bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Digital Education on Human Papillomavirus Knowledge, Vaccination Intent and Completion Rates in Adolescents and Young Adults: A Meta‐Analysis
Authors: Sandi Yudisa Diaz Lutfi , Yang Li‐Yu , Andarini Esti , Maryam Dewi , Wu Li‐Min
Published: October 2024

Aims

To examine the effects of digital educational intervention on HPV knowledge, vaccination intent and completion rates among adolescents and young adults.

Design

A systematic review and meta‐analysis.

Methods

The study followed PRISMA guidelines. Studies included randomised controlled trials assessing digital HPV educational interventions on individuals aged 9–26 years. Odds ratios (ORs), confidence intervals (CIs) and standardised mean differences (SMDs) were calculated and analysed with fixed‐ and random‐effects models, depending on the degree of heterogeneity.

Data Sources

Seven databases (Medline, PubMed, CINAHL, Cochrane Library, Web of Science, EMBASE and ASC) were searched from inception through April 9, 2024.

Results

Twelve studies enrolled 4925 participants were included. Six studies demonstrated that the intervention group significantly had higher HPV knowledge compared to the control group. Five studies reported a significant improvement on vaccination intent and vaccine completion rate. Subgroup analysis of the completion rates indicated that male participants demonstrated significantly greater vaccine competed rates. A tailored educational intervention was likely to effectively enhance HPV vaccine completion rates.

Conclusion

Our findings confirmed that digital education was beneficial in enhancing adolescents and young adults' HPV knowledge, vaccination intention and vaccine completion rates. The tailored education might be considered prioritised in the design of interventions, while also considering the impact of gender on digital education.

Impacts

Digital interventions for HPV vaccinations require at least 7 months of follow‐up, highlighting the vital role of tailored education for high‐risk groups in designing effective interventions. The efficacy of digital interventions for HPV vaccination may differ across genders.

Patient or Public Contribution

There was no direct patient or public contribution, as this is a review of previous research.

Trial Registration: CRD‐42023406919
Assistive Technology Uses and Barriers in the Home and Workplace for Adults With Intellectual and Developmental Disabilities
Authors: Randall Kristina N. , Drew Hannah , Gilman Elizabeth S. , Dixon Emma
Published: October 2024

Background

Assistive technology (AT) has been successfully used by researchers and practitioners to increase task completion and independence in work and home environments for individuals with intellectual and developmental disabilities. While prior research has shown increased outcomes of incorporating AT into daily tasks, research has also indicated that actual use of AT in these settings is much lower.

Method

The current qualitative study used semi‐structured interviews with a sample of 25 adults (22 individuals with intellectual and developmental disabilities and three job coaches) to examine the perceived use and implementation of AT into home and work environments, along with potential challenges and barriers. Interviews were analyzed using a thematic analysis approach.

Results

Three themes were identified: (1) technologies used to support daily living skills, (2) technologies used to support employment and (3) challenges and barriers to using technologies.

Conclusions

Findings indicate that while individuals with intellectual and developmental disabilities are using a variety of AT in their homes both successfully and independently, they have extremely limited use in their workplaces. Implications for practice and future research are discussed.
Chest x‐ray images: transfer learning model in COVID‐19 detection
Authors: Mao Siqi , Kulbayeva Saltanat , Osadchuk Mikhail
Published: October 2024

Rationale, Aims and Objectives

This research aims to develop an effective algorithm for diagnosing COVID‐19 in chest X‐rays using the transfer learning method and support vector machines.

Method

In total, data was collected from 10 clinics, including both large city hospitals and smaller medical institutions. This ensured a diverse range of geographical and demographic information in the sample. An extensive data set was collected, including 10,000 chest X‐ray images. 5000 images represent normal cases, 3993 images represent pneumonia cases, and 1007 images represent COVID‐19 cases. Machine learning methods were applied to develop a classification model, and the results were compared with seven state‐of‐the‐art models and a lightweight CNN architecture.

Results

The results showed that the proposed method achieves high accuracy values (Accuracy): 0.95 for COVID‐19, 0.89 for pneumonia, and 0.92 for normal images (p < 0.05). Comparison with other models demonstrates statistically significant superiority of our method in accuracy across all three classes. The EfficientNet‐B0 model surpasses our method only in accuracy for normal images with p < 0.01, confirming the advantages of our method. Our method demonstrates high sensitivity values (Sensitivity): 0.96 for COVID‐19, 0.88 for pneumonia, and 0.93 for normal images (p < 0.05), outperforming most of the compared models. Correlation analysis showed Pearson coefficients of 0.92, 0.89, and 0.94 for COVID‐19, pneumonia, and normal images, respectively, confirming a high degree of consistency between predicted and true class labels. In addition, the model was validated on external datasets to assess its generalizability. This validation confirmed its high level of effectiveness in a variety of clinical settings.

