bluuebunny/crossref_metadata_2025 huggingface dataset:
Coercition
Authors: Perina Mickaella
Published: December 2024

Cet article propose une analyse des lieux de coercition en prenant pour exemple les anciennes colonies françaises d’Amérique dans leur rapport avec la République française. La coercition y est conçue comme stratégie coloniale et postcoloniale, et l’affaire de l’OJAM en Martinique en 1962 est offerte comme exemple pour explorer les structures de coercition et les réponses qu’elles peuvent susciter. Une approche relationnelle de la coercition est développée et fait apparaître des structures distinctes qui ne peuvent être véritablement comprises que dans la durée.
Mermaid Dialectics
Authors: Ploug Anna Cornelia
Published: December 2024

This article uncovers an underestimated Hegelian legacy in Beauvoir’s method of analysis, which is “concrete” not only experientially but also logically, because of its dialectical concept formation. It traces the conceptual movement from abstract to concrete in The Second Sex by identifying three determinations of “woman,” culminating in the figure of the mermaid, an expression of the inner contradiction of sexed existence. Consequently, Beauvoir is recognized as a thinker of immanent critique, pointing towards a politics of emancipation rather than equality.
A Copyist and Restorer in Seventeenth-Century Coptic Egypt
Authors: Soldati Agostino G.F.
Published: December 2024

The copyist and restorer Solomon, whose lineage originated from the city of Arish—the ancient Rhinokolura—hailing from the suburb of Muḥnān (now known as Umm Khenan, in the outskirts of Gizah) and ultimately residing in Old Cairo, served the monastic communities of the Wādī al-Naṭrūn for at least a decade, in the first half of seventeenth century. In 1616, he copied the Coptic-Arabic missal, currently preserved in the Vatican Library under the shelfmark Vat. copt. 26, and in 1626, on behalf of the Coptic Patriarch John XV, he restored a magnificent Pentaglot Psalter, a codex belonging to the library of the monastery of St. Macarius and nowadays known as Ms Barb. or. 2.
A Newly Discovered Fragment of the Babylonian Talmud, Tractate Soṭah, in the Vatican Library
Authors: Olszowy-Schlanger Judith
Published: December 2024

In the process of systematic search for reused Hebrew fragments in the bindings of printed books in the collections of the Vatican Library, as a part of the collaborative project “Books within Books,” two previously unknown fragments of a manuscript of the Babylonian Talmud (Tractate Soṭah) have been discovered. This paper is a preliminary study of these fragments and focuses on their material features.
Conserving the Albani Lectionary-Menologion (Vat. gr. 2144)
Authors: di Remigio Maruska , Németh András
Published: December 2024

The Museum of the Bible in Washington, DC, financed the conservation and digitization of Vat. gr. 2144, an eighth-century Greek Lectionary of Gospel readings. The manuscript was in a bad state of conservation when it arrived to the Vatican Library about two hundred years ago. Gelatin was used for the repair of its damaged folios, and its loose leaves were sewn into a structure which did not correspond to the original one. It became apparent that the manuscript deserved a more careful approach to its conservation than originally planned. With close collaboration between the conservation and manuscript departments of the Vatican Library, a compromise was found to conserve and consolidate this significant manuscript for future generations. In addition to the conservation treatment, information concerning the manuscript is briefly presented. It is mostly known from Morcelli’s publication of 1788 when it was already a part of Cardinal Alessandro Albani’s collection in Rome.
Pope Sixtus V and the Hunt for Manuscripts Containing the Works of Bonaventure of Bagnoregio
Authors: Metzger Stephen M.
Published: December 2024

This short note considers two manuscripts now among the Vaticani latini that were acquired during the pontificate of Sixtus V in order to publish his desired edition of the Opera omnia of Bonaventure of Bagnoregio. Sixtus had named Bonaventure the sixth Latin Doctor of the Catholic Church and announced the preparation of the edition in 1588, the first volume of which was published that same year. The hypothesis, most recently put forward by Pierre Petitmengin, that Vat. lat. 918 was acquired from the Carthusian monastery of Seitz (Žiče, modern-day Slovenia) in June 1587 expressly for this project is confirmed.
Creating affordances for families with young children: Experiences of music education in social work
Authors: Huhtinen-Hildén Laura , Kivijärvi Sanna , Elomaa-Krapu Minna , Isola Anna-Maria
Published: December 2024

The current research examines the possibilities of music education in supporting the well-being of families living in demanding life situations. The context for the study is Family Sound Hammock, a 3-year research and development project that took place in the metropolitan area of Finland from 2020 to 2023. The project aimed at systematically supporting the well-being of families especially by strengthening their capacities for interaction in and through music education activities. This phenomenological-hermeneutic research focusses on the affordances emerging in family music activities, asking the following: What kinds of affordances can be recognised in and through music activities as part of family social work? The findings are presented in three categories: (1) Experiential environment of music education practice, (2) Social interaction and (3) Experiences of consistency that each highlight the potential of music education for redirecting agency, participation and inclusion of parents and children. The findings emphasise the professional facilitation of an inviting and safe musico-pedagogical environment applying pedagogical sensitivity.
Can Intra-Operative Cell Salvage Reduce the Rate of Allogeneic Transfusion in Pediatric Spinal Deformity Surgery?
Authors: Chan Vivien , Shumilak Geoffrey , Malhotra Armaan K. , Lebel David E. , Skaggs David L.
Published: December 2024

Study Design

Retrospective cohort study.

