bluuebunny/crossref_metadata_2025 huggingface dataset:
Intellectual disabilities teaching for medical students: a scoping review
Authors: Towson Georgia , Daley Stephanie , Banerjee Sube
Published: November 2023

Background

People with intellectual disabilities are a marginalized group whose health experiences and outcomes are poor. Lack of skill and knowledge in the healthcare workforce is a contributing factor. In England, there is a new legislative requirement for mandatory intellectual disability training to be given to the existing healthcare workforce, including doctors. There is a lack of evidence about effective models of educational delivery of such training in medical schools. We undertook a scoping review to assess the range of intellectual disabilities educational interventions and their effectiveness.

Methods

We included any study from 1980 onwards which reported an educational intervention on intellectual disability, or intellectual disability and autism, for medical students from any year group. Databases searched included PUBMED, ERIC, Scopus and Web of Science as well as searches of grey literature and hand searching two journals (Medical Education and Journal of Learning Disabilities). 2,020 records were extracted, with 1,992 excluded from initial screening, and a further 12 excluded from full-text review, leaving 16 studies for inclusion. Data was extracted, quality assessed, and findings collated using narrative analysis.

Results

We found a variety of intervention types: classroom-based teaching, simulation, placement, home visits, and panel discussions. There was substantial variation in content. Most studies involved lived experience input. Across studies, interventions had different learning outcomes which made it difficult to assess effectiveness. Overall study quality was poor, with high use of non-validated measures, making further assessment of effectiveness problematic.

Conclusions

There is a need for more consistency in intervention design, and higher quality evaluation of teaching in this area. Our review has drawn attention to the variety in teaching on this topic area and further research should focus on updating this review as curriculum changes are implemented over time.
Geographical challenges and inequity of healthcare access for high-risk paediatric heart disease
Authors: Auld Benjamin C. , Abell Bridget , Venugopal Prem S. , McPhail Steven
Published: November 2023

Background

Geographical context is an important consideration for health system design to promote equality in access to care for patients with childhood heart disease (CHD), particularly those living in regional, rural, and remote areas. To help inform future policy and practice recommendations, this study aimed to (i) describe the geographic distribution of high-risk CHD patients accessing an Australian state-wide specialist service and (ii) estimate travel time for accessing healthcare via general practitioners (primary), nearest paediatric centre (secondary) and specialist paediatric cardiac centre (tertiary).

Methods

Participants included a cohort of children (0–18 year) who accessed state-wide specialist CHD services over a 3-year period (2019–2021) in Queensland, Australia. Locations for patient residence, general practitioner, closest paediatric centre and tertiary cardiac centre were mapped using geographical information system (GIS) software (ArcGIS Online). Travel distance and times were estimated using a Google Maps Application Programming Interface (API).

Results

1019 patients (median age 3.8 years) had cardiac intervention and were included in the sample. Of this cohort, 30.2% lived outside the heavily urbanised South East Queensland (SEQ) area where the tertiary centre is located. These patients travel substantially further and longer to access tertiary level care (but not secondary or primary level care) compared to those in SEQ. Median distance for patients residing outside SEQ to access tertiary care was 953 km with a travel time of 10 h 43 min. This compares to 5.5 km to the general practitioner and 20.6 km to a paediatric service (8.9 and 54 min respectively).

Conclusion

This geographical mapping of CHD services has demonstrated a key challenge inherent in providing specialist cardiac care to children in a large state-based healthcare system. A significant proportion of high-risk patients live large distances from tertiary level care. The greater accessibility of primary care services highlights the importance of supporting primary care physicians outside metropolitan areas to acquire or build the ability and capacity to care for children with CHD. Strengthening local primary and secondary services not only has the potential to improve the outcomes of high-risk patients, but also to reduce costs and burden associated with potentially avoidable travel from regional, rural, or remote areas to access specialist CHD services.
The novel HS-mimetic, Tet-29, regulates immune cell trafficking across barriers of the CNS during inflammation
Authors: Peck Tessa , Davis Connor , Lenihan-Geels Georgia , Griffiths Maddie , Spijkers-Shaw Sam , Zubkova Olga V. , La Flamme Anne Camille
Published: November 2023

Background

Disruption of the extracellular matrix at the blood–brain barrier (BBB) underpins neuroinflammation in multiple sclerosis (MS). The degradation of extracellular matrix components, such as heparan sulfate (HS) proteoglycans, can be prevented by treatment with HS-mimetics through their ability to inhibit the enzyme heparanase. The heparanase-inhibiting ability of our small dendrimer HS-mimetics has been investigated in various cancers but their efficacy in neuroinflammatory models has not been evaluated. This study investigates the use of a novel HS-mimetic, Tet-29, in an animal model of MS.

