bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the value and acceptability of a patient navigator program for people who inject drugs and are hospitalized for bacterial infections: patients’, community organization and healthcare workers’ perspectives
Authors: Bédard Karine , Boisvert Isabelle , Rochette Marianne , Racine Eric , Martel-Laferrière Valérie
Published: February 2025

Background

Hospitalizations for bacterial infections are often difficult for people who inject drugs (PWID) and healthcare workers, in part due to biases and stigma associated with substance use, patients’ competing needs, such as pain and withdrawal management, and strict antibiotic treatment protocols. In recent years, peer navigators have been introduced as a strategy to reduce stigma and bridge the gap between patients and healthcare workers, but little is known about their involvement in hospitalization settings. The aim of this study was to assess the value of adding a peer navigator program and to evaluate the elements that key stakeholders identified as essential for the program to be successful.

Methods

This was a qualitative study using focus groups. The interview guide was collaboratively developed by ethicists, physicians, and a person with lived experience and validated with a PWID and a community worker. Three two-hour focus groups were conducted in February 2022 with PWID, community organizations and healthcare workers. Descriptive and interpretive thematic analyses were carried out.

Results

Nineteen people (5 PWID, 6 community organization workers, 8 healthcare workers) participated in the focus groups. The final coding strategy involved 4 main themes: challenges in current care, positive aspects of current care, aspirations for quality care, the contribution of peer navigators as a solution to current challenges and the realization of aspirations. Improvements in the quality of care should focus on an approach centered on patients’ values and aspirations; improving the current hospital environment, particularly in terms of training and communication; and encouraging collaborative partnerships with all parties involved. The integration of peer navigators seems to be a promising strategy for improving communication and trust and, consequently, to facilitate shared decision-making and adapted care.

Conclusions

Our study showed that any innovative model should be centered on patients’ needs and values and therefore co-constructed with them and other parties involved, notably the community organizations offering services to these patients. The inclusion of well-trained and well-supported peer navigators has the potential to improve care and work toward achieving aspirations of quality care.
Neutralizing and binding antibody dynamics following primary and booster COVID-19 vaccination among healthcare workers
Authors: Güzel Irmak , Öztürk Gamze , Appak Özgür , Çağlayan Derya , Süner Ahmet F. , Irmak Çağlar , Türe Neslişah , Işik Elif , Çelik Muammer , Ergör Gül , Ergör Alp , Demiral Yücel , Alp Çavuş Sema , Kilic Bulent , Sayiner Arzu
Published: February 2025

Background

Vaccine-induced neutralizing antibodies (NAbs) are key for COVID-19 protective-immunity. As the efficacy of SARS-CoV-2 vaccines declines over time and variants of the virus continue to emerge, the need for booster doses of vaccine remains on the agenda. The aim of this study was to assess NAbs dynamics and its correlation with anti-RBD IgG levels during the nine-month follow-up period after primary-CoronaVac vaccination and booster vaccinations to evaluate vaccination strategies.

Methods

This prospective longitudinal observational study followed 226 healthcare workers who received primary (two doses CoronaVac) and booster (CoronaVac or BNT162b2) immunization. Serum samples were collected at four different time points, two after primary vaccination and two after booster. Anti-RBD IgG antibody levels were assessed with the SARS CoV-2 IgG-II-QUANT kit (Abbott, USA) and neutralizing antibody levels were determined with the ACE2-RBD-Neutralization-Assay (Dia-Pro, Italy) using a surrogate virus neutralization method. Factors affecting antibody response were analyzed. Statistical analysis was performed with IBM-SPSS-22.0.

Results

One month after the second dose of CoronaVac, 79.2% of participants had NAb, but this had decreased to 49.7% by the fourth month and was influenced by smoking, BMI and chronic diseases. Boosters, regardless of type, significantly raised NAb levels. Heterologous vaccination yielded higher NAb and anti-RBD IgG responses. Both single or double-BNT162b2 boosters resulted in similar NAb responses. There was a strong correlation between anti-RBD IgG and NAb levels following CoronaVac vaccination, leading to the identification of predictive IgG threshold for the presence of NAb. The type of booster influenced the correlation strength and threshold-value.

Conclusions

NAbs levels decreased rapidly after primary CoronaVac vaccination. Boosters significantly increased levels while the heterologous vaccine combination induced a greater response. Anti-RBD IgG levels were able to predict the NAb response, however the correlation varied by the vaccine type, NAb response strength and the time since vaccination.
Knowledge, attitudes, and practices of Lebanese licensed dietitians regarding hyperphosphatemia management in patients undergoing hemodialysis in a Lebanese Governorate
Authors: Mannan H. , Issa E. , Attieh R. , Sacre Y.
Published: February 2025

Background

Hyperphosphatemia is deemed to be an asymptomatic silent killer, its high prevalence in patients undergoing hemodialysis (HD) is correlated mainly with malnutrition and mortality. Dietitian’s renal nutrition education has a major impact on chronic kidney disease patients’ knowledge, and attitude towards nutrition guidelines. However, a large number of factors are acting as barriers to the appropriate practices of Lebanese dietitians in renal therapy. This study evaluated the knowledge, attitudes, and practices (KAP) of licensed dietitians (LDs) regarding hyperphosphatemia management in patients undergoing HD.

Methods

A total of 408 LDs from Mount-Lebanon Governorate in Lebanon participated in this study. A 52-item online questionnaire was used to assess nutritional phosphorus’ KAP of all LDs, in compliance with dietetic practices with KDOQI guidelines updated version 2020 and identified the factors preventing dietitians from dealing with renal patients undergoing HD, e.g., nutrition care. The data was analyzed using SPSS version 25.