Conclusion

This study confirms the importance of applying machine learning methods in medical applications and opens new perspectives for early diagnosis of infectious diseases. The practical application of the obtained results can enhance the efficiency of diagnosis and control the spread of COVID‐19, as well as contribute to the development of innovative methods in medical practice.
Submissions of diagnostic samples of two critically endangered species of handfish (Branchionichthys hirsutus and Thymichthys politus) from a public aquarium from 2018 to 2024
Authors: Nowak Barbara F. , Knowles Graeme , Handlinger Judith , Hawkins Rachelle , Jantawongsri Khattapan , Dang Mai , Thompson Andrew , van Gelderen Rebecca , Bott Nathan J.
Published: October 2024

Handfish (Family Brachionichthyidae) is the most threatened marine teleost fish family, however, there is little information on handfish health. We reviewed the results of submissions of mortalities from captive and captive bred spotted handfish (Branchionichthys hirsutus (Lacepède, 1804)) and red handfish (Thymichthys politus (Richardson, 1844)) from a public aquarium from January 2018 to February 2024. Seventeen cases for spotted handfish (comprising 33 individuals) and five cases for red handfish (one individual each) were submitted for mortality investigation. In 2018–2019, six of seven cases were diagnosed with scuticociliatosis. Other conditions included epitheliocystis (1 of 17), infections with metazoan parasites (2 of 17 for spotted handfish and 2 of 5 for red handfish) and hepatic lipidosis (4 of 17). Most submissions were fixed samples for histology with only one fish suitable for microbiology. We recommend development of a coordinated health program for all captive breeders and aquaria, which should include sampling protocols, collection, and preservation in a range of fixatives of all the dying or dead handfish and adapting sublethal sampling, including tank water to assess presence of pathogens and other microorganisms. Risk factors for handfish health in captivity should be assessed. Handfish health database should be established to avoid loss of corporate knowledge in this area.
Gαo1 and Gαo1/Gαo2 deletion differentially affect hippocampal mossy fiber tract anatomy and neuronal morphogenesis
Authors: Höltje Markus , Wolkowicz Anton , Brunk Irene , Baron Jens , Ahnert‐Hilger Gudrun
Published: October 2024

The heterotrimeric G‐protein αo subunit is ubiquitously expressed in the CNS as two splice variants Gαo1 and Gαo2, regulating various brain functions. Here, we investigated the effect of single Gαo1, Gαo2, and double Gαo1/2 knockout on the postnatal development of the murine mossy fiber tract, a central pathway of the hippocampal connectivity circuit. The size of the hippocampal synaptic termination fields covered by mossy fiber boutons together with various fiber length parameters of the tract was analyzed by immunohistochemical staining of the vesicular Zinc transporter 3 (ZnT3) or Synaptoporin at postnatal days 2, 4, 8, 12, 16, and in the adult. Ultimately, Gαo1 knockout resulted in a reduced developmental growth of synaptic mossy fiber terminal fields by 37% in the adult Stratum lucidum and by 30% in the total mossy fiber tract size. Other morphological parameters such as projection length of the infrapyramidal bundle of the tract were increased (+52% in Gαo1−/− mice). In contrast, Gαo2 knockout had no effects on the mossy fiber tract. Moreover, by using primary heterozygous and homozygous Gαo1 knockout hippocampal cultures, we detected a strongly pronounced reduction in axon and dendrite length (−50% and −38%, respectively) as well as axon and dendrite arborization complexity (−75% and −72% branch nodes, respectively) in the homozygous knockout. Deletion of both splice variants Gαo1 and Gαo2 partially rescued the in vivo and completely reconstituted the in vitro effects, indicating an opposing functional relevance of the two Gαo splice variants for neuronal development and synaptic connectivity.

image
Does Floor Trading Matter?
Authors: BROGAARD JONATHAN , RINGGENBERG MATTHEW C. , ROESCH DOMINIK
Published: October 2024

Although algorithmic trading now dominates financial markets, some exchanges continue to use human floor traders. On March 23, 2020 the NYSE suspended floor trading because of COVID‐19. Using a difference‐in‐differences analysis around the closure of the floor, we find that floor traders are important contributors to market quality. The suspension of floor trading leads to higher spreads and larger pricing errors for treated stocks relative to control stocks. To explore the mechanism, we exploit two partial floor reopenings that have different characteristics. Our finding suggests that in‐person human interaction facilitates the transfer of valuable information that algorithms lack.
Genome‐Wide Data Uncover Cryptic Diversity With Multiple Reticulation Events in the Balkan‐Anatolian Cardamine (Brassicaceae) Species Complex
Authors: Šlenker Marek , Kantor Adam , Senko Dušan , Mártonfiová Lenka , Šrámková Gabriela , Cetlová Veronika , Dönmez Ali A. , Yüzbaşıoğlu Sırrı , Zozomová‐Lihová Judita
Published: October 2024

