bluuebunny/crossref_metadata_2025 huggingface dataset:
Gingival crevicular fluid levels of TLR‐9, AIM‐2, and ZBP‐1 in periodontal diseases
Authors: Yılmaz Büşra , Emingil Gülnur , Öztürk Veli Özgen , Atmaca Harika , Köse Timur , Kantarcı Alpdoğan
Published: August 2024

Objectives

Toll‐like receptor (TLR)‐9, may play a role in periodontal disease inflammation. This study measured TLR‐9 and its related molecules, absence in melanoma‐2 (AIM‐2) and Z‐DNA‐binding protein‐1 (ZBP‐1), in gingival crevicular fluid (GCF) from patients with varying stages of periodontal disease to assess the role of pathogen‐derived nucleic acids in inflammation.

Materials and Methods

The study comprised 80 participants: 20 with Stage III Grade C periodontitis, 20 with Stage III Grade B periodontitis (P‐Stage III‐B), 19 with gingivitis, and 21 with periodontal health. Parameters including probing depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP) were recorded. ELISA was used to analyze TLR‐9, AIM‐2, and ZBP‐1 levels in GCF. Nonparametric tests were used for statistical comparisons.

Results

The total amount of TLR‐9 was higher in P‐Stage III‐B than in the healthy group (p < 0.05). Similarly, the gingivitis group exhibited elevated GCF TLR‐9 levels compared to the healthy group (p < 0.05). GCF AIM‐2 and ZBP‐1 levels remained consistent across groups (p > 0.05). Significant correlations were found between GCF TLR‐9 and CAL (p < 0.05), BOP (p < 0.05), PI (p < 0.01), and GCF volume (p < 0.001).

Conclusion

These findings suggested that the TLR‐9‐mediated inflammatory process plays a role in periodontal disease, as evidenced by the increased levels of TLR‐9 in GCF.
Harnessing the Power of an Extensive EMS‐Induced Sorghum Population for Rapid Crop Improvement
Authors: Mason Patrick John , Blaakmeer Anko , Furtado Agnelo , Stuart Peter Norman , Nomula Rajesh , Bjarnholt Nanna , Sørensen Mette , Koleva Donka Teneva , Pedas Pai Rosager , Knudsen Søren , Møller Birger Lindberg , Skadhauge Birgitte , Henry Robert James
Published: August 2024

Plant breeders leverage mutagenesis using chemical, biological, and physical mutagens to create novel trait variations. Many widely used sorghum genotypes have a narrow genetic base, which hinders improvements using classical breeding. Enhancing the diversity of the sorghum genome thus remains a key priority for sorghum breeders. To accelerate the genetic enhancement of sorghum, an extensive library comprised of seeds from 150,000 individual mutant plants of the Sorghum bicolor inbred line BTx623 was established using ethyl methanesulphonate (EMS) as a mutagen. The sorghum mutant library was bulked into 1498 pools (~100 seed heads per pool). In each pool, DNA was extracted from a subset of the seed and screened using the FIND‐IT technology based on droplet digital PCR. All 43 nucleotide substitutions that were screened using FIND‐IT were identified, demonstrating the potential to identify any EMS‐derived mutation in an elite line of sorghum within days. This diverse library represents the largest collection of sorghum mutants ever conceived, estimated to cover 240% of all possible EMS‐induced mutation points within the Sorghum genome. Using FIND‐IT, the speed at which a specific desired EMS‐derived mutation can be identified is a major upgrade to conventional reverse genetic techniques. Additionally, the ease at which valuable variants can be integrated into elite commercial lines is a far simpler and less expensive process compared to genome editing. Genomic variations in the library will have direct utility as a breeding resource for commercial sorghum applications, allowing enhanced adaptation to climate change and enhanced yield potential in marginal environments.
The effects of sleep quality on loneliness among older adults: cohort analysis from the life course perspective
Authors: Qin Hui , Chen Na , Zhuo Li , Yu Fei
Published: August 2024

Background

Using cohort analysis to examine the effects of sleep quality on loneliness among older adults from the life course perspective.

Methods

The hierarchical age‐period‐cohort growth curve model was used to analyze the data from the 2005–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Results

(1) Loneliness has a ‘U’ curve relationship with age, but with the rate of increase gradually slowing down. (2) There were significant differences in loneliness across birth cohorts, with younger cohorts having higher predicted loneliness than older cohorts at the same age. (3) The influence of different sleep quality on loneliness showed a trend of increasing with age. (4) There were no significant differences in the impact of sleep quality on loneliness in different cohorts.

