bluuebunny/crossref_metadata_2025 huggingface dataset:
Do students carry their home in their pocket?
Authors: Mroz Aurore
Published: February 2024

This longitudinal mixed methods study followed 16 U.S.-affiliated learners of French in Paris. After merging
monthly social network and weekly smartphone usage reports, K-means clusters analysis revealed significant differences between (1)
learners displaying attachment to versus detachment from their friends and family at home, and (2) smartphone usage profiles –
spectators versus communicators and explorers. Triangulation with pre-/during-/post-study abroad in-depth interviews allowed
identification of what was most instrumental for participants’ interactions in the target language and intercultural gains:
geolocation applications on their phones and living with host families. The electronic umbilical cord hypothesized to exist for
those displaying attachment was in fact not a detrimental force – quite the opposite. Instead, the way participants had
(detrimentally) taken their home with them to Paris was by being visited by friends and family, by often interacting with U.S.
students on site, and by frequently consuming English-speaking audiovisual content on their phones.
Narrating/translating online plantation tourism
Authors: Federici Eleonora
Published: February 2024

The purpose of the essay is to conduct an analysis of plantation tourism websites in the USA South, measuring the degree to which the history of slavery remains (in)visible or is explained within online promotional texts like websites, and to outline if today the digital space can become a space for inclusivity and equality. The essay will be divided in two parts: the analysis of a corpus of 10 major Historical Plantations websites in order to outline the principal verbal and visual strategies used to portray the history of slavery in the American South, and a comparison of 3 websites which offer translations in Italian and/or French in order to outline differences, adaptations, omissions, changes in the target texts. The methodology used will refer to CDA, Social Semiotics and Tourism Translation with the primary aim of outlining all the aspects of a website as a multimodal text. The essay will offer the results of both a quantitative and qualitative analysis trying to show how plantations as tourist attractions are represented through linguistic, cultural, and visual choices that represent the tourist experience in a highly codified way, and to demonstrate how this representation is adapted into different languages/cultural contexts, often reducing information and useful data to attract international tourists, and simplifying the message.
Blind watermarking algorithm with 2D-SCCM chaotic system encryption based on SURF and RHFMs
Authors: Lu Chen-Chen , Feng Xiu-fang , Teng Lin , Wang Chun-peng , Zhang Hao
Published: February 2024

In this paper, a digital watermarking algorithm was proposed based on local feature regions and radial harmonic Fourier moments. It used a quantized modulation algorithm to embed the watermark information into the frequency domain information of the image. Compared with traditional watermarks directly embedded into the pixel values, the algorithm enhanced the invisibility of the watermark. Many existing digital watermarking algorithms neglected the security of the embedding process, because of more attention on the effect of post-embedding and extraction. To overcome this problem, we proposed a two-dimensional hyperchaotic system named 2D-SCCM chaotic system, which used classical sine mapping and cubic mapping for coupling. Before embedding, the correlation among the pixels of the watermarked image was disrupted, resulting in a full process security enhancement. Combining the clustering algorithm with feature point extraction, the obtained local feature region was more stable and suitable for watermark embedding. Results showed that the improved watermark embedding algorithm was more effective for resisting geometric attacks such as cropping attacks. Moreover, the PSNR values of the final watermark-embedded images were all greater than 50 dB, indicating a good balance between imperceptibility and robustness.
The solid-fluid transmission problem
Authors: Eptaminitakis Nikolas , Stefanov Plamen
Published: February 2024

We study microlocally the transmission problem at the interface between an isotropic linear elastic solid and a linear inviscid fluid. We set up a system of evolution equations describing the particle displacement and velocity in the solid, and pressure and velocity in the fluid, coupled by suitable transmission conditions at the interface. We show well-posedness for the coupled system and study the problem microlocally, constructing a parametrix for it using geometric optics. This construction describes the reflected and transmitted waves, including mode converted ones, related to incoming waves from either side. We also study formation of surface Scholte waves. Finally, we prove that under suitable assumptions, we can recover the s- and the p-speeds, as well as the speed of the liquid, from boundary measurements.
Syncope in older adults: challenges, approach and treatment
Authors: Jansen Sofie , van der Velde Nathalie
Published: February 2024

Syncope can have devastating consequences, resulting in injuries, accidents or even death. In our ageing society, the subsequent healthcare usage, such as emergency room presentations, surgeries and hospital admissions, forms a significant and growing socioeconomic burden. Causes of syncope in the older adult include orthostatic hypotension, carotid sinus syndrome, vasovagal syncope, structural cardiac abnormalities, cardiac arrhythmias and conduction abnormalities. As stated in the recently published World Falls Guidelines, syncope in older adults often presents as falls, which is either due to amnesia for loss of consciousness, or pre-syncope leading to a fall, especially in those prone to falls with several other risk-factors for falls present. This difference in presentation can hinder the recognition of syncope. In patients with unexplained falls, or in whom the history comprises red flags for potential syncope, special attention to (pre)syncope is therefore warranted. When syncope is mistaken for other causes of a transient loss of consciousness, such as epileptic seizures, or when syncope presents as falls, patients are often referred to multiple specialists, which may in turn lead to excessive and unnecessary diagnostic testing and costs. Specialist services that are able to provide a comprehensive assessment can improve diagnostic yield and minimise diagnostic testing, thus improving patient satisfaction. Comprehensive assessment also leads to reduced length of hospital stay. Increasingly, geriatricians are involved in the assessment of syncope in the older patient, especially given the overlap with falls. Therefore, awareness of causes of syncope, as well as state-of-the-art assessment and treatment, is of great importance.
Expression and characterization of α-1,3-glucanase from Paenibacillus alginolyticus NBRC15375, which is classified into subgroup 2 (minor group) of GH family 87
Authors: Konishi Yasuhito , Sato Kaito , Nabetani Kai , Shirasaka Norifumi , Fukuta Yasuhisa
Published: February 2024

