High Level Research Articles

Median Breslow thickness during, post and pre-COVID-19 lockdown and correlation with socioeconomic factors.

e21574 Background: Access to routine cancer care during COVID-19 pandemic was greatly affected. The impact of this on melanoma care is unknown. Breslow thickness (BT) was seen to decrease and then increase during and post-COVID-19 lockdown in Italy. Here, we aim to study the impact of COVID-19 lockdown on melanoma care in the United States. Methods: Patients diagnosed with cutaneous melanoma (CM) pre (September 15th 2019-March 14th 2020), during (March 15th-June 14th 2020), and post-lockdown (June 15th-December 14th 2020) were retrospectively studied using Metropolitan Detroit Cancer Surveillance System (MDCSS) database. Patients without an identifiable primary lesion, or with ocular, mucosal, or acral melanoma were excluded. Demographic and clinical characteristics were reviewed. The primary endpoint was median BT during and post vs pre-lockdown. Fisher's exact and Kruskal-Wallis tests were performed for categorical and continuous variables, respectively, to compare groups. Interaction in subgroup analyses was assessed using likelihood ratio tests. Linear regression analyses were performed with Box-Cox transformed BT. Cox proportional hazards regression analyses were performed for overall survival. Covariates for multivariable analysis were selected using LASSO-based penalized regression models. Results: 802 patients were included (pre N = 347, during N = 87, post N = 368). Patients diagnosed with CM post-lockdown were younger (age < 50 years pre = 14%, during = 13%, post = 23%). More patients diagnosed pre-lockdown carried government-issued insurance (pre = 48%, during = 39%, post = 38%). No difference (diff) in median BT was seen between periods (median = 0.6mm for pre, during, and pos). Married status was associated with a lower BT vs unmarried (diff = -0.19, 95% CI -0.36 to -0.014, p = 0.034) and higher census tract poverty level was associated with a higher BT (5%-10% diff = 0.17, 95% CI 0.004 to 0.33, p = 0.045; 10%-100% diff = 0.27, 95% CI 0.093 to 0.45, p = 0.003) vs 0-5% poverty on univariable analysis. Male gender was associated with a lower BT on multivariable analysis (diff = -0.12, 95% CI -0.20 to -0.04, p = 0.005) and lower risk of death on univariable analysis (HR = 0.50, 95% CI 0.31 to 0.82, p = 0.006). Conclusions: We found no difference in median BT during and post- vs pre-lockdown. We also identified at-risk populations (female, unmarried, and living in greater poverty areas) who could benefit from proactive melanoma care. Time to surgery from initial diagnosis during and post vs pre-lockdown would be of interest to study further.

Rural Areas and Big Game Hunting in Spain: Analysis of Preferences According to Hunter's Gender and Family Income

Abstract Hunting is one of the main uses associated with land which, in the current context, has a strong economic significance for rural areas. This work generates knowledge that can be useful for designing strategies that favour the economic dynamisation of rural areas, in a context of population loss and scarce economic diversification. In this sense and based on the results of a survey of hunters (N = 1662), the objectives of the work are first to analyse the territorial distribution and abundance of big game species in Spain and secondly, to examine the existence of correlations, between hunters' income, hunters’ gender and preferences for certain big game species. This analysis is based on primary and secondary sources and its characteristics are explained in the methodology section. Univariate and bivariate descriptive statistics were used, specifically the chi-square contingency test, which allows us to determine the relationship of dependence between two variables. We found that female hunters showed greater interest than their male counterparts in hunting big game species, and the same interest was found in hunters with higher income level regardless of their gender. Our results may help to design and develop socio-economic strategies related to supply and demand hunting activities.

Immune-related adverse event prediction and influential factor identification.

