bluuebunny/crossref_metadata_2025 huggingface dataset:
Female solo travels to south Asian destinations and sustaining loneliness
Authors: Neluhena Malithi , Chandralal Lalith , Dahanayake Thilinika
Published: May 2023

While there has been an increase in the number of tourists travelling solo, there is a steady growth in females travelling alone as tourists around the globe. This phenomenon has led to a growing scholarly interest, yet solo female travel as a research topic is relatively under-researched. Only limited knowledge exists about the psychological issues of female solo travel, such as loneliness. There is a gap in our understanding of interpreting solo travel by females, depending on their country of origin and the type of destinations they have travelled solo. This study examined these aspects by exploring female solo travelling in South Asian destinations with European and Asian participants. The results revealed that the meaning of solo travelling is associated with four themes: freedom pursuit, being with the self, self-enhancement, and connectedness with people. It also disclosed that solo female travellers have different perceptions about ‘loneliness,’ and everyone does not see loneliness as a negative outcome. The results further indicate that the perception of solo travel and loneliness and how to cope with lonely times are likely to be subjective to the type of destinations where solo travelling takes place and the country of origin of the travellers.
Music Video, Remediation, and Generic Recombination
Authors: Westrup Laurel
Published: May 2023

Music videos continue to be one of the most adaptable forms of media due to their unique ability to remediate everything from Western films to Zoom meetings. Their relatively low budgets and ever flexible assemblages of audiovisual components make them sites for experimentation, and they regularly recombine generic conventions from a range of media. This essay makes the case that studying music video demands a multifaceted approach to genre: if we accept that music video is a moving assemblage of genres and media, we can move toward unpacking the unique configurations of genre and medium in a given music video or subset of music videos. This method might suggest a shift in the way we think through genre in the future, moving away from single genre studies (however expansive or changeable a given genre might be) and toward studies that treat genre in a more recombinatory way.
Using the Delphi process to determine the minimum clinically important effect size for the Balanced-2 randomised controlled trial
Authors: Deng Carolyn , Sidebotham David
Published: May 2023

Background:

The sample size calculation is an important step in designing randomised controlled trials. For a trial comparing a control and an intervention group, where the outcome is binary, the sample size calculation requires choosing values for the anticipated event rates in both the control and intervention groups (the effect size), and the error rates. The Difference ELicitation in TriAls guidance recommends that the effect size should be both realistic, and clinically important to stakeholder groups. Overestimating the effect size leads to sample sizes that are too small to reliably detect the true population effect size, which in turn results in low achieved power. In this study, we use the Delphi approach to gain consensus on what the minimum clinically important effect size is for Balanced-2, a randomised controlled trial comparing processed electroencephalogram-guided ‘light’ to ‘deep’ general anaesthesia on the incidence of postoperative delirium in older adults undergoing major surgery.

Methods:

Delphi rounds were conducted using electronic surveys. Surveys were administered to two stakeholder groups: specialist anaesthetists from a general adult department in Auckland City Hospital, New Zealand (Group 1), and specialist anaesthetists with expertise in clinical research, identified from the Australian and New Zealand College of Anaesthetist’s Clinical Trials Network (Group 2). A total of 187 anaesthetists were invited to participate (81 from Group 1 and 106 from Group 2). Results from each Delphi round were summarised and presented in subsequent rounds until consensus was reached (>70% agreement).

Results:

The overall response rate for the first Delphi survey was 47% (88/187). The median minimum clinically important effect size was 5.0% (interquartile range: 5.0–10.0) for both stakeholder groups. The overall response rate for the second Delphi survey was 51% (95/187). Consensus was reached after the second round, as 74% of respondents in Group 1 and 82% of respondents in Group 2 agreed with the median effect size. The combined minimum clinically important effect size across both groups was 5.0% (interquartile range: 3.0–6.5).

Conclusions:

This study demonstrates that surveying stakeholder groups using a Delphi process is a simple way of defining a minimum clinically important effect size, which aids the sample size calculation and determines whether a randomised study is feasible.
Treatment of last resort? Psychological therapy seeking in chronic pain patients
Authors: Farley Dominika , Kłosowska Joanna , Brączyk Justyna , Buglewicz Ewa , Bąbel Przemysław
Published: May 2023

Objective

Our goal was to assess how many chronic pain patients seek psychological treatment for their condition and what psychological and demographic characteristics are associated with that decision.

Methods

The association between pain intensity, quality of life and psychological treatment seeking was tested in two hypothetical models which differed according to beliefs about either external or internal control over pain.

Results

A minority of patients had experience with psychological treatment of chronic pain. Patients who had that experience were younger, suffered from more intense pain, and applied many more coping strategies than patients who never tried this kind of treatment. Intense pain and low quality of life motivated chronic pain patients to seek psychological treatment only if they believed that doctors could control their pain.

