bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple complex developmental disorder (MCDD): Did we throw the baby out with the bathwater too fast? A systematic review
Authors: Zaccaria Valerio , Ardizzone Ignazio , Pisani Francesco , Raballo Andrea , Poletti Michele
Published: September 2024

Background

Multiple complex developmental disorder (MCDD) manifests as early-onset impairment across different domains. Although it could appear as a transitional condition between autism and childhood-onset schizophrenia, interest in MCDD has progressively waned. This study attempts to discern MCDD current relevance to avoid “throwing the baby out with the bathwater” too fast.

Methods

All available studies published up to January 2024 were retrieved and evaluated following on the PRISMA guidelines for systematic reviews using the term “multiple complex developmental disorder” or “MCDD”, without any filter for study design nor year of publication.

Results

Only 16 studies were included and analyzed. Overall, a variable heterogeneity was observed in terms of country of investigation, study design, and clinical groups. Most of the included studies explored the construct of MCDD in developmental age, comparing MCDD mostly with autistic patients, and observing how the former group had higher levels of paranoia, illusions, and psychotic thoughts, whereas the latter showed more frequently difficulties in social interactions and stereotypical behaviors.

Conclusion

Overall, these results showed how progressive changes in diagnostic criteria over time led MCDD to be abandoned as nosographic construct, leaving perhaps a diagnostic void between autism and psychotic disorders that needs to be further studied. A systematic review on the Multiple Complex Developmental Disorder (MCDD): a forgotten diagnosis between autism and schizophrenia.
The heterogeneity of insomnia symptoms for emerging workers in the digital economy: Latent profile and network analysis
Authors: Huang Ying , Zheng Ruobing , Xiong Xiaxin , Chen Yanping , Zheng Wanqing , Lin Rongmao
Published: September 2024

Although insomnia symptoms is a common public health issue, few studies pay attention to insomnia symptoms among emerging workers in the digital economy. In this study, a total of 1093 emerging workers were recruited. Latent profile analysis was used to investigate the heterogeneity profiles and the relationship between job characteristics and these profiles. Additionally, core symptoms of insomnia were explored through network analysis. Latent profile analysis identified four insomnia profiles: severe insomnia without daytime dysfunction (8.8%), good sleepers (39.6%), mild insomnia (41.7%), and moderate to severe insomnia (9.9%). Job characteristics (e.g. daily working duration, intensity, and performance measurement system) significantly affected the profiles. Network analysis revealed that four profiles had similar network structures, but the edge and strength were varied. The implication for preventing and intervening insomnia symptoms for emerging workers in the digital economy has been discussed.
Research on time-delayed vibration reduction control of 1/4 vehicle semi-active suspension system with three degrees of freedom
Authors: Guo Yong , Xu Guang-Fei , Duan Cai-Yun
Published: September 2024

This paper is dedicated to the fundamental research of the mechanical model of a 1/4-vehicle semi-active suspension system with time-delayed state feedback control during wheel vertical displacement. The strategy combining the “equivalent harmonic excitation” optimization algorithm with the particle swarm optimization algorithm is proposed in this paper. Through the optimization and solution of time-delayed feedback control parameters of the 1/4 vehicle semi-active suspension system, the dynamic response of the vehicle suspension system before and after parameter optimization is studied. The research results indicate that, compared to passive control, time-delayed feedback control of wheel vertical displacement can significantly improve the smoothness, handling stability, and safety of vehicle operation.
Optimization of cavitation performance and hydraulic performance of multistage pump based on response surface method
Authors: Chen Qian , Hui Liu , Zhipeng Qi , Lihuan Yang , Congxin Yang
Published: September 2024

The structural parameters of the first stage impeller have an important influence on the performance of multistage pumps, and the purpose of our study is to find the most significant factors affecting the performance of double-casing multistage pumps, and then to carry out a comprehensive optimization of the hydraulic performance and cavitation performance. With the Plackett-Burman design method, we made a notability analysis on impeller parameters, and the three control variables that are most sensitive to performance of multistage pumps were found. Based on the response surface method, we carried out the central composite design experiments for the sensitive control variables, and established the multiple regression model between the sensitive parameters and the performance parameters. By solving the regression model, the most significant parameters affecting the performance were obtained: impeller outlet angle, outlet diameter and wrap angle. After analyzing the interaction between impeller parameters, it was found that the optimal hydraulic performance and the optimal NPSHr will constrain each other, and the optimal parameter combination with the lowest NPSHr and the hydraulic performance not lower than that of original model is impeller outlet diameter, D21 = 292 mm, the impeller outlet angle, β21 = 19°, and the wrap angle, φ1 = 160°.
A novel on-line approach for evaluating transmission errors in harmonic drives
Authors: Zhang Songhui , Gao Jianqiu , Wang Ling , Chen Changjun , Xu Suan , Wang Binrui
Published: September 2024