Objectives

The objective of this study was to characterize the association between cell-salvage and allogeneic transfusion rate in pediatric patients undergoing posterior arthrodesis for scoliosis.

Methods

NSQIP Pediatric database years 2016-2022 was used. Patients under the age of 18 who received posterior arthrodesis with 7 or more surgical levels for spinal deformity correction were included. Rates of cell-salvage and allogeneic transfusion were determined. We assessed the impact of cell-salvage on the rate of allogeneic transfusion using chi-square test and multivariable logistic regression.

Results

There were 34,241 patients in this study. The rate of allogeneic transfusion was 21.6% (n = 7407). The allogeneic transfusion rates for idiopathic, neuromuscular, and congenital/syndromic scoliosis were 12.3%, 50.8%, and 25.9%, respectively. Cell-salvage was used in 71.1% of patients (n = 24,344). In the multivariable regression analysis, longer operative time ( P < .001), non-idiopathic scoliosis ( P < .001), hematocrit less than 35 ( P < .001), and ≥13 surgical levels ( P < .001) were associated with higher odds of allogeneic transfusion. Use of cell-salvage ( P < .001), increasing age ( P < .001), and increasing patient weight ( P < .001) were associated with significantly lower odds of allogeneic transfusion. In a subanalysis, use of cell-salvage was associated with reduced rate of allogeneic transfusion in patients with idiopathic scoliosis. Cell-salvage was not associated with reduced rates of allogeneic transfusion in neuromuscular and congenital/syndromic scoliosis.

Conclusion

This is the largest study investigating the impact of cell-salvage on rate of allogeneic transfusion in pediatric spinal deformity surgery. Use of cell-salvage is associated with reduced allogeneic transfusion rates in idiopathic scoliosis surgery.
Variables Affecting 90-Day Overall Reimbursement After Anterior Cruciate Ligament Reconstruction: Analysis of Nearly 250,000 Patients in the United States
Authors: Halperin Scott J. , Prenner Sofia , Dhodapkar Meera M. , Santos Estevao , Medvecky Michael J. , Grauer Jonathan N.
Published: December 2024

Background:

Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure. As the number of ACLRs continues to increase in incidence, understanding the variability and drivers of cost to the health care system may help target cost-saving measures.

Purposes:

To examine the variability in overall 90-day reimbursements (amount paid for health care services) for ACLR using a national, multi-insurance, administrative database and to assess factors associated with variability.

Study Design:

Cross-sectional study.

Methods:

Using the M151 PearlDiver data set (data from 2010 to April 30, 2021), the authors identified the 90-day total reimbursements in patients who underwent ACLR. Patient age, sex, and comorbidity burden; insurance type; inpatient versus outpatient surgery status; and 90-day postoperative adverse events were determined and were correlated with overall reimbursements using multivariable logistic regression.

Results:

A total of 249,484 patients who underwent ACLR during the study period were identified. The mean patient age was 31.6 ± 13.58 years, 50.3% were female, the mean Elixhauser Comorbidity Index (ECI) was 1.4 ± 1.8, and procedures were performed on an outpatient basis for 245,507 patients (98.4%). Insurance type was commercial for 220,284 patients (88.3%), Medicaid for 17,660 (7.1%), and Medicare for 3500 (1.4%). The mean overall 90-day reimbursement was $4281.91 ± $4982.61 (median [interquartile range], $3032 [$1681-5142]), and the total reimbursement for the patient cohort was $1,049,250,747. On multivariable linear regression, the variables independently associated with the greatest changes in overall reimbursement were (in decreasing order) hospital readmission (+$17,675.23), adverse events (+$1554.14), inpatient procedure (+$1246.51), and emergency department visits (+$784.06). Lesser but significant associations were found with greater ECI (+$252.30) and female sex (+$101.01). Decreased overall reimbursement was associated with older age (−$12.19) and Medicare (−$883.48)/Medicaid (−$493.18) relative to commercial insurance.

