bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationships Between Test Results for Oral Hypofunction, Subjective Frailty Symptoms and Oral Health‐Related Quality of Life of Japanese Dental Outpatients: A Multicentre, Cross‐Sectional Study
Authors: Morinaga Daisaku , Itoh Takatoshi , Soejima Yoshiki , Horikawa Tadashi , Nagai Shoji , Takeshita Fumitaka , Abe Naruyoshi , Kaku Toshio , Iijima Toshikazu , Soejima Daigo , Hara Toshihiro , Sato Ryuta , Murakami Mamoru , Sawase Takashi , Nishimura Masahiro
Published: September 2024

Background

Oral hypofunction is the stage before oral dysfunction. The subjective symptoms of poor oral function and the decline in oral health‐related quality of life (OHRQoL) that occur in the oral hypofunction stage can be missed.

Objective

This multicentre cross‐sectional study was performed to examine the relationships between the test results for oral hypofunction, subjective frailty symptoms and OHRQoL of outpatients in dental clinics.

Methods

The basic characteristics and oral function test results of 637 dental clinic outpatients were evaluated. The subjective symptoms of physical and oral frailty were investigated using a questionnaire. OHRQoL was assessed using the Japanese short version of the Oral Health Impact Profile (OHIP‐JP16) and OHRQoL dimension score.

Results

The overall prevalence of oral hypofunction was 37.8%, with no significant difference between men and women. No significant differences in the presence or absence of subjective symptoms of frailty and a high OHIP score were observed based on sex. However, the prevalence of oral hypofunction was significantly different among the age groups and increased with age. The subjective symptoms of frailty score, OHIP score and OHRQoL dimension score were significantly higher in patients with versus without oral hypofunction. Age, number of underlying diseases, total score for subjective symptoms of frailty, total score for OHIP and OHRQoL dimension score were significantly associated with oral hypofunction.

Conclusion

Oral hypofunction may affect the subjective symptoms of frailty and OHRQoL in older adults.
Critical Appraisal of Clinical Trials Evaluating Physical Therapy Treatments for Temporomandibular Disorders: A Scoping Review
Authors: Ballesteros‐Frutos Jorge , Fernandez‐Matias Ruben , Gallardo‐Zamora Pablo , Pecos‐Martín Daniel
Published: September 2024

Background

Physical therapy seems the most promising treatment for temporomandibular disorders (TMD), although their effectiveness is controversial in general, due to high heterogeneity regarding study designs, applied treatments and outcomes measures.

Objectives

The aim of this scoping review is to analyse the methodological characteristics of clinical trials evaluating physical therapy treatments in subjects with TMD.

Methods

A systematic search was conducted in Medline/PubMed, SPORTDiscus, Scopus, Web of Science, SciELO, Cochrane, ScienceDirect and EMBASE databases on 31 October 2023. Clinical trials evaluating physical therapy interventions in patients older than 18 years with TMD, published in English or Spanish languages. Data regarding content reporting of study designs, sample characteristics, interventions and outcome measures was extracted. Descriptive summary statistics were reported.

Results

The search retrieved 15 322 records, and 136 were included. There were 107 randomised clinical trials, 5 non‐randomised controlled trials and 24 non‐controlled trials. Most studies had moderate to high risk of bias, small sample sizes (median, 44 subjects) and short follow‐up periods (1–3 months). The most common diagnostic criteria used was the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) (48.9%). The most reported experimental interventions were manual therapy (40.4%), exercise (30.2%) and electrotherapy modalities (27.2%), and the most common outcome measure domains were pain (83.8%), range of movement (61.8%), disability (45.6%) and mechanosensitivity (29.4%). There was poor content reporting of experimental interventions.

Conclusions

Current literature of clinical trials of physical therapy interventions for TMD has moderate to high risk of bias, poor content reporting, small sample size and short‐term follow‐ups which limit internal and external validity, as well as applicability into clinical practice.
Effect of finishing and polishing techniques on the fit accuracy and dimensions of conventional and CAD‐CAM removable partial denture frameworks
Authors: Altoman Majed S. , Soltanzadeh Pooya , Suprono Montry S. , Gadah Thrya S. , Kattadiyil Mathew T.
Published: September 2024

Purpose

The purpose of this study was to compare the effects of finishing and polishing techniques on the fit accuracy, metal loss, and surface roughness of conventional versus CAD‐CAM removable partial denture (RPD) frameworks.

Materials and Methods

A 3D‐printed maxillary Kennedy class III modification I model served as the master cast. Forty impressions (20 conventional and 20 digital) were divided into four groups: lost‐wax technique (Group I: LWT), CAD‐printed (Group II: CAD‐RP), CAD‐printed from a stone cast (Group III: CAD‐RPS), and lost‐wax technique from resin‐printed models (Group IV: LWTR). Various finishing and polishing techniques were applied, followed by digital scanning for fit accuracy assessment using surface matching software. Metal thickness loss and surface roughness were evaluated pre‐ and post‐finishing and polishing. The Kruskal‐Wallis test followed by the Scheffe post‐hoc test were conducted to evaluate the fit accuracy between groups (α = 0.05).

