bluuebunny/crossref_metadata_2025 huggingface dataset:
Sedimentology of Lower Triassic (Induan Stage) Mixed Carbonate‐Siliciclastic Succession of an Epeiric Carbonate Ramp at the Northeastern Passive Margin of the Arabian Plate, Northern Iraq‐Kurdistan Region
Authors: Balaky Sardar M. , Sh. Asaad Irfan , Tamar‐Agha Mazin Y. , Radwan Ahmed E.
Published: January 2025

The Mirga Mir Formation (Lower Triassic) was studied for its sedimentology and lithostratigraphy from two outcrops (Nazdur and Beduhe areas) c. 20 km apart, in the Northern Iraq‐Kurdistan Region. The collected samples were investigated by standard polarised microscope, X‐ray diffraction and scanning electron microscopy to infer their mineralogical characteristics, provenance and paleodepositional environments. The Mirga Mir Formation is a mixed carbonate‐siliciclastic succession consisting of thin‐, medium‐, occasionally thick‐bedded, and yellowish‐grey limestones, sandy dolomitic and argillaceous limestones, alternating with thin‐ to thick‐bedded grey shale/marl. Thin‐laminated siltstones and fine‐ to coarse‐grained sandstones are seen in the lower and middle parts of the formation. The petrographic study of carbonates and clastics (sandstones) showed that most limestones are carbonate mud (micrite). The skeletal grains consist principally of thin‐shelled pelagic bivalves (Posidonia), serpulid worm tubes (Spirorbis), microgastropods, ammonoids, calcispheres, brachiopods, dasyclad green algae, miliolid foraminifers and ostracods. Non‐skeletal grains include ooids, peloids, intraclasts and extraclasts. Depending on field observations, five different lithologic units were recognised. These are in ascending order: oolitic limestone unit, sandy limestone‐shale unit, shale‐limestone unit, argillaceous limestone‐shale unit and brecciated‐slumped limestone unit. Sandstones occur as thin beds within the lower and middle parts of the studied formation. In addition, thick coarse‐grained sandstone beds occur in the middle part of the Nazdur section only. Petrographically, thin sandstone beds consist of fine‐grained quartz. The thick sandstone bed is an immature, litharenite and consists of rock fragments (mostly sedimentary), quartz and feldspars. The X‐ray diffraction analysis and scanning electron microscope micrographs of shales revealed that the abundant clay minerals in the Mirga Mir Formation are illite, followed by kaolinite and chlorite. In addition to illite‐chlorite mixed layers, non‐clay minerals include calcite and quartz, with low feldspars. Based on detailed microfacies analysis of the limestones, 12 microfacies types from the carbonates and mixed detrital carbonates are distinguished. These facies were subdivided, according to their environmental interpretation, into five facies associations: Offshoal/basinal, Foreshoal/slope, Shoal, Back Shoal/Lagoon. The study introduces a good example of a gently sloping epeiric carbonate ramp that shows a gradual shallowing of the basin from the offshoal/basinal sediments to the foreshoal/slope and backshoal/lagoonal environments.
Blue and Green Water Scarcity in the McKenzie Creek Watershed of the Great Lakes Basin
Authors: Deen Tariq A. , Arain M. Altaf , Champagne Olivier , Chow‐Fraser Patricia , Nagabhatla Nidhi , Martin‐Hill Dawn
Published: January 2025

Climate change and extreme weather events affect hydrology and water resources in catchments worldwide. This study analysed Blue Water (BW) and Green Water (GW) scarcity in the McKenzie Creek watershed in Ontario, Canada, and explored how changes in temperature and precipitation may impact water scarcity dynamics. The McKenzie Creek is the main water source for agricultural activities for the Six Nations of the Grand River reserve (the largest Indigenous community in Canada) and other non‐Indigenous communities in the watershed. Data from the water use surveys and streamflow simulations performed using the Coupled Groundwater and Surface‐Water Flow Model (GSFLOW) under the Intergovernmental Panel on Climate Change (IPCC) Representative Concentration Pathways (RCP) scenarios 4.5 and 8.5, representing moderate and high greenhouse gas emissions and climate warming, respectively, were used to calculate BW and GW scarcity. Study results showed that BW scarcity may increase to ‘moderate’ levels if water users extract the maximum permitted water withdrawal allocation. This level of scarcity has the potential to cause ecological degradation and water quality issues in the watershed. GW scarcity will steadily increase throughout the 21st century due to climate warming with the western portion of the McKenzie Creek watershed projected to experience slightly higher levels of GW scarcity. This may cause users to withdraw more water resources, thereby decreasing BW available for downstream communities, including the Six Nations of the Grand River. This study provides water resource managers and regional planners with important information about potential challenges facing the watershed due to increased water use and changing climate conditions.
Segmentation of Brain Tumor Resections in Intraoperative 3D Ultrasound Images Using a Semisupervised Cross nnSU‐Net
Authors: Li Yuhua , Jiang Shan , Yang Zhiyong , Wang Liwen , Liu Zifeng , Zhou Zeyang
Published: January 2025

