bluuebunny/crossref_metadata_2025 huggingface dataset:
Unraveling novel Mutation Patterns and Morphological Variations in Two Dalbavancin-resistant MRSA strains in Austria using Whole Genome Sequencing and Transmission Electron Microscopy
Authors: Hotz Julian Frederic , Staudacher Moritz , Schefberger Katharina , Spettel Kathrin , Schmid Katharina , Kriz Richard , Schneider Lisa , Hagemann Jürgen Benjamin , Cyran Norbert , Schmidt Katy , Starzengruber Peter , Lötsch Felix , Leutzendorff Amelie , Daller Simon , Ramharter Michael , Burgmann Heinz , Lagler Heimo
Published: February 2024

Purpose: The increasing prevalence of methicillin-resistant Staphylococcus aureus(MRSA) strains resistant to non-beta-lactam antimicrobials poses a significant challenge in treating severe MRSA bloodstream infections. This study explores resistance development and mechanisms in MRSA isolates, especially after the first dalbavancin-resistant MRSA strain in our hospital in 2016.
Methods: This study investigated 55 MRSA bloodstream isolates (02/2015–02/2021) from the University Hospital of the Medical University of Vienna, Austria. The MICs of dalbavancin, linezolid, and daptomycin were assessed. Two isolates (16-33 and 19-362) resistant to dalbavancin were analyzed via whole-genome sequencing, with morphology evaluated using transmission electron microscopy (TEM).
Results: S.aureusBSI strain 19-362 had two novel missense mutations (p.I515M and p.A606D) in the pbp2 gene. Isolate 16-33 had a 534bp deletion in the DHH domain of GdpP and a SNV in pbp2 (p.G146R). Both strains had mutations in the rpoB gene, but at different positions. TEM revealed significantly thicker cell walls in 16-33 (p < 0.05) compared to 19-362 and dalbavancin-susceptible strains. Over the observed years, a noticeable MIC creep for dalbavancin emerged. None of the MRSA isolates showed resistance to linezolid or daptomycin.
Conclusion: Inlight of increasing vancomycin resistance reports, continuous surveillance is essential to comprehend the molecular mechanisms of resistance in alternative MRSA treatment options. Furthermore, based on the observed dalbavancin MIC creep, inclusion of dalbavancin in routine antimicrobial susceptibility testing should be considered.
Comparison of the Efficacy of Enfortumab Vedotin between patients with Metastatic Urothelial Carcinoma who were treated with Avelumab or Pembrolizumab: Real-World Data from a Multi-Institutional Study in Japan
Authors: Hirasawa Yosuke , Adachi Takahiro , Hashimoto Takeshi , Fukuokaya Wataru , Koike Yuhei , Yata Yuji , Komura Kazumasa , Uchimoto Taizo , Tsujino Takuya , Nishimura Kazuki , Takahara Kiyoshi , Saruta Masanobu , Fujita Kazutoshi , Hashimoto Mamoru , Uemura Hirotsugu , Shiroki Ryoichi , Azuma Takashi , Kimura Takahiro , Ohno Yoshi
Published: February 2024

Objectives
Enfortumab vedotin (EV) is a novel antibody-drug conjugate approved for metastatic urothelial carcinoma (UC) refractory to prior treatment with immune checkpoint inhibitors (ICIs). However, the difference in efficacy of EV after each ICIs and prognostic factors are not well known. We aimed to compare the efficacy of EV in patients with metastatic UC who were treated with avelumab or pembrolizumab and to identify the prognostic factors.
Methods
The records of 100 patients with advanced metastatic UC who received EV after the administration of either avelumab or pembrolizumab were retrospectively collected from five academic hospitals in Japan.
Results
The median follow-up period was 6.7 months. The median overall survival (OS) and progression-free survival (PFS) in the EV after avelumab/pembrolizumab group were not reached/14.7 months (p = 0.17) and 10.4/5.2 months (p = 0.039), respectively. The objective response rates (ORR) were 66.6% and 46.8% in EV after avelumab and EV after pembrolizumab groups, respectively (p = 0.14). Multivariate analysis identified histological variants, liver metastasis, low serum albumin levels, and high serum CRP level as significant poor prognostic factors. The median OS and PFS of cachexia patients with both low serum albumin levels and high serum CRP levels were 6.0 months and 0.93 months, respectively.
Conclusion
PFS was superior in patients treated with EV after avelumab to EV after pembrolizumab. However, OS showed no significant difference between the two groups. Because the prognosis of patients with cachexia is extremely poor, the initiation of EV should be discussed in these patients.
Eco-Friendly Fabrication of Nanoplastic Particles and Fibrils Using Polymer Blends as Templates
Authors: Rusli Andri , Hedenqvist Mikael S. , Yin Haiyan , Feng Zhaoxuan , Liu Baicang , Wei Xin-Feng
Published: February 2024

