bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design and Mechanical Testing of a Novel Dual-Stiffness Ankle-Foot Orthosis
Authors: Nigro Luke , Arch Elisa S. 
Published: June 2023

Abstract
This study details the concept, design, and mechanical testing results of a novel dual-stiffness ankle-foot orthosis (DS-AFO). The DS-AFO utilizes two separate stiffness elements (rear struts) to yield an AFO with low stiffness properties about the ankle in the sagittal plane at small dorsiflexion angles, and higher stiffness at larger dorsiflexion angles. The motivation behind this DS-AFO follows from the existence of similar moment-angle (stiffness) properties of the healthy human ankle during walking, referred to as dual-stiffness natural ankle quasi-stiffness (DS-NAS). Crucial to the design of the DS-AFO is the ability to adjust both the stiffness and the dorsiflexion angle at which the net stiffness increases, referred to as the activation angle. Three different DS-AFO stiffness configurations were tested, each with three different activation angles, along with a standard single strut/stiffness AFO configuration. The DS-AFO was able to achieve distinct regions of low and high stiffness at every configuration. Additionally, altering the activation angle by ±1 deg generally did not result in different stiffness properties. This work is a step forward in AFOs with complex stiffness properties that can better approximate the mechanics of a healthy human ankle.
Automotive Silicon Carbide Power Module Cooling With a Novel Modular Manifold and Embedded Heat Sink
Authors: Osman Ammar , Moreno Gilberto , Myers Steve , Major Joshua , Feng Xuhui , Narumanchi Sreekant V. J. , Joshi Yogendra 
Published: June 2023

Abstract
The next generation of integrated power electronics packages will implement wide-bandgap devices with ultrahigh device heat fluxes. Although jet impingement has received attention for power electronics thermal management, it is not used in commercial electric vehicles (EVs) because of the associated pressure drop and reliability concerns. In this paper, we present a modular thermal management system designed for automotive power electronics. The system achieves superior thermal performance to benchmarked EVs while adhering to reliability standards and with low pumping power. The system utilizes a low-cost and lightweight plastic manifold to generate jets over an optimized heat sink, which is embedded in the direct-bonded-copper (DBC) substrate. The embedded heat sink concept leverages additive manufacturing to add elliptical pin fins to the DBC substrate. The heat sink geometry is optimized for submerged jet impingement using a unit-cell model and an exhaustive search algorithm. The model predictions are validated using unit-cell experiments. A full-scale power module model is then used to compare the DBC-embedded heat sink against direct DBC cooling and baseplate-integrated heat sinks for single-sided (SS) and double-sided (DS) cooling concepts. Using the SS and DS DBC-embedded cooling concepts, the models predict a thermal resistance that represents a reduction of 75% and 85% compared to the 2015 BMW i3, respectively, for the same water-ethylene glycol inverter flowrate. We have shown that an inverter with a 100-kilo-Watt-per-liter power density is achievable with the proposed design.
Additive benefit of rehabilitation on physical status, symptoms and mental health after hospitalisation for severe COVID-19 pneumonia
Authors: Asimakos Andreas , Spetsioti Stavroula , Mavronasou Aspasia , Gounopoulos Pantelis , Siousioura Dimitra , Dima Effrosyni , Gianniou Niki , Sigala Ioanna , Zakynthinos Georgios , Kotanidou Anastasia , Vogiatzis Ioannis , Katsaounou Paraskevi 
Published: June 2023

