bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis
Authors: Bali Vishal , Schelfhout Jonathan , Sher Mandel R. , Tripathi Peters Anju , Patel Gayatri B. , Mayorga Margaret , Goss Diana , Romano Carla (DeMuro)
Published: March 2024

Background:

Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals’ lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies.

Objectives:

The primary objectives of this study were to assess respondents’ perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships.

Design:

Qualitative study.

Methods:

This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes.

Results:

A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0–24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents.

Conclusion:

RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals’ lived experiences may inform the development of RCC and UCC therapeutic strategies.
Tibialis Anterior Tendon Reconstruction Utilizing Split Tendon Turn-down: A Case Report and Technique Guide
Authors: Hill Zachary , Stone Ryan , Holmes Timothy
Published: March 2024

Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient’s postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.

Level of Evidence: Level V
Presidential Authority and the Legitimation of Far-Right News
Authors: Archer Allison M. N. , Schmitt Carolyn E. , McGregor Shannon C. , Jang Heesoo
Published: March 2024

What position do far-right news outlets occupy in contemporary U.S. politics, and how did Trump use the power of the presidency to contribute to their rise among Republican legislators and mainstream American media? We posit that Trump’s position as president, in conjunction with his populist communication style that favored far-right outlets, contributed to the legitimation of such outlets. We first analyze Trump’s tweets during his presidency (January 2017–January 2021) mentioning three far-right outlets (One America News Network, Newsmax, and Breitbart), conceptualizing these messages as authority signals that symbolically lend legitimacy to the media sources. We then provide rich descriptive information regarding subsequent mentions of the far-right outlets in four national mainstream newspapers as well as appearances by GOP (Republican) members of Congress in the far-right outlets. We find significant and positive correlations between Trump’s tweets and mainstream media coverage of One America News Network (OANN) and Newsmax, and significant and positive correlations between Trump’s tweets and GOP Congressional interviews on OANN and Newsmax. Together, these results represent an example of presidential authority signals that bolster far-right outlets and aid in their legitimization among legislators and the mainstream press. The findings shed light on the role of political leaders in the recent mainstreaming of the far-right across many democratic countries.
Safeguarding the Peaceful Transfer of Power: Pro-Democracy Electoral Frames and Journalist Coverage of Election Deniers During the 2022 U.S. Midterm Elections
Authors: Jang Heesoo , Kreiss Daniel
Published: March 2024

This study develops a new normative and analytical framework of “democracy-framed electoral coverage” grounded in literatures that stress the role of governmental and communicative institutions in protecting democracies from threats. We define “democracy-framed electoral coverage” as journalism that embraces fairly contested elections as an established norm and political ideal, and clearly alerts the public to threats to the peaceful transfer of power. Using the U.S. as a case study of a consolidated democracy facing autocratization threats, the study applies the framework to analyze a comprehensive dataset of 708 articles encompassing twenty one races during the 2022 U.S. midterm elections when candidates who denied the results of the 2020 presidential election were on the ballot. Additionally, we conducted interviews with twelve journalists to evaluate their perspectives and practices regarding election denying candidates. We find that journalists routinely failed to alert the public to the threat posed by candidates unwilling to embrace the legitimacy of U.S. elections. This paper demonstrates the necessity of a normative framework for pro-democracy election coverage, and the findings underscore the electoral fragility of the U.S.—a case of a democracy undergoing autocratization processes and facing threats to the legitimacy of its elections and the peaceful transfer of power.
A Traumatic Impact Immediately Changes the Mechanical Properties of Articular Cartilage
Authors: Blom Robin P. , Rahim Danka , Paardekam Erik , Kerkhoffs Gino M. M. J. , Iannuzzi Davide , Smit Theodoor H.
Published: March 2024

Objective

To investigate whether and how a single traumatic impact changes the mechanical properties of talar articular cartilage.

Design

A marble was placed on the joint surface and a weight was dropped on both medial and lateral caprine talus to create a well-defined single focal impact. The mechanical properties of intact and impacted talar cartilage were measured with a micro-indenter. Elastic (storage) and viscous (loss) moduli were determined by oscillatory ramp and dynamic mechanical analysis protocols.

Results

We found significant differences between ankles and within the same ankle joint, with the medial talus having significantly higher storage- and loss moduli than the lateral talus. The storage- and loss moduli of intact articular cartilage increased with greater indentation depths. However, postimpact the storage- and loss moduli were significantly and consistently lower in all specimens indicating immediate posttraumatic damage. The deeper regions of talar cartilage were less affected by the impact than the more superficial regions.

