Separate Search Research Articles

Risk of Inflammatory Central Nervous System Diseases After Tumor Necrosis Factor–Inhibitor Treatment for Autoimmune Diseases

Tumor necrosis factor (TNF) inhibitors have been used extensively to treat various autoimmune diseases. However, there are ongoing debates about the risk of inflammatory central nervous system (CNS) disease events following TNF inhibitor therapy, as well as uncertainty about how this risk varies across different autoimmune diseases or TNF-blocking agents. To evaluate the risk of inflammatory CNS diseases after anti-TNF initiation and assess the difference in risk among different types of underlying autoimmune diseases or TNF inhibitors. Separate searches were conducted across PubMed, Embase, and the Cochrane Library from inception until March 1, 2024. Observational studies assessing the association between anti-TNF therapy and inflammatory CNS diseases relative to a comparator group. Study eligibility assessment and data extraction were independently conducted by 2 investigators following PRISMA guidelines. The risk ratio (RR) was used as the effect measure of the pooled analysis. The primary outcome was the risk of incident inflammatory CNS events after anti-TNF therapy for autoimmune diseases. Secondary analyses were performed based on different types of underlying autoimmune diseases and TNF inhibitors. Eighteen studies involving 1 118 428 patients with autoimmune diseases contributing more than 5 698 532 person-years of follow-up were analyzed. The incidence rates of new-onset inflammatory CNS events after initiating TNF inhibitors ranged from 2.0 to 13.4 per 10 000 person-years. Overall, exposure to TNF inhibitors was associated with a 36% increased risk of any inflammatory CNS disease compared to conventional therapies (RR, 1.36; 95% CI, 1.01-1.84; I2, 49%), mainly attributed to demyelinating diseases (RR, 1.38; 95% CI, 1.04-1.81; I2, 31%). Secondary analyses revealed a similar risk of inflammatory CNS diseases across different types of underlying autoimmune diseases (rheumatic diseases: RR, 1.36; 95% CI, 0.84-2.21; inflammatory bowel disease 1.49; 95% CI, 0.93-2.40; P for subgroup = .74) and TNF inhibitors (anti-TNF monoclonal antibodies vs etanercept: RR, 1.04; 95% CI, 0.93-1.15; I2, 0%). Compared to conventional therapies, exposure to TNF inhibitors was associated with a 36% increased risk of inflammatory CNS diseases, irrespective of background autoimmune disease or TNF inhibitor type.

Systematic review of the evidence for treatment and management of common skin conditions in resource-limited settings: An update.

The skin is the largest and most visible organ of the human body. As such, skin infections can have a significant impact on overall health, social wellbeing and self-image. In 2019, we published a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource-limited settings where skin infections are endemic. This current review serves as an update to assess the evidence for treatment of these conditions as well as atopic dermatitis, molluscum contagiosum and head lice in endemic settings. The data from this systematic review have supported an update to the Australian National Healthy Skin guidelines. A systematic review was conducted using two separate searches in MEDLINE, PubMed, Embase, CINAHL, Cochrane and Web of Science. The first search was an update of the 2018 systematic review using the same search strategy for the same skin conditions to identify emerging literature from 2018 to 2022. The second search strategy used the same key terms but with the addition of atopic dermatitis, head lice and molluscum contagiosum from 1960 to 2022. Eligible studies included Indigenous peoples and populations in resource-limited settings with a diagnosis of impetigo, scabies, crusted scabies, tinea capitis, atopic dermatitis, molluscum contagiosum or who presented with head lice. Studies conducted in high-income countries were excluded. Articles were screened for inclusion independently by one author with a second group of reviewers independently double screening. Data extraction and an in-depth quality assessment conducted by one author and checked by two others. Of 1466 original articles identified, 68 studies were included and key findings outlined for impetigo, scabies, crusted scabies, atopic dermatitis, head lice and molluscum contagiosum. Recommendations for each condition based on the available evidence are provided. The importance of assessing literature relevant to the populations with heavy burden of skin infections is outlined in this systematic review. We have summarised updates to this literature, which may benefit in developing guidelines for skin infection management similar to the National Healthy Skin Guidelines for Australia.

Is there still protected health information in openly available PowerPoint files?