Bacterial α-1,3-glucanase, classified as glycoside hydrolase (GH) family 87, has been divided into 3 subgroups based on differences in gene sequences in the catalytic domain. The enzymatic properties of subgroups 1 and 3 of several bacteria have been previously investigated and reported; however, the chemical characterization of subgroup 2 enzymes has not been previously conducted. The α-1,3-glucanase gene from Paenibacillus alginolyticus NBRC15375 (PaAgl) belonging to subgroup 2 of GH family 87 was cloned and expressed in Escherichia coli. PgAgl-N1 (subgroup 3) and PgAgl-N2 (subgroup 1) from P. glycanilyticus NBRC16188 were expressed in E. coli, and their enzymatic characteristics were compared. The amino acid sequence of PaAgl demonstrated that the homology was significantly lower in other subgroups when only the catalytic domain was compared. The oligosaccharide products of the mutan-degrading reaction seemed to have different characteristics among subgroups 1, 2, and 3 in GH family 87.
Cardiac MRI in diagnosis, prognosis, and follow-up of hypertrophic cardiomyopathy in children: current perspectives
Authors: Spaapen Tessa O M , Bohte Anneloes E , Slieker Martijn G , Grotenhuis Heynric B
Published: February 2024

Hypertrophic Cardiomyopathy (HCM) is an inherited myocardial disease characterised by left ventricular hypertrophy, which carries an increased risk of life-threatening arrhythmias and sudden cardiac death. The age of presentation and the underlying aetiology have a significant impact on the prognosis and quality of life of children with HCM, as childhood-onset HCM is associated with high mortality risk and poor long-term outcomes. Accurate cardiac assessment and identification of the HCM phenotype are therefore crucial to determine the diagnosis, prognostic stratification, and follow-up. Cardiac magnetic resonance (CMR) is a comprehensive evaluation tool capable of providing information on cardiac morphology and function, flow, perfusion, and tissue characterisation. CMR allows to detect subtle abnormalities in the myocardial composition and characterise the heterogeneous phenotypic expression of HCM. In particular, the detection of the degree and extent of myocardial fibrosis, using late-gadolinium enhanced sequences or parametric mapping, is unique for CMR and is of additional value in the clinical assessment and prognostic stratification of paediatric HCM patients. Additionally, childhood HCM can be progressive over time. The rate, timing, and degree of disease progression vary from one patient to the other, so close cardiac monitoring and serial follow-up throughout the life of the diagnosed patients is of paramount importance. In this review, an update of the use of CMR in childhood HCM is provided, focussing on its clinical role in diagnosis, prognosis, and serial follow-up.
7. ANALYSIS OF THE RESULTS OF LAPAROSCOPIC TUNNELLED PERITONEAL DIALYSIS CATHETER PLACEMENT
Authors: Martínez Izquierdo G , Ramos Montes C , Sanz Navarro S , Rodríguez Uría R , Amoza Pais S , Moreno Gijón M , Rodicio Miravalles J L , Sanz Álvarez L
Published: February 2024

Introduction

Peritoneal dialysis is a type of renal replacement therapy that improves quality of life and empowers patients with advanced chronic kidney disease. The best method of peritoneal dialysis catheter (PDC) placement remains to be defined.

Methods

Retrospective observational study from October 2019 to March 2023, aiming to analyse the results of this new technique for PDC placement in our centre.

Results

The study consisted of 45 patients, 66.7% of whom were men. The study comprised 45 patients, with 66.7% being men. The mean age was 57 years, and the mean BMI was 27.9 kg/m2, with 82.8% of the patients classified as ASA III. In 66.7% of cases, it was the first catheter to be placed. Of the surgeries conducted, 41 involved initial placements, and 4 involved laparoscopic repositioning, the latter following a previously unsuccessful Alpha manoeuvre. In 6 cases, an associated surgery was performed. The mean duration of surgery was 34 minutes, with a median length of stay of 24 hours.

In 3 patients, catheter malfunction occurred, with 2 requiring laparoscopic repositioning and the remaining one laparoscopic replacement. Additionally, 3 other patients experienced infectious complications, which were treated conservatively. No major complications or laparoscopy conversions were noted. The mean follow-up from surgery was 15.4 months, with 42.2% of PDCs being removed after a mean of 11.5 months, and renal transplantation being the most common reason for removal (79%).