Discussion

The study results stress the importance of diversifying the methods used to treat chronic pain and educating patients about the benefits of psychological treatment. Low numbers of chronic pain patients who take advantage of psychological treatment indicate that encouragement from medical professionals might be necessary.
Barriers to optimizing inflammatory bowel disease care in the United States
Authors: Spencer Elizabeth A. , Abbasi Sadeea , Kayal Maia
Published: May 2023

Significant progress in the management and modification of inflammatory bowel disease (IBD) has been made; however, significant barriers to the optimization of IBD care in the United States still exist. The majority of these barriers are constructed by insurance carriers and the integration of market pressures into healthcare decision-making. In this review, we highlight the barriers to IBD care optimization within the context of the US insurance system and review current and proposed solutions.
The efficacy of immune checkpoint inhibitors in biliary tract cancer with KRAS mutation
Authors: Jeong Sun Young , Hong Jung Yong , Park Joon Oh , Park Young Suk , Lim Ho Yeong , Jang Jae Yeon , Jeon Youngkyung , Kim Seung Tae
Published: May 2023

Background:

With a 15% incidence, KRAS is one of the most common mutations in biliary tract cancer (BTC) and is a poor prognostic factor. Immune checkpoint inhibitors (ICIs) as salvage therapy have modest activity in BTC.

Objectives:

There are limited data on the efficacy of ICIs according to KRAS mutation in BTC. We evaluated the efficacy of ICIs in BTC patients with or without KRAS mutations.

Design:

Retrospective observational study.

Methods:

We conducted molecular profiling in BTC patients who received ICIs as salvage therapy. The expression of programmed death ligand 1 (PD-L1) on tumor cells was assessed using immunohistochemistry. The TruSightTM Oncology 500 assay from Illumina was used as a cancer panel. We analyzed overall survival (OS) and progression-free survival (PFS) of ICI in BTC patients according to KRAS mutation and PD-L1 expression.

Results:

A total of 62 patients were included in this analysis. The median age was 68.0 years; 47 patients (75.8%) received pembrolizumab and 15 (24.2%) received nivolumab as salvage therapy. All patients received gemcitabine plus cisplatin as the frontline therapy, and 53.2% received fluoropyrimidine plus oxaliplatin (FOLFOX) before ICI. The median number of lines of prior chemotherapy was 2.5. The KRAS mutation was found in 13 patients (19.1%), and 28 patients (45.2%) showed 1% or more of tumor cells out of visible tumor cells positive for PD-L1. There was no statistical correlation between KRAS mutation and PD-L1 expression. The median OS and PFS with ICI were 5.6 [interquartile range (IQR): 3.3–8.0] and 3.8 (IQR: 3.0–4.5) months, respectively. There were no statistically significant differences in PFS with ICIs according to KRAS mutation (mutant type versus wild type) and PD-L1 expression (positive versus negative). In subgroup analysis, patients with both KRAS mutation and PD-L1 positivity had longer PFS compared with patients with KRAS mutation and PD-L1 negativity (10.1 versus 2.6 months, p = 0.047). This finding was not shown in patients with wild-type KRAS.

Conclusion:

Our analysis suggested that PD-L1 expression might be a useful biomarker for ICIs in BTC patients with KRAS mutation but not in those with wild-type KRAS.
Politicians and the General Public Communicating on Facebook and Messenger: Public and Private Interactions in a Two-Level Online Sphere
Authors: Ólafsson Jón Gunnar
Published: May 2023

One of the early democratic promises of social networking sites concerned their potential to break down barriers between elites and citizens and facilitate two-way online interactions. More pessimist views have emphasized how inequality is present online as it is offline, with little interaction between those in power and the public taking place. This article expands these debates using online interactions in the small state of Iceland as a case study, with survey data ( N = 1,264) and elite interviews ( N = 93). First, Iceland is an ideal case to examine in relation to the pessimist perspective, with more interactions and less distance found there between elites and the public than in larger democracies usually studied. Second, the Icelandic case illustrates limitations with studying public aspects of online engagement. Research on the internet and social media commonly focuses on publicly available data and therefore does not examine the more private online interactions that can take place. I show that this can be especially problematic in small states like Iceland, where much of the engagement between elites and the public happens through Facebook Messenger and other more private settings. Based on my findings, I illustrate that it is helpful to use a public–private dichotomy framework to understand different types of political interactions in Iceland, other small states, and more widely. I refer to this as a “two-level online sphere.” The first level is the public version of the communication and the second level is the more private avenue.
Exploring L2 Motivational Dynamics Among Chinese EAP Learners in an EMI Context From a Socio-cultural Perspective
Authors: Li Chili
Published: May 2023

This paper reports the findings pertinent to the motivational dynamics in learning English for Academic Purposes (EAP), which are a part of a large-scale mixed-methods study. The study was aimed to explore the adaptation of a cohort of Chinese tertiary students when transiting to an English-as-Medium-of-Instruction (EMI) university from Chinese-medium schools in China. Data sources include a questionnaire survey and semi-structured interviews over a 10-month length of time. Analysis of the quantitative data revealed that the participants became much more strengthened in the overall and dimensional level of motivation after being engaged into EAP learning at the EMI context for two semesters. The qualitative results indicated that the consolidation of the participants’ motivation might result from the newly mediational roles of socio-cultural elements at the EMI environment pertaining to the learning discourses, cultural artifacts, important others and the study of content subjects with the target language. This study crystallizes the situationally constructed disposition of second language (L2) motivation which is responsive to context. The pedagogical implications for EAP teaching are also discussed.
Intimate Partner Violence: Views and Perspectives of Young Women at Maputo-city Secondary Schools, Mozambique
Authors: Bata Maguele Maria Suzana , Taylor Myra , Khuzwayo Nelisiwe
Published: May 2023

