bluuebunny/crossref_metadata_2025 huggingface dataset:
Might as Right? The Nature of Laws of War applicable to Targeting and Detention in International Armed Conflicts
Authors: Kinoti Festus M.
Published: November 2022

Do laws of war applicable to International Armed Conflicts (iac s) authorize targeting and detention or do they simply regulate targeting and detention as an exercise of power in war by belligerents without providing authorization? This question has been the subject of debate in the recent past. The traditional understanding of laws of war, simply as a protective regime has come under increasing challenge from claims laws of war authorize targeting and detention in International Armed Conflicts. While these claims have mainly been made to establish in laws of war satisfaction for the requirement of Human rights law for a legal basis for targeting and detention, the transmutation of what in the perspective of laws of war is simply an exercise of power into legal permission has consequences beyond that relationship. It also impacts the relationship between laws of war and jus ad bellum, and more gravely it cloaks what is an otherwise exercise of brute power in war with the garb of legal competence. It transmutes what is simply might into right. The transmutation, re characterizes an iac from the perspective of laws of war as simply a fact, into its legal construct. Therefore, this paper interrogates the nature of the laws of war, to show they simply regulate targeting and detention in iac s without providing legal permission.
Incidence of Manifold Slip on Transport and Reaction Dynamics in Magneto-Bioconvective and Magnetic Nanoparticles Fe3O4 (Magnetite) Power-Law Flow Between Two Parallel Plates
Authors: Ebenezer Olubunmi Ige , Falodun Bidemi Olumide
Published: November 2022

The focus of this paper is based on the incidence of manifold slip on the transport and dynamics of magnetobioconvective and magnetic nanoparticles Fe3O4 (magnetite) power-law flow between two parallel plates. An interaction takes place between nanoparticles and
the organism by inhalation routes, oral, dermal, and distributed to different tissue through the circulatory system The equations of motion are a set of partial differential equations (PDEs). The governing equations are transformed into ordinary differential equations (ODE) by utilizing similarity
transformations. The transformed equations are solved by using the Runge-Kutta Gill method alongside the shooting techniques MATLAB software implementation. The velocity of fluid decreases when the magnetic parameter increases. The outcomes of this model find usefulness in controlling the
turbulent flow of fluid due to the presence of a magnetic field and also helpful in reducing the dosage of anticancer drugs in the medical field because of the presence of the magnetic nanoparticles. The correctness of the present result is ascertained by comparing it with reported data.
Exploring the Virtual-Representational-Abstract Instructional Sequence Across the Learning Stages for Struggling Students
Authors: Bouck Emily , Long Holly , Bae Yukyung
Published: November 2022

In recent years, virtual manipulatives have been explored and used as an alternative to concrete manipulatives in mathematics for students on their own and as part of manipulative-based instructional sequences. Researchers examining virtual manipulative-based instructional sequences tend to focus on students documented with disabilities, as opposed to students at-risk or struggling with mathematics, as well as students’ acquisition of the target skill, despite students experiencing learning in four stages: acquisition, fluency, maintenance, and generalization. This study explored the virtual-representational-abstract (VRA) instructional sequence across four stages of learning for three elementary students struggling in mathematics. In the single-case design study, researchers found a functional relationship between the VRA instructional sequence delivered online via explicit instruction and students’ computational accuracy in their targeted area of mathematics need. Researchers also found limited influence on fluency rate or generalization to word problem accuracy but that students did maintain.
Endoscopic Endonasal Surgery for Dermoid Cysts Arising From the Middle Cranial Fossa Floor: A Rare Case Series
Authors: Xu Haoyuan , Li Wanpeng , Zhang Huankang , Wang Huan , Hu Li , Wang Dehui
Published: November 2022

Objective

Dermoid cysts (DCs) are congenital, slowly growing, and may cause nervous system symptoms. Related literature is limited and mainly includes case reports. We report a case series of DCs originating from the middle cranial fossa floor (MCFF) and investigate their demographic information, clinical characteristics, imaging findings, surgical procedures, and prognostic outcomes.

Methods

We reviewed the patients with DCs arising from the MCFF undergoing endoscopic endonasal surgery (EES) in our center between 2012 and 2022.

Results

A total of 5 patients with DCs were enrolled (2 males and 3 females), with a mean age of 46.2 years at the onset. All DCs originated from the MCFF with 1 case involving the middle cranial fossa bone and another 1 case affecting the dura mater. One (20.0%) patient had neurological involvement. After admission, all patients received EES with a total resection rate of 100.0% (5 of 5). After a median follow-up of 73.2 months, all patients achieved complete clinical and radiological improvements. No surgical-related complications or relapses were observed during the long-term follow-up.

