bluuebunny/crossref_metadata_2025 huggingface dataset:
Tailoring of mechanical, thermal and vibration behaviour of hybrid fibre with core honeycomb energy-absorbing materials reinforced polymer sandwich laminates
Authors: Florence Antony , Jain AR Tony Benedict , Ramraji Kirubakaran
Published: July 2023

Sandwich laminates are particularly important in the early stages of structural design due to their excellent mechanical, energy absorption, and other structural properties. High-strength carbon and glass fibre with honeycomb core sandwich laminates were fabricated by vacuum bag moulding. Three different energy-absorbing materials are used to develop sandwich structure laminates, such as cores filled with Rohacell, naturally available wheat husk and polyurethane foam (PUF). Some tests, such as flexural strength, vibrational behaviour, flammability analysis and impact tests, are carried out to assess the mechanical and dynamical properties of the sandwich laminates. According to the results, the PUF sandwich layer designed laminate exhibits good vibration with higher mechanical properties compared to the Rohacell and wheat husk laminates. Moreover, the PUF core laminate enhances the fire resistance property. PUF foam with fibres reinforced sandwich composite exhibited a higher natural frequency (825 Hz) and a higher damping value (0.059) than the wheat husk and Rohacell core sandwich laminates. This is because the PUF core dissipates energy more efficiently than other core sandwich laminates at all modes.
Fabrication of structurally graded material (pure PLA/WFPC): Mechanical and microscopic aspects
Authors: Veeman Dhinakaran , Subramaniyan Mohan Kumar , Vellaisamy Murugan , Kannan Sanjay
Published: July 2023

The aim of this study is to provide first-hand knowledge on additively manufactured structurally graded material (SGM) (polylactic acid / wood-fiber polymer composites) wall. Polylactic acid or polylactide is most effectively used in manufacturing plastic films, bottles, biodegradable medical devices, textile, and agricultural goods. Wood-fiber polymer composites are essentially used in furniture, particleboard, oriented strand board, medium-density fibreboard, plywood, and constructions. SGM is characterized through the change in material composition that is applicable to specific functions. Fabricated SGM exhibited mechanical property such as tensile strength (15.78 ± 0.05 MPa), compressive strength (46.8 ± 2.7 MPa), flexural strength (88.2 ± 0.15 MPa), and impact energy (1.64 ± 0.07 J). Hardness value of SGM is 74.5 shore-D. The coupon studies revealed that SGM possesses better mechanical characteristics than wood-fiber polymer composites and is on par with polylactic acid. The observed morphologies on fracture surface indicate the brittle nature of fracture. This SGM come under advanced materials that are utilized in biomedical, defence, energy, aviation, and nuclear sector, for integrated structural and thermal application.
Are persons living with diagnosed HIV capable of mounting a strong inflammatory response to the new coronavirus?
Authors: Maro Anna , Rosenthal Elizabeth M. , Abdallah Marie , Tesoriero James , Dehovitz Jack
Published: July 2023

Background

The impact of COVID-19 on persons living with diagnosed HIV (PLWDH) remains incompletely understood. It’s unclear whether an impaired immune system offers protection against mounting cytokine storm.

Methods

Retrospective matched cohort study of COVID-19 hospitalized individuals in New York State (NYS). Medical records were abstracted and analyzed for 853 PLWDH hospitalized with COVID-19 in NYS and 1621 HIV-negative controls. Preexisting comorbidities and inflammatory markers measured within 24 h of hospital admission were abstracted.

Results

PLWDH were significantly less likely to have elevated inflammatory markers compared to matched controls. Elevated WBC occurred in 23.3% of PLWDH vs 30.1% of controls ( p = .0002), elevated CRP in 37.4% of PLWDH vs 43.2% of controls ( p = .03), elevated ferritin in 73.4% of PLWDH vs 78.9% of controls ( p = .004). There was an inverse but not statistically significant relationship between the frequency of elevated inflammatory markers and HIV disease stage, with greatest percent of PLWDH with elevated WBC, LDH, CRP, and ferritin among PLWDH with HIV disease stage 1.

Conclusion

PLWDH had lower inflammatory marker elevation during COVID-19 infection compared to matched controls. PLWDH with low CD4 were less likely to mount a cytokine storm in the setting of impaired immune function.
The power to promise and forgive: Stabilizers of action and the moral ecology
Authors: Brinkmann Svend
Published: July 2023

As human beings, we do not live in a world devoid of value, but rather in what could be called a moral ecology that gives us reasons for action. Theorists of social practice such as Alasdair MacIntyre have analyzed the moral ecology as practices with inherent values and goods, but they have given less attention to the moral agents living in the moral ecology. In this article, I build on Hannah Arendt’s analysis of promising and forgiving and argue that these are “stabilizers of action” that cut across various practices and constitute a moral life of self-constancy. Human beings are moral agents in virtue of these moral powers, and they must be cultivated within the social practices where humans develop. This is made difficult in a liquid modern world that puts emphasis on change and flexibility rather than on integrity and self-constancy.
Prevalence of mental disorders among older Australians: Contrasting evidence from the 2020–2021 National Study of Mental Health and Wellbeing among men and women and the Health In Men Data Linkage Study
Authors: Almeida Osvaldo P. , Hankey Graeme J. , Yeap Bu B. , Golledge Jonathan , Etherton-Beer Christopher , Robinson Suzanne , Flicker Leon
Published: July 2023

Objective

To determine the prevalence of common mental disorders among older Australians included in the Health In Men Data Linkage Study and compare those with the results of the 2020–2021 National Study of Mental Health and Wellbeing (NSMHW).