Conclusion:

In the current study, large variability was found in overall ACLR reimbursement/cost within the health care system. Hospital admissions (inpatient surgery and readmission) and adverse events were associated with the greatest increase in costs and emphasize the need to optimize these metrics above and beyond patient experience.
The potential carcinogenicity of orthopaedic implants – a scoping review
Authors: Sun Cherry W.Y. , Lau Lawrence C.M. , Cheung Jason P.Y. , Choi Siu-Wai
Published: December 2024

Background

Every year, hundreds of thousands of patients receive an orthopaedic or dental implant containing metals such as cobalt, chromium and titanium. Since the European Chemicals Agency (2020) classified pure cobalt metal as a Category 1B carcinogen, manufacturers of products containing ≥ 0.1% of this metal must perform a risk assessment and justify that there are no viable alternatives. The up-classification of cobalt metal to a carcinogen without good evidence that its use in implants is carcinogenic may cause unnecessary concern to the many patients who have, or may require such implants. Although in vitro and animal studies have shown such metals to be carcinogenic, human epidemiological studies have not been definitive. In addition, although many advances have been made in the past few decades with regard to the materials used in implant metals, no recent review of their carcinogenic effects have been published.

Methods

This scoping review aims to summarise epidemiological studies conducted in recent years (from 2010 to present) to outline the carcinogenic effects of orthopaedic metal implants that have been published. This encompasses implants of different materials and surfaces, including metal, polyethylene and ceramic orthopaedic implants, cemented and cementless joint replacement surgeries, and surgical techniques such as resurfacing and total joint replacements that are currently in use and the potential carcinogenicity related to their use. Research papers with various study designs published in the English language were included. Studies were excluded if participants had a prior history of cancer before receiving orthopaedic implants and if they focused solely on the carcinogenicity of metals or materials not related to orthopaedic implants.

Results

A total of 16 studies, encompassing over 700,000 implant patients, were identified through PubMed and have been included in this review. In long term follow-up of up to 17.9 years, no increased risk of all-site cancer was seen in these patients. However, an increase in site-specific cancers, namely prostate, melanoma and haematological cancers have been identified. Specifically, an increase in prostate cancer was identified in three studies.

Conclusion

Based on the summarised evidence, there is no consistent evidence to show that patients with any type of orthopaedic implant has an increased risk of cancer, although slight (non-statistically significant) increases in prostate cancer was observed and this, in particular, deserves longer-term surveillance.
A pilot study of a gratitude journaling intervention to enhance spiritual well-being and exercise self-efficacy in Black breast cancer survivors
Authors: Cousin Lakeshia , Braithwaite Dejana , Anton Stephen , Zhang Zhongyue , Lee Ji-Hyun , Leewenburgh Christiaan , Lyon Debra
Published: December 2024

Background

Breast cancer (BC) survivorship presents significant health disparities, particularly affecting Black women, who experience a 40% higher BC death rate compared to White women. These disparities are exacerbated by comorbidities, which contribute to poorer overall health outcomes. Additionally, Black BC survivors often face psychosocial challenges, including increased stress and lower well-being, which can lead to adverse physical health effects. This pilot study aims to assess the feasibility and efficacy of a culturally sensitive gratitude journaling intervention designed to enhance spiritual well-being, exercise self-efficacy, and reduce inflammation among Black BC survivors.

Methods

This pilot study employed a two-group, parallel random-assignment experimental design to compare a gratitude journaling intervention with a general memory journaling control group. Twenty-six Black women aged 40 to 70 years with a history of BC were randomly assigned to either the gratitude journaling intervention group (n = 13) or the control group (n = 13). The gratitude intervention group engaged in gratitude journaling twice weekly for eight weeks, while the control group documented daily memories. Outcomes measured included Gratitude Questionnaire-6, FACIT-Spiritual Well-Being 12 Item Scale, Perceived Stress Scale, Giscombe Superwoman Schema Questionnaire, and the Stage of Motivational Readiness for Physical Activity questionnaire and inflammatory biomarkers. Statistical analyses included the Wilcoxon rank sum test and Fisher’s exact test.

Results

Twenty-six participants were enrolled, with 73% completing baseline and post-intervention assessments. The intervention group showed a significant improvement in spiritual well-being (p = 0.014) with a large effect size (ES = 0.57). Marginal improvements in exercise self-efficacy were also observed (ES = 0.39). Although there were no significant differences in dispositional gratitude and perceived stress between groups, the intervention group exhibited trends toward increased gratitude and reduced stress. Inflammatory biomarker analysis indicated non-significant changes, though IL-6 levels increased in the intervention group.

Conclusion

This study demonstrates the feasibility and acceptability of a gratitude journaling intervention among Black BC survivors. The intervention significantly enhanced spiritual well-being and showed promise in improving exercise self-efficacy, suggesting its potential for promoting holistic wellness in this population. These findings provide a foundation for future larger-scale randomized controlled trials to further evaluate the efficacy of gratitude-based interventions for Black BC survivors.

Trial registration

This study was registered prospectively at ClinicalTrials.gov (NCT05473026) on 07-13-2022.
Characterising the activity, lifestyle behaviours and health outcomes of UK university students: an observational cohort study with a focus on gender and ethnicity
Authors: Savage Matthew J. , Procter Eleanor L. , Magistro Daniele , Hennis Philip J. , Donaldson James , Leslie-Walker Anika , Jones Bethany A. , James Ruth M.
Published: December 2024

Background

Health-related outcomes and behaviours in university students are known to be poor relative to the general population. The substantial contextual shifts related to the COVID-19 pandemic, combined with increased numbers of students from minoritised ethnicity backgrounds and presenting as trans and gender diverse (TGD), means that up-to-date information is unavailable. The primary aim of this study was therefore to characterise the current movement, dietary and lifestyle behaviours, mental health, and Body Mass Index (BMI) of UK university students and assess differences between genders and ethnic groups.