Conclusions

This study has identified heterogeneity in loneliness, emphasising the need for a diversified intervention approach. Sleep quality has a protective effect on loneliness and is easy to assess, making it an important intervention tool. In addition, it is imperative to account for the influences of age and cohort effects when formulating intervention strategies.
Unveiling complexities: Income inequality and inequality of opportunity in China
Authors: Zhu Mingying
Published: August 2024

The analysis of income and opportunity inequality in China reveals fluctuating trends at both national and provincial levels. The decrease in income inequality within provinces is attributed to regional development, while the widening income gap nationwide is linked to faster economic growth in developed areas. Since 2010, inequality of opportunity has represented between 29% and 47% of income inequality. Utilizing Roemer's “circumstance‐effort” framework, the study highlights the direct and indirect influences of circumstances on inequality of opportunity, with regional factors, age, and family economic status having significant impacts. In the indirect channel, the impact of internet usage has decreased, while education, employment, and health have shown deepened role on income. Overall, the changing influence of circumstance factors on current income underscores the evolving nature of these disparities, emphasizing the importance of addressing inequality of opportunity to foster a more inclusive and equitable society in China.
The effect of inter vivos gift taxation on wealth inequality and economic growth
Authors: Nakano Ryota
Published: August 2024

This study examines the effect of inter vivos gift taxation on wealth inequality and economic growth. We develop a simple model with inter vivos gifts, which are generated by altruism and gift taxation in an overlapping generation setting. The analysis shows that an increase in the gift tax rate reduces inequality, and a positive tax rate maximizes the economic growth rate. From a policy perspective, rather than exempting gifts from taxation, raising the gift tax rate to some extent reduces inequality and promotes human capital accumulation and, therefore, economic growth.
General adapted‐threshold monitoring in discrete environments and rules for imbalanced classes
Authors: Steland Ansgar , Rafajłowicz Ewaryst , Rafajłowicz Wojciech
Published: August 2024

Having in mind applications in statistics and machine learning such as individualized care monitoring, or watermark detection in large language models, we consider the following general setting: When monitoring a sequence of observations, , there may be additional information, , on the environment which should be used to design the monitoring procedure. This additional information can be incorporated by applying threshold functions to the standardized measurements to adapt the detector to the environment. For the case of categorical data encoding of discrete‐valued environmental information we study several classes of level threshold functions including a proportional one which favors rare events among imbalanced classes. For the latter rule asymptotic theory is developed for independent and identically distributed and dependent learning samples including data from new discrete autoregressive moving average model (NDARMA) series and Hidden Markov Models. Further, we propose two‐stage designs which allow to distribute in a controlled way the budget over an a priori partition of the sample space of . The approach is illustrated by a real medical data set.
Sanction Busting Within and Outside Regional Integration
Authors: Issabayev Murat , Moldashev Kairat
Published: August 2024

The trade balance of Russia with its top 20 trade partners has increased over the last few years till 2022 with few exceptions such as the United States and the United Kingdom. Even the Russian trade deficit with Germany till 2021 has turned to trade surplus in 2022. However, as a result of the strict sanctions imposed on certain trade products by European Union (EU) nations and the US, the total import values of Russia declined from $266 billion in 2021 to $199 billion in 2022. To explain if third countries, including Eurasian Economic Union (EAEU) nations, aid Russia by means of sanctions-busting, we offer several empirical tests. In this paper, we use annual cross-sectional data for 22,648 products exported to Russia along with tariff rates imposed on them in 2022. We first notice that even though the number of sanctioned exports is three times lower than that of non-sanctioned exports, the total import value from sanctioned exports is predicted to be larger than that from non-sanctioned exports on average by 0.36 percentage point. Second, the Russian import values from both EU and Rest of the World (ROW) exports are significantly greater than those from EAEU nations. Last but not least, EAEU nations, which are Russia's partners within the union, and EU nations, are more susceptible to activities such as sanction-busting compared to other third countries.
Forced Response of Rotating Blisks: Prediction and Correlation to Blade Tip-Timing Measurements
Authors: Zhou Biao , Xie Chengyu , Battiato Giuseppe , Berruti Teresa Maria
Published: August 2024

This paper explores two different blisk dynamic models for resonant vibration prediction of a rotating blisk test piece, i.e., the Model-BDTID and geometrically mistuned models (GMM). The former represents a mistuned blisk model with blade mistuning pattern experimentally retrieved by a recently proposed blade mistuning identification method based on blade detuning tests (BDTID). It falls into the scope of the frequency-mistuning modeling approach. The latter refers to a geometrically mistuned model constructed upon high-precision blisk geometry data by leveraging the advanced optical geometry measurement technology. A specifically developed “Sector Mode Assembling Reduction Technique” is exploited for efficient dynamic analyses of the large-sized GMM. Forced response tests are performed in a spinning rig under well-controlled laboratory condition. The blade tip-timing (BTT) technique is employed to give all-blade vibration measurements of the rotating blisk. Correlation results between the forced response predictions to BTT measurements demonstrate that both the Model-BDTID constructed upon the identified blade mistuning of the blisk at rest and the GMM, can predict the resonant vibration of the rotating blisk with satisfactory accuracy.
Role of the oxidation conditions on the orientation of TiNxOy grown by atomic layer deposition: Impact on the optical and electrical properties
Authors: Ihara Kou , Cardin Julien , Leménager Maxime , Portier Xavier , Bousbia Hind , Labbé Christophe
Published: August 2024