Intraoperative ultrasound (iUS) has been widely used in recent years to track intraoperative brain tissue deformation. Outlining tumor boundaries on iUS not only facilitates the robustness and accuracy of brain shift correction but also enables the direct use of iUS information for neurosurgical navigation. We developed a semisupervised cross nnU‐Net with depthwise separable convolution (SSC nnSU‐Net) for real‐time segmentation of 3D iUS images by two networks with different initialization but consistent network structure networks. Unlike previous methods, RESECT as labeled data and ReMIND as unlabeled data for hybrid dataset training selected break down the barriers between different datasets and further alleviate the problem of “data hunger.” The SSC nnSU‐Net method was evaluated by ablation of semisupervised learning, comparison with other state‐of‐the‐art methods, and model complexity. The results indicate that the proposed framework achieves a certain balance in terms of computation time, GPU memory utilization, and segmentation performance. This motivates segmentation of 3D iUS images for real‐time application in clinical surgery. The method can assist surgeons in identifying brain tumors through iUS.
Protective Effect of Transient Receptor Potential Ankyrin 1 Inhibition on Renal Ischemia Reperfusion Injury in Rats
Authors: Çakır Murat , Aydın Ali , Fırat Semanur , Şekerci Güldeniz , Bircan Burak , Öz Samet
Published: January 2025

The transient receptor potential ankyrin 1 (TRPA1) channels, characterized as nonselective cation channels with permeability to calcium ions (Ca2 +), are part of the extensive family of transient receptor potential (TRP) channels. Research has demonstrated that TRPA1 channels function as sensors for oxidative stress in the renal tubules. Additionally, TRPA1 expression has increased in renal tissue following ischemia‐reperfusion (IR). There is also a significant correlation between IR‐induced renal injury and TRPA1 expression. This study investigated the effects of selective TRPA1 agonist ASP7663 and selective TRPA1 antagonist HC‐030031 on renal IR injury. A total of 40 rats were divided into four groups: control, IR, IR+ASP7663, and IR + HC‐030031. The rat kidneys were exposed to 45 min of ischemia, followed by 24 h of reperfusion. TRPA1 agonist ASP7663 and selective TRPA1 antagonist HC‐030031 were administered intraperitoneally to the treatment groups with renal IR. HC‐030031 administration reduced the elevated kidney injury molecule‐1 (KIM‐1), blood urea nitrogen (BUN), and creatinine (Cre) caused by renal IR. HC‐030031 administration reduced the increased histopathological damage in renal tissue due to IR. It also reduced renal tissue interleukin‐1beta (IL‐1β), interleukin‐6 (IL‐6), toll‐like receptor‐4 (TLR‐4), phosphorylated‐NF‐κB, phosphorylated‐IκB‐α, tumor necrosis factor‐alpha (TNF‐α), and caspase‐3 levels. In this study, TRPA1 antagonist HC‐030031 showed a protective behavior on renal IR injury by averting inflammation and apoptosis. After further studies, TRPA1 inhibition may be a new treatment strategy to prevent renal IR injury.
Double‐level osteotomy (DLO) for varus deformity results in over a decade of mean survival without compromising subsequent total knee arthroplasty function at a mean 26‐year follow‐up
Authors: Clark Sean C. , Simon Karissa N. , Saris Daniel B. F. , Taunton Michael J. , Krych Aaron J. , Hevesi Mario
Published: January 2025

Purpose

Double‐level osteotomies (DLOs) have shown promising results for knee joint preservation, however, most ultimately progress in terms of degenerative disease resulting in conversion to total knee arthroplasty (TKA). Therefore, the purpose of this study was to examine the time to TKA conversion, long‐term clinical outcomes and revision rates of patients who have undergone TKA after prior ipsilateral DLO.

Methods

Patients who underwent simultaneous or staged DLO and subsequently underwent conversion to TKA at a single academic institution from 1997 to 2022 were evaluated. The type of osteotomy performed (opening‐ vs. closing‐wedge), osteotomy hardware fixation, when and if osteotomy hardware was removed, implanted TKA components and revision rates were recorded. Postoperative outcomes, including Forgotten Joint Score‐12 (FJS‐12), Tegner Activity Scale score and subjective knee preference were also obtained.

Results

A total of 22 patients (24 knees) underwent TKA following DLO and were followed for an average of 26.1 ± 7.7 years. The average time from DLO to TKA conversion was 14.1 ± 6.5 years, with 70.8% of knees converting to TKA more than 10 years after DLO. The mean follow‐up after conversion to TKA was 12.0 ± 7.7 years. Only 12.5% of patients received a varus‐valgus or hinged‐constrained TKA. At the final follow‐up, the mean FJS‐12 was 75.8 ± 23.1, while the mean Tegner Activity Scale score was 2.5 ± 1.1. Seventy‐seven percent of patients had no subjective knee preference or preferred their DLO‐TKA knee. Only two knees (7.4%) underwent subsequent revision after index arthroplasty at a mean of 9.3 years postoperatively.

Conclusions

A majority of DLOs (70.8%) converted to TKA after more than a decade. Subsequent TKA function was favorable as most patients had either no subjective knee preference or preferred their DLO‐TKA knee. This study demonstrates both long‐term joint preservation and uncompromised TKA function after prior DLO.