e14650 Background: Immune checkpoint inhibitors (ICIs), have demonstrated efficacy in treating patients with non-small cell lung cancer (NSCLC) and advanced melanoma. However, ICIs can lead to immune-related adverse events (irAE), which will cause discontinuance of the ICI treatment. The objective of this study is to identify factors that predict which patients with NSCLC or melanoma will develop irAE(s) from ICIs. Methods: We curated the patient cohort from the Immune-Oncology data repository developed at the Georgetown-Lombardi Comprehensive Cancer Center. This cohort encompassed 466 patients (245 individuals with NSCLC and 221 with advanced melanoma) who received single-agent anti-PD-(L)1 or combination of anti-PD-1 and anti-CTLA4 therapy. Parameters selected for prediction comprises baseline demographics, laboratory results, treatment information, and cancer-related mutations. The classification of irAE were identified by CTCAE V4.03 guidelines. Overall, 219 patients experienced one or more irAE, while the remaining 247 patients were irAE-free. We employed machine learning models for prediction, which were trained using 80% of the dataset with a five-fold cross-validation, and their performance was evaluated using the area under the receiver-operating curve (AUROC) and F1 score. Furthermore, we identified the key factors that significantly impacted the model by SHAP values. Results: Nine machine learning models were deployed, including logistic regression, support vector machine, gradient boosting (GB), etc. The GB model demonstrated the highest performance, achieving an AUROC score of 75% and an F1 score of 77%. According to the SHAP value obtained from the GB model, NSCLC patients exhibited a higher propensity for irAE development compared to melanoma patients. The top three features associated with a heightened likelihood of irAE development are the treatment of the combination of anti PD-1 and anti CTLA-4, a higher albumin/globulin ratio, and a pre-treatment ECOG Performance Status score of 0. The top three features associated with a lower likelihood of irAE development are an elevated red cell distribution width, the treatment with single agent anti-PD-1, and a higher globulin level. Conclusions: Our research harnesses a comprehensive set of variables to forecast the development of irAEs in NSCLC and melanoma patients undergoing ICI treatment. The results underscore the predictive capabilities of ML models. Investigating the connections between pivotal biomarkers, such as globulin and red cell distribution width, has the potential to offer insights that enable patients to mitigate irAE. These findings emphasize the promising potential of ML techniques not only in predicting the likelihood of irAE but also in the grade of irAE. To mitigate the limitation of a relatively small sample size, we are actively working to expand the data registry by collaborating with additional institutions.

Predictive Value of the Chinese Visceral Adiposity Index for Metabolic Dysfunction-Associated Fatty Liver Disease and Elevated Alanine Aminotransferase Levels in Nonobese Chinese Adults: A Cross-Sectional Study.

It is unclear how the Chinese Visceral Adiposity Index (cVAI) relates to metabolic dysfunction-associated fatty liver disease (MAFLD) and alanine aminotransferase (ALT) in nonobese individuals. In this study, we evaluated the ability of the cVAI to predict MAFLD and elevated ALT in nonobese participants. This cross-sectional study recruited 541 nonobese subjects from March 2019 to January 2022 with the age range of 18-80 years. Hepatic steatosis was diagnosed by ultrasound. Participants were divided into four groups according to cVAI quartiles. To assess the associations between cVAI and MAFLD and elevated ALT, multivariate logistic regression was used. Receiver operating characteristic (ROC) curves were generated to evaluate the ability of the cVAI to predict MAFLD and elevated ALT. Compared to the group with the lowest cVAI, the group with the highest cVAI was positively associated with nonobese MAFLD [16.173 (4.082-64.073), P < 0.001] and elevated ALT [8.463 (2.859-25.049), P < 0.001]. The area under the ROC curve (AUC) of the cVAI was greater than that of WC, waist-to-height ratio, or BMI for predicting nonobese MAFLD in the male, female, > 38 and ≤ 38 years old subgroups (P < 0.05), respectively. In addition, the ability of the cVAI to predict MAFLD was better in females, young individuals, and individuals with a higher education level (P < 0.05). The cVAI also had good predictive ability for elevated ALT levels [0.655 (0.602-0.708)], particularly in females, young people, and highly educated participants. Furthermore, the cVAI was strongly positively correlated with the liver fibrosis score (P < 0.05) and was also a strong indicator of concomitant metabolic syndrome in nonobese MAFLD patients [AUC = 0.688 (0.612-0.763)]. The cVAI was strongly related to nonobese MAFLD and elevated ALT. The cVAI may be a reliable and accessible predictor of nonobese MAFLD and elevated ALT.