This study delves into the impact of oxidation conditions on the orientation of titanium nitride (TiN) films grown by atomic layer deposition (ALD) and its subsequent effects on optical and electrical properties. Through systematic variations in oxygen exposure during ALD processes, the interplay among titanium, oxygen, and nitrogen is investigated. X-ray diffraction (XRD) analysis reveals distinct modifications in crystallographic orientation, particularly the (111) and (002) preferred orientations, influenced by different oxidation processes. Characterization techniques, including spectroscopic ellipsometry and secondary ion mass spectrometry (SIMS), provide insights into the thickness, refractive index, and chemical composition of the TiN films. Notably, the study observes a correlation between oxygen concentration, crystallographic orientation, and sheet resistance. Samples subjected to integrated oxidation processes exhibit lower (111) texture coefficients, indicating enhanced oxygen incorporation and altered crystalline structures. Conversely, samples with surface oxidation processes display comparable (111) texture coefficients and higher growth per cycle (GPC) values to the reference sample, underscoring the nuanced influence of oxidation timing. The study’s findings offer valuable insights into tailoring the properties of TiN films through controlled oxidation conditions, crucial for optimizing their performance in various applications.
Interpretation of complex x-ray photoelectron peak shapes. II. Case study of Fe 2p3/2 fitting applied to austenitic stainless steels 316 and 304
Authors: Hughes A. E. , Easton C. D. , Gengenbach T. R. , Biesinger M. C. , Laleh M.
Published: August 2024

In this paper, a review of the analysis of Fe 2p3/2 peak and other transition metals in the austenitic stainless steel literature is presented. It reveals the significant shortcomings of the most widely used approaches, based on the principle of “chemistry fitting,” where single symmetric peaks are used to represent either individual oxidation states or specific compounds. No meaningful conclusions can be drawn from these commonly employed two- or three-component peak fitting (2C and 3C) approaches; the implication being that a large portion of the literature that relies on this approach is flawed. As a significantly more accurate and reliable alternative to “chemistry fitting,” we also assess “envelope fitting” (using empirical multiplet structures) and examine its limitations when applying the approach to austenitic stainless steel data. A detailed comparison of these two fitting approaches is described in Part I. For other elements such as Cr 2p, the problems associated with using single components to represent oxidation states or compounds are not as severe. It was found that it does not impact binding energy measurements, but does influence relative intensities, which will have a flow-on effect for oxide thickness calculations and obtaining a correct understanding of the surface more broadly.
Photon under repeated transverse Lorentz boosts: An apparent paradox
Authors: LeBohec Tugdual
Published: August 2024

We investigate the effects of the repeated application of Lorentz boosts to the four momentums of a photon in the transverse direction and observe that this can take us to a reference frame in which the direction of the photon's momentum is apparently reversed. This raises an apparent paradox: how could two observers see the same photon traveling in opposite directions? We further extend this process to an infinite succession of infinitesimal transverse Lorentz boosts and show it amounts to a rotation of the photon's momentum, but as part of a Lorentz transformation and not as a simple rotation. These possibly surprising results can be understood in light of the Wigner rotation: the combination of Lorentz boosts along different directions amounts to a Lorentz boost combined with a rotation. The presented exercises offer illustrations of the counterintuitive behavior of Lorentz boost combinations.
Narrowband noise induces frequency-specific underwater temporary threshold shifts in freshwater turtles
Authors: Salas Andria K. , Sims Michele A. , Harms Craig A. , Piniak Wendy E. D. , Mooney T. Aran
Published: August 2024

Freshwater turtles exhibit temporary threshold shifts (TTS) when exposed to broadband sound, but whether frequency-restricted narrowband noise induces TTS was unknown. Underwater TTS was investigated in two freshwater turtle species (Emydidae) following exposures to 16-octave narrowband noise (155–172 dB re 1 μPa2 s). While shifts occurred in all turtles at the noise center frequency (400 Hz), there were more instances of TTS and greater shift magnitudes at 12 octave above the center frequency, despite considerably lower received levels. These frequency-specific data provide new insight into how TTS manifests in turtles and expand empirical models to predict freshwater turtle TTS.
Lumbar Spine and Neural Tissue Mobilizations Improve Outcomes in Runners Presenting With Foot/Ankle Pathology: A Case Series
Authors: Hagan Christopher R. , Anderson Alexandra R. , Hensley Craig P.
Published: August 2024