Conclusion

Endoscopic endonasal surgery is considered a safe and effective approach for the treatment of DCs in the MCFF. A larger sample size and longer follow-up time are needed.
Longitudinal associations between mindfulness and change in attachment orientations in couples: The role of relationship preoccupation and empathy
Authors: Gazder Taranah , Stanton Sarah C. E.
Published: November 2022

Attachment orientations predict relationship outcomes and health and well-being, making it important to illuminate factors which enhance attachment security. We investigated how general and relationship-specific mindfulness predict changes in attachment orientations in couples over time, testing relationship preoccupation and partner-focused empathy as mediators. We also explored whether the longitudinal links between general mindfulness and attachment are bidirectional. Couples reported their general and relationship mindfulness and attachment orientations in a baseline session (Phase 1). They then reported relationship preoccupation and empathy each day for 14 days (Phase 2). Lastly, they reported general mindfulness and attachment orientations 2 months later (Phase 3). Results revealed that higher Phase 1 actor general—but not relationship—mindfulness directly predicted Phase 1-3 decreases in actor attachment anxiety. Conversely, greater Phase 1 actor relationship—but not general—mindfulness indirectly predicted Phase 1-3 decreases in actor attachment avoidance via greater Phase 2 actor empathy. Finally, lower Phase 1 actor and partner attachment anxiety directly predicted Phase 1-3 increases in general mindfulness. This research provides the first dyadic longitudinal demonstration of the interplay between partners’ mindfulness and attachment.
Graphogame intervention as a tool for early diagnosis of reading difficulties in Spanish-speaking children with developmental language disorder
Authors: Martínez Camila , Maurits Natasha , Maassen Ben
Published: November 2022

GraphoGame is a computer-based game that trains grapheme-to-phoneme associations and has been shown to benefit reading acquisition in different languages and countries. In transparent languages, such as Spanish, learning grapheme-to-phoneme associations is of great importance when learning to read, and GraphoGame can help children at risk of developing reading difficulties overcome their struggles. Children with developmental language disorder (DLD) are at high risk of developing reading difficulties, and they are therefore an interesting target group for a study on the effects of using GraphoGame as an intervention tool, as well as a tool for early diagnosis of later reading difficulties. Using generalised linear mixed models, this article explores the progress made in GraphoGame and reading-related skills by children with DLD – with and without comprehension difficulties – and their typically developing (TD) classmates in kindergarten or first grade. Fifty-nine children were included in the current study (16 TD and 43 DLD; mean age = 6.4 years, SD = 0.7 years). By testing children before and after six weeks of GraphoGame intervention, changes in their performance at letter recognition, pseudoword recognition and phonological awareness are studied. In addition to the differences due to oral language skills (expressive and receptive), how the children perform in GraphoGame and whether the progress in the aforementioned reading-related skills is predictive of reading status in second grade (good or poor readers) are examined. After six weeks of GraphoGame intervention, all children improved at all of the assessed reading-related skills, regardless of the test (letter recognition, phonological awareness and pseudoword recognition). Additionally, the children with DLD with comprehension difficulties made less progress in GraphoGame than the other two groups. The same was found for the children who were classified as poor readers in second grade: none of the poor readers reached the highest levels of the game. Finally, performance at the first level of GraphoGame mildly correlated with reading fluency, as assessed one year after the intervention. Future studies should consider larger populations, as well as the long-term effect of interventions such as the one studied here.
Strategies and checklist for designing and conducting palliative care research with family carers: EAPC international expert elicitation study
Authors: Hudson PL , Gardiner C , Alvariza A , Nicholas Dionne-Odom J , Öhlén J , Carduff E , Harding R , Witkamp E , Payne S
Published: November 2022

Background:

Palliative care services seek to improve the wellbeing of family carers of people living with serious and life-limiting illness. To help achieve this goal, systematic reviews have recommended priority areas for family carer research and the need to improve the quality of study design. Policy makers have also advocated for enhanced family carer support. However, there are specific methodological considerations and challenges in designing and conducting carer research conducted during the course of the serious illness trajectory and in bereavement.

Aim:

To develop strategies to improve the design and conduct of research with family carers.

Design:

Expert elicitation study using an adapted version of the ‘Identify, Discuss, Estimate and Aggregate’ elicitation protocol, supplemented with strategies from peer-reviewed literature.

Setting/participants:

Nine members of the management committee of the European Association for Palliative Care’s Reference group on family carer research, comprising international senior research academics in family caregiving.

Results:

A compilation of recommended strategies and checklist was created to: (a) help researchers plan research involving family carers focussing on: preparation, conduct and dissemination and (b) assist ethics committees and funding bodies to evaluate proposals.

