taiwo A. O. , Olasoji H. O. , Legbo J. N. , Amundson M. , Ibikunle A. A. , Suleiman I. K. , Bala M. , Ile-Ogedengbe B. O.
Published: November 2023

Study Design

This was a retrospective study at Noma Children Hospital, Sokoto, Nigeria, from January 2018 to December 2021.

Objective

The main objective of this appraisal was to present Braimah-Taiwo et al’s new classification system for mandibulo-maxillary synostosis secondary to noma and also to provide a guide to their treatment.

Methods

Noma with mandibulo-maxillary synostosis was the main inclusion criteria. Excluded were cases of acute noma and noma without mandibulo-maxillary synostosis. Data retrieved include demographics of patients and extent of bony ankylosis and mandibulo-maxillary synostosis.

Results

A total of 64 patients (30 (46.9%) males and 34 (53.1%) females) were managed. Ages ranged from 6 to 40 years with mean ± SD (18.2 ± 7.6) years. Regarding the new classification system of mandibulo-maxillary synostosis, 6 (9.4%) patients presented with Type 1 (Mild joint obliteration)±Soft tissue scarring, 24 (37.5%) presented with Type II (Total joint obliteration)±Soft tissue scarring, 21 (32.8%) presented with Type III (Coronoid, zygoma and maxilla) ±Soft tissue scarring, 4 (6.3%) presented with Type IV (Condyle, glenoid fossa, coronoid, sigmoid notch and zygoma) ±Soft tissue scarring, 7 (10.9%) presented with Type V (Condyle, glenoid fossa, coronoid, sigmoid notch, zygoma and pterygo-maxilla) ±Soft tissue scarring, while 2 (3.1%) patients presented with Type VI (condyle, glenoid fossa, coronoid, sigmoid notch, zygoma, pterygo-maxilla and the orbit) ±Soft tissue scarring.

Conclusions

Pattern of tissue destruction in noma patients is complex involving both soft and hard tissues. This new classification will guide surgeons in the effective management of these patients.
The spatial representation of loudness in a timbre discrimination task
Authors: Koch Sarah , Schubert Torsten , Blankenberger Sven
Published: November 2023

When participants decide whether a presented tone is loud or soft they react faster to loud tones with a top-sided response key in comparison to a bottom-sided response key and vice versa for soft tones. This effect is comparable to the well-established horizontal Spatial-Numerical Association of Response Codes (SNARC) effect and is often referred to as Spatial-Musical Association of Response Codes (SMARC) effect for loudness. The SMARC effect for loudness is typically explained by the assumption of a spatial representation or by the polarity correspondence principle. Crucially, both theories differ in the prediction of the SMARC effect when loudness is task-irrelevant. Therefore, we investigated whether the SMARC effect still occurs in a timbre discrimination task: Participants ( N = 36) heard a single tone and classified its timbre with vertically arranged response keys. Additionally, the tone's loudness level varied in six levels. In case of a spatial representation, the SMARC effect should still occur while in case of polarity corresponding principle, the effect should be absent. Results showed that the SMARC effect was still present and that the differences between top-sided and bottom-sided responses were a linear function of loudness level indicating a continuous spatial representation of loudness.
Data citizenship: Quantifying structural racism in COVID-19 and beyond
Authors: Garrett Cal Lee , Decoteau Claire Laurier
Published: November 2023

Data-driven public health policies were widely implemented to mitigate the uneven impact of COVID-19. In the United States, evidence-based interventions are often employed in “racial equity” initiatives to provide calculable representations of racial disparities. However, disparities in working or living conditions, germane to public health but outside the conventional scope of epidemiology, are seldom measured or addressed. What is the effect of defining racial equity with quantitative health outcomes? Drawing on qualitative analysis of 175 interviews with experts and residents in Chicago during the emergence of COVID-19, we find that these policies link the distribution of public resources to effective participation in state projects of data generation. Bringing together theories of quantification and biosocial citizenship, we argue that a form of data citizenship has emerged where public resources are allocated based on quantitative metrics and the variations they depict. Data citizenship is characterized by at least two mechanisms for governing with statistics. Data fixes produce better numbers through technical adjustments in data collection or analysis based on expert assumptions or expectations. Data drag delays distribution of public relief until numbers are compiled to demonstrate and specify needs or deservingness. This paper challenges the use of racial statistics as a salve for structural racism and illustrates how statistical data can exacerbate racial disparities by promising equity.
The usability of two mobile health assistive technologies for wheelchair-related in-seat movement and pressure
Authors: Jordan Kathleen , Vos-Draper Tamara , Morrow Melissa , Sonenblum Sharon
Published: November 2023

Introduction

This study aimed to understand the degree to which two different mobile health assistive technologies, AW-Shift© and Sensoria® Mat, addressed seven constructs for managing wheelchair-related in-seat movement and pressure.