Plant species diversity may be considerably underestimated, especially in evolutionarily complex genera and in diversity hotspots that have enabled long‐term species persistence and diversification, such as the Balkan Peninsula. Here, we address the topic of underexplored plant diversity and underlying evolutionary and biogeographic processes by investigating the hygrophytic mountain species complex of Cardamine acris s.l. distributed in the Balkans (three subspecies within C. acris) and northwestern Anatolia (C. anatolica). We performed a series of phylogenetic and phylogeographic analyses based on restriction‐site associated DNA sequencing (RADseq) and target enrichment (Hyb‐Seq) data in combination with habitat suitability modelling. We found C. anatolica as a clade nested within the Balkan C. acris, probably resulting from a founder event, and uncovered three allopatric cryptic lineages within C. acris subsp. acris, allowing us to recognise a total of six entities in this complex. We observed the deepest genetic split within C. acris subsp. acris in the western Balkans, which was at odds with taxonomy and showed no distribution gap. We inferred vicariance as the most likely process for population divergence in the Balkans, accompanied by gene flow between the recognised entities, which was consistent with the modelled habitat suitability dynamics. Furthermore, we discovered several polyploid populations in C. acris, representing both pure intra‐ and inter‐lineage hybrid polyploids, but detected only minor traces of hybridization with related congeners. Overall, our results illustrate that diverse evolutionary processes may influence the history of mountain plant species in the Balkan Peninsula, including vicariance, reticulation, polyploidization and cryptic diversification.
Tapping Into Awareness: Assessing Nursing Students’ Water Consumption Behaviors and Sustainability Perceptions Through a Cross‐Sectional Study With Machine Learning Approach
Authors: Kucukkuya Aycan , Bodur Gonul , Ozata Sabri Yasir , Goktas Polat
Published: October 2024

Introduction

Investigating water consumption behaviors and perceptions of water sustainability among nursing students is crucial for effective resource management. This study employs machine learning (ML) techniques to analyze these factors in detail.

Methods

This descriptive cross‐sectional study involved 182 senior nursing students from an accredited faculty in Istanbul, Turkey, during the 2023–2024 academic year. Data were collected through an online survey, including an information form, a visual analog scale toward foresight about water scarcity (VAS), and a water consumption behavior scale. Advanced ML techniques were utilized to identify intricate patterns and correlations in the students’ behaviors and perceptions.

Results

The survey revealed that nursing students primarily rely on packaged water and perceive an imminent threat of water scarcity, though they exhibit limited awareness of their personal water footprint. High VAS scores indicated a strong awareness of global water crises but skepticism about local water scarcity. The ML model identified “Domestic Water Use Efficiency” as the primary factor influencing attitudes toward water sustainability, with “Water Awareness” and “Sustainable Water Ethics” also playing significant roles.

Conclusions

The study highlights the need to integrate sustainable water management education into nursing curricula and demonstrates nursing students’ awareness and preparedness for sustainable practices.
Rehabilitation of a degraded acid Mediterranean soil after 11 years of by‐product calcium amendments and pasture improvement
Authors: Mariscal‐Sancho Ignacio , Peregrina Fernando , Espejo Rafael , Hontoria Chiquinquirá
Published: October 2024

The clearing of natural vegetation and tillage for agricultural purposes makes acid soils highly vulnerable to degradation, resulting in significant losses of soil fertility and crop productivity. This work focused on nature‐based agricultural solutions to rehabilitate degraded acid soils in low‐resource systems. We studied after 6 and 11 years how the introduction of a legume‐rich pasture replacing a natural pasture or a tilled forage crop, with and without Ca‐amendment, contributed to recover the soil health, the fertility and the productivity of degraded Ultisols in Western Spain. Industrial by‐products, mainly sugar foam, were used as Ca‐amendment to promote circular economy. The Ca‐amendment factor influenced soil chemistry to 30 cm depth, while the type of soil use affected soil organic matter (SOM) to 15 cm; and both factors had positive effects on biomass productivity. Except for pH and Ca, no interaction between factors was found. Ca‐amendment increased nutrient availability and soil pH, and Al ion precipitated at 0–15 cm depth. As a result, biomass production increased by 35% relative to no Ca‐amendment. Forage cop produced 66% more biomass than pastures, but this increase did not translate into an increase in SOM. In fact, the legume‐rich pasture was the best option to recover soil organic C and N levels, earlier and deeper. Over the 11 years, the use of pastures and Ca‐amendment enhanced biomass production stability. Relative to natural, the improved pasture did not increase plant biomass but provided higher biomass stability and quality in terms of legume abundance, which was promoted when sugar foam was applied. Pastures also favoured key biological variable as earthworm's population, increasing it by four times with respect to forage crops. Compared to the non‐amended and unfertilized natural pasture out of the experiment, the use of improved pasture, followed by natural pasture, combined with sugar foam and fertilization enhanced soil health, soil fertility and biomass production stability. Thus, this solution has proven effective for restoring degraded acid soils, promoting diversity and mitigating climate change, while offering a more economically beneficial alternative.
A simplified liquid chromatography‐mass spectrometry methodology to probe the shikimate and aromatic amino acid biosynthetic pathways in plants
Authors: El‐Azaz Jorge , Maeda Hiroshi A.
Published: October 2024

