bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of knowledge, attitude and self‐efficacy on Opisthorchis viverrini and cholangiocarcinoma prevention: A One Health approach in high‐risk areas of Thailand
Authors: Busabong Worathon , Songserm Nopparat , Woradet Somkiattiyos , Sripa Banchob
Published: December 2024

Objective

Opisthorchis viverrini and cholangiocarcinoma have been recognised by the World Health Organisation as critical public health concerns, particularly in northeastern Thailand, where Opisthorchis viverrini is a significant cause of cholangiocarcinoma. This study examines the factors influencing Opisthorchis viverrini and cholangiocarcinoma prevention within the One Health framework in Kanthararom District, Sisaket Province, Thailand.

Methods

A cross‐sectional study was conducted among 327 residents aged 20 and above, utilising a structured questionnaire to assess knowledge, attitudes, perceived self‐efficacy and prevention behaviours. Data were analysed using descriptive statistics, Pearson's product–moment correlation coefficient and multiple regression analysis to identify relationships and predictors within the dataset.

Results

The results showed that 53.52% of participants had moderate knowledge and attitudes towards prevention, while perceived self‐efficacy was generally high. Positive correlations were found between income, knowledge, attitudes, self‐efficacy and prevention behaviours. Key predictors of Opisthorchis viverrini and cholangiocarcinoma prevention behaviours included attitudes towards human health (β = 0.212), perceived self‐efficacy in human health (β = 0.211), attitudes towards animal health (β = 0.205) and knowledge about human health (β = 0.138), accounting for 24.40% of the variance in prevention behaviours. These predictors were statistically significant at 0.05 (F = 25.95; p <0.001).

Conclusion

The findings suggest that enhancing knowledge, attitudes and self‐efficacy is crucial to improving Opisthorchis viverrini and cholangiocarcinoma prevention. This study underscores the need for integrated public health strategies incorporating human, animal and environmental health to reduce the prevalence of Opisthorchis viverrini and cholangiocarcinoma in high‐risk regions.
Retrospective clinical performance evaluation of the Abbott Bioline HAT 2.0, a rapid diagnostic test for human African trypanosomiasis based on recombinant antigens
Authors: Tablado Alonso Sara , Biéler Sylvain , Inocêncio da Luz Raquel , Verlé Paul , Büscher Philippe , Hasker Epco
Published: December 2024

Background

Rapid diagnostic tests for the serological detection of gambiense human African trypanosomiasis (gHAT) have been developed to overcome the limitations of the traditional screening method, CATT/T. b. gambiense. The Abbott Bioline human African trypanosomiasis (HAT) 2.0 rapid diagnostic test has recently been developed by Abbott using only recombinant antigens. The objective of this study was to evaluate its clinical sensitivity and specificity, in comparison with the other available rapid diagnostic tests and CATT.

Methodology/Principal Findings

For this study, archived plasma samples from 150 gHAT cases and 150 endemic controls originating from Chad, Guinea, the Democratic Republic of the Congo and Uganda were analysed on the following tests: CATT/T. b. gambiense, the HAT Sero K‐SeT, SD BIOLINE HAT and Abbott Bioline HAT 2.0 rapid diagnostic tests, and the immune trypanolysis test. The sensitivity and specificity of Abbott Bioline HAT 2.0 were 96.7% and 78.4%, respectively, and the sensitivity and specificity of SD BIOLINE HAT were 99.3% and 74.1%. The sensitivity and specificity of CATT were 98.7% and 89.2%. The sensitivity and specificity of HAT Sero K‐SeT were 99.3% and 81.3%.

Conclusions/Significance

The sensitivity and specificity of the Abbott Bioline HAT 2.0 are comparable to those of its predecessors HAT Sero K‐SeT and SD BIOLINE HAT. However, considering the decreasing prevalence of gHAT, a higher specificity of the tests used for screening is desirable to improve their positive predictive value.
A Cultural Evolutionary Model for the Law of Abbreviation
Authors: Morin Olivier , Koshevoy Alexey
Published: December 2024