Comparing clinical outcomes between PD-1 and PD-L1 inhibitors plus bevacizumab combined with hepatic arterial interventional therapies in unresectable hepatocellular carcinoma: A single-center real-world study.

e16229 Background: Systemic therapies combined with locoregional therapies were considered a potent therapeutic strategy in treating patients with unresectable hepatocellular carcinoma (uHCC). Given the A+T strategy became the first-line treatment for advanced HCC patients, the roles of programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitors in the combination therapies for treating patients with uHCC needed to be further discussed. The current study compared the clinical outcomes between PD-1 and PD-L1 inhibitors plus bevacizumab combined with hepatic arterial interventional therapies (HAIT) among patients with uHCC. Methods: From October 2019 to May 2023, 142 uHCC patients were retrospectively analyzed in Sun Yat-sen University Cancer Center, including 73 or 69 patients treated with either PD-1 (PD-1 group) or PD-L1 (PD-L1 group) inhibitors, respectively, combined with HAIT plus bevacizumab. The progression-free survival (PFS) and tumor responses were analyzed per mRECIST. Results: At the data cut-off, the median PFS was 5.5 months (95% CI 5.3-7.1 months) in the PD-1 group and 7.5 months (95% CI 7.0-9.6 months) in the PD-L1 group, respectively ( P=0.280; HR=0.74; 95%CI 0.43-1.28). The PD-L1 group showed a significantly better median intrahepatic PFS (8.1 months, 95%CI 7.6-10.2 months) than the PD-1 group (6.5 months, 95%CI 6.2-9.0 months; P=0.014; HR=0.35; 95%CI 0.16-0.81). The overall response rate (ORR; 49.3% vs. 66.7%, P=0.054), intrahepatic control rates (53.4% vs. 69.6%, P=0.070) and overall disease control rate (DCR; 68.5% vs. 78.3%, P=0.261) showed no significant difference in both groups, while the PD-L1 group demonstrated significantly higher intrahepatic disease control rate than the PD-1 group (76.7% vs. 92.6%, P=0.016). Conclusions: PD-1 and PD-L1 plus bevacizumab combined HAIT shared similar PFS, DCRs, and ORRs in treating uHCC patients. The PD-L1 plus bevacizumab combined with HAIT demonstrated a better intrahepatic control than those of PD-1, which needed further validation at a higher evidence level.

Consumer Preferences and Reactions to Brand Expansion

Abstract Consumer purchasing power is one of the key determinants of consumer behavior, among other factors. Acceptance of new brands or product line extensions of existing brands is influenced by perceived value. New products can be added to existing product lines by introducing new products within them, or brands can expand horizontally by entering entirely new categories or product lines. Any vertical expansion, whether to a higher or lower level, comes after a price shift and a product quality achievement relative to its base product. While survey-based research provides valuable insights that support the growth of the Premium brand, building a strong relationship with customers, quickly identifying preferences, personalizing the offer and fostering a climate of trust remain its main sources of value. The purpose of the paper is to show the positive relationship that exists between the vertical growth of the brand and the increase in customer loyalty, as shown by the research conducted on a deliberate sample.

Assessing the missions and visions of NCI-designated cancer centers and their affiliated hospitals.

e23118 Background: Mission and vision statements (MVS) help convey an institution's identity and priorities. Missions describe objectives and responsibilities, while visions describe overarching directions for the future. Effectively communicating MVS is particularly important for cancer centers and hospitals seeking to inspire and reach patients and employees. We sought to assess the composition, readability, and topics addressed for MVS provided by NCI-designated cancer centers and their affiliated hospitals. Methods: We extracted MVS data from institutional websites for 65 NCI-designated cancer centers and 59 affiliated hospitals in 2023 (6 cancer centers did not have an affiliated hospital). We determined the composition of statements using word counts and time to read. We assessed the readability of statements using Flesch-Kincaid (FK) reading ease and grade level scores. We reviewed the MVS to determine the presence of four topics: equity, quality care, training, and research. We used descriptive statistics to compare these issues in MVS for cancer center versus the hospital. Results: Among the 65 cancer centers, we found mission statements for 93.9% (61/65) and vision statements for 63.1% (41/65). All affiliated hospitals provided a mission statement and 86.4% (51/59) had a vision statement. Data for composition, readability, and topics addressed for MVS are provided in the table. Overall, readability of MVS was difficult based on FK reading ease scores, with relatively high reading grade levels. Mission statements for cancer centers had a significantly lower reading ease and higher grade level compared with hospitals. In general, mission statements were slightly longer than vision statements, more frequently addressing the topics of quality care, training, and research. Compared with hospitals, cancer centers had a significantly lower frequency of mentioning the topic "training" in their MVS. Conclusions: We found that the majority of NCI-designated cancer centers report mission statements, but fewer provide vision statements. We demonstrated difficult readability for the MVS provided, highlighting a need to consider simpler diction and structure of language. Additionally, our work provides an overview of topics addressed for these statements including equity, quality care, training, and research. These topics underscore the values and priorities of an institution, and this review of MVS provides insights into the messaging that cancer centers communicate. [Table: see text]