Conclusions:

The strategies and checklist for conducting research with family carers may enhance methodologically rigorous research. Consequently, researchers, practitioners and policy makers will not only gain a more comprehensive understanding of the unmet needs of family carers but also promote the development of empirically sound interventions.
Impact of soaking and cooking treatments on the physicochemical and antioxidant properties of parboiled and non-parboiled rice (Oryza sativa L.)
Authors: Kanan Md. Kawser Alam , Nahar Towrin , Islam Nazmul , Rahman Md. Jiaur , Ahmed Shakil , Kabir Md. Shahjahan , Ahmed Maruf
Published: November 2022

The effects of soaking and cooking on the physicochemical properties and bioactive compounds of two parboiled and non-parboiled rice cultivars (BRRI-28 and Katari bhog) were investigated in this study. Total phenolic content (TPC) increased significantly ( p ≤ 0.5) after soaking, while total flavonoid content (TFC) and proanthocyanidin content (PC) decreased significantly ( p ≤ 0.5) compared to untreated rice samples. TPC increased by around 23% and 20% in parboiled BRRI 28 and Katari bhog rice extracts, respectively, due to the cooking process, while TFC and PC decreased significantly. DPPH radical scavenging increased whereas reducing power activity decreased after soaking and cooking in parboiled BRRI 28. After processing, the protein, starch, and amylose content of all samples decreased in the majority of cases. After being soaked, all samples L * and b * values increased as compared to raw rice samples. As a result, it can be concluded that the treatment of soaking and cooking of parboiled rice (BRRI-28) was suitable to improve the antioxidant properties as compared to non-parboiled rice.
Identification of Contributing Factors of Falls and Non-Fall Accidents Among Home Care Clients: A Retrospective Study Using Incident Reports
Authors: Kiljunen Outi , Kankkunen Päivi , Välimäki Tarja
Published: November 2022

To prevent falls and other accidents among home care clients, it is essential to gather high-quality information on the factors contributing to the accidents. Incident reporting systems are used in home care units to generate information for risk management. This study aimed to explore the contributing factors of falls and non-fall accidents among home care clients and to evaluate the accuracy of the information on contributing factors gained from the incident reporting system. An existing dataset was used—safety incident reports concerning accidents involving home care clients. The incident reports (n = 323) were stored in the social- and health care organization’s incident reporting database from 2018 to 2020. The free-text narratives describing factors contributing to the event’s occurrence were analyzed using inductive content analysis, and the frequencies of the main category codes were recorded. The results were then compared with the frontline managers’ analyses of the narratives, where the managers used the classification of contributing factors provided by the system. According to incident reports, intrinsic (person-specific), behavior-related and extrinsic (environment-related) factors contributed to accidents among home care clients. Intrinsic and behavior-related factors were reported more often than extrinsic factors. The classified information on contributing factors did not correspond in all respects to the descriptions in the incident reports. To ensure high-quality information for safety management, incident reporting tools must be appropriate for use in the home care context. Both the reporter of an adverse event and the individual responsible for analyzing the report play essential roles in identifying contributing factors of accidents.
Renoprotective effects of docosahexaenoic acid in cats with early chronic kidney disease due to polycystic kidney disease: a pilot study
Authors: Kobayashi Saori , Kawarasaki Masataka , Aono Ayami , Cho Junko , Hashimoto Tomoaki , Sato Reeko
Published: November 2022

Objectives

Lipids containing n-3 fatty acids have been reported to have protective effects on renal function, with docosahexaenoic acid (DHA) expected to be particularly effective. However, no reports have demonstrated the renoprotective effects of DHA-enriched lipids in cats with chronic kidney disease (CKD). Therefore, the aim of this pilot study was to examine the renoprotective effects of DHA-enriched fish oil in cats.

Methods

Five healthy cats and five cats with early non-azotaemic CKD due to autosomal dominant polycystic kidney disease (PKD) were orally administered DHA-enriched fish oil in liquid form (250 or 500 mg/kg body weight [BW] and 250 mg/kg BW of DHA, respectively) for 28 days. Inappropriately dilute urine and markedly increased urinary N-acetyl-d-glucosamine (NAG) index were detected in cats with PKD before DHA-enriched fish oil administration. Changes in the fatty acid composition ratio in the blood of all 10 cats were assessed after orally administering 250 mg/kg of DHA.

Results

Post-administration, no adverse clinical effects were observed, and blood and urine tests were within the reference intervals in healthy cats. Cats with PKD showed significantly decreased serum symmetric dimethylarginine (SDMA), urine protein:creatinine ratio (UPC) and urinary NAG index at post-administration. Furthermore, oral administration of DHA-enriched fish oils significantly decreased the blood concentration ratio of arachidonic acid (AA) in cats with PKD post-administration. Furthermore, the concentration ratio of DHA in the blood significantly increased in both healthy cats and cats with PKD, and the DHA:AA ratio also increased.