Conclusion

In our centre, tunnelled PDC placement has proven to be safe and effective, with a low percentage of infections, relocations or replacements, and it is considered the technique of choice for patients capable of undergoing surgery under general anaesthesia.
11. UPDATED VALIDATION OF 3D PRINTING-BASED TRAINING TOOLS FOR TRANSANAL SURGERY
Authors: Pedregosa Sandoval È , Sánchez Margallo J A , Lobato Gómez C , Sánchez Varo I , Durán Meléndez B , Sánchez Margallo F M
Published: February 2024

Introduction

Due to the complexity of colorectal surgery, the development of specialised training tools is necessary to improve the technical skills of surgeons in a controlled environment. In the framework of the MIREIA Project, this study proposes an updated design of a toolkit to provide a safe and effective environment for colorectal surgery training.

Methods

Work was carried out on the design of a silicone colon model using injection moulds, consisting of two components (the colon model and its wrap), using the fused deposition 3D printing technique. Two layers of silicone were added to simulate the mucosal and muscular layers. A group of surgeons evaluated the formative utility of the model in transanal surgery, performing resection and suturing of polyps inside the model.

Results

According to the results of the validation study, the silicone colon model showed adequate behaviour during insufflation and a positive haptic response to contact with laparoscopic forceps. This model accurately reproduces the layers of the colon and allows customisation for each patient. In addition, polyp removal is realistic and the elastic layers support stitches, providing greater realism during surgery.

Conclusion

A realistic simulator has been developed for training in transanal laparoscopic surgery, but improvements in the final design are needed for widespread implementation. The application of an aqueous gel on the mucosal layer is proposed to improve the realism of the training.
24. CRITICAL IMPORTANCE OF NOZZLE TEMPERATURE TO BIOPRINT VASCULAR GRAFTS WITH SHEAR-THINNING HYDROGEL
Authors: Barbosa F R , Patrocinio Caballero D , Pereira Miguel S A , Countinho P I , Cardoso Castro T M , Gómez Blanco J C , Sánchez Margallo F M , Pagador Carrasco J B
Published: February 2024

Introduction

The development of vascular grafts adapted to the nature of the patient and their treatment is constantly evolving. Fine control of the bioprinting manufacturing process is a key issue to obtain proper personalized vascular grafts. The aim is to check the influence of the nozzle temperature during bioprinting a Gelatin/Gellan Gum/Alginate hydrogel vascular grafts.

Methods

Vascular grafts were printed using a Gelatin/Gellan Gum/Alginate (8:3:0.5 %w/v) hydrogel in an BioX bioprinter with the printhead and bed set up to 65 °C. Two configurations were set: 1) a standard conical tip (nozzle) and 2) the same nozzle thermally insulated with aluminum foil to uniformly distribute the temperature. A temperature control using a 100 kΩ thermistor was performed in four points: chamber, nozzle, printhead, and bed. Four heating/cooling cycles were performed in each control point.

Results

The grafts printed with the standard nozzle exhibited irregular wall thickness and an uneven surface, attributed to lower temperatures in the conical tip. In contrast, results from the aluminum-covered nozzle indicated temperature distributions of 33.13±0.87, 49.03±3.92, 52.38±3.53, and 64.98±0.10 °C for chamber, nozzle, printhead, and bed, respectively. This improved temperature distribution enhanced the printability of Gelatin/Gellan Gum/Alginate vascular grafts, resulting in a more regular wall thickness and surface profile.

Conclusion

The optimization of temperature in the nozzle during the printing process is a critical parameter for bioprinting vascular grafts using this shear-thinning Gelatin/Gellan Gum/Alginate hydrogel.
25. VALIDATION OF ELECTRICAL MODEL OF THE CARDIOVASCULAR SYSTEM WITH PRECLINICAL AND CLINICAL DATA
Authors: Nuevo-Gallardo C , Traver J E , Mancha-Sánchez E , Ortega-Morán J F , Pagador J B , Fernández-Portales J , Tejado I , Vinagre B M
Published: February 2024

Introduction

Cardiovascular diseases are the leading cause of death worldwide. Since the cardiovascular system (CVS) is complex, the use of computational models to diagnose and/or predict its behavior is a common practice, being of great interest in the case of certain pathologies. This work presents a novel electrical model of the CVS that extends the classical Windkessel models to the left common carotid artery for prototype validation or simulator generation.

Methods

The model has been validated by comparing the simulated hemodynamic parameters (pressure and flow) with the healthy state (nominal condition) that can be found in the literature and with preclinical and clinical experimental data obtained from catheterization trials in porcine (due to its similarities with human anatomy and hemodynamics) and human models, respectively.

Results

Model indices and experiments are consistent with each other and within the ranges suggested in the literature: heart rate (bpm) = 68 (model), 57-70 (experiments), 50-90 (literature); mean arterial pressure (mmHg) = 92 (model), 68-102 (experiments), 70-105 (literature). Also, the cardiovascular waveforms of the model confirm correct hemodynamics, being similar to those extracted from the experiments.