Intimate partner violence (IPV) among young women is of serious concern due to the early age of occurrence. This study explored young women’s views about IPV in Maputo City, Mozambique. An explorative, qualitative study design was employed using purposive sampling. The themes were developed in line with the socio-ecological model and the data were analyzed using a thematic content approach. Four themes emerged: (1) Individual level, related to the knowledge of young women about IPV; (2) Relationship level, related to the influence of friends; (3) Community level, related to the religious beliefs; and (4) Societal level, related to factors promoting acceptance of IPV. There is need for an integrated approach to address the individual, relationship, community and societal concerns about IPV among young women in Mozambique to improve skills to challenge the dominant male norms and enhance their autonomy to manage and end violent relationships.
Achieving Legitimacy Through Gender Equality Policies
Authors: Blanco-González Alicia , Díez-Martín Francisco , Miotto Giorgia
Published: May 2023

The academic literature has shown some positive effects of gender equality policies’ development on the companies’ performance. However, often companies are not promoting this type of policies. This research analyzes the effect of corporate gender equality policies from an institutional perspective. Using a structural equation model, based on 150 questionnaires, the results have empirically demonstrated that gender equality policies positively influence four dimensions of organizational legitimacy: pragmatic, moral, regulatory, and cognitive. These results extend our knowledge of the effect of corporate social responsibility policies on organizational legitimacy, underlying that gender equality strategies are very useful for improving organizational legitimacy. Furthermore, these results provide new strategic arguments for managers to manage the organizational change and to develop gender equality policies and foster the decrease of the gender gap.
Board Governance Mechanisms and Capital Structure of Saudi Non-Financial Listed Firms: A Dynamic Panel Analysis
Authors: Bazhair Ayman Hassan
Published: May 2023

The dynamic trade-off model emphasizes that random shocks and other constraints may force firms to deviate from their optimum debt ratio. In addition, firms must incur adjustment costs for them to revert to their target level due to market frictions. However, prior literature in Saudi does not consider the effect of adjustment costs in determining how board governance mechanisms influence capital structure. By exploiting the generalized method of moments framework (GMM), this study analyzed the balanced panel of 100 Saudi non-financial listed firms covering the period from 2010 to 2019. The research found that Saudi firms observed a dynamic adjustment to attain their target leverage at 30.46% annually. Besides that, findings from the present study equally indicate strongly that board size and CEO tenure are negatively associated with leverage. There is also strong evidence that Saudi firms with a substantial number of independent directors pursue a more levered capital structure. Gender diversity appears insignificant in predicting the firms’ target debt ratio. Consequently, the Saudi board of directors and firms’ managers should consider the adjustment costs and other market frictions when designing the optimum debt-equity ratio.
Linking Supply Chain Management Practices of Micro, Small, and Medium-Sized Enterprises to Customer Relationship Management Objectives: A Proposed Framework
Authors: Saad Nourhan Ah. , Kac Sonja Mlaker , Elgazzar Sara
Published: May 2023

Highlighting the importance of micro, small, and medium-sized enterprises (MSMEs) for economic development and growth, and the appearance of their supply chain vulnerability due to the pandemic attack. Thus, the aim of this research is to propose a framework linking the supply chain management practices (SCMPs) of MSMEs to CRM objectives for the purpose of improving MSMEs’ operational performance. This article conducted a systematic review of all available publications from two prominent databases (WoS and Scopus) through PRISMA guidelines to explore the relationship between variables upon which the theoretical framework will be identified. Followed by semi-structured interviews with MSMEs’ eco-system stakeholders to validate the proposed framework using content analysis based on NVivo software. The findings revealed the relationship between SCMPs and CRM objectives through MSMEs’ operational performance, and a set of indicators has been determined for each variable, upon which a theoretical framework has been developed. Moreover, content analysis for interviews validates the key determinants for SCMPs, operational performance, customer satisfaction, and loyalty for MSMEs, upon which a proposed framework has been developed. This research provides a framework that can be used by academics and practitioners to assess the impact of SCMPs on CRM objectives through improving MSMEs’ operational performance and corrective action for MSMEs’ procedures.
Tax, Financial and Social and Governance (ESG) Reporting Concerns of Sexual Harassment Non-disclosure Clauses
Authors: Ryle Patrick M. , McKnight Mark A. , Bueltel Brett L. , Beckman Judy K.
Published: May 2023