IntroductionPowerPoint presentations containing radiographic images continue to be an important educational tool for healthcare professionals. When properly deidentified, these radiographic imaging files are valuable and do not pose any privacy concerns for patients. However, when these images are not properly managed, patient information can be uncovered; raising concerns about patient privacy and potential legal consequences for healthcare systems and academic institutions. This study revisited and expanded upon previous work published by Weadock et. al in an attempt to see how this issue has changed in the last 15 years. MethodsThis study consisted of 8 separate Google Web searches related to a medical imaging modality. Each PowerPoint file was manually inspected for imaging files including x rays, CT scans, MRI's, PET scans, CT and MR angiography and ultrasounds. If a PowerPoint contained an image file, it was then inspected for PHI. Full PHI included all of the following: patient's full name, medical registration number (MRN), date and a geographic indicator smaller than a state. ResultsThe first two Google searches “Magnetic Resonance Imaging filetype:ppt” and “Cardiac CT CAT Scan filetype:ppt” returned 146 search results with 7.6 % containing full PHI. “Radiology Chest X-ray filetype:ppt” resulted in accessible PHI in 40 % of the presentations with images and “Post-Operative CT Scan filetype:ppt” resulted in accessible PHI in 29 %. Magnetic Resonance Imaging filetype:pptx” returned 0 results with PHI. “Cardiac CT CAT scan filetype:pptx” returned 1 result with partial PHI.“Radiology Chest X-ray filetype:pptx” contained 4 results with partial PHI and 1 result with full PHI. “Post-Operative CT scan filetype:pptx” contained 2 presentations with partial PHI. DiscussionWhile a declining percentage of PowerPoint files containing PHI is reassuring, this follow up study demonstrated that PHI can still be easily accessed openly on the internet by anyone who has basic familiarity with Microsoft PowerPoint. Work remains to continue to educate users on how to properly protect patient information in PowerPoint files. Appropriately protecting private healthcare information is essential for patient safety and can prevent unintentional HIPAA violations. Radiologists are uniquely positioned to educate other healthcare providers on how to properly remove PHI from radiologic imaging files.

A Combined Quasi-Newton-Type Method Using 4th-Order Directional Derivatives for Solving Degenerate Problems of Unconstrained Optimization

Introduction. Methods of unconstrained optimization play a significant role in machine learning [1–6]. When solving practical problems in machine learning, such as tuning nonlinear regression models, the extremum point of the chosen optimality criterion is often degenerate, which significantly complicates its search. Therefore, degenerate problems are the most challenging in optimization. Known numerical methods for solving the general unconstrained optimization problem, up to the second order, have very low convergence rates when solving degenerate problems [7, 8]. This is explained by the fact that for a significant improvement in convergence rate in this case, it is necessary to use higher-order derivatives in the method than the second order [10]. The purpose of the paper is to develop an efficient quasi-Newton method for solving degenerate unconstrained optimization problems, the idea of which (unlike regularization) involves dividing the entire space into the sum of two orthogonal subspaces. This idea was introduced in [23]. The space division at each iteration of the method is based on the spectral decomposition of the matrix approximating the Hessian of the objective function using the BFGS formula [3]. Each subspace exhibits its own behavior of the objective function, and therefore, an appropriate minimization method is applied on it. Results. A combined quasi-Newton method is presented for solving degenerate unconstrained optimization problems, based on orthogonal decomposition of the Hessian approximation matrix and division of the entire space into the sum of two orthogonal subspaces. On one subspace (the kernel of the Hessian approximation matrix), a method is applied where derivatives in the direction of the 4th order are computed, while on the orthogonal complement to it, a quasi-Newtonian method is applied. A separate one-dimensional search is applied on each of these subspaces to determine the step multiplier in the respective direction. The effectiveness of the presented combined method is confirmed by numerical experiments conducted on widely accepted test functions for unconstrained optimization problems. The proposed method allows obtaining fairly accurate solutions to test tasks in case of degeneracy of the minimum point with significantly lower computational costs for gradient calculations compared to optimization procedures of well-known mathematical packages. Conclusions. The idea of dividing the entire space into the sum of two (or possibly more) orthogonal subspaces when solving complex optimization problems is quite promising in terms of applying a combination of different numerical methods on separate subspaces. In the future, it is planned to conduct theoretical research on the convergence rate of the presented combined method in solving degenerate unconstrained optimization problems. Keywords: unconstrained optimization, quasi-Newton methods, degenerate minimum point, spectral matrix decomposition, Machine Learning.