Efficiency principles are increasingly called upon to study features of human language and communication. Zipf's law of abbreviation is widely seen as a classic instance of a linguistic pattern brought about by language users’ search for efficient communication. The “law”—a recurrent correlation between the frequency of words and their brevity—is a near‐universal principle of communication, having been found in all of the hundreds of human languages where it has been tested, and a few nonhuman communication systems as well. The standard explanation for the law of abbreviation derives from pressures for efficiency: speakers minimize their cumulative effort by using shorter words for frequent occurrences. This explanation, we argue here, fails to explain why long words exist at all. It also fails to explain why the law of abbreviation, despite being robust, is systematically weakened by many short and rare words. We propose an alternative account of the law of abbreviation, based on a simple cultural evolutionary model. Our model does not require any pressure for efficiency. Instead, it derives the law of abbreviation from a general pressure for brevity applying to all words regardless of their frequency. This model makes two accurate predictions that the standard model misses: the correlation between frequency and brevity is consistently weak, and it is characterized by heteroskedasticity, with many short and rare words. We argue on this basis that efficiency considerations are neither necessary nor sufficient to explain the law.
Medial hypothalamic MC3R signalling regulates energy rheostasis in adult mice
Authors: Possa‐Paranhos Ingrid Camila , Butts Jared , Pyszka Emma , Nelson Christina , Congdon Samuel , Cho Dajin , Sweeney Patrick
Published: December 2024

Although mammals resist both acute weight loss and weight gain, the neural circuitry mediating bi‐directional defense against weight change is incompletely understood. Global constitutive deletion of the melanocortin‐3‐receptor (MC3R) impairs the behavioural response to both anorexic and orexigenic stimuli, with MC3R knockout mice demonstrating increased weight gain following anabolic challenges and increased weight loss following anorexic challenges (i.e. impaired energy rheostasis). However, the brain regions mediating this phenotype are not well understood. Here, we utilized MC3R floxed mice and viral injections of Cre‐recombinase to selectively delete MC3R from the medial hypothalamus (MH) in adult mice. Behavioural assays were performed on these animals to test the role of MC3R in MH in the acute response to orexigenic and anorexic challenges. Complementary chemogenetic approaches were used in MC3R‐Cre mice to localize and characterize the specific medial hypothalamic brain regions mediating the role of MC3R in energy homeostasis. Finally, we performed RNAscope in situ hybridization to map changes in the mRNA expression of MC3R, pro‐opiomelanocortin and agouti‐related peptide following energy rheostatic challenges, as well as to characterize the MC3R expressing cells in dorsal MH. Our results demonstrate that MC3R deletion in MH increases feeding and weight gain following high‐fat diet feeding, and enhances the anorexic effects of semaglutide, in a sexually dimorphic manner. Furthermore, although the arcuate nucleus exerts an important role in MC3R‐mediated effects on energy homeostasis, viral deletion in the dorsal MH also resulted in altered energy rheostasis, indicating that brain regions outside of the arcuate nucleus also contribute to the role of MC3R in energy rheostasis. Together, these results demonstrate that MC3R‐mediated effects on energy rheostasis result from the loss of MC3R signalling in medial hypothalamic neurons and suggest an important role for dorsal‐MH MC3R signalling in energy rheostasis.

image

Key points

Melanocortin‐3‐receptor (MC3R) signalling regulates energy rheostasis in adult mice.

Medial hypothalamus regulates energy rheostasis in adult mice.

Energy rheostatic stimuli alter mRNA levels of agouti‐related peptide, pro‐opiomelanocortin and MC3R.

Dorsal‐medial hypothalamus (DMH) MC3R neurons increase locomotion and energy expenditure.

MC3R cell types in DMH are sexually dimorphic.
Entre objetos y palabras. De lo enunciado sobre el arte a lo enunciado por el arte colombiano
Authors: Pineda Repizzo Adryan Fabrizio
Published: December 2024

Este artículo presenta una reflexión en torno a la posición de enunciación en el arte colombiano, tomando como referente el problema de hablar por otros planteado por Linda Alcoff. Para ello, explora la distinción entre lo enunciado sobre el arte y lo enunciado por el arte, a la luz de algunos casos de obras de arte colombiano de la década de 1970 en adelante. En particular, aquellas obras que se apropian de un objeto de uso cotidiano pero cuya poética difícilmente se reduce a una importación de vanguardias. Ello permite contemplar una forma de identificar lo que el arte enuncia del contexto cultural (por ejemplo, el estado de viaje) y a la vez la posibilidad de provincializar el lenguaje del arte como modo de reconocer el potencial creativo y categorial emergente de la producción artística.
DYNAMIC TIP-OVER AVOIDANCE METHOD FOR MOBILE MANIPULATORS BASED ON THE EXTENDED ZMP ALGORITHM FOR HUMAN-ROBOT COLLABORATION
Authors: Tao Yong , Liu Haitao , Song Yian , Deng Changyi , Wang Baicun , Zheng Pai
Published: December 2024