Methods

After using each intervention system, participants answered questions regarding the general usability and usefulness of the systems.

Results

System Usability Survey scores ranged from 5 (Poor) to 97.5 (Excellent), with a median response of 60.0 (Okay) for AW-Shift© and 76.3 (Good) for Sensoria® Mat. Participants reported using AW-Shift© to check areas of high pressure on their cushion, the quality of their weight shifts, and their posture significantly more often than to check the condition of their cushion or to track their movement goals. Participants reported using Sensoria® Mat to check the quality and number of weight shifts, and their posture significantly more often than to check the condition of their cushion.

Conclusions

The findings of this study highlight that there is no one-size-fits-all solution and that different subpopulations of wheelchair users may have different needs and preferences. Optimizing the design for specific cohorts or constructs can result in an effective product that consistently provides meaningful and accurate information about behavior and performance.
Exploring an innovative method for objectively assessing the social value of university-community engagement and research
Authors: Higgins Kathryn , Kelly Grace , Munck Ronaldo , Kelly Ursula , Grounds Andrew
Published: November 2023

There is increasing recognition regarding the potential of Higher Education Institutions (HEIs) to be significant Anchor institutions capable of impacting the wellbeing of the local communities where they are situated. Subsequently, more universities are prioritising their social and civic responsibility by embedding a research ethos based on closer engagement with their locality, within their key institutional processes. However, demonstrating the social value of community engagement in a meaningful way is difficult, particularly the type of intangible benefits such as relationship building and co-production of knowledge that are forged through collaboration. We present results of a pilot study which applied a Socially Modified Economic Valuation (SMEV) approach to three very different case study projects within a University-Community partnership initiative situated in Belfast, Northern Ireland, to help evaluate how well the university’s civic and social obligations are being fulfilled. Two sets of potential social weights were derived. The first was based on the official Deprivation Index and the second on a combination of desirable ‘social’ and ‘strategy’ goals. Findings showed that the social valuation element of SMEV may potentially be crucially important in assisting with nuanced interpretation of social value across different communities in different places.
Exploring Vaccination Sentiments: A Population-Centric Examination
Authors: Dimassi Omar , Dimassi Mohamad , Tritschler Alexander , Laban Tariq , Santhosh Daphne
Published: November 2023

Vaccine hesitancy has, for a considerable time, been a significant risk to global health. As an integral part of disease prevention, vaccines have become a public health matter which is often debated among the community in spite of proven scientific evidence of their efficiency. A questionnaire was designed to evaluate the perception and knowledge of a population and compare it with behavior in order to assess a demographic within a sample population of 245 individuals selected at random within the United States, Here, we aim to clarify the difference between vaccine opinion among the general public as compared to vaccination status. Chi-squared analysis was done with the categorical data showing a statistically significant result when comparing parents versus non-parents, and Asian/Asian Americans against other ethnicities. All other comparisons were statistically insignificant. When looking at participant responses, PCPs did not discuss vaccines at all with 32% of the sample. The need for PCPs to provide educational information to certain ethnicities may play an important role in public health.
Effectiveness of Program to Slow Progression of Chronic Kidney Disease Among T2DM With HT With CKD 3 in the Community: A Randomized Controlled Trial
Authors: Suvamat Jiraporn , Powwattana Arpaporn , Thaingtham Weena , Pichayapinyo Panan , Boonlue Surapon
Published: November 2023

Chronic kidney disease (CKD) is a significant threat to the quality of life of the global population. Thus, slowing kidney disease progression is considered vital in the treatment of CKD patients. The study aimed to evaluate the effectiveness of a program designed to slow the progression of CKD among Type 2 diabetes mellitus patients with HT with stage 3 CKD (CKD 3) in Thailand by adopting the information-motivation-behavioral skills (IMB) model and applying technology. This study was conducted as a cluster randomized controlled trial. The program activities comprised: (i) providing disease information and teaching behaviors to slow the progression of kidney disease to patients and family members via a 2-h session; (ii) teaching practical behavioral skills for appropriate diet and exercise to patients and family members via a 2-h session; (iii) enhancing personal motivation via the Line application and motivational interviewing via telephone calls; (iv) enhancing social motivation with the support of a family member; (v) employing technology to monitor behaviors and increase patient motivation; and (vi) assessing behaviors that were not practical, exploring barriers to behavior modification, and teaching further practical behavioral skills via the Line application. The data were analyzed using percentages, means, standard deviations, chi-square tests, t-tests, and a 2-way repeated-measures analysis of variance. The results showed that after the experiment, the experimental group had significantly higher mean scores in terms of knowledge, perceived benefits, perceived severity, self-efficacy, and behaviors to slow the progression of kidney disease than the control group ( P < .05). Further, the experimental group had significantly better clinical outcomes (SBP, DBP, eGFR, BUN, creatinine, albuminuria, FBS, and HbA1c) than the control group ( P < .05). In summary, the findings indicate that the program improved clinical outcomes, especially kidney function, effectively slowing the progression of kidney disease.
A Rare Case of Losartan-Induced Visceral Angioedema
Authors: Rosas Steven , Fowler Austin , Stodgill Emily , Deyo-Svendsen Mark , Phillips Michael
Published: November 2023