Results

There was a significant association between KAP levels, and almost all sociodemographic characteristics evaluated. Only 2% of dietitians applied all KDOQI guidelines, 64% attained poor and moderate knowledge, and 60% had a positive attitude towards renal care. Working in a clinical field was a common predictor of positive knowledge (adjusted OR = 2.453, 95% CI 1.244–4.836), positive attitude (adjusted OR = 1.900, 95% CI 1.300–2.541) and positive practice (adjusted OR = 0.192, 95% CI 0.184–0.491) while HD/hospital-based field increased the odds for positive knowledge (adjusted OR = 4.520, 95% CI 1.189–17.182). LDs, compared to registered dietitians, had lower odds of positive knowledge (adjusted OR = 0.390, 95% CI 0.231–0.658) and positive attitude (adjusted OR = 0.270, 95% CI 0.154–0.471). Lack of training was the main reason preventing the appropriate dietetic practices regarding hyperphosphatemia management in patients undergoing HD.

Conclusion

The Ministry of Public Health (MOPH) should be asked to endorse the integration of renal nutrition programs in the Lebanese curriculum, to aid in the empowerment of dietitians from different backgrounds towards renal therapy, in order to enhance the knowledge and attitude regarding nutritional guidelines of poorly supported Lebanese patients undergoing HDhemodialysis. Other stakeholders may include the Syndicate of Dietitians in Lebanon.
The association of low-level air pollution with birth weight in a register-based study: potential effects below WHO AQ guidelines
Authors: Rumrich Isabell K. , Korhonen A. , Forsberg B. , Frohn L. M. , Geels C. , Brandt J. , Hänninen O.
Published: February 2025

Background

Air pollution exposure during pregnancy has been associated with adverse birth outcomes. Uncertainties remain about the effect at very low exposure levels. The aim of this study was to explore the association of maternal exposure to air pollutants during pregnancy at very low exposure levels with birth weight and estimate the health impact.

Methods

The MATEX birth cohort (226,551 singleton births in 2012–2016) was linked with eight modelled air pollutants (PM2.5, PM10, PMcoarse, NO2, NOx, CO, SO2, O3) at home address during pregnancy. Multiple regression was used to estimate the change in birth weight (in g) associated with individual-level mean exposure during pregnancy. We tested different adjustment models and conducted sensitivity analyses. We also estimated the potential number of low birth weight cases attributable to PM2.5 to quantify the public health issues at the prevailing low exposure levels.

Results

PM2.5 was associated with the largest reduction of birth weight (-6.5 g per 1 µg/m3) followed by PMcrs (-4.9 g) and PM10 (-3.0 g). Among the gaseous pollutants the strongest reduction in birth weight was observed for NO2 (-0.8 g), followed by CO (-0.5 g), NOx (-0.4 g) and SO2 (-0.2 g). On the contrary, O3 was associated with a modest increase in birth weight (+ 0.9 g). Effects on births weight were observed also below WHO guideline values. When accounting for the prevailing exposure levels in Finland, CO was associated with the biggest reduction in birth weight. The effect of PM2.5 exposure on birthweight corresponds to a loss of 30 g at mean exposure. Assuming a causal relationship, about 700 cases of low birth weight could be attributable to PM2.5 in Finland during the study period.

Conclusions

No clear evidence on safe exposure level was found in this study. All pollutants were associated with reduced birthweight except ozone. Causality and confounding due to correlations warrant specific attention.
Effect of printing orientation and resin thickness on flexural strength of direct 3D-printed aligners
Authors: Khalil Ahmed S. , Zaher Abbas R.
Published: February 2025

Background

Direct 3D-printed aligners served as a breakthrough era in clear aligner fabrication. Yet, there is a scarcity of studies evaluating their mechanical properties. The aim of this study was to compare direct 3D-printed aligners derived from different printing orientations (vertically, horizontally, 30, and 45 degrees) and thickness (0.5 and 0.7 mm) in terms of flexural strength.

Methods

This laboratory-based comparative study utilized 96 aligner flat specimens. They were designed, supported, and directly printed using shape memory resin, then randomly allocated into 8 groups. Group 1 (A, B, C, and D): 0.5 mm thickness printed vertically, horizontally, 30, and 45 degrees, respectively. Group 2 (A, B, C, and D): 0.7 mm thickness printed vertically, horizontally, 30, and 45 degrees, respectively. Each aligner specimen was placed on a custom-made bending jig, with the whole setup enclosed in a temperature-controlled water bath. Three-point bending test was performed using a universal testing machine, and the resulting force was recorded. Statistical analysis was performed using Student t-test for resin thickness comparison and one-way ANOVA with Tukey post-hoc test for comparison between printing orientations. Statistical significance was set at p ≤ 0.05.

Results

No statistically significant differences were found between vertically, horizontally, 30, and 45 degrees printed aligner specimens. Aligner specimens of 0.7 mm thickness demonstrated significantly higher flexural strength values compared to those of 0.5 mm thickness.

Conclusions

Printing orientation did not alter the flexural strength of the direct 3D-printed aligner flat specimens, regardless of whether they were printed vertically, horizontally, or at angles of 30 or 45 degrees relative to the printer build plate. Additionally, specimens with a thickness of 0.7 mm exhibited higher bending resistance compared to those with a thickness of 0.5 mm.
The effect of the Tai Chi intervention on self-esteem and self-confidence perception in adult populations: a systematic review and meta-analysis
Authors: CHAIR Sek Ying , LAW Bernard Man Hin , CHAN Aileen Wai Kiu , GAO Ruitong
Published: February 2025

Background

Self-esteem is a psychological outcome that is positively related to mental and psychological health, one of the most important elements in nursing. Developing strategies for self-esteem promotion is therefore of great importance in nursing practice. Previous reviews suggested that exercise interventions such as Tai Chi practice may confer both mental and physical benefits in humans, but reviews on the effect of Tai Chi exercise on self-esteem of adults are lacking. Thus, this systematic review and meta-analysis was conducted to evaluate the effectiveness of Tai Chi interventions in promoting self-esteem among adults.