Human-Robot Collaboration (HRC), as an important role in intelligent manufacturing, is widely utilized in modern factories. Mobile manipulators offer greater flexibility due to the ability to simultaneously move their bases and arms. This provides them an advantage facing challenging tasks such as flexible production and intelligent manufacturing. The environment of modern factories is complex, with slopes and thresholds at the entrance. Stability plays a fundamental role in complex environments. Therefore, for the future deployment and application of mobile manipulator in HRC, a novel dynamic tip-over avoidance method is proposed for mobile manipulators based on the extended zero moment point (ZMP) algorithm. This method extends the traditional ZMP stability criterion into three dimensions, deriving a system-wide three-dimensional zero moment point. The integration of the extended ZMP with redundant features facilitates adaptive weight matrix adjustments, enabling the robot to adapt its motion based on environmental constraints, thus preventing instability such as tip-over. Simulation verification is carried out with CoppeliaSim. Experimental verification is performed using the MR2000+Franka mobile manipulator. The results confirm that the extended ZMP algorithm effectively prevents tipping in complex environments.
Reading Users' Minds With Large Language Models: Mental Inference for Artificial Empathy in Design
Authors: Zhu Qihao , Chong Leah , Yang Maria , Luo Jianxi
Published: December 2024

In human-centered design, developing a comprehensive and in-depth understanding of user experiences—empathic understanding—is paramount for designing products that truly meet human needs. Nevertheless, accurately comprehending the real underlying mental states of a large human population remains a significant challenge today. This difficulty mainly arises from the tradeoff between depth and scale of user experience research: gaining in-depth insights from a small group of users does not easily scale to a larger population, and vice versa. This paper investigates the use of large language models (LLMs) for performing mental inference tasks, specifically inferring users' underlying goals and fundamental psychological needs (FPNs). Baseline and benchmark datasets were collected from human users and designers to develop an empathic accuracy metric for measuring the mental inference performance of LLMs. The empathic accuracy of inferring goals and FPNs of different LLMs with varied zero-shot prompt engineering techniques are experimented against that of human designers. Experimental results suggest that LLMs can infer and understand the underlying goals and FPNs of users with performance comparable to that of human designers, suggesting a promising avenue for enhancing the scalability of empathic design approaches through the integration of advanced artificial intelligence technologies. This work has the potential to significantly augment the toolkit available to designers during human-centered design, enabling the development of both large-scale and in-depth understanding of users' experiences.
Warning Signs, Monitoring Tools, and Actions Taken by World-Class Endurance Coaches in Cases of Underperformance
Authors: Talsnes Rune Kjøsen , Tønnessen Espen , Bucher Sandbakk Silvana , Haugen Thomas , Sandbakk Øyvind
Published: December 2024

Purpose: To describe warning signs, monitoring tools, and training- and non-training-related actions taken by world-class endurance coaches in cases of underperformance. Methods: Twelve highly acclaimed male Norwegian coaches known for coaching world-class endurance athletes with a remarkable collection of over 350 Olympic, World, and European Championship medals—primarily with Norwegian athletes—participated in the study. Data collection and analyses followed a 3-step pragmatic qualitative study design, including an initial questionnaire, in-depth interviews, and structured negotiation between researchers and coaches. Results: Reduced performance levels and discrepancies between external (speed or power output) and internal (heart rate, lactate concentrations, and rating of perceived exertion) training-intensity measures in competitions, key training sessions, and testing scenarios, as well as observed changes in emotional state and coach–athlete communication, were highlighted as early warning signs of underperformance. Consistently, daily follow-up, systematic use of training diaries, training-intensity measures, and information from testing scenarios were rated as the most important monitoring tools in both detection and management of underperformance. In cases of underperformance, ruling out medical conditions as underlying causes was followed by a decreased training load (intensity and volume) and actions to reduce life stress to restore athletes’ performance levels. Conclusions and Practical Applications: The presented data collectively propose applying both objectively and subjectively measured monitoring tools and systems to the early detection and management of underperformance in endurance athletes. In addition, this should be complemented by the holistic and observational role of the coach.
How Does Blood-Flow Restriction Alter Forehand Drive Performance and Muscle Recruitment in Tennis Players?
Authors: Han Zilong , Guo Zhenxiang , Yan Bing , Girard Olivier
Published: December 2024

