bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of Complex Oral and Maxillofacial Defects After Oral Cancer Resection With Individualized Anterolateral Thigh Multiple Paddle Flaps
Authors: Zhang Shuai , Zhang Shanshan , Zou Jingyuan , Jiang Tiancheng , Chen Lin , Gong Zhaojian 
Published: October 2024

Purpose:
This study aimed to use reconstructive methods for complex oral and maxillofacial defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) multiple paddle flaps.

Patients and Methods:
The authors performed a retrospective case series of 33 patients who underwent oral and maxillofacial defect reconstruction using the ALT multiple paddle flaps. The design and harvest of the flaps, methods for defects reconstruction, and reconstructive efficacy are described.

Results:
All 33 patients were men, with a mean age of 49.5 years. Of the flaps, triple skin paddles plus muscle paddles were included in 3 cases, triple skin paddles were included in 1 case, 2 skin paddles plus muscle paddles were included in 29 cases. The skin paddles measured 3×5 cm to 10×16 cm. Postoperatively, all flaps survived completely. Parotid salivary fistula and orocutaneous fistula occurred in 1 patient of each, thigh wound infection and effusion occurred in 1 and 2 patients, respectively. All patients were followed up for ~2 to 93 months; most patients’ oral functions and appearance were acceptable, and thigh motor dysfunction was not observed.

Conclusions:
With separate skin paddles for defects of different positions, individualized muscle flap for dead spaces, combination of different skin paddles for larger defects, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT multiple paddle flaps are an ideal candidate for complex oral and maxillofacial defects reconstruction.
Role of caregivers being trained in assisting in end of life care – Latin American perspective
Authors: de Vries Esther , Calvache José A. , Hernández Zambrano Sandra M. 
Published: October 2024

Purpose of review
Palliative care in Latin America is evolving, but training for informal caregivers remains underexplored. This review summarizes recent interventions to educate or train caregivers in end-of-life care.

Recent findings
The literature search identified three interventions published by 2023, two with reception evaluations, all with small sample sizes and no control groups. Needs of caregivers have been more frequently described and include training on aspects of the disease, nursing skills, how to handle patients´ and own emotions; help in navigating the complex healthcare systems in Latin America; help in conversations about the end of life and dying, still taboos in the region; help in finding additional caregivers or other types of support to make the caregiving role sustainable over time for the caregiver. Interventions mainly focused on emotional support and identifying additional caregivers without guilt; two included nursing skills training.

Summary
There are very few formal interventions described and evaluated to assist caregivers in end-of-life care in Latin America described in the literature. This illustrates the rather invisible but very important role of these important stakeholders in the care for patients. Multidimensional interventions should be developed and evaluated to support caregivers.
A rigidly foldable and reconfigurable thick origami antenna
Authors: Yao Shun , Zekios Constantinos L. , Georgakopoulos Stavros V. 
Published: October 2024

A rigidly foldable and reconfigurable origami antenna is developed here. This antenna uses thick folding panels thereby providing robust operation and folding/unfolding actuation, which are very important for many applications in extreme environments, such as space. Also, this antenna can be constructed using standard printed circuit boards, which simplifies its manufacturing. For the reconfigurable antenna developed here, the origami flasher pattern is chosen to achieve a spatial transformation of a dipole operating at 0.48 GHz to a conical spiral antenna (CSA) operating from 2.1 to 3.7 GHz. The design equations for the origami CSA are derived. A prototype is built using a 0.81-mm-thick FR4 substrate to validate the proposed methodology. The antenna parameters are investigated in a wide frequency range. Our simulated results agree very well with the measurements. The rigid structure of the proposed design and its reconfigurable nature make it a good candidate for satellite communications.
This article is part of the theme issue ‘Origami/Kirigami-inspired structures: from fundamentals to applications’.
Programmable adhesion through triangular and hierarchical cuts in metamaterial adhesives
Authors: Hwang Dohgyu , Lee Chanhong , Bartlett Michael D. 
Published: October 2024

Metamaterial design approaches, which integrate structural elements into material systems, enable the control of uncommon behaviours by decoupling local and global properties. Leveraging this conceptual framework, metamaterial adhesives incorporate nonlinear cut architectures into adhesive films to achieve unique combinations of adhesion capacity, release, and spatial tunability by controlling how cracks propagate forward and in reverse directions during separation. Here, metamaterial adhesive designs are explored with triangular cut features while integrating hierarchical and secondary cut patterns among primary nonlinear cuts. Both cut geometry and secondary cut features tune adhesive force capacity and energy of separation. Importantly, the size and spacing of cut features must be designed around a critical length scale. When secondary cut features are greater than a critical length, cracks can be steered in multiple directions, going both forward and backwards within a primary attachment element. This control over crack dynamics enhances the work of separation by a factor of 1.5, while maintaining the peel force relative to a primary cut. If hierarchical cut features are too small or too compliant, they interact and do not distinctly modify crack behaviour. This work highlights the importance of adhesive length scales and stiffness for crack control and attachment characteristics in adhesive films.
This article is part of the theme issue ‘Origami/Kirigami-inspired structures: from fundamentals to applications’.
Improving mass lumping and stiffness parameters of bar and hinge model for accurate modal dynamics of origami structures
Authors: Lahiri Anandaroop , Pratapa Phanisri Pradeep 
Published: October 2024