Methods

We included randomized controlled trials that investigated Tai Chi interventions in adults, where self-esteem and/or self-confidence were reported as outcomes. The literature search was conducted in ten electronic databases. Two independent reviewers performed abstract and full-text screening using Covidence. These reviewers also independently extracted data from the included studies, and conducted critical appraisal of their methodological quality, using the revised Cochrane risk-of-bias tool for randomized trials (RoB2).

Results

Eleven studies were included in the review, of which all were rated as having high risk of bias or some concerns in their methodological quality. Our meta-analysis demonstrated that Tai Chi intervention can significantly improve self-esteem among adults, where the post-intervention self-esteem score was higher among the intervention participants compared to the controls (standardized mean difference: 0.46; 95% CI: 0.18–0.74; p = 0.001). Sensitivity analyses by excluding studies not reporting data using means and standard deviations revealed similar findings. One study also showed a positive effect of Tai Chi intervention on self-confidence perception.

Conclusions

Tai Chi interventions have a moderately positive effect on self-esteem among adults. Tai Chi exercise classes could be a potential strategy to implement within communities, especially among individuals in higher need to improve their self-esteem such as older adults and patients having chronic illnesses that have detrimental effects on their psychological well-being. However, given the high risk of bias in most studies, caution is advised before recommending widespread implementation. Further high-quality research, including qualitative studies exploring how Tai Chi can improve self-esteem, is needed to strengthen the evidence base.
Infusion of young donor plasma components in older patients modifies the immune and inflammatory response to surgical tissue injury: a randomized clinical trial
Authors: Gaudilliere Brice , Xue Lei , Tsai Amy S. , Gao Xiaoxiao , McAllister Tiffany N. , Tingle Martha , Porras Gladys , Feinstein Igor , Feyaerts Dorien , Verdonk Franck , Sabayev Maximilian , Hedou Julien , Ganio Edward A. , Berson Eloïse , Becker Martin , Espinosa Camilo , Kim Yeasul , Lehallier Benoit , Rawner Esther , Feng Chunmiao , Amanatullah Derek F. , Huddleston James I. , Goodman Stuart B. , Aghaeepour Nima , Angst Martin S.
Published: February 2025

Background

Preclinical evidence suggests that young plasma has beneficial effects on multiple organ systems in aged mice. Whether young plasma exerts beneficial effects in an aging human population remains highly controversial. Despite lacking data, young donor plasma infusions have been promoted for age-related conditions. Given the preclinical evidence that young plasma exerts beneficial effects by attenuating inflammation, this study examined whether administering a young plasma protein fraction to an elderly population would exert anti-inflammatory and immune modulating effects in humans, using surgery as a tissue injury model.

Methods

This double-blind, placebo-controlled study enrolled and randomized 38 patients undergoing major joint replacement surgery. Patients received four separate infusions of a plasma protein fraction derived from young donors, or placebo one day before surgery, before and after surgery on the day of surgery, and one day after surgery. Blood specimens for proteomic and immunological analyses were collected before each infusion. Based on the high-content assessment of circulating plasma proteins with single-cell analyses of peripheral immune cells, proteomic signatures and cell-type-specific signaling responses that separated the treatment groups were derived with regression models.

Results

Elastic net regression models revealed that administration a young plasma protein fraction significantly altered the proteomic (AUC = 0.796, p = 0.002) and the cellular immune response (AUC 0.904, p < 0.001) to surgical trauma resulting in signaling pathway- and cell type-specific anti-inflammatory immune modulation. Affected proteomic pathways regulating inflammation included JAK-STAT, NF-kappa B, and MAPK (p < 0.001). These findings were confirmed at the cellular level as the MAPK and JAK/STAT signaling responses were diminished and IkB, the negative regulator of NFkB, was elevated in adaptive immune cells.

Conclusion

Reported findings provide a first proof of principle in humans that a young plasma protein fraction actively regulates inflammatory and immune responses in an elderly population. They provide a solid rationale for elucidating active principles in young plasma that may be of therapeutic benefits for a range of age-related pathologies.

Trial registration

ClinicalTrials.gov, NCT 03981419.
Maraviroc enhances Bortezomib sensitivity in multiple myeloma by inhibiting M2 macrophage polarization via PI3K/AKT/RhoA signaling pathway in macrophages
Authors: Yang Huiye , He Yuchan , Qu Fujun , Zhu Jie , Deng Liyuan , Jiang Fang , Wu Xianyi , Chen Yixuan , Kashif Ali , Wang Xiaotao
Published: February 2025

Background

Multiple myeloma (MM) is a malignancy where drug resistance often leads to relapse or refractory disease. Chemokine receptor 5 (CCR5) has emerged as a novel therapeutic target. However, the role of CCR5-antagonist Maraviroc (MVC) in M2 macrophage polarization and its potential to enhance Bortezomib sensitivity in MM has not been fully explored.

Methods

We used human bone marrow samples, RPMI 8226 cells, and THP-1 monocytes to investigate CCL3/CCR5 axis. ELISA measured CCL3/CCR5 levels. Knockdown/overexpression vectors modulated expression. Cell proliferation, apoptosis, and macrophage polarization were assessed using CCK8, flow cytometry, and transwell assays. QRT-PCR analyzed CCL3 expression, and western blotting examined PI3K/AKT/RhoA signaling. CCR5 was targeted via siRNAs or MVC. NOD/SCID mouse model evaluated CCL3/CCR5 effects on macrophage polarization and MVC’s impact on Bortezomib efficacy.