Plastic pollution poses a critical global environmental challenge, and within this context, nanoplastics (NPs), the smallest plastic fragments, remain poorly understood. The progress in studying NP toxicity and developing analytical methods highly depends on access to well-defined NP materials. Herein, a straightforward and eco-friendly method for fabricating NP particles and fibrils using polymer blends as templates is presented. The process began with blending plastics with a water-soluble polymer (polyvinyl alcohol (PVA)), followed by the dissolution of the PVA matrix in water and the isolation of the NPs through a two-stage filtration process. NP materials from three widely used plastics, polyethylene, polypropylene, and polystyrene, were prepared, underscoring the versatility of this method. The resulting NPs were primarily submicron in size, and their size and distribution were tuned by varying the blend ratio. Furthermore, by incorporating a stretch operation during the extrusion, the NP shape could be varied, enabling the fabrication of NP fibril materials. This method, which does not rely heavily on specialized equipment and avoids the use of harsh solvents, offers a viable and eco-friendly approach to fabricating NP samples suitable for a broad range of research applications.
Deep learning pricing of food processor agents in agricultural spatial markets
Authors: Khalili Hamed
Published: February 2024

Pricing behavior of agricultural processing firms in agricultural input markets has large impacts on the farmers and processors prosperity as well as the overall structure of the market. Despite established analytical contributions with regard to explanation of food processors’ pricing policies in agricultural spatial markets, the need for models, which can reflect real complex market environment features is contemporary. Agent-based models ABMs serve by now as computational laboratories to help understand market outcomes emerging from autonomously interacting agents. Yet, individual agents within ABMs must be equipped with appropriate intelligent learning algorithms. The objective of this paper is to development robust deep learning agents to simulate the pricing behavior of agricultural processing agents in agricultural input markets. Besides, our simulations contribute to improve the existing explanations of agricultural processors’ spatial pricing policies.
Awareness of medical students at the Syrian Private University about hypothyroidism
Authors: Teeba Lana , Shaal Mohammad Qusai , Hammoud Taghrid
Published: February 2024

Background and purpose of the research:
Hypothyroidism is defined as a disorder in the functioning of the thyroid gland in which it does not produce enough thyroid hormone, and it can cause a number of symptoms, such as: poor ability to tolerate cold, feeling tired, constipation, depression, low heart rate, and increased Weight: This study aims to know the awareness of medical students at the Syrian Private University about the symptoms of hypothyroidism.
Methods and materials:
Samples were collected at the Syrian Private University through an electronic questionnaire that was distributed to the special groups of the Syrian Private University. The samples were analyzed using the SPSS program during official working hours. The sample selection method was convenience sampling. Our required sample size was 204, meeting the inclusion and exclusion criteria and design. The study is cross-sectional.
Results
The sample included 204 students, and most of the participating students were sixth-year students, 32%. Most students answered about the skin symptoms of hypothyroidism, 93.2%. Most students answered the neurological symptoms, which revolved around depression and difficulty sleeping, 66.6%, while examining the thyroid gland. 71.1% are made through manual and radiological examination, 65.1% are diagnosed through TSH measurement, while 92.4% are treated through thyroxine.
Conclusion
The awareness rate was higher among sixth and fifth year students regarding symptoms associated with hypothyroidism, examination, diagnosis, and treatment, but a smaller percentage of students were aware of complications of hypothyroidism and other uncommon symptoms (60.6%/55.5%) and treatment of hypothyroidism in pregnant women (60%). \ 50%), and based on the unsatisfactory results, scientific seminars must be held to raise awareness for students of all academic years so that they are fully aware and knowledgeable of all complications of the disease and the means of diagnosis and treatment.
Prevalence and associated factors of forgone care among hypertensive patients in selected public hospitals in Addis Ababa, Ethiopia: Cross-sectional study
Authors: Gebretsadik Kirubel Workiye , Enkoye Biruktawit Destaw , Suleyiman Feruza Mehammed
Published: February 2024