Method

We used longitudinal record linkage to estimate the prevalence of mental disorders from age 65 years in a random sample of 38173 Australian men aged 65–85 years living in the Perth metropolitan region. Outcome was the proportion of participants affected by depressive episodes or dysthymia, bipolar disorder, anxiety disorder, psychotic disorder and alcohol use disorder.

Results

Prevalence estimates for participants aged 65–69, 70–74, 75–79, 80–84 and ≥85 years were 0.9%, 2.0%, 3.6%, 5.8% and 12.6% for depressive, 0.2%, 0.3%, 0.4%, 0.4% and 0.7% for bipolar, 0.1%, 0.5%, 1.3%, 2.2%, 6.9% for anxiety, 0.2%, 0.4%, 0.5%, 0.4% and 0.6% for psychotic and 1.2%, 1.7%, 2.1%, 2.2% and 4.2% for alcohol use disorders.

Conclusions

In contrast to the NSMHW, our data indicate that the prevalence of depressive and anxiety disorders increases with age, particularly among the older old. We conclude that the NSMHW should not be relied upon to guide planning or policies to address the mental health needs of older Australians.
Fast-Track Pathway: An Effective Way to Boost Diabetic Foot Care
Authors: lashkarbolouk Narges , Mazandarani Mahdi , Mohajeri Tehrani Mohammad Reza , Aalaa Maryam , Sanjari Mahnaz , Mehrdad Neda , Reza Amini Mohammad
Published: July 2023

Diabetes is a chronic disease that challenges global health issues in many aspects. Diabetic foot ulcer (DFU) is one of the most common causes of reduced quality of life and increased hospitalization, amputation, treatment costs, and mortality in patients. Improper patients’ knowledge, unsatisfactory education and training of healthcare workers, and limited facilities are the major cause of delayed referral and downscale management in DFUs. The diabetic foot clinical pathway is pivotal in providing best practices based on the latest standards and patient preferences. In the diabetic foot clinical pathway provided by the Iran Ministry of Health, the common concepts and grading systems are well defined for diabetic foot specialists so that patients can be diagnosed correctly and referred properly. Based on clinical examination guidelines, patients with diabetes are classified into low-risk, moderate-risk, high-risk, and active diabetic foot ulcer groups. One of this Pathway’s main objectives is to prevent the patient from getting the first ulcer, prevent frequent recurrence ulcers, and most importantly, prevent minor and major amputation.
The elephant is in the room: Diversity regimes, liminality and play in a dialog program for Palestinian-Arab and Jewish students in an Israeli university
Authors: Sapir Adi , Alimi Asaf
Published: July 2023

How do higher education institutions “do” diversity in the context of protracted national conflict? The present study examines a diversity and inclusion program in an Israeli university through a case study of one of the program’s initiatives in practice: a dialog workshop for Palestinian-Arab and Jewish students. Analyzing observational, interview and documentary data, and drawing on the theoretical constructs of liminality and play, we explore the workshop as a liminal space within a de-politicized diversity regime. We contribute to critical diversity literature by exploring the unfolding of inclusion work in the context of protracted national conflict, in which the university’s policy of imposing a strict apolitical agenda resulted in benign commitment to diversity and inclusion, as well as silencing of staff and students who attempted to bring up “off-limits” topics. We also contribute to research on liminality and play in organizational contexts by examining the dialog workshop as a case of a structured and regulated liminal space. In particular, we reveal how leisure time and play, specifically role play and role reversal, serve as “small openings”: outlets for experimentation and reflection within the predetermined confines of the liminal space.
Misconceptions: a multimodal study of Danish contraception information
Authors: Nørgaard Nina , Jepsen Carole
Published: July 2023

With sexually transmitted infections (STIs) on the rise, recent reports have revealed ignorance and inequality in matters of sexual health among young people in Denmark. In this article, the authors use a Multimodal Critical Discourse Analysis approach to examine the use and functions of visual resources in Danish sexual health communication. They focus on the role visuals play in communicating content and framing certain reader identities, which may indicate possible connections between the nature of the available information and the findings of the reports. In the material that is available, they find that the visual information is inconsistent and unclear in relation to representations of different contraceptives and their use. Moreover, they find a tendency to foreground normative assumptions with representations of heterosexuality and gender inequality persisting in the contraception information and the responsibility for contraception predominantly falling to the woman.
Effects of blue-enriched white light with same correlated colour temperature on visual fatigue
Authors: Zhang Y , Tu Y , Wang L , Shi Y
Published: July 2023