Results

CCL3, CCR5, and M2 macrophage markers are upregulated in MM patients, with CCL3/CCR5 expression correlating with M2 macrophage polarization. Myeloma-secreted CCL3 and paracrine CCR5 significantly promoted M2 macrophage polarization by activating PI3K/AKT/RhoA signaling, which in turn enhanced myeloma proliferation, inhibited apoptosis, and reduced Bortezomib sensitivity. MVC inhibited M2 macrophage polarization and improved Bortezomib sensitivity in vitro and xenograft mouse myeloma models.

Conclusions

MVC reduced macrophage polarization and enhanced Bortezomib sensitivity in MM cells.
$q,\omega $-Tricomi expansions and exponential integral associated with Hahn difference operator
Authors: Oraby Karima M.
Published: February 2025

In this paper, we introduce a

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q
,
ω

-analog of Tricomi expansion based on Hahn’s difference operator. Some properties of

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,
ω

-Tricomi expansion are derived and proved in terms of incomplete

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,
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,
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-analog of the exponential integral is presented as a series expansion of incomplete

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q
,
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-gamma functions and shown to be a limiting case of a

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Assessing the knowledge, attitudes, and practices (KAP) of dengue in Thailand: a systematic review and meta-analysis
Authors: Crowley Julia , Liu Bowen , Jan Hanan
Published: February 2025

Aim

Dengue cases are on the rise in Thailand, coinciding with increases in flooding events. Studies pertaining to public knowledge, attitudes, and practices (KAP) of dengue prevention have frequently been used to better understand the public’s needs towards dengue. While these studies were conducted in different settings, it is necessary to initiate a systematic review and meta-analysis of relevant studies.

Subjects and method

We conducted a systematic review and meta-analysis of prior studies in Thailand that assessed the KAP towards dengue. Eligibility criteria were established and independently used by reviewers to select nine studies for the systematic review and three for the meta-analysis. Collectively, the nine studies included 3,058 individuals and 2,519 households.

Results

The overall estimate of the proportion of participants with good knowledge of dengue prevention is 35% (95% CI: 14-59%), suggesting the majority of the population in Thailand had low levels of knowledge towards dengue. The poor levels of practice in Thailand were also observed and confirmed for the majority of the population by meta-analysis, with the pooled estimate of the proportion of participants with good practice of dengue prevention being 25% (95% CI: 22-27%). In contrast, most of the studies included in the systematic review reported positive attitudes towards dengue prevention, and this finding was also affirmed by the meta-analysis, as the pooled estimate of the proportion of positive attitudes towards dengue prevention is 61% (95% CI: 43-77%).

Conclusion

Despite good attitudes towards dengue prevention, poor knowledge and poor practices predominate, highlighting the need for enhanced public health campaigns to educate the public on dengue risks and prevention methods.
Empirical and numerical hill slope health evaluation at Malling Nala, NH-505, Himachal Pradesh, India
Authors: Azad Md Alquamar , Kainthola Ashutosh , Fissha Yewuhalashet , Kushwaha Gaurav , Yadav Vikas , Singh T. N.
Published: February 2025

Slope failures and rock mass movements are continuous geomorphic processes, particularly in a dynamically charged terrane like the Himalaya. Thus, failures emanating from weak geology, hydrogeology and anthropogenic disturbances are aplenty. Present research evaluates slope stability in the vicinity of Malling Nala, along NH-505 in Himachal Pradesh, India. For the two most vulnerable sections in the study area, geo-mechanical and structural attributes have initially been ascertained. Field surveys and laboratory tests identified weak and weathered mica schist and gneissic rocks in the study area. Kinematic analysis, Rock Mass Rating (RMR), Geological Strength Index (GSI), Slope Mass Rating (SMR), modified Global Slope Performance Index (mGSPI) led to determination of possible failure mechanism and rock mass behaviour. Finite element analysis provided a comprehensive understanding of slope behaviour under various conditions, highlighting significant shear strain and displacement in both sections. As noticed from the field and classification schemes, planar and localized bench failures were established. Slope section L-1 was found to collapse under saturated water condition, manifesting the influence of snow melt. The findings indicate that both natural and human factors are causing instability. Effective risk management and mitigation strategies are essential to maintain the stability and reliability of this critical frontier region.
Macrotroponin interference and association with cardiotoxicity in patients receiving cardiotoxic breast cancer therapy: a pilot study
Authors: Soosaipillai Andrea , Nardi-Agmon Inbar , Brinc Davor , Fabros Anselmo , Kavsak Peter A. , Thavendiranathan Paaladinesh , Di Meo Ashley
Published: February 2025

Background

Cancer therapy-related cardiac dysfunction (CTRCD) is an important adverse effect in patients receiving potential cardiotoxic cancer therapies. Interpretation of cardiac troponin results can be affected by presence of macrotroponin, which can complicate CTRCD assessment. We aimed to assess whether macrotroponin is detectable in women with ERBB2 + breast cancer receiving sequential therapy with anthracyclines and trastuzumab.

Methods

A total of 20 serum samples from 12 ERBB2 + breast cancer patients (median age: 55 years, range: 30–69 years) who exhibited a significant increase in high-sensitivity cardiac troponin I (hs-cTnI) from baseline to post-anthracycline (~ 2 months after therapy initiation) and/or 3-months into trastuzumab therapy (~ 5 months after therapy initiation) and/or who had at least one hs-cTnI value above the female-specific 99th percentile (hs-cTnI > 16 ng/L) and had available banked blood for analysis were included in this pilot study. Samples were analyzed using the Abbott STAT High-Sensitive Troponin-I and Roche Elecsys Troponin T hs STAT assays. Macrotroponin was detected by treating the sample with protein G and re-measuring hs-cTn. Macrotroponin presence was defined as a hs-cTnI or hs-cTnT recovery of < 40% or 85%, respectively.