The health condition monitoring of harmonic drives plays an important role in ensuring the rotational motion accuracy of robot or manipulator joints. Capitalizing on the periodic and repetitive nature of manipulator tasks, a novel on-line data-driven evaluation method is developed in this paper, which employs a One-Dimensional Convolutional Neural Network (1D-CNN) and Hidden Markov Model (HMM) to classify static transmission errors of harmonic drives based on the current and torque data of their driving motors. The 1D-CNN encodes multiple dimensional data including numerical features, Wavelet Packet Energy Entropy (WPEE) values, and marginal spectrums of the current and torque data. Then, based on these features, the HMMs under different transmission error levels are trained. In order to demonstrate this method, a test rig is developed, in which the load moves in a reciprocating motion as an inverted pendulum. The load is driven by the servo motor and the harmonic drive. The experimental results show that the proposed evaluation method can identify six distinct levels of static transmission errors in harmonic drives with an accuracy greater than 91% in this study. The presented research holds potential for the development of a Prognostics and Health Management (PHM) system for robots.
Sustainability and Capability Building in Organizations: A Focused Group Approach
Authors: Verma Shubhangi , Raut Sachin Kumar , Narula Radhika , Rao Purnima
Published: September 2024

This study investigates business sustainability and the development of comprehensive capabilities that are crucial for future-ready organizations. It delineates the sustainable business practices that are necessary to enhance the functional, operational, technological and strategic dimensions of an organization. Furthermore, we examine methods to augment a firm’s capacity to foster sustainable growth. The authors utilized a structured approach; four focused group discussions (FGDs) were conducted with experts from multinational firms to garner real-time industry insights in the context of the new normal. The discussions emphasized key practices such as change management, competency building, green business functions, regenerative strategies, empathetic leadership and the triple bottom line approach. This research underscores the real-time business practices implemented during and after the pandemic to address and mitigate the disruptions caused by the outbreak.
Poster 228: A Novel Description of Medial Meniscus Vascularization: A Multicenter Study Introducing the Medial Meniscal Artery
Authors: Śmigielski Robert , Azua Eric N. , Gursoy Safa , Mameri Enzo , Khan Zeeshan A. , Ciszkowska-Łysoń Beata , Hevesi Mario , Zielińska Aleksandra , Chahla Jorge
Published: September 2024

Objectives:

The microvasculature of the human meniscus has been previously described by Arnoczky and Warren. However, to date the qualitative and quantitative extra-articular vascular anatomy of the medial meniscus has not yet been characterized. Therefore, the purpose of our study was to perform a qualitative and quantitative anatomic study of the extra-articular medial meniscal vasculature and to introduce the novel “medial meniscal artery” (MMA), potentially providing future guidelines for the treatment of meniscal pathology.

Methods:

Thirty-three unpaired frozen human cadaveric knees were dissected. The popliteal artery was identified and cannulated with an angiocatheter. The arteries were perfused with a red acrylic paint solution allowing for improved visualization. Artery dimensions and distances were measured using a digital caliper. Perfused specimens were imaged with Computed Tomography scanning and segmented using software to identify vessels and repeat artery measurements.

Results:

The MMA was consistently identified in all specimens. In 26 of 33 (82%) specimens, the MMA branched directly from the popliteal artery, while in 6, the MMA shared a common trunk with the inferior medial genicular artery (IMGA). The MMA was easily distinguishable from the superior MGA, inferior MGA, and MGA, given its direct course to the medial joint line with terminal branches to the posterior horn of the medial meniscus and deep to the semimembranosus tendon. The MMA exhibited a consistently smaller vessel diameter relative to the genicular arteries.

Conclusions:

This is the first study identifying and quantitively describing the MMA in the human knee. The MMA can be identified consistently on gross anatomic dissection in patients of varying demographics. The findings of this study will provide future avenues of study toward understanding the medial meniscus vascularization and the genesis of potential degenerative changes when vascularization is poor. This will help to further refine diagnostic and treatment options for meniscus revascularization and compartment preservation. Additionally, this study may help define safe zones in the knee during posterior approaches, as well as furthering the base of knowledge for emerging vascular procedures such as genicular artery embolization. Further research is needed to identify and characterize the artery in vivo and to determine the MMA’s role in meniscus preservation.
Career and Technical Education Alignment Across Five States
Authors: Carruthers Celeste K. , Dougherty Shaun , Goldring Thomas , Kreisman Daniel , Theobald Roddy , Urban Carly , Villero Jesús
Published: September 2024

We describe alignment between high school career and technical education (CTE) and local labor markets across five states—Massachusetts, Michigan, Montana, Tennessee, and Washington. We find that CTE is partially aligned with local labor markets. A 10-percentage-point higher share of local jobs related to a CTE career cluster is associated with a 3-point higher rate of CTE concentration in that cluster. Women and students from racial or ethnic minority groups are better aligned with local employment than men, in part due to their selection of CTE fields like Education & Training, Health Science, and Hospitality & Tourism, which correspond with a large portion of the workforce in almost every metro area. We find more limited evidence of dynamic, short-term adjustments in CTE after changes in local labor markets. A small degree of realignment lags the labor market by 2 to 3 years and is only observed following changes in college-level employment.
Public Health Nurses’ Experiences in Preventing Obesity in Preschool Children. A Vignette Study From Child Health Clinics in Norway
Authors: Vinsjevik Marte Cecilie Grøsvik , Øen Kirsten Gudbjørg
Published: September 2024