Visual fatigue has become a public health issue, while the relevant retinal mechanism and characteristics of blue light that induce visual fatigue have been rarely studied. In the retina, both short wavelength-sensitive (S) cones and melanopsin-containing intrinsically photoreceptive retinal ganglion cells (ipRGCs) are sensitive to blue light, and their responses are opposite in pupil mediation. Thus, effects of blue-enriched white light with different S-cone-opic Equivalent Daylight Illuminance (EDI) on visual fatigue was investigated, maintaining the same melanopic EDI to avoid interferences of melanopsin-containing ipRGCs. Two white illuminants (one with low S-cone-opic EDI, the other with high S-cone-opic EDI) were characterized based on α-opic EDI with the same correlated colour temperature and illuminance. Melanopic EDI was lower than S-cone-opic EDI of these two illuminants. Psychological, visual, physiological and cognitive performances were measured to investigate visual fatigue. Results showed that blue-enriched white light with high S-cone-opic EDI can induce visual fatigue. Participants felt more discomfort in their eyes under high S-cone-opic EDI along with the decline of tear film stability and changes of heart rhythm. Furthermore, the reaction time in a memory task increased significantly under high S-cone-opic EDI. The findings provide new insights into the optimization of indoor lighting environments for human health.
Essential Oils of Two Vietnamese Plants Piper betle f. densum (Piperaceae) and Disepalum plagioneurum (Annonaceae): Chemical Composition, Antimicrobial, and Cytotoxic Activities
Authors: Dai Do Ngoc , Pham Ty Viet , Dinh Luyen Nguyen , Dung Vo Thi , Huong Le Thi , Son Ninh The
Published: July 2023

The chemical compositions were determined by the leaf essential oils of 2 Vietnamese plants, Piper betle f. densum and Disepalum plagioneurum. The main chemical classes in the P densum leaf essential oil were sesquiterpene hydrocarbons (30.1%) and oxygenated sesquiterpenes (60.1%), with γ-elemene (12.7%), valeranone (9.3%), and ishwarone (6.0%) being the principal compounds. Disepalum plagioneurum leaf essential oil was dominated by monoterpene hydrocarbons (23.9%) and sesquiterpene hydrocarbons (59.8%). Bicyclogermacrene (26.8%), ( E)-caryophyllene (12.7%), ( E)- β-ocimene (8.4%), and ( Z)- β-ocimene (6.0%) were the major compounds of this essential oil. With the same MIC of 64 µg/mL, the leaf essential oils of P betle f. densum and D plagioneurum strongly controlled the growth of the Gram (+) bacterium Clostridium sporogenes NCTC 12935 and the fungus Aspergillus niger ATCC 1015, respectively. It was also found that D plagioneurum leaf essential oil was cytotoxic to cancer cell lines MCF7 and HeLa with IC50 values of 63.2 and 41.4 µg/mL, respectively.
Designing School Health Services to Provide Multi-Tiered Systems of Support (MTSS) for All Students
Authors: Bobo Nichole , Clark Elizabeth , Griffin Renee
Published: July 2023

A system-level health equity lens is needed to meet the needs of today’s students. School nurses stand at the intersection of health and education, poised to improve the health and academic outcomes for all children in collaboration with school health and education colleagues with a focus to reframe “learning and health losses” to “learning and health recovery.” The Multi-Tiered System of Support is a familiar approach used in schools to address education equity for students. Working alongside educators, school nurses can demonstrate how including health in this framework augments reaching the goal of supporting student academic success.
Medial Meniscal Posterior Horn Suturing Influences Tibial Internal-External Rotation in ACL-Reconstructed Knees
Authors: Grassi Alberto , Agostinone Piero , Paolo Stefano Di , Lucidi Gian Andrea , Pinelli Erika , Marchiori Gregorio , Bontempi Marco , Bragonzoni Laura , Zaffagnini Stefano
Published: July 2023

Background:

The role of meniscal lesions and repair in combination with anterior cruciate ligament (ACL) injury and reconstruction has not been extensively investigated in vivo and under weightbearing conditions.

Purpose:

The purposes of this study were to (1) compare the in vivo knee kinematics between patients with ACL tear and those with combined ACL and medial meniscal tears and (2) investigate kinematic differences between isolated ACL reconstruction and ACL reconstruction plus medial meniscal repair (MR). It was hypothesized that concomitant posterior horn medial meniscal tear and ACL deficiency would affect knee internal-external rotation and anterior-posterior translation but MR would restore these parameters.

Study Design:

Controlled laboratory study.

Methods:

Nineteen patients who underwent ACL reconstruction were included: 10 had intact menisci (IM group) and 9 had a medial meniscal injury that was repaired during ACL reconstruction using an all-inside technique (MR group). Preoperatively and 18 months postoperatively, active knee kinematics under weightbearing conditions was evaluated during a single-leg squat using a dynamic biplane x-ray imaging system. The general linear model was used to investigate the differences between group (IM vs MR) and time (preoperative vs follow-up) and their interactions.

Results:

Tibial internal rotation was higher in the MR group than the IM group both before and after surgery ( P = .007). Knee valgus rotation was higher in the MR group preoperatively ( P < .001), while no differences were found postoperatively because of an increase of valgus rotation in the IM group, which was significant in the descendant phase ( P < .001). Preoperatively, the IM group showed a more medial tibial translation compared with the MR group in the descendant phase ( P = .006).

Conclusion:

When performing a single-leg squat, patients with ACL-deficient knees and a medial meniscal tear demonstrated a more valgus rotation, tibial internal rotation, and lateral tibial translation versus those with intact menisci. After ACL reconstruction and MR, these patients demonstrated significantly higher tibial internal rotation when compared with patients who underwent isolated ACL reconstruction.