Results

Color mapping revealed significant differences (p < 0.001) between conventionally casted RPD frameworks and 3D‐printed groups post‐finishing and polishing. The most significant gap was observed with the guide plates from printed RPD frameworks. The D‐Lyte technique resulted in less metal loss compared to the conventional finishing and polishing technique (p < 0.001).

Conclusion

Within the limitations of this study, conventionally processed RPD groups exhibited better overall fit accuracy post‐finishing and polishing. Both conventional cast and 3D‐printed RPD frameworks showed clinically acceptable fit accuracy. The D‐Lyte technique presented less metal loss and smoother surfaces compared to other groups, suggesting it as a viable alternative.
Secondary prophylaxis and specialist review compliance in paediatric patients with acute rheumatic fever and rheumatic heart disease in a Western Australian metropolitan setting
Authors: Tarca Adrian , Melvin Jennifer , MacDonald Bradley , Jeyaseelan Ahilan , Ramsay James , Shipton Stephen , Vine Julie , Yim Deane
Published: September 2024

Aim

Rheumatic heart disease (RHD), a consequence of acute rheumatic fever (ARF), continues to cause significant morbidity and mortality in susceptible young people. Secondary antibiotic prophylaxis is an effective strategy to prevent ARF recurrence and RHD progression. However, the proportion of patients receiving the recommended minimum benzathine penicillin injections (>80%) remains low. This retrospective cohort study reviews the utility of the Hospital in the Home nursing service in providing secondary prophylaxis for outpatients in a metropolitan state capital.

Methods

Fifty‐eight patients with ARF/RHD receiving secondary prophylaxis through the Hospital in the Home service between 1 July 2012 and 30 June 2020 were included. Compliance of secondary prophylaxis, specialist review and echocardiogram frequency were compared against the recommendations from the Australian RHD guidelines.

Results

Forty‐six (79%) patients received >80% of recommended doses, with 36% (n = 21) receiving 100% and a further 29% (n = 17) achieving compliance of 90%–99%. We found that 35% of patients attended all specialist reviews (including echocardiography) at the recommended frequency, with 75% of those not attending all reviews, missing only one or two appointments. Compliance was greater in those with more severe disease. In the 12 (21%) patients who did not meet the >80% target, compliance ranged between 33% and 79% (mean 64.5%) and all had priority 3 disease.

Conclusion

Community‐based administration of secondary prophylaxis through a registry‐based system is an effective strategy of improving compliance within a metropolitan area and should be utilised in a culturally safe and collaborative manner to increase uptake.
Seeking simplicity, navigating complexity: How veterinarians select an antimicrobial drug, dose, and duration for companion animals
Authors: Scarborough Ri O. , Bailey Kirsten E. , Sri Anna Ellen , Browning Glenn Francis , Hardefeldt Laura Y.
Published: September 2024

Background

Minimizing harm from antimicrobials requires use of the narrowest spectrum drug, at an effective dose for the minimum effective duration. Many prescribers are not currently following these guidelines. To address suboptimal antimicrobial use, the underlying reasons must be understood.

Objectives

To identify factors influencing choices of antimicrobial drug, dose, and duration for companion animals.

Subjects

Twenty‐two veterinarians treating companion animals in Australia. Diversity of participants was deliberately sought.

Methods

Semistructured interviews were conducted online. Two case studies were discussed, and then a range of broader questions was posed. Transcripts were analyzed thematically, using an inductive approach.

Results

Few participants chose guideline‐concordant management for the case studies. Prescribing choices were influenced by a complex array of factors associated with the clinical case, pet owner, drug, veterinarian, veterinary colleagues, and external factors. Key factors driving broad‐spectrum antimicrobial use included a sense of safety, habit, ease of administering the drug (especially in cats), pharmaceutical marketing, and the self‐perpetuating dispensary cycle. Many participants were concerned about antimicrobial resistance, but insufficiently informed about how to minimize this risk. Several participants believed that longer duration of treatment and ensuring patients finish a predetermined course would decrease the risk of antimicrobial resistance and improve clinical outcomes.

Conclusions and Clinical Importance

Veterinarians are engaged with the concept of antimicrobial stewardship, but face numerous practical barriers and require more information. In particular, improved education is needed on enhancing patient safety by minimizing both spectrum of activity and duration of treatment, and dispelling myths about “finishing the course.”
New Sources of Resistance to Terbinafine Revealed and Squalene Epoxidase Modelled in the Dermatophyte Fungus Trichophyton interdigitale From Australia
Authors: Mechidi Phemelo , Holien Jessica , Grando Danilla , Huynh Tien , Lawrie Ann C.
Published: September 2024

Background

Terbinafine is widely used to treat onychomycosis caused by dermatophyte fungi. Terbinafine resistance in recent years is causing concern. Resistance has so far been associated with single‐nucleotide substitutions in the DNA sequence of the enzyme squalene epoxidase (SQLE) but how this affects SQLE functionality is not understood.