The bar and hinge framework uses truss elements and rotational springs to efficiently model the structural behaviour of origami. The framework is especially useful to investigate origami metamaterials as they have repeating geometry, which makes conventional finite element simulations very expensive due to a large number of degrees of freedom. This work proposes improvements to the parameters of bar and hinge model within the context of structural dynamics, specifically modal analysis under small deformations, which has not been carried out previously in the literature. A range of low-frequency modes involving origami folding and panel bending deformations that can be accurately captured by the bar and hinge framework are identified. Within this range, bar and hinge parameters like the lumped masses and the rotational spring stiffness values are derived using conservation laws and finite element tests. The best among the proposed schemes is found to predict natural frequencies of the considered origami structures to within 10% maximum error, improving the accuracy by more than three times from existing schemes. In most cases, the errors in natural frequencies are less than 5%.
This article is part of the theme issue ‘Origami/Kirigami-inspired structures: from fundamentals to applications’.
Reconfigurable origami with variable stiffness joints for adaptive robotic locomotion and grasping
Authors: Lerner Elisha , Chen Zhe , Zhao Jianguo 
Published: October 2024

With its compactness and foldability, origami has recently been applied to robotic systems to enable versatile robots and mechanisms while maintaining a low weight and compact form. This work investigates how to generate different motions and shapes for origami by tuning its creases’ stiffness on the fly. The stiffness tuning is realized by a composite material made by sandwiching a thermoplastic layer between two shape memory polymer layers. This enables the composite to act as a living hinge, whose stiffness can be actively controlled through Joule heating. To demonstrate our concept, we fabricate an origami module with four variable stiffness joints (VSJs), allowing it to have freely controlled crease stiffnesses across its surface. We characterize the origami module’s versatile motion when heating different VSJs with different temperatures. We further use two origami modules to build a two-legged robot that can locomote on the ground with different locomotion gaits. The same robot is also used as an adaptive gripper for grasping tasks. Our work can potentially enable more versatile robotic systems made from origami as well as other mechanical systems with programmable properties (e.g. mechanical metamaterials).
This article is part of the theme issue ‘Origami/Kirigami-inspired structures: from fundamentals to applications’.
Toward mechanical proprioception in autonomously reconfigurable kirigami-inspired mechanical systems
Authors: Jiao Weijian , Shu Hang , He Qiguang , Raney Jordan R. 
Published: October 2024

Mechanical metamaterials have recently been exploited as an interesting platform for information storing, retrieval and processing, analogous to electronic devices. In this work, we describe the design and fabrication a two-dimensional (2D) multistable metamaterial consisting of building blocks that can be switched between two distinct stable phases, and which are capable of storing binary information analogous to digital bits. By changing the spatial distribution of the phases, we can achieve a variety of different configurations and tunable mechanical properties (both static and dynamic). Moreover, we demonstrate the ability to determine the phase distribution via simple probing of the dynamic properties, to which we refer as mechanical proprioception. Finally, as a simple demonstration of feasibility, we illustrate a strategy for building autonomous kirigami systems that can receive inputs from their environment. This work could bring new insights for the design of mechanical metamaterials with information processing and computing functionalities.
This article is part of the theme issue ‘Origami/Kirigami-inspired structures: from fundamentals to applications’.
Lagrangian approach to origami vertex analysis: kinematics
Authors: Grasinger Matthew , Gillman Andrew , Buskohl Philip R. 
Published: October 2024