Background
Hypertension is a complex chronic disease requiring appropriate continuous medical care, and forgone care may exacerbate the severity of the disease and associated complications. The assessment of forgone care indicates the gap between perceived need and actual utilization of healthcare services. This study aimed to investigate the prevalence and associated factors affecting forgone care in patients with hypertension.
Method
A cross-sectional study was also conducted. Study subjects were selected by using a systematic sampling technique. The data were collected using an interview-administered written questionnaire. A descriptive analysis was conducted to obtain a summary value for each variable. All variables with a p value < 0.25 in the bivariate analysis were entered into a multivariable logistic regression model to identify factors that were significantly associated with the outcome variable. A p value < 0.05 indicated statistical significance. The data are presented in statements, tables, and graphs.
Results
A total of 405 patients were included in the study. Of these, 35.2% reported forgone care. The most frequently stated reason for forgoing care was the financial burden resulting from the costs of disease treatment (46.3%). According to the final multivariable regression model, the odds of receiving care among hypertensive patients who did not have community-based health insurance were 2.754 times greater than those among those who did. The odds of receiving care among hypertensive patients who did not have family support were 2.31 times greater than those among patients who had family support.
Conclusion and recommendation:
A considerable number of patients with hypertension had a history of forgoing care, and the most important reasons for forgoing care were related to financial pressure and lack of family support for receiving treatment. A qualitative study is needed to further investigate the underlying reasons why hypertensive patients forgo healthcare.
A splanchnic venous thrombosis revealing Biermer's disease: A case report.
Authors: A Bachir Cherif. , S Benzaamia. , Y Djebbar. , A Taleb.
Published: February 2024

Background The relationship between Biermer's disease and increased thrombotic risk, while uncommon, represents a critical clinical concern necessitating heightened diagnostic awareness for patients presenting with unexplained thrombotic symptoms.Case presentation: This report details the case of a 57-year-old male, with a prior diagnosis of Graves' disease, who developed splanchnic venous thrombosis. An extensive etiological investigation revealed mild hyperhomocysteinemia, associated with an undiagnosed Biermer's disease.Conclusions Our case underscores a critical association between Biermer's disease, hyperhomocysteinemia, and venous thrombosis, emphasizing the imperative for further research elucidating their interconnected pathogenesis.
‹Mitmachen ist besser als nur Zuschauen›
Authors: Bach Stephan , Altieri Mike , Vilsmeier Lena
Published: February 2024

Videos bieten einerseits ein grosses Potenzial zur Unterstützung von Lehr-Lern-Prozessen; andererseits stellt ihr primär rezeptiver Charakter mit Blick auf die Aktivierung der Lernenden eine Herausforderung dar. Hier verspricht die Integration interaktiver Elemente einen Mehrwert. Der vorliegende Beitrag stellt die Ergebnisse einer qualitativen Studie vor, die im Jahr 2021 an Berufsschulen in Bayern durchgeführt wurde. Im Rahmen zweier Zyklen eines Design-Research-Vorhabens wurden Wahrnehmung und motivationale Wirkung eines interaktiven Lernvideos zur elementaren Algebra untersucht. Das Video enthält über die üblichen Steuerungsfunktionen hinaus interaktive Elemente, beispielsweise Aufgaben mit automatischem Feedback sowie kognitive Prompts. Es wurde von den Teilnehmenden in einem Laborsetting in Zweierteams bearbeitet. Die im Anschluss an die Bearbeitung geführten Interviews wurden durch eine qualitative Inhaltsanalyse nach Mayring mit der Technik der induktiven Kategorienbildung ausgewertet. Die Ergebnisse des ersten Zyklus zeigen, dass die Lernenden der Interaktion mit dem Video eine grosse Bedeutung beimessen, während Aspekte der Mediengestaltung eine eher untergeordnete Rolle spielen. Daher wurde die Bedeutung der interaktiven Elemente, konkret deren Wirkung auf die Lernmotivation, in Zyklus 2 genauer untersucht. Hier unterstreichen die Ergebnisse das grosse Potenzial interaktiver Elemente für die motivationale Gestaltung von Lernvideos. Dies ist zum einen in situationsspezifischen Anreizen, zum anderen in verschiedenen Personenfaktoren begründet. Aus den Ergebnissen lassen sich Empfehlungen für die Gestaltung interaktiver Elemente in Lernvideos ableiten.
‹Making im Unterricht›
Authors: Spieler Bernadette , Schifferle Tobias M. , Dahinden Manuela
Published: February 2024