Clinical Relevance:

Surgeons should be aware that MR does not fully restore knee kinematics in vivo and under weightbearing conditions in the context of ACL reconstruction.
Caregiver Quality of Life During Pediatric Influenza-Like Illness: A Cross-Sectional Study During the COVID-19 Pandemic
Authors: Overmann Kevin M , Porter Stephen C , Zhang Yin , Britto Maria T
Published: July 2023

The objective of this study was to quantify the quality of life (QoL) of caregivers with children with influenza-like illnesses (ILI) and to identify factors associated with worse QoL. This was a cross-sectional cohort study of caregivers in a pediatric emergency department with previously healthy young children with ILI. The primary outcome was caregiver QoL. Additional measures included health literacy, social support, and caregiver health status. Two hundred and eighty-one caregivers completed the study. And 41% reported overall QoL was worse during their child's illness. The median QoL score was 3.8 [3.1, 4.6] in a 7-point scale. Illness duration was associated with worse overall QoL score (0.128 worse for each additional day of illness). The median emotions domain score was 2.5 [1.5, 4.0], the worst of any domain. Caregivers who perceived worse illness severity had lower emotions domain scores (2.61 vs 6.00, P = .0269). Caregivers with adequate literacy had lower mean QoL scores (3.08 vs 4.44, P < .0001). Childhood illnesses worsen caregiver QoL. Factors associated with worse QoL were perception of illness severity and duration. Addressing caregiver QoL could mitigate the impact of childhood acute illnesses on caregiver wellbeing.
Book review: Shannon Philip, Becoming Young Men in a New India: Masculinities, Gender Relations and Violence in the Postcolony
Authors: Agarwal Mehul
Published: July 2023

Shannon Philip, Becoming Young Men in a New India: Masculinities, Gender Relations and Violence in the Postcolony (Cambridge: Cambridge University Press, 2022), 209 pp., ₹780, ISBN: 978-1-009-15871-8.
Biomechanical Assessment and Neuromuscular Training to Mitigate Risk of Reinjury After ACLR
Authors: Thornton Laura , Goodloe J. Brett , Groseclose Inga , Cross Kevin , Diduch David R.
Published: July 2023

Background:

Reinjury rates following anterior cruciate ligament (ACL) reconstruction remain high, and the cause is often multifactorial. There is growing literature supporting asymmetric biomechanical deficits leading to increased risk of reinjury. Neuromuscular training during postoperative rehabilitation may mitigate risk of reinjury by addressing these biomechanical deficits.

Indications:

Neuromuscular training is supported in the literature to reduce primary ACL injury risk and modify biomechanical risk factors. Incorporating neuromuscular training into postoperative rehabilitation following ACL reconstruction may reduce the risk of reinjury.

Technique Description:

The Landing Error Scoring System, or LESS test, is an assessment tool utilized to detect biomechanical asymmetries following ACL reconstruction. Video analysis allows for observation of subtle biomechanical differences. Neuromuscular training programs help improve these deficits through stepwise gradual and individualized progressions that are specific to each patient’s needs and desired athletic return.

Results:

A patient who participates in neuromuscular training as a component of postoperative rehabilitation should demonstrate improvements in their individual biomechanical deficits at the completion of the program described.

Discussion/Conclusion:

Biomechanical assessment following ACL reconstruction, such as the LESS test, can identify deficits that may increase risk of reinjury. Neuromuscular training following ACL reconstruction can address these deficits and potentially mitigate risk of reinjury.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Physiological responses and Ethylene-Response AP2/ERF Factor expression in Indica rice seedlings subjected to submergence and osmotic stress
Authors: Chi Hsin-Yu , Ou Shang-Ling , Wang Mao-Chang , Yang Chin-Ying
Published: July 2023

Background

The increased frequency of heavy rains in recent years has led to submergence stress in rice paddies, severely affecting rice production. Submergence causes not only hypoxic stress from excess water in the surrounding environment but also osmotic stress in plant cells. We assessed physiological responses and Ethylene-Response AP2/ERF Factor regulation under submergence conditions alone and with ionic or nonionic osmotic stress in submergence-sensitive IR64 and submergence-tolerant IR64-Sub1Indica rice cultivars.

Results

Our results indicate that both IR64 and IR64-Sub1exhibited shorter plant heights and root lengths under submergence with nonionic osmotic stress than normal condition and submergence alone. IR64-Sub1seedlings exhibited a significantly lower plant height under submergence conditions alone and with ionic or nonionic osmotic stress than IR64 cultivars. IR64-Sub1seedlings also presented lower malondialdehyde (MDA) concentration and higher survival rates than did IR64 seedlings after submergence with ionic or nonionic osmotic stress treatment. Sub1A-1 affects reactive oxygen species (ROS) accumulation and antioxidant enzyme activity in rice. The results also show that hypoxia-inducible ethylene response factors (ERF)-VII group andalcohol dehydrogenase 1(ADH1) andlactate dehydrogenase 1(LDH1) genes exhibited different expression levels under nonionic or ionic osmotic stress during submergence on rice.

Conclusions

Together, these results demonstrate that complex regulatory mechanisms are involved in responses to the aforementioned forms of stress and offer new insights into the effects of submergence and osmotic stress on rice.
Characterization of non-cardiac arrest PulsePoint activations in public and private settings
Authors: Blackwood Jennifer , Daya Mohamud R. , Sorenson Ben , Schaeffer Brian , Dawson Mike , Charter Michael , Nania James Mark , Charbonneau Julie , Robertson Jeremy , Mancera Michael , Carbon Chris , Jorgenson Dawn B. , Gao Mengqi , Price Richard , Rosse Chris , Rea Thomas
Published: July 2023

Background

Geospatial smartphone application alert systems are used in some communities to crowdsource community response for out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification of OHCA is imperfect so that activation may occur for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well-investigated.