Level of Evidence

Level IV.
Mental Health and Well‐Being Support for Individuals Living With Skin Conditions: A Global Landscape Analysis of Patient Needs and Current Resources
Authors: Shipowick Tammi , Austin Jennifer , Sudiacal Nicole , Miller Stephanie , Pereira Jennifer A. , Bundy Christine
Published: January 2025

The impact of skin diseases can be devastating, encompassing physical symptoms such as bumps, rashes, hyper‐ or loss of pigmentation, redness, itch, pain and scarring. The consequences on mental health and well‐being are often more detrimental, impacting the ability to conduct routine daily activities and engage socially. Given the prevalence of dermatological conditions, it is critical that resources are available to address these needs. We conducted a review of dermatology patient advocacy groups and health organizations’ websites to determine what types of resources to support mental health and well‐being currently exist globally for individuals with skin conditions and identified 26 websites featuring resources such as sections dedicated to providing mental health information, programs on mental health topics and coping strategies, peer support forums, and counselling. Clinical trials and observational studies have demonstrated that many of these tools improve key mental health and well‐being‐related symptoms. In order for new and existing resources to be effective on a global scale, they should be delivered through methods that are sensitive to a spectrum of mental health‐related stigma, and cultural beliefs. In parts of the world where individuals value privacy above openly speaking about one's feelings, or where smartphone adoption is ubiquitous (i.e., Europe, South‐East Asia), digital health resources might hold the most potential for uptake. In regions such as Africa, and remote and rural Western Pacific, task‐shifting, a process whereby laypeople are trained by health professionals to deliver community‐based interventions, may be a promising format given mental health professional shortages. To provide optimal support for the mental health and well‐being of those around the world with skin conditions, future efforts should focus on evaluation of the patient benefits offered by existing resources, and their adaptation and expansion to befit other world regions, and align with varied cultural needs and beliefs.
Young age and return to play increase the likelihood of subsequent ACL reconstruction in football players: Data from the Swedish National Knee Ligament Registry
Authors: Fältström Anne , Forssblad Magnus , Sandon Alexander
Published: January 2025

Purpose

To compare football players who have undergone one anterior cruciate ligament (ACL) reconstruction (ACLR) with those who have undergone a subsequent ACLR (revision or contralateral) regarding (1) demographics, (2) football‐related factors and (3) injury‐specific data.

Methods

Players who voluntarily completed a football‐specific questionnaire available at the Swedish National Knee Ligament Registry website between April 2017 and September 2020 at the time of their primary ACL injury were included in the study. The questionnaire covered demographics, football‐related activities and injury‐specific factors. Subsequent ACLR registrations within 4 years of the primary ACLR were identified in December 2023. Data on game participation post‐primary ACLR were retrieved from the Swedish Football Association's administrative system in September 2022.

Results

A total of 992 football players (66% men) were included, of whom 99 (10%) were registered for subsequent ACLRs. Univariable analysis showed that the following factors significantly increased the odds of a subsequent ACLR: female sex, younger age, a lower weight and body mass index, fewer years played, use of knee control exercises during warm‐up, more likely to plan a return to football, more game participation registered following the primary ACLR, and shorter time between injury and ACLR. Multivariable logistic regression analysis indicated that the odds of undergoing subsequent ACLR decreased significantly with each additional year of age (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.83‒0.92, p < 0.01). Players using knee control exercises during warm‐up (OR, 1.71; 95% CI, 1.08‒2.72, p = 0.02), planning to return to football (OR, 2.74; 95% CI, 1.27‒5.91, p = 0.01), and participating in games after primary ACLR (OR, 1.81; 95% CI, 1.13‒2.91, p = 0.01) increased the odds of undergoing a subsequent ACLR.

Conclusions

Younger age and returning to play after an ACLR significantly increase the likelihood of undergoing a subsequent ACLR in football players.

Level of Evidence

Level IV.
Light and nutrients modulate the temperature‐sensitivity of growth in phytoplankton
Authors: Weber de Melo Vanessa , Suter Marc J.‐F. , Narwani Anita
Published: January 2025

In aquatic ecosystems facing climate change, higher temperatures often co‐occur with alterations in resource availability. The metabolic theory of ecology uses activation energy to assess the sensitivity of biological processes to temperature, but neglects how resource availability might modify temperature sensitivities. To understand the impacts of resource limitation on temperature sensitivities, we performed experiments manipulating temperature and three key resources (nitrogen, phosphorus, and light) in six species of freshwater phytoplankton. We measured activation energies of population growth rates and how they were modulated by resource limitation. We find that the interaction of temperature and resource limitation is dependent on the resource type. Phosphorus limitation did not modify the temperature sensitivity of growth rates, light limitation reduced the sensitivity of growth rates to temperature in all species, and nitrogen limitation had species‐dependent effects. We explore how stoichiometry and cell physiology may explain the complex responses of phytoplankton to multiple environmental changes.
Relational coordination and team‐based care: Change initiative overload and other challenges in a learning health system
Authors: Hajjar Lauren , Olaleye Olawale , Yang Julius , McGirr Susan , Sullivan Erin E.
Published: January 2025

Introduction

Most change interventions to address quality of care and lower costs focus on technical aspects of the work through process improvements, which have not consistently delivered the anticipated impact for healthcare organizations. This study aims to (1) understand how relational interventions including shared huddles and cross‐role shadowing opportunities, impact team dynamics and functioning and (2) describe the challenges and opportunities associated with implementing relational interventions at an Academic Medical Center in a large metropolitan city in the United States.