This study explored the experiences of public health nurses (PHN) in preventing obesity in preschool children and following national guidelines. We used a descriptive qualitative design with an online open-ended questionnaire based on vignettes describing fictitious practical situations during the follow-up of children presenting with overweight issues in child health clinics. Following qualitative content analysis, we identified one main theme: Strong but complex feelings of responsibility toward supporting parents in preventing obesity in preschool children and adhering to the guidelines. We also identified four subthemes: (a) Difficulties in deciding if the child’s weight is a concern. (b) Challenges with meeting children’s healthcare needs when weight is a concern. (c) Approaches for engagement and caring weight talks with parents. (d) The need for resources and interdisciplinary collaboration. PHNs suggested improvements for preventing childhood obesity and called for municipal prioritizing of organizational and personnel-related resources to ensure PHNs can efficiently follow national guidelines.
Undergraduate Nursing Students’ Attitude and Perception Toward High-Fidelity Simulation-Based Education in a Middle Eastern Country
Authors: Raman Savithri , Arulappan Judie , Zaabi Omar Al , Hashmi Iman Al , Cyril Vincent Sophia , Raghavan Divya , Panchatcharam Sathiyamurthi
Published: September 2024

Introduction

Rapid use of technologically driven simulation environment in teaching–learning has caused mixed feelings among students. High-fidelity simulation-based education is superior in cultivating the knowledge, skills, caring, learning interest, and collaboration among nursing students. However, the nursing students’ attitudes and perceptions toward high-fidelity simulation-based education are unexplored.

Objectives

The present study aims to explore the attitude and perception of undergraduate nursing students toward high-fidelity simulation-based education.

Methods

Cross-sectional survey research design was adopted. We used self-administered Education Practices Questionnaire (student version) and Attitude Scale toward Simulation-Based Education to collect the data. A total of 109 nursing students were recruited.

Results

Nursing student's attitude shows (mean = 68.26); perception on educational practices of high-fidelity simulation-based education demonstrates ( M = 39.33 ± 7.87) and the importance of high-fidelity simulation-based education shows ( M = 37.73 ± 7.45). However, no significant difference observed between the male and female student's attitude ( t = −0.286 [0.78]) and perception ( t [107] = 0.960 [0.34]). Similarly, no significant difference was observed among the different levels of students p > .005 on perception and attitude toward high-fidelity simulation-based education.

Conclusion

The study proposed to have high-fidelity simulation-based education as an integral part of teaching in clinical training of students at all levels of nursing program.
Descriptive Analysis of Student Diagnostic and Documentation Skill Development in a low Fidelity Simulation in Psychiatric Nurse Practitioner Education
Authors: Guenzel Nicholas , Dai Hongying , Dean Lyndsay
Published: September 2024

Introduction

Nursing educators face challenges in helping registered nurses prepare to be psychiatric nurse practitioners. Nursing educators must consider the variation of students’ skill sets, experience levels, and the shortage of preceptors. Simulations can help overcome limited clinical sites and standardize skill acquisition. High-fidelity simulations can be helpful but are labor-intensive and expensive. Low-fidelity simulations are adaptable to fit the learning needs of psychiatric nurse practitioner students but little research has evaluated these simulations.

Objective

This paper evaluates a series of low-fidelity interventions used to help students learn diagnostic criteria, treatment decisions, and documentation.

Methods

A retrospective descriptive analysis was performed on the results of all students in five cohorts in a psychiatric nurse practitioner course ( n=68) on 45 low-fidelity online simulations over five years during the course on advanced psychiatric nursing of adults. Diagnostic notes were graded on four criteria by a psychologist or a psychiatric nurse practitioner. A representative sample of grades on eight notes were analyzed for this manuscript. Survey responses from the students in one cohort were obtained to evaluate their confidence levels and perceptions of simulation utility and responses were analyzed using descriptive and qualitative methods.

Results

The overall mean of description, detail, completeness, and professionalism increased from 7.6 (out of 10) to 9 over the semester with statistically significant improvements in all four areas. The strongest correlation was between detail and completeness and the weakest correlation was between professionalism and description. Students reported that they found significant value in the low-fidelity simulation exercises.

Conclusion

This analysis demonstrates one of the first efforts to analyze low-fidelity simulations for psychiatric nurse practitioner students. The data indicate these simulations can help students improve their confidence and skills in several areas.
To the Extreme: Exploring the Rise of a Deviant Culture in a Misogynist Digital Community
Authors: Shi Yongren , Kiley Kevin , DiPietro Stephanie M.
Published: September 2024