Results

Macrotroponin was not identified after anthracycline treatment but was present in four patients 3-months into trastuzumab therapy, two of which had hs-cTnI concentrations above the 99th percentile. None of these patients exhibited a significant reduction in LVEF and/or GLS despite having significant elevations in hs-cTnI.

Conclusions

Clinicians should be cautious of benign hs-cTn elevations resulting from macrotroponin presence, as it can complicate CTRCD assessment.
Radiodiagnostic performance of canine morphology for sexual dimorphism in Brazilian adults — a cross-sectional study
Authors: Stibich Christian , Soares Mariana , Rossetto Carolina , Rangel-Coelho João Pedro , Boedi Rizky , Franco Ademir
Published: February 2025

Background

Sex estimation through dental features is an important contribution of forensic odontology for human identification. Permanent canines have been used to this end with disputable reliability across studies. The present study aimed to test the sexual dimorphism of permanent human canines using ratios of linear measurements performed in periapical radiographs of Brazilian adults. The sample consisted of 112 canine periapical radiographs. Three ratios of six linear measurements were established: (1) maximum crown length/maximum tooth length, (2) tooth width at the cementum-enamel junction/maximum crown width, and (3) thickness of the crown enamel/width of the crown dentin.

Results

Ratio 2 was statistically significant for the maxillary and mandibular canines, and ratio 3 was statistically significant for the mandibular canine (p < 0.05). Their accuracy was between 63 and 65%.

Conclusion

Canine sexual dimorphism was discrete and seems to be more associated with measurements of crown, dentin, and enamel width. Sex-related differences were more evident in the mandibular canine. Future radiodiagnostic use of the permanent human canines should be solely adjuvant and when no other traditional method is suitable.
Topological data analysis with digital microscope leather images for animal species classification
Authors: Ehiro Takuya , Onji Takeshi
Published: February 2025

This study presents a method for classifying cow and horse leather using a small number of digital microscope images and topological data analysis. In this method, hair pore coordinates in the images are used as essential information for classification. First, the coordinates were semiautomatically extracted using conventional image processing methods and persistent homology (PH) computation. Binary images with white pixels corresponding to the coordinates were generated, and their PHs were computed using filtration based on the Manhattan distance. In addition to the pairwise distance between the two pores, zeroth- and first-order lifetimes were used as explanatory variables to construct the classifier. Among the three explanatory variables, the zeroth-order lifetime resulted in the highest classification accuracy (86%) for the test data. Furthermore, we constructed logistic regression (LR) and random forest (RF) models using the zeroth-order lifetime computed from all images and conducted model interpretation. In both LR and RF, information on a zeroth-order lifetime of less than 10 was used as an important explanatory variable. Additionally, the inverse analysis of birth–death pairs suggested that the zeroth-order lifetime contains topological information distinct from the conventional pairwise distance. Our proposed method is designed to be robust in data-limited situations because it only uses hair pore coordinates as explanatory variables and does not require other information, such as hair pore density or pore size. This study demonstrates that accurate classifiers can be obtained using topological features related to hair pore arrangement.

Graphical Abstract
Methodologic Approach to Defining Comorbidities in a Cohort of Patients With Cancer: An Example in the Optimal Breast Cancer Chemotherapy Dosing Study
Authors: Wang Peng , O'Connell Kelli , Bhimani Jenna , Blinder Victoria , Burganowski Rachael , Ergas Isaac J. , Gallagher Grace B. , Griggs Jennifer J. , Heon Narre , Kolevska Tatjana , Kotsurovskyy Yuriy , Kroenke Candyce H. , Laurent Cecile A. , Liu Raymond , Nakata Kanichi G. , Persaud Sonia , Rivera Donna R. , Roh Janise M. , Tabatabai Sara , Valice Emily , Bandera Elisa V. , Kushi Lawrence H. , Aiello Bowles Erin J. , Kantor Elizabeth D.
Published: February 2025

PURPOSE

We evaluated the definitions of five comorbidities (renal and hepatic impairments, anemia, neutropenia, and thrombocytopenia) in women with breast cancer using data from electronic health records.

METHODS

In 11,097 women receiving adjuvant chemotherapy for stage I-IIIA breast cancer at Kaiser Permanente Northern California or Kaiser Permanente Washington, we assessed comorbidity definitions in two commonly used lookback windows (1 year before diagnosis, T1; and extending until chemotherapy initiation, T1-2). Within each, we assessed data availability and agreement between International Classification of Diseases (ICD)–defined and lab-defined comorbidities of varying severity. To assess how different pieces of information may affect providers in making treatment decisions, we used multivariable logistic regression to evaluate four-category (with comorbidity indicated by both ICD and lab, ICD-only, lab-only, or neither) and collapsed binary (comorbidity indicated by either ICD or lab
v
neither) definitions in relation to first cycle chemotherapy dose reduction (FCDR).

RESULTS

Extending the lookback period to chemotherapy initiation increased laboratory data availability (missingness ≤4.1% in T1-2
v
>40% in T1). Assessment of agreement guided selection of laboratory cutpoints. In both time periods, the four-category and binary comorbidity variables were associated with use of FCDR, but binary variables had larger cell sizes and more stability of regression models. Ultimately, the comorbidity variables in T1 were defined by a combination of either ICD/qualifying laboratory values. Results were similar in T1-2, except laboratory data alone outperformed the combination variable for renal and hepatic comorbidity.