Purpose: To examine the acute effects of forehand drive (FD) preconditioning with or without blood-flow restriction (BFR) on subsequent forehand performance and muscle recruitment in tennis. Methods: On separate visits, 12 well-trained tennis players participated in 4 randomized trials. Each visit included pretests (maximal muscle-activation capacity or FD performance), a preconditioning phase, and posttests after 5 minutes of rest (ie, similar to pretests). The preconditioning phase involved 5 sets of 10 maximal-effort FD exercises, performed either with (EXP) or without (CON) BFR (50% of the arterial occlusion pressure applied to dominant lower and upper limbs). During the pretest and posttests, either maximal voluntary isometric contraction (MVIC) with surface electromyography recordings of 6 muscles (gastrocnemius, rectus femoris, biceps brachii, anterior deltoid, external oblique, and pectoralis major) or ball velocity and accuracy of 10 crosscourt forehands were assessed. Results: Peak ball velocity increased from pretests to posttests (+2.3% [2.3%]; P = .004), regardless of the condition (P = .130). Peak ball accuracy remained unchanged (P > .05). From pretests to posttests, increases in electromyography levels for the biceps brachii muscle were larger for EXP (+14.5% [7.4%]; P < .001) than CON (+7.3% [10.3%]; P = .042). During the preconditioning phase, biceps brachii muscle activity was higher for EXP than CON (+7.4% [7.3%]; P = .006) during MVICs. Surface electromyography levels remained unchanged for other muscles. Conclusion: Executing FD exercises during a preconditioning phase acutely improved FD velocity but not accuracy in tennis, also accompanied by increased recruitment of the biceps brachii muscle. However, adding BFR did not significantly enhance these benefits.
Time to Rehabilitation in Pediatric Concussion Patients Influences Recovery Outcomes
Authors: Mathew Abel S. , Datoc Alison E. , Choi Daniel M. , Tak Chris R. , Abt John P.
Published: December 2024

Context: Targeted and directed rehabilitation with a healthcare provider can be an effective approach in the treatment of concussion, particularly for patients with protracted recovery, high symptom reporting, cervicogenic dysfunction, musculoskeletal involvement, and/or vestibular/oculomotor dysfunction. While many environmental and intrinsic medical history factors may influence concussion recovery, little is known about whether an individual’s recovery trajectory can be influenced by the amount of time taken to receive rehabilitation. The purpose of this study was to evaluate recovery trajectories of concussion patients requiring targeted multimodal rehabilitation after a specialty concussion clinic visit within ≤3 days, 4 to 7 days, and >7 days. We also sought to evaluate risk factors for protracted recovery. Design and Methods: The study involved a retrospective chart review of 103 patients (mean age = 13.78 [2.89]; 55% female) who, after their initial specialty concussion clinic visit, received rehabilitation in ≤3 days, 4 to 7 days, and >7 days. Patients were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023, and diagnosed with concussion by a specialist (primary care sports medicine physician, nurse practitioner, and/or neuropsychologist), referred for rehabilitation via physical therapy services, completed more than one rehabilitation session, and received medical clearance to initiate the return-to-sport protocol. Groups were compared based on relevant clinical factors, Vestibular Ocular Motor Screening, neurocognitive testing (Trails B-A), Post-Concussion Symptom Scale, days from injury to concussion evaluation, days from concussion evaluation to rehabilitation, number of rehabilitation sessions, recovery days after rehabilitation, and total recovery days (ie, days from injury to medical clearance to initiate return-to-sport protocol). Data analysis included chi-square, correlations, 1-way analysis of variance, and general linear regression. Adjusted odds ratios for protracted recovery were derived from a logistic regression model. Discussion: Days from injury to concussion evaluation (P < .001), days from concussion evaluation to rehabilitation (P = .006), and Trails B-A (P = .009), were significant predictors of total recovery time among pediatric concussion patients who required multimodal rehabilitation. Risk of protracted recovery increased by 34% each day from injury to concussion evaluation a patient did not receive treatment (Nagelkerke Pseudo R2 = .45; P < .001). Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to concussion care and rehabilitation for patients with a need for multimodal rehabilitation can improve recovery outcomes.
Challenges and Research Opportunities for Integrating Quantitative Electroencephalography Into Sports Concussion Rehabilitation
Authors: Ledwidge Patrick S. , Hartland Lindsey C. , Brickman Kirstiana , Burkhart Scott O. , Abt John P.
Published: December 2024