Methods

This paper is a mixed method, pre–post‐intervention study in which data were collected using a validated survey, observations, interviews, and one focus group. Relational coordination survey data were analyzed within and across eight interdependent workgroups on three inpatient medical units at baseline and 16 months post‐intervention. Qualitative data were coded and analyzed for themes.

Results

While there were some improvements in overall relational coordination between baseline and post‐intervention measures, the findings were not statistically significant. Qualitative data reveal four themes, highlighting the strengths and barriers to the intervention: (1) incomplete fidelity to the relational coordination framework, (2) leadership, (3) meeting structure and participation, and (4) stakeholder engagement.

Conclusions

Within the healthcare context, this study contributes to our learning about implementing and measuring relational interventions. We offer insights for future research and practice on change initiative overload and operational constraints, socializing relational interventions, and balancing core and non‐core roles in the intervention strategy.
Rigidity in Parkinson's Disease: The Objective Effect of Levodopa
Authors: Falletti Marco , Asci Francesco , Zampogna Alessandro , Patera Martina , Pinola Giulia , Centonze Diego , Hallett Mark , Rothwell John , Suppa Antonio
Published: January 2025

Background

Quantitative evidence of levodopa‐induced beneficial effects on parkinsonian rigidity in Parkinson's disease (PD) is lacking. Recent research has demonstrated the velocity‐dependent nature of objective rigidity in PD and revealed its neural underpinning.

Objective

The present study aimed to examine the effect of levodopa on objective rigidity in PD.

Methods

Eighteen patients with PD underwent clinical and instrumental evaluations of muscle tone in the OFF and ON states. The clinical assessments focused on rigidity in the most affected upper limb. The biomechanical components of objective rigidity were assessed using robot‐assisted wrist extensions at seven angular velocities (5–280°/s). Surface electromyography of the flexor carpi radialis muscle enabled the concurrent evaluation of short‐ and long‐latency stretch reflexes (SLR and LLR).

Results

Levodopa improved the clinical scores of rigidity. Biomechanical measurements showed that levodopa reduced the total and neural components of force but had no effect on viscoelastic components. Levodopa reduced the velocity dependence of the LLRs but did not affect the SLRs. Finally, we found significant clinical–instrumental correlations between levodopa‐induced changes and biomechanical and neurophysiological measures of objective rigidity in PD.

Conclusions

Levodopa improved objective rigidity in PD by decreasing its biomechanical neural component as well as the size of LLRs. The beneficial effect of levodopa on biomechanical and neurophysiological features of objective rigidity was related to the specific angular velocity of wrist extensions; that is, the higher the angular velocity, the greater the beneficial impact of levodopa on objective rigidity. These findings allowed the description of a new pathophysiological model of rigidity in PD. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Free Functional Muscle Transfer in Brachial Plexus Injury Patients With Subclavian Artery Injury Using Arteriovenous Loop Grafts
Authors: Limthongthang Roongsak , Wongtrakul Saichol , Laohaprasitiporn Panai , Monteerarat Yuwarat , Vathana Torpon
Published: January 2025

Background

Free functional muscle transfer (FFMT) for brachial plexus injury (BPI) requires adequate donor arterial flow for successful anastomosis. However, concomitant BPI and subclavian artery injury are not uncommon. Arteriovenous (AV) loop graft is one of the methods used to extend vessels to areas with vascular depletion. This case series aims to report the feasibility and outcomes of AV loop grafts for FFMT in BPI patients with subclavian artery injury.

Patients and Methods

This longitudinal descriptive report included adult patients with BPI and concomitant subclavian artery injury. Patients with adequate intra‐operative thoracoacromial and/or thoracodorsal arterial flow, sufficient for FFMT without the need for an AV loop graft, were excluded.

Results

Of the 10 initially enrolled patients, three were excluded: two for adequate intra‐operative arterial flow, and one for extensive adhesions around the external jugular vein, precluding the index surgery. Seven patients, with a median age of 37 years, mostly male and injured in motorcycle accidents, were included. Four patients underwent a single‐stage operation (AV loop graft and FFMT simultaneously), while three patients underwent a two‐stage operation. Success rates were 100% for the single‐stage operation and 33% for the two‐stage operation. The two‐stage operation led to increased operative time, extended hospital stays, and anastomosis mismatch challenges. Successful cases regained gracilis muscle motor power for elbow flexion, achieving grade III‐IV within 13–29 months.

Conclusion

FFMT with AV loop graft for BPI patients with subclavian artery injury is feasible and effective. Despite complex microsurgical requirements, these procedures significantly restore limb functionality when standard FFMT operations are insufficient.