Conclusions

A single traumatic impact results in an immediate and significant decrease of storage- and loss moduli. Further research must focus on the development of non- or minimally invasive diagnostic tools to address the exact microdamage caused by the impact. We speculate that the traumatic impact damaged the collagen fibers that confine the water-binding proteoglycans and thereby decreasing the hydrostatic pressure of cartilage. As part of the treatment directly after a trauma, one could imagine a reduction or restriction of peak loads to prevent the progression of the cascade towards PTOA of the ankle joint.
Development of a mobile app to optimize organization and assessment for clinical teaching in dentistry
Authors: Schick Simona , Eberhard Lydia , Wettach Luis , Fazeli Shila , Heberle Andreas , Neumann Rainer , Miebach Jörg , Titz Stefan , Fuchs Jennifer , Sen Sinan , Lux Christopher , Frese Cornelia
Published: March 2024

The aim of the current study was to develop an application for mobile devices that can improve the organization and documentation of clinical teaching in dental schools. The app should include a calendar to organize treatments, an overview of all treatments including the treatment stages, a digital waiting-list for the teacher’s assessment, and a standardized recording of all assessment results. Students and members of a Medical Faculty and a Faculty of Computer Science and Business Information Systems jointly developed the app. Twenty-three students tested the usability after 4 weeks. Next, the new app was tried and tested by n = 79 forth-year students who used it for 2 months during their clinical course. Fifth-year students of the same clinical course who did not use the app constituted the control group. Afterwards, the app was standard implemented in both integrated clinical courses and evaluated after 1 year by the same students both in winter and summer semester. After usability test, the majority of students (81%, n = 18) said they would recommend the app and gave it a mean overall score of 2.0 ± 0.6. Next, course organization and assessment was evaluated by n = 75 fourth-year students (95%) who used the app and by n = 40 control students (74%) who did not use the app. Students who used the app reported significantly better organization of treatment ( p = .002), documentation of treatment ( p = .001), waiting for the teacher’s assessment ( p = .038), overview of treatment sessions ( p = .040), and transparency of grading and assessment ( p = .012). After 12 months, the now fifth-year students still gave very good ratings for the organization of the treatment and the transparency of the grading in both evaluations, so that no significant changes were detectable (organization p = .959 and the rating p = .751). The newly created app improves the organization and evaluation of clinical education and even after 1 year of service, the students still perceive the consistently high advantages of digitization.
Principles and clinical applications of transcutaneous laser-assisted drug delivery: A narrative review
Authors: Liu Baoyi , Sood Rajiv , Wang Fuyang , Zhang Feng , Sun Lu , Qiu Xing , Zhao Dewei , Lineaweaver William Charles
Published: March 2024

Introduction

Transcutaneous laser-assisted drug delivery (LADD) is recognized as a developing therapy for skin disorders.

Method

Current literature was reviewed to summarize current applications for LADD.

Discussion

12 clinical applications for this therapy are currently reported.

Conclusion

LADD has potential for wide application in skin disorder treatment.

Lay Summary

Laser assisted drug delivery improves drug bioavailability for treatment of skin disorders. This technique is being assessed clinically in disorders ranging from skin cancers to alopecia.
Effect of a Multidisciplinary Review Panel on Daily Morphine Milligram Equivalents for Patients With Chronic Pain
Authors: Kauppila Glenn R. , Strahm Sarah M. , Vogel Erica L. , Raap Stephanie M. , Cash Dana H. , Yost Kaitlin J.
Published: March 2024

Introduction/Objective:

Physicians and other health care professionals are challenged regularly to balance managing pain for patients with chronic pain receiving chronic opioid therapy (COT) with following the national guidelines and standards regarding daily morphine milligram equivalents (MME). This quality improvement project aimed to determine the effect of referral to a multidisciplinary review panel on daily MME for patients receiving COT for chronic pain.

Methods:

This quality improvement project included patients who had an established relationship with a primary care or community internal medicine clinician at a large health care organization and were referred to a newly created multidisciplinary review panel for their recommendations regarding treatment of pain. Criteria for patient referral were diagnosis of a chronic, painful condition, and use of chronic opioid medications. These patients were selected and referred at the discretion of their primary care clinician from January 2, 2019, through December 31, 2020. Data for this project were collected at the time of initial referral to the panel and 6 months after recommendations. The daily MME were assessed at the 2 time points.

Results:

Thirteen patients were referred to the review panel during the project period. The median daily MME at the time of referral was 180. Daily MME decreased by a median of 14 MME after 6 months. The MME did not increase during the project period for any participants.

Conclusions:

Referral of patients receiving COT to a multidisciplinary review panel may reduce their daily opioid dose.
When Do Patients Achieve PROMIS Milestones After Rotator Cuff Repair?
Authors: Yedulla Nikhil R. , Mehta Nabil , Bernstein David N. , Cross Austin G. , Elhage Kareem G. , Moutzouros Vasilios , Makhni Eric C.
Published: March 2024

Background:

Given the variability of the questions asked, the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT) Version 2.0 item bank aids in the evaluation of rotator cuff repair (RCR) rehabilitation by determining when recovery milestones are possible based on the quality of patient responses at certain time points.

Purpose:

To assess the time point at which patients with RCR were able to achieve specific functional milestones, determined as positive responses to the 5 most frequently asked items on the PROMIS UE CAT Version 2.0.

Study Design:

Case series; Level of evidence, 4.