Plants direct substantial amounts of carbon toward the biosynthesis of aromatic amino acids (AAAs), particularly phenylalanine to produce lignin and other phenylpropanoids. Yet, we have a limited understanding of how plants regulate AAA metabolism, partially because of a scarcity of robust analytical methods. Here, we established a simplified workflow for simultaneous quantification of AAAs and their pathway intermediates from plant tissues, based on extraction at two alternative pH and analysis by Zwitterionic hydrophilic interaction liquid chromatography coupled to mass spectrometry. This workflow was then used to analyze metabolic responses to elevated or reduced carbon flow through the shikimate pathway in plants. Increased flow upon expression of a feedback‐insensitive isoform of the first shikimate pathway enzyme elevated all AAAs and pathway intermediates, especially arogenate, the last common precursor within the post‐chorismate pathway of tyrosine and phenylalanine biosynthesis. Additional overexpression of an arogenate dehydrogenase enzyme increased tyrosine levels and depleted phenylalanine and arogenate pools; however, the upstream shikimate pathway intermediates remained accumulated at high levels. Glyphosate treatment, which restricts carbon flow through the shikimate pathway by inhibiting its penultimate step, led to a predictable accumulation of shikimate and other precursors upstream of its target enzyme but also caused an unexpected accumulation of downstream metabolites, including arogenate. These findings highlight that the shikimate pathway and the downstream post‐chorismate AAA pathways function as independently regulated modules in plants. The method developed here paves the way for a deeper understanding of the shikimate and AAA biosynthetic pathways in plants.
Evaluation of the effects of cementless total hip replacement on femoral length in skeletally immature dogs
Authors: Forzisi Ida , Vezzoni Aldo , Vezzoni Luca , Drudi Dario , Bourbos Alexandros , Marcellin‐Little Denis J.
Published: October 2024

Objective

To describe percentage length changes in the femur after total hip replacement (THR) performed before skeletal maturity.

Study design

Retrospective study.

Animals

Twenty‐four dogs younger than 8.5 months which underwent unilateral THR and had radiographic follow up.

Methods

Preoperative and follow‐up radiographs were reviewed. Radiographic measurements included the length of the greater trochanter, femoral diaphysis and distal epiphysis, width of the femur 10 mm distal to the distal aspect of the greater trochanter, width of the femur at 50%, and femoral condylar offset. Percentage changes in length over time were compared among operated and contralateral femurs used as controls. Measurements were collected in triplicate in 10 dogs to evaluate consistency.

Results

All repeated measurements had excellent consistency. The percentage increase in length of the greater trochanter was smaller in operated femurs than controls (mean difference: −11.5%, p = .017), but no differences were observed for the femoral diaphysis and distal epiphysis (−1.0%, p = .595), or the femur overall (−2.3%, p = .232). The percentage increase in femoral cortical width was greater in operated femurs than controls, both 10 mm distal to the greater trochanter (4.6% difference, p = .037) and at 50% length (8.5% difference, p = .030).

Conclusion

In growing dogs, cementless THR decreased trochanteric growth by approximately 10% but did not change diaphyseal growth and femoral growth.

Clinical significance

Cementless THR performed in skeletally immature dogs with severe hip problems did not impact femoral length in a clinically relevant fashion.
Social Media Shaping Youth’s Perception of Moroccan Female Political Leaders
Authors: Bourass Nouhaila , El Attari Anoire , Belaziz Hind , Tenkoul Abderrahman , Ennam Abdelghanie
Published: October 2024

This paper addresses the role of social media consumption amongst youth and its implications in shaping their perceptions of Moroccan female political leaders. Based on examining previous scholarly works, this research investigates a large body of literature including how social media platforms impacts youth’s engagement in political and civic activities. The role of social media in shaping perceptions about female political leaders is also discussed from a theoretical standpoint. Aiming to identify, the influence of a number of identified form the literature, this paper adopted a quantitative strategy utilizing a survey that was addressed to (N=309) participant targeted on both social media platforms and within university campus. Based on the descriptives, the correlation analysis and regression analysis of the data gathered, this study identified that the level of education, social media exposure, online interactions, political awareness, and cultural factors significantly influence youth’s perceptions of female political leaders. These findings highlight the factors influencing young adults’ perceptions about the Moroccan political landscape and the importance of media education and literacy to enhance critical thinking skills amongst Moroccan youth.
Rolling Formability Optimization of Locking Bolt Based on a Double-Thread Structure Composed of Coaxial Single and Multiple Threads
Authors: Amano Shuichi , Shinbutsu Toshinaka , Okimoto Yuki , Takemasu Teruie , Shimura Jyo , Hasegawa Osamu , Kuwabara Toshihiko
Published: October 2024

In previous studies, we developed innovative anti-loosening bolts and nuts with a double-thread structure (denoted DTB-IIC) composed of coaxial single and multiple coarse threads. It was also experimentally proven that the DTB-IIC has high anti-loosening performance. In this study, we analytically and experimentally investigated the effects of multiple thread groove depths and rolling methods on the thread rolling formability of DTB-IIC fasteners. The bottom rise rate, which is the ratio of the bottom rise amount of the multi-thread groove to the reference thread height, was set in three ways of 50%, 60%, and 70%. As the bottom rise rate increased, peeling on the thread surface was suppressed and the high temperatures produced by thread rolling decreased significantly, but the loosening resistance against vibration clearly decreased. We compared three typical mass production processes for bolts: the round die method, the flat die method, and the planetary method, with the bottom rise rate set at 50%. It was found that the flat die method had the best rolling formability in terms of screw-thread shape and surface quality. A finite element simulation consistently reproduced the deformation process of the complex DTB-IIC thread and revealed that the material shear flow due to over-rolling led to the occurrence of surface peeling.
Investigating the Feasibility of Focused Ultrasound Actuation of Shape Memory Alloy
Authors: Chipana Aldo , Moore Joseph , Hancock Matthew , Sanderson Sarah G. , Hill Jeffrey R. , Dillon Christopher R.
Published: October 2024

Nitinol, a shape memory alloy, has shown immense promise and utility in biomedical engineering with its remarkable biocompatibility and corrosion resistance. Most biomedical applications rely on Nitinol’s superelasticity rather than its hysteretic properties, otherwise known as its shape memory. The aim of this research is to determine if local heating from focused ultrasound could be used to induce the shape memory effect of Nitinol safely and non-invasively for biomedical applications deep within the body.

