bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of metal artifact removal modes on the accuracy of linear measurement around titanium implants by applying different voltages: an original article
Authors: Goodarzi Pour Daryoush , Emami Meybodi Elham , Sodagar Kosar , Emami Meybodi Zahra Alsadat , Safari Sanaz
Published: June 2023

Background

This study aims to evaluate the effects of the artifact removal algorithm on linear measurements of the buccal cortical plate by altering the voltage.

Methods

Ten titanium fixtures were inserted at the site of central, lateral, canine, premolars and molars of dry human mandibles. Vertical height of buccal plate was measured using a digital caliper as a gold standard. Mandibles were scanned with 54 and 58 kVp. Other parameters were constant. Images were reconstructed with none, low, medium and high artifact removal modes. Two Oromaxillofacial radiologists evaluated and measured the buccal plate height using Romexis software. Statistical package for the social sciences (SPSS) version 24 was used for data analysis.

Results

In medium and high modes, the difference between 54 and 58 kVp was significant (p < 0.001). No significance was noted by using low ARM (artifact removal mode) at the 54 kVp and 58 kVp.

Conclusion

Using artifact removal in low voltage decreases the accuracy of linear measurement and buccal crest visibility. By using high voltage, artifact removal would have no significant effect on accuracy of linear measurements.
A dynamic nomogram for predicting the probability of irreversible neurological dysfunction after cervical spinal cord injury: research based on clinical features and MRI data
Authors: Chen Si , Li Guangzhou , Li Feng , Wang Gaoju , Wang Qing
Published: June 2023

Background

Irreversible neurological dysfunction (IND) is an adverse event after cervical spinal cord injury (CSCI). However, there is still a shortage of objective criteria for the early prediction of neurological function. We aimed to screen independent predictors of IND and use these findings to construct a nomogram that could predict the development of neurological function in CSCI patients.

Methods

Patients with CSCI attending the Affiliated Hospital of Southwest Medical University between January 2014 and March 2021 were included in this study. We divided the patients into two groups: reversible neurological dysfunction (RND) and IND. The independent predictors of IND in CSCI patients were screened using the regularization technique to construct a nomogram, which was finally converted into an online calculator. Concordance index (C-index), calibration curves analysis and decision curve analysis (DCA) evaluated the model's discrimination, calibration, and clinical applicability. We tested the nomogram in an external validation cohort and performed internal validation using the bootstrap method.

Results

We enrolled 193 individuals with CSCI in this study, including IND (n = 75) and RND (n = 118). Six features, including age, American spinal injury association Impairment Scale (AIS) grade, signal of spinal cord (SC), maximum canal compromise (MCC), intramedullary lesion length (IMLL), and specialized institution-based rehabilitation (SIBR), were included in the model. The C-index of 0.882 from the training set and its externally validated value of 0.827 demonstrated the model's prediction accuracy. Meanwhile, the model has satisfactory actual consistency and clinical applicability, verified in the calibration curve and DCA.

Conclusion

We constructed a prediction model based on six clinical and MRI features that can be used to assess the probability of developing IND in patients with CSCI.
Enhancing equity and diversity in palliative care clinical practice, research and education
Authors: Koffman Jonathan , Shapiro Gilla K. , Schulz-Quach Christian
Published: June 2023

Health disparities in palliative care are preventable consequences of structural discrimination and marginalization. The first step in addressing a problem is recognizing there is one and devotion to fully understanding its multifaceted nature. Palliative care clinicians, educators and researchers must prioritize investigating and mitigating the effects of racial, social, and intersectional injustice.
Australian nursing students’ perception, knowledge, and attitude towards oral healthcare of older people and associated factors: a national cross-sectional survey
Authors: Bhagat Vandana , Hoang Ha , Crocombe Leonard A. , Goldberg Lynette R.
Published: June 2023

Background

The oral health of many older Australians is poor and associated with many systemic health problems. However, nurses often have a limited understanding of the importance of oral healthcare for older people. This study aimed to investigate Australian nursing students’ perception, knowledge, and attitude toward providing oral healthcare for older people and associated factors.

Methods

A cross-sectional study was conducted among final year nursing students studying at accredited nursing programs using an online self-reported 49-item survey. The data were analysed using univariate and bivariate analysis (t-test, ANOVA, Spearman’s correlation test).

Results

A total of 416 final-year nursing students from 16 accredited programs in Australia completed the survey. Mean scores showed that more than half of the participants felt they lacked confidence (55%, n = 229) and had limited knowledge about oral healthcare for older people (73%, n = 304); however, their attitude towards providing such care was favourable (89%, n = 369). A positive correlation was found between students’ confidence in delivering oral healthcare to older people and their perceived knowledge (r = 0.13, p < 0.01). Results revealed a statistically significant positive association between students’ experience in providing oral healthcare to older people and students’ perception (t = 4.52, p < 0.001), knowledge (t = 2.87, p < 0.01), and attitude (t = 2.65, p < 0.01) mean scores in such care. Nearly 60% (n = 242) of participants received education/training in oral healthcare for older people at university, but this was often for less than one hour. Around 56% (n = 233) believed that the current nursing curriculum did not prepare them to provide effective oral healthcare to older people.