Recent instances of lethal mass violence have been linked to digital communities dedicated to misogynist and sexist ideologies. These forums often begin with discussions of more conventional or mainstream ideas, raising the question about the process through which these communities transform from relatively benign to extremist. This article presents a study of the Reddit incel community, active from mid-2016 to its ban in late 2017, which evolved from a self-help forum to a hub for extremist ideologies. We use computational grounded theory to deduce empirical patterns in forum composition, psychological states reflected in language use, and semantic content before refining and testing an interactional process that explains this change: a shift away from drawing on real-world experiences in discussion toward a greater reliance on cognitively simple symbols of group membership. This shift, in turn, leads to more discussions centered on deviant ideology. The results confirm that understanding the dynamics of conversation—specifically, how ideas are interpreted, reinforced, and amplified in recurrent, person-to-person interactions—is crucial for understanding cultural change in digital communities. Implications for sociology of groups, culture, and interactions in digital spaces are discussed.
Glass Ceilings, Step Stools, and Sticky Floors: The Racialized Gendered Promotion Process
Authors: Corbett Christianne , Wullert Katherine E. , Gilmartin Shannon K. , Simard Caroline
Published: September 2024

Organizations play a central role in replicating societal inequalities. Despite theories of gendered and racialized organizations, evidence of unequal outcomes, and research on proposed mechanisms, we have few intersectional analyses demonstrating how the promotion process varies by race and gender across job levels in actual organizations. In this first-ever analysis of advancement in a U.S. firm by gender, race, and job, we run random effects logistic regression models on five years of novel longitudinal data from the software engineering workforce of a U.S.-based technology company. Results show intersectional performance-reward bias in patterns that help maintain the racialized gendered hierarchy so commonly observed in organizations: White men overrepresented at the top, women of color overrepresented at the bottom, and in the technology sector, men of Asian descent overrepresented in midlevel technical jobs and White women overrepresented in midlevel management positions. Findings suggest monitoring promotions by gender, race, and position to make visible biases that continue to impede workplace equity.
Case Study: First Ever Visualization of Esophagogastric Junction Following Endoscopic Fundoplication in an Awake Patient Using Magnetically Controlled Capsule Endoscopy
Authors: Fanous Medhat , Lorenson David
Published: September 2024

Background:

Endoscopic retroflexion evaluates the gastroesophageal junction (GEJ) which is traversed by the gastroscope in a sedated patient. Magnetically Controlled Capsule Endoscopy (MCCE) examines the GEJ in a collapsed natural state in awake patients. This report is the first-ever visualization of endoscopic fundoplication status post transoral incisionless fundoplication (TIF) without gastroscope or sedation.

Case Description:

This patient is a 69-year-old female with recurrent antral gastritis. She underwent laparoscopic hiatal hernia repair and concomitant TIF (cTIF) in 2019. She tolerated swallowing the MCCE capsule well. As we guided the MCCE to evaluate the cardia, we observed the first visualization of a collapsed postoperative TIF valve. She had no adverse events and was discharged 30 minutes post-procedure.

Discussion:

MCCE has the advantage of avoiding sedation and its risks. There is no need to stop critical medications, including anticoagulants. MCCE has a short duration, enabling the physician to show high-resolution images and discuss the plan with an awake patient who can drive after the procedure. The use of MCCE in evaluating the reconstructed postoperative valve is promising. It enables visualization of the valve in its natural position, can measure the length of the valve, and has the potential to perform dynamic evaluation of the GEJ in an awake patient.

Conclusion:

The Magnetically Controlled Capsule Endoscopy system evaluates the original and reconstructed gastroesophageal valve in its natural status without sedation. It can potentially enhance the understanding of GERD and its surgical treatment.
Influence of crystal shape and orientation on the magnetic microstructure of bullet-shaped magnetosomes synthesized by magnetotactic bacteria
Authors: Kovács András , Pósfai Mihály , Zingsem Benjamin , Li Zi-An , Pekker Péter , Caron Jan , Prévéral Sandra , Lefèvre Christopher T. , Bazylinski Dennis A. , Frankel Richard B. , Dunin-Borkowski Rafal E.
Published: September 2024

Cells of magnetotactic bacteria are used as model systems for studying the magnetic properties of ferrimagnetic nanocrystals. Each individual bacterial strain produces magnetosomes (membrane-bounded magnetic crystals) that have distinct sizes, shapes, crystallographic orientations and spatial arrangements, thereby providing nanoparticle systems whose unique magnetic properties are unmatched by synthetic chemically-produced crystals. Here, we use off-axis electron holography in the transmission electron microscope to study the magnetic properties of isolated and closely-spaced bullet-shaped magnetite (Fe3O4) magnetosomes biomineralized by the following magnetotactic bacterial strains: the cultured Desulfovibrio magneticus RS-1 and the uncultured strains LO-1 and HSMV-1. These bacteria biomineralize magnetite crystals whose crystallographic axes of elongation are parallel to <100> (RS-1 and LO-1) or <110> (HSMV-1). We show that the individual magnetosome crystals are single magnetic domains and measure their projected in-plane magnetization distributions and magnetic dipole moments. We use analytical modelling to assess the interplay between shape anisotropy and the magnetically preferred <111> magneto-crystalline easy axis of magnetite.
Rates of strokes in Californians with sickle cell disease in the post-STOP era
Authors: Oluwole Olubusola , Brunson Ann M. , Adesina Oyebimpe O. , Willen Shaina M. , Keegan Theresa H. M. , Fertrin Kleber Yotsumoto , Wun Ted
Published: September 2024