Context: Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. Case Presentations: Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. Management and Outcomes: All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. Conclusions: This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.
The value of decentralized clinical trials: Inclusion, accessibility, and innovation
Authors: Jean-Louis Girardin , Seixas Azizi A.
Published: August 2024

In this Review, we explore the transformative potential of decentralized clinical trials (DCTs) in addressing the limitations of traditional randomized controlled trials (RCTs). We highlight the merits of DCTs fostering greater inclusivity, efficiency, and adaptability. We emphasize the challenges of RCTs, including limited participant diversity and logistical barriers, geographical constraints, and mistrust in research institutions, showing how DCTs are preferred in addressing these challenges by utilizing remote digital technologies and community providers to enable broader, more inclusive participation. Furthermore, we underscore the potential of DCTs for democratizing clinical research. We also stress the importance of addressing unresolved challenges, including data security and privacy, remote patient monitoring, and regulatory variations. Research is needed to devise standardized protocols to streamline DCT processes, explore its long-term impacts on patient outcomes, and overcome challenges through equitable stakeholder engagement.
Probing our planet’s rocky logic
Turning to Stone: Discovering the Subtle Wisdom of Rocks
Marcia Bjornerud
Flatiron Books, 2024. 320 pp.
Authors: Dixon Deborah P.
Published: August 2024

A lyrical ode to Earth’s geologic landscapes invites readers to ponder our place in the cosmos
In Other Journals
Authors: Simonti Corinne , Wible Brad , Vignieri Sacha , Walia Ankit , Sofowora Iyinoluwa , Stajic Jelena , Smith Jesse
Published: August 2024

Editors’ selections from the current scientific literature
Resolved genomes of wastewater ESBL-producing
Escherichia coli
and metagenomic analysis of source wastewater samples
Authors: Cheney Clinton , Johnson Jared D. , Ste. Marie John P. , Gacosta Kayla Y. M. , Denlinger Drumm Natalie B. , Jones Gerrad D. , Waite-Cusic Joy , Navab-Daneshmand Tala
Published: August 2024

Extended-spectrum beta-lactamase (ESBL)-producing
Escherichia coli
pose a serious threat to human health because of their resistance to the most commonly prescribed antibiotics: penicillins and cephalosporins. In this study, we provide a genomic and metagenomic context for the determinant beta-lactam resistance genes of ESBL-positive
E. coli
isolated from various wastewater treatment utilities in Oregon, USA. Class A beta-lactamase genes on chromosomes (
bla
CTX-M,
bla
TEM) were clustered with antibiotic resistance genes associated with other classes of antibiotics (sulfonamides and aminoglycosides) along with insertional elements. ESBL genes such as
bla
CTX-M,
bla
TEM, and
bla
SHV were also detected on conjugable plasmids of IncF and IncI incompatibility types. One novel IncF plasmid (pSHV2A_ESBLF) was identified, which carried a multidrug resistance genotype (
bla
SHV-2A,
aadA22
,
aac
3,
aph
6,
tet
A, and
sul
1) in addition to a
mer
(mercury resistance) operon, colicin, and aerobactin genes. Shotgun metagenomic analysis of the ESBL-producing
E. coli
-originating wastewater samples showed the presence of class A beta-lactamases; however, the ESBL genes identified in the
E. coli
genomes were below the detection limits. Other ESBL-associated genes (i.e.,
bla
OXA.11,
bla
FOX.7, and
bla
GES.17) were identified in the wastewater samples, and their occurrences were correlated with the core microbial genera (e.g.,
Paraprevotella
). In the
E. coli
genomes and wastewater samples, tetracycline, aminoglycoside, and beta-lactam resistance determinants frequently co-occurred. The combination of whole-genome and metagenomic analysis provides a holistic description of ESBL-producing organisms and genes in wastewater systems.

IMPORTANCE

Using a hybrid sequencing and assembly strategy (short- and long-read sequencing), we identified the distribution of ARGs and virulence factors harbored on plasmids and chromosomes. We further characterized plasmids’ incompatibility types and the co-occurrences of ARGs and virulence factors on plasmids and chromosomes. We investigated the transferability of plasmid-mediated beta-lactams via conjugation. Finally, using shotgun metagenomic analysis of the ESBL-producing
Escherichia coli
-originated wastewater samples, we described the microbial community, the resistome composition, and the potential associations with plasmid-mediated beta-lactam genes and other ARGs.
The environmental microbial retrieving assessment of cell-processing facilities for cell therapy in a hospital laboratory
Authors: Lian Jiabian , Ma Xiaobo , Li Xun , Xia Lu
Published: August 2024