Objectives

The aim of this study was to understand newly discovered resistance in two Australian strains of Trichophyton interdigitale.

Patients/Methods

Resistance to terbinafine was tested in four newly isolated strains. Three‐dimensional SQLE models were prepared to investigate how the structure of their SQLE affected the binding of terbinafine.

Results

This study found the first Australian occurrences of terbinafine resistance in two T. interdigitale strains. Both strains had novel deletion mutations in erg1 and frameshifts during translation. Three‐dimensional models had smaller SQLE proteins and open reading frames as well as fewer C‐terminal α‐helices than susceptible strains. In susceptible strains, the lipophilic tail of terbinafine was predicted to dock stably into a hydrophobic pocket in SQLE lined by over 20 hydrophobic amino acids. In resistant strains, molecular dynamics simulations showed that terbinafine docking was unstable and so terbinafine did not block squalene metabolism and ultimately ergosterol production. The resistant reference strain ATCC MYA‐4438 T. rubrum showed a single erg1 mutation that resulted in frameshift during translation, leading to C‐terminal helix deletion.

Conclusions

Modelling their effects on their SQLE proteins will aid in the design of potential new treatments for these novel resistant strains, which pose clinical problems in treating dermatophyte infections with terbinafine.
Navigating Public–Private Partnership success: A cross‐country study of key factors in Nigeria and South Africa
Authors: Deinde‐Adedeji Oluwatimilehin , Nchuchuwe Francis , Abasilim Ugochukwu , Gberevbie Daniel , Oni Samuel
Published: September 2024

Public–private partnership (PPP) has delivered expected results on a number of significant projects. Yet, despite the growing appeal, problems have been encountered which have either resulted in slow progress or the total failure of such arrangements. This study offers a comparison between Nigeria and South Africa focusing on several identified critical success factors (CSFs) for PPPs. We rely on secondary data to compare Nigeria and South Africa based on the top ten ranking CSFs identified in the literature. Findings reveal that both countries account for the highest number of PPP projects in Africa but have not recorded huge successes as a result of their shortcomings in important CSFs responsible for the success of PPPs. Nigeria, for instance, is still being challenged with poor energy supply, bad road networks, and ineffective waste management practices, among others. South Africa appears to have had better success in PPP delivery due to a suitable financial market, stable economic policy, favorable legal framework, and a transparent procurement process. We conclude by highlighting the key CSFs for PPPs in Nigeria and South Africa and emphasize the need to address the identified shortcomings. The relevance of this study is in its contribution to the understanding of CSF in PPP projects thereby offering useful insights for policy makers and administrators in improving the success rate of PPPs and enhancing the delivery of public services in these countries.

Related Articles

Ikeanyibe, Okechukwu Marcellus. 2018. “Bureaucratic Politics and the Implementation of Liberalization Reforms in Nigeria: A Study of the Unbundling and Reorganization of the Nigerian National Petroleum Corporation.” Politics & Policy 46(2): 263–94. https://doi.org/10.1111/polp.12249.

Iwuoha, Victor Chidubem, Nneka Ifeoma Okafor, and Emmanuel Ifeadike. 2022. “State Regulation of Nigeria's Maritime Ports: Exploring the Impact of Port Concession on both the Regulator and the Operators.” Politics & Policy 50(5): 1032–52. https://doi.org/10.1111/polp.12495.

McNamara, Madeleine W., John C. Morris, and Martin Mayer. 2014. “Expanding the Universe of Multi‐Organizational Arrangements: Contingent Coordination and the Deepwater Horizon Transportation Challenges.” Politics & Policy 42(3): 346–68. https://doi.org/10.1111/polp.12073.
From local networks to national reform? Programmatic groups in the regionalization of German health policy
Authors: Bandelow Nils C. , Iskandar Lina Y. , Klingner Sofie , Schröder Ilana
Published: September 2024

Before policy reform initiatives reach the agenda of national decision makers, such initiatives often start at a small‐scale, local level. The Programmatic Action Framework (PAF) emphasizes the importance of biographical connections to understand how a group of policy actors forms, and how it develops programs that may lead to decade‐long policy change. This article applies the PAF to study the emergence of a programmatic group behind initiatives on regionalization in German health policy through discourse analysis and expert interviews. The study contributes to understanding social networks behind policy programs and social‐psychological, partly informal drivers of policy change. The results show that many PAF conditions have already been met in the German health policy subsystem. We describe a network of policy actors with local and organizational drivers that has led to nationwide cooperation on regionalization.

Related Articles

Caliskan, Cantay. 2020. “The Influence of Elite Networks on Green Policy Making.” Politics & Policy 48(6): 1104–37. https://doi.org/10.1111/polp.12382.

Petridou, Evangelia, Per Becker, and Jörgen Sparf. “Policy Entrepreneurs in Public Administration: A Social Network Analysis.” Politics & Policy 49(2): 414–45. https://doi.org/10.1111/polp.12400.