Specifically, Nitinol’s shape memory properties and focused ultrasound’s precise and localized heating in deep tissues could be utilized for non-invasive actuation and slow deployment of stents in the treatment of peripheral artery disease, which affects approximately 21 million Americans today. This approach could reduce the risk of in-stent restenosis, a consequence of injury to arterial walls caused by the traditionally rapid deployment of stents. The current study investigates whether focused ultrasound can actuate a tight coil of Nitinol (representing a simple stent) under experimental conditions that mimic in vivo conditions. Results demonstrate that focused ultrasound-induced actuation of Nitinol stents in deep vessels under physiological conditions is a possibility. Precise positioning and control of the stent and ultrasound transducer will be necessary to achieve stent actuation at power levels that prevent thermal damage to surrounding healthy tissues.
Enhancing Indirect Electromechanical Impedance NDE Sensitivity Using Elastic Metamaterial
Authors: Oyekola Peter O. , Albakri Mohammad I. , Rao Mohan D.
Published: October 2024

This paper introduces a novel approach to non-destructive evaluation (NDE) and quality control (QC) of engineered structures by employing an indirectly bonded electromechanical impedance (iEMI) technique with a metamaterial fixture. Traditional NDE methods encounter limitations such as high cost, restricted accessibility, or sensitivity to complex geometries. The iEMI technique offers a cost-effective alternative by utilizing a piezoelectric element attached to a fixture instead of directly to the part, eliminating the need for individual part instrumentation. However, conventional iEMI setups may be affected by fixture dynamics, obscuring the test specimen’s impedance signature. To address this challenge, this paper proposes using a metamaterial fixture with broad bandgap properties to prevent wave propagation within specific frequency ranges, accurately reflecting the part’s characteristics. The study focuses on developing a chiral metamaterial beam with two-unit cell designs to control mechanical wave propagation, emphasizing bandgap formation within desired frequency ranges. Experimental setup, bandgap analysis, fixture development, and iEMI performance evaluation are detailed, demonstrating the feasibility of the proposed approach. Conclusions offer valuable insights into the effectiveness of metamaterial fixtures in enhancing iEMI sensitivity and accuracy for defect detection in engineered structures.
Flexible Matrix Composite Wafers in Smart Prosthetic Sockets for Improved Socket Comfort and Fit
Authors: Hada Masaki , Bailey Abigail , Squibb Carson , Kaluf Brian , Madigan Michael L. , Philen Michael
Published: October 2024

Improving comfort is a paramount objective in the design process of a lower-limb prosthetic socket. A common issue with maintaining a comfortable socket fit during the day is that volume changes in the residual limb can result in regions of severe discomfort on the limb. These changes in residual limb volume can occur during both brief and long-term timescales. The objective of this research is to develop smart prosthetic sockets that can adjust for changes in the volume of the residual limb. Flexible Matrix Composites (FMCs) are high performance actuators that exhibit a high mechanical advantage when internally pressurized. FMCs are composed of symmetric layers of carbon fiber surrounding a flexible rubber tube. The actuators are then coiled into custom molds and filled with an elastomer, thus forming the active wafer. While FMCs are typically used for axial actuation, the FMC wafers take advantage of the radial expansion of the actuator to obtain actuation through the thickness of the wafer. Previous research characterized the effect of several design variables on the stiffness and actuation performance of wafer-style FMC actuators. Building upon the previous work, custom FMC wafers are fabricated and integrated into prosthetic sockets, thus forming a smart socket that can accommodate for volume changes. A socket was fabricated with custom wafers designed to target critical regions identified for the participant. An external gas canister and pressure regulation valve was used for precise control of the air pressure within the wafers. The participant was subjected to a physical activity regimen, recording their socket comfort every 150 seconds. The participant’s socket comfort score improved using the FMC wafers after actuation.
Guided-Wave Structural Health Monitoring for Assessing the Bond Strength of Induction-Welded Thermoplastic Composite Joints
Authors: Mazzeschi Mattia , Farhangdoust Saman , Ahmed Shabbir , Cañibano Esteban , Fernandez Maite , Chang Fu-Kuo
Published: October 2024

This study investigates the interaction between ultrasonic guided waves (GW) propagation and bond quality of induction-welded thermoplastic composite joints. Using ultrasonic piezoelectric transducers, the proposed robust structural health monitoring (SHM) method established a strong correlation between ultrasonic signals and the health status of joint. Three joint batches were manufactured with varying shear strength by adjusting welding parameters. Batch 1 had superior properties, while batches 2 and 3 were intermediate and lower, respectively. Transducers were placed on opposite sides of the joint overlap, operating at 350 kHz and 450 kHz. Time of flight (ToF) measurements, indicating wave group velocity, showed a direct correlation with weld-line stiffness and wave propagation velocity. These findings significantly contribute to the understanding of the interaction between mechanical properties and guided wave propagation in induction-welded thermoplastic composite joints, providing valuable insights for monitoring the performance of such joints in engineering applications.
Body Mass Management Practices of Olympic Weightlifting Athletes
Authors: Cox Amie M. , Langan-Evans Carl , Jenkins David , Reale Reid , Pelly Fiona , Slater Gary J.
Published: October 2024