Methods

Neuroinflammation was induced in mice by experimental autoimmune encephalomyelitis, a murine model of MS. In addition, the BBB and choroid plexus were modelled in vitro using transmigration assays, and migration of immune cells in vivo and in vitro was quantified by flow cytometry.

Results

We found that Tet-29 significantly reduced lymphocyte accumulation in the central nervous system which, in turn, decreased disease severity in experimental autoimmune encephalomyelitis. The disease-modifying effect of Tet-29 was associated with a rescue of BBB integrity, as well as inhibition of activated lymphocyte migration across the BBB and choroid plexus in transwell models. In contrast, Tet-29 did not significantly impair in vivo or in vitro steady state-trafficking under homeostatic conditions.

Conclusions

Together these results suggest that Tet-29 modulates, rather than abolishes, trafficking across central nervous system barriers.
DNA damage response(DDR): a link between cellular senescence and human cytomegalovirus
Authors: Wu Xinna , Zhou Xuqiang , Wang Sanying , Mao Genxiang
Published: November 2023

The DNA damage response (DDR) is a signaling cascade that is triggered by DNA damage, involving the halting of cell cycle progression and repair. It is a key event leading to senescence, which is characterized by irreversible cell cycle arrest and the senescence-associated secretory phenotype (SASP) that includes the expression of inflammatory cytokines. Human cytomegalovirus (HCMV) is a ubiquitous pathogen that plays an important role in the senescence process. It has been established that DDR is necessary for HCMV to replicate effectively. This paper reviews the relationship between DDR, cellular senescence, and HCMV, providing new sights for virus-induced senescence (VIS).
Angelica acutiloba Kitagawa flower induces A549 cell pyroptosis via the NF-κB/NLRP3 pathway for anti-lung cancer effects
Authors: Chen Yonghu , Zhu Fangying , Che Xianhua , Li Yanwei , Li Ning , Jiang Zhe , Li Xuezheng
Published: November 2023

Angelica acutiloba Kitagawa, a traditional medicinal herb of the Umbelliferae family, has been demonstrated to have anticancer activity. In this study, we investigated the anti-lung cancer effects of two compounds extracted from A. acutiloba flowers: kaempferol-3-O-α-L-(4″-E-p-coumaroyl)-rhamnoside (KAE) and platanoside (PLA). MTT, cell colony formation, and cell migration (scratch) assays revealed that both KAE (100 μM) and PLA (50 μM and 100 μM) inhibited the viability, proliferation, and migration of A549 cells. Dichlorodihydrofluorescein diacetate assays showed that KAE and PLA also induced the generation of reactive oxygen species in A549 cells. Morphologically, A549 cells swelled and grew larger under treatment with KAE and PLA, with the most significant changes at 100 μM PLA. Fluorescence staining and measurement of lactate dehydrogenase release showed that the cells underwent pyroptosis with concomitant upregulation of interleukin (IL)-1β and IL-18. Furthermore, both KAE and PLA induced upregulation of NF-κB, PARP, NLRP3, ASC, cleaved-caspase-1, and GSDMD expression in A549 cells. Subsequent investigations unveiled that these compounds interact with NLRP3, augment NLRP3’s binding affinity with ASC, and stimulate the assembly of the inflammasome, thereby inducing pyroptosis. In conclusion, KAE and PLA, two active components of A. acutiloba flower extract, had significant anti-lung cancer activities exerted through regulation of proteins related to the NLRP3 inflammasome pathway.
Costs of orphan medicinal products: longitudinal analysis of expenditure in Wales
Authors: Pijeira Perez Yankier , Wood Eifiona , Hughes Dyfrig A
Published: November 2023

Background

The Orphan Regulation ((EC) No 141/2000) has successfully redirected private and public investment towards previously neglected areas through incentives, regulatory obligations and rewards. However, the growth in the number of licensed orphan medicinal products (OMPs) has led to concerns about increased costs. The aims were to investigate the trend in the costs of OMPs to the National Health Service in Wales, to attribute costs of medicines within and outside periods of marketing exclusivity, and estimate the contribution of individual medicines to the overall costs of OMPs.

Methods

Expenditure on OMPs in Wales was analysed between the 2014/15 and 2019/20 financial years using data on prescriptions dispensed in primary care, secondary care, and specialised commissioned services. OMP spend was calculated as a proportion of total medicines expenditure, whether it was incurred during, or outside the marketing exclusivity period (MEP), and by therapeutic area and medicine.

Results

Overall spend on OMPs and all medicines increased from £32 m to £82 m, and from £1,030 m to £1,198 m, respectively, with the proportion of spend on OMPs more than doubling from 3.1% to 6.9% per annum. Average year-on-year growth in the costs of OMPs was 21%, compared to 2% for other medicines. Costs following MEP expiry contributed significantly to overall OMP costs, increasing from £8 m to £30 m, corresponding to an increase from 24% to 37%. Treatments for ‘malignant disease and immunosuppression’, ‘nutrition and blood’ and the ‘respiratory system’ accounted for 90% of all OMP spend. Half of total OMP annual expenditure was on just 4 medicines in 2014/15, increasing to 8 in 2019/20.