The following describes a case of isolated visceral angioedema related to an angiotensin II receptor blocker (ARB) medication. Additionally, we discuss the pathophysiology of drug-induced angioedema, various presentations that can be encountered, and the leading theorized mechanisms of how renin-angiotensin-aldosterone system (RAAS) blocking medications lead to angioedema. The goal of sharing this case is to help increase awareness of the possibility of ARB-induced angioedema and to recommend keeping visceral angioedema as part of the differential diagnosis when presented with a patient who is taking an angiotensin converting enzyme inhibitor (ACEI) or ARB medication that is experiencing gastrointestinal symptoms of unclear etiology.
Understanding the Influence of Teacher-Student Relationship on Mathematics Achievement: Evidence From Korean Students
Authors: Choi Jungah , Han Hyunsuk
Published: November 2023

Learning does not occur through one-way lecturing. Rather, it occurs through reciprocal interactions. This means that a student’s response to a teacher’s guidance is critical in their learning. Moreover, it has been known that student learning can be influenced by school mean SES (socioeconomic status) insofar as it impacts the shared learning environment. In the present study, we examine (1) the relationship between math teacher support and student motivation on student mathematics achievement; and (2) whether student motivation interacts with teacher support in learning mathematics and how those interactions affect student mathematics achievement across various school mean SES (low, medium, high). The Programme for International Student Assessment 2012 survey data for 5,033 South Korean students was used in this research. In this study, the results show that (1) the effects of math teacher support and student motivation differ by school mean SES; and (2) there is no interaction between student motivation and math teacher support. Therefore, the findings of this study indicate that school SES impacts the shared learning environment and has a strong influence on student response to math teacher support and the relationship between student motivation and math achievement. Based on these results, implications for teacher education to improve teacher support are suggested.
An Educational Framework in Digital Rights and Responsibilities for Young Entrepreneurs
Authors: Gallego-Arrufat María-Jesús , Torres-Hernández Norma , García-Martínez Inmaculada , Domene-Martos Soledad
Published: November 2023

A strong link currently exists between entrepreneurship and use of technology and the Internet, primarily because young people increasingly use digital and online strategies to start and develop entrepreneurial initiatives. The goal of this document analysis is to propose a reference framework for digital rights in youth entrepreneurship based on selection and analysis of 20 documents with legislation, regulations, and reports that focus on guaranteeing safe, responsible digital environments. The study resulted in a framework for connecting digital rights and responsibilities with young entrepreneurs, based on three main points: rights to equality and participation; rights to freedom; and rights to development, creation, and sustainability. In addition to including concepts, practices, and applications in young people’s initiatives, the framework is useful for educating young entrepreneurs, guiding future research, and helping public administrations to promote the guarantee of digital rights and responsibilities for all.
Selecting a Technological Progress Path and Upgrading Export Product Quality: Evidence From China
Authors: Feng Qian , Liu Hong , Liu Yuwei , Zhao Hengyuan
Published: November 2023

This study investigates the effects of different technological progress paths on firms’ export product quality in China based on Fixed Effect and System GMM models. Using matched data from 2000 to 2010 from the Chinese Industrial Enterprise Database, the Chinese Customs Database and the list of overseas investment enterprises, we find that the four paths (OFDI, FDI, import of intermediate goods, and R&D) can all significantly improve firms’ export product quality; Among them, OFDI has the most significant effect, followed by import of intermediate goods, FDI, and R&D, in that order. The results remain robust after considering selectivity bias and sample endogeneity. The heterogeneity test shows that the path of technological progress is more significant in improving the quality of export products of private, eastern, labor-intensive and processing trade enterprises. The article suggests that Chinese enterprises should further expand OFDI levels, fully stimulate the innovation energy of private enterprises, and emphasize the key role of independent innovation in promoting the upgrading of export product quality.
Drivers of Libyan Students’ Desire for Emigration: A Cross-Sectional Study
Authors: Pourmehdi Mansour , El Abani Suaad
Published: November 2023