Conclusion

Findings suggested a need for nursing curricula to be revised to include oral health education and clinical experience. Knowledge of evidence-based oral healthcare by nursing students may improve the quality of oral healthcare for older people.
Does vitamin D reduce the mortality rate of Plasmodium infection?: a systematic review and meta-analysis
Authors: Kalantari Narges , Sepidarkish Mahdi , Ghaffari Salman , Rostami-Mansoor Sahar
Published: June 2023

Background

Vitamin D supplementation is recommended as an effective adjunct to counteract malaria pathogenesis, but the evidence on this point is limited and controversial. This systematic review and meta-analysis aimed to investigate the effect of vitamin D administration on the survival rate of Plasmodium-infected animals in experimentally-induced malaria on days 6 and 10 post-infection.

Methods

Five electronic databases were searched up to 20 December 2021. The pooled risks ratio (RR) and associated 95% confidence interval were estimated using the Restricted-maximum likelihood (REML) random-effects model. Heterogeneity was assessed by Cochran’s Q test and I2 value. Sub-group analyses were used to identify the sources of heterogeneity for several variables, such as type of vitamin D, type of intervention, and dose of vitamin D.

Results

Out of 248 articles found in the electronic database, six were eligible for inclusion in the meta-analysis. The current study found that the pooled random effect of risks ratio favored a statistically significant effect of vitamin D administration on survival rate in infected mice on day 6 post Plasmodium infection (RR = 1.08, 95%CI 1.03, 1.15, p < 0.99; I2 = 0%). It also found that vitamin D administration significantly affected the survival rate on day 10 post-infection (RR = 1.94, 95%CI 1.39, 2.71, p < 0.001; I2 = 69.02%). Subgroup analyses demonstrated a significant pooled RRs of the positive effect of vitamin D administration for cholecalciferol (RR = 3.11, 95%CI 2.41, 4.03, p < 0.001; I2 = 0%), doses higher than 50 µg/kg (RR = 3.37, 95%CI 2.55, 4.27, p < 0.001; I2 = 0%), and oral administration (RR = 3.01, 95%CI 2.37, 3.82, p < 0.001; I2 = 0%).

Conclusion

This systematic review and meta-analysis showed that vitamin D administration positively affects the survival rate in Plasmodium-infected mice. Since, the mouse model may not accurately reproduce the clinical and pathological features of human malaria, future research should investigate the impact of vitamin D in human malaria.
Estimation of the value of curative therapies in oncology: a willingness-to-pay study in China
Authors: Huang Li , Peng Xiaochen , Sun Lihua , Zhang Dawei
Published: June 2023

The objective of this study was to estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) among people with malignancies in China. The WTP for a QALY was estimated using a contingent valuation survey. Health utility was measured in EuroQol-5 dimensions (EQ-5D). The questionnaires were completed in face-to-face interviews. Respondents consisted of patients with malignant tumors and their family members and came from three tertiary hospitals in different cities with high, medium, and low gross domestic product (GDP) levels. In this study, we offered lump-sum payments and 10 year installment plans to respondents. Finally, we conducted sensitivity analysis and stepwise regression analyses to identify factors that affected the WTP/QALY ratios. A total of 1264 people participated in this survey, and 1013 people gave WTP responses for further analysis. The mean and median WTP/QALY values based on the lump-sum payments were 366,879 RMB (53,171USD, 5.1 times the GDP per capita) and 99,906 RMB (14,479USD, 1.39 times the GDP per capita) for the overall sample; 339,330 RMB (49,178USD, 4.71 times the GDP per capita) and 83,875 RMB (12,156USD, 1.16 times the GDP per capita) for the patient group; and 407,396 RMB (59,043USD, 5.66 times the GDP per capita) and 149,436 RMB (21,657USD, 2.08 times the GDP per capita) for the family group. Considering the skewedness of the data distribution, we suggest setting the cost-utility threshold with reference to the median. When the payment plan changed to 10-year installments, the median increased to 134,734RMB (19,527USD), 112,390 RMB (16,288USD) and 173,838 RMB (25,194USD) for the above groups, respectively. EQ-5D-5L health utility, annual household income per capita, patients with other chronic diseases, occupation, regular physical examinations (patients) and age (family members) were significantly related to WTP/QALY. This study provides empirical evidence of the monetary value of a QALY from a sample of the Chinese population with malignancies. In addition, the ratio of the WTP/QALY to GDP per capita was related to the disease and hypothetical scenario, and a higher ratio of GDP per capita for malignant tumor therapies should be considered.
Primary leiomyosarcoma of the thyroid with concurrent papillary thyroid cancer: a rare case report and a review of literature
Authors: Asiri Mohamed , Alsarrani Faisal , Altasan Abdullah , Alqahtani Faisal , Ali Lujain Akram , Pharaon Majed , Alshehri Saad , Alshahrani Awad
Published: June 2023

Background

Leiomyosarcoma (LMS) is a soft tissue malignant tumor that has a predilection to the abdominopelvic and limb smooth muscles. LMS of the thyroid is exceptionally rare. Papillary thyroid cancer (PTC) is the most common thyroid malignancy and originates from the thyroid epithelial layer. To our knowledge, the presence of both tumors in the same patient has not been reported previously.