Neurovascular complications, including strokes and transient ischemic attacks (TIAs), are common and cause significant morbidity in individuals with sickle cell disease (SCD). The Stroke Prevention Trial in Sickle Cell Anemia (STOP) (1998) established chronic transfusions as the standard of care for children with SCD at high risk for stroke. Using statewide data from the California Department of Health Care Access and Innovation (1991-2019), we determined the cumulative incidence (CMI) and rates of primary and recurrent strokes/TIAs in people with SCD pre- and post-STOP trial. For the 7636 patients included in our SCD cohort, the cumulative incidence of the first ischemic stroke was 2.1% by the age of 20 years and 13.5% by the age of 60 years. The CMI of the first intracranial hemorrhage (ICH) was 0.5% and 6.8% by the age of 20 and 60 years, respectively. Ischemic stroke rates increased in children (age <18 years; 234.9 vs 165.1 per 100 000 patient years [PY]; P = .012) and adults (age 31-50 years; 431.1 vs 303.2 per 100 000 PY; P = .031) in 2010 to 2019 when compared with the preceding decade. There was an increase in the rates of ICH in those aged 18 to 30 years and TIA in children <18 years from 2010 to 2019 when compared with the previous decade. Risk factors for strokes included increasing age, hypertension, and hyperlipidemia. These findings underscore the need for stroke prevention in adults with SCD, suggesting an emphasis on management of modifiable cerebrovascular risk factors that have been proven to be effective in the general population.
Design and Optimization Analysis of an Adaptive Knee Exoskeleton
Authors: Yang Xinhua , Guo Sheng , Wang Peiyi , Wu Yifan , Niu Lianzheng , Liu Duxin
Published: September 2024

To solve the problem of undesired relative motion of human-machine interaction positions caused by misalignment of the human-machine joints rotation axis of the knee exoskeleton, this study designed an adaptive knee exoskeleton based on a gear-link mechanism (GLM) by considering the human body as a component of the exoskeleton mechanism. Simultaneously, the concept of the wearable area (WA) was proposed, which transformed the operation of aligning the exoskeleton rotation axis with the human knee joint rotation axis into a "face alignment point" in the sagittal plane, reducing the difficulty of aligning the human-machine joint rotation axis. In the kinematic analysis of GLM, the phenomenon of instantaneous movement of the central axis of the human knee joint was considered. Based on the kinematic model, the WA, velocity transfer ratio, and initial position static stiffness of GLM were analyzed. The NSGA-II optimization algorithm was used to optimize the size parameters of GLM, which increased the WA by 18.4%, the average velocity transfer ratio by 4.98%, and the average initial position static stiffness by 6.01%. Finally, the ability of the exoskeleton to absorb movement displacement (MD) was verified through simulation, and the good human-machine kinematic compatibility of the exoskeleton was verified through wearable tests conducted on the initial mechanism principle prototype.
High abundance of butyrate-producing bacteria in the naso-oropharynx of SARS-CoV-2-infected persons in an African population: implications for low disease severity
Authors: Akorli Jewelna , Opoku Millicent , Appiah-Twum Francis , Akpo Margaret Sena , Ismail Rahmat Yusif , Boamah Georgina Yaa Kwartemaa , Obeng-Aboagye Elizabeth , Adu-Asamoah Dina , Donkor Irene Owusu
Published: September 2024

Background

The association of the oral microbiome with SARS-CoV-2 infections and disease progression has been documented in European, Asian, and American populations but not in Africa.

Methods

We conducted a study in Ghana to evaluate and compare the naso-oropharyngeal microbiome in SARS-CoV-2-infected and uninfected persons before (pre-vaccine) and after vaccine availability (post-vaccine) in the country. 16S rRNA V3-V4 variable region was sequenced and analysed from DNA extracted from naso-oropharyngeal swabs.

Results

Considering only the infection status, infected and uninfected groups had no difference in their within-group diversity and was evident in the study population pre- and post-vaccine availability. The introduction of vaccines reduced the diversity of the naso-oropharyngeal microbiome particularly among SARS-CoV-2 positive persons and, vaccinated individuals (both infected and uninfected) had higher microbial diversity compared to their unvaccinated counterparts. SARS-CoV-2-positive and -negative individuals were largely compositionally similar varying by 4–7% but considering vaccination*infection statuses, the genetic distance increased to 12% (P = 0.003) and was mainly influenced by vaccination. Common among the pre- and post-vaccine samples, Atopobium and Finegoldia were abundant in infected and uninfected individuals, respectively. Bacteria belonging to major butyrate-producing phyla, Bacillota (particularly class Clostridia) and Bacteroidota showed increased abundance more strikingly in infected individuals before vaccines were available. They reduced significantly after vaccines were introduced into the country with Fusobacterium and Lachnoanaerobaculum being the only common bacteria between pre-vaccine infected persons and vaccinated individuals, suggesting that natural infection and vaccination correlate with high abundance of short-chain fatty acids.