Causal link between oxidative stress and epilepsy: A two‐sample Mendelian randomization study

AbstractBackgroundAlthough a growing body of research has indicated a strong link between oxidative stress and epilepsy, the exact nature of their interaction remains elusive. To elucidate this intricate relationship, we conducted a bidirectional Mendelian randomization (MR) analysis employing two independent datasets.MethodsA two‐sample MR analysis was performed using instrumental variables derived from genome‐wide association study summary statistics of oxidative stress injury biomarkers (OSIB) and epilepsy. The OSIBs were selected from eight primary metabolic pathways associated with oxidative stress. Additionally, seven distinct epilepsy phenotypes were considered, which encompassed all epilepsy, generalized epilepsy, generalized tonic‐clonic seizures, focal epilepsy, focal epilepsy with hippocampal sclerosis (focal HS), focal epilepsy with lesions other than HS (focal NHS), and lesion‐negative focal epilepsy. Causal estimates were computed using the inverse‐variance weighted method or the Wald ratio method, and the robustness of causality was assessed through sensitivity analyses.ResultsFor OSIB and epilepsy, 520 and 23 genetic variants, respectively, were selectively extracted as instrumental variants. Genetically predicted higher kynurenine level was associated with a decreased risk of focal epilepsy (odds ratio [OR] 1.950, 95% CI 1.373–2.528, p = .023) and focal NHS (OR 1.276, 95% CI 1.100–1.453, p = .006). For reverse analysis, there was a suggestive effect of focal NHS on urate (OR 1.19 × 1015, 95% CI 11.19 × 1015 to 1.19 × 1015, p = .0000746) and total bilirubin (Tb) (OR 4.98, 95% CI 3.423–6.543, p = .044). In addition, genetic predisposition to focal HS was associated with higher Tb levels (OR 9.83, 95% CI 7.77–11.888, p = .034).ConclusionThis MR study provides compelling evidence of a robust association between oxidative stress and epilepsy, with a notable emphasis on a causal relationship between oxidative stress and focal epilepsy. Additional research is warranted to confirm the connection between oxidative stress and the risk of epilepsy and to unravel the underlying mechanisms.

Hemostatic mechanism of Jianpi Yiqi Shexue decoction in treatment of immune thrombocytopenia.

To explore the early hemostatic mechanism of Jianpi Yiqi Shexue decoction (, JYSD) in treating immune thrombocytopathy (ITP), based on the functional homeostasis of brain-intestine axis and blood neurotransmitter METHODS: Non-drug treatment cases: Healthy volunteers were selected as normal control group and compared with patients with dysfunctional uterine bleeding, gastrointestinal tumors with bleeding and ITP, to detect the changes of blood 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), vasoactive intestinal peptide (VIP) and compare the changes of blood neuro-transmitters in patients with different disease symptoms. Drug treatment cases: According to the randomized controlled multicenter clinical trial, 272 ITP patients were randomly divided into three groups: treatment group (JYSD) combined group (JYSD + Prednisone) control group (Prednisone). The changes of blood neuro-transmitter (5-HT, β-EP, VIP) before and after treatment were detected on the basis of peripheral blood platelet (PLT) and grade score. Non-drug treatment cases: compared with the normal control group, the 5-HT level was higher, and the VIP and β-EP levels were both lower in the ITP group (P < 0.001), and the 5-HT, VIP and β-EP levels in the Gastrointestinal tumors with bleeding group were also lower compared with the normal control group (P < 0.05, 0.001). Drug treatment cases: The PLT grading scores of the combination group and the control group after treatment were lower than that before treatment (P < 0.05, 0.001). The PLT grading score of the 3 groups were compared in pairs after treatment: the combination group was the lowest among the 3 groups, which was better than the treatment group, but no better than the control group (vs the treatment group, P = 0.005, vs the control group, P = 0.709). The statistical results of full analysis set (FAS) and per protocol set (PPS) were consistent. The bleeding symptom scores of the treatment and combination groups began to drop 7 d after treatment, and kept dropping 14 d after treatment until the end of the study (P < 0.05). On the other hand, the control group started to show favorable results 14 d after treatment (P < 0.05). The FAS and PPS analysis results were consistent. In the control group, the 5-HT level was higher and VIP level was lower after treatment, compared with those before treatment (P < 0.05, 0.001). The β-EP levels were both increased in the treatment and combination group after treatment, compared with those before treatment (P < 0.05). After treatment, the β-EP levels in the treatment and control groups were significantly lower compared with the combination groups (P < 0.05). After treatment, compared with the control group, the VIP levels in the treatment and combination groups were up-regulated, and the differences were statistically significant by rank sum test (P < 0.01), and by t-test (P = 0.0002, 0.0001). The prednisone tablet is better than the JYSD in increasing the level of PLT, while prednisone tablet combined with JYSD has more advantages in improving patients' peripheral blood PLT levels. However, in improving the bleeding time of ITP patients, the combination of the two drugs was significantly delayed compared with the single usage, showing the characteristics and advantages of traditional Chinese medicine. JYSD can regulate the neurotransmitter level of ITP patients through the function of the brain-gut axis, mobilize 5-HT in the blood of ITP patients to promote the contraction of blood vessels and smooth muscles, and activate the coagulation mechanism are the early hemostatic mechanisms of JYSD. Up-regulate the levels of β-EP and balancing VIP levels may be an important part of the immune mechanism of JYSD for regulating ITP patients.