Methods

We undertook a prospective 3-year cohort investigation of patients for whom a smartphone geospatial application was activated for suspected OHCA in four United States communities (total population ~1 million). The current investigation evaluates those patients with an activation for suspected OHCA who did not experience cardiac arrest. The volunteer response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) and laypersons notified to public locations. The study linked the smartphone application information with the EMS records to report the frequency, condition type, and EMS treatment for these non-arrest patients.

Results

Of 1779 calls where volunteers were activated, 756 had suffered OHCA, resulting in 1023 non-arrest patients for study evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). The assessment distribution was similar for private and public locations. Overall, the most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG(27.9%, n=285), naloxone treatment (9.8%, n=100), airway or ventilation assistance (8.7%, n=89), and oxygen administration (6.6%, n=68).

Conclusions

More than half of patients activated for suspected OHCA had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care that could be provided by both layperson and public safety volunteers if they were appropriately trained and equipped.
Patients’ recovery of mobility and return to original residence after hip fracture are associated with multiple modifiable components of hospital service organisation: the REDUCE record-linkage cohort study in England and Wales
Authors: Patel Rita , Judge Andrew , Johansen Antony , Marques Elsa M. R. , Chesser Tim , Griffin Xavier L. , Javaid Muhammad K. ,   REDUCE Study Group, Ben-Shlomo Yoav , Gregson Celia L.
Published: July 2023

Background

Hip fractures are devastating injuries causing disability, dependence, and institutionalisation, yet hospital care is highly variable. This study aimed to determine hospital organisational factors associated with recovery of mobility and change in patient residence after hip fracture.

Methods

A cohort of patients aged 60 + years in England and Wales, who sustained a hip fracture from 2016 to 2019 was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality records were linked to 101 factors derived from 18 hospital-level organisational metrics. After adjustment for patient case-mix, multilevel models were used to identify organisational factors associated with patient residence at discharge, and mobility and residence at 120 days after hip fracture.

Results

Across 172 hospitals, 165,350 patients survived to discharge, of whom 163,230 (99%) had post-hospital discharge destination recorded. 18,323 (11%) died within 120 days. Among 147,027 survivors, 58,344 (40%) across 143 hospitals had their residence recorded, and 56,959 (39%) across 140 hospitals had their mobility recorded, at 120 days. Nineteen organisational factors independently predicted residence on hospital discharge e.g., return to original residence was 31% (95% confidence interval, CI:17–43%) more likely if the anaesthetic lead for hip fracture had time allocated in their job plan, and 8–13% more likely if hip fracture service clinical governance meetings were attended by an orthopaedic surgeon, physiotherapist or anaesthetist. Seven organisational factors independently predicted residence at 120 days. Patients returning to their pre-fracture residence was 26% (95%CI:4–42%) more likely if hospitals had a dedicated hip fracture ward, and 20% (95%CI:8–30%) more likely if treatment plans were proactively discussed with patients and families on admission. Seventeen organisational factors predicted mobility at 120 days. More patients re-attained their pre-fracture mobility in hospitals where (i) care involved an orthogeriatrician (15% [95%CI:1-28%] improvement), (ii) general anaesthesia was usually accompanied by a nerve block (7% [95%CI:1-12%], and (iii) bedside haemoglobin testing was routine in theatre recovery (13% [95%CI:6-20%]).

Conclusions

Multiple, potentially modifiable, organisational factors are associated with patient outcomes up to 120 days after a hip fracture, these factors if causal should be targeted by service improvement initiatives to reduce variability, improve hospital hip fracture care, and maximise patient independence.
Design, validation and implementation of an automated e-alert for acute kidney injury: 6-month pilot study shows increased awareness
Authors: Niemantsverdriet Michael S.A. , Tiel Groenestege Wouter M. , Khairoun M. , Hoefer Imo E. , van Solinge Wouter W. , Bellomo Domenico , van Vliet Martin H. , Kaasjager Karin A.H. , Haitjema Saskia
Published: July 2023

Background

Acute kidney injury (AKI) is defined as a sudden episode of kidney failure but is known to be under-recognized by healthcare professionals. The Kidney Disease Improving Global Outcome (KDIGO) guidelines have formulated criteria to facilitate AKI diagnosis by comparing changes in plasma creatinine measurements (PCr). To improve AKI awareness, we implemented these criteria as an electronic alert (e-alert), in our electronic health record (EHR) system.

Methods

For every new PCr measurement measured in the University Medical Center Utrecht that triggered the e-alert, we provided the physician with actionable insights in the form of a memo, to improve or stabilize kidney function. Since e-alerts qualify for software as a medical device (SaMD), we designed, implemented and validated the e-alert according to the European Union In Vitro Diagnostic Regulation (IVDR).

Results

We evaluated the impact of the e-alert using pilot data six months before and after implementation. 2,053 e-alerts of 866 patients were triggered in the before implementation, and 1,970 e-alerts of 853 patients were triggered after implementation. We found improvements in AKI awareness as measured by (1) 2 days PCr follow up (56.6–65.8%, p-value: 0.003), and (2) stop of nephrotoxic medication within 7 days of the e-alert (59.2–63.2%, p-value: 0.002).