Case presentation & literature review

A 42-year-old woman presented with a progressively enlarging neck mass for a few months. She underwent left thyroid lobectomy, and the histology showed high-grade primary LMS of the thyroid. She subsequently underwent a complete thyroidectomy, which identified a classical PTC on her right lobe.

Our comprehensive literature review identified 39 published cases of primary LMS of the thyroid. The average tumor size was 5.88 cm and occurred more in women. The most common presentation was neck mass, followed by compressive symptoms. Recurrence and metastasis were uncommon at 15% and 10–25%, respectively.

Conclusion

Thyroid LMS is a rare malignancy with a worse prognosis than PTC. A thorough workup must be done to rule out metastasis before labeling it as primary thyroid cancer.
Mechanistic insights into the interactions between cancer drivers and the tumour immune microenvironment
Authors: Misetic Hrvoje , Keddar Mohamed Reda , Jeannon Jean-Pierre , Ciccarelli Francesca D.
Published: June 2023

Background

The crosstalk between cancer and the tumour immune microenvironment (TIME) has attracted significant interest in the latest years because of its impact on cancer evolution and response to treatment. Despite this, cancer-specific tumour-TIME interactions and their mechanistic insights are still poorly understood.

Methods

Here, we compute the significant interactions occurring between cancer-specific genetic drivers and five anti- and pro-tumour TIME features in 32 cancer types using Lasso regularised ordinal regression. Focusing on head and neck squamous cancer (HNSC), we rebuild the functional networks linking specific TIME driver alterations to the TIME state they associate with.

Results

The 477 TIME drivers that we identify are multifunctional genes whose alterations are selected early in cancer evolution and recur across and within cancer types. Tumour suppressors and oncogenes have an opposite effect on the TIME and the overall anti-tumour TIME driver burden is predictive of response to immunotherapy. TIME driver alterations predict the immune profiles of HNSC molecular subtypes, and perturbations in keratinization, apoptosis and interferon signalling underpin specific driver-TIME interactions.

Conclusions

Overall, our study delivers a comprehensive resource of TIME drivers, gives mechanistic insights into their immune-regulatory role, and provides an additional framework for patient prioritisation to immunotherapy. The full list of TIME drivers and associated properties are available at http://www.network-cancer-genes.org.
Stability of Cayley dynamic systems with impulsive effects
Authors: Younus Awais , Atta Gulnaz , Aloqaily Ahmad , Mlaiki Nabil , Abdeljawad Thabet
Published: June 2023

Linear dynamic systems with impulsive effects are considered. For such a system we define a new impulsive exponential matrix. Necessary and sufficient conditions for exponential stability and boundedness have been established. The fundamental tool is an impulsive exponential matrix for exponential stability.
A remark on Jleli–Samet’s best proximity point theorems for α-ψ-contraction mappings
Authors: Ardsalee Pinya
Published: June 2023

Inspired by the work of Jachymski, we slightly extend some fixed point theorems with a graph and show that some best proximity point theorems for α-ψ-contraction mappings of Jleli and Samet can be deduced by our results.
Pre-assessment and management of long COVID patients requiring elective surgery: challenges and guidance
Authors: Boles Sophie , Ashok Sundar Raj
Published: June 2023

Whilst most patients infected with COVID-19 make a full recovery, around 1 in 33 patients in the UK report ongoing symptoms post-infection, termed ‘long COVID’. Studies have demonstrated that infection with early COVID-19 variants increases postoperative mortality and pulmonary complications for around 7 weeks after acute infection. Furthermore, this increased risk persists for those with ongoing symptoms beyond 7 weeks. Patients with long COVID may therefore also be at increased postoperative risk, and despite the significant prevalence of long COVID, there are minimal guidelines on how best to assess and manage these patients perioperatively. Long COVID shares several clinical and pathophysiological similarities with conditions such as myalgic encephalitis/chronic fatigue syndrome and postural tachycardia syndrome; however, there are no current guidelines for the preoperative management of these patients to help develop something similar for long COVID patients. Developing guidelines for long COVID patients is further complicated by its heterogenous presentation and pathology. These patients can have persistent abnormalities on pulmonary function tests and echocardiography 3 months after acute infection, correlating with a reduced functional capacity. Conversely, some long COVID patients can continue to experience symptoms of dyspnoea and fatigue despite normal pulmonary function tests and echocardiography, yet demonstrating significantly reduced aerobic capacity on cardiopulmonary exercise testing even a year after initial infection. How to comprehensively risk assess these patients is therefore challenging. Existing preoperative guidelines for elective patients with recent COVID-19 generally focus on the timing of surgery and recommendations for pre-assessment if surgery is required before this time interval has elapsed. How long to delay surgery in those with ongoing symptoms and how to manage them perioperatively are less clear. We suggest that multidisciplinary decision-making is required for these patients, using a systems-based approach to guide discussion with specialists and the need for further preoperative investigations. However, without a better understanding of the postoperative risks for long COVID patients, it is difficult to obtain a multidisciplinary consensus and obtain informed patient consent. Prospective studies of long COVID patients undergoing elective surgery are urgently required to help quantify their postoperative risk and develop comprehensive perioperative guidelines for this complex patient group.
Effect of Wollastonite Microfibers and Waste Tire Rubber on Mechanical Properties of Concrete
Authors: Lotfollahi Sina , Jaidari Alireza , Bakhtiari Parham , Hosseini Mojtaba , Ghorbani Mohammad
Published: June 2023