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion. QEEG’s low-cost relative to other brain recording/imaging techniques and precedent in clinical and medical care makes it a potential tool for concussion rehabilitation. Although uncommon, licensed and certified clinicians and medical professionals are implementing QEEG neurofeedback for concussion management within their score of practice. These approaches are not widely adopted nor recommended by professional medical societies, likely because of a limited evidence base of well-designed studies with available standard protocols. Thus, the potential efficacy of QEEG neurofeedback for treating persistent symptoms or cognitive dysfunction after sports-related concussion is unknown. This commentary will update the concussion clinician–scientist on the emerging research, techniques, and disagreements pertaining to the translation of QEEG neurofeedback for concussion management, particularly in the treatment of persistent cognitive difficulties. This commentary will also introduce to readers the fundamentals of how the electroencephalogram may be acquired, measured, and implemented during QEEG neurofeedback. An evidence base of supportive findings from well-designed studies, including those that are retrospective, outcomes-based, and, ultimately, placebo/sham-controlled is recommended prior to considering more widespread adoption of QEEG neurofeedback approaches for treating persistent symptoms or cognitive deficits after sports-related concussion. We review the considerable barriers to this research and clinical implementation, and conclude with opportunities for future research, which will be necessary for establishing the quality and efficacy of QEEG neurofeedback for concussion care.
Preparing Kinesiology’s Future Leaders: Navigating the Ever-Changing Higher Education Landscape
Authors: Guskiewicz Kevin M.
Published: December 2024

The field of Kinesiology is at a pivotal juncture in higher education. This paper, adapted from the Rainer and Julie Martens Invited Lecture at the 2024 National Academy of Kinesiology meeting, examines leadership’s crucial role in preparing the next generation of scholars and leaders in Kinesiology. Drawing on personal experience and leadership theory, the author presents a framework focused on hypothesis-driven, servant, and mission-oriented leadership. These principles address current challenges like budget constraints, enrollment fluctuations, equity concerns, and the balance between specialization and interdisciplinary collaboration. By fostering positive organizational culture and cultivating future leaders, the paper provides a roadmap for advancing Kinesiology’s role in academia and society. It integrates theoretical perspectives with practical insights, contributing to the ongoing dialogue about the future of Kinesiology in higher education, and offers guidance for current and aspiring leaders in the field.
Harnessing the Power of Sport and Physical Activity for Social Change: An Interdisciplinary Approach to Address Health Equity
Authors: Robinson Leah E. , Colabianchi Natalie , Hasson Rebecca E. , Heinze Kathryn , Kinnett-Hopkins Dominique , Shin NaRi
Published: December 2024

Health equity remains one of the most pressing challenges in public health, with significant inequities in health outcomes across various social, economic, and demographic lines. Factors such as socioeconomic status, race, ethnicity, gender, and geographic location often determine access to health care, healthy environments, and opportunities to engage in sport and physical activity. These inequities contribute to an increased risk of chronic diseases, poorer mental health, and reduced quality of life in marginalized populations. This paper explores the potential of sport and physical activity as powerful tools to address these persistent health inequities and support broader social change through an interdisciplinary approach. By leveraging insights from various disciplines including public health, sociology, psychology, education, epigenetics, and sport sciences (kinesiology) to form an interdisciplinary lens, this paper aims to highlight how sport and physical activity can not only reduce health inequities but also serve as catalysts for broader societal transformations.
Normal tension glaucoma following the treatment of normal pressure hydrocephalus
Authors: Tsilegeridis-Legeris Theodore , Babovic Radomir , Burton Benjamin J L
Published: December 2024