Conclusions and relevance

Oral administration of DHA-enriched fish oils for 28 days significantly decreased blood AA levels and significantly increased DHA concentration and DHA:AA ratios in cats with PKD, and improved the SDMA, UPC and urinary NAG index, suggesting its potential for renoprotective effects in cats with early non-azotaemic CKD due to PKD.
Application of multicolour reflectance imaging for the characterisation of inherited retinal disorders
Authors: Lorenzana-Blanco Natalia , Jimenez-Rolando Belen , Garcia-Sandoval Blanca , Blanco-Kelly Fiona , Avila-Fernandez Almudena , Martin-Merida Inmaculada , Garcia-Ferreira Milagros , Campos-Seco Silvia , Ayuso Carmen , Carreño Ester
Published: November 2022

Aim

To describe the role of multicolour reflectance images (MCI) in the phenotypic diagnosis of inherited retinal disorders (IRDs).

Methods

A retrospective review of consecutive patients affected by IRDs examined with MCI techniques from January to December 2019 at a tertiary care referral centre. All patients had MCI, fundus autofluorescence and optical coherence tomography taken at the same time point. The ability of each modality to highlight clinical features was assessed. Lesions’ size was also measured and compared among imaging modalities.

Results

Thirty eyes of 15 patients were included in the study, 6 males and 9 females, with a mean age of 44 years (range: 19–57.5). The most frequent clinical diagnosis were: pattern dystrophies, and late-onset retinal degeneration. Next-generation or Sanger sequencing analysis was carried out in all patients. Blue and green reflectance were relevant in highlighting peripheral mottling in fundus albipunctatus, pseudoreticular drusen in late-onset retinal degeneration, parafoveal hyperreflective area in bull's eye maculopathy and crystals in Bietti's crystalline dystrophy. Likewise, it is to mention the ability of infrared reflectance to detect hyperreflective patches in posterior pole in neurofibromatosis type 1 and retinal changes in pattern dystrophies and cone dystrophies.

Conclusion

Multicolour imaging technique enables the detection of clinical features that could be overlooked by other imaging modalities, allowing accurate phenotypic characterisation of IRDs and guiding genetic diagnose, and may become a meaningful monitoring tool for future treatments.
The Paradox of a Mobile Society: Situating Cultural Studies in the Global South Context
Authors: Cabalquinto Earvin
Published: November 2022

This provocation presents a critical reflection on the role of cultural studies in examining the consequences of an increasingly global and digital society. More specifically, I extend and situate the inquiry within the new mobilities paradigm, underlining how everyday personal, familial and social interactions have been shaped by the widespread uptake of digital technologies among migrants and their distant networks. Here I centre the transnational and networked home as a critical site of performing, embodying and negotiating linkages beyond borders. Importantly, reflecting on situating cultural studies within the context of the global South, I underscore the paradox of everyday, intimate and transnational practices as symptomatic of the operations of a neo-colonial and global economy. In doing so, this approach sheds light on advancing cultural studies as an intellectual and political inquiry on rethinking mobility justice in a globalising and networked society.
Tailoring Cognitive Mapping Analysis Methods to Different Management Styles of Collective Action by Handling Actor Reasoning Diversity
Authors: Christiansen Gwen , Simonneaux Jean , Hazard Laurent
Published: November 2022

Collective action is needed to conceive and implement sustainability transitions within our society. Yet, it requires the coordination of a diversity of actors, each possessing their own reasoning. Integrating diversity, characterized by variety, disparity and balance, is thus a crucial methodological challenge to address, notably in order to enhance the quality of policy decisions concerning sustainability issues. Here we show how to tailor the way of collecting, analyzing and using actor reasoning diversity to the management style of collective action, characterized by the role the actors are allowed to play in defining collective action. To this purpose, we compare three design experiments using actor reasoning in the context of collective action aiming at developing sustainable food production: (1) considering actor reasoning in top-down decision-making (scallop fishery in Integrated Coastal Zone Management); (2) building consensus for a common strategy (quality in a sheep milk cooperative); and (3) fostering collective intelligence for individual and collective paths for action (agroecological transition of an agricultural territory). The diversity of actor reasoning in each of the design experiments was collected through cognitive mapping, a systemic representation tool adapted to represent actor reasoning. We propose a framework to adapt cognitive mapping methods to different management styles of collective action. In practice, adjusting the level and nature of the reasoning diversity considered at each step of a participatory process, through the way cognitive maps are collected and analyzed, is key to the tailoring of a cognitive mapping method to a management style of collective action. Overall, we show that the level of reasoning diversity considered in collective action should increase with actor involvement in analyses and decision-making.
Serial ultrasonographic imaging can predict failure after meniscus allograft transplantation
Authors: Cook James L , Cook Cristi R , Rucinski Kylee , Stannard James P
Published: November 2022

Introduction:

Treatment monitoring after meniscus allograft transplantation (MAT) is challenging. Ultrasonographic (US) imaging has been proposed as a modality that may allow for treatment monitoring after MAT, but has yet to be clinically validated for this purpose. The objective of this study was to assess the capabilities for serial US imaging during the first year after surgery to predict short-term MAT failure.