Methods

An online, self-report survey was administered across three years (2021–2023). Three independent cohorts of university students’ (n = 6,327) completed the survey on four key topic areas. One-way ANOVAs were used to assess differences between genders (men, women, TGD), and independent samples t-tests were used to assess differences between ethnic groups (White, Minoritised Ethnicity).

Results

30% of students were not meeting physical activity guidelines, 54% were sedentary for ≥ 6 h·d− 1, 83% had poor diet quality, 51% were in high or increased risk groups for alcohol consumption, 18% experienced terrible or poor sleep quality, and 32% were overweight or obese. Gender differences were present for all variables other than walking physical activity (WPA) (P < 0.05), with men having better mental health and engaging in healthier movement and sleeping behaviours, whereas women had more healthful dietary and drinking behaviours, and TGD students had poorer outcomes compared to cis-gender students in most domains. Differences between White and minoritised ethnicity students were present for all variables other than sedentary behaviour, diet quality, WPA and BMI (P < 0.05); students of minoritised ethnicity engaged in better movement, drinking and sleep behaviours in addition to having more positive mental health than White students.

Conclusion

The findings of the current study provide an update on the landscape of UK university students’ health and health-related behaviours. Overall, health-related outcomes and behaviours are poor in this population and these data suggest that gender and ethnicity play a role in determining students’ health and health-related behaviours. Therefore, these factors should be considered when developing strategies to promote healthy living in the context of higher education.
Evaluating maternal death surveillance and response system in Sunyani Municipality of Bono region in Ghana from 2017-2021
Authors: Ngegbai Amara S. , Kuma George Khumalo , Noora Charles L. , Maya Ernest Tei , Guure Chris
Published: December 2024

Introduction

Maternal death rates in Ghana have decreased overall but remain high in rural areas. The Maternal Death Surveillance and Response System (MDSR) aims to eliminate preventable maternal deaths effectively. However, its effectiveness is less pronounced at district and subdistrict levels than at national and regional levels. Despite the requirement for periodic evaluation, there is a lack of evidence supporting these assessments. This study focuses on evaluating the MDSR in Sunyani Municipal.

Methods

The evaluation was conducted using a cross-sectional design, using both qualitative and quantitative approaches. Data from the District Health Information Management Systems (DHIMS) and the maternal death line list from January 2017 to December 2021 on maternal deaths were reviewed. Stakeholders, including health professionals, were interviewed. The means, proportions, and other statistical measures were calculated using Epi Info Version 7. Qualitative data underwent content analysis, and the results were visually presented in tables and flowcharts to illustrate the flow of surveillance information.

Results

Most respondents were female, constituting 51.4% (19/37), with midwives comprising the largest group at 32.4% (12/37). Approximately 75.7% (28/37) were able to explain how the surveillance data has been used for public health action. The notification and reporting process was clear to 85% (17/20) of respondents. Although 94.6% (35/37) expressed willingness to notify and participate in audits at facility and community levels, the audits remained facility-based. All facilities consistently reported maternal deaths, but data storage equipment was lacking. Approximately 80% (20/25) of forms were reported within 24 h, and 88% (22/25) were investigated within seven days. Only 68% (17/25) of forms were filled out correctly, with no municipal and facility-level line list. All reported deaths came from healthcare facilities, with no community-reported maternal deaths.

Conclusions

The MDSR system in Sunyani Municipal demonstrates high awareness and willingness to participate among healthcare providers but faces challenges in data accuracy and community engagement. Death audits remain facility-based, and the lack of community-reported maternal deaths and municipal-level line lists indicates gaps in comprehensive reporting and data management. To improve the system, it is recommended that community case searches be enhanced for better reporting and to address data management issues by ensuring proper data quality assessment.
Relationships between neurodivergence status and adverse childhood experiences, and impacts on health, wellbeing, and criminal justice outcomes: findings from a regional household survey study in England
Authors: Wilson Charley , Butler Nadia , Quigg Zara , Moore David , Bellis Mark
Published: December 2024

Background

Evidence indicates that neurodivergent (ND) populations may be more at risk of experiencing adverse childhood experiences (ACEs), compared to neurotypical (NT) populations. However, this evidence has typically not examined a comprehensive set of ACEs and has only included ND individuals on the basis that they have a diagnosis. Very little research has examined the impacts of ACEs on negative adulthood outcomes for ND populations. The current study aimed to examine the associations between neurodivergence and experiences of ACEs, and the impact of being ND and experiencing ACEs on health, wellbeing, and criminal justice outcomes.