The Libyan revolution, which overthrew Gaddafi’s regime in 2011, did not result in social, political and economic development for the people of Libya. For the youth who played a vital role in the old regime’s downfall, the revolution brought frustration, insecurity, unemployment, disruption of education, uncertainty and a lack of freedom. This article aims to develop an under-researched field of youth migration by exploring the factors that influence desire for emigration amongst the youth in Libya, by using a sample of 500 university students. Modelling the data through binary logistic regression, we found that gender, family, satisfaction with life, the outlook of the country and conflict and war were key factors influencing the Libyan students’ desire for emigration.
Hooking the Self Onto the Past: How Positive Autobiographical Memory Retrieval Benefits People With Social Anxiety
Authors: Moscovitch David A. , White Kendra , Hudd Taylor
Published: November 2023

Do people with social anxiety (SA) benefit from positive memory retrieval that heightens self-relevant meaning? In this preregistered study, an analog sample of 255 participants with self-reported clinically significant symptoms of SA were randomly assigned to retrieve and process a positive social-autobiographical memory by focusing on either its self-relevant meaning (deep processing) or its perceptual features (superficial processing). Participants were then socially excluded and instructed to reimagine their positive memory. Analyses revealed that participants assigned to the deep processing condition experienced significantly greater improvements than participants in the superficial processing condition in positive affect, social safeness, and positive beliefs about others during initial memory retrieval and in negative and positive beliefs about the self following memory reactivation during recovery from exclusion. These novel findings highlight the potential utility of memory-based interventions for SA that work by “hooking” self-meaning onto recollections of positive interpersonal experiences that elicit feelings of social acceptance.
Complications Have Not Improved With Newer Generation Robots
Authors: Farivar Daniel , Kim Terrence T. , Sy Christopher A. , Baron Eli M. , Nomoto Edward K. , Walker Corey T. , Skaggs David L.
Published: November 2023

Study Design

Retrospective cohort study.

Objective

The purpose of this study was to see whether upgrades in newer generation robots improve safety and clinical outcomes following spine surgery.

Methods

All patients undergoing robotic-assisted spine surgery with the Mazor X Stealth EditionTM (Medtronic, Minneapolis, MN) from 2019 to 2022 at a combined orthopedic and neurosurgical spine service were retrospectively reviewed. Robot related complications were recorded.

Results

264 consecutive patients (54.1% female; age at time of surgery 63.5 ± 15.3 years) operated on by 14 surgeons were analyzed. The average number of instrumented levels with robotics was 4.2 ± 2.7, while the average number of instrumented screws with robotics was 8.3 ± 5.3. There was a nearly 50/50 split between an open and minimally invasive approach. Six patients (2.2%) had robot related complications. Three patients had temporary nerve root injuries from misplaced screws that required reoperation, one patient had a permanent motor deficit from the tap damaging the L1 and L2 nerve roots, one patient had a durotomy from a misplaced screw that required laminectomy and intra-operative repair, and one patient had a temporary sensory L5 nerve root injury from a drill. Half of these complications (3/6) were due to a reference frame error. In total, four patients (1.5%) required reoperation to fix 10 misplaced screws.

Conclusion

Despite newer generation robots, robot related complications are not decreasing. As half the robot related complications result from reference frame errors, this is an opportunity for improvement.
Creating ZPDs for emergent bilingual children to engage in literacy learning in a virtual Chinese heritage language classroom
Authors: Cun Aijuan , Cheng Yuwen
Published: November 2023

The purpose of this study is to explore how a language teacher helped her emergent bilingual students with literacy learning in a community-based Chinese heritage language classroom during the Covid-19 pandemic. The theoretical concept of the Zone of Proximal Development was utilized to support the exploration. Data that informed this article included field notes, video recordings of class conversations, and artifacts made by the participants. The findings show that the teacher strategically asked questions, used digital technology, and drew upon visual means to create opportunities for the children to engage in literacy learning and move toward advanced levels of literacy development. The study informs suggestions for heritage language teaching practices and advocates for sustaining emergent bilingual children’s Chinese heritage language in the post-pandemic world.
Toothbrushing and Access to Dental Services in Peruvian Children
Authors: Hadad-Arrascue Natalie , Garcés-Elías María Claudia , Chirinos Jesús L.
Published: November 2023

Objective. The aim was to determine the association between access to dental services and toothbrushing in Peruvian children under 12 years old. Methods. This was a cross-sectional study with a population of 2021 database of the Demographic and Family Health Survey. Records of children under 12 years old who provided answers about their toothbrushing were included. Variables were evaluated descriptively and followed by a bivariate analysis; multivariate tests were performed using Poisson regression with a multilevel regression analysis. Results. General toothbrushing was 96.32% (n = 34 198), and daily toothbrushing was 88.05% (n = 28 444). Access to dental services was associated with general toothbrushing (aPR: 1.18; 95% CI: 1.14-1.22; P < .001), daily toothbrushing (aPR: 1.08; 95% CI: 1.04-1.12; P < .001) and minimum toothbrushing 2 times a day (aPR: 1.12; 95% CI: 1.07-1.17; P < .001). Conclusion. Access to dental services was associated with general toothbrushing, daily toothbrushing and toothbrushing at least twice a day.
Priority Outcomes in Sickle Cell Disease Treatment: Co-Creation and Implementation of a Preference Exercise With Patients and Caregivers to Inform Drug Development
Authors: Jalowsky Maggie , Hauber Brett , Scott Mariah Jacqueline , Arkin Steven , Coulter Joshua R. , Watt Stephen J , Kelly L Mariah G , Valentine Ashley
Published: November 2023