Methods:

Patients who had undergone Meniscus-only or Meniscus-Tibia MAT for treatment of medial or lateral meniscus deficiency were prospectively evaluated by US imaging at various time points after transplantation. Each meniscus was evaluated for abnormalities in echogenicity, shape, associated effusion, extrusion and extrusion with weightbearing (WB).

Results:

Data from 31 patients with a mean follow-up of 32 ± 16 (range, 12–55) months were analysed. MAT failure occurred in 6 patients (19.4%) at a median time point of 20 (range, 14–28) months with 4 (12.9%) converted to total knee arthroplasty. US imaging was effective for assessing MAT extrusion and imaging with WB demonstrated dynamic changes in MAT extrusion. US characteristics that were significantly associated with higher likelihood for MAT failure included abnormal echogenicity, localised effusion, extrusion with WB at 6 months, and localised effusion and extrusion with WB at 1 year.

Conclusions:

US assessments of meniscus allografts at 6 months after transplantation can effectively determine risk for short-term failure. Abnormal meniscus echogenicity, persistent localised effusion and extrusion with weightbearing were associated with 8–15 times higher odds for failure, which occurred at a median of 20 months post-transplantation.
Introduction to the Special Issue: Creating Social Capital through School Counselor-Principal Collaboration
Authors: Dahir Carol , Geesa Rachel Louise
Published: November 2022

Intentional collaboration among school principals and school counselors can improve the student experience by better meeting students’ social/emotional, academic, and career and college readiness needs. In this special issue, we seek to share the many ways school counselors and school administrators (e.g., principals, assistant principals) can effectively work together to ensure that school counseling programs throughout pre-K–12 schools are comprehensive, support equitable opportunities, and empower all students to experience success. This special issue includes 11 articles representing conceptual, qualitative, quantitative, mixed-methods, and best practices methodologies with a commitment to equity and access while simultaneously bridging social capital to create networks of resources within the school and the community to support all students.
A Culturally Affirming Shared Leadership Framework
Authors: Gibson Eva M. , Thompson James M. , Cook Sandifer Mariama I. , Brant-Rajahn Sarah N.
Published: November 2022

The American School Counselor Association (ASCA) encourages school counselors to promote equity experiences for all students through leadership, advocacy, and collaboration. School counselors and school administrators (e.g., principals, assistant principals) are uniquely positioned to combine their social capital in an effort to create a positive school culture and empower students who have been historically oppressed. We acknowledge the existence of current leadership approaches applicable to the educational setting; however, the literature lacks action steps for these professionals to collaboratively utilize their leadership skills as they champion social justice. Therefore, we present a culturally affirming, shared leadership framework that may be applied within P–12 schools and school counselor and leadership educator preparation programs.
Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation
Authors: Miller Matt , Latt L. Daniel , Ahmad Aamir N. , Taljanovic Mihra S.
Published: November 2022

Category:

Ankle

Introduction/Purpose:

Suspected peroneal tendinopathy, tears, and subluxation are often confirmed using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). The choice between these two imaging modalities is commonly based on surgeon preference as the accuracy of these tests for the diagnosis of peroneal tendinopathy, tears, and subluxation is not known. The purpose of this study was to compare MRI and US to the intraoperative findings in patients who underwent surgery for the treatment of suspected peroneal tendinopathy, tears, and subluxations to determine the diagnostic accuracy of each imaging modality.

Methods:

The operative records and diagnostic images for 21 patients who underwent surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. Two fellowship trained musculoskeletal radiologists conducted a systematic blinded review of the stored MRI and US images. The results of this review were compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality.

Results:

For the diagnosis of peroneus brevis tears, both MRI and ultrasound were equally good at detecting tears. In the diagnosis of peroneus brevis tears, MRI was marginally better with a sensitivity and specificity of 100% versus ultrasound, which had a sensitivity of 90% and specificity of 100%. In the diagnosis of peroneal subluxation, ultrasound had a sensitivity of 100% and a specificity of 100% compared to MRI, which had a sensitivity of 33% and specificity of 100%.

Conclusion:

In comparing MRI and US to intraoperative findings for the diagnosis of peroneal tendinosis, tears and subluxation, we found ultrasound to be more effective at diagnosing peroneal tendinopathy and subluxation, while MRI was found to be slightly more accurate in the diagnosis of peroneus brevis tendon tears. Both MRI and ultrasound were effective for the diagnosis of peroneus longus tears.
Emergency Department Visits for Ankle Fractures: Trends Through COVID-19
Authors: Mo Kevin C. , Gupta Arjun , Ortiz-Babilonia Carlos D. , Mun Frederick , Malan Sam A. , Aiyer Amiethab A.
Published: November 2022

Category:

Ankle

Introduction/Purpose:

Ankle fractures are common and can potentially lead to devastating consequences if not treated appropriately. The aim of this study was to assess trends in incidence, presentation, causes, and final disposition of emergency department visits for ankle fractures from 2019 to 2020.