Making bietet Schüler:innen die Möglichkeit, praktische Fähigkeiten in einem selbstgesteuerten Lernumfeld zu entwickeln. Für Lehrpersonen kann die Maker-Education ein innovativer Ansatz sein, um das Interesse am Lernen durch kreatives Design oder digitale Projekte zu wecken. Im Rahmen des zweijährigen DIZH-Projekts «Making im Unterricht» entwickelt die Pädagogische Hochschule Zürich (PH Zürich) unterschiedliche Szenarien für Making-Weiterbildungen für die 5. bis 9. Schulstufe. In diesem Beitrag werden die Ergebnisse von drei dieser Weiterbildungen mit insgesamt 13 Lehrpersonen präsentiert sowie ihre Erfahrungen, die sie anschliessend mit ca. 60 Klassen (rund 600 Schüler:innen) sammeln konnten. Im Sinne des Design-Based-Research-Ansatzes wurden verschiedene Methoden wie Interviews und Fokusgruppengespräche mit den beteiligten Lehrpersonen durchgeführt sowie Unterrichtspläne und abschliessende Statements gesammelt. Dabei wurde besonderes Augenmerk auf verschiedene Details in der Planung der Unterrichtsdurchführungen gelegt, z. B. der Fokus auf bestimmte Kompetenzen, Lerninhalte oder die Struktur der Einheit. Erste Erkenntnisse zeigen, dass Lehrpersonen gut neue Ideen mit ihren Klassen umsetzen konnten, aber insbesondere in den Vertiefungskursen zusätzliche Unterstützung benötigten. Vor allem im Hinblick auf das Wissen über spezifische Werkzeuge (z. B. Lasercutter, Stickmaschine) oder Anwendungen (z. B. Programmierung, Vektorisierung, App Embroidery Designer) wurden zusätzliche Unterstützungsangebote der PH Zürich in Anspruch genommen.
K. Matijevi?, Rezension zu: Josiah Osgood, Caesar's Legacy. Civil War and the Emergence of the Roman Empire
Authors: Matijević Krešimir
Published: February 2024

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Vehicle suspension based on torsion bar and elastic hinge
Authors: Zotov Alexey , Valeev Anvar , Tokarev Artem
Published: February 2024

The article is devoted to the development of a vehicle suspension with a nonlinear characteristic based on a torsion bar and an elastic hinge with a given characteristic on the example of tracked vehicles for constructing oil and gas pipelines. The characteristic of the elastic hinge is such that when the existing torsion bar suspension and the elastic hinge are connected in parallel, the desired characteristic is obtained. For this non-linear characteristic in the static displacement region, low stiffness was obtained, but the total stored energy at the maximum deflection of the balance bar of the resulting suspension is greater than that of existing torsion suspensions. The smoothness of the tracked vehicles with a low stiffness of the suspension increases significantly. The calculation of vibrations of the proposed suspension under kinematic excitation was carried out. A harmonic function is considered as the trajectory of the profile; a function corresponding to a single obstacle and a function corresponding to an ascent to a ledge of a given height. The elastic hinge is a pneumatic spring moving between the guides of the design form. The force characteristic of the hinge depends on the shape of the guides and on the pressure in the air spring. The calculation of the circular shapes of the guides of the elastic hinge is given. The values of the forces arising between the pneumatic spring and the guides are determined.
Conflict in Ukraine – Legal Battlefield. Editorial
Authors: Grzebyk Patrycja
Published: February 2024

Article describes unprecedented (in terms of scope, time framework, arguments) legal actions undertaken by Ukraine in response to Russian aggression which began in 2014 and which escalated in 2022. In the framework of lawfare conducted by Ukraine, article focuses on the allegations of genocide which appeared on both sides of conflict. In consequences, it addresses the current proceeding in the International Court of Justice: Ukraine v. Russian Federation, with 32 States intervening, in which Ukraine attempts to prove that Russia started intervention under the pretext of genocide allegedly committed in Eastern Ukraine. At the same time, article presents arguments concerning the possibility of classification of crimes committed by Russia in Ukraine as genocide. At the end the article presents the content of the volume 2 of PRIEL of the year 2023.
Pyrazole Scaffold: Potential PTP1B Inhibitors for Diabetes Treatment
Authors: Danao Kishor R. , Rokde Vijayshri V. , Nandurkar Deweshri M. , Mahajan Ujwala N.
Published: February 2024