Involving patients as co-leaders and co-creators in research is key to reflecting the patient’s voice in decision-making. However, co-creation of patient-centered data to inform decisions is rare, especially in early drug development where patient input is critical to prioritizing patient-relevant outcomes and endpoints for use in clinical trials. Despite the industry's growing commitment to patient centricity, most patients are excluded from sharing their expertise in research; more inclusive methods of engaging patients as research partners are needed. We describe a collaboration between a pharmaceutical company and a patient organization in co-leading and co-creating a program to understand priorities of patients and caregivers for treatment features and outcomes in sickle cell disease to inform endpoint selection in clinical development. The results of this program will be used as a basis for continued interaction between patients and the sponsor and to inform ongoing clinical development and evidence-generation activities. This case study demonstrates an approach to meaningful collaborations between patient organizations and pharmaceutical companies aimed at including the patient's voice early in the medical product lifecycle.
Examining the Effect of COVID-19 on Consumer Health Perception and Decision-Making Towards Organic Foods
Authors: Ezhilvani C. M. , Jayakumar A. , Mahesh P.
Published: November 2023

Currently, a number of industries are concentrating on spreading the word about nature’s goodness in order to save our ecosystem. One of the most significant among them is the organic industry because it not only concerns the protection of human health but also the health of the environment. The COVID-19 pandemic had a significant effect on public health awareness, which made it evident that the organic food industry would dominate. For anyone involved in the organic food industry, such as marketers, producers and politicians, understanding their viewpoints is essential. The goal of this review is to provide a thorough grasp of the subject by synthesising the existing research on consumer opinions about organic foods. The purpose of this article is to examine the effects of the coronavirus on such a thriving industry by evaluating the theories and opinions advanced by many writers in a number of significant research studies on customers’ perceptions of the healthfulness of organic foods following COVID-19. A conceptual model has been framed based on the factors scrutinised from the works of literature reviewed in this article. This review research also provides tactics to marketers and producers of organic foods and suggestions that were made to the government in taking measures to improve the organic food sector based on the consumers health perception.
Microvascular Soft Tissue Reconstruction Outcomes and Risk Factors in Pediatric Patients Undergoing Head and Neck Reconstruction
Authors: James Justin , Seyidova Nargiz , Takyi Evans , Oleru Olachi , Taub Peter J.
Published: November 2023

Background:

Despite improvements in microsurgical techniques and broad application of free tissue transfer for reconstruction in the adult population, there is currently a paucity of literature regarding microsurgical reconstruction in the pediatric population, notably a limited number of case series evaluating outcomes following head and neck reconstruction.

Methods:

A retrospective analysis of National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2015 to 2020 was performed. Pediatric patients undergoing head and neck reconstruction with microvascular muscle and fasciocutaneous flaps were identified using Current Procedural terminology codes (CPT). Multivariate logistic regressions were conducted to assess postoperative outcomes of interest.

Results:

A total of 120 head and neck free flap reconstructions were performed in the pediatric population. Most free flaps were microvascular muscle (n = 82, 68%) followed by fasciocutaneous (n = 38, 32%) flaps. The surgical complication rate was 8% (n = 9) and was primarily due to wound infection 6% (n = 7), whereas medical related complication rate was 14% (n = 17) with majority of patients requiring blood transfusion 12% (n = 14). The median length of stay was 4 days, and ventilator dependence was found to be significantly different among microvascular free flap types. Patients with underweight BMI and ASA Class >2 had higher odds (OR 59.7 and 17.0, P < .05 respectively) of developing any complication for microvascular muscle flaps.

Conclusion:

Analysis of a national cohort of pediatric patients revealed a low flap-related complication rate. Although free flap reconstruction in the pediatric population is technically demanding, microsurgical free tissue transfer in this population is safe and should be considered if indicated.
Achieving and Maintaining Equitable Health Outcomes for all, Including for Future Generations
Authors: Goldstein Susan , Mabry Ruth M. , Friedman Eric A. , Sales André Luis Leite de Figueirêdo , Castro Arachu
Published: November 2023

Sustainable health equity means achieving and maintaining equitable health outcomes for all people, including for future generations. It encompasses realizing the right to health, setting the conditions for leading a healthy life, and fulfilling the full range of human rights. Achieving sustainable health equity requires that public services be designed and provided, and public policies be developed through empowering, inclusive, participatory, accountable, and democratic processes and mechanisms.
Exploring the Relationship Between Sonographers’ Work-Related Musculoskeletal Disorders and Occupational Burnout
Authors: Bagley Jennifer E. , Amos Danielle , Baldwin Jonathan D.
Published: November 2023

Objective:

Work-related musculoskeletal disorders (WRMSDs) are injuries developed through repetitive use or strain. These may lead to an early career-ending injury. Work-related burnout has also been documented among sonographers, but the potential relationship between WRMSDs and burnout has not been well studied.