Methods:

The National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS databases contains variables such as age, race, drug use, alcohol use, location, disposition, cause, body part, and injury type. The NEISS database from 2001 to 2020 was queried for patients who sustained an ankle fracture. Two cohorts: before COVID-19 (BC) (July 2019 - Dec 2019) and during COVID-19 (DC) (July 2020 - Dec 2020) were compared.

Results:

This study assessed 3,350 (NE: 131, 672) total patients who presented to emergency departments around the United States. 1,683 (NE: 17,936) patients presented BC and 1,667 (NE: 64,380) DC, representing a 4% decrease compared to the year before. The median age was 44 (Interquartile Range (IQR) 24-62), with 60% (NE: 79,051) females. On bivariate analysis, the rate of alcohol related ankle fractures increased (1.9% BC vs. 2.6% DC; p<0.001). Further, the number of ankle fractures at school (3% BC vs. 0.7% DC; p<0.001) and during sports (19% BC vs. 14% DC) decreased. Emergency departments visits leading to hospitalization increased (23% BC vs. 24% DC). The top three causes of ankle fracture during COVID-19 were stairs (NE 18,026, 28%), floors (NE 4,635, 7.2%), and skateboards (4.40%). The three largest increases in ankle fracture etiologies during COVID-19 were skateboards (+2.80%), floors (+1.10%), and powered scooters (+0.80%).

Conclusion:

There was a decrease in ankle fractures during the COVID-19 pandemic compared to the year before. Drug related fractures increased as did those resulting in hospitalization. Fractures caused by skateboards, powered scooters, and mopeds experienced an increase during COVID-19.
The complement receptor C3AR constitutes a novel therapeutic target in NPM1-mutated AML
Authors: von Palffy Sofia , Thorsson Hanna , Peña-Martínez Pablo , Puente-Moncada Noelia , Sandén Carl , Blom Anna M. , Henningsson Rasmus , Juliusson Gunnar , King Ben , Landberg Niklas , Lazarevic Vladimir , Orsmark-Pietras Christina , Rissler Marianne , Rissler Vendela , Ågerstam Helena , Järås Marcus , Lilljebjörn Henrik , Fioretos Thoas
Published: November 2022

Mutated nucleophosmin 1 (NPM1) is the most common genetic alteration in acute myeloid leukemia (AML), found in ∼30% of cases. Although mutations in this gene are considered favorable according to current risk stratification guidelines, a large fraction of patients will experience relapse, demonstrating the urgent need for new treatment options. Therefore, we aimed to identify cell surface proteins specifically expressed on NPM1-mutated AML cells, allowing for potential targeting with antibody-based therapies. Herein, we report on an arrayed flow cytometry–based screen directed to 362 cell surface markers. In comparing the cell surface expression on NPM1-mutated AML cells with primitive (CD34+ CD38−) normal bone marrow cells, we identified the complement receptor C3AR as being specifically expressed in NPM1-mutated AML. By flow cytometry and single-cell RNA sequencing, we further show that normal hematopoietic stem and progenitor cells lack detectable C3AR gene and protein expression, making it particularly suitable as a target for antibody therapy. We also demonstrate that C3AR in combination with GPR56 distinguishes the leukemic stem cells (LSCs) in NPM1-mutated AML from the normal hematopoietic stem cells, defining the LSC population, as shown by transplantation into immunodeficient mice. Mechanistically, the stimulation of C3AR-expressing cells with C3a, the ligand of C3AR, leads to the activation of ERK1/2 and increased survival of AML cells, suggesting that this is an important signaling axis in this subtype of AML. Finally, we show that antibodies directed against C3AR efficiently elicit natural killer cell–mediated killing of primary AML cells ex vivo, highlighting C3AR as a candidate therapeutic target in NPM1-mutated AML.
Extracorporeal carbon dioxide removal in acute hypoxaemic respiratory failure: a systematic review, Bayesian meta-analysis and trial sequential analysis
Authors: Millar Jonathan E. , Boyle Andrew J. , Drake Thomas M. , Adams Claire E. , Glass Adam W. , Blackwood Bronagh , McNamee James J. , McAuley Daniel F.
Published: November 2022

Purpose:

To assess the safety and efficacy of extracorporeal carbon dioxide removal (ECCO2R)versusstandard care in patients with acute hypoxaemic respiratory failure (AHRF).

Methods:

MEDLINE, Embase and clinical trial registries were searched from 1994 to 31 December 2021. We included randomised controlled trials (RCTs) and observational studies. Pairs of reviewers independently extracted data and assessed the risk of bias. The primary outcome was mortality. Secondary outcomes included ventilator-free days, length of stay, safety and adverse events and physiological changes. As a primary analysis, we performed a meta-analysis of mortality until day 30 using a Bayesian random effects model. We then performed a trial sequential analysis of RCTs.