Imaging in Renal Cell Carcinoma Detection.

Imaging in renal cell carcinoma (RCC) is a constantly evolving landscape. The incidence of RCC has been rising over the years with the improvement in image quality and sensitivity in imaging modalities resulting in "incidentalomas" being detected. We aim to explore the latest advances in imaging for RCC. A literature search was conducted using Medline and Google Scholar, up to May 2024. For each subsection of the manuscript, a separate search was performed using a combination of the following key terms "renal cell carcinoma", "renal mass", "ultrasound", "computed tomography", "magnetic resonance imaging", "18F-Fluorodeoxyglucose PET/CT", "prostate-specific membrane antigen PET/CT", "technetium-99m sestamibi SPECT/CT", "carbonic anhydrase IX", "girentuximab", and "radiomics". Studies that were not in English were excluded. The reference lists of selected manuscripts were checked manually for eligible articles. The main imaging modalities for RCC currently are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Contrast-enhanced US (CEUS) has emerged as an alternative to CT or MRI for the characterisation of renal masses. Furthermore, there has been significant research in molecular imaging in recent years, including FDG PET, PSMA PET/CT, 99mTc-Sestamibi, and anti-carbonic anhydrase IX monoclonal antibodies/peptides. Radiomics and the use of AI in radiology is a growing area of interest. There will be significant change in the field of imaging in RCC as molecular imaging becomes increasingly popular, which reflects a shift in management to a more conservative approach, especially for small renal masses (SRMs). There is the hope that the improvement in imaging will result in less unnecessary invasive surgeries or biopsies being performed for benign or indolent renal lesions.

Current evidence on CA-125 levels in differentiation between endometriomas and endometriosis-associated ovarian cancer – A systematic review and meta-analysis

Background: Although significant advancements have been made in the diagnostic and therapeutic methods of gynecological oncology, ovarian cancer continues to pose a significant challenge. The measurement of CA-125 levels is commonly considered the preferred approach for assessing the necessity of surgical intervention, hence guaranteeing a conclusive diagnosis. The objective of this study is to conduct a comparative analysis of existing literature about the effectiveness of serum CA-125 levels in distinguishing between endometriosis-associated ovarian cancer (EAOC) from ovarian endometrioma. Material and methods: The researchers conducted separate searches in the PubMed and Web of Science databases to identify peer-reviewed papers that examined the serum or plasma CA-125 marker. The search was conducted from the start of both databases until April 4th, 2024. Results: After conducting a literature search, a total of 114 studies were identified for review. Out of these, three studies satisfied the inclusion criteria and were consequently included. The results of the pooled analysis indicate that there is no statistically significant difference between the groups (336.3 ± 667.6 vs 530.6 ± 548.9, respectively; standard deviation = 0.51; 95% confidence interval: −0.63 to 1.64; p = 0.39). Conclusion: Unfortunately, the biomarker CA-125, which is commonly selected, has exhibited restricted effectiveness in distinguishing between EAOC and endometriomas. The existing body of literature on this topic indicates a significant dearth of research regarding the use of CA-125 as a means of differentiating between EAOC and endometriomas. Enhanced diagnostic techniques are necessary for the detection and characterization of ovarian tumors, encompassing those originating from endometriosis.

A - 12 Neuropsychological Test Best Fit for Identifying on-the-Road Driving Behaviors in Normal and Abnormal Aging Populations: a Systematic Review

Abstract Objective This systematic review’s purpose is to identify neuropsychological assessments that are accurate at predicting driving behaviors in geriatric populations. The population included normal aging, mild cognitive impairment (MCI), and dementia. Data Selection PubMed and APA PsycNet databases were searched using two separate keyword searches: cognitive evaluation and driving behaviors and aging; neuropsychological test and driving behaviors and aging. The databases were searched March 10, 2024, and again on April 26, 2024. This yielded 278 articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to identify articles. Articles were excluded if they did not have on-road driving behaviors or simulated driving behaviors, neuropsychological test, if the average participant age was not geriatric, or if it was a non-peer reviewed article. Data Synthesis After following PRISMA selections, eight articles were included, creating a combined sample size of 927 (Mean age = 74.16, SD = 2.38; mean years of education = 14.17, SD = 1.09; female percentage = 40.78). The test deemed most correlated were Neuropsychological Assessment Battery: Driving Scene Test, Clock Drawing, Useful Field of View, Trail making task, Mini-Mental State Exam, verbal and visual memory components from the Wechsler Memory Scale, Rey-Osterrieth Complex Figure, and Maze Navigation Task. Conclusion General cognitive screening tests as well as visuomotor, visual–spatial, visual attention and verbal and non-verbal memory tests highly correlate with real driving behaviors and accurately predict on-the-road driving behaviors. This indicates the cognitive and behavioral complexity of driving. Though these tests accurately predict driving behaviors, their abilities to do so may differ depending on cultural groups.