CONCLUSION

Leveraging both ICD and lab data and extending the lookback period to include postdiagnosis but prechemotherapy initiation may provide better capture of comorbidity. Future studies may consider validating our findings with a gold-standard comorbidity status and in other community health care settings.
Real-World Patient-Reported Outcome Measure Implementation: Challenges and Successes of a Pan-Canadian Initiative to Improve the Future of Patient-Centered Cancer Care
Authors: Lambert Sylvie , McKenzie Michael , Coronado Andrea C. , Caissie Amanda , Tracey Linda , Watson Linda , Deiure Andrea , Shaw-Moxam Raquel , Ryan Jean Ann , Arab Marianne , Jorgensen Bryan , Crump Ashley , Rayner Lisa , Lecours Mireille , Howatt Peter Shaw
Published: February 2025

PURPOSE

Implementation of patient-reported outcome measures (PROMs) in routine care continues to be limited, despite their demonstrated efficacy and substantial investments. We report on the lessons learned and the challenges of the concerted implementation of the same PROMs across teams in nine provinces/territories (jurisdictions) in Canada, as well as the solutions to move implementation forward despite cost containments and the COVID-19 pandemic.

METHODS

Each team from nine jurisdictions submitted a final report describing their PROM implementation project. Reports were analyzed for themes on lessons learned, challenges, and solutions. Themes were compared for similarities and differences. The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were used.

RESULTS

Six key lessons learned were identified from eight challenges. To address these challenges, 27 solutions were used. The six lessons learned were as follows: Harness the power of change management, ensure consistent stakeholder engagement at all levels for success, establish buy-in as soon as possible, plan to maintain buy-in through changing circumstances, identify ways to make technology the solution, and optimal implementation includes a sustainability plan. Examples of solutions included the following: develop a multipronged, multilevel communication plan; include change management experts on the team; identify champions; restructure and reprioritize as needed; leverage existing technology; and leave a permanent trace of the project.

CONCLUSION

To our knowledge, this is the first analysis to synthesize lessons learned from real-world PROM implementation across geographically diverse jurisdictions. We identified generalizable solutions that other health care managers and policymakers can use to accelerate PROM implementation, despite pervasive implementation barriers. Future studies can integrate these solutions with methods and tools from implementation science (eg, theoretical frameworks, implementation strategies) for more successful spread and scale of PROMs.
Metabolic phenotype of Stage 1 and Stage 2 type 1 diabetes using modelling of beta cell function
Authors: Galderisi Alfonso , Bonet Jacopo , Ismail Heba M , Moran Antoinette , Fiorina Paolo , Bosi Emanuele , Petrelli Alessandra
Published: February 2025

Context

Staging preclinical type 1 diabetes (T1D) and monitoring the response to disease-modifying treatments rely on the oral glucose tolerance test (OGTT). However, it is unknown whether OGTT-derived measures of beta-cell function can detect subtle changes in metabolic phenotype, thus limiting their usability as endpoints in prevention trials.

Methods

We characterized the metabolic phenotype of individuals with islet autoimmunity in the absence (Stage 1) or presence (Stage 2) of dysglycemia. Participants were screened at a TrialNet site and underwent a 5-point, 2-hour OGTT. Standard measures of insulin secretion (AUC C-peptide, HOMA2-B) and sensitivity (HOMA-IR, HOMA2-S, Matsuda Index) and oral minimal model derived insulin secretion (phi total), sensitivity (SI), and clearance were adopted to characterize the cohort.

Results

Thirty participants with Stage 1 and 27 with Stage 2 T1D were selected. Standard metrics of insulin secretion and sensitivity did not differ between Stage 1 and Stage 2 T1D, while the oral minimal model revealed lower insulin secretion (p<0.001) and sensitivity (p=0.034) in those with Stage 2 T1D, as well as increased insulin clearance (p=0.006). A higher baseline phi total was associated with reduced odds of disease progression, independent of Stage [OR 0.92 (0.86, 0.98), p=0.016].

Conclusion

The oral minimal model describes the differential metabolic phenotype of Stage 1 and Stage 2 T1D and identifies phi total as a progression predictor. This supports its use as a sensitive tool and endpoint for T1D prevention trials.
Machine Learning–Based Survival Prediction Tool for Adrenocortical Carcinoma
Authors: Saygili Emre Sedar , Elhassan Yasir S , Prete Alessandro , Lippert Juliane , Altieri Barbara , Ronchi Cristina L
Published: February 2025

Context

Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with difficult to predict clinical outcomes. The S-GRAS score combines clinical and histopathological variables (tumor stage, grade, resection status, age, and symptoms) and showed good prognostic performance for patients with ACC.

Objective

To improve ACC prognostic classification by applying robust machine learning (ML) models.

Method

We developed ML models to enhance outcome prediction using the published S-GRAS dataset (n = 942) as the training cohort and an independent dataset (n = 152) for validation. Sixteen ML models were constructed based on individual clinical variables. The best-performing models were used to develop a web-based tool for individualized risk prediction.

Results

Quadratic Discriminant Analysis, Light Gradient Boosting Machine, and AdaBoost Classifier models exhibited the highest performance, predicting 5-year overall mortality (OM), and 1-year and 3-year disease progression (DP) with F1 scores of 0.79, 0.63, and 0.83 in the training cohort, and 0.72, 0.60, and 0.83 in the validation cohort. Sensitivity and specificity for 5-year OM were at 77% and 77% in the training cohort, and 65% and 81% in the validation cohort, respectively. A web-based tool (https://acc-survival.streamlit.app) was developed for easily applicable and individualized risk prediction of mortality and disease progression.