Conclusions

Both the number of OMPs and the amount spent on OMPs in Wales has increased over time, possibly as a consequence of favourable licensing conditions, permissive health technology assessment policies and dedicated funding.
Epicardial pacing lead implantation for congenital complete atrioventricular block immediately after birth: a case report
Authors: Amino Hiroaki , Kinoshita Mao , Shibasaki Masayuki
Published: November 2023

Background

The incidence of congenital complete atrioventricular block is estimated to be 1 per 20,000 deliveries. In the fetal period, the fetal mortality rate is high, but the treatment strategy has not yet been established. In severe cases, early postnatal pacing therapy is necessary.

Case presentation

A 0-day-old Japanese baby girl was diagnosed with fetal congenital complete atrioventricular block during a prenatal physical examination. A joint conference was held preoperatively among multidisciplinary departments, and a cesarean section was performed at 37 weeks pregnancy, immediately followed by scheduled internal ventricular pacing lead implantation in an adjacent room. Percutaneous pacing was ineffective. The epicardial pacing lead was sutured at 17.5 minutes after birth, and perioperative management was successful with a heart rate and pulse rate of 150 beats per minute.

Conclusion

The infant with a congenital complete atrioventricular block was rescued by an uneventful epicardial lead implantation.
Microbial hitchhikers harbouring antimicrobial-resistance genes in the riverine plastisphere
Authors: Zadjelovic Vinko , Wright Robyn J. , Borsetto Chiara , Quartey Jeannelle , Cairns Tyler N. , Langille Morgan G. I. , Wellington Elizabeth M. H. , Christie-Oleza Joseph A.
Published: November 2023

Background

The widespread nature of plastic pollution has given rise to wide scientific and social concern regarding the capacity of these materials to serve as vectors for pathogenic bacteria and reservoirs for Antimicrobial Resistance Genes (ARG).In-andex-situincubations were used to characterise the riverine plastisphere taxonomically and functionally in order to determine whether antibiotics within the water influenced the ARG profiles in these microbiomes and how these compared to those on natural surfaces such as wood and their planktonic counterparts.

Results

We show that plastics support a taxonomically distinct microbiome containing potential pathogens and ARGs. While the plastisphere was similar to those biofilms that grew on wood, they were distinct from the surrounding water microbiome. Hence, whilst potential opportunistic pathogens (i.e.Pseudomonas aeruginosa,AcinetobacterandAeromonas) and ARG subtypes (i.e. those that confer resistance to macrolides/lincosamides, rifamycin, sulfonamides, disinfecting agents and glycopeptides) were predominant in all surface-related microbiomes, especially on weathered plastics, a completely different set of potential pathogens (i.e. Escherichia,Salmonella,KlebsiellaandStreptococcus) and ARGs (i.e. aminoglycosides, tetracycline, aminocoumarin, fluoroquinolones, nitroimidazole, oxazolidinone and fosfomycin) dominated in the planktonic compartment. Our genome-centric analysis allowed the assembly of 215 Metagenome Assembled Genomes (MAGs), linking ARGs and other virulence-related genes to their host. Interestingly, a MAG belonging toEscherichia–that clearly predominated in water– harboured more ARGs and virulence factors than any other MAG, emphasising the potential virulent nature of these pathogenic-related groups. Finally,ex-situincubations using environmentally-relevant concentrations of antibiotics increased the prevalence of their corresponding ARGs, but different riverine compartments –including plastispheres– were affected differently by each antibiotic.

Conclusions

Our results provide insights into the capacity of the riverine plastisphere to harbour a distinct set of potentially pathogenic bacteria and function as a reservoir of ARGs. The environmental impact that plastics pose if they act as a reservoir for either pathogenic bacteria or ARGs is aggravated by the persistence of plastics in the environment due to their recalcitrance and buoyancy. Nevertheless, the high similarities with microbiomes growing on natural co-occurring materials and even more worrisome microbiome observed in the surrounding water highlights the urgent need to integrate the analysis of all environmental compartments when assessing risks and exposure to pathogens and ARGs in anthropogenically-impacted ecosystems.
Establishment of a novel ER-stress induced myopia model in mice
Authors: Kang Longdan , Ikeda Shin-ichi , Yang Yajing , Jeong Heonuk , Chen Junhan , Zhang Yan , Negishi Kazuno , Tsubota Kazuo , Kurihara Toshihide
Published: November 2023

Background

Recent studies have indicated a strong correlation between endoplasmic reticulum (ER) stress and myopia and that eyedrops containing the ER stress inducer tunicamycin (Tm) can induce myopic changes in C57BL/6 J mice. Therefore, this study aimed to create a new myopia model using Tm eyedrops and to explore the mechanism of ER stress-mediated myopia development.