IntroductionThe potential additive benefits of rehabilitation beyond spontaneous recovery post-COVID-19 currently remain unknown.MethodsIn this prospective, interventional, non-randomised parallel assignment two-arm study, we investigated the effects of an 8-week rehabilitation programme (Rehab, n=25) added to usual care (UC) versus UC (n=27) on respiratory symptoms, fatigue, functional capacity, mental health and health-related quality of life in patients with COVID-19 pneumonia, 6–8 weeks post-hospital discharge. The rehabilitation programme included exercise, education, dietary and psychological support. Patients with chronic obstructive pulmonary disease, respiratory and heart failure were excluded from the study.ResultsAt baseline, groups were not different in mean age (56 years), gender (53% female), intensive care unit admission (61%), intubation (39%), days of hospitalisation (25), number of symptoms (9) and number of comorbidities (1.4). Baseline evaluation was conducted at median (IQR) 76 (27) days after symptoms onset. Groups were not different regarding baseline evaluation outcomes. At 8 weeks, Rehab showed significantly greater improvement in COPD Assessment Test by a mean±SEM (95% CI) 7.07±1.36 (4.29–9.84), p <0.001andall three fatigue questionnaires: Chalder-Likert: 5.65±1.27 (3.04–8.25), p <0.001; bimodal: 3.04±0.86 (1.28–4.79), p=0.001; Functional Assessment of Chronic Illness Therapy: 6.37±2.09 (2.08–10.65), p=0.005 and Fatigue Severity Scale: 1.36±0.433 (0.47–2.25), p=0.004. At 8 weeks rehab also showed significantly greater improvment in Short Physical Performance Battery: 1.13±0.33 (0.46–1.79), p=0.002; Hospital Anxiety and Depression Scale (HADS)Anxiety: 2.93±1.01 (0.67–5.18), p=0.013; Beck Depression Inventory: 7.81±3.07 (1.52–14.09), p=0.017; Montreal Cognitive Assessment: 2.83±0.63 (1.5–4.14), p <0.001; EuroQol (EQ-5D-5L) Utility Index: 0.21±0.05 (0.1–0.32), p=0.001 and Visual Analogue Scale: 6.57±3.21 (0.2–13.16), p=0.043. Both groups significantly improved 6-min walking distance by approximately 60 m and pulmonary function measures, whereas post-traumatic stress disorder measurement IES-R (Impact of Event Scale, Revised) and HADS-Depression score were not different between groups at 8 weeks. A 16% attrition rate was observed in the rehabilitation group exhibiting a threefold increase in training workload. There were no adverse effects reported during exercise training.DiscussionThese findings highlight the added value of rehabilitation post-COVID-19 to amplify the natural course of physical and mental recovery that otherwise would remain incomplete with UC.
An Approach Based on Machine Learning for the Cybersecurity of Blockchain-Based Smart Internet of Medical Things (IoMT) Networks
Authors: Alatawi Mohammed Naif 
Published: June 2023

This paper presents a hybrid blockchain architecture for Internet of Medical Things (IoMT) systems, aiming to enhance their security and performance. The proposed approach combines artificial intelligence (AI) models with blockchain technology to create a safe and efficient healthcare system. The study focuses on addressing the challenges related to data storage, data management, real-time medical applications, and system precision in IoMT. Through experimental evaluations, the effectiveness of the proposed techniques in terms of communication overhead, transaction performance, and privacy preservation is demonstrated. The results highlight the potential of leveraging AI and blockchain to improve the overall functionality of IoMT systems.
A note on Gorenstein projective and Gorenstein flat modules
Authors: Wang Xinxin 
Published: June 2023

We prove that all Gorenstein projective modules are Gorenstein flat if and only each Gorenstein projective module has finite Gorenstein flat dimension. As applications, some characterizations of strongly CM-free rings are established and an affirmative answer to a question posed by Wang [Colloq. Math. 170 (2022) 1–13] is obtained.
Electrochemical Detection of Melatonin at Tungsten Oxide Nanospheres Decorated Chitosan Electrode
Authors: Thenrajan Thatchanamoorthy , Girija Srinivasan , Sangeetha Selvaraj , Alwarappan Subbiah , Wilson Jeyaraj 
Published: June 2023

Melatonin is a clinically important hormone as it plays a key role in maintaining immune system, circadian rhythm, blood pressure and cortisol levels. Therefore, its real time detection is crucial for monitoring body function. Melatonin detection by electrochemical sensors exhibits advantages such as high sensitivity, point-of-care analysis, rapid response time, easy to use and cost-effective. Natural polymer based biocomposites including chitosan, gum acacia, xanthan gum, chitin are widely employed due to their ready availability, low cost, biocompatibility and high surface area for biosensing applications. Herein, we investigated tungsten oxide (WO3) nanospheres decorated with functionalized chitosan (FCH) for melatonin detection. The functionalization of chitosan introduced plentiful amine groups and inter-hydrogen bonding that are essential for the formation of WO3/FCH biocomposite. Further, the large density of amine groups offered efficient binding affinity with WO3 and improved the conductivity of the nanocomposite thereby enabling sensitive melatonin detection. Electroanalysis confirmed the excellent electrocatalytic performance of the biocomposite towards melatonin with a limit of detection of 4.9 nM. The proposed nanocomposite exhibited excellent selectivity, reproducibility, stability. Further, its practical reliability was evaluated in real samples thereby demonstrating its usefulness in the detection of clinically relevant biomolecules.
A Th1-like CD4+ T-cell Cluster That Predicts Disease-free Survival in Early-stage Lung Cancer
Authors: Yanagihara Akitoshi , Yamasaki Satoshi , Hashimoto Kosuke , Taguchi Ryo , Umesaki Tetsuya , Imai Hisao , Kaira Kyoichi , Nitanda Hiroyuki , Sakaguchi Hirozo , Ishida Hironori , Kobayashi Kunihiko , Horimoto Katsuhisa , Kagamu Hiroshi 
Published: June 2023