Svallfors, Stefan, Erica Falkenström, Corrie Hammar, and Anna T. Höglund. 2022. “Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance.” Politics & Policy 50(3): 580–97. https://doi.org/10.1111/polp.12462.
Shrimp Processing Waste in Aquaculture Feed: Nutritional Value, Applications, Challenges, and Prospects
Authors: Eggink Kylian Manon , Gonçalves Renata , Skov Peter Vilhelm
Published: September 2024

The global shrimp processing industry generates substantial amounts of solid waste (head, abdominal exoskeleton, and tail), with a considerable part currently being disposed of in landfills. It holds significant potential as an alternative ingredient in aquaculture feed due to its relatively high crude protein content, balanced amino acid profile, and presence of bioactive compounds. However, one of the main challenges with shrimp processing waste is its rapid spoilage. Consequently, shrimp solid processing waste must undergo further refinement to produce shrimp‐derived products suitable as aquaculture feed ingredients, such as meal, hydrolysate, or silage. This literature review describes the nutritional value, applications, challenges, and prospects of these shrimp‐derived products in aquaculture feed. Among the investigated shrimp‐derived products, shrimp hydrolysate has the highest nutritional value considering the high crude protein content, balanced amino acid profile, low chitin content, and low ash content. However, producing shrimp hydrolysate requires extensive processing, which can be costly, limiting its applications to high‐value aquaculture species. On the other hand, shrimp meal and shrimp silage, which require less energy‐intensive processing, may be more suitable for lower‐value aquaculture species that naturally consume feeds high in ash and chitin. The prospects for using shrimp‐derived products in aquafeed are promising, with advances in processing technologies showing potential to reduce costs, improve nutritional value, and enhance product quality and safety. Ultimately, shrimp‐derived products could replace current aquafeed ingredients while simultaneously utilizing current shrimp solid waste streams, provided that quality and safety measures are carefully considered.
The dark side of clarity
Authors: Nie Chenwei
Published: September 2024

We all have experiences in which it “seems clear” to us that something is true. This kind of clear experience can play significant roles in determining whether we believe something to be true. But what are the significant roles? So far, the literature has focused on optimal cases where a person's clear experience might provide prima facie justification for their belief. This article will develop the hypothesis that, in less optimal cases, these clear experiences can be epistemically damaging. Specifically, it will argue that, in certain cases, such experiences may causally compel belief even in the face of counterevidence.
Epidermal renewal during the treatment of atopic dermatitis lesions: A study coupling line‐field confocal optical coherence tomography with artificial intelligence quantifications
Authors: Le Blay Heiva , Raynaud Edouard , Bouayadi Sonia , Rieux Elodie , Rolland Géraldine , Saussine Anne , Jachiet Marie , Bouaziz Jean‐David , Lynch Barbara
Published: September 2024

Objective

This study explores the application of Line‐field Confocal Optical Coherence Tomography (LC‐OCT) imaging coupled with artificial intelligence (AI)‐based algorithms to investigate atopic dermatitis (AD), a common inflammatory dermatosis.

Materials and methods

AD acute and chronic lesions (ADL) were compared to clinically healthy‐looking skin (ADNL). LC‐OCT was used noninvasively and in real‐time to image the skin of AD patients during flare‐ups and monitor remissions under topical steroid treatment for 2 weeks. Quantitative parameters were extracted from the images, including morphological and cellular‐level markers of epidermal architecture. A novel cellular‐level parameter, nuclei “atypia,” which quantifies the orderliness of epidermal renewal, was used to highlight abnormal maturation processes.

Results

Compared to healthy skin, AD lesions exhibited significant increases in both epidermal and stratum corneum (SC) thickness, along with a more undulated dermo‐epidermal junction (DEJ). Additionally, keratinocyte nuclei (KN) were larger, less compact, and less organized in lesional areas, as indicated by the atypia parameter. A higher degree of atypia was observed in chronic lesions compared to acute ones. Following treatment, all the parameters normalized to levels observed in healthy skin within 2 weeks, mirroring clinical improvements.

Conclusion

This study provides insights into the quantification of epidermal renewal using a noninvasive imaging technique, highlighting differences between ADL/ADNL and acute/chronic lesions. It also presents the AD treatment mechanism, paving the way for future investigations on AD and other skin barrier function‐related conditions.
Supporting the expansion of organ transplant: Transfusion services handle the details
Authors: Poisson Jessica
Published: September 2024

See article on page 1899–1908, in this issue
Vincristine Induced Adverse Effects in Lymphoma Bearing Dogs With Asymptomatic Neutropenia at the Time of Drug Administration
Authors: Thomas Albert , Finlay Jessica , McKinnon Elizabeth , Wyatt Ken
Published: September 2024