Methods

Three-week-old C57BL/6 J mice were treated with different concentrations (0, 25, 50, and 100 μg/mL) and/or number of applications (zero, one, three, and seven) of Tm eyedrops. Refraction and axial length (AL) were measured before and one week after Tm treatment. Scleral collagen alterations were evaluated under polarised light after picrosirius red staining. ER stress-related indicators, such as the expression of collagen I and cleaved collagen were detected using Western blotting.

Results

Compared with the control group, mice administered eyedrops with 50 μg/mL Tm only once showed the greatest myopic shifts in refraction and AL elongation and reduced scleral expression of collagen I. Picrosirius red staining showed a lower percentage of bundled collagen in the Tm group. Expression of ER-stress indicators increased in the Tm groups. Furthermore, optimised administration of Tm induced matrix metalloproteinase-2 (MMP2) expression in the sclera, which plays a major role in collagen degradation.

Conclusions

We have demonstrated that ER stress in the sclera is involved in myopia progression. Tm eyedrops induced myopic changes, loosening of the scleral collagen and decreased expression of collagen I. This process may be associated with ER stress in the sclera, which upregulates the expression of MMP2 leading to collagen degradation.
Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis
Authors: Parvini Puria , Lermen Yanislava , Sader Robert , Schwarz Frank , Obreja Karina
Published: November 2023

Background/aim

The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters.

Material and methods

All dental records of patients ≥ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments.

Results

The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011).

Conclusions

Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel–dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

Graphical Abstract
Maternal and perinatal outcomes of women with vaginal birth after cesarean section compared to repeat cesarean birth in select South Asian and Latin American settings of the global network for women’s and children’s health research
Authors: Figueroa Lester , Harrison Margo , Mazariegos Manolo , Goudar Shivaprasad , Kavi Avinash , Derman Richard , Patel Archana , Das Prabir , Hibberd Patricia L. , Saleem Sarah , Naqvi Farnaz , Goldenberg Robert L. , Haque Rashidul , Billah Sk Masum , Petri William A. , McClure Elizabeth M. , Tan Sylvia , Krebs Nancy F.
Published: November 2023

Objective

Our objective was to analyze a prospective population-based registry including five sites in four low- and middle-income countries to observe characteristics associated with vaginal birth after cesarean versus repeat cesarean birth, as well as maternal and newborn outcomes associated with the mode of birth among women with a history of prior cesarean.

Hypothesis

Maternal and perinatal outcomes among vaginal birth after cesarean section will be similar to those among recurrent cesarean birth.

Methods

A prospective population-based study, including home and facility births among women enrolled from 2017 to 2020, was performed in communities in Guatemala, India (Belagavi and Nagpur), Pakistan, and Bangladesh. Women were enrolled during pregnancy, and delivery outcome data were collected within 42 days after birth.

Results

We analyzed 8267 women with a history of prior cesarean birth; 1389 (16.8%) experienced vaginal birth after cesarean, and 6878 (83.2%) delivered by a repeat cesarean birth. Having a repeat cesarean birth was negatively associated with a need for curettage (ARR 0.12 [0.06, 0.25]) but was positively associated with having a blood transfusion (ARR 3.74 [2.48, 5.63]). Having a repeat cesarean birth was negatively associated with stillbirth (ARR 0.24 [0.15, 0.49]) and, breast-feeding within an hour of birth (ARR 0.39 [0.30, 0.50]), but positively associated with use of antibiotics (ARR 1.51 [1.20, 1.91]).

Conclusions

In select South Asian and Latin American low- and middle-income sites, women with a history of prior cesarean birth were 5 times more likely to deliver by cesarean birth in the hospital setting. Those who delivered vaginally had less complicated pregnancy and labor courses compared to those who delivered by repeat cesarean birth, but they had an increased risk of stillbirth. More large scale studies are needed in Low Income Country settings to give stronger recommendations.

Trial registration

NCT01073475, Registered February 21, 2010, https://clinicaltrials.gov/ct2/show/record/NCT01073475.
Faculty publication trends in a Japanese national university: a diachronic document analysis
Authors: Muller Theron , Takano Miho , Gallagher Nicole
Published: November 2023

Background

We previously demonstrated that in a Japanese national university’s medical faculty, overall paper publication frequency increased between 1979﻿–1980 and 2017–2018, while original paper publication did not increase. Further, publication language changed from predominantly Japanese to English. However, whether these trends are specific to medicine or representative of other faculties remains unclear.

Methods

We diachronically analyzed annual university library-produced publication reports for four pharmaceutical and three medical units between 1979﻿–1980 and 2019–2020, elucidating how publication frequency, type, and language medium changed.