Perioperative immune checkpoint inhibitors have been shown to improve prognosis in early-stage lung cancer. However, no biomarkers are known to indicate the requirement for treatment. This study aimed to identify T-cell clusters responsible for antitumor immunity in patients with early-stage lung cancer. Preoperative blood samples from 50 consecutive patients with lung cancer who were diagnosed as operable and underwent complete resection were analyzed by mass cytometry. Patients were divided into two groups: no recurrence at a minimum observation period of 851 days (median observation period: 1,031.5 days) and recurrence by the last observation date. Mass cytometry and single-cell RNA sequencing analysis of lymph nodes (LN) and tumor-infiltrating T cells were also performed. CCR4−CCR6+ Th7R showed discriminative ability between recurrence and non-recurrence patients with lung cancer. Patients with more than 3.04% Th7R showed significantly favorable disease-free survival. Th7R was a major component of CD4+ T cells in tumor microenvironments and LNs adjacent to lung cancer tissues and was the only cluster that decreased in peripheral blood after the removal of cancer tissues, suggesting that Th7R was primed and proliferated in tumor-draining LNs in the presence of cancer tissues. Th7R had the kinetics that antitumor T cells should have, as indicated by the cancer immunity cycle; thus, peripheral blood Th7R could represent the potency of tumor immunity by reflecting priming and proliferation in tumor-draining LNs and Th7R in the tumor microenvironment. Prediction using peripheral Th7R before surgery could allow the selection of patients who require perioperative drug therapy and optimize therapeutic interventions with clinical implications.

Significance:
Peripheral Th7R, a Th1-like CD4+ T-cell cluster reflecting priming status in draining LNs and immune status in the tumor microenvironment, predicts disease-free survival after complete resection and has significant clinical relevance in selecting appropriate therapeutic interventions in patients with early-stage lung cancer.
Plasma Proteomic Patterns Show Sex Differences in Early Concentric Left Ventricular Remodeling
Authors: van Ommen Anne-Mar , Diez Benavente Ernest , Onland-Moret N. Charlotte , Valstar Gideon B. , Cramer Maarten J. , Rutten Frans H. , Teske Arco J. , Menken Roxana , Hofstra Leonard , Tulevski Igor I. , Sweitzer Nancy , Somsen G. Aernout , den Ruijter Hester M. 
Published: June 2023

BACKGROUND:
Concentric remodeling (cRM) can precede heart failure with preserved ejection fraction (HFpEF), a condition prevalent in women.

METHODS:
Patients (n=60 593, 54.2% women) visiting outpatient clinics of Cardiology Centers of the Netherlands were analyzed for cRM, HFpEF development, and mortality risk. We studied risk factors for relative wall thickness both sex-stratified and in women and men combined. Biomarker profiling was performed (4534 plasma proteins) in a substudy involving 557 patients (65.4% women) to identify pathways involved in cRM.

RESULTS:
cRM was present in 23.5% of women and 27.6% of men and associated with developing HFpEF (HR, 2.15 [95% CI, 1.51–2.99]) and mortality risk (HR, 1.09 [95% CI, 1.00–1.19]) in both sexes. Age, heart rate, and hypertension were statistically significantly stronger risk factors for relative wall thickness in women than men. Higher circulating levels of IFNA5 (interferon alpha-5) were associated with higher relative wall thickness in women only. Pathway analysis revealed differential pathway activation by sex and increased expression of inflammatory pathways in women.

CONCLUSIONS:
cRM is prevalent in approximately 1 in 4 women and men visiting outpatient cardiology clinics and associated with HFpEF development and mortality risk in both sexes. Known risk factors for cRM were more strongly associated in women than men. Proteomic analysis revealed inflammatory pathway activation in women, with a central role for IFNA5. Differential biologic pathway activation by sex in cRM may contribute to the female predominance of HFpEF and holds promise for identification of new therapeutic avenues for prevention and treatment of HFpEF.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT001747.
Impact of Neighborhood Social Deprivation on Health Care Costs Associated With TAVR
Authors: Sidhu Hasrit , Qiu Feng , Manoragavan Ragavie , Ko Dennis T. , Mamas Mamas A , Sud Maneesh , Tam Derrick Y. , Wijeysundera Harindra C. 
Published: June 2023

BACKGROUND:
Cumulative costs of transcatheter aortic valve replacement (TAVR) differ in the referral, procedural and postprocedural phases depending on patient comorbidities, type of procedure, and procedural complications. Our goal was to determine the association between neighborhood measures of social deprivation and TAVR costs in each of the 3 phases.