Vincristine sulphate, a microtubule inhibitor, is used extensively in veterinary oncology for treating lymphoma. Neutropenia during multiagent protocols is a common reason for treatment delay and reduced dose intensity. This study evaluated toxicities associated with treating systemically well neutropenic lymphoma patients with vincristine. Lymphoma patients undergoing CHOP were evaluated retrospectively for instances of vincristine administration when absolute neutrophil counts (ANC) were 1.5 × 109/L or below. Instances of vincristine administration when ANC was equal to or less than 1.5 × 109/L were compared to vincristine administration where ANC was greater than 1.5 × 109/L in the same patient. Univariate and multivariate modelling compared VCOG‐CTCAE v1.1 grading of vomiting, diarrhoea, anorexia and 7‐day neutrophil nadir between groups. The median dose of vincristine administered was 0.7 mg/m2 for both study groups. A total of 112 doses of vincristine were administered to neutropenic patients (grade 2 n: 76, grade 3 n: 26, and grade 4 n: 10). These were compared to 223 doses of vincristine administered to the same patients when ANC was above 1.5 × 109/L. Neutropenic administration was most prevalent 7 days following cyclophosphamide administration. Day 7 post‐administration neutropenia was more prevalent in patients with ANC greater than 1.5 × 109/L at the time of vincristine administration (neutropenic 9%; non‐neutropenic 18%). Relative risk of 7‐day neutropenia, vomiting, diarrhoea, and anorexia was similar between groups on multivariate analysis. Patients with lymphoma who receive vincristine when ANC is 1.5 × 109/L or below are at no greater risk of adverse effects than the same patient who receives vincristine when neutrophil counts are greater than 1.5 × 109/L.
Modified closed sacculectomy in 50 dogs with non‐neoplastic anal sac disease
Authors: Davis Allyson T. , Hosgood Giselle L.
Published: September 2024

Objective

To describe a modified closed sacculectomy technique for non‐neoplastic anal sac disease in dogs, and to describe the management and short‐term outcomes in dogs undergoing sacculectomy by the described technique.

Study design

Retrospective case series.

Sample population

A total of 50 dogs.

Methods

Electronic medical records were reviewed to identify dogs undergoing bilateral anal sacculectomy for non‐neoplastic anal sac disease using the described closed technique between January 1, 2013 and February 1, 2024.

Results

A total of 50 dogs underwent bilateral anal sacculectomy for non‐neoplastic anal sac disease. Intraoperative anal sac perforation was reported in five dogs (10%). A total of 43 dogs were available for two‐week follow‐up. Grade 1 complications were reported in 14/43 dogs (32%), grade 2 complications in 2/43 dogs (5%), and grade 3B in 2/43 dogs (5%). At two‐weeks postoperatively, 13/14 dogs (93%) had resolution of grade 1 complications. Both dogs with grade 2 complications had resolution reported at two weeks postoperatively, and both dogs with grade 3B complications had resolution reported at two weeks following revision surgery.

Conclusion

Intraoperative complications consisted of anal sac perforation without further complication. Minor postoperative complications were mostly self‐limiting, supporting previous literature. Major complications were infrequent and resolved following single revision surgery.

Clinical significance

The technique reported provides an alternative to excise intact and non‐neoplastic anal sacs in dogs. The key features of this technique are immediate anal sac identification by following the anatomic path of the duct, minimal peri‐saccular dissection, no requirement for packing of the anal sac, and complete removal of the duct and anal sac.
Effective generic freeness and applications to local cohomology
Authors: Cid‐Ruiz Yairon , Smirnov Ilya
Published: September 2024

Let be a Noetherian domain and be a finitely generated ‐algebra. We study several features regarding the generic freeness over of an ‐module. For an ideal , we show that the local cohomology modules are generically free over under certain settings where is a smooth ‐algebra. By utilizing the theory of Gröbner bases over arbitrary Noetherian rings, we provide an effective method to b make explicit the generic freeness over of a finitely generated ‐module.
SEMAT Essence Game: A Fun Way to Learn about the SEMAT Initiative
Authors: Zapata Jaramillo Carlos Mario , Maturana González Grissa Vianney , Calle Gallego Johnathan Mauricio
Published: September 2024

Objective: we aim to propose the SEMAT Essence game, a game-based simulation of the big picture related to the SEMAT Essence kernel. SEMAT (Software Engineering Method and Theory) is an initiative for re-founding software engineering based on a solid theory, proven principles, and best practices. SEMAT has the Essence kernel of universal elements for any software engineering endeavor. The SEMAT Essence has been taught by using workshops and some games, but such strategies only cover some topics related to the kernel.
Materials and methods: We use the SEMAT Essence kernel as a starting point and we select a game to be the template of our game. Then, we define the metaphor linked to our field of study and design the game by defining equivalences to the game elements.
Results and discussion: We also show the results of practicing the game with a set of students from four universities by summarizing the answers to a survey.
Conclusions: Results are promising since practitioners report some usage of the SEMAT Essence kernel elements after the game and they are satisfied with the fun factor, realism, and the current version of the game.
Support vector machines for predicting the level of integration in agri-food chains
Authors: Verduga-Alcívar Douglas Andrés , Muñoz-Grillo Emanuel Guillermo , Orozco-Crespo Erik , López-Joy Teresita , Acevedo-Urquiaga Ana Julia , Sablón-Cossío Neyfe
Published: September 2024