Results

All publication types increased for the pharmaceutical faculty, from 2.87 per faculty member per year to 10.77. Publication of original papers more than doubled, from 1.06 per faculty member per year to 2.37. This increase was exclusively in English publication, with no publication of Japanese original papers in 2019–2020. This contrasts with medicine, which, while it demonstrated similar increases in all publication types combined, from 4.92 papers per faculty member per year to 12.78, did not demonstrate as striking an increase in total original paper publication (English and Japanese), from 1.21 papers per faculty member per year to 1.30. However, these two faculties observed similar trends in that English largely replaced Japanese original paper publication. That both faculties’ Japanese original paper publication decreased suggests English language original paper publication comes at the expense of publishing in Japanese. Concerning both faculties together, the increase in publishing frequency for all publication types more than tripled from 4.01 to 12.38. This was largely driven by changes in conference paper publication for the pharmaceutical sciences faculty, where English publication increased 2,775% (0.06 to 1.7 papers per faculty member per year) and Japanese language publication 258% (1.33 to 4.77). While conference paper publication did increase for the medical sciences, its change in total publication frequency was largely driven by ‘other’ types of publication, which increased from 0.51 publications per faculty member per year in 1979–1980 to 5.41 in 2019–2020, largely driven by Japanese language publication.

Conclusion

In 2019–2020, pharmaceutical sciences faculty members largely published original papers in English, so postgraduate education should consider the future likelihood of graduates needing to publish in English.
Utility of in vitro release testing (IVRT) to assess ‘sameness’ of 1% clotrimazole creams for use as a biowaiver
Authors: Wellington Hannah , Rath Seeprarani , Abboo Sagaran , Kanfer Isadore
Published: November 2023

The October 2022 draft United States Food and Drug Administration (FDA) guidance presents an option of in vitro release test (IVRT) studies as a biowaiver for topical drug products submitted in abbreviated new drug applications (ANDAs). However, the product-specific guidance (PSG) for 1% clotrimazole (CLZ) topical cream does not provide an in vitro option for biowaiver and requires a clinical endpoint study to demonstrate bioequivalence (BE). Therefore, the main objective was to use IVRT to investigate pharmaceutical equivalence of several 1% CLZ topical creams from two countries — South Africa (SA) and Canada. This investigation aims at demonstrating the utility of IVRT to determine ‘sameness’ and/or differences between topical creams containing 1% CLZ and the potential of IVRT for supporting biowaivers, thereby obviating the necessity to conduct clinical endpoint studies in patients. A validated IVRT method was applied to conduct comparative IVRT runs on five generic products marketed in SA and one Canadian generic, which were compared against a relevant comparator product from their country of origin in accordance with the FDA’s acceptance criteria of 75–133.33%. All five SA-marketed generic creams showed pharmaceutical inequivalence to the SA comparator product indicating Q1/Q2/Q3 differences. Despite containing the same excipients as both comparator products, the Canadian generic showed substantially lower release rate compared to the comparator products which could be attributed to Q2/Q3 differences. The IVRT method displayed the requisite ability to assess the various 1% CLZ creams and confirmed the potential of the IVRT method to support a biowaiver for 1% CLZ topical creams.

Graphical Abstract
P300 in peripheral neuropathy: cognitive functions assessment and gender effect
Authors: Mejahed Mohammad , Ibrahim Amira M. , Haydara Tamer , Ragab Salma , Gabr Takwa A.
Published: November 2023

Background

Patients with peripheral neuropathy (PN) have subtle central pathology that might contribute to cognitive impairment. P300 is a cognitive potential that is connected to both sensory and cognitive processes. Subjects with neurocognitive disorders have considerably longer P300 latency. This study aims to investigate P300's potential as a marker of early-stage cognitive deterioration in PN patients and also, the effect of gender on P300 in patients with PN.

Results

A study group of 60 subjects with PN of various etiologies and no other neurological conditions was included, in addition to, a control group of 40 volunteers with normal hearing sensitivity and no central or peripheral auditory neurological abnormalities. P300 response showed significant delayed latencies in study group when compared to control group. Male group had significant delayed P300 latencies in comparison to female group. As regard P300 amplitude, male group showed no statistically significant differences in comparison to female group.