Background:

The overexpression of the Protein Tyrosine Phosphatase 1B (PTP1B), a
key role in the development of insulin resistance, diabetes (T2DM) and obesity, seems to have a
substantial impact as a negative regulator of the insulin and leptin signaling pathways. Therefore,
inhibiting PTP1B is a prospective therapeutic approach for the treatment of diabetes and
obesity. However, the pyrazole scaffold is expected to be of significant pharmaceutical interest
due to its broad spectrum of pharmacological actions. This study aims to focus on the significance
of pyrazole scaffold in medicinal chemistry, the impact of PTP1B in diabetes and the therapeutic
approach of pyrazole scaffold to treat T2DM.

Methods:

A comprehensive analysis of the published literature in several pharmaceutical and
medical databases, such as the Web of Science (WoS), PubMed, ResearchGate, ScienceDirect
etc., were indeed successfully completed and classified accordingly.

Results:

As reviewed, the various derivatives of the pyrazole scaffold exhibited prominent
PTP1B inhibitory activity. The result showed that derivatives of oxadiazole and dibenzyl amine,
chloro substituents, 1, 3-diaryl pyrazole derivatives with rhodanine-3-alkanoic acid groups,
naphthalene and also 1, 3, 5-triazine-1H-pyrazole-triazolothiadiazole derivatives, octyl and
tetradecyl derivative, indole- and N-phenylpyrazole-glycyrrhetinic acid derivatives with trifluoromethyl
group, 2,3-pyrazole ring-substituted-4,4-dimethyl lithocholic acid derivatives with 4-
fluoro phenyl substituted and additional benzene ring in the pyrazole scaffold significantly inhibits
PTP1B. In silico study observed that pyrazole scaffold interacted with amino acid residues
like TYR46, ASP48, PHE182, TYR46, ALA217 and ILE219.

Conclusion:

Diabetes is a metabolic disorder that elevates the risk of mortality and severe complications.
PTP1B is a crucial component in the management of diabetes and obesity. As a result,
PTP1B is a promising therapeutic target for the treatment of T2DM and obesity in humans. We
concluded that the pyrazole scaffold has prominent inhibitory potential against PTP1B.
Prevalence of Diabetes, Hypertension, and Obesity in Punjab: A Comparison between NFHS-4 and NFHS-5 Surveys
Authors: Kaur Amandeep , Kumar Ranjeet , Sharma Amit
Published: February 2024

:

Diseases that are caused by a person's everyday habits are known as lifestyle diseases.
Habits that devoid people of their daily activities and direct them towards a sedentary lifestyle
cause numerous health problems that can lead to non-communicable diseases. Noncommunicable diseases, or NCDs, kill more than 41 million individuals per year, accounting for
74% of all deaths worldwide. In India, 63% of all fatalities were attributed to NCDs in 2016,
with 23% of those deaths being early. Compared to the current state of various lifestyle diseases,
the prevalence of adult obesity, hypertension, and other lifestyle disorders in Punjab was determined by the National Family Healthcare Surveys (NFHS-4 and NFHS-5). NFHS-5 survey conducted in Punjab was used to examine the general distribution of these disorders. The National
Family Health Survey 2019–21 (NFHS-5), the fifth survey in the NFHS series, provides information on the population, health, and nutritional status of all states and union territories (UT) in
India. NFHS-5 also gives district-level estimates for several crucial variables, similar to the
NFHS-4 survey 2015–16.
Preventive Habits in University Workers during SARS-CoV-2 Pandemic
Authors: Guerrini Luca , Tobia Loreta , Fiasca Fabiana , Provvidenti Luca , Mastrangeli Giada , Mattei Antonella , Bianchi Serena , Cipollone Claudia , Fabiani Leila
Published: February 2024

Background

SARS-CoV-2 and the consequent public health measures changed our habits, including prevention in oral health.

Objectives

The aim was to investigate the relationship between the perceived risk for SARS-CoV-2 infection and preventive habits, including COVID-19 preventive measures, general health preventive attitudes and oral-hygiene habits.

Materials and Methods

Data were collected via a web-based questionnaire, matched with medical history data obtained by the Occupational Medicine Service. Descriptive statistics were used to analyze the results of this observational cross-sectional study. Potential and investigated associations were studied through multivariate logistic regression.