The main objective of the present research is to investigate the effect of adding wollastonite microfibers and waste tire rubber on the mechanical properties of concrete. For this purpose, two different series of mixtures were considered. Different percentages (5, 10, 15, and 20 percent) of wollastonite microfibers were added to the ordinary concrete and tested in the first series. Then, in the second series, wollastonite microfibers were added to the specimens in the amount of 20% by the weight of cement, and waste tire rubber was replaced with fine aggregate in different percentages (3, 5, 7, and 10 percent by the weight of fine aggregate), and the specimens were tested again. All the specimens were cured at the two ages of 7 and 28 days, and they were tested for the slump, compressive strength, tensile strength, and flexural strength. The results showed that the addition of 20% wollastonite microfibers to the specimens increased the compressive, flexural, and tensile strengths of the concrete at 28 days of age by 16, 87, and 78%, respectively, compared to the control specimen. The outcomes also demonstrated that replacing fine aggregate with tire rubber in samples containing 20% wollastonite microfibers reduces the strength of the samples. The highest reduction is related to the sample containing 20% of waste tire rubber, which has a reduced compressive strength of about 20% compared to the control sample. Furthermore, the results of this research showed that adding wollastonite microfibers to concrete reduces the concrete slump, while the density of the samples increases with the addition of wollastonite. Moreover, the presence of wollastonite microfibers reduces the porosity of concrete, but there is an increase in the number of pores in concrete samples containing waste tire rubber.
Leveraging large-scale assessments for effective and equitable school practices: the case of the nordic countries
Authors: Teig Nani , Steinmann Isa
Published: June 2023

One of the primary goals of educational research is to identify effective and equitable school practices that aim to promote desired educational outcomes for all students, regardless of their background. This pursuit raises the question of why certain countries or schools demonstrate more favourable outcomes than others. To shed light on this question, this special issue delves into the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) as a showcase.

Despite their similar historical, cultural, and economic characteristics, these countries show vastly different levels of student outcomes. This special issue comprises seven studies that utilize data from the international large-scale assessments (PIRLS, TIMSS, and PISA), leveraging their international comparative design and nationally representative student samples. The present article provides an overview of the seven included studies by underlining the key themes that transcend them as well as their contributions and implications. These themes include the measurement of educational effectiveness with international large-scale assessments, the central role of teachers, and the importance of both cognitive and non-cognitive student outcomes in studying different perspectives on effective and equitable school practices.
Comprehensive analysis of geographic and breed-purpose influences on genetic diversity and inherited disease risk in the Doberman dog breed
Authors: Wade Claire M. , Nuttall Robin , Liu Sophie
Published: June 2023

Background

Publicly available phenotype data and genotyping array data from two citizen science projects: “Doberman Health Surveys” and “The Doberman Diversity Project” were analyzed to explore relative homozygosity, diversity, and disorder risk according to geographical locale and breeding purpose in the Doberman.

Results

From the phenotypic data cohort, life expectancy of a Doberman at birth is 9.1 years. The leading causes of death were heart disease (accounting for 28% of deaths) and cancers (collectively accounting for 14% of deaths).

By genotyping, the world Doberman population exists as four major cohorts (European exhibition-bred, Americas exhibition-bred, European work, Americas pet/informal). Considering the entire Doberman population, four genomic regions longer than 500 Kb are fixed in 90% or more of 3,226 dogs included in this study. The four fixed regions reside on two autosomal chromosomes: CFA3:0.8–2.3 Mb (1.55 Mb); CFA3: 57.9–59.8 Mb (1.8 Mb); CFA31:0–1.2 Mb (1.2 Mb); and CFA31:4.80–6.47 Mb (1.67 Mb). Using public variant call files including variants for eight Doberman pinschers, we observed 30 potentially functional alternate variants that were evolutionarily diverged relative to the wider sequenced dog population within the four strongly homozygous chromosomal regions.

Effective population size (Ne) is a statistical measure of breed diversity at the time of sampling that approximates the number of unique individuals. The major identified sub-populations of Dobermans demonstrated Ne in the range 70–236. The mean level of inbreeding in the Doberman breed is 40% as calculated by the number of array variants in runs of homozygosity divided by the assayed genome size (excluding the X chromosome). The lowest observed level of inbreeding in the Dobermans assayed was 15% in animals that were first generation mixes of European and USA bred Dobermans. Array variant analysis shows that inter-crossing between European and USA-bred Dobermans has capacity to re-introduce variation at many loci that are strongly homozygous.