Conclusions

Although patients with PN apparently have normal cognitive function, the results in this study revealed the possibility of subtle cognitive impairment. Cognitive functions are affected in both axonal PN and demyelinating PN, however there were no differences found between the two subgroups. Auditory evoked potentials, particularly P300 can be used easily for early detection of subclinical cognitive impairment before appearance of any neurological manifestations. P300 latencies are more important than amplitudes and may be used alone or in addition to amplitudes in cognitive function assessment.
First-order CO2 trapping characteristics of fold-and-thrust belts: Assessing carbon storage potential in the Appalachian Basin and beyond
Authors: Koehn Lars W. , Prince Phillip S. , Godbey Wes , Verne Mary , Fowler Nick , McCrady Patrick , Pollyea Ryan M.
Published: November 2023

Carbon capture and storage (CCS) is a strategy that is used to reduce global greenhouse gas emissions. As a result of increased government incentives and maturing carbon markets, CCS is currently experiencing an unprecedented level of public and commercial interest. In the United States, the Appalachian Basin contains abundant hydrocarbon resources and is the location of numerous industrial facilities, making the region a promising target for CCS development. However, the lack of seismic reflection surveys and well data, along with complex geologic structure throughout much of the basin, has limited the commercial interest in CCS development. This study proposes that the thin-skinned fold-and-thrust belt of the Appalachian Basin may contain geology suitable for secure long-term CO2 storage. This region, known as the Valley and Ridge physiographic province, holds complex fold-and-thrust structures that may effectively trap commercial volumes of CO2. We test this idea by developing a suite of kinematically feasible geologic interpretations for the Catawba syncline Pulaski thrust system in southwest Virginia. We then use these geologic models to conduct numerical simulations for CO2 storage within the fold-and-thrust belt structures of the Catawba syncline. Our simulation results indicate that the geometric configuration of fold-and-thrust belt structures may offer commercially viable CO2 traps for CCS projects within the Appalachian Basin and similar geologic settings worldwide.
Detection of a CO2 plume by time-lapse analysis of Rayleigh-wave amplitudes extracted from downhole DAS recordings of ocean microseisms
Authors: Pevzner Roman , Collet Olivia , Glubokovskikh Stanislav , Tertyshnikov Konstantin , Gurevich Boris
Published: November 2023

Amplitudes of Rayleigh waves are known to decrease exponentially away from the surface. If elastic properties of the solid are stratified on a scale much smaller than the wavelength, the Rayleigh-wave amplitude at a given depth should also be affected by the formation properties at that depth: the softer the medium, the larger the amplitude. An increasingly widespread deployment of fiber-optic cables in wells makes it possible to record this depth variation of Rayleigh-wave strain amplitudes and their variations over time (due to changes of formation properties) using distributed acoustic sensing (DAS). To investigate this opportunity, we have explored temporal variations of downhole DAS amplitudes of ocean-generated Rayleigh waves during injection of CO2 into a water-saturated thin porous layer. Analysis of these data clearly shows changes of these amplitudes related to the CO2 injection. To understand these amplitude variations, we perform a theoretical analysis and numerical simulations, which explain our field observations. In particular, analysis of downhole DAS data and theoretical modeling show that Rayleigh-wave amplitudes measured with vertical fiber-optic cables can be used to detect thin layers in the subsurface. Furthermore, time-lapse analysis of these amplitudes indicates temporal changes of stiffness of these layers, such as changes in saturation or pressure of the fluid in a porous layer in the vicinity of the borehole. In particular, Rayleigh-wave amplitudes are sensitive to the presence in the vicinity of the wellbore of a CO2 plume created as a result of a small injection into a thin porous reservoir layer. Our analysis also shows that the effect of a thin layer on Rayleigh-wave amplitudes strongly depends on frequency so that at different frequencies the amplitude is affected by different combinations of elastic properties. This opens an opportunity to use amplitude variations with depth at different frequencies to separately estimate changes in bulk and shear moduli.
Impacts of repeated social defeat on behavior and the brain in a cichlid fish
Authors: Wayne C. Rose , Karam Ava M. , McInnis Alora L. , Arms Catherine M. , Kaller Michael D. , Maruska Karen P.
Published: November 2023

Social defeat is a powerful experience leading to drastic changes in physiology and behavior, many of which are negative. For example, repeated social defeat in vertebrates results in reduced reproductive success, sickness and behavioral abnormalities that threaten individual survival and species persistence. However, little is known about what neural mechanisms are involved in determining whether an individual is resilient or susceptible to repeated social defeat stress. It also remains unknown whether exclusive use of reactive behaviors after repeated social defeat is maintained over time and impacts future behaviors during subsequent contests. We used a resident–intruder experiment in the African cichlid fish Astatotilapia burtoni to investigate the behavior and neural correlates of these two opposing groups. Behavior was quantified by watching fish during defeat trials and used to distinguish resilient and susceptible individuals. Both resilient and susceptible fish started with searching and freezing behaviors, with searching decreasing and freezing increasing after repeated social defeat. After a 4 day break period, resilient fish used both searching and freezing behaviors during a social defeat encounter with a new resident, while susceptible fish almost exclusively used freezing behaviors. By quantifying neural activation using pS6 in socially relevant brain regions, we identified differential neural activation patterns associated with resilient and susceptible fish and found nuclei that co-varied and may represent functional networks. These data provide the first evidence of specific conserved brain networks underlying social stress resilience and susceptibility in fishes.
Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers
Authors: Tettelbach William H , Driver Vickie , Oropallo Alisha , Kelso Martha R , Niezgoda Jeffrey A , Wahab Naz , De Jong Julie L , Hubbs Brandon , Forsyth R Allyn , Magee Gregory
Published: November 2023

Objective:

To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs).