This research focuses on the tax, financial reporting, and sustainability consequences that companies face as a part of settling agreement non-disclosure clauses for workplace sexual harassment claims and cases. Given recent events such as the sexual harassment cases of former Governor Andrew Cuomo and those in the entertainment industry like Harvey Weinstein, managers, and decision-makers must be able to justify decisions to include such clauses in a settlement agreement, and then require an external review of the facts, circumstances, practices, and institutional policies which helped lead to such claim(s). The recent change in legislation and regulation has impacted how companies can work to eliminate and combat sexual harassment cases in the workplace. Using contextual analysis, we first examine the tax considerations of non-disclosure clauses, post-adoption of I.R.C. §162(q), and subsequently review emerging financial reporting consequences of sexual harassment, and finally, we review sexual harassment in relation to the growing SRI movement and its focus on the two specific ESG factors related to governance and social issues. Our research proposes practical guidelines, considerations, and reforms for companies to manage tax, financial, public relations, and environmental, social and governance (ESG) elements associated with efforts to “weed out” sexual harassment behaviors within organizations.
Analysis of Indian Port Performance Post Reforms in an Overlapping Hinterland: A Segmented Regression Approach
Authors: Kumar Das Jayanta , Sinha Deepankar , Mukherjee Sujit
Published: May 2023

India has about 12 major ports under the aegis of the Indian Government, in its approximately 7,500 km long coastline and competing with another 200 state- government-run ones. Over the last 20 years, the Indian government has implemented several reforms. This article answers two research questions. RQ1: Have port reforms improved port performance? RQ2: Do ports with overlapping hinterlands compete, or does one port’s performance complement the other? The article proposed a composite operational port performance index (PPI) and carried out a breakpoint (segmented) regression analysis to study the impact of port reforms. This article makes three crucial propositions––First, port performance affects its output, that is, the ship calls when competition is high, but the same does not hold if the port enjoys monopoly or oligopoly status or due to other factors such as cargo demand. Second, performance of ports with lower capacity, also referred to as satellite ports, is affected by the performance of its complementing ports with higher capacity. Third, Reforms may lead to competition and cannibalisation of profits and growth of ports in a dynamic environment.
Mapping splice QTLs reveals distinct transcriptional and post-transcriptional regulatory variation of gene expression and identifies putative alternative splicing variation mediating complex trait variation in pigs
Authors: Zhang Fei , Velez-Irizarry Deborah , Ernst Catherine W. , Huang Wen
Published: May 2023

Background

Alternative splicing is an important step in gene expression, generating multiple isoforms for the same genes and greatly expanding the diversity of proteomes. Genetic variation in alternative splicing contributes to phenotypic diversity in natural populations. However, the genetic basis of variation in alternative splicing in livestock including pigs remains poorly understood.

Results

In this study, using a Duroc x Pietrain F2 pig population, we performed genome-wide analysis of alternative splicing estimated from stranded RNA-Seq data in skeletal muscle. We characterized the genetic architecture of alternative splicing and compared its basic features with those of overall gene expression. We detected a large number of novel alternative splicing events that were not previously annotated. We found heritability of quantitative alternative splicing scores (percent spliced in or PSI) to be lower than that of overall gene expression. In addition, heritabilities showed little correlation between alternative splicing and overall gene expression. We mapped expression QTLs (eQTLs) and splice QTLs (sQTLs) and found them to be largely non-overlapping. Finally, we integrated sQTL mapping with phenotype QTL (pQTL mapping to identify potential mediator of pQTL effect by alternative splicing.

Conclusions

Our results suggest that regulatory variation exists at multiple levels and that their genetic controls are distinct, offering opportunities for genetic improvement.
Impact of a comprehensive cardiac rehabilitation programme versus coronary revascularisation in patients with stable angina pectoris: study protocol for the PRO-FIT randomised controlled trial
Authors: Heutinck Joyce M. , De Koning Iris A. , Vromen Tom , Van Geuns Robert-Jan M. , Thijssen Dick H.J. , Kemps Hareld M.C. ,   On behalf of the PRO-FIT Research Group, Adang Eddy M. , Geleijnse Johanna M. , van Gorp Pieter , van ‘t Hof Arnoud W. J. , Janssen Veronica R. , Jorstad Harald T. , Kraaijenhagen Roderik A. , Lammers Jeroen , de Man Frits H. A. F. , Nollen Gijs J. , van Ofwegen-Hanekamp Clara E. E. , Onkelinx Steven , Oostveen Laurence M. L. C. , Roes Kit C. B. , Sunamara Madoka , Tonino Pim A. L.
Published: May 2023

Background

Currently, in the majority of patients with stable angina pectoris (SAP) treatment consists of optimal medical treatment, potentially followed by coronary angiography and subsequent coronary revascularisation if necessary”. Recent work questioned the effectiveness of these invasive procedures in reducing re-events and improving prognosis. The potential of exercise-based cardiac rehabilitation on clinical outcomes in patients with coronary artery disease is well-known. However, in the modern era, no studies compared the effects of cardiac rehabilitation versus coronary revascularisation in patients with SAP.