Results

The perceived risk increases with age and decreases with a diabetes family history. The percentage of those with a dentist visit in the past three months is about three times higher among people who tested negative for COVID-19 than the positives. The percentage of those who had a dentist visit in more than six months is higher among the positives. Gingival bleeding was more frequent among people who tested positive for COVID-19, while it was a less frequent symptom in the negative group.

Conclusion

Results highlight a relation between the risk of testing positive for COVID-19 and oral health preventive habits. There is a relationship between oral health and risk perception for SARS-CoV-2.
Relationships and Predictors of Resilience, Social Support, and Perceived Stress among Undergraduate Nursing Students
Authors: Hamaideh Shaher , Abu Khait Abdallah , Al Modallal Hanan , Malak Malakeh , Masa’deh Rami , Hamdan-Mansour Ayman , AL Bashtawy Mohammed
Published: February 2024

Background

Nursing students experience high levels of stress. Therefore, they need to have adequate levels of resilience and social support to overcome the negative consequences of perceived stress.

Objective

The objective of the study is to assess the levels, relationships, and predictors of resilience, social support, and perceived stress among Jordanian nursing students.

Methods

A descriptive, cross-sectional design was employed. Data were collected from 150 Jordanian nursing students chosen conveniently using the Connor-Davidson Resilience Scale, Multidimensional Scale of Perceived Social Support, and Perceived Stress Scale (PSS).

Results

The mean total score of resilience was 71.61, with one-third of the participating students being resilient. Results indicated moderate levels of social support and perceived stress. A significant positive correlation was found between resilience and social support, and significant negative correlations were found between perceived stress and resilience and social support. Differences in resilience, social support, and perceived stress were found in regard to some demographics. Also, different independent variables predicted resilience, social support, and perceived stress.

Conclusion

Students reported low levels of resilience and moderate levels of perceived stress and social support. Therefore, conducting programs that aim to improve resilience techniques is crucial for nursing students. Special attention should be directed toward social support, especially from family members.
Risk Factors Associated with Malignant Lung Nodules in Smokers with Coal Worker’s Pneumoconiosis: An Exploratory Case-control Study
Authors: Balakrishnan Bathmapriya , Sarkar Sauradeep , Choi Janie , Patel Ruhee , Adkins Timothy , Fang Wei
Published: February 2024

Background

Benign lung nodules (LN) in coal worker’s pneumoconiosis (CWP) may be indistinguishable from lung cancer (LC) on radiography. There is a lack of validated LN risk calculators and LN management guidelines for CWP patients.

Objective

We sought to identify characteristics predictive of LC in LN detected in smokers with CWP.

Methods

An exploratory case-control study was conducted between 2015 to 2020. All adult ever-smokers with radiographic-proven CWP and LN, which were biopsied, were included. Multivariable logistic regression models were used to quantify adjusted associations between demographic and radiographic characteristics.

Results

Of the 29 eligible patients, 15 (52%) had biopsy-proven LC and 14 (48%) had benign LN. Solid LN increased the odds of LC by 21.6 times (p=0.17). Patients with radiographic emphysema were 2.21 times more likely to have a malignant LN (p=0.51). LN spiculation was associated with a higher risk of LC (OR=1.73, p=0.72), as was the presence of a solitary LN (OR=9.35, p=0.13). Multiple LN was found to be negatively associated with LC (OR=0.18, p=0.36). Family history of LC, pack-years of smoking, and exposure to silica and/or coal were not found to be predictive of malignancy (OR≤1, p>0.05).

Conclusion

Solid and spiculated LN associated with emphysema and multiple LN was found to be correlated with a higher risk for LC in CWP ever-smokers. No statistically significant association was found due to the small number of patients. This study highlights unique LN features conferring a higher risk of LC among smokers with CWP. Larger, prospective, multicentric studies should be conducted to confirm these findings.

Clinical Trial Registration

The clinical trial registration number approved by the Institutional Review Board, West Virginia University, was #2109411710.
Immunostimulant and Pharmacological Activities, of Cucurbita Maxima Seeds on Humoral and Cellular Immunity Cells and their Functions
Authors: Laaraj Soukaina , Ouahidi Ibtissam , Al Moudani Nada , Allali Mustapha , Aarab Lotfi
Published: February 2024

Background

Natural resources are key for discovering medicinal compounds. Hence, the objective of this study was to evaluate the immunomodulatory activities of Cucurbita maxima (pumpkin) seeds, a component of Moroccan folk medicine believed to enhance immunity.