Conclusions

We conclude that efforts to improve breed diversity first should focus on regions with the highest fixation levels, but managers must ensure that mutation loads are not worsened by increasing the frequencies of rarer haplotypes in the identified regions. The analysis of global data identified regions of strong fixation that might impact known disorder risks in the breed. Plausible gene candidates for future analysis of the genetic basis of cardiac disease and cancer were identified in the analysis.
Skin absorption of felbinac solid nanoparticles in gel formulation containing l-menthol and carboxypolymethylene
Authors: Kadowaki Reita , Ogata Fumihiko , Fushiki Aoi , Daimyo Saki , Deguchi Saori , Otake Hiroko , Nagata Mayumi , Sasaki Hiroshi , Kawasaki Naohito , Nagai Noriaki
Published: June 2023

Background

It is important to design an effective formulation to enhance the skin penetration, and nanotechnologies have been used in dermal and transdermal drug delivery. In this study, we prepared formulations (gels) containing l-menthol and felbinac (FEL) solid nanoparticles (FEL-NP gel) for topical application, and investigated the local and systemic absorption of the prepared FEL-NP gel.

Methods

FEL solid nanoparticles were obtained by bead milling of FEL powder (microparticles), and a topical formulation (FEL-NP gel) consisting of 1.5% FEL solid nanoparticles), 2% carboxypolymethylene, 2% l-menthol, 0.5% methylcellulose, and 5% 2-hydroxypropyl-β-cyclodextrin (w/w %) were prepared.

Results

The particle size of FEL nanoparticles was 20–200 nm. The released FEL concentration from FEL-NP gel was significantly higher than that from FEL gel without bead mill treatment (carboxypolymethylene gel in which FEL microparticles (MPs) instead of FEL nanoparticles were incorporated, FEL-MP gel), and FEL was released as nanoparticles from the gel. Moreover, both transdermal penetration and percutaneous absorption of FEL-NP gel were significantly increased compared with those of FEL-MP gel, and the area under the FEL concentration-time curve (AUC) of FEL-NP gels was 1.52- and 1.38-fold of commercially available FEL ointment and FEL-MP gel, respectively. In addition, after 24 h of treatment, the FEL content in rat skin treated with FEL-NP gels was 1.38- and 2.54-fold higher than that when treated with commercially available FEL ointment and FEL-MP gel, respectively. Moreover, the enhanced skin penetration of FEL-NP gels was significantly attenuated by inhibition of energy-dependent endocytosis, such as clathrin-mediated endocytosis.

Conclusions

We successfully prepared a topically applied carboxypolymethylene gel containing FEL nanoparticles. In addition, we observed that the endocytosis pathway was mainly related to the high skin penetration of FEL nanoparticles, and FEL-NP gel application resulted in high local tissue concentration and systemic absorption of FEL. These findings provide useful information for the design of topically applied nanoformulations against inflammation by providing local and systemic effects.
An adenocarcinoma in an inverted Meckel’s diverticulum with intussusception
Authors: Miwa Yamato , Sato Yo , Hirano Kenichiro , Sunami Eiji , Takahashi Motoko , Kosugi Shin-ichi , Suda Takeshi , Hasegawa Go
Published: June 2023

Background

Adenocarcinoma in an inverted Meckel's diverticulum with intussusception has not been reported to date. We discuss the clinical issues concerning this rare condition and review the relevant literature.

Case presentation

A 71-year-old Japanese female was referred to our hospital for further investigation of severe anemia. Computed tomography revealed a tumorous lesion in the terminal ileum. Capsule endoscopy did not provide detailed images. Exploratory laparoscopy revealed intussusception in the terminal ileum. An intraluminal tumor 70 cm proximal to the ileocecal valve was observed to be the lead point. Partial resection including the tumor was performed. Macroscopically, a polypoid tumor at the tip of an inverted diverticulum-like structure was observed. The tumor was histologically composed of adenocarcinoma accompanied by gastric and pyloric gland metaplasia in the background mucosa, which was confirmed by immunohistochemical staining. Based on these characteristics, this tumor is considered to have developed from the ectopic gastric mucosa in a Meckel's diverticulum.

Conclusions

When we encounter patients with unfamiliar lesions in the small bowel, we need to differentiate Meckel's diverticulum related disease. Meckel's diverticulum can invert into the lumen of the small bowel and cause an intussusception, and has potential of malignant transformation.
Dietary risk of donated food at an Australian food bank: an audit protocol
Authors: Mossenson Sharonna , Giglia Roslyn , Pulker Claire E. , Chester Miranda , Pollard Christina M.
Published: June 2023

Background

Sufficient, safe and nutritious food is unattainable for many people experiencing severe food insecurity, putting them at dietary risk. Food banks, a growing part of the charitable food system (CFS), are the main source of food relief in developed countries. Donations of surplus, unsalable food from supermarkets, producers and manufacturers is the main source of the food supply, and this can be unpredictable, insufficient and inappropriate. The universal performance indicator of food-banking success is a weight-based measure, complemented by various initiatives to track the nutritional quality of food provided. There is currently no method that assesses the dietary risk of donated food related to nutrition and food safety. This protocol describes a method developed to identify and assess the dietary risk of donated food at an Australian food bank including the type, amount, nutrition quality, and food safety.