Methods

From November 2023 to April 2024, a household survey using representative sampling was undertaken with 5395 residents of an English region aged 18 + years. Neurodivergence status was measured using one self-report item. Nine ACEs were measured using validated self-report items. Outcome measures included: poor general health, low mental wellbeing, ever being arrested, and ever being incarcerated. Multinomial regression models were used to examine relationships between neurodivergence status and ACEs. Binary logistic regression models were used to examine independent relationships between neurodivergence status and ACE count and each outcome measure. Generalised linear models with an estimated marginal means function were used to estimate the increased risk of each outcome for different combinations of neurodivergence and ACE count status (NT less than four ACEs (reference group), NT 4 + ACEs, ND less than four ACEs, ND 4 + ACEs).

Results

A higher proportion of ND individuals experienced each ACE type than NT individuals. While controlling for sociodemographics, ND individuals were more likely to experience a greater number of ACEs than their NT peers. While controlling for sociodemographics, each outcome measure was more likely amongst those who were ND, and each outcome measure except for poor general health was more likely amongst those with higher ACE counts.

Conclusions

The combination of being ND and experiencing ACEs could additively increase risks of experiencing poor wellbeing and criminal justice outcomes by a greater extent than expected. Preventing and responding to ACEs in ND populations should be a priority to reduce risks of poor health, wellbeing, and criminal justice outcomes in this population.
Unravelling the cardio-renal-metabolic-foot connection in people with diabetes-related foot ulceration: a narrative review
Authors: Lan Nick S. R. , Dwivedi Girish , Fegan P. Gerry , Game Fran , Hamilton Emma J.
Published: December 2024

Diabetes-related foot ulceration (DFU), a serious but preventable complication of diabetes, is a leading cause of hospitalisation, lower extremity amputation and disability worldwide. People with DFU have a greater burden of cardiovascular risk factors, heart failure and chronic kidney disease, resulting in over two-fold higher risk of cardiovascular death compared with people with diabetes without DFU. Here, we propose a “cardio-renal-metabolic-foot” connection in people with diabetes based on shared pathophysiological mechanisms linking DFU with cardiovascular and renal disease. Whilst these mechanistic links remain to be fully elucidated, systemic inflammation and infection in the context of DFU are postulated as key mediators in the development, and progression of, cardiovascular and renal disease. However, cardiovascular and renal disease are also implicated in the pathogenesis of DFU, highlighting the multi-directional interplay between conditions. The impact of screening, prevention, and early management of cardiovascular complications associated with DFU requires further research. Multi-modality cardiac imaging could play a role in unravelling disease mechanisms leading to novel therapeutic strategies, as well as facilitating personalised risk assessment and management. Recent clinical trials have transformed the therapeutic landscape for people with type 2 diabetes, by demonstrating that sodium glucose co-transporter 2 inhibitors, glucagon-like peptide-1 agonists and non-steroidal mineralocorticoid receptor antagonists improve cardiovascular and renal outcomes. Although dedicated research in people with DFU is warranted, these therapies could target multiple facets of the “cardio-renal-metabolic-foot” connection. The holistic, person-centred approach to managing DFU should incorporate new multidisciplinary models of care focusing on the prevention and management of cardiovascular and kidney disease.

Graphical abstract

The cardio-renal-metabolic-foot connection in people with diabetes. There is a critical need for (1) a better understanding of mechanisms connecting DFU with cardiovascular and kidney disease, perhaps guided by cardiac imaging, novel biomarkers, multi-omics and artificial intelligence to facilitate current treatments and the development of novel therapeutic strategies, (2) more data from clinical trials, registries and biobanks to inform clinical guidelines and evidence-based medicine, and (3) health system-wide integration of structured models of care with a contemporary emphasis on cardio-renal-metabolic-foot health to improve patient outcomes. DFU diabetes-related foot ulceration. Created with BioRender.com
Exploring the prognostic impact of triglyceride-glucose index in critically ill patients with first-ever stroke: insights from traditional methods and machine learning-based mortality prediction
Authors: Chen Yang , Yang Zhenkun , Liu Yang , Li Yuanjie , Zhong Ziyi , McDowell Garry , Ditchfield Coleen , Guo Taipu , Yang Mingjuan , Zhang Rui , Huang Bi , Gue Ying , Lip Gregory Y. H.
Published: December 2024

Background

The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes.

Methods

We included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score.

Results

The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG < 9.265). TyG was also correlated with ICU length of stay (r = 0.077), hospital length of stay (r = 0.042), and Glasgow Coma Score (r = -0.132). TyG and other six features were used to construct ML models. The random forest model performed best in internal validation with AUC (0.900) and G-mean (0.443), and in external validation with AUC (0.776) and G-mean (0.399).