Cell therapy represents a promising treatment modality. A critical component in the production of cell therapy products is maintaining the sterility of cell therapy clean rooms (CTCRs). This study aimed to evaluate the environmental microbial load within CTCRs. We systematically monitored microbial load in CTCRs, following established guidelines. Cultured microbial samples underwent metagenomic sequencing, and alpha and beta diversity analyses, functional annotation, and resistance gene profiling were performed using various bioinformatics tools to assess microbial diversity and function. From November 2023 to January 2024, we collected 42 environmental microbial colony samples from various sources within the CTCR and performed metagenomic sequencing on 39 samples. Alpha diversity analysis revealed no significant differences among surface, settle_plate, and airborne categories, but significant disparities within surface subgroups were revealed. Beta diversity analysis showed notable differences between surface and airborne categories and among surface subgroups. Species distribution analysis identified
Bacillus
as the predominant genus on surfaces. Functional annotation and resistance gene analysis indicated distinct resistance patterns, with significant variations between subgroups, such as microscopes and transfer windows, and hands and other Grade_B environments. Resistance to hydrogen peroxide was notably higher in the transfer window group. These findings highlight the importance of stringent disinfection protocols and enhanced hand hygiene to maintain sterility in CTCRs. These findings provide valuable insights for implementing effective measures to maintain cleanliness throughout CTCRs. The annotation and study of resistance genes can help rapidly identify methods to control cellular contamination under circumstances of environmental microbial pollution.

IMPORTANCE

Maintaining the sterility of cell therapy clean rooms (CTCRs) is crucial for the production of safe and effective cell therapy products. Our study systematically evaluated the environmental microbial load within CTCRs, revealing significant microbial diversity and distinct resistance patterns to disinfection methods. These findings underscore the need for stringent disinfection protocols and enhanced hand hygiene practices to ensure CTCR sterility. By identifying key microbial species and their resistance genes, our research provides essential insights into controlling contamination and safeguarding the production environment, ultimately contributing to the reliability and success of cell therapy treatments.
Intergenerational and genetic influences on physical activity: family data from the HUNT study, Norway
Authors: Flaaten Mats , Skarpsno Eivind Schjelderup , Kongsvold Atle , Åsvold Bjørn Olav , Carslake David , Mork Paul Jarle , Nilsen Tom Ivar Lund
Published: August 2024

Objectives

The objectives of this study are to examine the association of physical activity in parents with physical activity in their adult offspring and explore if the offspring’s genetic liability (ie, polygenic risk score) to physical activity influences this association.

Methods

The Trøndelag Health Study cohort is a population-based longitudinal study with data collected in 1984–1986, 1995–1997, 2006–2008 and 2017–2019. We calculated the odds ratio for being physically active and mean difference in physical activity levels according to parental physical activity (device-measured and self-reported) and own polygenic risk score.

Results

Compared with offspring with mothers in the lowest third of metabolic equivalent of task (MET)-min/day accumulated by vigorous physical activities, offspring with mothers in the upper third had an OR of 1.93 (95% CI 1.65 to 2.27) for accumulating ≥900 MET-min/week of vigorous physical activity. The OR for the corresponding father–offspring association was 1.78 (95% CI 1.48 to 2.14). Compared with offspring of parents not accumulating ≥900 MET-min/week, we found an OR of 1.89 (95% CI 1.45 to 2.44) for offspring to meet the same threshold if both parents accumulated ≥900 MET-min/week. Offspring with higher polygenic risk score to bephysically active and having physically active parents did more weekly physical activity, but we found no strong evidence of multiplicative synergistic effects between these two factors (all p values ≥0.01).

Conclusion

Both parental physical activity and offspring’s polygenic risk score were positively associated with physical activity levels in the adult offspring, but there was no evidence of effect modification between these factors. A family-based approach to promote physical activity may be effective from a public health perspective.
Suicide rates among physicians compared with the general population in studies from 20 countries: gender stratified systematic review and meta-analysis
Authors: Zimmermann Claudia , Strohmaier Susanne , Herkner Harald , Niederkrotenthaler Thomas , Schernhammer Eva
Published: August 2024

Objectives

To estimate age standardised suicide rate ratios in male and female physicians compared with the general population, and to examine heterogeneity across study results.

Design

Systematic review and meta-analysis.

Data sources

Studies published between 1960 and 31 March 2024 were retrieved from Embase, Medline, and PsycINFO. There were no language restrictions. Forward and backwards reference screening was performed for selected studies using Google Scholar.

Eligibility criteria for selecting studies

Observational studies with directly or indirectly age standardised mortality ratios for physician deaths by suicide, or suicide rates per 100 000 person years of physicians and a reference group similar to the general population, or extractable data on physician deaths by suicide suitable for the calculation of ratios. Two independent reviewers extracted data and assessed the risk of bias using an adapted version of the Joanna Briggs Institute checklist for prevalence studies. Mean effect estimates for male and female physicians were calculated based on random effects models, with subgroup analyses for geographical region and a secondary analysis of deaths by suicide in physicians compared with other professions.