A scoping review on adult patients with de novo glomerular diseases following COVID-19 infection or vaccine.

There are increasing reports of glomerular disease (GD) following COVID-19 infection and vaccination. Current evidence on the possible link between COVID-19 infection or vaccination and GD is conflicting. The present study undertakes a scoping review of research to describe the relationship between COVID-19 infection and vaccination with GD and the common management strategies and overall outcomes of the disease to identify knowledge gaps and guide further research. All original research studies published in English until 5th September 2022 were considered for inclusion in the review. Exclusion criteria were animal studies, autopsy studies, and data involving patients who were paediatric patients (< 16years), were transplant recipients, had a recurrence of glomerular disease, had concomitant cancer or non-COVID-19 infection which may cause glomerular disease, or did not receive a renal biopsy. The five electronic databases searched were MEDLINE, PubMed, Scopus, EMBASE, and Cochrane. Two separate search strings related to COVID-19, and glomerular disease were combined using the Boolean operator 'AND'. Filters were used to limit publications to original research studies published in English. Search results from each database were imported into Covidence software ( www.covidence.org ) and used for de-duplication, article screening, and data extraction. Descriptive analyses were used to summarise demographics, diagnoses, and treatment outcomes. After removing duplicates, 6853 titles and abstracts were screened. Of the 188 studies included, 106 studies described 341 patients with GD following COVID-19 infection and 82 described 146 patients with GD following a COVID-19 vaccination. IgA nephropathy was the most common GD pathology reported following COVID-19 vaccination with GD most common following mRNA vaccines. Collapsing focal segmental glomerulosclerosis was the most common GD following COVID-19 infection. Immunosuppressive treatment of GD was more common in the vaccine cohort than in the infection cohort. Despite the significant number of COVID-19 infections and vaccinations around the world, our understanding of GD associated with COVID-19 infection and vaccination remains poor, and more research is needed to understand the possible relationship better.

Dyslipidemia and lower extremity arterial disease.

Dyslipidemia is an established risk factor for cardiovascular diseases. We aimed to review its role in the pathogenesis of lower extremity arterial disease (LEAD), as well as the effect of lipid-lowering treatment on the progression of LEAD. PubMed/MedLine, EMBASE and Scopus were searched between January 1990 and January 2024 for articles investigating the role of dyslipidemias and hyperlipidemias in the pathogenesis of LEAD. A separate search focused on the effects of lipid-lowering therapy on patients with LEAD. There is evidence that dyslipidemias play a major role in the development of LEAD. All patients with LEAD should receive intensive lipid-lowering therapy for the reduction not only of claudication symptoms and amputation rates, but also of myocardial infarction and cardiovascular event rates. Vascular specialists should keep in mind the pivotal role of dyslipidemia in the pathogenesis and progression of LEAD.

Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review.

The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people's way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50%) assessed climate change-related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36%), knowledge databases (n=5, 36%), data collection and analysis (n=3, 21%), gamification (n=1, 7%), and educational resources (n=2, 14%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7%), collaborative (n=1, 7%), and cocreative (n=1, 7%) approaches, to ensure the relevance and use of digital apps. Most digital apps identified provided a service to citizens to either prevent adverse climate change-related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions.