Conclusion

TyG (optimal cut-off: 9.265) was identified as an independent risk factor for ICU and hospital all-cause mortality in first-ever strokes. The ML model incorporating TyG demonstrated strong predictive performance. This emphasises the importance of insulin resistance (with TyG as a surrogate measure) in the prognostic assessment and early risk stratification of first-time stroke patients.
Tension at the gate: sensing mechanical forces at the blood–brain barrier in health and disease
Authors: Hansen Cathrin E. , Hollaus David , Kamermans Alwin , de Vries Helga E.
Published: December 2024

Microvascular brain endothelial cells tightly limit the entry of blood components and peripheral cells into the brain by forming the blood–brain barrier (BBB). The BBB is regulated by a cascade of mechanical and chemical signals including shear stress and elasticity of the adjacent endothelial basement membrane (BM). During physiological aging, but especially in neurological diseases including multiple sclerosis (MS), stroke, small vessel disease, and Alzheimer’s disease (AD), the BBB is exposed to inflammation, rigidity changes of the BM, and disturbed cerebral blood flow (CBF). These altered forces lead to increased vascular permeability, reduced endothelial reactivity to vasoactive mediators, and promote leukocyte transmigration. Whereas the molecular players involved in leukocyte infiltration have been described in detail, the importance of mechanical signalling throughout this process has only recently been recognized. Here, we review relevant features of mechanical forces acting on the BBB under healthy and pathological conditions, as well as the endothelial mechanosensory elements detecting and responding to altered forces. We demonstrate the underlying complexity by focussing on the family of transient receptor potential (TRP) ion channels. A better understanding of these processes will provide insights into the pathogenesis of several neurological disorders and new potential leads for treatment.
Solid organ transplantation originating from uncontrolled donation after circulatory death in Europe: a narrative review
Authors: Pionnier Yann , Darius Tom , Penaloza Andrea , Steenebruggen Francoise , Dupriez Florence , Neyrinck Arne , Genbrugge Cornelia
Published: December 2024

Human organ transplantation has begun in the 1960s with donation after circulatory death. At that time this was named non heart beating donation, later donation after cardiac death and nowadays it is named donation after circulatory death. Currently, we are facing a significant shortage of transplant organs in Europe and worldwide. To increase the graft acceptance from donation after controlled or uncontrolled circulatory death, preceding regional normothermic perfusion by an extracorporeal circulation before organ procurement or ex-situ machine perfusion are frequently implemented in clinical practice as organ assessment and reconditioning techniques. Due to these advancements more organs can be potentially transplanted, even after out-of-hospital cardiac arrest (OHCA). First line actors like emergency physicians and pre-hospital paramedics must be aware of such programs to recognize and refer patients for donation in OHCA situations. This review provides an overview of organs transplanted from uncontrolled donation after circulatory death (uDCD) and emphasize the role of the emergency physician in the organ donation cascade. Outcome of uDCD has a lower effectiveness than donation after brain death (DBD) and controlled donation after circulatory death (cDCD) for short term graft survival. However, observational studies illustrate that long term outcome from uDCD is comparable to graft outcome from cDCD and DBD. We summarize the studies reporting the procured organ rate and functional outcome of organs originated from uDCD. European databases indicate a high incidence of OHCA, where resuscitation efforts are initiated but the rate of return of spontaneous circulation (ROSC) remains limited. These patients represent a substantial potential pool of organ donors for uDCD programs. However, these programs tend to overestimate the number of potential donors. While organ procurement from uDCD has yielded favorable outcomes, further research is required to accurately assess the associated costs and benefits and to establish clear donor selection guidelines. Furthermore, the use of new technologies like extracorporeal Cardiopulmonary Resuscitation (E-CPR) for organ donation should be investigated from both medical and economical perspectives. Emergency departments must also explore the feasibility of implementing these programs.
Adherence to national trauma triage criteria in Norway: a cross-sectional study
Authors: Hoås Einar Frigstad , Majeed Waleed Mohammed , Røise Olav , Uleberg Oddvar
Published: December 2024

Background

Norwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals.

Methods

A digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator’s discretion in cases of non-respondents or need to clarify answers.

Results

Thirty-eight trauma hospitals were invited to answer the survey, where 35 hospitals responded (92%), making 35 the denominator of the results. Thirty-four (97.1%) hospitals stated that they followed NTrC. Thirty-three (94.3%) of the responding hospitals provided documentation of their criteria in use, of which twenty-eight (80%) of responding hospitals adhered to the NTrC. Three (8.6%) hospitals employed a tiered TTA approach with different sized teams. In addition four hospitals (11.4%) used specialized teams to meet the needs of defined patient groups (e.g. geriatric patients, traumatic brain injury). Twenty-one (60%) of the responding hospitals had written guidelines on who could perform TTA and in 18 hospitals (51.4%) TTA could be performed by pre-hospital personnel. Twenty-three (65.7%) of the hospitals documented which criteria that were used for TTA.