Material and Methods:

A 43-question survey was sent to sonographers and included questions regarding work culture, presence of WRMSDs, early career-ending injury, and occupational burnout. The Oldenburg Burnout Inventory was used to determine gauge occupational burnout.

Results:

Of 127 respondents, 64% (n = 81) reported a WRMSD and 76% (n = 96) self-reported occupational burnout. The total burnout score was 3.3 points higher among those reporting a WRMSD, compared with those not reporting. ( P = .0077).

Conclusion:

Work-related musculoskeletal disorders and occupational burnout were associated conditions among this group of sonographers. Hospital and clinic administrators should listen to employees to identify potential occupational burnout or a WRMSD, prior to either condition resulting in an exit from the profession.
Nonactivated and IL-7 cultured CD19-specific CAR T cells are enriched in stem cell phenotypes and functionally superior
Authors: Wang Siao-Yi , Scurti Gina M. , Dalheim Annika V. , Quinn Suzanne , Stiff Patrick J. , Nishimura Michael I.
Published: November 2023

CD19-specific chimeric antigen receptor (CAR) T cells have demonstrated impressive responses in patients with relapsed and refractory B cell malignancies. However, many patients relapse or fail to respond to CD19 CAR T cells, demonstrating the need to improve its efficacy and durability. Current protocols for generating CAR T cells involve T cell activation through CD3 stimulation to facilitate efficient CAR transfer followed by ex vivo expansion with exogenous cytokines to obtain adequate cell numbers for treatment. Both T cell activation and expansion inevitably lead to terminal differentiation and replicative senescence, which are suboptimal for therapy. Interleukin-7 (IL-7) was previously shown to allow for lentiviral transduction of T cells in the absence of activation. In these studies, we used IL-7 to generate CD19 CAR T cells without stimulating CD3. Nonactivated and IL-7 cultured (NICE) CD19 CAR T cells were enriched with the T memory stem cell population, retained novel markers of stemness, had lower expression of exhaustion markers, and increased proliferative potential. Furthermore, our findings are consistent with engraftment of NICE CD19 CAR T cells and demonstrate a superior therapeutic response in both intraperitoneal and subcutaneous in vivo B cell lymphoma models. These results suggest that NICE CD19 CAR T cells may improve outcomes for B cell malignancies and warrant clinical evaluation.
Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience
Authors: Shotton Rohan , Broadbent Rachel , Alchawaf Alia , Mohamed Mohamed Bakri , Gibb Adam , Martinez-Calle Nicolás , Fox Christopher P. , Bishton Mark , Pender Alexandra , Gleeson Mary , Cunningham David , Davies Andrew , Yadollahi Sina , Eyre Toby A. , Collins Graham , Djebbari Faouzi , Kassam Shireen , Garland Paula , Watts Emily , Osborne Wendy , Townsend William , Pocock Rachael , Ahearne Matthew J. , Miall Fiona , Wang Xin , Linton Kim M.
Published: November 2023

Bendamustine is among the most effective chemotherapeutics for indolent B-cell non-Hodgkin lymphomas (iNHL), but trial reports of significant toxicity, including opportunistic infections and excess deaths, led to prescriber warnings. We conducted a multicenter observational study evaluating bendamustine toxicity in real-world practice. Patients receiving at least 1 dose of bendamustine with/without rituximab (R) for iNHL were included. Demographics, lymphoma and treatment details, and grade 3 to 5 adverse events (AEs) were analyzed and correlated. In total, 323 patients were enrolled from 9 National Health Service hospitals. Most patients (96%) received bendamustine-R, and 46%, R maintenance. Overall, 21.7% experienced serious AEs (SAE) related to treatment, including infections in 12%, with absolute risk highest during induction (63%), maintenance (20%), and follow-up (17%) and the relative risk highest during maintenance (54%), induction (34%), and follow-up (28%). Toxicity led to permanent treatment discontinuation for 13% of patients, and 2.8% died of bendamustine-related infections (n = 5), myelodysplastic syndrome (n = 3), and cardiac disease (n = 1). More SAEs per patient were reported in patients with mantle cell lymphoma, poor preinduction performance status (PS), poor premaintenance PS, and abnormal preinduction total globulins and in those receiving growth factors. Use of antimicrobial prophylaxis was variable, and 3 of 10 opportunistic infections occurred despite prophylaxis. In this real-world analysis, bendamustine-related deaths and treatment discontinuation were similar to those of trial populations of younger, fitter patients. Poor PS, mantle cell histology, and maintenance R were potential risk factors. Infections, including late onset events, were the most common treatment-related SAE and cause of death, warranting extended antimicrobial prophylaxis and infectious surveillance, especially for maintenance-treated patients.
Structural analysis of platelet fragments and extracellular vesicles produced by apheresis platelets during storage
Authors: De Paoli Silvia H. , Patel Mehulkumar , Elhelu Oumsalama K. , Tarandovskiy Ivan D. , Tegegn Tseday Z. , Simak Jan
Published: November 2023