Conclusion

The similarity between the hemodynamic parameters of the model, the experiments and the literature confirm the validity of the proposed model, providing comparable results with the available preclinical and clinical data. This model will simplify and reduce costs associated with in vivo or in vitro cardiac experiments, as well as describe and simulate singular pathologies, such as aortic stenosis.
28. IS THE SWAB USEFUL AS AN ALTERNATIVE METHOD OF COLLECTING MICROBIOTA SAMPLES IN PATIENTS WITH COLON CANCER?
Authors: García Galocha J L , Domínguez Serrano M I , De la Serna Esteban S C , Dziakova J , Sánchez González S , Martín Garre D , Iniesta M P , Torres García A J
Published: February 2024

Introduction

This study aims to investigate the intestinal microbiota in rectal samples obtained by swab, comparing them with stool samples, tumor, and non-tumor tissue in patients who underwent colorectal cancer surgery at our hospital.

Methods

Eight patients (3 women and 5 men) who underwent surgery at our center between 2021 and 2022 were included in the study.

The anatomopathological stage was evenly distributed, with 50% in stage II and 50% in stage III. Tumor location was also varied, with 37.5% of patients having neoplasms in the left side colon and 62.5% in the right side.

During the preoperative period, stool samples were collected from the patients. Additionally, a rectal exudate was obtained with a swab, and samples of tumor and non-tumor tissue were collected during the procedure. The composition of the intestinal microbiota in all samples was analyzed using rRNA sequencing.

Results

The analysis of all samples identified the phyla Firmicutes, Bacteroidota, Actinobacteriota, Fusobacteriota, and Proteobacteria. No significant differences were observed in terms of alpha and beta diversity when analyzing the different types of samples (feces, exudate, tumor, and non-tumor tissue).

Stage II patients showed a greater abundance of Pasteurellacea, Magasphera, Citrobaceter, and Clostridium in the exudate, while Velillonella and Blautia were more prominent in feces. All the genera were different from those of stage III. The composition did not vary depending on the location of the tumor.

Conclusion

Swabs are a reliable alternative to stool collection for obtaining microbiota samples in patients with colon cancer.
29. SOFT ROBOTICS APPLIED TO MEDICINE: STEERABLE TIP CATHETER GUIDED BY COMPUTER VISION
Authors: Serrano-Baltontín A J , Mancha-Sánchez E , Tejado I , Vinagre B M
Published: February 2024

Introduction

A soft, biocompatible, and deformation-controlled robotic catheter, guided by computer vision and propelled by the pressurized injection of a saline solution, has been developed. The catheter incorporates a camera at its end to navigate through the human circulatory system to the point where the problem is located and it can release the appropriate surgical instruments for the situation, for example, microscalpel, laser or even a microrobot. This work contributes to the reduction of the risks associated with conventional catheterization, such as unwanted punctures, and eliminates the need to use radiation on the patient for guidance.

Methods

Finite element simulation models are created in COMSOL to evaluate the performance of hydraulically actuated deformable catheter designs. The catheter is manufactured using flexible materials through additive manufacturing and curing of a biocompatible silicone, PDMS, on molds. Experimental measurements include the pressure reached by the saline solution, the curvature achieved by the catheter, the distance traveled within the conduit system, and the acquisition and processing of images of the traversed conduits.

Results

Simulation results identify the optimal design among the considered alternatives. A prototype of the catheter is fabricated, and its movement is precisely controlled to navigate safely within a conduit.

Conclusion

The feasibility of a soft and autonomous catheter with the desired characteristics and behavior to contribute to the reduction of risks associated with catheterization practices is demonstrated.
30. NEW VASCULAR IMPLANT VALIDATION: PRECLINICAL STUDY
Authors: Durán Rey D , Sánchez Rumbo C , Crisóstomo V , Brito Pereira R , Lanceros Méndez S , Sánchez Margallo F M
Published: February 2024

Introduction

The main cause of death in the world are pathologies associated with the cardiovascular system. Tissue engineering is a promising technology as a clinical treatment, since it enables the design of vascular grafts capable of replacing or repairing the biological functions of blood vessels. Polyvinylidene fluoride (PVDF) is a synthetic material that shows strong potential in the field of tissue engineered vascular grafts (TEVGs). The thermoplastic polymer has piezoelectric properties, exhibits excellent physicochemical and biological performance, mechanical properties, high levels of cell viability and biocompatibility, which promotes endothelial cell proliferation, a key factor in maintaining vascular permeability.

Methods

Tissue-engineered vascular grafts (TEVGs) were fabricated using the electrospinning technique. Twelve female Merino sheep were utilized in this experimental model, with a division into two groups: a PVDF test group and an expanded polytetrafluoroethylene (ePTFE) control group.

Results

PVDF grafts showed better outcomes than commercial grafts in terms of patency and endothelialization.

Conclusion

These results suggest that PVDF test grafts may present better efficacy compared to commercial ePTFE grafts in most of the established parameters, while commercial grafts appear to present better safety than PVDF test grafts.

Further statistical studies are needed to determine if the observed differences are statistically significant.
32. IMPACT OF SURGERY ON BODY COMPOSITION IN PATIENTS UNDERGOING COLECTOMY FOR COLON CANCER IN AN ERAS PROGRAM
Authors: Nieto Martos M R , Juez Saez L D , Fernández Cebrián J M , Blázquez Sánchez J , Ruiz Torres I , García Pérez J C
Published: February 2024

Introduction

The prevalence of sarcopenia in CC patients undergoing colon cancer surgery is high and is associated with increased morbi-mortality. However, there are few studies assessing the impact of surgery on body composition. The main objective of this study was to analyze changes in body composition after colectomy for CC.