Conclusion

Here, we describe the design and implementation of the e-alert in line with the IVDR, leveraging a multi-disciplinary team consisting of physicians, clinical chemists, data managers and data scientists, and share our firsts results that indicate an improved awareness among treating physicians.
Role of pelitinib in the regulation of migration and invasion of hepatocellular carcinoma cells via inhibition of Twist1
Authors: Lee Sewoong , Kang Eunjeong , Lee Unju , Cho Sayeon
Published: July 2023

Background

Overexpression of Twist1, one of the epithelial-mesenchymal transition-transcription factors (EMT-TFs), is associated with hepatocellular carcinoma (HCC) metastasis. Pelitinib is known to be an irreversible epidermal growth factor receptor tyrosine kinase inhibitor that is used in clinical trials for colorectal and lung cancers, but the role of pelitinib in cancer metastasis has not been studied. This study aimed to investigate the anti-migration and anti-invasion activities of pelitinib in HCC cell lines.

Methods

Using three HCC cell lines (Huh7, Hep3B, and SNU449 cells), the effects of pelitinib on cell cytotoxicity, invasion, and migration were determined by cell viability, wound healing, transwell invasion, and spheroid invasion assays. The activities of MMP-2 and -9 were examined through gelatin zymography. Through immunoblotting analyses, the expression levels of EMT-TFs (Snail1, Twist1, and ZEB1) and EMT-related signaling pathways such as mitogen-activated protein kinases (MAPKs) and Akt signaling pathways were measured. The activity and expression levels of target genes were analyzed by reporter assay, RT-PCR, quantitative RT-PCR, and immunoblotting analysis. Statistical analysis was performed using one-way ANOVA with Dunnett's Multiple comparison tests in Prism 3.0 to assess differences between experimental conditions.

Results

In this study, pelitinib treatment significantly inhibited wound closure in various HCC cell lines, including Huh7, Hep3B, and SNU449. Additionally, pelitinib was found to inhibit multicellular cancer spheroid invasion and metalloprotease activities in Huh7 cells. Further investigation revealed that pelitinib treatment inhibited the migration and invasion of Huh7 cells by inducing Twist1 degradation through the inhibition of MAPK and Akt signaling pathways. We also confirmed that the inhibition of cell motility by Twist1 siRNA was similar to that observed in pelitinib-treated group. Furthermore, pelitinib treatment regulated the expression of target genes associated with EMT, as demonstrated by the upregulation of E-cadherin and downregulation of N-cadherin.

Conclusion

Based on our novel finding of pelitinib from the perspective of EMT, pelitinib has the ability to inhibit EMT activity of HCC cells via inhibition of Twist1, and this may be the potential mechanism of pelitinib on the suppression of migration and invasion of HCC cells. Therefore, pelitinib could be developed as a potential anti-cancer drug for HCC.
Safety and efficacy of topical interferon alpha 2B and mitomycin C for localized conjunctival intraepithelial neoplasia: long-term report of their pharmacological safety and efficacy
Authors: Alvarado-Castillo Beatriz , Santa Cruz-Pavlovich Francisco J. , Gonzalez-Castillo Celia , Vidal-Paredes Isaac Alejandro , Garcia-Benavides Leonel , Rosales-Gradilla Maria Elena , Navarro-Partida Jose
Published: July 2023

Purpose

Ocular surface squamous neoplasia (OSSN) comprises a wide spectrum of squamous tumors, from which corneal/conjunctival intraepithelial neoplasia (CIN) is the most common one. The classic treatment is complete excision, but recurrence rates are high. Antineoplastic drugs such as mitomycin C (MMC) and interferon alpha 2b (IFNα2b) have been used as adjuvants or as primary treatment. To evaluate the efficacy and safety of topical IFNα2b and MMC in patients with CIN, a phase IIb double-blind clinical trial was performed.

Methods

Patients diagnosed with localized CIN were evaluated by slit lamp and impression cytology and were randomly given MMC 0.04% or INF2b (1 million IU/mL) 4 times daily until neoplasia resolution. Time of resolution and frequency of adverse effects were analyzed to determine the pharmacological efficacy and safety of both medications.

Results

Seventeen patients were included. Nine patients were treated with MMC and 8 with IFNα2b. All patients responded to treatment. The resolution time in days was 59.11 ± 24.02 in patients treated with MMC and 143.50 ± 47.181 in those treated with IFNα2b (p < 0.001). In the MMC group, one recurrence was reported (11%). There were no recurrences at 2 years of follow-up in the IFNα2b group. Regarding adverse effects, one or more mild adverse reaction occurred in 77% of patients managed with MMC and in 50% of patients managed with IFNα2b (p > 0.05). No serious adverse effects were reported.

Conclusions

Topical chemotherapy with MMC and IFNα2b demonstrate pharmacological safety and efficacy. Therefore, these drugs could be considered as primary therapies for localized CIN .
Using a theory-informed approach to guide the initial development of a post-tuberculosis care package in British Columbia, Canada
Authors: Romanowski Kamila , Cook Victoria Jane , Gilbert Mark , Johnston James Cameron
Published: July 2023

Background

The importance of addressing the long-term needs of tuberculosis (TB) survivors is gaining increasing attention. One promising approach to improving post-TB care is implementing a post-TB care package. With a specific focus on the perspectives of healthcare providers in British Columbia, Canada, this study aimed to (1) determine a set of components to be included in a post-TB care package, (2) explore barriers and facilitators influencing their implementation, and (3) propose potential solutions to overcome identified challenges.