Methods

We produced three distinct extracts employing ethanol, ethyl acetate, and water as solvents. The immunomodulatory effects of these extracts were assessed on rabbit immune cell proliferation and their functions, including IgG production, cytotoxicity, and phagocytosis.

Results

The study findings reveal a significant stimulation in thymocyte proliferation, yielding a remarkable 285.7% response, along with a 146.5% increase in cytotoxicity (MLR) in response to the aqueous extract. Furthermore, there was a notable enhancement in complement activity by 119.9% in response to the aqueous extract, implying the potential of C. maxima to modulate both humoral and cellular immunity. Additionally, both EtOAc and aqueous extracts led to a reduction in macrophage phagocytic function. The assessment of the antibacterial properties of ethanol extract showed greater effectiveness against Bacillus, E. Coli, and Staphylococcus. In a separate analysis, antioxidant activity was gauged through DPPH, FRAP, and ABTS methods. These tests exhibited robust antioxidative effects across all extracts, characterized by higher levels of phenolic and flavonoid content. The FT-IR spectrum indicated the presence of compounds such as triglycerides, sterol esters, phospholipids, and unsaturated fatty acids in the extracts.

Conclusion

Collectively, these outcomes prompt the consideration of utilizing the aqueous extract of Cucurbita maxima to strengthen humoral and cellular immunity, as well as lymphocyte toxicity, in various ailments.
Effect of Ketamine versus Dexmedetomidine on Release of Inflammatory Mediators in Laparoscopic Hysterectomy. A Randomized Trial
Authors: Elghamry Mona Raafat , Naguib Tamer Mohamed , AbdAlraheem Taysser Mahmoud , Dawood Lamees Mohamed
Published: February 2024

Background:

Surgery and anesthesia are sources of patients' stress and release of inflammatory mediators that have adverse effects on wound healing and remote organs.

Objectives:

To compare the effects of dexmedetomidine and ketamine on perioperative serum levels of inflammatory biomarkers (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP).

Methods:

We included 75 patients aged 30-60, ASA I and II, and scheduled for laparoscopic hysterectomy. Randomized patients received either intraoperative ketamine (bolus dose 0.25mg/kg then continuous infusion of 250µg/kg/h), dexmedetomidine (1µg/kg bolus dose then continuous infusion of 0.5µg/kg/h), or placebo. The primary outcome was to measure perioperative inflammatory biomarkers. Hemodynamic parameters, Recovery time, and complications were secondary outcomes.

Results:

At 6 and 24 hours, IL-6 significantly increased in the control group versus ketamine and dexmedetomidine groups (113.4±14.1,107.4±13.7;50.1± 8.1,48.2± 8.1;47.7±7.1, 46.01±7.1;p<0.001). Similarly, At 6 and 24 hours, TNF-α significantly increased in the control group versus ketamine and dexmedetomidine groups (81.8±18.6,72.7±16.4; 40.6±7.1, 39.2±6.9;41.6± 7.6,39.9±7.6;p<0.001).The same for CRP (17.4±3.6,40.0±6.0;10.2±1.3,16.2± 1.2;10.9±1.8,16.3±1.9;p<0.001). Regarding hemodynamic parameters, there were significant increases in the ketamine group and decreases in the dexmedetomidine group compared to baseline. Recovery time was significantly longer in the ketamine group than in the control and dexmedetomidine group (24.3±6.4,12.6±2.0,13.5±3.3 min, respectively; P<0.001). There were no significant differences between the three groups regarding agitation, nausea, and vomiting (P=1,0.126,0.776, respectively).

Conclusion:

Both dexmedetomidine and ketamine could attenuate the inflammatory response. However, dexmedetomidine has a shorter recovery time.

Trial Registry No

Trial registry at Pan African Clinical Trials Registry.

The number is (PACTR201910617459894: date of registration 10/24/2019).