Methods:

The postoperative PROMIS UE CAT Version 2.0 scores of patients who underwent RCR between February 16, 2017, and July 30, 2019, were reviewed with respect to individual PROMIS item, response, and timing of response. A functional milestone was considered achieved if the patient response was “without any difficulty” or “with a little difficulty” to any of the 5 most frequently asked PROMIS items. The percentage of patients in each monthlong postoperative interval who answered with either response was recorded. The logit generalized estimating equations method was used to analyze the association between milestone achievement for each PROMIS item and predictor variables (age, sex, body mass index, smoking status, race, ethnicity, and employment status).

Results:

A total of 1131 responses from 371 patients were included. The majority of patients attained milestone achievement on 4 of the 5 most frequently asked PROMIS items at time points ranging from 1 to 5 months postoperatively: “Are you able to carry a shopping bag or briefcase?” (by 1 month), “Are you able to put on and take off a coat or jacket?” (by 3 months), “Are you able to pour liquid from a bottle into a glass?” (by 3 months), and “Are you able to carry a heavy object (over 10 pounds/5 kg)?” (by 5 months). For the item “Are you able to put on a shirt or blouse?”, the majority of patients did not achieve the milestone by 1 year.

Conclusion:

These findings support the application of PROMIS UE CAT Version 2.0 milestone achievement in the shared decision-making process and postoperative monitoring, as patients can use this information to determine when they can return to certain activities and providers can apply these standards to identify patients needing additional clinical support.
Unmet Needs and Care Delivery Gaps Among Rural Cancer Survivors
Authors: Stout Nicole L , Boatman Dannell , Rice Madeline , Branham Emelia , Miller Meadow , Salyer Rachel
Published: March 2024

Community-based healthcare delivery systems frequently lack cancer-specific survivorship support services. This leads to a burden of unmet needs that is magnified in rural areas. Using sequential mixed methods we assessed unmet needs among rural cancer survivors diagnosed between 2015 and 2021. The Supportive Care Needs Survey (SCNS) assessed 5 domains; Physical and Daily Living, Psychological, Support and Supportive Services, Sexual, and Health Information. Needs were analyzed across domains by cancer type. Survey respondents were recruited for qualitative interviews to identify care gaps. Three hundred and sixty two surveys were analyzed. Participants were 85% White (n = 349) 65% (n = 234) female and averaged 2.03 years beyond cancer diagnosis. Nearly half (49.5%) of respondents reported unmet needs, predominantly in physical, psychological, and health information domains. Needs differed by stage of disease. Eleven interviews identified care gap themes regarding; Finding Support and Supportive Services and Health Information regarding Care Delivery and Continuity of Care. Patients experience persistent unmet needs after a cancer diagnosis across multiple functional domains. Access to community-based support services and health information is lacking. Community based resources are needed to improve access to care for long-term cancer survivors.
MRI hypoperfusion as a determinant of cognitive impairment in adults with Moyamoya angiopathy
Authors: Giroud Marine , Planton Mélanie , Darcourt Jean , Raposo Nicolas , Brandicourt Pierre , Mirabel Hélène , Hervé Dominique , Viguier Alain , Albucher Jean-François , Pariente Jérémie , Olivot Jean Marc , Bonneville Fabrice , Péran Patrice , Calviere Lionel
Published: March 2024

Introduction:

In Moyamoya angiopathy (MMA), mechanisms underlying cognitive impairment remain debated. We aimed to assess the association of cognitive impairment with the degree and the topography of cerebral hypoperfusion in MMA.

Methods:

A retrospective analysis of neuropsychological and perfusion MRI data from adults with MMA was performed. Ischemic and haemorrhagic lesion masks were created to account for cerebral lesions in the analysis of cerebral perfusion. Whole brain volume of hypoperfused parenchyma was outlined on perfusion maps using different Tmax thresholds from 4 to 12 s. Regional analysis produced mean Tmax values at different regions of interest. Analyses compared perfusion ratios in patients with and without cognitive impairment, with multivariable logistic regression analysis to identify predictive factors.

Results:

Cognitive impairment was found in 20/48 (41.7%) patients. Attention/processing speed and memory were equally impaired (24%) followed by executive domain (23%). After adjustment, especially for lesion volume, hypoperfused parenchyma volume outlined by Tmax > 4 s or Tmax > 5 s thresholds was an independent factor of cognitive impairment (OR for Tmax > 4 s = 1.06 [CI 95% 1.008–1.123]) as well as attention/processing speed (OR for Tmax > 4 s = 1.07 [CI 95% 1.003–1.133]) and executive domains (OR for Tmax > 5 s = 1.08 [CI 95% 1.004–1.158]). Regarding cognitive functions, patients with processing speed and flexibility impairment had higher frontal Tmax compared to other ROIs and to patients with normal test scores.

Discussion:

Cerebral hypoperfusion emerged as an independent factor of cognitive impairment in MMA particularly in attention/processing speed and executive domains, with a strong contribution of frontal areas.