Adherence to single inhaler triple therapy and digital inhalers in Chronic Obstructive Pulmonary Disease: a literature review and protocol for a randomized controlled trial (TRICOLON study)

BackgroundMedication non-adherence is a significant problem in patients with Chronic Obstructive Pulmonary Disease (COPD). Efforts to address this issue are receiving increased attention. Simplifying treatment by prescribing single-inhaler triple therapy (SITT) as an alternative to multi-inhaler triple therapy (MITT) or with smart inhalers are often considered potential solutions. However, the actual impact of these innovations on adherence and clinical outcomes is unclear.MethodsTo address this knowledge gap we first conducted a literature review focusing on two research questions: 1) the difference in adherence between SITT and MITT users in COPD, and 2) the effect of smart inhalers on adherence in COPD. Separate searches were conducted in PubMed and two authors independently assessed the articles. In addition, we present a protocol for a study to acquire knowledge for the gaps identified.ResultsTo address the first research question, 8 trials were selected for further review. All trials were observational, i.e. randomized controlled trials were lacking. Seven of these trials showed higher adherence and/or persistence in patients on SITT compared with patients on MITT. In addition, four studies showed a positive effect of SITT on various clinical outcomes. For the second research question, 11 trials were selected for review. While most of the studies showed a positive effect of smart inhalers on adherence, there was considerable variation in the results regarding their effect on other clinical outcomes.The TRICOLON (TRIple therapy COnvenience by the use of one or multipLe Inhalers and digital support in ChrONic Obstructive Pulmonary Disease) trial aims to improve understanding regarding the effectiveness of SITT and smart inhalers in enhancing adherence. This open-label, randomized, multi-center study will enroll COPD patients requiring triple therapy at ten participating hospitals. In total, 300 patients will be randomized into three groups: 1) MITT; 2) SITT; 3) SITT with digital support through a smart inhaler and an e-health platform. The follow-up period will be one year, during which three methods of measuring adherence will be used: smart inhaler data, self-reported data using the Test of Adherence to Inhalers (TAI) questionnaire, and drug analysis in scalp hair samples. Finally, differences in clinical outcomes between the study groups will be compared.DiscussionOur review suggests promising results concerning the effect of SITT, as opposed to MITT, and smart inhalers on adherence. However, the quality of evidence is limited due to the absence of randomized controlled trials and/or the short duration of follow-up in many studies. Moreover, its impact on clinical outcomes shows considerable variation. The TRICOLON trial aims to provide solid data on these frequently mentioned solutions to non-adherence in COPD. Collecting data in a well-designed randomized controlled trial is challenging, but the design of this trial addresses both the usefulness of SITT and smart inhalers while ensuring minimal interference in participants' daily lives.Trial registrationNCT05495698 (Clinicaltrials.gov), registered at 08–08-2022. Protocol version: version 5, date 27–02-2023.

Differences in manifestations of epilepsy and developmental delay in PURA syndrome and 5q31 microdeletions.

PURA is mapped to chromosome 5q31 and plays a vital role in neuronal development and synapse formation. Here, we aim to explore PURA's impact on cognitive development and epilepsy phenotype by comparing patients with single nucleotide variants (SNPs) in the PURA gene (PURA-SNP patients) to those with 5q31 microdeletions including PURA (5q31del + PURA) and those with 5q31 microdeletions not including the PURA gene (5q31del-PURA). A systematic literature search was conducted in PubMed. Two separate searches were performed in order to find patients with PURA SNPs and 5q31 microdeletions. This review includes data from 191 patients collected from a total of 18 articles; 174 of the patients had PURA SNPs, 13 had 5q31 microdeletions involving the PURA gene, and 4 had 5q31 microdeletions without PURA gene implication. All patients exhibited hypotonia, feeding difficulties and dysmorphic features, however epilepsy was primarily present in patients with PURA syndrome, that is, groups PURA-SNP and 5q31del + PURA. Regarding the developmental milestones the 5q31del + PURA group stood out as being the most severe, while the 5q31del-PURA group showed a relatively mild phenotype. Our findings support the hypothesis of PURA being the key contributor of developmental delay and epilepsy among patients with PURA syndrome.

Identification and assessment of factors that impact the demand for and supply of dental hygienists amidst an evolving workforce context: a scoping review