URL

https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9479).
Considering New and Emerging Treatment Strategies for
Depression: Beyond STAR*D and the Monoamines
Authors: McInnes L. Alison , Marton Tobias F
Published: February 2024

While the number of treatment options for major depressive disorder (MDD)
has grown in recent years, the lack of quality data to guide optimal modality selection has
lessened the potential impact of having a more diverse set of mechanistic approaches to
treatment. The last attempt to investigate treatment sequencing for MDD was the Sequenced Treatment Alternatives for Relief of Depression Study (STAR*D), which gave
rise to the concept of treatment-resistant depression (TRD) as a failure to respond to two or
more monoaminergic antidepressants. However, a recent reanalysis of the STAR*D data
indicates that most patients do not remit even when treated with multiple traditional antidepressants. Given these new results, labeling the majority of patients as treatmentresistant is not appropriate or useful. If monoamine-based drugs are not that effective for
the majority of MDD patients, then it is necessary to consider the mechanistically distinct
pharmacological and non-pharmacological treatment options that have emerged recently,
including brain stimulation, glutamate receptor modulators, and psychedelic medicines.
While these new treatment modalities have the potential to enhance patient outcomes, clinicians and patients currently lack a framework to guide their choices other than cost, feasibility, personal preference, and certain medical contraindications. Here, we review alternative treatment modalities for monoamine non-responders and consider the possibility
that there will be new first-line therapies for MDD. We will review how treatment decisions for these patients are currently being made and how developments in precision psychiatry may help guide rational treatment selection in the future
Rail Transport across the Strait of Messina: Some Policies to Improve the Service
Authors: Di Gangi Massimo , Belcore Orlando Marco , Polimeni Antonio
Published: February 2024

Background

The railway system represents a more sustainable alternative to road and air transport. In some cases, barriers negatively impact travel by train, thus affecting users' choices. Some of such barriers (e.g., rivers, and maritime straits) divide urbanized areas (especially if a stable connection between the two areas is unavailable). In these cases, methods, policies, and planning procedures must be adopted to improve the service. The Strait of Messina (South Italy), considered in the paper as a case study, represents a particular barrier so long as the trains must be decomposed before embarking on a ferry, thus increasing dwelling time.

Objectives

This paper moves from analyzing the current crossing condition in the Strait of Messina and offers an analysis of the most pointless activities at the maritime barrier. In it, some policies (with short or middle time horizons) aimed at reducing long embarkation and disembarkation times due to the decomposing operation of the convoys, as well as the subsequent recompositing and verification operations of the rolling stock, are proposed.

Methods

The proposed solutions are based on time schedules and direct observation. The proposals are not to be considered mutually exclusive, and they could represent a progressive improvement whose results are beneficial in reducing the crossing time. For each one, setup time and costs are considered to evaluate which is more appropriate.

Results

The report assesses the benefits of introducing some interventions, and the solutions have been organized sequentially to reduce infrastructure costs. Consequently, some of the proposed solutions can be implemented immediately, thus improving the quality of the service without requiring high financial and time costs.

Conclusion

Planning a succession of actions could lead to a progressive improvement in the quality of the services offered, letting public administration focus on priorities, thus offering the opportunity to monitor and evaluate the efficiency of each measure.
Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach
Authors: Dang Thu Ha , Wickramasinghe Nilmini , Forkan Abdur Rahim Mohammad , Jayaraman Prem Prakash , Burbury Kate , O’Callaghan Clare , Whitechurch Ashley , Schofield Penelope
Published: February 2024

Background

Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence.

Objective

The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer.

Methods

Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution.

Results

The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78%). The app was engaging (18/27, 67%), informative, increased user interactions, and well organized (19/27, 70%). Most of the participants (21/27, 78%) commented that SAMSON’s activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users’ technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration.

Conclusions

This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions.
Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study
Authors: Locke Sean , Osborne Jenna
Published: February 2024

Background

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy.

Objective

This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase.

Methods

The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes.

Results

Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model.

Conclusions

The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.
Effect of a Mobile Game–Based Intervention to Enhance Child Safety: Randomized Controlled Trial
Authors: Wong Rosa S , Tung Keith T S , Ho Frederick K W , Wong Wilfred H S , Chow Chun Bong , Chan Ko Ling , Fu King Wa , Ip Patrick
Published: February 2024

Background

Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population.

Objective

This study aimed to investigate the potential of a mobile game–based safety education program in improving children’s safety and psychosocial outcomes.

Methods

Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models.

Results

No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3.

Conclusions

Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries.

Trial Registration

ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196

International Registered Report Identifier (IRRID)

RR2-10.2196/17756
Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study (Preprint)
Authors: Locke Sean , Osborne Jenna
Published: February 2024

BACKGROUND

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy.

OBJECTIVE

This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase.

METHODS

The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes.

RESULTS

Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model.

CONCLUSIONS

The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

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