The Impact of HAPPY (Humanity Assurance Protocol in Interventional Radiotherapy) on the Psychological Well-being of Gynecological Cancer Patients.

HAPPY (Humanity Assurance Protocol in interventional radiotherapy) reports the necessity for gynecological cancer patients to undergo interventional radiotherapy (IRT, also called brachytherapy). The present paper has evaluated how some precautions may improve the psychological well-being of the patients during IRT. Patients with gynecological cancer undergoing IRT-HDR were analyzed. Patients answered three questionnaires before the IRT procedure (T0) and at the end of IRT (T1): Distress Thermometer (DT), Numerical Rating Scale for IRT procedure distress (NRS), and Hospital Anxiety and Depression Scale (HADS). Correlations have been calculated pairwise through pandas. corrwith with a Pearson algorithm, and the p-values have been calculated through scipy.stats.pearsonr. Plots have been generated through seaborn and matplotlib. A Wilcoxon test was used. 55 patients were selected for this study. The median age of the patients was 64 (range, 39-84) years. 52 patients were with stage I endometrial cancer, whereas 3/3 patients with cervical cancer had locally advanced stages (IIB-IVA). 26 patients had a high education level (47.3%), and 38 were married or with a partner (69.1%). Only 14/55 (25.45%) patients were working. The HADS, DT, and NRS averages before the IRT procedure (T0) were 10.2, 3.8, and 4.3, respectively. After applying the HAPPY protocol, the HADS, DT, and NRS averages after IRT (T1) were 9.4, 3.4, and 2.6, respectively. The Wilcoxon signed rank test analysis showed a significant improvement in NRS (p < 0.00001) and HADS (p = 0.034). Living with a partner, parents or relatives was the only parameter statistically significantly associated with better DT pre-IRT (p = 0.04), HADS pre-IRT (p = 0.01), DT post-IRT (p = 0.01), and HADS post-IRT (p = 0.04). In our study, the HAPPY protocol was associated with a significant reduction in patients' distress, anxiety, and discomfort.

Intra-read analysis of radiologists in the setting of blinded independent central review of oncology studies.

11179 Background: This study explored the outcome of an analysis completed on the Intra-reader variability of radiologists when assessing the imaging endpoint surrogates of Date of Progression (DOP) and Best Overall Response (BOR) within the context of Blinded Independent Central Review (BICR) in Oncology clinical trials. The analysis encompassed 55,000 test cases derived from 217 clinical trials involving 138 readers. Methods: Data collection and parsing were executed through a Python script, enabling a manual analysis of the results. The analysis posited that Intra-read variability serves as a valuable tool when seeking to exclusively observe the consistency of readers in a specific re-read setting. Results: The data analysis yielded significant insights, revealing that 89.81% of readers demonstrated substantial and above agreement in DOP determinations, while 72.38% achieved the same in BOR determinations. This suggests a higher level of consistency in DOP compared to BOR determination. Notably, 11 DOP and 20 BOR inconsistencies were observed. This prompted further investigation which led to 5 of the 138 readers being flagged based on discrepancies against their own prior or subsequent reads. The kappa values for these 5 readers ranged from 0.33 to 0.59, consistently indicating fair and moderate agreement. Conclusions: This analysis underscored the role of Intra-read variability in identifying inconsistent readers within the landscape of BICR in Oncology clinical trials. The re-read inconsistency is not a universal requirement, and its application is recommended primarily for complex oncology clinical trials or those with indications known to have elevated adjudication metrics. The study emphasized the potential for targeted retraining strategies based on Intra-read analysis outcomes, contributing to the ongoing refinement of reader proficiency. Future directions may involve further exploration of specific retraining strategies or assessing the effectiveness of exclusively using Intra-read variability as a metric for reader performance.