This study explored the body mass (BM) management practices among competitive male and female Olympic weightlifting athletes, hypothesizing that athletes compete in lighter weight categories than their habitual training weight (i.e., making weight). Utilizing a validated, anonymous survey, data were collected from 149 Olympic weightlifting athletes (>18 years; female = 94). The survey comprised five sections: demographics, training/competition history, weight history, source of influence, and BM management practices. The prevalence, magnitude, and methods employed for BM management were analyzed with subgroup analysis using one-way analysis of variance. Post hoc testing including Spearman’s rho and chi-square analysis was completed when a significant effect was found. Three quarters (76%) of athletes acknowledged using chronic weight loss and/or acute weight loss strategies to make weight. Usual BM loss (2%–3%) in the week before competition was within recommended guidelines. Gradual dieting, fluid restriction, and low food weight, high-calorie options were the most commonly used BM management strategies. Female athletes were more likely to use gradual dieting (p = .043; r = .104) and were less likely to increase their exercise (p = .046; r = −.105) and utilize fasting (p = .038; r = .05) compared with their male counterparts. Women further identified dietitians/nutritionists (p = .006; r = .022) as a highly influential source of information. This research offers new insights into the BM management practices of Olympic weightlifting athletes, identifying that the majority of athletes compete at a BM lighter than their habitual training weight, achieved using a range of chronic weight loss and acute weight loss strategies.
Greater Relative First and Second Lactate Thresholds in Females Compared With Males: Consideration for Exercise Prescription
Authors: Benítez-Muñoz José Antonio , Rojo-Tirado Miguel Ángel , Benito Peinado Pedro José , Murias Juan M. , González-Lamuño Domingo , Cupeiro Rocío
Published: October 2024

Purpose: To investigate differences between females and males at lactate thresholds 1 (LT1) and 2 (LT2). Methods: Twenty-four female and twenty male participants performed an incremental cycle-ergometer test until exhaustion, where LT1 and LT2 were determined in each volunteer. Results: Power output at LT1 and LT2 was lower in females than in males (P < .001). In addition, power output relative to peak power was higher in females at LT1 and LT2 (P < .001). However, heart rate was higher in females than males at LT1 and LT2 (P = .008). Furthermore, the heart rate relative to maximal heart rate was higher in females compared with males at LT1 and LT2 (P = .002). Conclusion: Females and males may be in a different metabolic situation at the same percentage of maximum. This study helps to reduce sex bias in science, and future guidelines should consider establishing exercise prescription recommendations according to sex. Clinical Trial: NCT06104150.
Clinically sound and person centred: streamlining clinical decision support guidance for multiple long-term condition care
Authors: Cornick Ruth Vania , Petersen Inge , Levitt Naomi S , Kredo Tamara , Mudaly Vanessa , Cragg Carol , David Neal , Kathree Tasneem , Rabe Mareike , Awotiwon Ajibola , Curran Robyn Leigh , Fairall Lara R
Published: October 2024

The care of people with multiple long-term conditions (MLTCs) is complex and time-consuming, often denying them the agency to self-manage their conditions—or for the clinician they visit to provide streamlined, person-centred care. We reconfigured The Practical Approach to Care Kit, our established, evidence-based, policy-aligned clinical decision support tool for low-resource primary care settings, to provide consolidated clinical guidance for a patient journey through a primary care facility. This places the patient at the centre of that journey and shifts the screening, monitoring and health education activities of multimorbidity care more equitably among the members of the primary care team. This work forms part of a study called ENHANCE, exploring how best to streamline MLTC care in South Africa with its high burden of communicable, non-communicable and mental health conditions. This practice paper describes the four steps of codeveloping this clinical decision support tool for eleven common long-term conditions with local stakeholders (deciding the approach, constructing the content, clinical editing, and design and formatting) along with the features of the tool designed to facilitate its usability at point of care. The process highlighted tensions around prioritising one condition over another, curative over preventive treatment and pharmacological therapies over advice-giving, along with the challenges of balancing the large volume of content with a person-centred approach. If successful, the tool could augment the response to MLTC care in South Africa and other low-resource settings. In addition, our development process may contribute to scant literature around methodologies for clinical decision support development.
Ethiopian primary healthcare clinical guidelines 5 years on—processes and lessons learnt from scaling up a primary healthcare initiative
Authors: Kibret Aklog Getnet , Belete Wondosen Mengiste , Hanlon Charlotte , Ataro Israel , Tsegaye Kiflemariam , Tadesse Zelalem , Feleke Meseret , Abdella Megersa , Wale Meseret , Befekadu Kassahun , Bekele Alemayehu , Georgeu-Pepper Daniella , Ras Christy-Joy , Fairall Lara R , Cornick Ruth Vania
Published: October 2024