Trial Registration

ClinicalTrials.gov identifier: NCT06437990
Fractional Integration and Differentiation of Asymptotic Relations and Applications
Authors: Řehák Pavel
Published: January 2025

The main results of this paper show how asymptotic relations are preserved when integrated or differentiated in the sense of fractional operators. In some of them, the concept of regular variation plays a role. We derive a fractional extension of the Karamata integration theorem and of the monotone density theorem, among others. We offer several approaches that provide deeper insight into relationships between different concepts. Illustrative applications in fractional differential equations are also presented.
Evaluation of Glutathione T2 in the Human Brain Using J‐Difference MRS at 3 T: Multicenter Multivendor Study
Authors: Choi Grace , Kim Seungho , Noeske Ralph , Moore Jason E. , Lee Gang Ho , Kim Jihyun , Newton Allen T. , Robison Ryan K. , Chang Yongmin , Choi Changho
Published: January 2025

The need to quantify brain glutathione (GSH) accurately by J‐difference spectroscopy has stimulated assessment of the TE effects on GSH edited signals at the popular field strength 3 T. We performed multiple‐TE J‐difference MRS at two sites to evaluate the GSH T2 relaxation and TE dependence of the GSH signal resolution. Two 10‐ms spectrally selective Gaussian editing RF pulses were implemented in 3 T MEGA‐PRESS sequences at two sites having different vendors. The sequences were optimized, with numerical and phantom analyses, for editing of the GSH 2.95 ppm resonance. The timings of the editing pulses within the sequences were tailored for high‐amplitude GSH signal production for a TE range of 58–160 ms. In vivo human brain data were collected at five TEs (58, 70, 88, 116, and 150 ms) from five subjects at each site. Following LCModel analysis of difference and edit‐off spectra independently between the sites, metabolite T2 values were estimated with mono‐exponential regression of the signal estimates. Simulations and phantom data indicated that the MEGA‐edited GSH peak amplitude was progressively larger with increasing TE up to 125–140 ms and the maximum amplitude was 2‐ to 2.5‐fold greater than the amplitude at TE of 58 ms. For in vivo data, the edited GSH peak was the largest at TE of 88 ms among the five TEs. Brain GSH T2 was measured as 88 ± 11 ms from 10 subjects, with no significant difference between the sites. The LCModel‐returned correlation coefficient between GSH and co‐edited N‐acetylaspartate (NAA) multiplet was significantly smaller at short TEs than at long TEs. Our data suggest that MEGA‐edited GSH signal undergoes extensive attenuation with increasing TE due to the fast T2 relaxation, and the edited GSH signal can be well resolved at short TEs with small interferences from adjacent co‐edited NAA multiplet.
Validation of a Deep Learning‐Based Method for Accelerating Susceptibility‐Weighted Imaging in Clinical Settings
Authors: Wu Xiao , Xu Shan , Zhang Yao , Ye Yongquan , Zhang Deying , Yu Lei , Zhang Ruiting , Sun Jianzhong , Huang Peiyu
Published: January 2025

Susceptibility‐weighted imaging (SWI) has been widely used in clinical contexts, in which the speed of acquisition is frequently a critical issue. In this study, we aim to test the feasibility of a deep learning (DL)‐based reconstruction method for accelerating SWI acquisition in clinical settings. A total of 61 subjects were consecutively enrolled. SWI scans using prospective under‐sampling and DL‐based reconstruction method (acceleration factor = 5, acquisition time: 1:46) and parallel imaging (PI, acceleration factor = 2, acquisition time: 4:45) were acquired from each subject. The DL‐based method utilizes a cascaded convolutional neural network, namely, ReconNet3D, to perform k‐space to image reconstruction with the capacity of single‐channel input and single‐channel output. The DL‐SWI and PI‐SWI results were compared quantitatively using structural similarity index (SSIM) and peak signal‐to‐noise ratio (PSNR). Two raters independently assessed image quality from five aspects: artifacts, noise level, sharpness, lesion conspicuity, and overall image quality. The numbers of microbleeds were also counted. Finally, both sets of images of the same subject were reviewed side‐by‐side for noninferiority assessments. The DL‐SWI images showed good similarity in terms of SSIM (mean ± SD: 0.89 ± 0.02) and PSNR (mean ± SD: 36.91 ± 2.41) with PI‐SWI. In comparison, DL‐SWI images had significantly better scores in terms of artifacts, noise, and overall image quality score (4.15 vs. 3.33; 3.85 vs. 3.16; 3.85 vs. 3.44, all with p < 0.001). DL‐SWI showed reduced image sharpness (p = 0.031), but no significant difference regarding lesion conspicuity. The number of microbleeds identified from the DL‐SWI images completely matched the PI‐SWI results. We had not observed any false‐negative or false‐positive readings on DL‐SWI images. The DL‐based SWI acceleration method could significantly reduce scan time and maintain image quality, suggesting its great potential in clinical applications.
Real‐Time Encrypted Traffic Classification in Programmable Networks with P4 and Machine Learning
Authors: Akem Aristide Tanyi‐Jong , Fraysse Guillaume , Fiore Marco
Published: January 2025