METHODS:
Demographics, patient comorbidities, procedural details, in-hospital complications, and costs for adults undergoing TAVR between 2017 and 2020 in Ontario, Canada were obtained from administrative databases and linked to social deprivation data using the Ontario Marginalization Index. The 3 dimensions of social deprivation assessed were (1) material deprivation, (2) residential instability, and (3) ethnic concentration. Hierarchical generalized linear models were used to determine the association between neighborhood social deprivation and cumulative TAVR costs, reported in 2018 Canadian dollars.

RESULTS:
We identified a total of 7617 TAVR referrals with 3784 patients undergoing TAVR within our study period. Cumulative mean costs in the referral, procedural and postprocedural phases were $8116±$11 374, $32 790±$17 766, and $18 901±$32 490, respectively. After adjustment for clinical and demographic variables, higher factor scores in residential instability were associated with greater cumulative costs in the postprocedural phase, whereas higher factor scores in the other 2 dimensions of marginalization were not significantly associated with higher costs in any of the 3 phases.

CONCLUSIONS:
This analysis shows that residential instability is associated with higher cumulative costs in the postprocedural phase of TAVR. This lays the foundation for future studies to understand the mechanism of this finding and identify potential mitigation policies.
New arsenate minerals from the Arsenatnaya fumarole, Tolbachik volcano, Kamchatka, Russia. XX. Evseevite, Na2Mg(AsO4)F, the first natural arsenate with an antiperovskite structure
Authors: Pekov Igor V. , Zubkova Natalia V. , Agakhanov Atali A. , Vigasina Marina F. , Yapaskurt Vasiliy O. , Britvin Sergey N. , Turchkova Anna G. , Sidorov Evgeny G. , Zhitova Elena S. , Pushcharovsky Dmitry Yu. 
Published: June 2023

AbstractThe new mineral evseevite was found in the Arsenatnaya fumarole, Second scoria cone of the Northern Breakthrough of the Great Tolbachik Fissure Eruption, Tolbachik volcano, Kamchatka, Russia. Evseevite is represented by two chemical varieties. The variety close to the end-member Na2Mg(AsO4)F (holotype) is associated with sanidine, hematite, tenorite, aegirine, cassiterite, sylvite, halite, johillerite, badalovite, calciojohillerite, hatertite, arsmirandite, yurmarinite, axelite, polyarsite, aphthitalite, potassic-magnesio-fluoro-arfvedsonite, litidionite, ferrisanidine and tridymite. The P- and S-enriched variety (cotype) is associated with hematite, fluorophlogopite, svabite, fluorapatite, tilasite, calciojohillerite, forsterite, cassiterite, belomarinaite and aphthitalite. Evseevite occurs as prismatic, acicular or hair-like crystals up to 0.7 mm long combined in clusters up to 0.5 mm, brushes or crusts up to 2 × 2 mm. It is transparent, colourless or pale pinkish, with vitreous lustre. Dcalc is 3.377 g cm–3 for the holotype and 3.226 g cm–3 for the cotype. Evseevite is optically uniaxial (+), α = 1.545(2), β = 1.546(2), γ = 1.549(2) and 2Vmeas = 40(10)°. The empirical formulae calculated based on O+F = 5 apfu are (Na1.99Ca0.03K0.01)Σ2.03(Mg0.98Fe3+0.01Zn0.01Cu0.01)Σ1.01[(As0.98Si0.01)Σ1.01O4](F0.97O0.03) for the holotype and Na2.02(Mg1.00Fe3+0.03)Σ1.03[(As0.69P0.25S0.07)Σ1.01O4](F0.78O0.22) for the cotype. Evseevite is orthorhombic, Pbcn, a = 5.3224(1), b = 14.1255(3), c = 12.0047(3) Å, V = 902.53(4) Å3 and Z = 8. Strong reflections of the powder XRD pattern [d,Å(I)(hkl)] are: 4.001(100)(121), 3.479(56)(023), 3.041(45)(042), 2.657(44)(200), 2.642(68)(142) and 2.613(36)(104). The crystal structure was solved from single-crystal XRD data and refined on powder data by the Rietveld method, Rwp = 0.0068, Rp= 0.0047 and Robs = 0.0435. Evseevite is isostructural to moraskoite Na2Mg(PO4)F. The structure of evseevite can be described in terms of anion-centred polyhedra. F-centred octahedra [FNa4Mg2]7+ share faces to form chains [FNa2Mg]3+ and AsO4 tetrahedra are located between the chains. Evseevite belongs to a small set of minerals with antiperovskite structures and is the first natural arsenate with antiperovskite units. The mineral is named in honour of the Russian mineralogist Aleksandr Andreevich Evseev (born 1949).
Genome wide transcriptome analysis provides bases on hepatic lipid metabolism disorder affected by increased dietary grain ratio in fattening lambs
Authors: Mi Hui , Hu Fan , Gebeyew Kefyalew , Cheng Yan , Du Ruiping , Gao Min , He Zhixiong , Tan Zhiliang 
Published: June 2023