Conclusion:

Considering this association, revascularization surgery could improve cognitive impairment.
A phase 1 study of the irreversible FLT3 inhibitor FF-10101 in relapsed or refractory acute myeloid leukemia
Authors: Levis Mark , Perl Alexander , Schiller Gary , Fathi Amir T. , Roboz Gail , Wang Eunice S. , Altman Jessica , Rajkhowa Trivikram , Ando Makoto , Suzuki Takeaki , Subach Ruth Ann , Maier Gary , Madden Timothy , Johansen Mary , Cheung Kin , Kurman Michael , Smith Catherine
Published: March 2024

FLT3 tyrosine kinase inhibitors (TKIs) have clinical efficacy for patients with FLT3-mutated AML (acute myeloid leukemia), but their impact is limited by resistance in the setting of monotherapy and by tolerability problems when used in combination therapies. FF-10101 is a novel compound that covalently binds to a cysteine residue near the active site of FLT3, irreversibly inhibiting receptor signaling. It is effective against most FLT3 activating mutations, and, unlike other inhibitors, is minimally vulnerable to resistance induced by FLT3 ligand. We conducted a phase 1 dose escalation study of oral FF-10101 in patients with relapsed and/or refractory AML, the majority of whom harbored FLT3-activating mutations and/or had prior exposure to FLT3 inhibitors. Fifty-four participants enrolled in cohorts receiving doses ranging from 10 to 225 mg per day and 50 to 100 mg twice daily (BID). The dose limiting toxicities were diarrhea and QT prolongation. Among 40 response-evaluable participants, the composite complete response rate was 10%, and the overall response rate (including partial responses) was 12.5%, including patients who had progressed on gilteritinib. Overall, 56% of participants had prior exposure to FLT3 inhibitors. The recommended phase 2 dose was 75 mg BID. FF-10101 potentially represents a next-generation advance in the management of FLT3-mutated AML. This trial was registered at www.ClinicalTrials.gov as #NCT03194685.
Plasmon assisted synthesis of TiN-supported single-atom nickel catalysts
Authors: De Silva Keeniya-Gamalage-Gehan Chaturanga , Helsel Naomi , Jeyashangararaj Hirithya Sharad , Choudhury Pabitra , Chowdhury Sanchari
Published: March 2024

We report the deposition of single atom nickel catalyst on refractory plasmonic titanium nitride (TiN) nanomaterials supports using the wet synthesis method under visible light irradiation. TiN nanoparticles efficiently absorb visible light to generate photoexcited electrons and holes. Photoexcited electrons reduce nickel precursor to deposit Ni atoms on TiN nanoparticles’ surface. The generated hot holes are scavenged by the methanol. We studied the Ni deposition on TiN nanoparticles by varying light intensity, light exposure time, and metal precursor concentration. These studies confirmed the photodeposition method is driven by hot electrons and helped us to find optimum synthesis conditions for single atoms deposition. We characterized the nanocatalysts using high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM), energy dispersive X-ray spectroscopy (EDX), and X-ray photoelectron spectroscopy (XPS). We used density functional theory (DFT) calculations to predict favorable deposition sites and aggregation energy of Ni atoms on TiN. Surface defect sites of TiN are most favorable for single nickel atoms depositions. Interestingly, the oxygen sites on native surface oxide layer of TiN also exhibit strong binding with the single Ni atoms. Plasmon enhanced synthesis method can facilitate photodeposition of single atom catalysts on a wide class of metallic supports with plasmonic properties.
Refining shape and size of silver nanoparticles using ion irradiation for enhanced and homogeneous SERS activity
Authors: Sherpa Laden , Nimmala Arun , Rao S. V. S. Nageswara , Khan S. A. , Pathak Anand P. , Tripathi Ajay , Tiwari Archana
Published: March 2024

We present green synthesis of silver nanoparticles in water using unirradiated and Ag$$^{15+}$$

15
+

ion irradiated phytoextracts of Bergenia Ciliata leaf, Eupatorium adenophorum leaf, Rhododendron arboreum leaf and flower. The use of different plant extracts and their subsequent ion irradiation allow for successful refinement of nanoparticle size and morphology. Due to changes in reducing and capping agents the nanoparticle surface functionalization also varies which not only controls the morphology but also allows for surface oxidation and aggregation processes. In this work, we have synthesized silver nanoparticles which exhibit sizes in the range from 13 to 24 nm and having shapes like spherical, quasispherical, trigonal, hexagonal, cylindrical, dendritic assemblies, and porous nanoparticles. Owing to changes in the size and shape of the nanoparticles, their direct bandgap (2.05 eV - 2.48 eV) and local surface plasmon resonance (420 nm - 490 nm) could also be tuned. These nanoparticles are examined as SERS substrates, where their enhancement factors, limit of detection for methylene blue, and SERS substrate homogeneity have been tested. It has been observed the nanoparticles synthesized using unirradiated plant extracts present an enhancement factor of 10$$^6$$

6

with a limit of detection 10$$^{-8}$$

-
8

M. Whereas nanoparticles with refined morphology and shapes upon irradiation present high enhancement factors of >10$$^7$$