Network traffic encryption has been on the rise in recent years, making encrypted traffic classification (ETC) an important area of research. Machine learning (ML) methods for ETC are widely regarded as the state of the art. However, most existing solutions either rely on offline ETC based on collected network data or on online ETC with models running in the control plane of software‐defined networks, all of which do not run at line rate and would not meet the strict requirements of ultra‐low‐latency applications in modern networks. This work exploits recent advances in data plane programmability to achieve real‐time ETC in programmable switches at line rate, with high throughput and low latency. An extensive analysis is first conducted to show how tree‐based models excel in ETC on various datasets. Then, a workflow is proposed for in‐switch ETC with tree‐based models. The proposed workflow builds on (i) an ETC‐aware random forest (RF) modelling process where only features based on packet size and packet arrival times are used and (ii) an encoding of the trained RF model into off‐the‐shelf P4‐programmable switches. The performance of the proposed in‐switch ETC solution is evaluated on three use cases based on publicly available encrypted traffic datasets. Experiments are then conducted in a real‐world testbed with Intel Tofino switches, in the presence of high‐speed background traffic. Results show how the solution achieves high classification accuracy of up to 95% in QUIC traffic classification, with submicrosecond delay while consuming less than 10% on average of the total hardware resources available on the switch.
Views and Experiences of Nurses Receiving Care as Inpatients: An Empirical Qualitative Study From Ankara
Authors: Atasayar Semra , Gül Şenay , Dinç Leyla
Published: January 2025

Aim

To determine the views and experiences of inpatient nurses receiving care.

Background

Switching from the care provider role to being a patient allows nurses to realise patients' real care expectations and to test their colleagues' care practices. Nurses' experience as inpatients is essential for understanding patients' care‐related expectations and improving care quality by reflecting on their practices.

Design

This qualitative study used a descriptive phenomenological design.

Methods

Data were collected from nine volunteer nurses between July 2018 and June 2020 in Ankara, Türkiye, through face‐to‐face interviews using semi‐structured questionnaires and audio recordings. The research data were analysed by following the descriptive phenomenological data analysis steps. The Consolidated Criteria for Reporting Qualitative Research [COREQ] checklist was used to report study findings.

Results

Three themes emerged from the views and experiences of nurses receiving inpatient care: care‐receiving experiences, components of good nursing care and change in perception of care.

Conclusion

It is important to reveal the opinions and experiences of hospitalised nurses regarding care to understand the expectations of the care recipients and to increase the quality of the care provided. The study revealed that the experiences of nurses receiving inpatient care improved their professional sensitivity and this was reflected in the quality of the nursing care they provided.

Implication for Nursing

Nurses can provide higher quality and humanistic care by combining their professional knowledge and skills with the increased awareness of the inpatient experience of nurses.

No patient or public contribution.
Association Between Antibiotic Exposure During Pregnancy and Postpartum Depressive Symptoms: The Japan Environment and Children's Study
Authors: Kisaka Yumi , Yamamoto Midori , Yanase Kana , Sakurai Kenichi , Eguchi Akifumi , Watanabe Masahiro , Mori Chisato , Todaka Emiko ,   and the Japan Environment and Children's Study (JECS) Group
Published: January 2025

Postpartum depressive symptoms (PDS) are a common mental health condition among women after delivery. Although various causative factors have been reported, PDS remains a challenging condition to predict and prevent. The disruption of the gut microbiota due to antibiotic exposure has been reported to affect psychiatric conditions. Similarly, previous research suggests that antibiotic exposure during pregnancy could be related to PDS. Therefore, this prospective study examines the association between antibiotic exposure during pregnancy and PDS for 6 months after delivery. Data were obtained from 65,272 mothers from the Japan environment and children's study, a prospective birth cohort study. The ratios of maternal PDS at 1 and 6 months after delivery were 12.3% and 10.1%, respectively. During pregnancy, 10.7% of women took antibiotics orally. Antibiotic exposure during pregnancy was associated with an increased risk of PDS only at 6 months after delivery (OR = 1.13, 95% CI [1.00, 1.26]), adjusted for potential confounding factors. An increase in Edinburgh Postnatal Depression Scale scores in relation to antibiotic exposure during pregnancy was primarily observed via psychological distress during pregnancy. Although a causal link was not established, antibiotic exposure during pregnancy may be a contributing risk factor for PDS. Therefore, when antibiotic administration is required, clinical practitioners and perinatal care providers should consider the potential risk for PDS.
Green Preparation of Ammonium Polyphosphate With Shell–Core Structure for Enhancing Fire Safety of Thermoplastic Polyurethane
Authors: Duan Jiahao , Shi Congling , Yang Ling , Qian Xiaodong , Wan Mei , Zhu Hongqing , Wang Houwang
Published: January 2025