Method:

Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups.

Results:

In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use).

Conclusion:

Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation.
Whole versus hole: enabling community nurses to implement holistic wound care
Authors: Moattari Marzieh , King Emily C , Ruco Arlinda
Published: November 2023

Objective:

To improve wound-related quality of life (QoL) in clients with hard-to-heal wounds in their lower limbs and to increase referrals to multidisciplinary teams in the management of care for these clients.

Method:

This was a quality improvement project with a two-group pretest–posttest interventional evaluation design. We implemented a package of interventions including the WounDS app, education related to wound care, and client engagement through a QoL self-assessment. Wound-related QoL was measured using the Cardiff Wound Impact Schedule and referrals to the multidisciplinary team were tracked through chart audits. We explored nurses' experiences with the interventions through semi-structured interviews.

Results:

Clients' average ratings for ‘wellbeing’, ‘physical symptoms and daily living’, and ‘overall QoL’ improved by 27%, 38% and 54%, respectively. The number of referrals increased by 78% post intervention. Nurses described the interventions as effective strategies that motivated them to implement a holistic approach to care.

Conclusion:

The project was successful in creating a culture shift to practice holistic wound care. This package of interventions (WounDS app, education and client self-assessment of QoL) led to improvements in the QoL of clients with hard-to-heal wounds. Further studies are needed to generalise the findings. Strategies for sustainability include forming a champion group and providing the education and decision supports based on nurses' educational needs assessment.
Eco-friendly Synthesis of Strontium Oxide Nanoparticles using Solanum nigrum Leaf Extract: Characterization and Antibacterial Potential
Authors: Kasthuri A. , Pandian P.
Published: November 2023

In this study, strontium oxide nanoparticles (SrO NPs) were successfully synthesized using Solanum nigrum leaf extract. The extract acted as a stabilizing agent during the synthesis process. Characterization techniques such as FTIR spectroscopy confirmed the existence of functional groups of the nanoparticles. Photon Correlation Spectroscopy analysis revealed an average particle size of 94.8 nm with a polydisperse distribution. SEM images showed the morphology of the nanoparticles, ranging from individual particles to agglomerates. XRD analysis indicated a cubic crystal structure for the SrO NPs. Importantly, the synthesized SrO NPs exhibited significant antibacterial activity against Mycobacterium TB, Candida albicans, and E. coli, highlighting their potential as antimicrobial agents. This eco-friendly approach utilizing Solanum nigrum extract opens up possibilities for the green synthesis of SrO NPs with promising biomedical applications.
No difference in component migration at five years between the cemented cruciate-retaining ATTUNE and PFC-Sigma knee prosthesis: an update of a randomized clinical radiostereometry trial
Authors: Yüksel Yasin , Koster Lennard A. , Kaptein Bart L. , Nelissen Rob G. H. H. , den Hollander Peter
Published: November 2023

Aims

Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes.

Methods

A total of 74 primary TKAs were included in this single-blind RCT. RSA examinations were performed, and PROMs and clinical outcomes were collected immediate postoperatively, and at three, six, 12, 24, and 60 months’ follow-up. Radiolucent lines (RLLs) were measured in standard anteroposterior radiographs at six weeks, and 12 and 60 months postoperatively.

Results

At five-year follow-up, RSA data from 61 patients were available and the mean maximum total point motion (MTPM) of the femoral components were: ATTUNE: 0.96 mm (95% confidence interval (CI) 0.79 to 1.14) and PFC-Sigma 1.37 mm (95% CI 1.18 to 1.59) (p < 0.001). The PFC-Sigma femoral component migrated more in the first postoperative year, but stabilized thereafter. MPTM of the tibial components were comparable at five-year follow-up: ATTUNE 1.12 mm (95% CI 0.95 to 1.31) and PFC-Sigma 1.25 mm (95% CI 1.07 to 1.44) (p = 0.438). RLL at the medial tibial implant-cement interface remained more prevalent for the ATTUNE at five-year follow-up compared to the PFC-Sigma (20% vs 3%). RLL did not progress over time, and varied between patients at different timepoints for both TKA systems. Clinical outcomes and PROMs improved compared with preoperative scores, and were not different between groups.

Conclusion

MTPM migration at five-year follow-up of the femoral and tibial component of the ATTUNE were similar and as low as that of the PFC-Sigma. MTPM migration of both knee implants did not significantly change from one year post-surgery, indicating stable fixation. Long-term ATTUNE performance may be expected to be comparable to the clinically well-performing PFC-Sigma. We have not found evidence of increased tibial component migration as measured by RSA to support concerns about cement debonding and a higher risk of aseptic loosening with the ATTUNE TKA.