Methods

An audit of all food donated to a food bank servicing one Australian state was conducted over five consecutive days in May 2022. The audit process used a mobile device to take photographs of all incoming deliveries to the food bank. The images were manually annotated to document the type of food, product information (brand and product name, variety), the donor’s name, weight (kilograms), and date-marking details. Data was extracted from the photographs and assessed against pre-determined dietary risk criterion for food safety (date marking, damaged packaging, visible food spoilage) and nutrition quality according to the principles of the Australian Guide to Healthy Eating, and the NOVA classification of level of processing.

Discussion

Fifteen hundred images were required to assess the dietary risk of 86,050 kg of donated food. There were 72 separate donations, largely from supermarkets and food manufacturers. Data analysis will enable identification of dietary risk, particularly for nutrition quality and food safety. This is important given the absence of food regulation for CFS donations, and the vulnerability of the client group. This protocol highlights the need for more transparency and accountability from food donors, about the food they donate.
Decision curve analysis: confidence intervals and hypothesis testing for net benefit
Authors: Vickers Andrew J. , Van Claster Ben , Wynants Laure , Steyerberg Ewout W.
Published: June 2023

Background

A number of recent papers have proposed methods to calculate confidence intervals and p values for net benefit used in decision curve analysis. These papers are sparse on the rationale for doing so. We aim to assess the relation between sampling variability, inference, and decision-analytic concepts.

Methods and results

We review the underlying theory of decision analysis. When we are forced into a decision, we should choose the option with the highest expected utility, irrespective of p values or uncertainty. This is in some distinction to traditional hypothesis testing, where a decision such as whether to reject a given hypothesis can be postponed. Application of inference for net benefit would generally be harmful. In particular, insisting that differences in net benefit be statistically significant would dramatically change the criteria by which we consider a prediction model to be of value. We argue instead that uncertainty related to sampling variation for net benefit should be thought of in terms of the value of further research. Decision analysis tells us which decision to make for now, but we may also want to know how much confidence we should have in that decision. If we are insufficiently confident that we are right, further research is warranted.

Conclusion

Null hypothesis testing or simple consideration of confidence intervals are of questionable value for decision curve analysis, and methods such as value of information analysis or approaches to assess the probability of benefit should be considered instead.
Ultra-high-field MRI of postmortem human fetal wrist joints: initial experience
Authors: Josemans Sabine H. , van der Post Anne-Sophie , Strijkers Gustav J. , Dawood Yousif , van den Hoff Maurice J. B. , Jens Sjoerd R. J. , Obdeijn Miryam C. , Oostra Roelof-Jan , Maas Mario
Published: June 2023

Background

This study aimed to assess the feasibility of postmortem ultra-high-field magnetic resonance imaging (UHF-MRI) to study fetal musculoskeletal anatomy and explore the contribution of variation in iodine and formaldehyde (paraformaldehyde, PFA) treatment of tissue.

Methods

Seven upper extremities from human fetuses with gestational ages of 19 to 24 weeks were included in this experimental study, approved by the Medical Research Ethics Committee. The specimens were treated with various storage (0.2–4% PFA) and staining (Lugol’s solution) protocols and the wrist joint was subsequently imaged with 7.0 T UHF-MRI. Soft-tissue contrast was quantified by determining regions of interest within a chondrified carpal bone (CCB) from the proximal row, the triangular fibrocartilage (TFC), and the pronator quadratus muscle (PQM) and calculating the contrast ratios (CRs) between mean signal intensities of CCB to TFC and CCB to PQM.

Results

UHF-MRI showed excellent soft-tissue contrast in different musculoskeletal tissues. Increasing storage time in 4% PFA, CRs decreased, resulting in a shift from relatively hyperintense to hypointense identification of the CCB. Storage in 0.2% PFA barely influenced the CRs over time. Lugol’s solution caused an increase in CRs and might have even contributed to the inversion of the CRs.

Conclusions

UHF-MRI is a feasible technique to image musculoskeletal structures in fetal upper extremities and most successful after short storage in 4% PFA or prolonged storage in 0.2% PFA. The use of Lugol’s solution is not detrimental on soft-tissue MRI contrast and therefore enables effectively combining UHF-MRI with contrast-enhanced micro-computed tomography using a single preparation of the specimen.

Relevance statement

UHF-MRI can be performed after CE-micro-CT to take advantage of both techniques.

Key points

• UHF-MRI is feasible to study human fetal cartilaginous and ligamentous anatomy.

• Storage in low PFA concentrations (i.e., 0.2%) improves soft-tissue contrast in UHF-MRI.

• Limited preservation time in high concentrations of PFA improves soft-tissue contrast in UHF-MRI.