Results

Among 39 included studies, 38 studies for male physicians and 26 for female physicians were eligible for analyses, with a total of 3303 suicides in male physicians and 587 in female physicians (observation periods 1935-2020 and 1960-2020, respectively). Across all studies, the suicide rate ratio for male physicians was 1.05 (95% confidence interval 0.90 to 1.22). For female physicians, the rate ratio was significantly higher at 1.76 (1.40 to 2.21). Heterogeneity was high for both analyses. Meta-regression revealed a significant effect of the midpoint of study observation period, indicating decreasing effect sizes over time. The suicide rate ratio for male physicians compared with other professions was 1.81 (1.55 to 2.12).

Conclusion

Standardised suicide rate ratios for male and female physicians decreased over time. However, the rates remained increased for female physicians. The findings of this meta-analysis are limited by a scarcity of studies from regions outside of Europe, the United States, and Australasia. These results call for continued efforts in research and prevention of physician deaths by suicide, particularly among female physicians and at risk subgroups.

Systematic review registration

PROSPERO CRD42019118956.
Determinants of clinical nurses’ patient safety competence: a systematic review protocol
Authors: Park Jong-Hyuk , Lee Nam-Ju , Lee Hanseulgi , Park Gihwan
Published: August 2024

Introduction

Patient safety has become a fundamental element of healthcare quality. However, despite the ongoing efforts of various organisations, patient safety issues remain a problem in the healthcare system. Given the crucial role of nurses in the healthcare process, improving patient safety competence among clinical nurses is important. In order to promote patient safety competence, it is essential to identify and strengthen the relevant factors. This protocol is for a systematic review aiming to examine and categorise the factors influencing patient safety competence among clinical nurses.

Methods and analysis

This review protocol is based on the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews of Effectiveness and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Four electronic databases, including Ovid-MEDLINE, CINAHL, Cochrane Library and EMBASE, will be used for the systematic review. After consulting with a medical librarian, we designed our search terms to include subject heading terms and related terms in the titles and abstracts. Databases from January 2012 to August 2023 will be searched.

Two reviewers will independently conduct the search and extract data including the author(s), country, study design, sample size, clinical setting, clinical experience, tool used to measure patient safety competence and factors affecting patient safety competence. The quality of the included studies will be assessed using the JBI critical appraisal tool. Because heterogeneity of the results is anticipated, the data will be narratively synthesised and divided into two categories: individual and organisational factors.

Ethics and dissemination

Ethical review is not relevant to this study. The findings will be presented at professional conferences and published in peer-reviewed journals.

PROSPERO registration number

CRD42023422486.
Influence of HIV status on outcomes of children admitted with sepsis at a paediatric hospital in Zambia: protocol for a prospective longitudinal study
Authors: Gwasupika Jonathan , Hamer Davidson , Daka Victor , Mfune Ruth L , Jacobs Choolwe
Published: August 2024

Introduction

Sepsis, a condition of global public health concern, is a major cause of morbidity and mortality, especially in patients with underlying HIV infection. This study aims to determine outcomes, aetiology and antibiotic resistance patterns among children with HIV exposure or infection admitted with a clinical presentation suggestive of sepsis who have confirmed bloodstream infections at Arthur Davison Children’s Hospital (ADCH) in Ndola, Zambia.

Methods and analysis

This will be a prospective longitudinal study of 200 children aged <2 years admitted with sepsis at ADCH with two of the following conditions: temperature of 38.0°C, respiratory rate ≥20 breaths per minute and pulse rate ≥90 beats per minute. About 2–5 mL of blood collected from each participant will be inoculated into BACTEC culture bottles and incubated for 5–7 days. Positive cultures will be inoculated onto culture media for subculture followed by species identification followed by antibiotic susceptibility testing. Time-to-event outcomes such as hospital readmission and mortality will be analysed using Kaplan-Meier and Cox proportional hazards. Predictors will be identified using regression methods. All statistical tests will use a 5% significance level with a 95% confidence level. STATA V.16 will be used for statistical analysis.

Ethics and dissemination

Ethical clearance and approval have been granted by the Tropical Diseases Research Centre Ethics Committee (TDRC-EC 092/07/23). Caregiver consent will be obtained verbally for participants presenting as medical emergencies, and written informed consent will be obtained once stable. Findings from this study will be shared with the Ministry of Health Zambia and will be disseminated to the scientific community through peer-reviewed scientific journals.
Effectiveness of digital Cognitive-Behavioural Therapy for Insomnia in patients with musculoskeletal complaints and insomnia in primary care physiotherapy: study protocol for a randomised controlled trial
Authors: Skarpsno Eivind Schjelderup , Hofmo Jonas Grevle , Hrozanova Maria , Vedaa Øystein , Woodhouse Astrid , Landmark Tormod , Bentsen Lennart , Thorlund Jonas Bloch , Nordstoga Anne Lovise , Meisingset Ingebrigt
Published: August 2024

Introduction

Insomnia is prevalent among patients visiting physiotherapists due to musculoskeletal complaints and associated with poorer pain prognosis. Cognitive-Behavioural Therapy for Insomnia (CBT-I) may be effective for improving sleep quality and pain-related outcomes in these patients, but its availability and utility are limited in daily physiotherapy practice. The aim of this randomised controlled trial (RCT) is to evaluate the effectiveness of digital CBT-I in addition to usual treatment in patients with chronic musculoskeletal complaints and insomnia, compared with usual treatment only.