7

and detection limit down to 10$$^{-9}$$

-
9

M. In addition, uniformity in Raman spectra over the SERS substrates has been obtained for selected Ag NPs substrates synthesized using irradiated extracts with minimum relative standard deviation in enhancement factor < 12%.
How can on-street parking regulations affect traffic, safety, and the environment in a cooperative, connected, and automated era?
Authors: Sha Hua , Haouari Rajae , Singh Mohit Kumar , Papazikou Evita , Quddus Mohammed , Chaudhry Amna , Thomas Pete , Morris Andrew
Published: March 2024

On-street parking is a commonly used form of parking facility as part of transportation infrastructure. However, the emergence of connected and autonomous vehicles (CAVs) is expected to significantly impact parking in the future. This study aims to investigate the impacts of on-street parking regulations for CAVs on the environment, safety and mobility in mixed traffic fleets. To achieve this goal, a calibrated and validated network model of the city of Leicester, UK, was selected to test the implementation of CAVs under various deployment scenarios. The results revealed that replacing on-street parking with driving lanes, cycle lanes, and public spaces can lead to better traffic performance. Specifically, there could be a 27–30% reduction in travel time, a 43–47% reduction in delays, more than 90% in emission reduction, and a 94% reduction in traffic crashes compared to the other tested measures. Conversely, replacing on-street parking with pick-up/drop-off stations may have a less significant impact due to increased stop-and-go events when vehicles pick-up and drop-off passengers, resulting in more interruptions in the flow and increased delays. The paper provides examples of interventions that can be implemented for on-street parking during a CCAM era, along with their expected impacts in order for regional decision-makers and local authorities to draw relative policies. By replacing on-street parking with more efficient traffic measures, cities can significantly improve mobility, reduce emissions, and enhance safety.
Biomass and energy potential of Erianthus arundinaceus and Saccharum spontaneum-derived novel sugarcane hybrids in rainfed environments
Authors: Meena Mintu Ram , Govindaraj Perumal , Kumar Raja Arun , Elayaraja Kandasamy , Appunu Chinnaswamy , Kumar Ravinder , Chhabra Manohar Lal , Kulshreshtha Neeraj , Hemaprabha Govind
Published: March 2024

Background

Energy canes are viable feedstocks for biomass industries due to their high biomass production potential, lower susceptibility to insects and diseases, better ability to adapt to extreme conditions and clean bioenergy. Interspecific hybrids (ISH) and intergeneric hybrids (IGH) have great potential to meet the growing demand of biomass, biomass-derived energy and feedstock.

Results

In this study, two types of energy canes, Type I and Type II, derived from S. spontaneum and E. arundinaceous background were evaluated for high biomass, fiber and bioenergy potential under subtropical climate along with the check varieties Co 0238 and CoS 767. Out of 18 energy canes studied, six energy canes, viz., SBIEC11008 (204.15 t/ha), SBIEC11005 (192.93 t/ha), SBIEC13008 (201.26 t/ha), SBIEC13009 (196.58 t/ha), SBIEC13002 (170.15 t/ha), and SBIEC13007 (173.76 t/ha), consistently outperformed the check varieties under Type-I, whereas in type-II, SBIEC11004 (225.78 t/ha), SBIEC11006 (184.89 t/ha), and SBIEC14006 (184.73 t/ha) energy canes produced significantly higher biomass than commercial checks, indicating their superior potential for cogeneration. Estimated energy output from the energy canes (700–1300 GJ/ha/year) exceeded the range of co-varieties (400–500 GJ/ha/year) and energy utilization efficiency in plants and ratoon crops for energy canes viz., SBIEC11008 (3%, 1.97%), SBIEC14006 (1.93%, 2.4%), SBIEC11005 (1.7%, 1.9%), and SBIEC11001 (1.01%, 1.03%), was higher than best checks Co 0238 (0.77, 0.9%). Additionally, energy canes SBIEC 13001 (22.35%), SBIEC 11008 (22.50%), SBIEC 14006 (28.54%), SBIEC 11004 (30.17%) and SBIEC 11001 (27.03%) had higher fiber contents than the co-varieties (12.45%).

Conclusion

The study gives insight about the potential energy canes for higher biomass and energy value. These energy cane presents a vital option to meet the future demand of bioenergy, fiber and fodder for biomass due to their versatile capacity to grow easily under marginal lands without competing with cultivated land worldwide.
Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis
Authors: Yu Yun , Fu Yuxuan , Li Wenying , Sun Tiantian , Cheng Chan , Chong Yingzi , Han Ruquan , Cui Weihua
Published: March 2024

Background

Anemia can lead to secondary brain damage by reducing arterial oxygen content and brain oxygen supply. Patients with acute brain injury have impaired self-regulation. Brain hypoxia may also occur even in mild anemia. Red blood cell (RBC) transfusion is associated with increased postoperative complications, poor neurological recovery, and mortality in critically ill neurologic patients. Balancing the risks of anemia and red blood cell transfusion-associated adverse effects is challenging in neurocritical settings.

Methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE (PubMed) from inception to January 31, 2024. We included all randomized controlled trials (RCTs) assessing liberal versus restrictive RBC transfusion strategies in neurocritical patients. We included all relevant studies published in English. The primary outcome was mortality at intensive care unit (ICU), discharge, and six months.