BackgroundThis study involved a scoping review to explore factors influencing dental hygienist demand and supply in high-income countries.MethodsA six-stage scoping review was conducted with separate search strategies tailored to four databases (MEDLINE, CINAHL, Google Scholar, and Google) plus a targeted scan of dental hygienist organization websites. This yielded 2,117 unique citations, leading to 148 articles included in the review.ResultsNearly half of the articles (47%) focused on the United States, with 11% on Canada. Most articles (91%) were in English, alongside 13 in Korean and one in French. Journal articles comprised 62% of the publications, followed by reports/working papers (11%) and websites (11%). Other types included conference abstracts, policy briefs, and presentation slides. Content-wise, 47% were original research, with analysis articles (14%), commentaries (11%), and reviews (8%) also present. The articles were coded into three main categories: workforce characteristics/projections, factor-specific analyses, and workforce opportunities. The articles on workforce characteristics covered demographic, geographic, and employment aspects of dental hygienists, along with projections for supply and demand using simulation modelling and geospatial analyses. Factor-specific articles investigated the (1) working environment, (2) policy/regulatory/training environment, (3) job/career satisfaction and related human resource issues, and (4) scope of practice. The third key category of articles highlighted opportunities for expanding the workforce through alternative models in different sectors/settings (e.g., public health, primary care, long-term care, hospitals, mobile outreach, and non-clinical roles including research, education and leadership) and for a range of vulnerable or underserved populations (e.g., geriatric and pediatric populations, persons with disabilities, those living in rural/remote areas, Indigenous peoples, and incarcerated people).ConclusionsThis review provides a comprehensive documentation of the current state of the dental hygienist workforce, compiling factors affecting demand and supply, and highlighting opportunities for the dental hygienist workforce in Canada and other high-income countries. The findings offer a foundation for future research, highlighting the need for more focused and rigorous reviews and underscoring the necessity of high-quality studies to verify the effectiveness of various interventions and policies. This is crucial to address dental hygienist workforce challenges and ensure the sustainability and effectiveness of oral health care delivery.

ATLAS Run 2 searches for electroweak production of supersymmetric particles interpreted within the pMSSM

A summary of the constraints from searches performed by the ATLAS collaboration for the electroweak production of charginos and neutralinos is presented. Results from eight separate ATLAS searches are considered, each using 140 fb−1 of proton-proton data at a centre-of-mass energy of s\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$ \\sqrt{s} $$\\end{document} = 13 TeV collected at the Large Hadron Collider during its second data-taking run. The results are interpreted in the context of the 19-parameter phenomenological minimal supersymmetric standard model, where R-parity conservation is assumed and the lightest supersymmetric particle is assumed to be the lightest neutralino. Constraints from previous electroweak, flavour and dark matter related measurements are also considered. The results are presented in terms of constraints on supersymmetric particle masses and are compared with limits from simplified models. Also shown is the impact of ATLAS searches on parameters such as the dark matter relic density and the spin-dependent and spin-independent scattering cross-sections targeted by direct dark matter detection experiments. The Higgs boson and Z boson ‘funnel regions’, where a low-mass neutralino would not oversaturate the dark matter relic abundance, are almost completely excluded by the considered constraints. Example spectra for non-excluded supersymmetric models with light charginos and neutralinos are also presented.

Assessing the Efficacy of ChatGPT Versus Human Researchers in Identifying Relevant Studies on mHealth Interventions for Improving Medication Adherence in Patients With Ischemic Stroke When Conducting Systematic Reviews: Comparative Analysis.

ChatGPT by OpenAI emerged as a potential tool for researchers, aiding in various aspects of research. One such application was the identification of relevant studies in systematic reviews. However, a comprehensive comparison of the efficacy of relevant study identification between human researchers and ChatGPT has not been conducted. This study aims to compare the efficacy of ChatGPT and human researchers in identifying relevant studies on medication adherence improvement using mobile health interventions in patients with ischemic stroke during systematic reviews. This study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four electronic databases, including CINAHL Plus with Full Text, Web of Science, PubMed, and MEDLINE, were searched to identify articles published from inception until 2023 using search terms based on MeSH (Medical Subject Headings) terms generated by human researchers versus ChatGPT. The authors independently screened the titles, abstracts, and full text of the studies identified through separate searches conducted by human researchers and ChatGPT. The comparison encompassed several aspects, including the ability to retrieve relevant studies, accuracy, efficiency, limitations, and challenges associated with each method. A total of 6 articles identified through search terms generated by human researchers were included in the final analysis, of which 4 (67%) reported improvements in medication adherence after the intervention. However, 33% (2/6) of the included studies did not clearly state whether medication adherence improved after the intervention. A total of 10 studies were included based on search terms generated by ChatGPT, of which 6 (60%) overlapped with studies identified by human researchers. Regarding the impact of mobile health interventions on medication adherence, most included studies (8/10, 80%) based on search terms generated by ChatGPT reported improvements in medication adherence after the intervention. However, 20% (2/10) of the studies did not clearly state whether medication adherence improved after the intervention. The precision in accurately identifying relevant studies was higher in human researchers (0.86) than in ChatGPT (0.77). This is consistent with the percentage of relevance, where human researchers (9.8%) demonstrated a higher percentage of relevance than ChatGPT (3%). However, when considering the time required for both humans and ChatGPT to identify relevant studies, ChatGPT substantially outperformed human researchers as it took less time to identify relevant studies. Our comparative analysis highlighted the strengths and limitations of both approaches. Ultimately, the choice between human researchers and ChatGPT depends on the specific requirements and objectives of each review, but the collaborative synergy of both approaches holds the potential to advance evidence-based research and decision-making in the health care field.