Conclusion

There is good adherence to the national criteria for activation of the trauma team among Norwegian trauma hospitals after implementation of national guidelines. Individual hospitals argue the use of certain local criteria and trauma team activation decision-making processes to increase their precision in specific patient populations and demographics. Further steps should be done to reduce the variation in TTA decision-making processes among hospitals and improve documentation quality.
Process evaluation of an individually tailored complex intervention to improve activities and participation of older nursing home residents with joint contractures (JointConEval): a mixed-methods study
Authors: Thalhammer Regina , Nguyen Natalie , Meyer Gabriele , Skudlik Stefanie , Müller Martin , Beutner Katrin
Published: December 2024

Background

Older people with joint contractures in nursing homes often experience severe restrictions in their activities and participation. The effectiveness of an individually tailored complex intervention to improve residents’ activities and participation by incorporating the biopsychosocial perspective into nursing care using a structured facilitator approach could not be established in the JointConEval cluster-randomised controlled trial. This process evaluation aimed to systematically identify factors influencing implementation and effectiveness.

Methods

The mixed-methods process evaluation analysed recruitment, implementation, mechanisms of impact, and context. Qualitative data was generated in semi-structured focus groups and in individual interviews with facilitators, nursing and social care staff, residents, relatives and guardians. Quantitative data was recorded with facilitators and 20% of nursing and social care staff using standardised documentation forms and questionnaires. Qualitative data was analysed using qualitative thematic content analysis, while the quantitative data was analysed descriptively. An interpretation was performed by combining and comparing the qualitative and quantitative results after the separate analyses.

Results

The implementation was realised as planned, but the intervention did not always reach the nursing home staff, which hindered the planned change in attitude and behaviour. The attitude of the facilitators was mainly in line with the intervention. However, the intervention reached only half the residents. We identified various key influencing factors related to the context, setting and implementation agents. Nursing homes lacking facilitator support from staff or management or experiencing staff shortages and facing organisational weaknesses had difficulties in achieving the desired behavioural changes and positive primary outcomes.

Conclusions

The complex intervention was delivered as planned with several factors affecting the implementation. A key influencing factor was the organisational structure and leadership of the nursing homes, which had an impact on the behaviour and motivation of the implementation agents. The findings highlight challenges in achieving behavioural changes among nursing staff in the context of long-term care in Germany. We recommend a systematic organisational context analysis for similar complex interventions in long-term care, involving stakeholders and improving leadership participation for more effective implementation.

Trial registration

DRKS (German Clinical Trials Register), number DRKS00015185. Registered on 1 August 2018, https://drks.de/search/en/trial/DRKS00015185. Universal Trial Number U1111-1218–1555.
The efficacy and safety of stepwise oral food challenge in children with hen’s egg allergy
Authors: Ogata Mika , Kido Jun , Yoshida Takanobu , Nishi Natsuko , Shimomura Sachiko , Hirai Nami , Mizukami Tomoyuki , Yanai Masaaki , Nakamura Kimitoshi
Published: December 2024

Background

Oral food challenge (OFC) is the gold standard for diagnosing food allergies (FAs) but carries the risk of anaphylactic reaction. Stepwise OFC, starting with a low dose of allergen and progressing to medium and full doses, is effective in determining a tolerable dose. We retrospectively evaluated the results of a stepwise OFC for hen’s egg (HE) to demonstrate its safety and efficacy. We discuss whether early low-dose administration of HE induces early immune tolerance in HE allergy.

Methods

We included 2,058 children (median, 2.6 years) who underwent HE-OFC between 2017 and 2021 at two institutes in Japan. The target challenge dose of OFC was classified as low (less than 1/8 of a cooked egg), medium (1/8 or more but less than 1/2), or full (1/2 or more). If the low-dose OFC was negative, subjects were allowed to consume the same dose of HE and underwent medium-dose OFC within 12 months. Even if positive, individuals were recommended to consume previously-tolerated amounts of HE and repeat OFC at the same dose within 12 months. We evaluated the correlation between their OFC results and response.

Results

A total of 526 (25.6%) children presented positive reactions. There were no cases of anaphylactic shock. Higher serum egg white (EW)- (P < 0.001) and ovomucoid (OVM)- specific IgE (P < 0.001) (sIgE) levels were associated with positive OFC. The low-dose OFC group had more positive reactions (P < 0.001), younger children (P < 0.001), higher EW-sIgE (P < 0.001) and OVM-sIgE (P < 0.001), and more histories of anaphylaxis (P = 0.014). OFC-positive children were younger than OFC-negative children, particularly in low-dose OFC (P = 0.010). OFC results between complete and partial elimination of HE groups across all EW- or OVM-sIgE classes were similar (P > 0.05).