Results

Of 5195 records retrieved, 84 full-text articles were reviewed, and five eligible studies were included. There was no significant difference between the restrictive and liberal transfusion groups in ICU mortality (RR: 2.53, 95% CI: 0.53 to 12.13), in-hospital mortality (RR: 2.34, 95% CI: 0.50 to 11.00), mortality at six months (RR: 1.42, 95% CI: 0.42 to 4.78) and long-term mortality (RR: 1.22, 95% CI: 0.64 to 2.33). The occurrence of neurological adverse events and most major non-neurological complications was similar in the two groups. The incidence of deep venous thrombosis was lower in the restrictive strategy group (RR: 0.41, 95% CI: 0.18 to 0.91).

Conclusions

Due to the small sample size of current studies, the evidence is insufficiently robust to confirm definitive conclusions for neurocritical patients. Therefore, further investigation is encouraged to define appropriate RBC transfusion thresholds in the neurocritical setting.
The association of low serum uric acid with mortality in older people is modified by kidney function: National Health and Nutrition Examination Survey (NHANES) 1999–2018
Authors: Fan Zhongcheng , Li Zhongju , Guo Aixin , Li Yang
Published: March 2024

Background

In older individuals, the role of low serum uric acid (SUA) as risk factor for mortality is debated. We therefore studied whether SUA levels, particularly low SUA concentrations, are associated with all-cause and cardiovascular (CV) mortality in older population, and to clarify potential effect modification of kidney function.

Methods

We identified 14,005 older people in National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018. SUA was measured only at baseline. The relationship between SUA and mortality was assessed using Cox proportional hazards models and restricted cubic spline Cox regression stratified by the estimated glomerular filtration rate (eGFR).

Results

During mean 8.3 years of follow-up, 4852 all-cause death and 1602 CV death were recorded. A significant U-shaped association was observed between SUA with all-cause mortality, with the lowest risk concentration of 5.5 mg/dL. Comparing to the reference group (5 to 7 mg/dL), the HR of 2 to < 5 mg/dL group was 1.11 (1.03–1.21) and 1.14 (1.00–1.30). This relationship was more pronounced in participants with an eGFR ≥ 60 ml/min/1.73m2 (HR, 1.16; 95%CI, 1.06—1.28). This situation similarly occurred in Urine protein negative group (HR, 1.14; 95%CI, 1.04—1.25).

Conclusions

Low SUA concentrations are associated with an increased risk in all-cause and CV mortality among older participants. Extremely low SUA concentrations are especially undesirable, especially in the older adults with normal kidney function.
Convolutional neural network-based magnetic resonance image differentiation of filum terminale ependymomas from schwannomas
Authors: Gu Zhaowen , Dai Wenli , Chen Jiarui , Jiang Qixuan , Lin Weiwei , Wang Qiangwei , Chen Jingyin , Gu Chi , Li Jia , Ying Guangyu , Zhu Yongjian
Published: March 2024

Purpose

Preoperative diagnosis of filum terminale ependymomas (FTEs) versus schwannomas is difficult but essential for surgical planning and prognostic assessment. With the advancement of deep-learning approaches based on convolutional neural networks (CNNs), the aim of this study was to determine whether CNN-based interpretation of magnetic resonance (MR) images of these two tumours could be achieved.

Methods

Contrast-enhanced MRI data from 50 patients with primary FTE and 50 schwannomas in the lumbosacral spinal canal were retrospectively collected and used as training and internal validation datasets. The diagnostic accuracy of MRI was determined by consistency with postoperative histopathological examination. T1-weighted (T1-WI), T2-weighted (T2-WI) and contrast-enhanced T1-weighted (CE-T1) MR images of the sagittal plane containing the tumour mass were selected for analysis. For each sequence, patient MRI data were randomly allocated to 5 groups that further underwent fivefold cross-validation to evaluate the diagnostic efficacy of the CNN models. An additional 34 pairs of cases were used as an external test dataset to validate the CNN classifiers.

Results

After comparing multiple backbone CNN models, we developed a diagnostic system using Inception-v3. In the external test dataset, the per-examination combined sensitivities were 0.78 (0.71–0.84, 95% CI) based on T1-weighted images, 0.79 (0.72–0.84, 95% CI) for T2-weighted images, 0.88 (0.83–0.92, 95% CI) for CE-T1 images, and 0.88 (0.83–0.92, 95% CI) for all weighted images. The combined specificities were 0.72 based on T1-WI (0.66–0.78, 95% CI), 0.84 (0.78–0.89, 95% CI) based on T2-WI, 0.74 (0.67–0.80, 95% CI) for CE-T1, and 0.81 (0.76–0.86, 95% CI) for all weighted images. After all three MRI modalities were merged, the receiver operating characteristic (ROC) curve was calculated, and the area under the curve (AUC) was 0.93, with an accuracy of 0.87.