Are Orthopaedic Clinical Trials Linguistically and Culturally Diverse? A Systematic Review.

Underrepresentation and misrepresentation of historically underrepresented populations in randomized controlled trials (RCTs) may have implications for the validity of research results and their application for diverse populations. To evaluate the representation of historically linguistically, racially, and ethnically underrepresented participants in orthopaedic randomized controlled trials (RCTs) and to assess the use of translated and culturally adapted patient reported outcome measures (PROMs). Separate and comprehensive literature searches of PubMed, Web of Science, and Embase databases were performed to identify RCTs utilizing PROMs between the years 2012 - 2022 among the top five highest 5-year impact factor orthopaedic journals according to the 2021 Journal Citation Reports database. The primary outcomes of interest included reporting of linguistic, racial and ethnic demographic characteristics of trial participants and the utilization of translated PROMs. The methodological quality of each clinical trial was assessed using the Jadad Criteria. 230 RCTs met inclusion criteria. The language of participants was reported in 14% of trials and in 17% of trials when searching both the published text and clinical trial registration information. In addition, race and/or ethnicity was reported in 11% of trials, and the use of translated PROMs was reported in 7% of trials. Among the six multinational studies, none reported the language of the study population nor the use of translated PROMs. Notably, four studies (2%) reported utilizing culturally adapted PROMs. The average Jadad score was 3.07. Participant language, race, and ethnicity are infrequently reported in orthopaedic clinical trials, potentially limiting the application and interpretation of study results. Similarly, the linguistic and cultural adaptation of PROMs utilized are often not reported, which also limits interpretations of the validity and generalizability of orthopedic study results. Researchers and journals should promote standard reporting of demographic data and methods of PROM adaptation to ensure results are generalizable to diverse patient populations. III.

Assessment of CAD/CAM Fabrication Technologies for Post and Core Restorations—A Narrative Review

The primary objective of this study is to conduct a comprehensive review of the existing literature that discusses research on post and core restorations, covering aspects such as their composition, manufacturing methods, and clinical effectiveness. The methodology employed in this review encompasses the implementation of a well-defined search strategy, the establishment of criteria for inclusion and exclusion, and the selection of relevant studies to summarize their findings. To gather relevant literature published between 1993 and 2023, the research team conducted separate searches on PubMed, Web of Science, and Embase databases. In total, 168 titles were initially retrieved from these electronic databases. By applying the predefined exclusion criteria, the researchers identified 73 articles that specifically address the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) technologies employed in post and core restorations. These treatments are commonly employed to restore teeth that have received endodontic therapy and subsequently experienced loss of dental structure. The development of computerized technology for the creation of customized posts and cores has emerged as a straightforward and efficient alternative to traditional methods. The review synthesizes papers discussing the techniques and materials involved in CAD/CAM-based construction of post and cores. It explores strategies for restoring endodontically treated teeth, highlighting both direct and indirect approaches. Commonly mentioned materials include zirconia, composite resin, and hybrid ceramics. Despite the limited literature on CAD/CAM post and core procedures, the review emphasizes the necessity of further research to assess long-term outcomes and efficacy. Additionally, it suggests including implications for future research and clinical recommendations to enhance the depth and practical relevance of the review.