Methods

In this multicentre randomised controlled trial, 216 patients with stable angina pectoris and residual anginal complaints under optimal medical treatment will be randomised to: 1) usual care (i.e., coronary revascularisation), or 2) a 12-month cardiac rehabilitation (CR) programme. CR consists of a multidisciplinary intervention, including education, exercise training, lifestyle coaching and a dietary intervention with a stepped decline in supervision. The primary outcome will be anginal complaints (Seattle Angina Questionnaire-7) following the 12-month intervention. Secondary outcomes include cost-effectiveness, ischemic threshold during exercise, cardiovascular events, exercise capacity, quality of life and psychosocial wellbeing.

Discussion

In this study, we will examine the hypothesis that multidisciplinary CR is at least equally effective in reducing anginal complaints as the contemporary invasive approach at 12-months follow-up for patients with SAP. If proven successful, this study will have significant impact on the treatment of patients with SAP as multidisciplinary CR is a less invasive and potentially less costly and better sustainable treatment than coronary revascularisations.

Trial registration

Netherlands Trial Register, NL9537. Registered 14 June 2021.
Comparison of presepsin and Mid-regional pro-adrenomedullin in the diagnosis of sepsis or septic shock: a systematic review and meta-analysis
Authors: Liang Jun , Cai Yingli , Shao Yiming
Published: May 2023

Background

The early diagnosis of sepsis is hampered by the lack of reliable laboratory measures. There is growing evidence that presepsin and Mid-regional pro-adrenomedullin (MR-proADM) are promising biomarkers in the diagnosis of sepsis. This study was conducted to evaluate and compare the diagnostic value of MR-proADM and presepsin in sepsis patients.

Methods

We searched Web of Science, PubMed, Embase, China national knowledge infrastructure, and Wanfang up to 22th July, 2022, for studies evaluating the diagnosis performance of presepsin and MR-proADM in adult sepsis patients. Risk of bias was assessed using quadas-2. Pooled sensitivity and specificity were calculated using bivariate meta-analysis. Meta-regression and subgroup analysis were used to find source of heterogeneity.

Results

A total of 40 studies were eventually selected for inclusion in this meta-analysis, including 33 for presepsin and seven for MR-proADM. Presepsin had a sensitivity of 0.86 (0.82–0.90), a specificity of 0.79 (0.71–0.85), and an AUC of 0.90 (0.87–0.92). The sensitivity of MR-proADM was 0.84 (0.78–0.88), specificity was 0.86 (0.79–0.91), and AUC was 0.91 (0.88–0.93). The profile of control group, population, and standard reference may be potential sources of heterogeneity.

Conclusions

This meta-analysis demonstrated that presepsin and MR-proADM exhibited high accuracy (AUC ≥ 0.90) in the diagnosis of sepsis in adults, with MR-proADM showing significantly higher accuracy than presepsin.
Accessibility of the three-year comprehensive prevention and control of brucellosis in Ningxia: a mathematical modeling study
Authors: Gong Wei , Sun Peng , Zhai Changsheng , Yuan Jing , Chen Yaogeng , Chen Qun , Zhao Yu
Published: May 2023

Background

Brucellosis is a chronic zoonotic disease, and Ningxia is one of the high prevalence regions in China. To mitigate the spread of brucellosis, the government of Ningxia has implemented a comprehensive prevention and control plan (2022-2024). It is meaningful to quantitatively evaluate the accessibility of this strategy.

Methods

Based on the transmission characteristics of brucellosis in Ningxia, we propose a dynamical model of sheep-human-environment, which coupling with the stage structure of sheep and indirect environmental transmission. We first calculate the basic reproduction number$$R_0$$R0and use the model to fit the data of human brucellosis. Then, three widely applied control strategies of brucellosis in Ningxia, that is, slaughtering of sicked sheep, health education to high risk practitioners, and immunization of adult sheep, are evaluated.

Results

The basic reproduction number is calculated as$$R_{0}=1.47$$R0=1.47, indicating that human brucellosis will persist. The model has a good alignment with the human brucellosis data. The quantitative accessibility evaluation results show that current brucellosis control strategy may not reach the goal on time. “Ningxia Brucellosis Prevention and Control Special Three-Year Action Implementation Plan (2022-2024)” will be achieved in 2024 when increasing slaughtering rate $$\gamma$$γ by 30$$\%$$%, increasing health education to reduce$$\beta _{h}$$βh to 50$$\%$$%, and an increase of immunization rate of adult sheep$$\theta$$θby 40$$\%$$%.