Conclusions

CNN based MRI analysis has the potential to accurately differentiate ependymomas from schwannomas in the lumbar segment.
Examining the influence of global smoking prevalence on stroke mortality: insights from 27 countries across income strata
Authors: Abeysekera Isuri , De Silva Roshinie , Silva Disuri , Piumika Lakindu , Jayathilaka Ruwan , Rajamanthri Lochana
Published: March 2024

Background

This study investigates the influence of Global Smoking Prevalence (GSP) on Stroke Death Rates (SDR) across 27 countries categorized into High-Income Countries (HIC), Upper Middle-Income Countries (UMIC), Lower Middle-Income Countries (LMIC), and Low-Income Countries (LIC).

Methods

Analysing data from two distinct periods (1990–1999 and 2010–2019), countries exhibiting an increased SDR were selected. The study uses a polynomial regression model, treating income groups as cross-sectional and years as time series data.

Results

Results from the regression model reveal that 17 countries observed a significant impact of GSP on SDR, with only Turkey, Solomon Islands, and Timor-Leste resulting in negative values. However, the study emphasises that out of all 27 countries, the highest occurrence of the impact of GSP on SDR has been reported in the LMIC stratum for the period under review.

Conclusion

It is evident that GSP affects the risk of incidence of stroke death, specifically in the LMIC stratum. Furthermore, it has been identified that GSP is a major preventable risk factor affecting global mortality. To mitigate the risk of stroke death attributable to smoking prevalence, necessary preventive steps should be adopted to encourage smoking cessation, and essential policies should be implemented to reduce the burden of SDR.
Association between nintedanib adherence trajectory and healthcare use among idiopathic pulmonary fibrosis patients
Authors: Nili Mona , Epstein Andrew J. , Nunag Dominic , Olson Amy , Borah Bijan J
Published: March 2024

Background

Although inverse associations have been found between medication adherence and healthcare use and spending outcomes in many clinical settings, no studies to date have examined these relationships for patients with idiopathic pulmonary fibrosis (IPF) initiating nintedanib. We build on our prior study that used group-based trajectory modeling (GBTM) to compare inpatient hospitalization and medical care spending outcomes between groups of patients with different nintedanib adherence trajectories.

Methods

This analysis used 100% Medicare data and included beneficiaries with IPF who initiated nintedanib during 10/01/2014–12/31/2018. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A (inpatient care), B (outpatient care) and D (prescription drugs) for one year before (baseline) and after (follow-up) initiating nintedanib. Patients were assigned to the GBTM-derived adherence trajectory group closest to their own nintedanib adherence experience. All-cause and IPF-related hospitalization events and total medical spending were measured during the follow-up period. Unadjusted and adjusted regression models were estimated to compare outcomes between patients in different nintedanib adherence trajectories.

Results

Among the 1,798 patients initiating nintedanib, the mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectories: high adherence, moderate adherence, high-then-poor adherence, delayed-poor adherence, and early-poor adherence. All-cause hospitalizations and total all-cause medical spending were higher among patients in the high-then-poor, delayed-poor and early-poor adherence trajectories than those in the high adherence trajectory. For example, adjusted total all-cause medical spending was $4,876 (95% CI: $1,470 to $8,282) higher in the high-then-poor adherence trajectory, $3,639 (95% CI: $1,322 to $5,955) higher in the delayed-poor adherence trajectory and $3,907 (95% CI: $1,658 to $6,156) higher in the early-poor adherence trajectory compared with the high adherence trajectory. IPF-related hospitalizations and medical care spending were higher among those in the high-then-poor adherence trajectory compared with those in the high adherence trajectory.

Conclusions

Poor adherence to nintedanib was associated with all-cause hospitalizations and medical costs. Therefore, improved adherence programs, such as support programs, can be implemented to reduce economic burden.
Effect of low-level laser therapy in wound healing of primary molar teeth extraction
Authors: Özer Hazal , İnci Merve Abaklı
Published: March 2024

Introduction

Tooth extraction in children requires attention to wound healing and pain management, which are influenced by patient-related factors and behavioral guidance. Aim of the study: The study aimed to evaluate the effect of LLLT on healing sockets in pediatric patients with bilateral primary molar teeth extraction and determine its impact on pain management.

Methods

6–10 years of age, systemically healthy, and with atraumatic extraction indications of bilateral primary molar teeth were included in the study (n = 40). In the first session, randomly selected teeth were extracted under local anesthesia. In the control group, only clot formation in the socket was observed and photographed. The other group extractions were performed 2 weeks later. The low-level laser therapy (LLLT) group was treated with a 980 nm wavelength, in a continuous emission mode, 0.5 W power, 300 J of energy, 400 µm tip, 60 s diode laser and photographed. Nonepithelialized surface measurements were performed using ImageJ. Pain assessment was performed using the Wong-Baker Pain Scale. Statistical analyses were performed using SPSS software.

Results

There was a statistically significant difference between the groups in the Wong-Baker values in 3rd day (p < 0.05). In soft tissue healing on the 3rd and 7th day, the nonepithelialized surface of the laser socket was smaller than that of the control group, and the measurement results were found to be statistically significant (p < 0.05).