Association of CYP2C19 genotypes with postoperative atrial fibrillation after coronary artery bypass surgery.

This cohort study aims to assess the connection between cytochrome P450 family 2 subfamily C member 19 (CYP2C19) genotyping, platelet aggregability following oral clopidogrel administration, and the occurrence of postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass graft (CABG) surgery. From May 2017 to November 2022, a total of 258 patients undergoing elective first-time CABG surgery, receiving 100 mg/day oral aspirin and 75 mg/day oral clopidogrel postoperatively, was included for analysis. These patients were categorized based on CYP2C19 genotyping. Platelet aggregability was assessed serially using multiple-electrode aggregometry before CABG, 1 and 5 days after the procedure, and before discharge. The incidences of POAF were compared using the log-rank test for cumulative risk. CYP2C19 genotyping led to categorization into CYP2C19*1*1 (WT group, n = 123) and CYP2C19*2 or *3 (LOF group, n = 135). Baseline characteristics and operative data showed no significant differences between the two groups. The incidence of POAF after CABG was 42.2% in the LOF group, contrasting with 22.8% in the WT group (hazard risk [HR]: 2.061; 95% confidence interval [CI]: 1.347, 3.153; p = 0.0013). Adenosine diphosphate-stimulated platelet aggregation was notably higher in the LOF group compared to the WT group 5 days after CABG (30.4% ± 6.5% vs. 17.9% ± 4.1%, p < 0.001), remaining a similar higher level at hospital discharge (25.6% ± 6.1% vs. 12.2% ± 3.5%, p < 0.001). The presence of CYP2C19 LOF was linked to a higher incidence of POAF and relatively elevated platelet aggregation after CABG surgery under the same oral clopidogrel regimen.

Outcomes After Single-Stage Anatomic Multiligament Knee Reconstruction With Early Range of Motion in Adolescents.

Multiligament knee injuries (MLKI), rare in adolescents, are challenging injuries that require complex surgical reconstruction. Historically, nonanatomic reconstructions have been associated with prolonged immobilization and failure to restore normal knee biomechanics, resulting in arthrofibrosis and high rates of graft failure. To describe the clinical and patient-reported outcomes (PROs) for adolescent patients treated with single-stage anatomic multiligament knee reconstruction. Case series; Level of evidence, 4. A single-center retrospective study was performed of patients ≤18 years old who underwent reconstruction of MLKIs by a single surgeon between 2014 and 2019 using a single-stage anatomic technique, with protected weightbearing and early range of motion. Complications were defined as infection, arthrofibrosis, deep vein thrombosis (DVT) or pulmonary embolus, and secondary surgery. PROs, including the pediatric version of the International Knee Documentation Committee (Pedi-IKDC) and the Tegner activity score, were obtained at a minimum of 2 years postoperatively. Included were 30 patients (21 male, 9 female; mean age, 15.4 years). The most common ligamentous reconstruction types were anterior cruciate ligament (ACL) + fibular collateral ligament (12 patients; 40%) and ACL + medial collateral ligament (9 patients; 30%). Three patients (10%) had secondary surgeries, including irrigation and debridement of a granuloma, a staged osteochondral allograft transplantation to a lateral femoral condyle impaction fracture, and repair of a medial meniscal tear and lateral femoral condyle fracture associated with new injuries 2 years after ACL + fibular collateral ligament reconstruction. Two patients (7%) developed arthrofibrosis and 1 patient (3%) developed DVT. PRO scores obtained at a mean of 37 months postoperatively included a mean Pedi-IKDC of 87 (range, 52-92) and a median highest Tegner score at any point postoperatively of 9 (range, 5-10). Of the patients who were athletes before their injury, 70% returned to the same or higher level of sport postoperatively. Reconstruction of MLKI in this series of adolescents with single-stage anatomic techniques and early range of motion resulted in low rates of secondary surgery, few complications, and good knee function as well as PRO scores at mean 3-year follow-up.

Weighted Blanket: An Anxiety Reduction Tool in the Outpatient Oncology Infusion Setting.