The use of origami in engineering has significantly expanded in recent years, spanning deployable structures across scales, folding robotics and mechanical metamaterials. However, finding foldable paths can be a formidable task as the kinematics are determined by a nonlinear system of equations, often with several degrees of freedom. In this article, we leverage a Lagrangian approach to derive reduced-order compatibility conditions for rigid-facet origami vertices with reflection and rotational symmetries. Then, using the reduced-order conditions, we derive exact, multi-degree of freedom solutions for degree 6 and degree 8 vertices with prescribed symmetries. The exact kinematic solutions allow us to efficiently investigate the topology of allowable kinematics, including the consideration of a self-contact constraint, and then visually interpret the role of geometric design parameters on these admissible fold paths by monitoring the change in the kinematic topology. We then introduce a procedure to construct lower-symmetry kinematic solutions by breaking symmetry of higher-order kinematic solutions in a systematic way that preserves compatibility. The multi-degree of freedom solutions discovered here should assist with building intuition of the kinematic feasibility of higher-degree origami vertices and also facilitate the development of new algorithmic procedures for origami-engineering design.
This article is part of the theme issue ‘Origami/Kirigami-inspired structures: from fundamentals to applications’.
Clinical characteristics and serotype association of dengue and dengue like illness in Pakistan
Authors: Iqbal Najeeha Talat , Ahmed Kumail , Khalid Aqsa , Imtiaz Kehkashan , Ali Qamreen Mumtaz , Munir Tania , Mahmood Syed Faisal , Khan Unab , Afzal Badar , Qamar Farah , Waggoner Jesse J. , Fenelon Hannah , McOwen Helene , Khan Erum , Rabinowitz Peter , Van Voorhis Wesley C. 
Published: October 2024

AbstractBackgroundPakistan has been an endemic country for dengue virus since 1994, with a significant increase in cases reported in 2022 largely due to heavy rainfall and flooding. All four serotypes of the dengue virus (DENV) are present in Pakistan, with DENV 1 and DENV 2 being the most prevalent. The current study aimed to explore the clinical presentations and features of dengue fever in a tertiary care hospital.MethodologyWe enrolled and studied 349 cases of suspected and confirmed dengue presenting for care at the Aga Khan University Hospital in Karachi between June 2021 and November 2023. Collected data on cases including clinical symptoms and laboratory results including qRT-PCR and serotype characterization.FindingsThe majority of subjects enrolled (75%) had mild disease without warning signs, while 11% exhibited warning signs, 1.4% had severe dengue, and 12.6 % had no dengue diagnosis. Patients with severe dengue (SD) had significantly higher levels of liver enzymes (AST and ALT) compared to those with non-severe dengue (NSD) (AST; p=0.024 and ALT; p=0.047). Additionally, a higher grade of thrombocytopenia was significantly associated with hospitalization (p=0.0008), and prolonged illness (p=0.03). Both Platelet (p<0.0001) and WBC counts (p=0.001) were significantly lower in dengue PCR-positive patients in comparison to Dengue PCR-negative. Among those tested for dengue serotypes, DENV 1 (34%) and DENV 2 (45%) emerged as the predominant serotypes, with mixed infections accounting for 17%. The sensitivity of clinical diagnosis was found to be 87.25% and specificity of 68.35%. qRT-PCR detected 43.5% of cases with viral fever initially screened negative.ConclusionEpidemiology of dengue fever during a widespread outbreak in 2022 showed a predominance of DENV 1 and DENV 2 serotypes with milder phenotype of viral illness. Screening with rapid tests requires further confirmation by molecular assay in cases with dengue and dengue-like illness.
Metrics based on habitat area and condition are poor proxies for invertebrate biodiversity
Authors: Duffus Natalie E. , Atkins Thomas B. , zu Ermgassen Sophus O.S.E. , Grenyer Richard. , Bull Joseph W. , Castell Dan A. , Stone Ben. , Tooher Niamh. , Milner-Gulland E.J. , Lewis Owen T. 
Published: October 2024

AbstractThere is increasing demand for standardised, easy-to-use metrics to assess progress towards achieving biodiversity targets and the effectiveness of ecological compensation schemes. Biodiversity metrics based on combining habitat area and habitat condition scores are proliferating rapidly, but there is limited evidence on how they relate to ecological outcomes. Here, we test the relationship between the statutory biodiversity metric used for Biodiversity Net Gain (BNG) in England — and as the basis for new biodiversity credit systems around the world — and invertebrate richness, abundance, and community composition. We find that the combined area-condition BNG metric does not capture the value of arable farmland and grassland sites for invertebrate biodiversity: invertebrate communities were highly variable across sites that had the same type and condition under the BNG metric. There was no significant relationship between invertebrate abundance or species richness and metric scores. Our results highlight the need to incorporate factors beyond habitat type and condition into site evaluations, and to complement metric use with species-based surveys.
GRIN2B disease-associated mutations disrupt the function of BK channels and NMDA receptor signalling nanodomains
Authors: Martínez-Lázaro Rebeca , Minguez-Viñas Teresa , Alvarez de la Rosa Diego , Bartolomé-Martín David , Giraldez Teresa 
Published: October 2024