Cite this article: Bone Joint J 2023;105-B(11):1168–1176.
Effect of using a small baseplate on the radiological and clinical outcomes of reverse total shoulder arthroplasty in Asian patients
Authors: Kim Jae S. , Kim Seung H. , Kim Su C. , Park Jong H. , Kim Hyun G. , Lee Sang M. , Yoo Jae C.
Published: November 2023

Aims

The aim of this study was to compare the clinical and radiological outcomes of reverse shoulder arthroplasty (RSA) using small and standard baseplates in Asian patients, and to investigate the impact of a mismatch in the sizes of the glenoid and the baseplate on the outcomes.

Methods

This was retrospective analysis of 50 and 33 RSAs using a standard (33.8 mm, ST group) and a small (29.5 mm, SM group) baseplate of the Equinoxe reverse shoulder system, which were undertaken between January 2017 and March 2021. Radiological evaluations included the size of the glenoid, the β-angle, the inclination of the glenoid component, inferior overhang, scapular notching, the location of the central cage in the baseplate within the vault and the mismatch in size between the glenoid and baseplate. Clinical evaluations included the range of motion (ROM) and functional scores. In subgroup analysis, comparisons were performed between those in whom the vault of the glenoid was perforated (VP group) and those in whom it was not perforated (VNP group).

Results

Perforation of the vault of the glenoid (p = 0.018) and size mismatch in height (p < 0.001) and width (p = 0.013) were significantly more frequent in the ST group than in the SM group. There was no significant difference in the clinical scores and ROM in the two groups, two years postoperatively (all p > 0.05). In subgroup analysis, the VP group had significantly less inferior overhang (p = 0.009), more scapular notching (p = 0.018), and more size mismatch in height (p < 0.001) and width (p = 0.025) than the VNP group.

Conclusion

In Asian patients with a small glenoid, using a 29.5 mm small baseplate at the time of RSA was more effective in reducing size mismatch between the glenoid and the baseplate, decreasing the incidence of perforation of the glenoid vault, and achieving optimal positioning of the baseplate compared with the use of a 33.8 mm standard baseplate. However, longer follow-up is required to assess the impact of these findings on the clinical outcomes.

Cite this article: Bone Joint J 2023;105-B(11):1189–1195.
Does the time to surgery influence outcomes for patients with a hip fracture who undergo total hip arthroplasty?
Authors: Farrow Luke , Clement Nick D. , Mitchell Lewis , Sattar Mariam , MacLullich Alasdair M. J.
Published: November 2023

Aims

Surgery is often delayed in patients who sustain a hip fracture and are treated with a total hip arthroplasty (THA), in order to await appropriate surgical expertise. There are established links between delay and poorer outcomes in all patients with a hip fracture, but there is little information about the impact of delay in the less frail patients who undergo THA. The aim of this study was to investigate the influence of delayed surgery on outcomes in these patients.

Methods

A retrospective cohort study was undertaken using data from the Scottish Hip Fracture Audit between May 2016 and December 2020. Only patients undergoing THA were included, with categorization according to surgical treatment within 36 hours of admission (≤ 36 hours = ‘acute group’ vs > 36 hours = ‘delayed’ group). Those with delays due to being “medically unfit” were excluded. The primary outcome measure was 30-day survival. Costs were estimated in relation to the differences in the lengths of stay.

Results

A total of 1,375 patients underwent THA, with 397 (28.9%) having surgery delayed by > 36 hours. There were no significant differences in the age, sex, residence prior to admission, and Scottish Index of Multiple Deprivation for those with, and those without, delayed surgery. Both groups had statistically similar 30-day (99.7% vs 99.3%; p = 0.526) and 60-day (99.2% vs 99.0%; p = 0.876) survival. There was, however, a significantly longer length of stay for the delayed group (acute: 7.0 vs delayed: 8.9 days; p < 0.001; overall: 8.7 vs 10.2 days; p = 0.002). Delayed surgery did not significantly affect the rates of 30-day readmission (p = 0.085) or discharge destination (p = 0.884). The results were similar following adjustment for potential confounding factors. The estimated additional cost due to delayed surgery was £1,178 per patient.

Conclusion

Delayed surgery does not appear to be associated with increased mortality in patients with an intracapsular hip fracture who undergo THA, compared with those who are treated with a hemiarthroplasty or internal fixation. Those with delayed surgery, however, have a longer length of stay, with financial consequences. Clinicians must balance ethical considerations, the local provision of orthopaedic services, and optimization of outcomes when determining the need to delay surgery in a patient with a hip fracture awaiting THA.

Cite this article: Bone Joint J 2023;105-B(11):1201–1205.