Conclusions

Stepwise OFC is safe and effective in diagnosing HE allergy and facilitates the earlier introduction of HE in children. This study suggests the limited potential of early consumption of lower doses of HE to induce earlier immune tolerance, such that other strategies to induce earlier tolerance in infants with HE allergy should be considered.
Radiation-induced exosomal miR-21 enhances tumor proliferation and invasiveness in breast cancer: implications for poor prognosis in radiotherapy patients
Authors: Kim Kyungmin , Jung Kyung Oh , Oh Sera , Kim Young-Hwa , Lee Seok-Yong , Hong Seongje , Cho Su Han , Kim Hyejin , Rhee Siyeon , Cheon Gi Jeong , Kang Keon Wook , Chung June-Key , Youn Hyewon
Published: December 2024

Radiotherapy is widely used as an effective non-surgical strategy to control malignant tumors. However, recurrence is one of common causes of treatment failure even after the effective radiotherapy. In this study, we focused on the effects of radiation-induced exosomal miR-21 on the tumor microenvironment to investigate the causes of recurrence. Analysis of the TCGA database revealed that breast cancer patients with high levels of miR-21 have significantly reduced overall survival when treated with radiotherapy compared to those who did not receive radiotherapy, indicating a high hazard ratio for miR-21 in patients undergoing this treatment. Additionally, exosomal miR-21 is found to be highly expressed in the serum of breast adenocarcinoma patients. To explore how miR-21 induces poor prognosis in irradiated breast cancer, we irradiated 4T1 cell line with low or high doses of radiation, and examined the impact of secreted exosomal miR-21 on breast cancer cell and tumor microenvironment. After 10 Gy irradiation, 4T1 cells secreted 2.20 ± 0.10 times more exosomes and exhibited a 1.85 ± 0.01-fold increase in exosomal miR-21 levels. Treatment with exosomes from 10 Gy-irradiated cancer cells led to enhanced tumor cell proliferation, wound healing, and migration. The survival rate of 10 Gy-irradiated tumor cells incubated with 10 Gy-derived exosomes increased by 2.83-fold. Moreover, the growth of subcutaneous tumors treated with 10 Gy exosomes (n = 13) was significantly faster compared to tumors treated with 0 Gy exosomes (n = 10, P < 0.05). In summary, our study revealed high-dose irradiation-induced exosomes were found to enhance tumor proliferation and invasiveness via the transfer of exosomal miR-21. Based on these findings, we suggest that radiation-induced exosomal miR-21 may contribute to a poorer prognosis of breast cancer patients undergoing radiotherapy.
Functional limitations and firearm purchases among low-income U.S. military veterans
Authors: Testa Alexander , Tsai Jack
Published: December 2024

Objectives

Functional limitations may be associated with firearm ownership among veterans by amplifying perceptions of vulnerability and the need for security, yet their role remains underexplored despite emerging research on health-related factors influencing firearm acquisition in this group. This study examines the relationship between the number of functional limitations and recent firearm purchasing among a sample of low-income US military veterans.

Methods

Data are from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study, which surveyed US veterans in households under 300% of the US federal poverty level. The survey was conducted in December 2022 and January 2023 (n = 1,008). Functional limitations were assessed based on self-reported assistance needed in daily tasks. Multiple logistic regression was used to analyze the association between functional limitations and firearm purchases in the past year, adjusting for demographic and socioeconomic factors. Analyses were conducted in Stata v. 18, and statistical significance was determined at the p < 0.05 threshold.

Results

5.5% of respondents reported purchasing a firearm in the past year. Increased functional limitations were positively associated with recent firearm purchases (Adjusted Odds Ratio [aOR] = 1.14, 95% Confidence Interval [CI] = 1.03, 1.26). Sensitivity using Firth Logit for rare events confirmed the robustness of this finding.

Discussion

Veterans experiencing a greater number of functional limitations are more likely to report recently purchasing a firearm. These findings underscore the importance of addressing health needs among firearm-owning veterans through VA programs that support disabled veterans and their caregivers.
Deciphering the role of exosomal derived regulatory noncoding RNAs as potential biomarkers for diabetic retinopathy: a systematic review
Authors: Nandalal Santosh , Venkatesan Harshitha , Haridoss Madhumitha , Ramachandran Krithika , Lenin Raji Rajesh
Published: December 2024

About one-third of individuals with diabetes develop diabetic retinopathy (DR), with one-tenth experiencing vision-threatening conditions such as diabetic macular edema (DME) or proliferative diabetic retinopathy (PDR). Current treatments only show recovery in 50% of cases, and the disease often remains asymptomatic. Therefore, novel early detection methods and new biomarkers are crucial. Our study aims to summarise evidence on the role of altered exosomal regulatory noncoding RNAs in DR, based on human studies. Observational studies delineating the different exosomal noncoding RNAs in DR were searched systematically from inception to June 2024 in PubMed-MEDLINE and SCOPUS databases. Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) 2020 guidelines was used to conduct this systematic review (Prospero ID: CRD42023406724). We synthesised data from 13 human studies that assessed the expression of exosomal regulatory ncRNAs from individuals with DR. Among the 13 studies, nine focused on miRNA, while three examined lncRNA and one on circRNA. Although no common genes were identified across the studies, the review underscores the critical roles of exosomal noncoding RNAs in the pathogenesis of diabetic retinopathy, highlighting their potential as therapeutic targets. Future studies should aim for a unified approach in terms of sample selection, RNA analysis, and appropriate controls for a comprehension of exosomal expression patterns for early diagnosis of DR.