Abstract
Background
The liver is a principal metabolic organ and has a major role in regulating lipid metabolism. With the development of rapidly fattening livestock in the modern breeding industry, the incidence of hepatic steatosis and accumulation in animals was significantly increased. However, the molecular mechanisms responsible for hepatic lipid metabolic disturbances in a high concentrate diet remain unclear. The objective of this study was to evaluate the effects of increasing concentrate level in a fattening lamb diet on biochemical indices, hepatic triglycerides (TG) concentration, and hepatic transcriptomic profiles. In the present study, 42 weaned lambs (about 3 ± 0.3 months old) were randomly assigned to the GN60 group (60% concentrate of dry matter, GN60, n = 21) or GN70 group (70% concentrate of dry matter, n = 21) for a 3-months feeding trial.

Results
No difference was observed in the growth performance or plasma biochemical parameters between the GN60 group and the GN70 group. The hepatic TG concentration was higher in the GN70 group than GN60 group (P < 0.05). Hepatic transcriptomic analysis showed that there were 290 differentially expressed genes identified between GN60 and GN70 groups, with 125 genes up-regulated and 165 genes down-regulated in the GN70 group. The enriched Gene Ontology (GO) items and KEGG pathways and protein–protein interaction (PPI) network of differentially expressed genes (DEGs) revealed that the majority of enriched pathways were related to lipid metabolism. Further analysis revealed that the fatty acid synthesis was up-regulated, while fatty acid transport, oxidation, and TG degradation were down-regulated in the GN70 group when compared with the GN60 group.

Conclusions
These results indicated that GN70 induced excess lipid deposition in the liver of lambs during the fattening period, with high synthesis rates and low degradation rates of TG. The identified mechanisms may help understand hepatic metabolism in lambs with a high concentrate diet and provide insight into decreasing the risk of liver metabolism disorder in animals.
Factors related to the frequent use of emergency department services in Korea
Authors: Cho Eun Deok , Kim Bomgyeol , Kim Do Hee , Lee Sang Gyu , Jang Suk-Yong , Kim Tae Hyun 
Published: June 2023

Abstract
Background
Frequent Emergency Department (ED) visitors are identified by the policymakers to reduce avoidable ED visits and lessen the financial and operational burden. This study aimed to identify the factors related to the frequent use of ED services.

Methods
This nationwide, cross-sectional observational study was conducted using information obtained from the 2019 National Emergency Department Information System (NEDIS) database. Frequent ED users were defined as patients with four or more ED visits a year. We performed multiple logistic regression analyses to verify the relationship among sociodemographic characteristics, residential characteristics, clinical characteristics, and frequency of ED visits.

Results
Among 4,063,640 selected patients, 137,608 patients visited the ED four or more times a year (total number of visits = 735,502 times), which accounted for 3.4% and 12.8% of the total number of ED users and ED visits, respectively. A high ED visit frequency was associated with male sex, age < 9 or ≥ 70 years, Medical Aid (based on the insurance type), lower number of medical institutions and beds compared with that of the national average, and conditions, such as cancer, diabetes, renal failure, and mental illness. A low ED-visit frequency was associated with residence in regions vulnerable to emergency medical care and regions with high income. The possibility of frequent ED visits was high for patients with level 5 severity (non-emergent) and those with an increased need for medical treatment, including older patients and patients with cancer or mental illness. The possibility of frequent ED visits was low for patients aged > 19 years with level 1 severity (resuscitation).

Conclusions
Health service accessibility factors, including low income and medical resource imbalance, were associated with frequent ED visits. Future large-scale prospective cohort studies are warranted to establish an efficient emergency medical system.