Methods

Observational, retrospective study in which patients operated on for CC by RICA route between December 2019 and June 2022 were collected. Pre- and post-surgical measurement of skeletal muscle index (SMI), Psoas iliacus index (PI), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) of each patient was performed by computed tomography (CT). In addition, the influence of previous nutritional assessment and postoperative supplementation on body composition variation was analyzed.

Results

After surgery, SMI, PI, VAT, and SAT significantly decreased in patients. Moreover, the number of patients with sarcopenia increased significantly. Although no statistically significant differences were identified, patients who did not receive preoperative nutritional supplementation exhibited a greater decrease in muscle mass and fat tissue, along with a higher tendency for postoperative complications.

Conclusion

Surgical intervention presents a negative impact on body composition in patients with CC with a significant decrease in muscle mass and visceral and subcutaneous fat. Preoperative nutritional optimization could buffer this loss with a consequent decrease in associated complications.
The same social elevator? Intergenerational class mobility of second-generation immigrants across Europe
Authors: Kanitsar Georg
Published: February 2024

Ethnicity and social class are two of the main axes stratifying life chances in developed societies. Nevertheless, knowledge of the integration of ethnic minorities into the pattern of class reproduction remains incipient as evidence stems mostly from studies concentrating on specific ethnicities or single host countries. This article advances this knowledge by providing a comparative perspective on the intergenerational occupational mobility of second-generation immigrants and the majority population across 26 European countries. Drawing on pooled data from the European Social Survey (2004–2018), the article demonstrates that ethnic penalties arise for employment and occupational mobility in many countries, however, with crucial differences across and—to a smaller extent—within major country groups. Across countries, ethnic barriers for the second generation are connected to their social integration in the host society and the composition of the first migrant generation, emphasizing the importance of familial and social support for social advancement. By contrast, I detect no link between anti-immigration norms and ethnic penalties, and only mixed evidence for the role of integration policy. The article concludes that ‘ethnicity matters’ in many European societies, even if ethnic cleavages vary according to the composition of migrant populations and the context in the host society.
Exceptional Set Estimate Through Brascamp–Lieb Inequality
Authors: Gan Shengwen
Published: February 2024

Fix integers $1\le k<n$, and numbers $a,s$ satisfying $0<s<\min \{k,a\}$. The problem of exceptional set estimate is to determine $$\begin{align*} & T(a,s):=\sup_{A\subset \mathbb{R}^{n}\ \textup{dim}A=a}\textup{dim}(\{ V\in G(k,n): \textup{dim}(\pi_{V}(A))<s \}). \end{align*}$$In this paper, we prove a new upper bound for $T(a,s)$ by using Brascamp–Lieb inequality. As one of the corollaries, we obtain the estimate $$\begin{align*} & T(a,\frac{k}{n}a)\le k(n-k)-\min\{k,n-k\}, \end{align*}$$which improves a previous result $T(a,\frac{k}{n}a)\le k(n-k)-1$ of He.

By constructing examples, we can determine the explicit value of $T(a,s)$ for certain $(a,s)$:

When $k\le \frac{n}{2}$, $\beta \in (0,1]$ and $\gamma \in (\beta ,\frac{k}{n}(1+\beta )]$, we have $$\begin{align*} &T(1+\beta,\gamma)=k(n-k)-k.\end{align*}$$

When $k\ge \frac{n}{2}$, $\beta \in (0,1]$ and $\gamma \in (\beta , (1-\frac{k}{n})+\frac{k}{n}\beta ]$, we have $$\begin{align*} &T(n-1+\beta,k-1+\gamma)=k(n-k)-(n-k).\end{align*}$$
Deployment of vaccine cold chain equipment in resource-limited settings: lessons from the Gavi Cold Chain Optimization Platform in Cameroon
Authors: Nkwain Jude , Zambou Vouking Marius , Nchinjoh Sangwe Clovis , Agbor Valirie Ndip , Adidja Amani , Mbanga Clarence , Edwidge Nnang Nadege , Ndoula Shalom Tchokfe , Ateke Njoh Andreas , Diack Demba , Di Mattei Pietro , Wiwa Owens , Diaby Ousmane , Saidu Yauba
Published: February 2024

Background

Lack of or use of suboptimal cold chain equipment (CCE) is a major barrier to optimal immunization coverage and equity. Gavi established the CCE optimization platform (CCEOP) in 2015 to help eligible countries modernize their cold chain systems. However, there are limited data on CCE deployment at country level. We present lessons learnt from deploying CCE from the Gavi CCEOP in Cameroon.

Methods

This cross-sectional study collected data on the number of days items of CCE spent at each point on their trajectory from the entry port to 62 randomly selected health facilities in Cameroon.

Results

Once equipment arrived at the entry port, it took 10 d for customs clearance, 2 d from customs clearance to warehousing and 257 d (>9 mo) from the warehouse to facilities. Upon arrival at the facilities, it took a median of 53 (range 0–395) d from installation to final commissioning: most of the days (median=210) were spent between installation and final commissioning. The major causes of delays included insufficient coordination and communication across all levels, poor documentation and final commissioning.