Trend of research on oral hygiene in intubated patient based on bibliometric analysis

Background: ICU patients with critical conditions are generally intubated due to their inability to breathe independently. These patients require assistance from nurses in meeting their basic needs, one of which is oral hygiene. ICU nurses use several protocols when doing oral hygiene in intubated patients. Purpose: This study was conducted to reveal the trend of research on oral hygiene in intubated patients in the last two decades through bibliometric analysis. Methods: This study is a quantitative research. The research publications were collected from the Scopus and PubMed databases through the Publish or Perish application. Then, for further analysis, the VOSViewer application was used to create visualization maps of co-occurring terms that include the research themes. Results: There were a total of 88 publications from two databases in the last two decades that discussed oral hygiene in intubated patients. Visualization in VOSViewer illustrates five main clusters on oral hygiene-intubated patients. Most of the publication themes were oral hygiene protocols and the relationship between the oral hygiene and VAP incidence. However, suction toothbrush as one of the oral hygiene protocol did not appear in the co-occurring terms in the first search; therefore, the researchers conducted a separate search about this term. Conclusions: Based on the analysis, the most common themes used are oral hygiene protocols and the relationship between oral hygiene and VAP in the last two decades. However, research on suction toothbrush as one of the protocols is still lacking, so it can be used as a novelty in conducting further research.

Metformin-Associated Lactic Acidosis: Which Elimination Therapy to Use in Case of Haemodynamic Instability? A Retrospective Cohort Study

Introduction: Metformin, a commonly used oral antihyperglycemic drug, poses a rare risk related to the development of metformin-associated lactic acidosis (MALA). The Extracorporeal Treatments in Poisoning (EXTRIP) group recommended intermittent haemodialysis (IHD) as a primary elimination therapy in case of severe metformin poisoning. However, in haemodynamically unstable patients, our previous observations suggested that continuous venovenous haemofiltration (CVVH) might be more effective. This retrospective cohort study aimed to contribute evidence on the use of IHD and CVVH in patients with severe MALA, particularly in haemodynamically unstable patients. Methods: Data from January 2015 to December 2020 were collected from the Leuven University Hospital. Two separate search methods, based on hospital activity records and laboratory criteria, were used to identify patients with MALA. Patients diagnosed with MALA, receiving extracorporeal treatment within 24 h of admission, were included. Patients were categorized into the IHD and CVVH groups. Patient characteristics, treatment details, and outcomes were analysed. Results: Among 358,148 patient records, 35 MALA cases were identified. IHD was chosen as the initial elimination technique in 13 cases, whereas 22 patients were first commenced on CVVH. Patients treated with CVVH were sicker, had more comorbidities and had higher ventilation and vasopressor requirements. CVVH group had longer vasopressor use, longer ICU stays, and higher in-hospital mortality. Discussion: CVVH rather than IHD seems to be the preferred elimination technique in the more critically ill patients with MALA. Due to its retrospective design, this study failed to identify the superior elimination technique in terms of efficacy. Poorer outcomes in the CVVH group are likely attributed to the severity of illness rather than the inferiority of the elimination therapy. We acknowledge the diagnostic challenges regarding MALA. Using metformin assays could be beneficial in managing these patients. Conclusions: This study suggests clinicians’ preference for CVVH in severe cases of MALA with haemodynamic instability.

Burn Wounds and Enzymatic Debridement (ED)-Past, Present, and Future.

Excision of necrotic and devitalized tissues of deep burns is key for optimal care of burn injuries. However, the modality of early tangential excision followed by skin grafting proposed by Zora Janzekovic 5 decades ago was not received initially with great enthusiasm. At present, it developed to become the standard of care (SOC) despite the special expertise it necessitates and the general anesthesia it requires in addition to several drawbacks including excessive blood loss, risk of hypothermia, and most importantly potential excision of normal non-burned tissues. Conservative non-surgical selective enzymatic debridement (ED) at present is becoming more popular as an adjunct or even an alternative approach. A systematic review of the PubMed electronic database was conducted to identify all experimental and clinical studies about ED of burn wounds. Additional separate searches were also conducted to identify any reports missed by the initial systematic review. Full texts of 59 reports (42 clinical and 17 experimental studies) were retrieved for analysis. A total of 46 studies (11 experimental and 35 clinical) were about the pineapple extract debriding agent. In total, 23 clinical studies describing promising favorable results with pineapple bromelain-based debridement (BBD) concentrate were published in the last 3 years (2020-2023). Though available evidence is not entirely in favor of replacing the current surgical SOC with BBD, it certainly presents ED as a highly advantageous modality for the management of burn wounds. Newly described keratinase and SN514 also are promising new products. They both still await further investigation before being clinically adopted.