Methods

Employing a multi-method approach guided by the Theoretical Domains Framework, we first conducted virtual workshops with TB care providers and utilized a modified Delphi process to establish a preliminary list of care package components. Then, we surveyed healthcare providers using closed-ended, Likert-scale questions to identify implementation barriers and enablers. Lastly, we mapped the identified barriers and enablers to establish behaviour change techniques to identify possible solutions to overcome the challenges identified.

Results

Eleven participants attended virtual workshops, and 23 of 51 (45.1%) healthcare providers completed questionnaires. Identified components of the post-TB care package included:

1. Linking people with TB to a primary care provider if they do not have one.

2. Referring people with pulmonary TB for an end-of-treatment chest x-ray and pulmonary function testing.

3. Referring people with TB who smoke to a smoking cessation specialist.

4. Sharing a one-page post-TB information sheet with the patient's primary care provider, including a summary of post-TB health concerns, complications, and recommendations to prioritize age-appropriate screening for cardiovascular disease, lung cancer, and depression.

Survey results indicated that domain scores for ‘environment, context, and resources’ were the lowest, suggesting potential implementation barriers. Care navigation services to help individuals overcome health system barriers while transitioning from TB care, information leaflets, and checklists summarizing key post-TB health concerns for patients and healthcare providers to help facilitate discussions may help overcome the identified barriers.

Conclusion

Healthcare providers in British Columbia acknowledge that post-TB care is integral to comprehensive health care but are limited by time and resources. Care navigation services, a post-TB checklist, and patient information leaflets may help resolve some of these barriers.
vamos: variable-number tandem repeats annotation using efficient motif sets
Authors: Ren Jingwen , Gu Bida , Chaisson Mark J. P.
Published: July 2023

Roughly 3% of the human genome is composed of variable-number tandem repeats (VNTRs): arrays of motifs at least six bases. These loci are highly polymorphic, yet current approaches that define and merge variants based on alignment breakpoints do not capture their full diversity. Here we present a method vamos:VNTRAnnotation using efficientMotifSets that instead annotates VNTR using repeat composition under different levels of motif diversity. Using vamos we estimate 7.4–16.7 alleles per locus when applied to 74 haplotype-resolved human assemblies, compared to breakpoint-based approaches that estimate 4.0–5.5 alleles per locus.
Significance of methylation-related genes in diagnosis and subtype classification of renal interstitial fibrosis
Authors: Zhang Hanchao , Yang Yue , Liu Zhengdao , Xu Hong , Zhu Han , Wang Peirui , Liang Guobiao
Published: July 2023

Background

RNA methylation modifications, such as N1-methyladenosine/N6-methyladenosine /N5-methylcytosine (m1A/m6A/m5C), are the most common RNA modifications and are crucial for a number of biological processes. Nonetheless, the role of RNA methylation modifications of m1A/m6A/m5C in the pathogenesis of renal interstitial fibrosis (RIF) remains incompletely understood.

Methods

Firstly, we downloaded 2 expression datasets from the GEO database, namely GSE22459 and GSE76882. In a differential analysis of these datasets between patients with and without RIF, we selected 33 methylation-related genes (MRGs). We then applied a PPI network, LASSO analysis, SVM-RFE algorithm, and RF algorithm to identify key MRGs.

Results

We eventually obtained five candidate MRGs (WTAP, ALKBH5, YTHDF2, RBMX, and ELAVL1) to forecast the risk of RIF. We created a nomogram model derived from five key MRGs, which revealed that the nomogram model may be advantageous to patients. Based on the selected five significant MRGs, patients with RIF were classified into two MRG patterns using consensus clustering, and the correlation between the five MRGs, the two MRG patterns, and the genetic pattern with immune cell infiltration was shown. Moreover, we conducted GO and KEGG analyses on 768 DEGs between MRG clusters A and B to look into their different involvement in RIF. To measure the MRG patterns, a PCA algorithm was developed to determine MRG scores for each sample. The MRG scores of the patients in cluster B were higher than those in cluster A.

Conclusions

Ultimately, we concluded that cluster A in the two MRG patterns identified on these five key m1A/m6A/m5C regulators may be associated with RIF.
The benefits of digitisation of psychiatric care facilities
Authors: Skuse David
Published: July 2023

The potential benefits of providing digital mental healthcare to isolated rural populations are emphasised in two articles from Pakistan. Novel programmes of support have been instituted by both private and publicly funded services.
Visit-to-Visit Glucose Variability, Cognition, and Global Cognitive Decline: The Multi-Ethnic Study of Atherosclerosis
Authors: Schaich Christopher L , Bancks Michael P , Hayden Kathleen M , Ding Jingzhong , Rapp Stephen R , Bertoni Alain G , Heckbert Susan R , Hughes Timothy M , Mongraw-Chaffin Morgana
Published: July 2023

Context

Higher visit-to-visit glucose variability (GV) is associated with dysglycemia and type 2 diabetes (T2D), key risk factors for cognitive decline.

Objective

Evaluate the association of GV with cognitive performance and decline in racially/ethnically diverse older populations with and without T2D.