In the recent years, the development of high‐performance flame retardants (FRs) for thermoplastic polyurethane (TPU) has become increasingly important due to its wide applications in various industries and the growing demand for fire safety. In this study, ammonium polyphosphate (APP) was used as the core, whereas chitosan (CS) and nano‐silica (SiO2) served as the shell to create a shell–core‐structured FR through a self‐assembly process in an aqueous phase. APP, APP@CS, and APP@CS@SiO2 were incorporated into TPU at a concentration of 20 wt%, and their effects on TPU properties were compared. The findings showed that APP@CS@SiO2 exhibited superior flame retardancy for TPU. Compared to pure TPU, the TPU/APP@CS@SiO2 showed reductions in peak heat release rate, total heat release, peak smoke production rate, total smoke production, peak CO production rate, and peak CO2 production rate by 58%, 80%, 80.5%, 89.1%, 20.4%, and 60.1%, respectively. Additionally, APP@CS@SiO2 effectively inhibited the thermal degradation of TPU and enhanced its thermal stability, resulting in the residual carbon content of the composite rising to 28.5%, which is about 20 times higher than that of pure TPU. In conclusion, APP@CS@SiO2 significantly improved the fire safety of TPU by efficiently catalyzing char formation in the condensed phase, diluting flammable gases, and hindering gas‐phase free radical chain reactions, thereby opening new avenues for the practical application of TPU composites.
Brief, Family‐Centered, Videoconference‐Based Behavioral Insomnia Program in Elementary School‐Aged Pediatric Cancer Survivors: A Proof‐of‐Concept Study
Authors: Zhou Eric S. , Bice Briana , Crabtree Valerie McLaughlin , Recklitis Christopher J.
Published: January 2025

Pediatric cancer survivors are at heightened risk for insomnia. Though behavioral interventions are the recommended approach, there are not enough trained clinicians. No known published trials have been conducted among school‐aged survivors, despite them having unique age‐related sleep issues. Here, we tested a videoconference‐based behavioral insomnia intervention program enrolling 15 caregivers of cancer survivors (5–12 years) with insomnia. Staff without prior sleep education/training delivered intervention sessions providing evidence‐based strategies tailored to family needs. Self‐report measures were collected before intervention and approximately 2 weeks post intervention. Caregivers reported significant sleep and quality‐of‐life improvements. Thus, we show preliminary support for a brief intervention that does not require significant resources or clinical expertise.
Chemical modification of PLA for the design of 3D printed nanocomposite scaffolds with enhanced degradability for bone tissue engineering
Authors: Dal Poggetto Giovanni , D'Amora Ugo , Ronca Alfredo , Raucci Maria Grazia , Soriente Alessandra , Gomez d'Ayala Giovanna , Laurienzo Paola
Published: January 2025

In this study, 3D printing technology is used to develop nanocomposite scaffolds based on polylactic acid (PLA) and hydroxyapatite (HA). PLA was functionalized with itaconic anhydride (PLAf) via radical grafting to improve affinity with the inorganic nanofiller and accelerate hydrolytic degradation. Fourier‐transform infrared (FTIR) and Nuclear Magnetic Resonance (NMR) spectroscopies confirmed the occurrence of chemical functionalization. Preliminary characterization of films of PLA, PLAf and relative nanocomposites through water contact angle measurements highlighted an increase of wettability for PLAf, due to the hydrophilic groups grafted onto polymer chain. Thermal analysis showed an increase of glass transition temperature (Tg) in PLAf nanocomposites, likely due to enhanced matrix‐nanoparticle interactions. Scanning electron microscopy (SEM) analysis revealed more defined and homogeneous fibers for PLAf‐HA5 and PLAf‐HA10, meanwhile results from compression tests indicated improved processability and enhanced mechanical properties of nanocomposite PLAf‐based scaffolds, as evidenced by increased values of Young modulus. Hydrolytic degradation studies in Phosphate Buffered Saline (PBS) solution showed greater weight loss and molecular weight decrease for PLAf, PLAf‐HA5, and PLAf‐HA10, suggesting faster degradation due to increased hydrophilicity. Biological tests with human Mesenchymal Stem Cells (hMSCs) demonstrated that all scaffolds promoted cell proliferation, with PLAf‐HA formulations showing higher effect on cellular behavior in terms of cell growth and alkaline phosphatase (ALP) levels, indicating that chemical functionalization improves cell attachment, proliferation and early osteogenic differentiation.

Highlights

Functionalization of PLA enhances hydrophilicity and HA affinity.

Nanocomposite scaffolds based on PLAf are successfully developed by 3D printing.

PLA functionalization enhances ink printability, making more uniform structures.

PLAf‐based scaffolds exhibit an accelerated hydrolytic degradation

PLAf‐HA scaffolds support cell adhesion and early osteogenic differentiation.
Multiple Perspectives on the Need for Real‐World Evidence to Inform Regulatory and Health Technology Assessment Decision‐Making: Scoping Review and Stakeholder Interviews
Authors: Jansen Marieke S. , Dekkers Olaf M. , le Cessie Saskia , Hooft Lotty , Gardarsdottir Helga , de Boer Anthonius , Groenwold Rolf H. H.
Published: January 2025

Purpose

Real‐world evidence (RWE) is increasingly considered in regulatory and health technology assessment (HTA) decision‐making, though perspectives on its relevance may vary. Expanding on a recent review regarding regulatory decisions, this study aimed to identify factors influencing the need for RWE in HTA decision‐making, confirm and enrich factors with stakeholder views, and evaluate similarities and differences between regulatory and HTA needs.