Conclusion

The results demonstrate that the comprehensive control measures are the most effective for brucellosis control, and it is necessary to further strengthen the multi-sectoral joint mechanism and adopt integrated measures to prevention and control brucellosis. These results can provide a reliable quantitative basis for further optimizing the prevention and control strategy of brucellosis in Ningxia.
Accuracy of saliva for SARS-CoV-2 detection in outpatients and their household contacts during the circulation of the Omicron variant of concern
Authors: Calvet Guilherme , Ogrzewalska Maria , Tassinari Wagner , Guaraldo Lusiele , Resende Paola , Fuller Trevon , Penetra Stephanie , Borges Michele , Pina-Costa Anielle , Martins Ezequias , Moraes Isabella , Santos Heloisa , Damasceno Luana , Medeiros-Filho Fernando , Espindola Otavio , Mota Fernando , Nacife Valéria , Pauvolid-Corrêa Alex , Whitworth Jimmy , Smith Chris , Siqueira Marilda , Brasil Patrícia
Published: May 2023

Background

While nasopharyngeal (NP) swabs are considered the gold standard for severe acute respiratory coronavirus 2 (SARS-CoV-2) real-time reverse transcriptase-polymerase chain reaction (RT-PCR) detection, several studies have shown that saliva is an alternative specimen for COVID-19 diagnosis and screening.

Methods

To analyze the utility of saliva for the diagnosis of COVID-19 during the circulation of the Omicron variant, participants were enrolled in an ongoing cohort designed to assess the natural history of SARS-CoV-2 infection in adults and children. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s kappa coefficient were calculated to assess diagnostic performance.

Results

Overall, 818 samples were collected from 365 outpatients from January 3 to February 2, 2022. The median age was 32.8 years (range: 3–94 years). RT-PCR for SARS-CoV-2 was confirmed in 97/121 symptomatic patients (80.2%) and 62/244 (25.4%) asymptomatic patients. Substantial agreement between saliva and combined nasopharyngeal/oropharyngeal samples was observed with a Cohen’s kappa value of 0.74 [95% confidence interval (CI): 0.67–0.81]. Sensitivity was 77% (95% CI: 70.9–82.2), specificity 95% (95% CI: 91.9–97), PPV 89.8% (95% CI: 83.1–94.4), NPV 87.9% (95% CI: 83.6–91.5), and accuracy 88.5% (95% CI: 85.0-91.4). Sensitivity was higher among samples collected from symptomatic children aged three years and older and adolescents [84% (95% CI: 70.5–92)] with a Cohen’s kappa value of 0.63 (95% CI: 0.35–0.91).

Conclusions

Saliva is a reliable fluid for detecting SARS-CoV-2, especially in symptomatic children and adolescents during the circulation of the Omicron variant.
Prevalence and related factors of inappropriate gestational weight gain among pregnant women with overweight/ obesity in Thailand
Authors: Chairat Thanyawalai , Ratinthorn Ameporn , Limruangrong Piyanun , Boriboonhirunsarn Dittakarn
Published: May 2023

Background

An inappropriate gestational weight gain (GWG) among pregnant women with overweight/obesity is a crucial health problem. Its prevalence remains high worldwide, particularly in urban areas. The prevalence and predicting factors in Thailand are lack of evidence. This study aimed to investigate prevalence rates, antenatal care (ANC) service arrangement, predictive factors, and impacts of inappropriate GWG among pregnant women with overweight/obesity in Bangkok and its surrounding metropolitan area.

Methods

This cross-sectional, retrospective study used four sets of questionnaires investigating 685 pregnant women with overweight/obesity and 51 nurse-midwives (NMs) from July to December 2019 in ten tertiary hospitals. Multinomial logistic regression identified predictive factors with a 95% confidence interval (CI).

Result

The prevalence rates of excessive and inadequate GWG were 62.34% and 12.99%. Weight management for pregnant women with overweight/obesity are unavailable in tertiary cares. Over three-fourths of NMs have never received weight management training for this particular group. ANC service factors, i.e., GWG counseling by ANC providers, quality of general ANC service at an excellent and good level, NMs' positive attitudes toward GWG control, significantly decreased the adjusted odds ratio (AOR) of inadequate GWG by 0.03, 0.01, 0.02, 0.20, times, respectively. While maternal factors, sufficient income, and easy access to low-fat foods reduce AOR of inadequate GWG by 0.49, and 0.31 times. In contrast, adequate maternal GWG knowledge statistically increased the AOR of inadequate GWG 1.81 times. Meanwhile, easy access to low-fat foods and internal weight locus of control (WLOC) decreased the AOR of excessive GWG by 0.29 and 0.57 times. Finally, excessive GWG significantly increased the risk of primary C/S, fetal LGA, and macrosomia 1.65, 1.60, and 5.84 times, respectively, while inadequate GWG was not associated with adverse outcomes.

Conclusion

Prevalence rates of inappropriate GWG, especially excessive GWG remained high and affected adverse outcomes. The quality of ANC service provision and appropriate GWG counseling from ANC providers are significant health service factors. Thus, NMs should receive gestational weight counseling and management training to improve women's knowledge and practice for gestational weight (GW) control.
Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers
Authors: Magunda Andrew , Ononge Sam , Balaba Dorothy , Waiswa Peter , Okello Daniel , Kaula Henry , Keller Brett , Felker-Kantor Erica , Mugerwa Yvonne , Bennett Cudjoe
Published: May 2023

Background

It is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda.

Methods

A qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software.

Results

The main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care.