Methods

We calculated the standard deviation of glucose (SDG), average real variability (ARV), and variability independent of the mean (VIM) among 4367 Multi-Ethnic Study of Atherosclerosis participants over 6 clinical examinations. Participants completed a cognitive assessment at the fifth examination, and a subset completed a second assessment 6 years later. We used multivariable linear regression to estimate the association of intraindividual GV with cognitive test scores after adjustments for cardiovascular risk factors and mean glucose level over the study period.

Results

Two-fold increments in the VIM and SDG were associated with worse Cognitive Abilities Screening Instrument (CASI) performance, while two-fold increments in VIM and ARV were associated with worse Digit Symbol Coding test score. GV measures were not associated with change in CASI performance among 1834 participants with repeat CASI data 6 years later. However, among 229 participants with incident T2D, the SDG and VIM were associated with decline in CASI (−1.7 [95% CI: −3.1, −0.3] and −2.1 [−3.7, −0.5] points, respectively). In contrast, single-timepoint glucose and HbA1c were not associated with CASI decline among participants with or without incident T2D.

Conclusion

Higher visit-to-visit GV over 16 to 18 years is associated with worse cognitive performance in the general population, and with modest global cognitive decline in participants with T2D.
Intergenerational plasticity to cycling high temperature and hypoxia affects offspring stress responsiveness and tolerance in zebrafish
Authors: Lim Michael Y.-T. , Bernier Nicholas J.
Published: July 2023

Predicted climate change-induced increases in heat waves and hypoxic events will have profound effects on fishes, yet the capacity of parents to alter offspring phenotype via non-genetic inheritance and buffer against these combined stressors is not clear. This study tested how prolonged adult zebrafish exposure to combined diel cycles of thermal stress and hypoxia affect offspring early survival and development, parental investment of cortisol and heat shock proteins (HSPs), larval offspring stress responses, and both parental and offspring heat and hypoxia tolerance. Parental exposure to the combined stressor did not affect fecundity, but increased mortality, produced smaller embryos and delayed hatching. The combined treatment also reduced maternal deposition of cortisol and increased embryo hsf1, hsp70a, HSP70, hsp90aa and HSP90 levels. In larvae, basal cortisol levels did not differ between treatments, but acute exposure to combined heat stress and hypoxia increased cortisol levels in control larvae with no effect on larvae from exposed parents. In contrast, whereas larval basal hsf1, hsp70a and hsp90aa levels differed between parental treatments, the combined acute stressor elicited similar transcriptional responses across treatments. Moreover, the combined acute stressor only induced a marked increase in HSP47 levels in the larvae derived from exposed parents. Finally, combined hypoxia and elevated temperatures increased both thermal and hypoxia tolerance in adults and conferred an increase in offspring thermal but not hypoxia tolerance. These results demonstrate that intergenerational acclimation to combined thermal stress and hypoxia elicit complex carryover effects on stress responsiveness and offspring tolerance with potential consequences for resilience.
Safety and Efficacy of Oxaliplatin Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) in Colorectal and Appendiceal Cancer with Peritoneal Metastases: Results of a Multicenter Phase I Trial in the USA
Authors: Raoof Mustafa , Whelan Richard L. , Sullivan Kevin M. , Ruel Christopher , Frankel Paul H. , Cole Sarah E. , Tinsley Raechelle , Eng Melissa , Fakih Marwan , Chao Joseph , Lim Dean , Woo Yanghee , Paz Isaac Benjamin , Lew Michael , Cristea Michaela , Rodriguez-Rodriguez Lorna , Fong Yuman , Thomas Rebecca Meera , Chang Sue , Deperalta Danielle , Merchea Amit , Dellinger Thanh H.
Published: July 2023

Background

Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a laparoscopic locoregional treatment for peritoneal metastases (PM) from colorectal cancer (CRC) or appendiceal cancer (AC) in patients who cannot undergo cytoreductive surgery (CRS). While PIPAC has been studied in Europe and Asia, it has not been investigated in the USA.

Patients and Methods

We evaluated PIPAC with 90 mg/m2 oxaliplatin alone (cycle 1) and preceded by systemic chemotherapy with fluorouracil (5-FU) and leucovorin (LV) (cycle 2–3) as a multicenter prospective phase I clinical trial (NCT04329494). The primary endpoint was treatment-related adverse events (AEs). Secondary endpoints included survival and laparoscopic, histologic, and radiographic response.

Results

12 patients were included: 8 with CRC and 4 with AC. Median prior chemotherapy cycles was 2 (interquartile range (IQR) 2–3). All patients were refractory to systemic oxaliplatin-based chemotherapy. Median peritoneal carcinomatosis index (PCI) was 28 (IQR 19–32). Six (50%) of twelve patients completed three PIPAC cycles. No surgical complications or dose-limiting toxicities were observed. Two patients developed grade 3 treatment-related toxicities (one abdominal pain and one anemia). Median overall survival (OS) was 12.0 months, and median progression-free survival (PFS) was 2.9 months. OS was correlated with stable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria but not with laparoscopic response by PCI or histologic response by peritoneal regression grading system (PRGS).

Conclusions

This phase I trial in the USA demonstrated safety, feasibility, and early efficacy signal of PIPAC with oxaliplatin and chemotherapy in patients with PM from AC or CRC who are refractory to standard lines of systemic chemotherapy.