Adults with cancer experience a significantly higher level of anxiety compared with the general population. Anxiety is reported at diagnosis and throughout the cancer trajectory, and it is particularly heightened at the initiation of infusion treatments. In 2020, the COVID-19 pandemic exacerbated anxiety levels in patients receiving cancer treatments. This evidence-based practice project evaluated the feasibility and effectiveness of using medical-grade weighted blankets to reduce anxiety in patients with cancer receiving the first two infusion treatments in the ambulatory setting. Patients completed a modified version of the Visual Analog Scale for Anxiety to self-report anxiety pre- and postimplementation. Patients and nurses completed feasibility surveys. Patients reported reduced anxiety after using a weighted blanket and described weighted blankets as comforting and soothing. More than 90% of surveyed patients agreed or strongly agreed that the blanket was comfortable, not too heavy, and easy to put on, and did not interfere with nursing care or their own activities. Nurses valued the ease of use and adherence to infection control standards.

Generalization of single wake surrogates for multiple and farm-farm wake analysis

Wind farm efficiency is influenced by atmospheric turbulence and wake interactions from preceding turbines. Optimal performance necessitates effective control strategies, encompassing collective/individual pitch (and/or torque) control, yaw control, and innovative techniques, significantly boosting energy capture. Wake effects are crucial, impacting downstream turbines and reducing overall energy extraction. For this purpose, the study of wind farm flow control (WFFC) holds significant relevance in this context. In this study, a Deep Neural Network predicts downstream flow features of a wind turbine under diverse control scenarios, including varying thrust coefficient and yaw control. A feed-forward neural network models the deficit and added turbulent intensity of a single wake, trained using Computational Fluid Dynamics (CFD) simulations as reference data. Linear superposition establishes the wind farm flow field, allowing examination of downstream effects. Another feedforward neural network encompasses wind farm physics such as blockage and wake recovery in and around wind turbine arrays which are overlooked by the single wake model. The methodology employed in this study yields results that are more time-efficient compared to traditional CFD models while maintaining a higher level of accuracy (ideally) than the engineering models, especially when implemented for WFFC without calibration.

Study on the quality and consumer acceptance of sorghum (Sorghum bicolor L. Moench) flour-based dried noodle

Abstract Sorghum is growing to become an alternative substitute of food ingredients for various food products. Supported by its productivity and high nutrient content, sorghum can be converted into flour, substituting wheat flour in food products, such as dried noodles. This study aimed to evaluate the chemical, physical, and sensory quality of sorghum-based dried noodles. The research was conducted by Complete Randomized Design of Experiment (CRD) with Two Factors: the variety of sorghum and the level of sorghum substitution. The combinations of variety and substitution levels used in this study were Numbu-30%, 45%, 60% and Super 2-30%, 45%, 60%. The increased proportion of sorghum flour in noodles formulation resulted in higher ash, fat, and carbohydrate content but lower water and protein content. In addition, substituting wheat flour with sorghum flour increased the swelling index of the dried noodles but resulted in a higher cooking loss. In terms of sensory acceptance evaluation, the higher level of sorghum substitution increased the colour’s acceptance score, while on the other hand, reduced the acceptance score for aroma, flavour, and texture attributes of dried noodles.

Deciphering the mechanisms involved in reduced sensitivity to azoles and fengycin lipopeptide in Venturia inaequalis

Apple scab, caused by the hemibiotrophic fungus Venturia inaequalis, is currently the most common and damaging disease in apple orchards. Two strains of V. inaequalis (S755 and Rs552) with different sensitivities to azole fungicides and the bacterial metabolite fengycin were compared to determine the mechanisms responsible for these differences. Antifungal activity tests showed that Rs552 had reduced sensitivity to tebuconazole and tetraconazole, as well as to fengycin alone or in a binary mixture with other lipopeptides (iturin A, pumilacidin, lichenysin). S755 was highly sensitive to fengycin, whose activity was close to that of tebuconazole. Unlike fengycin, lipopeptides from the iturin family (mycosubtilin, iturin A) had similar activity on both strains, while those from the surfactin family (lichenysin, pumilacidin) were not active, except in binary mixtures with fengycin. The activity of lipopeptides varies according to their family and structure. Analyses to determine the difference in sensitivity to azoles (which target the CYP51 enzyme involved in the ergosterol biosynthesis pathway) showed that the reduced sensitivity in Rs552 is linked to (i) a constitutive increased expression of the Cyp51A gene caused by insertions in the upstream region and (ii) greater efflux by membrane pumps with the involvement of ABC transporters. Microscopic observations revealed that fengycin, known to interact with plasma membranes, induced morphological and cytological changes in cells from both strains. Sterol and phospholipid analyses showed a higher level of ergosta-7,22-dien-3-ol and a lower level of PI(C16:0/C18:1) in Rs552 compared with S755. These differences could therefore influence the composition of the plasma membrane and explain the differential sensitivity of the strains to fengycin. However, the similar antifungal activities of mycosubtilin and iturin A in the two strains indirectly indicate that sterols are probably not involved in the fengycin resistance mechanism. This leads to the conclusion that different mechanisms are responsible for the difference in susceptibility to azoles or fengycin in the strains studied.