Methods and analysis

In this RCT, eligible and consenting participants will be randomised (1:1 ratio) to one of two interventions: (1) digital CBT-I adjunct to physiotherapy treatment or (2) usual physiotherapy treatment. Patients with musculoskeletal complaints and insomnia visiting a physiotherapist in Norway will be invited to participate in the study. We aim to include 188 participants to detect a difference in the primary outcome. Outcome variables will be assessed at baseline (prior to randomisation) and at 6-week, 3-month, 6-month and 12-month follow-up. The primary outcome is between-group difference in insomnia severity, assessed with the Insomnia Severity Index (0–28 points) at 3 months. Secondary outcomes include between-group differences in pain intensity, physical function, work ability, health-related quality of life, mental distress, and self-reported use of sleep and pain medication. Exploratory analyses will identify patient characteristics influencing the effect of the digital intervention.

Ethics and dissemination

This trial is approved by the Regional Committee for Medical and Health Research Ethics in Central Norway (Ref. 2023/533381). The results of the trial will be published in peer-review journals and disseminated at national and international conferences.

Trial registration number

ISRCTN91221906.
Identifying the impact of climate variables on biological and chemical contaminants of preharvest foods and their associated food safety risks: a scoping review protocol
Authors: Zai Brenda , McReavy Samantha , Hogan Grant , Ng Victoria , Papadopoulos Andrew , Young Ian , Grant Lauren E
Published: August 2024

Background

Foodborne and waterborne illnesses affect over four million Canadians annually and pose a preventable burden on the nation’s healthcare system. Climate change can increase the risk of such illnesses by increasing the likelihood of exposure to contaminants. As climate change progresses, it is imperative to better understand its impact on the dissemination of foodborne and waterborne contaminants throughout the food system. Currently, there is limited, synthesised evidence for how future changes in Canada’s climate may affect the risk of contamination of preharvest foods. The aim of this research is to collate and describe available information on effects of climate variables on biological and chemical contamination of preharvest foods in Canada. This information will contribute to improved understanding of climate change impacts and potential adaptation and mitigation strategies to increase climate resiliency in Canada’s food system.

Methods

A preliminary search of MEDLINE, Web of Science and Google was conducted to verify the absence of existing reviews and to inform the development of this review protocol. Information will be identified by searching four academic databases: MEDLINE via Ovid, AGRICultural OnLine Access (AGRICOLA), CAB International and Web of Science. This search will be supplemented by a targeted grey literature search. The search strategy includes index terms and keywords for Canada-relevant foodborne and waterborne pathogens and chemical contaminants, preharvest foods and climate change. Search results will be managed using Covidence during all phases of the review, conducted by two independent reviewers. Data will be extracted, synthesised and presented using graphical and tabular formats.

This scoping review protocol describes the process for retrieving a comprehensive set of evidence for how climate change variables may increase risk of biological or chemical contamination of preharvest foods in Canada. This review will provide decision-makers with a detailed understanding of climate variable-preharvest food-contaminant combinations using the best available evidence.

Ethics and dissemination

Ethical considerations are not applicable to this protocol as scoping reviews conduct secondary data analysis that synthesises data from publicly available sources. The results from this review will be disseminated through a peer-reviewed publication and conference presentation.
Protocol for a phase 3, randomised, active-control study of four-factor prothrombin complex concentrate versus frozen plasma in bleeding adult cardiac surgery patients requiring coagulation factor replacement: the LEX-211 (FARES-II) trial
Authors: Karkouti Keyvan , Callum Jeannie , Bartoszko Justyna , Solomon Cristina , Knaub Sigurd , Levy Jerrold H , Tanaka Kenichi A
Published: August 2024

Introduction

Reduced thrombin generation is an important component of post cardiopulmonary bypass (CPB) coagulopathy. To replenish coagulation factors and enhance thrombin generation in bleeding surgical patients, frozen plasma (FP) and four-factor prothrombin complex concentrate (4F-PCC) are used. However, the efficacy–safety balance of 4F-PCC relative to FP in cardiac surgery is unconfirmed.