Conclusion

Our results show, in an African cohort, the abundance of bacteria taxa known for their protective pathophysiological processes, especially during infection, suggesting that this population is protected against severe COVID-19. The immune-related roles of the members of Bacillota and Bacteroidota that were found associated with infection and vaccination require further studies, and how these may be linked to ethnicity, diet and age. We also recommend expansion of microbiome–disease association studies across Africa to identify possible bacterial-mediated therapeutics for emerging infections.
Key stakeholders’ perspectives of illicit drug use and associated harms in the Northern Territory of Australia
Authors: Brickley Bryce , Moore Samuel , Tari-Keresztes Noemi , Brand Anthea , Bower Madeleine , Bonson Jason G. , McEntee Alice , Bartram Ashlea J. , Bovopoulos Nataly , McPhie Skye , Martin Craig , Wright Cassandra , Bowden Jacqueline , Smith James A.
Published: September 2024

Background

In the Northern Territory (NT) of Australia, there are significant evidence gaps about illicit drug use and harms, despite having established monitoring and reporting systems. This paper reports on illicit drug use, associated harms, contributing factors, service needs and priorities in the NT from the perspective and experiences of key stakeholders engaged in providing services for, or advocating on behalf of, people who use illicit drugs in the NT.

Methods

Face-to-face and online qualitative interviews were conducted with stakeholders across urban and remote locations in the NT. Key stakeholders were service providers, including acute and primary care clinicians, representatives of Aboriginal community controlled health organisations, lived experience advocates, peak body representatives and public health executives. Qualitative data were analysed thematically.

Results

Four researchers interviewed 21 participants across urban (62%), and remote areas (38%) of the NT. Themes identified were: (1) Illicit drug use and harms are diverse and distinct; (2) Client support needs are complex and influenced by co-morbidities, socio-demographic and cultural factors; (3) Priority population sub-groups need targeted strategies; (4) Local service strengths can be further developed and enhanced; (5) Local services need better resourcing; (6) Invest in progressive legislative and policy reforms; and (7) Improve routine monitoring and evaluation.

Conclusions

Key stakeholders described illicit drug use, harms and contributing factors, which provided insights into the local challenges. Participants emphasised that clients have complex care needs, and further investment into targeted strategies are required to improve service engagement with priority groups. Service needs included greater understanding the role of dual diagnosis and its implementation and enhancing integrated and collaborative care in both primary health and acute care contexts. The voices of people with lived experience captured in this paper must inform local strategy and policy development relating to illicit drug use, in alignment with national strategy.
Effects of high-definition tDCS targeting individual motor hotspot with EMG-driven robotic hand training on upper extremity motor function: a pilot randomized controlled trial
Authors: Hu Chengpeng , Ti Chun Hang Eden , Yuan Kai , Chen Cheng , Khan Ahsan , Shi Xiangqian , Chu Winnie Chiu-wing , Tong Raymond Kai-yu
Published: September 2024

Background

Delivering HD-tDCS on individual motor hotspot with optimal electric fields could overcome challenges of stroke heterogeneity, potentially facilitating neural activation and improving motor function for stroke survivors. However, the intervention effect of this personalized HD-tDCS has not been explored on post-stroke motor recovery. In this study, we aim to evaluate whether targeting individual motor hotspot with HD-tDCS followed by EMG-driven robotic hand training could further facilitate the upper extremity motor function for chronic stroke survivors.

Methods

In this pilot randomized controlled trial, eighteen chronic stroke survivors were randomly allocated into two groups. The HDtDCS-group (n = 8) received personalized HD-tDCS using task-based fMRI to guide the stimulation on individual motor hotspot. The Sham-group (n = 10) received only sham stimulation. Both groups underwent 20 sessions of training, each session began with 20 min of HD-tDCS and was then followed by 60 min of robotic hand training. Clinical scales (Fugl-meyer Upper Extremity scale, FMAUE; Modified Ashworth Scale, MAS), and neuroimaging modalities (fMRI and EEG-EMG) were conducted before, after intervention, and at 6-month follow-up. Two-way repeated measures analysis of variance was used to compare the training effect between HDtDCS- and Sham-group.

Results

HDtDCS-group demonstrated significantly better motor improvement than the Sham-group in terms of greater changes of FMAUE scores (F = 6.5, P = 0.004) and MASf (F = 3.6, P = 0.038) immediately and 6 months after the 20-session intervention. The task-based fMRI activation significantly shifted to the ipsilesional motor area in the HDtDCS-group, and this activation pattern increasingly concentrated on the motor hotspot being stimulated 6 months after training within the HDtDCS-group, whereas the increased activation is not sustainable in the Sham-group. The neuroimaging results indicate that neural plastic changes of the HDtDCS-group were guided specifically and sustained as an add-on effect of the stimulation.

Conclusions

Stimulating the individual motor hotspot before robotic hand training could further enhance brain activation in motor-related regions that promote better motor recovery for chronic stroke.

Trial registration

This study was retrospectively registered in ClinicalTrials.gov (ID NCT05638464).
WHO-recommended levels of physical activity in relation to mammographic breast density, mammographic tumor appearance, and mode of detection of breast cancer
Authors: Boraka Öykü , Sartor Hanna , Sturesdotter Li , Hall Per , Borgquist Signe , Zackrisson Sophia , Rosendahl Ann H.
Published: September 2024

Background

Despite known benefits of physical activity in reducing breast cancer risk, its impact on mammographic characteristics remain unclear and understudied. This study aimed to investigate associations between pre-diagnostic physical activity and mammographic features at breast cancer diagnosis, specifically mammographic breast density (MBD) and mammographic tumor appearance (MA), as well as mode of cancer detection (MoD).