Many effective health system innovations fail to reach those who need them most, falling short of the goal of universal health coverage. In the 5 years since the Federal Ministry of Health in Ethiopia localised the Practical Approach to Care Kit (PACK) programme to support primary care reforms, PACK has been scaled-up to over 90% of the country’s primary care health centres. Known as the Ethiopian Primary Healthcare Clinical Guideline (EPHCG), the programme comprises a comprehensive, policy-aligned clinical decision support tool (EPHCG guide) and an implementation strategy to embed comprehensive, integrated care into every primary care consultation for individuals over 5 years of age, while addressing barriers to streamlined primary healthcare delivery. We describe the components of the EPHCG programme and the work done to establish it in Ethiopia. Yamey’s framework for successful scale-up is used to examine the programme and health system factors that enabled its scale-up within a 5-year period. These included high-level ministry leadership and support, a cascade model of implementation embedded in all levels of the health system, regular EPHCG guide and training material updates and strategies to generate stakeholder buy-in from managers, health workers, patients and communities. Challenges, including stakeholder resistance, training fidelity and quality and procurement of medicines and diagnostic tests, are described, along with efforts to resolve them. Insights and learnings will be of interest to those implementing PACK programmes elsewhere, and managers and researchers responsible for design and delivery of health systems strengthening innovations at scale in low-income and middle-income countries.
Effects of PACK training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians during 2 years of implementation in Florianópolis, Brazil: extended follow-up after a pragmatic cluster randomised controlled trial with a stepped-wedge design
Authors: Shekar Sameer , Bachmann Max Oscar , Bateman Eric D , Stelmach Rafael , Cruz Alvaro Augusto , Zonta Ronaldo , Pacheco de Andrade Matheus , Zepeda Jorge , Cornick Ruth Vania , Wattrus Camilla , Georgeu-Pepper Daniella , Anderson Lauren Faye , Lombard Carl , Fairall Lara R
Published: October 2024

Background

Training primary care doctors and nurses to use Practical Approach to Care Kit (PACK) improved management of asthma and chronic obstructive pulmonary disease (COPD) in a previous randomised trial. The present study examined the training effects including a second year of follow-up with expanded coverage of repeated training sessions.

Methods

Using a stepped-wedge cluster randomised trial design, 48 clinics were randomly allocated either to sequence A: (1) no intervention, (2) no intervention, (3) intervention or sequence B: (1) no intervention, (2) intervention, (3) intervention, during three 12-month periods. Primary outcomes were change in treatment and spirometry ordering. Effects of any exposure to the training, and of exposure to the first and second years of training, were estimated with mixed effect logistic regression models.

Results

Any exposure to training was associated with increased changes in treatment (OR adjusted for calendar time (OR) 1.29, 95% CI 1.02 to 1.64) and more spirometry ordering (OR 1.55, (95% CI 1.22 to 1.97)) in asthma patients, and with more spirometry ordering (OR 1.50 (95% CI 1.15 to 1.96)) in patients with COPD. Change in asthma treatment was more likely during the first and second year of exposure to training compared with no exposure (ORs 1.43 (95% CI 1.09 to 1.87); 1.91 (95% CI 1.21 to 3.02)), respectively. Spirometry was more likely during the first and second year of exposure in asthma patients (ORs 1.76 (95% CI 1.34 to 2.30); 2.05 (95% CI 1.32 to 3.19)) and in patients with COPD (ORs 1.57 (95% CI 1.18 to 2.10)); 1.71 (95% CI 1.08 to 2.70)).

Conclusion

Extended follow-up suggested that PACK training continued to be effective in improving chronic respiratory care and that effective intervention delivery was sustainable for 2 years.

Trial registration number

NCT02786030.
Resilience in nursing medication administration practice: a systematic review with narrative synthesis
Authors: Kellett Pollyanna LR , Franklin Bryony Dean , Pearce Susie , Benn Jonathan
Published: October 2024

Resilience in nursing medication administration practice: a systematic review with narrative synthesis.

Objective

Little is known about how nurses adapt medication administration practices to preserve safety. The capacity to adapt and respond before harm occurs has been labelled ‘resilience’. Current evidence examining medication safety largely focuses on errors and what goes wrong. This review aimed to synthesise evidence for the application of resilience principles and practices in nursing medication administration.

Design

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review, which was registered with PROSPERO.

Data sources

MEDLINE, EMBASE, PsychINFO and CINAHL databases were searched from 14 August 2020 to 1 January 2021 for English-language studies.

Methods

A systematic review of empirical studies of any design relating to resilience and safety in nursing medication administration in the inpatient setting was conducted. Methodological quality was appraised using the Mixed Methods Appraisal Tool. Data were synthesised thematically.

Results

Thirty-two studies with a range of methodologies of mostly good quality met the inclusion criteria. Eleven interventional studies included two that evaluated the effectiveness of education interventions and nine exploratory studies with outcomes showing the impact of an intervention designed or examined to build resilience. Twenty-one non-interventional studies showed how resilience principles are put into practice. Only three studies explicitly named the concept of resilience. Resilient medication administration strategies result from five triggers.

Conclusions

Nurses’ resilience practices were found to be responses to identified trigers that threaten safety and productivity. These were often short term, real-time proactive adaptations to preserve safety, compensating for and responding to complexities in the modern healthcare setting.