Methods and analysis

LEX-211 (FARES-II) is an active-control, randomised, phase 3 study comparing two coagulation factor replacement therapies in bleeding adult cardiac surgical patients at 12 hospitals in Canada and the USA. The primary objective is to determine whether 4F-PCC (Octaplex/Balfaxar, Octapharma) is clinically non-inferior to FP for haemostatic effectiveness. Inclusion criteria are any index (elective or non-elective) cardiac surgery employing CPB and coagulation factor replacement with 4F-PCC or FP ordered in the operating room for bleeding management. Patients will be randomised to receive 1500 or 2000 international units of 4F-PCC or 3 or 4 units of FP, depending on body weight. The primary endpoint of haemostatic treatment response is ‘effective’ if no additional haemostatic intervention is required from 60 min to 24 hours after the first initiation of 4F-PCC or FP; or ‘ineffective’ if any other haemostatic intervention (including a second dose of study drug) is required. An estimated 410 evaluable patients will be required to demonstrate non-inferiority (one-sided α of 0.025, power ≥90%, non-inferiority margin 0.10). Secondary outcomes include transfusions, bleeding-related clinical endpoints, coagulation parameters and safety.

Ethics and dissemination

The trial has been approved by the institutional review boards of all participating centres. Trial completion is anticipated at the end of 2024, and results will be disseminated via publications in peer-reviewed journals and conference presentations in 2025. The results will advance our understanding of coagulation management in bleeding surgical patients, potentially reducing the need for allogeneic blood products and improving outcomes in surgical patients.

Trial registration number

NCT05523297.
Exploring self-care choices: a qualitative study of self-medication insights among university students in Lira City, Northern Uganda
Authors: Ikwara Emmanuel Asher , Siu Godfrey , Esther Akiru , Nyadoi Ruth , Humphrey Atwijukiire
Published: August 2024

Background

Self-medication, the practice of treating health issues without professional medical guidance, is a widespread phenomenon among students globally, raising concerns about potential consequences. This study investigates perceptions and knowledge of self-medication among students from a university in Uganda.

Methods

We conducted a qualitative study, with 20 in-depth interviews and 3 focus group discussions among students. Data were processed and analysed using NVivo V.12.

Results

This study found both positive and negative perceptions of self-medication among university students. Positive views highlighted the perception that self-medication was convenient and time-efficient method for managing health concerns as access drug shops enabled students to swiftly acquire medications, bypassing prolonged wait times. Self-medication shielded female students from potential stigma and judgement, by enabling them to discretely manage their menstrual health. By bypassing the need for clinic visits and accessing medications directly from drug shops, students could avoid the discomfort and inconvenience associated with public healthcare facilities, and allowing them to allocate time more productively for academic pursuits. However, students were concerned about potential negative consequences that encompassed drug resistance, overdose, complications, and potential fatality.

Conclusion

Limited access to convenient healthcare options, the concern for discrete access, particularly for potentially stigmatised conditions, coupled with the exigencies of academic life that demanded them to optimise time management, create a conducive environment for the prevalence of self-medication practices among university students. These themes demonstrate the intersection of health-seeking behaviours and contextual factors, shedding light on the pragmatic strategies adopted by students to navigate healthcare challenges, sometimes at the risk of harmful consequences. These issues also show the need for culturally and gender-sensitive healthcare approaches, regulatory oversight on medication practices and public health campaigns promoting safe medication practices among students.
Equity in home care use in Canada: a cross-sectional analysis of the Canadian longitudinal study on ageing
Authors: Lee James , Watt Jennifer A , Mayhew Alexandra , Sinn Chi-Ling , Schumacher Connie L , Costa Andrew P , Jones Aaron
Published: August 2024

Background

Although home care is an essential service that enables older adults to age at home, there are concerns that not all populations have equitable access to home care services in Canada. The primary objective of this study is to describe formal home care use in Canada across a broad set of demographic and socioeconomic factors.

Methods

We conducted a cross-sectional analysis of formal home care use among community-dwelling adults aged 45+ using data from the Canadian longitudinal study on ageing (CLSA) at the 3-year post-baseline follow-up (2015–18). We calculated crude prevalences of formal home care use, stratified by functional status, within the following equity stratification factors: sex, gender, income, education, immigration history, rurality, social support and population group. We used logistic regression models with marginal effects to calculate prevalences of formal home care use while further adjusting for factors related to home care need such as functional impairment, chronic conditions, assistive device use and self-reported health.

Results

Of 43 115 CLSA participants included, we found that 8.0% used formal home care services in the previous 12 months. Higher levels of functional impairment were consistently associated with greater home care use. Our unadjusted analysis found significant variations in home care use by sex, gender, income, education, immigration history, rurality and social support. After adjusting for factors related to home care need, we found that individuals with lower income, recent immigration and lower education were significantly less likely to use formal home care services, while individuals with less social support were significantly more likely to use formal home care services.

Conclusions

This study highlights disparities in home care use in Canada by income, immigration, education and social support. These findings emphasise the importance of developing federal and provincial policies to address barriers and promote equitable access to home care.