Conclusion

Although LLLT was not found to be very effective in reducing postoperative discomfort after extraction of primary molars, it provided better wound healing in extraction sockets.
Deep-learning-based radiomics of intratumoral and peritumoral MRI images to predict the pathological features of adjuvant radiotherapy in early-stage cervical squamous cell carcinoma
Authors: Zhang Xue-Fang , Wu Hong-yuan , Liang Xu-Wei , Chen Jia-Luo , Li Jianpeng , Zhang Shihao , Liu Zhigang
Published: March 2024

Background

Surgery combined with radiotherapy substantially escalates the likelihood of encountering complications in early-stage cervical squamous cell carcinoma(ESCSCC). We aimed to investigate the feasibility of Deep-learning-based radiomics of intratumoral and peritumoral MRI images to predict the pathological features of adjuvant radiotherapy in ESCSCC and minimize the occurrence of adverse events associated with the treatment.

Methods

A dataset comprising MR images was obtained from 289 patients who underwent radical hysterectomy and pelvic lymph node dissection between January 2019 and April 2022. The dataset was randomly divided into two cohorts in a 4:1 ratio.The postoperative radiotherapy options were evaluated according to the Peter/Sedlis standard. We extracted clinical features, as well as intratumoral and peritumoral radiomic features, using the least absolute shrinkage and selection operator (LASSO) regression. We constructed the Clinical Signature (Clinic_Sig), Radiomics Signature (Rad_Sig) and the Deep Transformer Learning Signature (DTL_Sig). Additionally, we fused the Rad_Sig with the DTL_Sig to create the Deep Learning Radiomic Signature (DLR_Sig). We evaluated the prediction performance of the models using the Area Under the Curve (AUC), calibration curve, and Decision Curve Analysis (DCA).

Results

The DLR_Sig showed a high level of accuracy and predictive capability, as demonstrated by the area under the curve (AUC) of 0.98(95% CI: 0.97–0.99) for the training cohort and 0.79(95% CI: 0.67–0.90) for the test cohort. In addition, the Hosmer-Lemeshow test, which provided p-values of 0.87 for the training cohort and 0.15 for the test cohort, respectively, indicated a good fit. DeLong test showed that the predictive effectiveness of DLR_Sig was significantly better than that of the Clinic_Sig(P < 0.05 both the training and test cohorts). The calibration plot of DLR_Sig indicated excellent consistency between the actual and predicted probabilities, while the DCA curve demonstrating greater clinical utility for predicting the pathological features for adjuvant radiotherapy.

Conclusion

DLR_Sig based on intratumoral and peritumoral MRI images has the potential to preoperatively predict the pathological features of adjuvant radiotherapy in early-stage cervical squamous cell carcinoma (ESCSCC).
Interventions, methods and outcome measures used in teaching evidence-based practice to healthcare students: an overview of systematic reviews
Authors: Nielsen Lea D. , Løwe Mette M. , Mansilla Francisco , Jørgensen Rene B. , Ramachandran Asviny , Noe Bodil B. , Egebæk Heidi K.
Published: March 2024

Background

To fully implement the internationally acknowledged requirements for teaching in evidence-based practice, and support the student’s development of core competencies in evidence-based practice, educators at professional bachelor degree programs in healthcare need a systematic overview of evidence-based teaching and learning interventions. The purpose of this overview of systematic reviews was to summarize and synthesize the current evidence from systematic reviews on educational interventions being used by educators to teach evidence-based practice to professional bachelor-degree healthcare students and to identify the evidence-based practice-related learning outcomes used.

Methods

An overview of systematic reviews. Four databases (PubMed/Medline, CINAHL, ERIC and the Cochrane library) were searched from May 2013 to January 25th, 2024. Additional sources were checked for unpublished or ongoing systematic reviews. Eligibility criteria included systematic reviews of studies among undergraduate nursing, physiotherapist, occupational therapist, midwife, nutrition and health, and biomedical laboratory science students, evaluating educational interventions aimed at teaching evidence-based practice in classroom or clinical practice setting, or a combination. Two authors independently performed initial eligibility screening of title/abstracts. Four authors independently performed full-text screening and assessed the quality of selected systematic reviews using standardized instruments. Data was extracted and synthesized using a narrative approach.

Results

A total of 524 references were retrieved, and 6 systematic reviews (with a total of 39 primary studies) were included. Overlap between the systematic reviews was minimal. All the systematic reviews were of low methodological quality. Synthesis and analysis revealed a variety of teaching modalities and approaches. The outcomes were to some extent assessed in accordance with the Sicily group`s categories; “skills”, “attitude” and “knowledge”. Whereas “behaviors”, “reaction to educational experience”, “self-efficacy” and “benefits for the patient” were rarely used.

Conclusions

Teaching evidence-based practice is widely used in undergraduate healthcare students and a variety of interventions are used and recognized. Not all categories of outcomes suggested by the Sicily group are used to evaluate outcomes of evidence-based practice teaching. There is a need for studies measuring the effect on outcomes in all the Sicily group categories, to enhance sustainability and transition of evidence-based practice competencies to the context of healthcare practice.