PROSPERO registration number

CRD42018087928.
Reducing healthcare waste by eliminating exam table paper in a primary care practice: a sustainable quality improvement initiative
Authors: Hale Ilona , McKenzie Amanda
Published: October 2024

Purpose

Climate change is now the greatest threat to human survival. The healthcare system contributes significantly to global pollution and greenhouse gas emissions. Individual practitioners play an important role in helping to reduce these impacts in day-to-day practice. Deimplementation of unnecessary processes and products, such as exam table paper, in medical offices is one simple approach to incorporating principles of planetary health into practice. All quality improvement (QI) projects must start to consider environmental impacts to fully evaluate change ideas.

Methods

We designed a single Plan-Do-Study-Act cycle using the Institute for Health Improvement Model for Improvement. We removed the exam table paper from our primary care office and measured changes in staff time, laundry, financial costs, paper use and carbon dioxide (CO2) emissions.

Results

Eliminating exam table paper in our clinic resulted in modest annual cost savings of $C718 and improved staff efficiency and motivation to introduce other green office practices. In our clinic alone, this change will save 8.2 km of exam table paper, 10 trees and 148 kg of CO2e (equivalent to driving 1233 km) every year. There were no negative consequences or feedback.

Conclusions

This simple QI project demonstrates the feasibility of implementing a small change in a primary care clinic that can improve environmental sustainability with multiple co-benefits. If all family physicians in Canada eliminated exam table paper in their offices, it would result in savings of approximately 95 940 km of paper, 121 680 trees, $C8 400 600 and 3054 T CO2emissions, equivalent to driving around the world 360 times.
Value of the central sensitisation inventory in patients with axial spondyloarthritis
Authors: van der Kraan Yvonne Maria , Paap Davy , Timmerman Hans , Wink Freke , Arends Suzanne , Reneman Michiel , Spoorenberg Anneke
Published: October 2024

Background

In many patients with axial spondyloarthritis (axSpA), pain persists despite anti-inflammatory medication. Quantitative sensory testing (QST) indirectly assesses altered somatosensory function, though its clinical practicality is limited. The Central Sensitisation Inventory (CSI) could be an alternative in the initial assessment of central sensitisation (CS). This study aimed to investigate the value of the CSI in evaluating CS in patients with axSpA by (1) assessing somatosensory function related to CS with QST and (2) exploring associations between CSI, QST, patient and disease characteristics and pain-related psychosocial factors.

Methods

Consecutive outpatients from the Groningen Leeuwarden AxSpA cohort underwent QST, including pressure pain threshold (PPT), temporal summation (TS) and conditioned pain modulation (CPM). Participants completed questionnaires assessing CS (CSI), illness perception (Revised Illness Perception Questionnaire, IPQ-R), pain-related worrying (Pain Catastrophising Scale, PCS), fatigue (Modified Fatigue Impact Scale, MFIS), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and coping. QST measurements were stratified for CSI≥40.

Results

201 patients with axSpA were included; 63% male, 64% radiographic axSpA, median symptom duration 12 years (IQR 5–24), mean Axial Spondyloarthritis Disease Activity Score 2.1±1.0. Patients with CSI≥40 had significantly lower PPTs and higher TS than CSI<40 (p<0.004). No significant differences in CPM were observed. In multivariable linear regression, sex, PCS, IPQ-R Identity, MFIS and HADS anxiety were independently associated with CSI (78% explained variance).

Conclusion

In this large cross-sectional study in patients with axSpA, the CSI appears as a useful initial CS assessment questionnaire. When CSI scores indicate CS, considering pain-related psychosocial factors is important. These results emphasise the need for a biopsychosocial approach to manage chronic pain in patients with axSpA.
Presence-only fisheries bycatch data produce biased species distribution predictions for Alcyonacean corals on British Columbia’s continental shelf and slope
Authors: Gemmell Olivia M. , Rooper Christopher N. , Doherty Beau , Cox Sean P. , Kronlund Allen Robert
Published: October 2024

Sedentary benthic species such as Alcyonacea corals form critical habitat for fishes and invertebrates. Assessing anthropogenic risks to these organisms requires unbiased, species distribution models (SDMs) that attempt to map probabilities of coral presence in relation to bio-physical ocean characteristics; however, in deep-water settings, the accuracy of SDMs is highly variable and dependent on spatial and taxonomic resolution. Here we investigated how data and model types affect SDM predictions of Alcyonacea probability of presence. We compared predictions from generalized additive models (GAMs) fitted to presence–absence observations over a stratified-random survey design with predictions from maximum entropy models (Maxent) fitted to presence-only bycatch records from commercial fisheries. We use a simulation analysis to show that both model types (i.e., GAM or Maxent) using presence-only bycatch data produced biased estimates of species distribution, while both model types using presence–absence data from a stratified random survey design produced unbiased estimates of species distribution. Additionally, the maxent model fit using presence-only bycatch data produced biased estimates of performance metrics (AUC and TSS) that were overly optimistic. This study demonstrates a need for presence–absence data collected using a robust survey sampling design to fit SDMs that will better inform marine protected area placement while minimizing unnecessary economic losses, such as forgone fishing yield, due to sub-optimal placement.