Exploring the direct and indirect effects of EFL learners’ online motivational self-system on their online language learning acceptance: the new roles of current L2 self and digital self-authenticity

The impact of students' intrinsic or extrinsic motivations on their future intentions for online language schooling has been widely documented, but further emphasis needs to be placed on examining motivation beyond traditional theories. Thus, the current study sought to pivot the focus from intrinsic and extrinsic motivation to university language learners’ L2 self-identities in shaping their intention to learn language online. Toward this, we extended the technology acceptance model by integrating language learners’ L2 motivational self-system (L2MSS). Accordingly, 422 Iranian territory students who learned language online completed surveys covering language motivation and attitudes toward online language learning. The results of partial least squares structural equation modeling validated that current L2-self and digital self-authenticity can be used as separable subcomponents of L2MSS in the Iranian territory context. Moreover, learners with a higher level of future self-image and current L2 self-description found online learning more useful and easy to use. A further finding revealed an authenticity gap among higher educators since they were more motivated to learn language online than in face-to-face classrooms. Besides introducing a new conceptual framework into the literature, the researchers suggest that as a way of influencing higher education language learners’ intentions towards online language learning, lecturers should uncover language learners’ future ideal selves in advance of attending this online language course and design their language syllabus accordingly. It is also imperative for instructors to encourage students to self-describe their progress during online courses as it influenced their behavioral intention to learn languages online.

Neural markers of reduced arousal and consciousness in mild cognitive impairment.

People with Alzheimer's Disease (AD) experience changes in their level and content of consciousness, but there is little research on biomarkers of consciousness in pre-clinical AD and Mild Cognitive Impairment (MCI). This study investigated whether levels of consciousness are decreased in people with MCI. A multi-site site magnetoencephalography (MEG) dataset, BIOFIND, comprising 83 people with MCI and 83 age matched controls, was analysed. Arousal (and drowsiness) was assessed by computing the theta-alpha ratio (TAR). The Lempel-Ziv algorithm (LZ) was used to quantify the information content of brain activity, with higher LZ values indicating greater complexity and potentially a higher level of consciousness. LZ was lower in the MCI group versus controls, indicating a reduced level of consciousness in MCI. TAR was higher in the MCI group versus controls, indicating a reduced level of arousal (i.e. increased drowsiness) in MCI. LZ was also found to be correlated with mini-mental state examination (MMSE) scores, suggesting an association between cognitive impairment and level of consciousness in people with MCI. A decline in consciousness and arousal can be seen in MCI. As cognitive impairment worsens, measured by MMSE scores, levels of consciousness and arousal decrease. These findings highlight how monitoring consciousness using biomarkers could help understand and manage impairments found at the preclinical stages of AD. Further research is needed to explore markers of consciousness between people who progress from MCI to dementia and those who do not, and in people with moderate and severe AD, to promote person-centred care.

Le stress parental chez des familles migrantes : le rôle des réseaux transnationaux

Parenthood can be a source of stress, especially for parents with young children. For migrants, the task is made more complex by cultural differences and the child's integration into a psychic filiation. Traditionally, parents rely on a social group to help them cope with the demands of parenthood. However, this support may be lacking in migratory situations. The literature in psychology has little data available on the composition of social support networks, particularly for transnational networks. The aim of this study is therefore to explore both the local and transnational support networks for migrant parents with respect to a sense of stress for parents. The sample consisted of 62 migrant parents living in Switzerland, and a quantitative and qualitative methodology was used to analyze the data. The results revealed that migrant parents maintain both local and transnational social networks to cope with the challenges of parenting. First-time arrivals have a less well-developed local support network and a corresponding higher level of parental stress. The density of the local support network increases with the duration of residency in Switzerland.