Conclusion

Early engagement on customs clearance, strengthening coordination and communication, ensuring proper documentation, as well as eliminating final commissioning, could significantly improve implementation of the program.
Effects of gait adaptation training on augmented reality treadmill for patients with stroke in community ambulation
Authors: Yang Hang , Gao Zhenzhen , Zhou Ye , Liao Zhenyi , Song Caiping , Mao Yajun
Published: February 2024

Gait adaptability is essential for stroke survivors to achieve efficient and safe community ambulation. However, conventional treadmill rehabilitation is only a repetitive practice of leg movement. This study compared the effects of augmented reality treadmill-based gait adaptation training with regular treadmill programs for patients with stroke. Forty patients with stroke (n = 40) were randomly assigned to the gait adaptation training {n = 20, age: 49.85 [standard deviation (SD) 8.44] years; onset of stroke: 107.80 (SD 48.31) days} and regular training [n = 20, age: 50.75 (SD 8.05) years, onset of stroke: 111.60 (SD 49.62) days] groups. Both groups completed three sessions of training per week for 5 weeks (15 sessions). The primary outcomes were the 10-m walk test and success rate of obstacle avoidance, while secondary outcomes included the Berg balance scale, component timed-up-and-go, and fall rate in a 6-month follow-up period. Assessments were performed before and after the intervention. The paired t-test was applied to compare the differences within groups and independent sample t-test was performed to compare the differences between groups. The 10-m walk test, success rate of obstacle avoidance, Berg balance scale, and component timed-up-and-go all significantly improved in the both groups (P < .001). The success rate of obstacle avoidance [P = .02, 95% confidence interval (CI): −21.07, −1.64], Berg Balance Scale (P = .02, 95% CI: −8.03, −0.67), ‘turning around time’ (P = .04, 95% CI: 0.08, 2.81), ‘stand-to-sit’ (P = .03, 95% CI: 0.16, 2.41) and ‘total time’ (P = .048, 95% CI: 0.04, 10.32) improved significantly in gait adaptation training group after intervention, while the 10-m walk test (P = .09, 95% CI: −0.17, 0.01), timed ‘sit-to-stand’ (P = .09, 95% CI: −0.14, 2.04), and ‘linear walking’ (P = .09, 95% CI: −0.27, 3.25) in gait adaptation training group did not show statistical difference compared to the regular training group. Total fall rate during the follow-up period was statistically decreased in the gait adaptation training group (P = .045). Both interventions improved mobility outcomes, with augmented reality treadmill-based gait adaptation indicating greater improvement in obstacle avoidance, balance, turning, and stand-to-sit. Augmented reality treadmill-based gait adaptation training emerges as an effective and promising intervention for patients with stroke in early rehabilitation.
Concerted adoption as an emerging strategy for digital transformation of healthcare—lessons from Australia, Canada, and England
Authors: Cresswell Kathrin , Sullivan Clair , Theal Jeremy , Mozaffar Hajar , Williams Robin
Published: February 2024

Objectives

With an increasing focus on the digitalization of health and care settings, there is significant scope to learn from international approaches to promote concerted adoption of electronic health records.

Materials and methods

We review three large-scale initiatives from Australia, Canada, and England, and extract common lessons for future health and social care transformation strategy.

Results

We discuss how, despite differences in contexts, concerted adoption enables sharing of experience and learning to streamline the digital transformation of health and care.

Discussion and conclusion

Concerted adoption can be accelerated through building communities of expertise and partnerships promoting knowledge transfer and circulation of expertise; commonalities in geographical and cultural contexts; and commonalities in technological systems.
Exploration of a Predictive Model for Keloid and Potential Therapeutic Drugs Based on Immune Infiltration and Cuproptosis-Related Genes
Authors: Liu Jiaming , Hu Ding , Wang Yaojun , Zhou Xiaoqian , Jiang Liyuan , Wang Peng , Lai Haijing , Wang Yu , Xiao Houan
Published: February 2024

The aim of this study was to investigate the correlation between cuproptosis-related genes and immunoinfiltration in keloid, develop a predictive model for keloid occurrence, and explore potential therapeutic drugs. The microarray datasets (GSE7890 and GSE145725) were obtained from Gene Expression Omnibus database to identify the differentially expressed genes (DEGs) between keloid and nonkeloid samples. Key genes were identified through immunoinfiltration analysis and DEGs and then analyzed for Gene Ontology and Kyoto Encyclopedia of Genes and Genomes, followed by the identification of protein–protein interaction networks, transcription factors, and miRNAs associated with key genes. Additionally, a logistic regression analysis was performed to develop a predictive model for keloid occurrence, and potential candidate drugs for keloid treatment were identified. Three key genes (FDX1, PDHB, and DBT) were identified, showing involvement in acetyl-CoA biosynthesis, mitochondrial matrix, oxidoreductase activity, and the tricarboxylic acid cycle. Immune infiltration analysis suggested the involvement of B cells, Th1 cells, dendritic cells, T helper cells, antigen-presenting cell coinhibition, and T cell coinhibition in keloid. These genes were used to develop a logistic regression-based nomogram for predicting keloid occurrence with an area under the curve of 0.859 and good calibration. We identified 32 potential drug molecules and extracted the top 10 compounds based on their P-values, showing promise in targeting key genes and potentially effective against keloid. Our study identified some genes in keloid pathogenesis and potential therapeutic drugs. The predictive model enhances early diagnosis and management. Further research is needed to validate and explore clinical implications.
The Incentive Complementarity Between Formal and Informal Enforcement
Authors: Jackson Matthew O , Xing Yiqing
Published: February 2024