The objective of this paper is derived from the theoretical analysis of the application of support vector machines to the design and management of agri-food chains. This analysis is conducted with an empirical approach, for the prediction of the level of integration in agri-food chains through support vector machines. The methodology designed and used for the  processing of research results, which consists in the training of support vector machines  is used to predict the level of integration in an agri-food chain. This type of predictive application appears in the literature consulted on the integration of agri-food chains. The analysis is performed comparing the method proposed with the neural network technique. The  results of this research are mainly focused on predicting the  level of integration in agri-food chains through vector machines. The study provides a support vector machine model that is applied to other case studies and therefore, allows predicting the outcome. The paper also shows the comparison of two techniques that share the goal of predicting, as applied in different contexts.
Metastatic gastric adenocarcinoma discovered in the bone marrow
Authors: Proskuriakova Ekaterina , Balamurali Vaisny , Hooda Anuradha , Khosla Paramjeet
Published: September 2024

Gastric cancer primarily metastasizes to the peritoneum, liver and lungs, with bone marrow involvement being a rare occurrence, found in less than 1% of cases. Disseminated carcinomatosis of the bone marrow (DCBM) is characterised by widespread infiltration of cancer cells into the bone marrow, leading to haematological disorders such as disseminated intravascular coagulation and thrombocytopenia. We present a unique case of a man in his late 50s with acute thrombocytopenia as the initial symptom, subsequently diagnosed with gastric cancer on bone marrow examination. Despite receiving chemotherapy, the patient’s condition deteriorated rapidly, emphasising the challenging management and poor prognosis associated with DCBM. This case underscores the need for improved diagnostic strategies and therapeutic approaches to enhance patient outcomes in DCBM associated with gastric cancer.
Rare intravascular large B-cell lymphoma (IVLBCL) can cause atypical intracerebral haemorrhage and mislead diagnostics
Authors: Oerding Clemens , Niederstrasser Olaf , Kaden Ingmar , Lepadatu Adina , Sorge Eberhard , Bethmann Daniel , Wohlfarth Kai , Harder Anja
Published: September 2024

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of non-Hodgkin’s lymphoma. Common neurological symptoms are cognitive impairment and dementia. Only a few cases have been published reporting intracranial haemorrhage due to IVLBCL. We present a case of a female patient in her late 60s who presented with an atypical intracerebral haemorrhage as the first major complication of an IVLBCL. The patient’s condition declined rapidly. She died several weeks later due to haemorrhagic shock. The definitive diagnosis was achieved postmortem. Due to aggressive disease progression, the diagnosis of IVLBCL is still challenging and can therefore lead to incorrect or delayed treatment, especially in cases of unusual manifestations like lobar intracranial haemorrhage.
Do tobacco regulatory and economic factors influence smoking cessation outcomes? A post-hoc analysis of the multinational EAGLES randomised controlled trial
Authors: Daniel Belinda , Lawrence David E , McKenna Benjamin S , Saccone Phillip , McRae Thomas , Evins A Eden , Anthenelli Robert M
Published: September 2024

Introduction

We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes.

Methods

EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment.

Results

In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)).

Conclusions

Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a country’s GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor.

Trial registration number

ClinicalTrials.gov,NCT01456936.
Radiograph accelerated detection and identification of cancer in the lung (RADICAL): a mixed methods study to assess the clinical effectiveness and acceptability of Qure.ai artificial intelligence software to prioritise chest X-ray (CXR) interpretation
Authors: Duncan Sean F , McConnachie Alex , Blackwood James , Stobo David B , Maclay John D , Wu O , Germeni Evi , Robert Dennis , Bilgili Banu , Kumar Shamie , Hall Mark , Lowe David J
Published: September 2024

Introduction

Diagnosing and treating lung cancer in early stages is essential for survival outcomes. The chest X-ray (CXR) remains the primary screening tool to identify lung cancers in the UK; however, there is a shortfall of radiologists, while demand continues to increase. Image analysis by machine-learning software has the potential to support radiology workflows with a focus on immediate triage of suspicious X-rays. The RADICAL study will evaluate Qure.ai’s ‘qXR’ software in reducing reporting time for suspicious X-rays in NHS Greater Glasgow & Clyde.

Methods and analysis

This is a stepped-wedge cluster-randomised study consisting of a retrospective technical evaluation and prospective clinical effectiveness study alongside the assessment of acceptability via qualitative work and evaluation of cost-effectiveness via a cost utility analysis. The primary objective is to assess the clinical effectiveness of qXR to prioritise patients suspected with lung cancer on CXR for follow-up CT. Secondary objectives will look at the utility, safety, technical performance, health economics and acceptability of the intervention. The study period is 24 months, consisting of an initial 12 month data collection period and a 12 month follow-up period. All the standard care CXRs from outpatient and primary care requests will be securely transmitted to Qure.ai software ‘qXR’ for interpretation. Images with features of cancer will be flagged as ‘Urgent Suspicion of Cancer’ and be prioritised for radiologist review within the existing reporting workflow.