Conclusion

S-GRAS parameters can efficiently predict outcome in patients with ACC, even using a robust ML model approach. Our web app instantly estimates the mortality and disease progression for patients with ACC, representing an accessible tool to drive personalized management decisions in clinical practice.
Small Intestine Perforation Due to an Intubation Stylet Fragment: A Case Report
Authors: Gultekin Yucel , Zora Muhammed Emin
Published: February 2025

This case highlights a rare complication of endotracheal intubation: intestine perforation caused by an intubation-stylet fragment. A patient undergoing an appendectomy had an esophageal intubation on the first attempt and a successful endotracheal intubation on the second, using the same stylet. The missing fragment went unnoticed after intubation. Postoperative symptoms led to reimaging, revealing a foreign body in the intestine, later identified as a stylet fragment. The stylet fragment was removed, and the patient recovered by postoperative day 7. This case emphasizes the importance of vigilance in airway management, prompt evaluation of symptoms, and proper handling of damaged equipment.
Development and applications of novel paper-based analytical devices
Authors: Σούλης Διονύσιος
Published: February 2025

Τα τελευταία χρόνια, οι αναλυτικές μικροδιατάξεις χάρτου (PADs) έχουν προσελκύσει το ενδιαφέρον των ερευνητών στον τομέα της αναλυτικής χημείας και των (βιο)αισθητήρων. Το χαρτί παρουσιάζει σημαντικά πλεονεκτήματα ως υπόστρωμα διατάξεων για αναλυτικές εφαρμογές. Είναι ένα υδρόφιλο, εμπορικά διαθέσιμο και φτηνό υλικό, φιλικό προς το περιβάλλον και διαθέτει ενεργές ομάδες που είναι κατάλληλες για την ακινητοποίηση βιομορίων, ενώ επιτρέπει ανάλυση με πολύ μικρούς όγκους δείγματος και αντιδραστηρίων που κινούνται κάτω από την επίδραση τριχοειδών δυνάμεων χωρίς τη χρήση αντλιών. Στις διατάξεις αυτές είναι εφικτή η ενσωμάτωση διάφορων τύπων μεταλλακτών (οπτικών και ηλεκτροχημικών) που μπορούν να συνδυαστούν με φορητή οργανολογία. Ο σκοπός της παρούσας διδακτορικής διατριβής είναι ο σχεδιασμός, η κατασκευή και η εφαρμογή καινοτόμων αναλυτικών συσκευών που βασίζονται σε χαρτί (PAD). Αρχικά, έγινε μελέτη κατασκευής ρευστονικών διατάξεων με σχεδιογράφο x-y. Αρχικά σχεδιάστηκαν ρευστονικά κανάλια χρησιμοποιώντας κατάλληλο πρόγραμμα σε ηλεκτρονικό υπολογιστή. Πραγματοποιήθηκε μελέτη διαφόρων τύπων χρωματογραφικών και διηθητικών χάρτων καθώς και της μεθοδολογίας δημιουργίας των υδρόφοβων τοιχωμάτων στο χαρτί με τη χρήση εμπορικά διαθέσιμων ανεξίτηλων μαρκαδόρων. Τα παραπάνω, αξιολογήθηκαν με κριτήρια την ικανοποιητική μόνωση των υδρόφιλων καναλιών, την αντοχή των υδρόφοβων τοιχωμάτων σε διάφορους διαλύτες καθώς και τα χαρακτηριστικά ροής υγρών. Στη συνέχεια, έγινε εναπόθεση ηλεκτροχημικών διατάξεων τριών ηλεκτροδίων από αγώγιμα μελάνια στο χάρτινο υπόστρωμα, χρησιμοποιώντας είτε σχεδιογράφο x-y, είτε της τεχνική της εκτύπωση με πλέγμα (screen-printing). Αυτοί οι αισθητήρες χρησιμοποιήθηκαν για την ανάπτυξη μεθοδολογιών αναδιαλυτικής βολταμμετρίας για την ηλεκτροχημική ανίχνευση ιχνών βαρέων μετάλλων σε περιβαλλοντικά δείγματα και δείγματα τροφίμων. Τέλος, μελετήθηκε η καινοτόμος τεχνική της θερμικής εκτύπωσης μελανιού με τη χρήση θερμικού εκτυπωτή, για την αποτύπωση υδρόφοβων τοιχωμάτων και κατασκευάστηκαν αισθητήρες χάρτου για τον οπτικό προσδιορισμό θειοκυανικών ιόντων σε σίελο.
Piśmiennictwo do stanu badań nad architekturą cerkiewną z obszaru Łemkowyny w latach 1989–2024
Authors: Nowak Damian
Published: February 2025

ЛIТЕРАТУРА ДО СТАНУ ДОСЛIДЖЫНЬ НАД ЦЕРКОВНОМ АРХІТЕКТУРОМ З ОБШЫРИ ЛЕМКОВИНЫ В РОКАХ 1989–2024Сеса статя зосереджат ся на омовліню дослiдничого доробку, што односит ся до церковной архітектуры на обшыри Лемковины. Першы публикациі посвячены тій проблематыцi вказали ся в меджевоєнным періоді, чого приміром сут працы Францішка Стжалкы і Михайла Драґана. По ІІ світовій войні і по выселінях Лемків тема стала ся менше доступна, але дослiджыня продолжали м.ін. Ришард Бриковскі, Єжы Тур, Барбара Тондос, Маріян Корнецкі і Зофія Шантер. Особливе ожывліня заінтересуваня церковном архітектуром наступило в 80. роках ХХ ст., чого доказом было печатаня переломных публикаций пера Ришарда Бриковского. По 1989 р. долучыло наступне поколіня дослiдникiв, в тым Піотр Красны, Ярослав Ґємза ци Євген Завалень, а орґанізуваны конференциі і науковы сесиі принесли чысленны опрацуваня. Спомнены працы становлят лем вытинок богатой колекциі публикаций посвяченых сакральній архітектурній спадковині Лемковины. Хоц є векше заінтересуваня, вельо квестий є дале непоясненых. Актуальні реалізуваны сут дослiдничы проєкты, в котрых хоснуваный є доробок попередніх поколінь дослiдникiв, якы диспонували меншыма можливостями. Тот доробок є основом для дальшых студий над історийом і архітектурном формом лемківскых церкви.
Імаґолоґія: О застосуваню етнічности до надаваня світу сенсу
Authors: Leerssen Joep
Published: February 2025