We introduce a model in which people exchange some goods and services informally in their community and others formally on a market. We show that enforcement by informal communities and a formal market are complements: If communities ostracize individuals who are caught cheating on the market, this bolsters incentives to comply with exchanges in both settings. Although transactions within a community generate lower gains from trade than those on the wider market, the enhanced incentives from simultaneously transacting in communities and on the overall market can be welfare-enhancing compared with either extreme. We discuss the implications of informal community exchanges in a country’s development as well as how moral or religious beliefs enhance the complementarity between community and formal enforcement.
Authorship and re-equilibration of the dynamics in the fashion industry: can the DSM Directive be the leader of a new regime for designers?
Authors: Sipetas Spyridon
Published: February 2024

Fashion designers’ persistent struggle to establish their author status is marked not only by external discrimination but also by internal industry biases. Historically, the alleged cultural elitism of copyright law has been the main hurdle for granting them this title. However, recent rulings of the Court of Justice of the European Union have dismantled any meaningful margin for discriminatory treatment across different art forms. With the clear acknowledgement of fashion designs as copyright-protectable subject matter, fashion designers can now proudly wear the badge of ‘authors’. But what does this newfound title bear, in practice, in a sector where authorship is built on an unjust foundation, on the grounds of the fashion industry’s discreditable hierarchy? What is the current fate of their moral and economic rights and how can the mechanisms provided to authors by Directive 2019/790 (DSM Directive) be leveraged to re-equilibrate the dynamics of the industry? These are, inter alia, the questions this article—ambitiously—attempts to explore.
Creating Efficient Workflows for Electron Microscopy Laboratories with Automated Specimen Preparation
Authors: Goodman Steven L , Benson Emily K , Flint Noah A , Dye Louis E , Chimento Melissa F , Phillips Edward , Percival Jeffrey W , Kidd Grahame J
Published: February 2024

Electron microscopy (EM) is essential to the biological and biomedical sciences and clinical diagnostic pathology. Electron microscopy specimen preparation is laborious and time-consuming, with transmission EM (TEM) chemical preparation typically requiring 1–3 days, while volume electron microscopy (vEM) takes 3–5 days of tedious manual reagent exchanges every few minutes or hours. This places a considerable burden on laboratory scientists with the ongoing demand for TEM, and the rapidly growing demand for vEM due to its potential to revolutionize structural biology, connectomics, and related fields. This burden is exacerbated by a shortage of trained electron microscopy scientists as current staff retire, and few enter the workforce. This report provides four case studies to illustrate how automated and faster specimen preparation workflows using mPrep™ Automated Specimen Processors (ASP-1000™ and ASP-2000™, Microscopy Innovations, LLC) free electron microscopy staff in academic and pre-clinical research labs and a clinical pathology laboratory.
Single‐cell transcriptome analysis of aging mouse liver
Authors: Lin Yan , Li Ying , Liang Guangyu , Yang Xiao , Yang Jiankun , Hu Qi , Sun Jian , Zhang Cuntai , Fang Haoshu , Liu Anding
Published: February 2024

Aging has a great impact on the liver, which causes a loss of physiological integrity and an increase in susceptibility to injury, but many of the underlying molecular and cellular processes remain unclear. Here, we performed a comprehensive single‐cell transcriptional profiling of the liver during aging. Our data showed that aging affected the cellular composition of the liver. The increase in inflammatory cells including neutrophils and monocyte‐derived macrophages, as well as in inflammatory cytokines, could indicate an inflammatory tissue microenvironment in aged livers. Moreover, aging drove a distinct transcriptional course in each cell type. The commonly significant up‐regulated genes were S100a8, S100a9, and RNA‐binding motif protein 3 across all cell types. Aging‐related pathways such as biosynthesis, metabolism, and oxidative stress were up‐regulated in aged livers. Additionally, key ligand–receptor pairs for intercellular communication, primarily linked to macrophage migration inhibitory factor, transforming growth factor‐β, and complement signaling, were also elevated. Furthermore, hepatic stellate cells (HSCs) serve as the prominent hub for intrahepatic signaling. HSCs acquired an “activated” phenotype, which may be involved in the increased intrahepatic vascular tone and fibrosis with aging. Liver sinusoidal endothelial cells derived from aged livers were pseudocapillarized and procontractile, and exhibited down‐regulation of genes involved in vascular development and homeostasis. Moreover, the aging‐related changes in cellular composition and gene expression were reversed by caloric restriction. Collectively, the present study suggests liver aging is linked to a significant liver sinusoidal deregulation and a moderate pro‐inflammatory state, providing a potential concept for understanding the mechanism of liver aging.
Evaluating a Situational Judgment Test for Use in Medical School Admissions: Two Years of AAMC PREview Exam Administration Data
Authors: Ellison Halle B. , Grabowski Christina J. , Schmude Michelle , Costa Joseph B. , Naemi Bobby , Schmidt Martin , Patel Dimple , Westervelt Marjorie
Published: February 2024

Purpose

To examine the relationship between the Association of American Medical Colleges (AAMC) Professional Readiness Exam (PREview) scores and other admissions data, group differences in mean PREview scores, and whether adding a new assessment tool affected the volume and composition of applicant pools.