Methods

Physical activity levels from study baseline (1991–1996) and mammographic information from the time of invasive breast cancer diagnosis (1991–2014) of 1116 women enrolled in the Malmö Diet and Cancer Study cohort were used. Duration and intensity of physical activity were assessed according to metabolic equivalent of task hours (MET-h) per week, or World Health Organization (WHO) guideline recommendations. MBD was dichotomized into low-moderate or high, MA into spiculated or non-spiculated tumors, and MoD into clinical or screening detection. Associations were investigated through logistic regression analyses providing odds ratios (OR) with 95% confidence intervals (CI) in crude and multivariable-adjusted models.

Results

In total, 32% of participants had high MBD at diagnosis, 37% had non-spiculated MA and 50% had clinical MoD. Overall, no association between physical activity and MBD was found with increasing MET-h/week or when comparing women who exceeded WHO guidelines to those subceeding recommendations (ORadj 1.24, 95% CI 0.78–1.98). Likewise, no differences in MA or MoD were observed across categories of physical activity.

Conclusions

No associations were observed between pre-diagnostic physical activity and MBD, MA, or MoD at breast cancer diagnosis. While physical activity is an established breast cancer prevention strategy, it does not appear to modify mammographic characteristics or screening detection.
The effect of cessation of drinking water fluoridation on dental restorations and crowns in children aged 3–5 years in Israel – a retrospective study
Authors: Nezihovski Shiran Shemesh , Findler Mordechai , Chackartchi Tali , Mann Jonathan , Haim Doron , Tobias Guy
Published: September 2024

Background

Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3–5, treated in “Assuta Tel Aviv” dental clinics, under general anesthesia or deep sedation.

Methods

The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014–2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation.

Results

A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages.

Conclusion

The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.
Navigating Hormone Therapy in Postmenopausal Women: Balancing Symptom Relief With Cancer Risk
Authors: Barbi Mali , Gorman Megan , John Veena S.
Published: September 2024

The Oncology Grand Rounds series is designed to place original reports published in the
Journal
into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in

Journal of Clinical Oncology,
to patients seen in their own clinical practice.
Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial
Authors: Nichols Anthony C. , Theurer Julie , Prisman Eitan , Read Nancy , Berthelet Eric , Tran Eric , Fung Kevin , de Almeida John R. , Bayley Andrew , Goldstein David P. , Hier Michael , Sultanem Khalil , Richardson Keith , Mlynarek Alex , Krishnan Suren , Le Hien , Yoo John , MacNeil S. Danielle , Winquist Eric , Hammond J. Alex , Venkatesan Varagur , Kuruvilla Sara , Warner Andrew , Mitchell Sylvia , Chen Jeff , Johnson-Obaseki Stephanie , Odell Michael , Corsten Martin , Parker Christina , Wehrli Bret , Kwan Keith , Palma David A.
Published: September 2024

Radiotherapy (RT) and transoral robotic surgery (TORS) are both curative-intent treatment options for oropharyngeal squamous cell carcinoma (OPSCC). Herein, we report the final outcomes of the ORATOR trial comparing these modalities, 5 years after enrollment completion. We randomly assigned 68 patients with T1-2N0-2 OPSCC to RT (with chemotherapy if node-positive) versus TORS plus neck dissection (± adjuvant RT/chemoradiation). The primary end point was swallowing quality of life (QOL) assessed with the MD Anderson Dysphagia Inventory (MDADI). Secondary end points included overall and progression-free survival (OS, PFS), adverse events (AEs), and other QOL metrics. The primary end point has been previously reported (Nichols 2019). In this report, the median follow-up was 5.1 years (IQR, 5.0-5.3 years). MDADI total scores converged by 5 years and were not significantly different across the follow-up period (
P
= .11). EORTC QLQ-C30 and H&N35 scores demonstrated differing profiles, including worse dry mouth in the RT arm (
P
= .032) and worse pain in the TORS arm (
P
= .002). Grade 2-5 AE rates did not differ between arms (91% [n = 31]
v
97% [n = 33] respectively,
P
= .61), with more neutropenia and hearing loss in the RT arm, and more dysphagia and other pain in the TORS arm based on grades 2-5 (all
P
< .05). There were no differences in OS or PFS. In conclusion, toxicity and QOL profiles differ in some domains between RT and TORS, but oncologic outcomes were excellent in both arms. Choice of treatment should remain a shared decision between the patient and their providers.
Adjuvant Nivolumab for Localized Renal Cell Carcinoma at High Risk of Recurrence After Nephrectomy: Part B of the Randomized, Placebo-Controlled, Phase III CheckMate 914 Trial
Authors: Motzer Robert J. , Bex Axel , Russo Paul , Tomita Yoshihiko , Cutuli Hernan Javier , Rojas Carlos , Gross-Goupil Marine , Schinzari Giovanni , Melichar Bohuslav , Barthélémy Philippe , Ruiz Garcia Abraham , Sosman Jeffrey , Grimm Marc-Oliver , Goh Jeffrey C. , Suarez Cristina , Kollmannsberger Christian K. , Nair Suresh G. , Shuch Brian M. , Huang Jian , Simsek Burcin , Spiridigliozzi Julia , Lee Chung-Wei , van Kooten Losio Maximiliano , Grünwald Viktor
Published: September 2024