Platelets (PLTs) for transfusion can be stored for up to 7 days at room temperature (RT). The quality of apheresis PLTs decreases over storage time, which affects PLT hemostatic functions. Here, we characterized the membranous particles produced by PLT storage lesion (PSLPs), including degranulated PLTs, PLT ghosts, membrane fragments, and extracellular membrane vesicles (PEVs). The PSLPs generated in apheresis platelet units were analyzed on days 1, 3, 5, and 7 of RT storage. A differential centrifugation and a sucrose density gradient were used to separate PSLP populations. PSLPs were characterized using scanning and transmission electron microscopy (EM), flow cytometry (FC), and nanoparticle tracking analysis (NTA). PSLPs have different morphologies and a broad size distribution; FC and NTA showed that the concentration of small and large PSLPs increases with storage time. The density gradient separated 3 PSLP populations: (1) degranulated PLTs, PLT ghosts, and large PLT fragments; (2) PEVs originated from PLT activation and organelles released by necrotic PLTs; and (3) PEV ghosts. Most PSLPs expressed phosphatidyl serine and induced thrombin generation in the plasma. PSLPs contained extracellular mitochondria and some had the autophagosome marker LC3. PSLPs encompass degranulated PLTs, PLT ghosts, large PLT fragments, large and dense PEVs, and low-density PEV ghosts. The activation-related PSLPs are released, particularly during early stage of storage (days 1-3), and the release of apoptosis- and necrosis-related PSLPs prevails after that. No elevation of LC3- and TOM20-positive PSLPs indicates that the increase of extracellular mitochondria during later-stage storage is not associated with PLT mitophagy.
Physiological roles of chloride ions in bodily and cellular functions
Authors: Marunaka Yoshinori
Published: November 2023

Physiological roles of Cl−, a major anion in the body, are not well known compared with those of cations. This review article introduces: (1) roles of Cl− in bodily and cellular functions; (2) the range of cytosolic Cl− concentration ([Cl−]c); (3) whether [Cl−]c could change with cell volume change under an isosmotic condition; (4) whether [Cl−]c could change under conditions where multiple Cl− transporters and channels contribute to Cl− influx and efflux in an isosmotic state; (5) whether the change in [Cl−]c could be large enough to act as signals; (6) effects of Cl− on cytoskeletal tubulin polymerization through inhibition of GTPase activity and tubulin polymerization-dependent biological activity; (7) roles of cytosolic Cl− in cell proliferation; (8) Cl−-regulatory mechanisms of ciliary motility; (9) roles of Cl− in sweet/umami taste receptors; (10) Cl−-regulatory mechanisms of with-no-lysine kinase (WNK); (11) roles of Cl− in regulation of epithelial Na+ transport; (12) relationship between roles of Cl− and H+ in body functions.
Complete plastid genome structure of 13 Asian Justicia (Acanthaceae) species: comparative genomics and phylogenetic analyses
Authors: Niu Zhengyang , Lin Zheli , Tong Yi , Chen Xin , Deng Yunfei
Published: November 2023

Background

Justicia L. is the largest genus in Acanthaceae Juss. and widely distributed in tropical and subtropical regions of the world. Previous phylogenetic studies have proposed a general phylogenetic framework for Justicia based on several molecular markers. However, their studies were mainly focused on resolution of phylogenetic issues of Justicia in Africa, Australia and South America due to limited sampling from Asia. Additionally, although Justicia plants are of high medical and ornamental values, little research on its genetics was reported. Therefore, to improve the understanding of its genomic structure and relationships among Asian Justicia plants, we sequenced complete chloroplast (cp.) genomes of 12 Asian plants and combined with the previously published cp. genome of Justicia leptostachya Hemsl. for further comparative genomics and phylogenetic analyses.