Method

Data from the 2020 and 2021 PREview exam administrations were analyzed. Two U.S. schools participated in the PREview pilot in 2020 and 6 U.S. schools participated in 2021. PREview scores were paired with data from the American Medical College Application Service (undergraduate grade point averages [GPAs], Medical College Admission Test [MCAT] scores, race, and ethnicity) and participating schools (interview ratings).

Results

Data included 19,525 PREview scores from 18,549 unique PREview examinees. Correlations between PREview scores and undergraduate GPAs (r = .16) and MCAT scores (r = .29) were small and positive. Correlations between PREview scores and interview ratings were also small and positive, ranging between .09 and .14 after correcting for range restriction. Small group differences in mean PREview scores were observed between White and Black or African American and White and Hispanic, Latino, or of Spanish origin examinees. The addition of the PREview exam did not substantially change the volume or composition of participating schools’ applicant pools.

Conclusions

Results suggest the PREview exam measures knowledge of competencies that are distinct from those measured by other measures used in medical school admissions. Observed group differences were smaller than group differences observed with traditional academic assessments and evaluations. The addition of the PREview exam did not substantially change the overall volume of applications or the proportions of out-of-state, underrepresented in medicine, or lower socioeconomic status applicants. While more research is needed, these results suggest the PREview exam may provide unique information to the admissions process without adversely affecting applicant pools.
Current Use and Impact of Pulmonary Artery Catheters on the Short-Term Outcomes in Patients With Cardiogenic Shock Treated With an Impella: Findings From the Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD)
Authors: Arai Riku , Murata Nobuhiro , Fukamachi Daisuke , Okumura Yasuo ,   Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) Investigators
Published: February 2024

Objectives:

This study aimed to investigate the current use and impact of pulmonary artery catheters (PACs) in patients with cardiogenic shock (CS) who underwent Impella support.

Design:

This was a prospective multicenter observational study between January 2020 and December 2021 that registered all patients with drug-refractory acute heart failure and in whom the placement of an Impella 2.5, CP, or 5.0 pump was attempted or successful in Japan.

Setting:

Cardiac ICUs in Japan.

Patients:

Between January 2020 and December 2021, a total of 3112 patients treated with an Impella were prospectively enrolled in the Japan registry for percutaneous ventricular assist device (J-PVAD). Among them, 2063 patients with CS were divided into two groups according to the PAC use.

Interventions:

None.

Measurements and Main Results:

The primary endpoint was the 30-day mortality, and the secondary endpoints were hemolysis, acute kidney injury, sepsis, major bleeding unrelated to the Impella, and ventricular arrhythmias within 30 days. PACs were used in 1358 patients (65.8%) who underwent an Impella implantation. The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) was significantly higher in the patients with PACs than in those without. Factors associated with PAC use were the prevalence of hypertension, out-of-hospital cardiac arrest, New York Heart Association classification IV, the lesser prevalence of a heart rate less than 50, and the use of any catecholamine. The primary and secondary endpoints did not significantly differ according to the PAC use. Focusing on the patients with VA-ECMO use, the 30-day mortality and hemolysis were univariately lower in the patients with PACs.

Conclusions:

The J-PVAD findings indicated that PAC use did not have a significant impact on the short-term outcomes in CS patients undergoing Impella support. Further prospective studies are required to explore the clinical implications of PAC-guided intensive treatment strategies in these patients.
Titin: The Missing Link in Cardiac Physiology
Authors: ElSaygh Jude , Zaher Anas , Peterson Stephen J. , Parikh Manish A. , Frishman William H.
Published: February 2024

Titin, an extraordinary protein known for its colossal size and multifaceted roles, is a cornerstone in the structural and functional dynamics of striated muscle tissues, including the heart and skeletal muscles. Its sheer enormity, with a molecular weight exceeding 3000 kDa, is paralleled only by the immense influence it exerts on muscle physiology. This review will delve into the remarkable structural organization of Titin and the genetics of this molecule, including the common mutations resulting in various cardiomyopathies. We will delve deeper into its role in dilated cardiomyopathy, familial restrictive cardiomyopathy, hypertrophic cardiomyopathy, and left ventricular noncompaction cardiomyopathy. This review culminates by discussing the prospects of therapeutic strategies targeting Titin. While these interventions remain primarily theoretical, the possibilities are intriguing. Patients with Titin truncation mutations present unique challenges, but innovative approaches like gene therapy or preemptive treatments with drugs such as angiotensin-converting enzyme inhibitors or beta-blockers offer hope. This multi-pronged approach highlights the significance of understanding Titin’s multifaceted role and its potential as a target for future therapeutic interventions.