Conclusions

Despite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.
Implanting toric implantable collamer lens displays better astigmatism correction than implantable collamer lens combined with manually limbal relaxing incision
Authors: Yang Ke , Li Jiaxin , Zhang Weihua , Liu Zhanjiang , Song Chenjie , Zhao Yang
Published: May 2023

Background

This retrospective study aimed to compare the outcomes of toric implantable collamer lens (TICL) surgery with those of implantable collamer lens (ICL) implantation combined with limbal relaxing incision (LRI) in patients with low myopia and astigmatism.

Methods

A total of 40 eyes of 28 patients who underwent TICL implantation and 40 eyes of 27 patients who underwent ICL implantation combined with manually LRI between 2021 and 2022 were included. Primary outcomes were manifest sphere and cylinder, intraocular pressure, visual acuity, and astigmatism parameters at 1 day, 1 week, and 1, 3, and 6 months postoperatively.

Results

The two surgeries showed comparable effects on manifest sphere and cylinder, intraocular pressure, and visual acuity (all p > 0.1). Surgery-induced astigmatism (SIA) was maintained as stable in the TICL group (1.73 to 1.68, p = 0.420), but was significantly reduced in the ICL/LRI group (1.74 to 1.17, p = 0.001) from preoperative to postoperative 6 months. The TICL group displayed significantly higher SIA and correction index at postoperative 1, 3, and 6 months than the ICL/LRI group (at 6 months: SIA, 1.68 (1.26, 1.96) vs., 1.17 (1.00, 1.64), p = 0.010; CI: 0.98 (0.78, 1.25) vs. 0.80 (0.61, 1.04), p = 0.018). No complications occurred during follow-up.

Conclusions

The effects of ICL/LRI are comparable to those of TICL in correcting myopia. TICL implantation displays better astigmatism correction than ICL/LRI.
Geographical disparities and determinants of infant mortality in Ethiopia: mapping and spatial analysis using EDHS data
Authors: Kefale Berhanu Awoke , Woya Ashenafi Abate , Tekile Abay Kassa , Bantie Getasew Mulat , Wubetu Gizachew Yismaw
Published: May 2023

Background

Infant mortality remains a public health challenge in Ethiopia. Exploring infant mortality will aid in tracking the progress toward achieving sustainable development goals.

Objective

The study aimed to explore the geographical variations and associated factors of infant mortality in Ethiopia.

Method

A total of 11,023 infants from the 2016 Ethiopian Demographic and Health Survey (EDHS) data were extracted and included in the analysis. EDHS used a two-stage cluster sampling design with a census enumeration area as the primary sampling unit and households as the secondary sampling unit. Arc GIS software was used for spatial analysis using clusters for exploring geographical variations in infant mortality. A binary logistic regression was employed using R software to identify the significant determinants of infant mortality.

Results

The study revealed that the spatial distribution of infant mortality was non-random in the country. Infants whose mothers not receiving ANC (AOR = 1.45; 95%CI: 1.17, 1.79), not breastfed status (AOR = 3.94; 95%CI: 3.19, 4.81), poor wealth index (AOR = 1.36; 95%CI: 1.04, 1.77), male infants (AOR = 1.59; 95%CI: 1.29, 1.95), birth order of six or above (AOR = 3.11; 95%CI: 2.08, 4.62), small birth size (AOR = 1.27; 95%CI: 1.26, 1.60), birth spacing [(≤ 24 months (AOR = 2.29; 95%CI: 1.79, 2.92), 25–36 months (AOR = 1.16; 95%CI: 1.12, 1.49)], multiple births (AOR = 6.82; 95%CI: 4.76, 10.81), rural residence (AOR = 1.63; 95%CI: 1.05, 2.77) and regions [Afar (AOR = 1.54; 95%CI: 1.01, 2.36), Harari (AOR = 1.56; 95%CI: 1.04, 2.56), and Somali (AOR = 1.52; 95%CI: 1.03, 2.39)] were the determinants of infant death in Ethiopia.

Conclusions

There is a great geographical disparity in infant mortality rates across regions. Afar, Harari, and Somali regions were verified as hot spot areas. ANC usage, breastfed status, wealth index, sex of the infant, birth order, birth size, birth spacing, birth type, residence, and region were the determinants of infant death in Ethiopia. Therefore, appropriate interventions need to be implemented in the hot spots to alleviate the risk factors for infant mortality.
Short-term environmental nitrogen dioxide exposure and neurology clinic visits for headaches, a time-series study in Wuhan, China
Authors: Xu Haoyue , Xu Min , JC Zheng , Ye Fei , Liu Xiaozhou , Liu Yumin , Jin Xiaoqing
Published: May 2023

Background

Previous studies showed the adverse impacts of air pollution on headache attacks in developed countries. However, evidence is limited to the impact of exposure to air pollutants on headache attacks. In this study, we aimed to explore the impact of nitrogen dioxide (NO2) exposure on neurology clinic visits (NCVs) for headache onsets.