Results:

21 studies met inclusion criteria: three RCTs, enrolling 531 patients, and 18 observational studies. In a pooled analysis of RCTs, the posterior probability of increased mortality with the use of ECCO2R was 73% (relative risk 1.19, 95% credible interval 0.70–2.29). There was substantial heterogeneity in the reporting of safety and adverse events. However, the incidence of extra and intracranial haemorrhage was higher (relative risk 3.00, 95% credible interval 0.41–20.51) among those randomised to ECCO2R. Current trials have accumulated 80.8% of the diversity-adjusted required information size and the lack of effect reaches futility for a 10% absolute risk reduction in mortality.

Conclusions:

The use of ECCO2R in patients with AHRF is not associated with improvements in clinical outcomes. Furthermore, it is likely that further trials of ECCO2R aiming to achieve an absolute risk reduction in mortality of ≥10% are futile.
Ribosomal protein RPL5 regulates colon cancer cell proliferation and migration through MAPK/ERK signaling pathway
Authors: Zhang Huahua , Liu Junli , Dang Qingqing , Wang Xueru , Chen Jie , Lin Xiaoyin , Yang Na , Du Juan , Shi Haiyan , Liu Yong , Han Jiming
Published: November 2022

Background

Abnormal expression of ribosomal proteins has an important regulatory effect on the progression of cancer. RPL5 is involved in the progression of various malignancies, however, the role of RPL5 in colon cancer remains is still unclear.

Methods

Data from TCGA and GTEx databases were used to analyze the RPL5 expression in pan-cancer. The expression level of RPL5 in clinical colon cancer tissue samples and human colon cancer cell lines was detected by western blotting; siRNA targeting RPL5 was designed, and its interference efficiency was verified by western blotting and RT-qPCR; CCK8 assay, clone formation assay, cell cycle assay, and cell scratch assay were used to observe the effect of RPL5 on colon cancer cell proliferation and migration; the changes of proteins related to MAPK/ERK signaling pathway were also detected using western blotting.

Results

The expression level of RPL5 in colon cancer tissues and cell lines was significantly higher than that in adjacent tissues and NCM460 cells, respectively, and its expression level was higher in HCT116 cells and RKO cells. Knockdown of RPL5 significantly inhibited the proliferation and migration of HCT16 and RKO cells, and arrested the cell cycle in G0/G1 phase. Mechanistic studies revealed that the expression of p-MEK1/2, p-ERK, c-Myc were down-regulated, and the expression of FOXO3 was up-regulated after down-regulation of RPL5, ERK activator (TBHQ) could partially reverse the above-mentioned effects caused by siRPL5. Moreover, TBHQ could partially reverse the inhibitory effect of siRPL5 on the proliferation and migration of colon cancer cells. Collectively, RPL5 promoted colon cell proliferation and migration, at least in part, by activating the MAPK/ERK signaling pathway.

Conclusion

RPL5 promoted colon cell proliferation and migration, at least in part, by activating the MAPK/ERK signaling pathway, which may serve as a novel therapeutic target for cancers in which MAPK/ERK signaling is a dominant feature.
Prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran: a multi-criteria decision-making approach
Authors: Aliasgharzadeh Soghra , Ebrahimi-Mameghani Mehrangiz , Mahdavi Reza , Karimzadeh Hossein , Nikniaz Leila , Tabrizi Jafar Sadegh , Pourali Fathollah
Published: November 2022

Background

Numerous nutrition-related policy options and strategies have been proposed to tackle hypertension and other risk factors of non-communicable diseases (NCDs). In this study, we developed a comparative analysis using a multi-criteria decision-making (MCDM) model for prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran.

Methods

We employed a combination of Delphi technique and Analytic Hierarchy Process (AHP) method as the methodological tool to prioritize decision alternatives using multiple criteria. The prominent assessment criteria and intervention strategies were derived using a literature review, focus group discussion (n = 11), and a 2-round modified Delphi technique with specialists and experts involved in different stages of health policy-making (round 1:n = 50, round 2:n = 46). Then, the AHP was used to determine the weightage of the selected interventions and develop the decision-making model. The sensitivity analysis was performed to test the stability of the priority ranking.

Results

Nine alternative interventions were included in the final ranking based on eight assessment criteria. According to the results, the most priority interventions to prevent and control hypertension included reformulation of food products to contain less salt and changing the target levels of salt in foods and meals, providing low-sodium salt substitutes, and reducing salt intake through the implementation of front-of-package labeling (FOPL). The results of the sensitivity analysis and a comparison analysis suggested that the assessment model performed in this study had an appropriate level of robustness in selecting the best option among the proposed alternatives.