Ethics and dissemination

The study will follow the principles of Good Clinical Practice. The protocol was granted REC approval in August 2023 from North West—Greater Manchester West Research Ethics Committee (REC 23/NW/0211). This study was registered on clinicaltrials.gov (NCT06044454). An interim report will be produced for use by the Scottish Government. The results from this study will be presented at artificial intelligence, radiology and respiratory meetings and published in peer-reviewed journals.

Trial registration number

NCT06044454.
Changes in physical activity among Canadian adults more than 6 months into the COVID-19 pandemic: a secondary analysis of the INTERACT cohort study
Authors: Sturrock Shelby , Gesink Dionne , Winters Meghan , Kestens Yan , Stanley Kevin , Moineddin Rahim , Woodruff Sarah , Fuller Daniel
Published: September 2024

Objective

To estimate the effect of (a) the COVID-19 pandemic and (b) COVID-19 restriction stringency on daily minutes of device-measured moderate-to-vigorous physical activity (MVPA).

Design

Physical activity data were collected from the INTerventions, Equity, Research and Action in Cities Team (INTERACT) cohorts in Montreal, Saskatoon and Vancouver before (May 2018 to February 2019, ‘phase 1’) and during the pandemic (October 2020 to February 2021, ‘phase 2’). We estimated the effect of the two exposures by comparing daily MVPA measured (a) before vs during the pandemic (phase 1 vs phase 2) and (b) at different levels of COVID-19 restriction stringency during phase 2. Separate mixed effects negative binomial regression models were used to estimate the association between each exposure and daily MVPA, with and without controlling for confounders. Analyses were conducted on person-days with at least 600 min of wear time. Effect modification by gender, age, income, employment status, education, children in the home and city was assessed via stratification.

Setting

Montreal (Quebec), Saskatoon (Saskatchewan) and Vancouver (British Columbia), Canada.

Main outcome measure

Daily minutes of MVPA, as measured using SenseDoc, a research-grade accelerometer device.

Results

Daily minutes of MVPA were 21% lower in phase 2 (October 2020 to February 2021) compared with phase 1 (May 2018 to February 2019), controlling for gender, age, employment status, household income, education, city, weather and wear time (rate ratio=0.79, 95% CI 0.69, 0.92). This did not appear to be driven by changes in the sample or timing of data collection between phases. The results suggested effect modification by employment, household income and education. Restriction stringency was not associated with daily MVPA between October 2020 and February 2021 (adjusted rate ratio=0.99, 95% CI 0.96, 1.03).

Conclusions

Between October 2020 and February 2021, daily minutes of MVPA were significantly lower than 2 years prior, but were not associated with daily COVID-19 restriction stringency.
Cohort profile: Rahima Moosa Mother and Child Hospital maternal HIV cohort, Johannesburg, South Africa
Authors: Technau Karl-Günter , Maskew Mhairi , Nattey Cornelius , Hwang Candice , van Dongen Nicola , Ferreira Brizido Thalia , Wise Amy
Published: September 2024

Purpose

The Rahima Moosa Mother and Child Hospital (RMMCH) maternal HIV cohort originated from data systems that were developed to support HIV-related birth care and track outcomes of a complete birth cohort of HIV-exposed infants at Rahima Moosa Hospital and their mothers living with HIV.

Participants

Supported by the Empilweni Services and Research Unit, maternal and infant data from 13 654 pregnant women living with HIV who delivered their infants (and a subset also attended antenatal care) were collected at RMMCH in Johannesburg, South Africa since 2013. Maternal data were collected using counsellor-administered interviews and the 2013–2018 subset of this cohort was linked to the National Health Laboratory Services (NHLS) national HIV cohort—a longitudinal cohort of people living with HIV accessing care in the public sector antiretroviral therapy programme in South Africa that can observe national access to HIV care through laboratory testing data.

Findings to date

Topics addressed by the cohort include antenatal care history, HIV treatment exposure, delivery/birth management, prophylaxis and maternal blood results relevant to HIV captured at delivery. The cohort was also one of the first to describe implementation of early infant diagnosis procedures in South Africa including evaluations of novel point-of-care testing strategies demonstrating improvements in uptake of HIV care among infants accessing point-of-care services.

Future plans

Annual linkage of infant delivery and testing data to longitudinal laboratory test data in the NHLS national HIV cohort is planned to allow for analysis of both infant continuity of care outcomes and as well as evaluation of maternal-infant pair treatment and mobility outcomes in the post partum and later period.
Is there a sufficient supply of clinical academics for UK medical schools? A retrospective cohort study
Authors: Waldock William J , Hughes Elizabeth , Dacre Jane , Sam Amir H
Published: September 2024

Objectives

Clinical academics lead research to deliver medical advancements while also teaching in medical schools to maintain high-quality medical services. The objective of this project was to determine if there is a sufficient supply of clinical academics for UK medical schools.