Methods

Records of NCVs for headaches, concentrations of ambient NO2, and meteorological variables were collected in Wuhan, China, from January 1st, 2017, to November 30th, 2019. A time-series study was conducted to investigate the short-term effects of NO2 exposure on daily NCVs for headaches. Stratified analyses were also computed according to season, age, and sex, and the exposure–response (E-R) curve was then plotted.

Results

A total of 11,436 records of NCVs for headaches were enrolled in our study during the period. A 10-μg/m3 increase of ambient NO2 corresponded to a 3.64% elevation of daily NCVs for headaches (95%CI: 1.02%, 6.32%, P = 0.006). Moreover, females aged less than 50 years of age were more susceptible compared to males (4.10% vs. 2.97%, P = 0.007). The short-term effects of NO2 exposure on daily NCVs for headaches were stronger in cool seasons than in warm seasons (6.31% vs. 0.79%, P = 0.0009).

Conclusion

Our findings highlight that short-term exposure to ambient NO2 positively correlated with NCVs for headaches in Wuhan, China, and the adverse effects varied by season, age, and sex.
Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up
Authors: Mikkonen Jani , Luomajoki Hannu , Airaksinen Olavi , Goubert Liesbet , Leinonen Ville
Published: May 2023

Background

Chronic low back pain (CLBP) is a leading cause of disability globally. Exercise therapies are one of the commonly prescribed treatment options for CLBP. The specific exercise therapies for CLBP most commonly target movement dysfunction, but seldom brain-based pain modulation. Exercise therapies with specific breathing techniques (SBTs) have been shown to influence and enhance brain-based structural and functional pain modulation.

Aims and objectives

To assess the feasibility of the SBTs protocol, eligibility criteria, randomization, and dropout rates. To quantify the changes in patient outcome measures and choose the most relevant measure for larger-scale study. To quantify self-adherence levels to home exercise and monitor and record possible pain medication and other treatment modality usage, and adverse events during exercise.

Design

A parallel randomised analyst-blinded feasibility trial with two-month follow-up.

Outcome measures

Feasibility related to aims and objectives. Multiple pain- and health-related patient-reported outcome measures of pain intensity, disability, central sensitization, anxiety, kinesiophobia, catastrophising, self-efficacy, sleep quality, quality of life, and health and well-being status. Exercise adherence, pain medication and other treatment modality usage, and possible adverse events related to exercises will be monitored and recorded.

Methods

Thirty participants will be randomized to movement control exercise with SBTs (15 subjects in experimental group) or movement control exercise without SBTs (15 subjects in control group) in private chiropractic practice setting with two-month follow-up. Trial registration number; NCT05268822.

Discussion

The clinical difference in effectiveness between practically identical exercise programs in uniform study settings with or without SBTs has not been studied before. This study aims to inform feasibility and help determine whether progression to a full-scale trial is worthwhile.
Retinal microvascular changes in diabetic patients with diabetic nephropathy
Authors: Yan Yujie , Yu Liping , Sun Chuan , Zhao Haipeng , Zhang Hongsong , Wang Zhijun
Published: May 2023

Background

To explore the characteristics of retina microvascular changes in patients with diabetic nephropathy (DN) and its risk factors.

Methods

Retrospective, observational study. 145 patients with type 2 diabetic mellitus (DM) and DN were included in the study. Demographic and clinical parameters were obtained from medical records. Presence of diabetic retinopathy (DR), hard exudates (HEs) and diabetic macular edema (DME) were evaluated according to the color fundus images, optical coherence tomography (OCT) and fluorescence angiography (FFA).

Results

DR accounted for 61.4% in type 2 DM patients with DN, of which proliferative diabetic retinopathy (PDR) accounted for 23.6% and sight threatening DR accounted for 35.7%. DR group had significantly higher levels of low-density lipoprotein cholesterol (LDL-C) (p = 0.004), HbA1c (P = 0.037), Urine albumin creatine ratio (ACR) (p < 0.001) and lower level of estimated glomerular filtration rate (eGFR) (P = 0.013). Logistic regression analysis showed DR was significantly associated with ACR stage (p = 0.011). Subjects with ACR stage3 had higher incidence of DR compared with subjects with ACR stage1 (OR = 24.15, 95%CI: 2.06–282.95). 138 eyes of 138 patients were analyzed for HEs and DME, of which 23.2% had HEs in posterior pole and 9.4% had DME. Visual acuity was worse in HEs group than in non-HEs group. There was significant difference in the LDL-C cholesterol level, total cholesterol (CHOL) level and ACR between HEs group and non-HEs group.

Conclusions

A relatively higher prevalence of DR was found in type 2 DM patients with DN. ACR stage could be recognized as a risk factor for DR in DN patients. Patients with DN needs ophthalmic examination more timely and more frequently.
Retraction Note: Protocatechuic aldehyde from Salvia miltiorrhiza exhibits an anti-inflammatory effect through inhibiting MAPK signalling pathway
Authors: Wu Shuang , Wang Qingyu , Wang Jinquan , Duan Baoyu , Tang Qihe , Sun Zhuojian , Han Jinlong , Shan Chenggang , Wang Zhifen , Hao Zhihui
Published: May 2023

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12906-020-03090-4.