PURPOSE

CheckMate 914 is a two-part, randomized phase III trial evaluating adjuvant nivolumab plus ipilimumab (part A) or adjuvant nivolumab monotherapy (part B) versus placebo in mutually exclusive populations of patients with localized renal cell carcinoma (RCC) at high risk of postnephrectomy recurrence. Part A showed no disease-free survival (DFS) benefit for adjuvant nivolumab plus ipilimumab versus placebo. We report results from part B.

METHODS

Patients were randomly assigned (2:1:1) to nivolumab (240 mg once every 2 weeks for up to 12 doses), placebo, or nivolumab (240 mg once every 2 weeks for up to 12 doses) plus ipilimumab (1 mg/kg once every 6 weeks for up to four doses). The planned treatment duration was 24 weeks (approximately 5.5 months). The primary end point was DFS per blinded independent central review (BICR) for nivolumab versus placebo; safety was a secondary end point.

RESULTS

Overall, 825 patients were randomly assigned to nivolumab (n = 411), placebo (n = 208), or nivolumab plus ipilimumab (n = 206). With a median follow-up of 27.0 months (range, 18.0-42.4), the primary end point of improved DFS per BICR with nivolumab versus placebo was not met (hazard ratio [HR], 0.87 [95% CI, 0.62 to 1.21];
P
= .40); the median DFS was not reached in either arm, and 18-month DFS rates were 78.4% versus 75.4%. The HR for DFS per investigator was 0.80 (95% CI, 0.58 to 1.12;
P
= .19). Grade 3-4 all-cause adverse events (AEs) occurred in 17.2%, 15.0%, and 28.9% of patients with nivolumab, placebo, and nivolumab plus ipilimumab, respectively. Any-grade treatment-related AEs led to discontinuation in 9.6%, 1.0%, and 28.4%, respectively.

CONCLUSION

Part B of CheckMate 914 did not meet the primary end point of improved DFS for nivolumab versus placebo in patients with localized RCC at high risk of postnephrectomy recurrence.
The Rise of Informal Unions in the MENASA Region
Authors: Friedland Roger , Afary Janet
Published: September 2024

This article examines the nature of informal marriages using data from a 2018 survey of over ten thousand Facebook users in seven Muslim-majority countries: Algeria, Egypt, Iran, Pakistan, Palestine, Tunisia, and Turkey. The article explores current attitudes toward informal marriages as well as the nature of such unions among the predominantly Sunni and Shiʿi Muslim social-media users who took the survey. First, the article finds that informal marriages have diffused across the Sunni Muslim world. These marriages are not necessarily loveless unions between women of modest means looking for financial support and men seeking legitimate sexual partners. In fact, the survey suggests that women in such unions are less likely to be financially dependent on their partners. Informally married spouses are as likely to say that they love their partners as those who are formally wed. However, this love, whether in formal or informal marriages, does not necessarily entail a deep bond between partners who share their most intimate feelings. Marriage—whether formal or informal—is perceived as fragile, not a lifelong commitment. The rates of divorce in the countries surveyed are approaching those in the West. These informal marriages might therefore be thought of as a new form of cohabitation, a practice increasing throughout the world.
A microtubule stability switch alters isolated vascular smooth muscle Ca2+ flux in response to matrix rigidity
Authors: Johnson Robert T. , Wostear Finn , Solanki Reesha , Steward Oliver , Bradford Alice , Morris Christopher , Bidula Stefan , Warren Derek T.
Published: September 2024

During ageing, the extracellular matrix of the aortic wall becomes more rigid. In response, vascular smooth muscle cells (VSMCs) generate enhanced contractile forces. Our previous findings demonstrate that VSMC volume is enhanced in response to increased matrix rigidity, but our understanding of the mechanisms regulating this process remain incomplete. In this study, we show that microtubule stability in VSMCs is reduced in response to enhanced matrix rigidity via Piezo1-mediated Ca2+ influx. Moreover, VSMC volume and Ca2+ flux is regulated by microtubule dynamics; microtubule-stabilising agents reduced both VSMC volume and Ca2+ flux on rigid hydrogels, whereas microtubule-destabilising agents increased VSMC volume and Ca2+ flux on pliable hydrogels. Finally, we show that disruption of the microtubule deacetylase HDAC6 uncoupled these processes and increased α-tubulin acetylation on K40, VSMC volume and Ca2+ flux on pliable hydrogels, but did not alter VSMC microtubule stability. These findings uncover a microtubule stability switch that controls VSMC volume by regulating Ca2+ flux. Taken together, these data demonstrate that manipulation of microtubule stability can modify VSMC response to matrix stiffness.