Methods

Previous scoping review methodology was used to identify factors influencing the need for RWE in HTA decision‐making. Semi‐structured interviews with stakeholders were conducted to confirm and enrich literature‐derived factors for both regulatory and HTA contexts. Insights from the reviews and interviews were combined to explore similarities and differences in RWE needs across these domains.

Results

The HTA review, featuring 118 articles, revealed two major themes and six subthemes, encompassing 45 factors. The need for RWE depended on (1) questions addressable with RWE, and (2) contextual factors. Stakeholder interviews confirmed literature‐derived factors. While contextual factors aligned between regulatory and HTA decision‐making, question‐related factors partly differed. Unlike the benefit–risk assessment in regulatory decision‐making, RWE serves as direct input for the HTA, and involves specific details and a broader scope. Regulators require RWE for orphan status submissions, alternative approval pathways and to evaluate the impact of risk minimization measures, whereas HTA uses RWE to guide comparator selection, evaluate treatment implementation, quality of care and general healthcare impacts.

Conclusion

Contextual factors that influence the need for RWE are similar between regulatory and HTA decision‐making, with variations seen in questions addressable with RWE.
Patient and Public Involvement in Pharmacoepidemiological Research: An Environmental Scan of an Emerging Area
Authors: Julie Rigoureau , Yael Busnel , Anaïs Havet , Anne Termoz , Julie Haesebaert , Marie Viprey
Published: January 2025

Background

Patient and public involvement (PPI) in research is required to improve the relevance, feasibility, and interpretability. However, research on PPIs in pharmacoepidemiology (PE) is still limited. This study aimed to provide an overview of PPI implementation in pharmacoepidemiology through an environmental scan.

Methods

The environmental scan combined systematic reviews and expert interviews. A systematic review was conducted in MEDLINE, EMBASE, and the Cochrane Library from January 1, 2010, to June 30, 2023, to identify PE studies in which PPIs were mentioned. An additional review covered British Medical Journal's (BMJ) original articles from January 1, 2019, to June 30, 2023, via a similar method. In parallel, a cross‐sectional study was conducted with a standardized questionnaire for French PE research teams, involving interviews via videoconference.

Results

We identified 3615 references for screening, among which 232 were selected for full‐text screening. However, no studies have reported the use of PPIs in PE studies. The additional BMJ review identified 1058 references, 74 of which met the full‐text selection criteria, and eight were included. Of 13 French PE research teams surveyed, three had prior PPI experience, and 12 affirmed the relevance of PPI in PE. The respondents identified barriers such as PE's complexity (n = 9). They suggested training for patients (n = 9) and collaboration with specialist teams (n = 5) to facilitate PPI.

Conclusion

Our environmental scan highlighted the emergence and relevance of PPIs in PE studies, even though they are still uncommon. Tools are needed to acculture and assist PE researchers in engaging in PPIs.
Multicomponent telerehabilitation program for veterans with multimorbidity: A randomized controlled feasibility study
Authors: Rauzi Michelle R. , Abbate Lauren M. , Churchill Laura , Garbin Alexander J. , Forster Jeri E. , Christiansen Cory L. , Stevens‐Lapsley Jennifer E.
Published: January 2025

Background

Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.

Objective

To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.

Design

Randomized controlled cross‐over feasibility study.

Setting

Telehealth from Veterans Affairs Medical Center to participants' homes.

Participants

Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.

Intervention

The MCTR program consisted of high‐intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.

Main Outcome Measures

The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient‐level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.

Results

Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64–0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78–0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85–0.99], p < .001). Thirty‐five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient‐level outcomes were similar between groups at 12‐weeks.

Conclusions

The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in‐session safety events were related to underlying medical conditions and consistent with in‐person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.
Psychological Distress in Patients With Asbestos‐Related Diseases and Their Families: A Systematic Literature Review
Authors: Franzoi Isabella Giulia , Sauta Maria Domenica , Bonafede Michela , Francioso Giulia , De Luca Alessandra , Barbagli Francesca , Granieri Antonella
Published: January 2025

Background

Exposure to asbestos in the workplace is currently recognized as one of the leading causes of work‐related deaths, with more than half of deaths attributable to cancer.

Aims

The aim of this systematic literature review was to investigate the mental health and psychological distress of patients affected by asbestos‐related diseases and their caregivers.

Methods

The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. The studies were identified in October 2023 by searching four electronic databases: Scopus, Web of Science, PubMed and PsycInfo/PsycArtcicles. Risk of bias was assessed using the JBI checklist.

Results

Fourteen articles were identified. The studies focused exclusively on the psychological distress of patients with malignant mesothelioma (MM) and their caregivers. MM appears to have traumatic effects on both patients and caregivers, who may experience anxiety and depression, an impoverished emotional life, somatization, social withdrawal, and a deterioration in their quality of life. In addition, a need for information about MM, its progression and associated care tasks was identified, and patients and caregivers reported frequently seeking information from online sources.

Conclusions

Our review has shown that there are still few studies addressing psychological distress in MM patients and their caregivers, and none addressing distress in the context of other asbestos‐related diseases. The somatopsychic consequences of MM in patients and caregivers should encourage institutions and health professionals to develop assessment and intervention models that are tailored to the specific suffering and needs of MM patients and their caregivers and promote their residual vitality.