AbstractLarge conductance calcium-activated potassium channels (BK channels) are unique in their ability to respond to two distinct physiological stimuli: intracellular Ca2+and membrane depolarization. In neurons, these channels are activated through a coordinated response to both signals; however, for BK channels to respond to physiological voltage changes, elevated concentrations of intracellular Ca2+(ranging from 1 to 10 μM) are necessary. As a result, it is believed that BK channels are typically localized within nanodomains near Ca2+sources (approximately 20-50 nm), such as N-methyl-D-aspartate receptors (NMDARs). Since the first evidence of NMDAR-BK channel coupling reported by Isaacson and Murphy in 2001 in the olfactory bulb, further studies have identified functional coupling between NMDARs and BK channels in other regions of the brain, emphasizing their importance in neuronal function. Mutations in the genes encoding NMDAR subunits have been directly linked to various neurodevelopmental disorders, including intellectual disability, epilepsy, and autism spectrum disorders. For instance, mutations such as V15M and V618G in the GRIN2B gene, which encodes the GluN2B subunit of NMDARs, are implicated in the pathogenesis of early infantile epileptic encephalopathy (EIEE27). Here, we explored the effects of these two GluN2B mutations on NMDAR-BK channel coupling, employing a combination of electrophysiological, biochemical, and imaging techniques. Taken together, our results demonstrate that mutation V618G specifically disrupts NMDAR-BK complex formation, impairing functional coupling, in spite of robust individual channel expression in the membrane. These results provide a potential mechanistic basis for EIEE27 pathophysiology and uncover new clues about NMDAR-BK complex formation.
Disruption of Normal Saline Supply Chain due to Natural Disaster: an analysis of the impact of normal saline shortage on anesthesia practice in a large hospital system and models towards resiliency
Authors: Hussain Rashid , Pickle Elizabeth , Lonjin Taylor , Then Janine , Rivosecchi Ryan , Cassavaugh Jessica , Fichman Mark , Kaynar Ata Murat 
Published: October 2024

AbstractIn the wake of the COVID-19 pandemic and upheaval in the global supply chain, the healthcare sector has grappled with acute shortages of essential resources. Such shortages, while intensified recently in scale and frequency, are not new, as natural disasters have posed recurrent challenges. An illustrative example is the impact of Hurricane Maria in September 2017, which severely disrupted the production of normal saline (% 0.9 NaCl fluid bags) in Puerto Rico. Hospitals relying on “just in time” delivery models found themselves in a precarious situation, prompting a need for innovative solutions to sustain care delivery amidst the crisis. The occurrence underscores the vulnerability of healthcare infrastructure to external disruptions and emphasizes the need for adaptive strategies to ensure the resilience of the system in the face of unforeseen challenges.Consequently, our focus shifted to an examination of the impact of Hurricane Maria on saline supplies at the University of Pittsburgh Medical Center (UPMC) towards building a resilient model. This study aims to elucidate how the flagship hospitals of the system navigated the challenges posed by the shortage, both at the individual provider level and on a broader, system-wide scale.This investigation spanned an 18-month study period, encompassing the analysis of intravenous (IV) fluid demand and usage patterns before, during, and after the hurricane. Employing a multi-faceted approach, we integrated quantitative data with qualitative insights derived from three months of “participant observation” and survey data. This mixed-methods approach enabled us to see how individuals and systems within UPMC adapted to the crisis. Systems level adaptation occurred at UPMC’s operating room (OR), pharmacy and distribution supply chain levels, including by decreasing OR demand, while at the individual level healthcare providers changed their behavior by turning to alternative medications and carrier fluids. These adaptive measures undertaken at UPMC offer insights for future crises at both the organizational and individual levels within the healthcare system.
Enhancing Breast Cancer Classification: A Few-Shot Meta-Learning Framework with DenseNet-121 for Improved Diagnosis
Authors: Upadhyay Nidhi , Bhargava Anuja , Singh Upasana , Alsharif Mohammed H. , Cho Ho-Shin 
Published: October 2024

AbstractBreast cancer is a significant health concern globally, requiring early and accurate detection to improve patient outcomes. However, manual detection of breast cancer from medical images is time-consuming and inaccurate. Accurate assessment of cancer stages is critical for effective treatment and post-diagnosis handling. The goal of this research is to develop a specialized meta-learning method for classifying breast cancer images, particularly effective when working with limited data. Traditional cancer stage classification methods often struggle with insufficient labeled data, but meta-learning addresses this challenge by rapidly adapting to new tasks with few examples. The proposed method begins with image segmentation to identify regions of interest in the medical images, followed by thorough feature extraction to capture essential data representations. The critical meta-training phase involves refining a classifier within a metric space, utilizing cosine distance and an adaptable scale parameter. During the meta-testing stage, the adapted classifier predicts cancer stages using minimal support samples, achieving approximately 96% accuracy. This approach shows significant promise for the medical field, providing practical solutions to enhance diagnostic processes and improve predictions for breast cancer detection and treatment.