• Prior staining with Lugol’s solution does not reduce soft-tissue contrast in UHF-MRI.

Graphical Abstract
Effect of microwave-assisted vacuum and hot air oven drying methods on quality characteristics of apple pomace powder
Authors: Bhat Iqra Mohiuddin , Wani Shoib Mohmad , Mir Sajad Ahmad , Naseem Zahida
Published: June 2023

Apple pomace, which makes up 20–30% of all processed apples, is an accessible source of bioactive ingredients that could be used in the food industry. A research of the impact of drying techniques on the quality characteristics of apple pomace powder was carried out to efficiently utilize this waste. The pomace was dried at 50 °C and 60 °C in a vacuum-assisted microwave dryer and an oven dryer, respectively. The different temperatures chosen for the drying of apple pomace were selected based on preliminary tests. Microwave drying resulted in reducing the drying time and improving the physicochemical, functional and morphological properties of the powder. The TPC (Total phenolic content) and AA (antioxidant activity) of pomace powder were found to be considerably influenced by the drying technique. Maximum TPC, DPPH and FRAP values observed for the apple pomace powder dried in the microwave were 5.21 ± 0.09 mg GAE/g, 93 ± 1% and 3.22 ± 0.04 µg/mg, respectively while as in oven drying, the values were 3.14 ± 0.06 mg GAE/g, 89 ± 1% and 2.22 ± 0.02 µg/mg. Microwave drying led to increasing bulk density (0.55 ± 0.01 g/cc), water hydration capacity (3.35 ± 0.09 mL/g), oil binding capacity (0.95 ± 0.04 g/g), solubility index (14.0 ± 0.9%), and emulsion capacity (60.0 ± 1.0%) of the powder. Lower values for bulk density (0.50 ± 0.01 g/cc), water hydration capacity (3.04 ± 0.08 mL/g), oil binding capacity (0.70 ± 0.03 g/g), solubility index (10.0 ± 0.8%), and emulsion capacity (48.0 ± 0.9%) were observed in oven-dried powder. Microwave drying resulted in a more disordered, crystalline and porous structure of apple pomace powder as compared to oven-dried powder as confirmed by SEM (Scanning electron microscopy) and XRD (X-ray diffraction). Microwave-dried powder also had a higher vitamin C content (20.00 ± 0.12 mg/100 mg) than oven-dried powder (12.53 ± 0.08 mg/100 mg). This study may be helpful in the preprocessing of apple pomace for bioconversion processes and extraction of valuable components from apple pomace.

Graphical abstract
The conundrum of metaplastic breast cancer: a single Egyptian institution retrospective 10-year experience (2011–2020)
Authors: Ismail Yahia , Kamal Amr , Allam Rasha , Zakaria Al-Shimaa
Published: June 2023

Background

Metaplastic breast cancer (MetBC) still represents a conundrum owing to its peculiar histogenesis and molecular drivers that render it extremely resistant to standard chemotherapy with ultimate dismal survival.

Aim

Describe the Egyptian National Cancer Institute’s (NCI-E) experience with MetBC regarding its clinicopathologic features, treatment, and survival outcomes.

Patients and methods

Between 2011 and 2020, all MetBC patients presented to NCI-E were retrospectively evaluated. Original clinicopathologic data, therapeutic modalities, pathologic response to neoadjuvant chemotherapy (NACT), recurrence, and date of last follow-up/death were obtained from archived charts.

Results

A cohort of 135 females, the median age was 52 years, and median follow-up period was 40 months (range: 2.6–130.8). Two-thirds were triple negative (TN). Squamous carcinoma was prevalent in 74.8% followed by carcinoma with osseous/chondroid differentiation, spindle cell, and low-grade adenosquamous carcinoma encountered in 13.3, 7.4, and 4.5%, respectively. Modified radical mastectomy was done in 59.3%, and positive nodes (pN+) were depicted in 37.7%. Median Ki-67 was 45% (range: 10–88); grade III and lymphovascular invasion (LVI) were observed in 83.7 and 43.7%, respectively. Stage II was the most common (49%), whereas initial stage IV was encountered in 8.1%. Anthracyclines/taxane combinations were rampant in adjuvant/neoadjuvant settings. The latter was employed in 41 patients, with only 3 cases (7.3%) achieving pathologic complete response (pCR), while moderate/significant residual tumor burden was found in 83%. The 5-year DFS and OS were 56.4 and 57.6%, respectively. Spindle cell carcinoma showed the worst survival parameters in univariate analysis. On the multivariate level, higher tumor stage (pT3 & 4), Ki-67 ≥ 45%, and TN subtype were independent variables for worse DFS and OS; age ≥ 52 years and the presence of LVI were independent features for worse DFS, whereas pN+ was an independent parameter for worse OS.