Results

All the cp. genomes exhibit a typical quadripartite structure without genomic rearrangement and gene loss. Their sizes range from 148,374 to 151,739 bp, including a large single copy (LSC, 81,434–83,676 bp), a small single copy (SSC, 16,833–17,507 bp) and two inverted repeats (IR, 24,947–25,549 bp). GC contents range from 38.1 to 38.4%. All the plastomes contain 114 genes, including 80 protein-coding genes, 30 tRNAs and 4 rRNAs. IR variation and repetitive sequences analyses both indicated that Justicia grossa C. B. Clarke is different from other Justicia species because its lengths of ndhF and ycf1 in IRs are shorter than others and it is richest in SSRs and dispersed repeats. The ycf1 gene was identified as the candidate DNA barcode for the genus Justicia. Our phylogenetic results showed that Justicia is a polyphyletic group, which is consistent with previous studies. Among them, J. grossa belongs to subtribe Tetramerinae of tribe Justicieae while the other Justicia members belong to subtribe Justiciinae. Therefore, based on morphological and molecular evidence, J. grossa should be undoubtedly recognized as a new genus. Interestingly, the evolutionary history of Justicia was discovered to be congruent with the morphology evolution.

Conclusion

Our study not only elucidates basic features of Justicia whole plastomes, but also sheds light on interspecific relationships of Asian Justicia plants for the first time.
Effect of empagliflozin on cardiac remodelling in South Asian and non-South Asian individuals: insights from the EMPA-HEART CardioLink-6 randomised clinical trial
Authors: Barbour William , Wolff Erika , Puar Pankaj , Hibino Makoto , Bakbak Ehab , Krishnaraj Aishwarya , Verma Raj , Verma Meena , Quan Adrian , Yan Andrew T. , Connelly Kim A. , Teoh Hwee , Mazer C. David , Verma Subodh
Published: November 2023

Background

This exploratory sub-analysis of the EMPA-HEART CardioLink-6 trial examined whether the previously reported benefit of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on left ventricular (LV) mass (LVM) regression differs between individuals of South Asian and non-South Asian ethnicity.

Methods

EMPA-HEART CardioLink-6 was a double-blind, placebo-controlled clinical trial that randomised 97 individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to either empagliflozin 10 mg daily or placebo for 6 months. LV parameters and function were assessed using cardiac magnetic resonance imaging. The 6-month changes in LVM and LV volumes, all indexed to baseline body surface area, for South Asian participants were compared to those for non-South Asian individuals.

Results

Compared to the non-South Asian group, the South Asian sub-cohort comprised more males, was younger and had a lower median body mass index. The adjusted difference for LVMi change over 6 months was -4.3 g/m2 (95% confidence interval [CI], -7.5, -1.0; P = 0.042) for the South Asian group and -2.3 g/m2 (95% CI, -6.4, 1.9; P = 0.28) for the non-South Asian group (Pinteraction = 0.45). There was no between-group difference for the adjusted differences in baseline body surface area-indexed LV volumes and LV ejection fraction.

Conclusions

There was no meaningful difference in empagliflozin-associated LVM regression between South Asian and non-South Asian individuals living with T2DM and CAD in the EMPA-HEART CardioLink-6 trial.

Trial registration

ClinicalTrials.gov Identifier: NCT02998970 (First posted on 21/12/ 2016).
How do patients with high cardiovascular risk evaluate online health information? A qualitative study
Authors: Lim Hooi Min , Ng Chirk Jenn , Abdullah Adina , Dunn Adam G.
Published: November 2023

Background

People are exposed to variable health information from the Internet, potentially influencing their health decision-making and behaviour. It remains a challenge for people to discern between good- and poor-quality online health information (OHI). This study explored how patients evaluate and determine trust in statin-related OHI in patients with high cardiovascular risk.

Methods

This qualitative study used vignettes and think-aloud methods. We recruited patients from a primary care clinic who were at least 18 years old, had high cardiovascular risk and had previously sought OHI. Participants were given two statin-related vignettes: Vignette 1 (low-quality information) and Vignette 2 (high-quality information). Participants voiced their thoughts aloud when reading the vignettes and determined the trust level for each vignette using a 5-point Likert scale. This was followed by a semi-structured interview which was audio-recorded and transcribed verbatim. The transcripts were coded and analysed using thematic analysis.

Results

A total of 20 participants were recruited, with age ranging from 38–74 years. Among all the high cardiovascular-risk participants, eight had pre-existing cardiovascular diseases. For Vignette 1 (low-quality information), five participants trusted it while nine participants were unsure of their trust. 17 participants (85%) trusted Vignette 2 (high-quality information). Five themes emerged from the analysis of how patients evaluated OHI: (1) logical content, (2) neutral stance and tone of OHI content, (3) credibility of the information source, (4) consistent with prior knowledge and experience, and (5) corroboration with information from other sources.

Conclusion

Patients with high cardiovascular risks focused on the content, source credibility and information consistency when evaluating and determining their trust in statin-related OHI. Doctors should adopt a more personalised approach when discussing statin-related online misinformation with patients by considering their prior knowledge, beliefs and experience of statin use.