Conclusion

MCDM techniques offer a potentially valuable approach to rationally structuring the problem, along with the opportunity to make explicit the judgments used as part of the decision-making model. The findings of this study provide a preliminary evidence base to guide future decisions and reforms aiming to improve appropriate population-based interventions for tackling hypertension and other risk factors of NCDs.
Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control
Authors: Wen Ruiling , Li Xinying , Liu Tingting , Lin Guihong
Published: November 2022

Background

The systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.

Methods

A retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.

Results

A total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).

Conclusion

The adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.
Protocol for the postoperative radiotherapy in N1 breast cancer patients (PORT-N1) trial, a prospective multicenter, randomized, controlled, non-inferiority trial of patients receiving breast-conserving surgery or mastectomy
Authors: Lee Tae Hoon , Chang Ji Hyun , Jang Bum-Sup , Kim Jae Sik , Kim Tae Hyun , Park Won , Kim Yong Bae , Kim Su Ssan , Han Wonshik , Lee Han-Byoel , Shin Kyung Hwan
Published: November 2022

Background

Postoperative radiotherapy (PORT) could be useful for pN1 breast cancer patients who have undergone breast-conserving surgery (BCS) or mastectomy. However, the value of regional nodal irradiation (RNI) for BCS patients, and the indications for post-mastectomy radiotherapy (PMRT) for pN1 breast cancer mastectomy patients, have recently been challenged due to the absence of relevant trials in the era of modern systemic therapy. “PORT de-escalation” should be assessed in patients with pN1 breast cancer.

Methods

The PORT-N1 trial is a multicenter, randomized, phase 3 clinical trial for patients with pN1 breast cancer that compares the outcomes of control [whole-breast irradiation (WBI) and RNI/PMRT] and experimental (WBI alone/no PMRT) groups. PORT-N1 aims to demonstrate non-inferiority of the experimental group by comparing 7-year disease-free survival rates with the control group. Female breast cancer patients with pT1-3 N1 status after BCS or mastectomy are eligible. Participants will be randomly assigned to the two groups in a 1:1 ratio. Randomization will be stratified by surgery type (BCS vs. mastectomy) and histologic subtype (triple-negative vs. non-triple-negative). In patients who receive mastectomy, dissection of ≥5 nodes is required when there is one positive node, and axillary lymph node dissection when there are two or three positive nodes. Patients receiving neoadjuvant chemotherapy are not eligible. RNI includes a “high-tangent” or wider irradiation field. This study will aim to recruit 1106 patients.

Discussion

The PORT-N1 trial aims to verify that PORT de-escalation after BCS or mastectomy is safe for pN1 breast cancer patients in terms of oncologic outcomes and capable of reducing toxicity rates. This trial will provide information crucial for designing PORT de-escalation strategies for patients with pN1 breast cancer.

Trial registration

This trial was registered at ClinicalTrials.gov (NCT05440149) on June 30, 2022.
An update on explaining the rural-urban gap in under-five mortality in India
Authors: Kumar Chandan , Piyasa  , Saikia Nandita
Published: November 2022

Background

Rural Indians have higher mortality rates than urban Indians. However, the rural-urban gap in under-five mortality has changed is less researched. This paper aims to assess 1) whether the rural-urban gap in under-five mortality has reduced over time 2) Whether rural children are still experiencing a higher likelihood of death after eliminating the role of other socioeconomic factors 3) What factors are responsible for India’s rural-urban gap in under-five mortality.

Methods

We used all rounds for National Family Health Survey data for understanding the trend of rural-urban gap in under-five mortality. Using NFHS-2019-21 data, we carried out a binary logistic regression analysis to examine the factors associated with under-five mortality. Fairlie’s decomposition technique was applied to understand the relative contribution of different covariates to the rural–urban gap in under-five mortality.

Results

India has witnessed a more than 50% reduction in under-five mortality rate between 1992 and 93 and 2019–21. From 1992 to 93 to 2019–21, the annual decrease in rural and urban under-five mortality is 1.6% and 2.7%, respectively. Yet, rural population still contributes a higher proportion of the under-five deaths. The rural-urban gap in under-five mortality has reduced from 44 per thousand live births in 1992–1993 to 30 per thousand in 2004–2005 which further decreased to 14 per thousand in 2019–2021. There is no disadvantage for the rural children due to their place of residence if they belong to economically well-off household or their mothers are educated. It is wealth index rather than place of residence which determines the under-five mortality. Economic (50.82% contribution) and educational differential (28.57% contribution) are the main reasons for rural-urban under-five mortality gaps.

Conclusion

The existing rural-urban gap in under-five mortality suggests that the social and health policies need to be need to reach rural children from poor families and uneducated mothers. This call for attention to ensure that the future programme must emphasize mothers from economically and educationally disadvantaged sections. While there should be more emphasis on equal access to health care facilities by the rural population, there should also be an effort to strengthen the rural economy and quality of education.