Conclusions

This study further solidifies the dreadful response of MetBC to conventional chemotherapy regimens employed in common non-metaplastic pathologies. A radical shift in treatment standards tailored to combat the molecular landscape of this distinctive tumor is urgently needed. Immunotherapy and molecularly targeted agents demonstrated promising results in phase I and II trials with hopeful sooner implementation in phase III studies.
A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI
Authors: Harris Alexandra , Jordan Neil , Carroll Allison J. , Graham Andrea K. , Wilson Charlton , Wilson Fernando A. , Berkel Cady , Smith Justin D.
Published: June 2023

Background

Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation.

Methods

We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016–June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity—namely, ambulatory pediatric care clinicians—was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices.

Results

The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1–15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333–$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524–$21,836 ($164–$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160–$94,208 ($497-$834 per family).

Conclusions

This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up.

Trial registration

This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
A narrative review on bacterial biofilm: its formation, clinical aspects and inhibition strategies
Authors: Vani S. , Vadakkan Kayeen , Mani Bince
Published: June 2023

Background

The predominant mode of life of most of the bacteria is their biofilm state. Based on the type of bacteria existing within the biofilm, it might be beneficial or harmful. Its beneficial aspects have been exploited mostly in waste management strategies. These biofilms affected the food industry, dairy industry and oil industry, causing huge losses by food spoilage, reduced heat transfer efficiencies and corrosion caused by biofilms in pipelines. They were considered a crucial risk to human well-being. Biofilms were responsible for more than 75% of the clinical infections caused in humans.

The main body of the abstract

Biofilms are multimicrobial complex structures that are resistant to antibiotics and stressful environments. The biofilm stage may provide various advantages to the bacteria during bacterial infections in human beings. The extracellular polymeric substances hold the bacterial community colonized in the biofilm. The bacteria within the biofilm are more resistant to antibiotics, whereas the planktonic bacteria are susceptible to them. Quorum sensing regulated biofilm formation, which can be manipulated to eradicate devastating effects caused by biofilms. The occurrence of biofilm on the clinical devices leads to the malfunction of the implants and complicates the patients’ health conditions. Biofilms also cause non-device-associated health problems. The major anti-biofilm strategies are the utilization of enzymatic activity and hindrance of quorum sensing. The auto-inducers, which play a major role in quorum sensing, are mimicked by inhibitors. This prevents the binding of auto-inducers to the receptors, eventually leading to blockage of biofilm formation.

Short conclusion

The significant background knowledge regarding the biofilm, its formation, clinical aspects and inhibition strategies has been highlighted in this review. This information dissipated anticipates new applications of plant compounds as an alternative to antibiotics, since they may act as anti-quorum sensing molecules. For instance, inhibitory compounds like Linalool and eugenol from the essential oil of different plants displayed antibiofilm activity against biofilms formed by Streptococcus pyogenes and Porphyromonas gingivalis, respectively. Further research is required to exploit the inhibitory properties of the various other bioactive compounds present in plant extract, and thereby, we can protect human beings from several device and non-device-related infections caused by biofilms such as catheter-related bloodstream infections, tuberculosis, cystic fibrosis, chronic obstructive pulmonary diseases, dental caries and periodontitis.
Matrix Matters: novel insights for the extraction, preparation, and quantitation of microplastics in a freshwater mesocosm study
Authors: Hankett Jeanne M. , Holtz Jennifer L. , Walker-Franklin Imari , Shaffer Kathryn , Jourdan Jerome , Batiste Derek C. , Garcia Jessie M. , Kaczan Christine , Wohlleben Wendel , Ferguson Lee
Published: June 2023

The extraction and characterization of secondary microplastics, those formed through subjection to the environment, must continuously improve in accuracy and applicability in order to generate robust microplastics exposure and risk assessments. Currently, there is a dearth of reliable extraction and quantitation methods for solid microplastic particles in sediment with chemical specificity. Herein we present advances in methodologies to extract and quantify microplastic particles from sediment, utilizing an outdoor mesocosm to model a freshwater coastal environment. Model secondary microplastics of crosslinked polyurethane (PU) were studied in comparison to model secondary polypropylene (PP) microplastics. Techniques to characterize particles in sediment included pyrolysis gas chromatography mass spectrometry (py GC/MS), stereoscope microscopy, and scanning electron microscopy. To complement particle analysis, plastic-associated leachable molecules were extracted from sediment and analyzed semi-quantitatively by high performance liquid chromatography with high-resolution mass spectrometry (HPLC/HR-MS). After developing and optimizing extraction and analytical methods we quantitated PU microparticles by count and weight and discovered that model PU particles fell from the water column into the sediment over the course of a year, while no PP particles were located in sediment samples. In addition, target small molecules associated with the crosslinked PU were identified in sediment by HPLC/HR-MS but leachable molecules associated with polypropylene could not be identified in sediment samples. We share the new py GC/MS method to quantify highly crosslinked PUs in complex environmental matrices containing both inorganic and organic components. In the process of generating robust extraction methods for microplastics in sediment, we discovered important considerations for the quantitation of microplastics by py GC/MS and the impacts of sample matrix on the quantitation of PU and PP specifically. We provide guidance for the preparation of microplastics from complex environmental matrices (e.g., sediment and soil) for analysis by py GC/MS.

Graphical Abstract