IMAGOLOGIA: O ZASTOSOWANIU ETNICZNOŚCI DO NADAWANIA ŚWIATU SENSUArtykuł przedstawia teorię i metodę imagologii, dyskursywnego studium etnotypów (stereotypowych atrybucji charakteru narodowego). Imagologia posiada znaczącą renomę historyczną i akademicką, ale w świetle ostatnich ustaleń konieczne są przeformułowania, które obejmują: (a) zamianę kategoryzacji tradycji literackich z narodowo-modułowej na podejście polisystemowe; (b) upadek fikcji drukowanej jako przodującego medium narracyjnego na rzecz filmu, telewizji i innych mediów; (c) uświadomienie sobie, że etnotypy często funkcjonują w przysłoniętej formie (wykorzystane ironicznie lub jako „meta-obrazy”, lub ich obecność jest „banalna” albo znajduje się w tle, jako chwilowo zapomniana rama); (d) nowe „krzyżujące się” ujęcie kształtowania się tożsamości; (e) upadek eurocentryzmu i powstanie postnacjonalizmu. Te nowe wyzwania wymagają dopasowania do analizy imagologicznej, a obecny klimat polityki tożsamościowej także zdradza ciągłą, pilną potrzebę, by zwrócić uwagę na to, co pozostaje samym sednem zainteresowania imagologii: dekonstruowanie dyskursu esencjalizmu narodowego i etnicznego.
Code and Data Repository for Diagnostic Tools for Evaluating and Comparing Simulation-Optimization Algorithms
Authors: Eckman David J. , Henderson Shane G. , Shashaani Sara
Published: February 2025

SimOpt is a testbed of simulation-optimization problems and solvers. Its purpose is to encourage the development and constructive comparison of simulation-optimization (SO) solvers (algorithms). We are particularly interested in the finite-time performance of solvers, rather than the asymptotic results that one often finds in related literature.
Dual Sourcing Under Internal and External Volatilities
Authors: Federgruen Awi , Liu Zhe , Lu Jiaqi
Published: February 2025

Problem definition: We study a dual sourcing problem in an increasingly volatile world. We consider two types of volatilities. External volatilities reflect fluctuating economic conditions via an underlying Markov-modulated state-of-the-world that affects the two suppliers’ cost structures, capacity limits, supply mechanisms, and demands. Internal volatilities affect the actual outputs resulting from random supply processes. Demand distributions are impacted by both types of volatilities. Methodology/results: We show how the optimal combined ordering strategy from the two suppliers, along with a salvaging policy, can be efficiently computed under the conventional assumption of consecutive lead times. We characterize the relatively simple structure of the optimal policies and systematically compare the two types of volatilities. Managerial implications: By exploiting dual sourcing options, we find that the firm can benefit from external volatilities; indeed, benefits increase as volatilities increase in specific ways. Numerical studies illustrate these results and reject other reasonable conjectures.

Funding: This work was supported by the Guangdong Key Lab of Mathematical Foundations for Artificial Intelligence and the National Natural Science Foundation of China [Grants 72192805 and 72401245].

Supplemental Material: The online appendices are available at https://doi.org/10.1287/msom.2024.0987 .
Pott’s puffy tumor associated with subperiosteal empyema and osteomyelitis in a pediatric patient
Authors: Akhtar Hassan , Sweeney Fiona , Wawrzynek Wojciech
Published: February 2025

Pott’s puffy tumor, a rare complication of frontal sinusitis or trauma, presents with subperiosteal abscess and osteomyelitis of the frontal bone. Early diagnosis with imaging studies and prompt treatment with antibiotics and percutaneous drainage of the abscess requires in most cases for a successful outcome. We report a case of a 12-year-old boy who initially presented with left sided retro-orbital/frontal area headache associated with high grade temperature and painful localized small forehead swelling. Symptoms developed few days after he had a dental extraction of left upper molar tooth. Initial workup showed raised inflammatory markers and a computed tomography scan (CT) of the brain was consistent with ethmoid/maxillary sinusitis. He was discharged home on his first presentation to a regional hospital after having intravenous antibiotics for 24 hours which were subsequently switched to oral antibiotics. He presented again after a week with recurrence of forehead swelling involving and extending into both retro-orbital areas associated with painful eye movements and few episodes of vomiting. Repeat imaging showed Pott’s puffy tumour overlying the left frontal bone with underlying osteomyelitis. He was given intravenous antibiotics, abscess was surgically drained by the ear, nose, and throat (ENT) department, and he had a good clinical outcome on discharge with follow-up planned with ENT. Pott’s puffy tumor, although rare, requires a high index of suspicion in patients presenting with frontal swelling and suggestive clinical features. Early diagnosis with CT scan and prompt treatment with antibiotics and percutaneous drainage, when indicated, can lead to a favorable outcome. Collaboration between clinicians, radiologists, and microbiologists is essential for optimal management of this potentially serious complication of frontal sinusitis.