Design

Retrospective cohort study.

Setting

Data were extracted from the UK Medical Education Database and the General Medical Council (GMC) annual National Trainee Survey between 2012 and 2022.

Participants

1769 registered UK doctors with academic training and a certificate of completion of training.

Main outcome measure

The percentage of doctors with clinical and academic training who ended up as incumbent clinical academics at UK medical schools.

Results

Approximately 50% of doctors with clinical and academic training were matched as incumbent clinical academics at UK medical schools. There was a low annual rate of incumbent clinical academics leaving their post.

Conclusion

Either clinical academic trainees do not find jobs at medical schools, or they do not want the jobs that are available. These results are indicative but not conclusive as generalisation is compromised by inconsistent disclosure of data by medical schools. We discuss variables which may contribute to the loss of clinical academics and explore the health economic case for clinical academic incentive packages to improve return on training investment.
Determination of appropriate policy targets to reduce the prevalence of stunting in children under five years of age in urban-poor communities in Indonesia: a secondary data analysis of the 2022 Indonesian national nutritional status survey
Authors: Laksono Agung Dwi , Izza Nailul , Trisnani Trisnani , Paramita Astridya , Sholikhah Hidayad Heny , Andarwati Pramita , Rosyadi Khoirul , Wulandari Ratna Dwi
Published: September 2024

Objective

Based on previous studies, urban-poor societies are very vulnerable to stunted children under five. The study aims to determine the appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia.

Design

A study was conducted using a secondary data analysis. The study analysed existing data from the 2022 Indonesian National Nutritional Status Survey.

Setting and participants

At the national level, Indonesia encompassed 43 284 toddlers.

Interventions

Non-intervention study.

Primary and secondary outcomes

The study’s eight independent factors were the mother’s age, education, marital status, employment, wealth, antenatal care (ANC), children’s age and sex, with nutritional status as the dependent variable. We employed a binary logistic regression test for the most recent exam.

Results

Maternal age was related to stunted toddlers in communities of urban poor in Indonesia. The lower the education, the higher the possibility of having stunted kids. Unemployed mothers were 1.153 times more likely than employed mothers to have stunted under-five children (95% CI 1.145 to 1.160). The poorest were 1.235 times more likely to get stunted under-five than the poorer (95% CI 1.227 to 1.242). Mothers without ANC during pregnancy were 1.212 times more likely to get stunted kids than those with ANC during pregnancy (95% CI 1.186 to 1.240). All kids' ages were more probable than 0–11 to be stunted. Boys were 1.099 times more likely to be stunted than girls (AOR 1.099; 95% CI 1.093 to 1.105).

Conclusion

The appropriate policy targets to reduce the prevalence of stunted under-five children in urban-poor communities in Indonesia were younger mothers, those with poor education, those unemployed, the most impoverished, those without ANC, those with older under-five and those with boy kids.
Implementation of an electronic prospective surveillance model for cancer rehabilitation: a mixed methods study protocol
Authors: Lopez Christian , Neil-Sztramko Sarah E , Campbell Kristin L , Langelier David M , Strudwick Gillian , Bender Jackie L , Greenland Jonathan , Reiman Tony , Jones Jennifer M
Published: September 2024

Introduction

An electronic prospective surveillance model (ePSM) uses patient-reported outcomes to monitor impairments along the cancer pathway for timely management. Randomised controlled trials show that ePSMs can effectively manage cancer-related impairments. However, ePSMs are not routinely embedded into practice and evidence-based approaches to implement them are limited. As such, we developed and implemented an ePSM, called REACH, across four Canadian centres. The objective of this study is to evaluate the impact and quality of the implementation of REACH and explore implementation barriers and facilitators.

Methods and analysis

We will conduct a 16-month formative evaluation, using a single-arm mixed methods design to routinely monitor key implementation outcomes, identify barriers and adapt the implementation plan as required. Adult (≥18 years) breast, colorectal, lymphoma or head and neck cancer survivors will be eligible to register for REACH. Enrolled patients complete brief assessments of impairments over the course of their treatment and up to 2 years post-treatment and are provided with a personalised library of self-management education, community programmes and when necessary, suggested referrals to rehabilitation services. A multifaceted implementation plan will be used to implement REACH within each clinical context. We will assess several implementation outcomes including reach, acceptability, feasibility, appropriateness, fidelity, cost and sustainability. Quantitative implementation data will be collected using system usage data and evaluation surveys completed by patient participants. Qualitative data will be collected through focus groups with patient participants and interviews with clinical leadership and management, and analysis will be guided by the Consolidated Framework for Implementation Research.

Ethics and dissemination

Site-specific ethics approvals were obtained. The results from this study will be presented at academic conferences and published in peer-reviewed journals. Additionally, knowledge translation materials will be co-designed with patient partners and will be disseminated to diverse knowledge users with support from our national and community partners.