A man in his 70s developed progressive normal tension glaucoma following treatment for normal pressure hydrocephalus. This treatment included cerebrospinal fluid drainage and ventriculo-peritoneal shunt insertion to lower the intracranial pressure (ICP). Subsequent retinal nerve fibre layer thinning was visible on optical coherence tomography scans and was accompanied by corresponding glaucomatous visual field defects on perimetry. These changes occurred with normal intraocular pressure, indicating the patient had progressive normal tension glaucoma. The patient’s ICP-lowering treatment for normal pressure hydrocephalus may, therefore, have contributed to his normal tension glaucoma, for which there is an emerging association.
Fatal intravascular haemolysis due to copper sulfate poisoning: insights and literature review
Authors: Chandra Atanu , Ansar Mariam , Chatterjee Arkaketan , Chatterjee Rupak , Dasgupta Sugata
Published: December 2024

This case report is of a young woman who presented to a tertiary hospital after ingestion of 30 g copper sulfate. On admission she complained of abdominal pain, nausea and vomiting. Examination showed tenderness in the epigastric and right hypochondriac regions along with tender hepatomegaly. Initial management consisted of gastric lavage, administration of activated charcoal and chelation therapy. Although her vital signs were stable at admission, her condition rapidly deteriorated over time. By the second day she had developed acute kidney injury, severe intravascular haemolysis and significant methaemoglobinaemia necessitating haemodialysis and red blood cell transfusions. Despite aggressive treatment, she died 48 hours after presentation. This case highlights the fulminant nature of copper sulfate poisoning, marked by rapid progression to hepatic and renal failure and massive intravascular haemolysis. Prompt recognition and aggressive multidisciplinary interventions are essential to improve outcomes in such critical cases.
Diverse nature of ovarian tumours: Van Wyk-Grumbach syndrome
Authors: Mukhopadhyay Indrani , Roy Bidhan , Varma Aanchal , Singh Sanjay
Published: December 2024

Van Wyk-Grumbach syndrome is a unique condition where a medical illness like hypothyroidism manifests as large ovarian masses, ascites and precocious puberty. This is a treatable condition and warrants a suitable and timely recognition. This study includes a series of three cases over 3 years where despite the myriad of apparently grave symptoms and signs, they resolved on treatment with thyroxine. The investigations included serum TSH levels to rule out hypothyroidism, serum FSH and LH levels, X-ray wrist bones to ascertain onset of precocious puberty and tumour markers including serum CA 125 and LDH for ovarian tumours in the young. The follow-up included an ultrasound after 3 months of Tab Eltroxin to see resolution of ovarian masses which miraculously disappeared. Awareness of such a condition avoids any unnecessary and unwarranted surgical intervention which would hamper the young girls’ fertility.
Antenatal diagnosis of lethal Costello syndrome: how fetal exome sequencing using NHS England’s R21 pathway accelerated the diagnosis of non-immune hydrops and improved patient experience
Authors: Currie Jane L D , Caldas Patricia , Montague Imogen , Bills Victoria L
Published: December 2024

Costello syndrome is a very rare genetic condition with a poor prognosis, caused by a mutation in theHRASgene. We report two lethal cases diagnosed antenatally using recently introduced exome sequencing technology (R21). Without this testing, they are unlikely to have been diagnosed so promptly, which the families found very helpful in coping with their loss.
Theory-based behaviour modification of Asian adults with type-2 diabetes mellitus after participating in a novel telemonitoring system: a qualitative research study
Authors: Tan Ngiap Chuan , Gong Pei Pei , Lee Cia Sin , Goh Shawn Kuan Liang , Ang Seng Bin , Koh Gerald Choon Huat
Published: December 2024

Objective

Telemonitoring (TM) remotely monitors individuals’ health. Awareness of personal clinical data has resulted in improved glycaemic control in adults with type-2 diabetes mellitus (T2DM). However, its effects on their health-seeking behaviour remain unclear. This study aims to explore and understand the effects of a multicomponent TM system on self-efficacy in adults with T2DM.

Design

A qualitative study using semistructured interviews.

Setting

A public primary care clinic which is located at an estate in north-eastern Singapore with a population of about 300 000 multiethnic Asian residents.

Participants

21 participants who completed 6 months of TM intervention which included immediate feedback on glucose and blood pressure readings, educational videos on exercise and nutrition, and personalised support with TM nurse when clinical parameters met high glucose or blood pressure thresholds.

Results

The health belief model was used to explain the participants’ behaviour change, including (1) immediate feedback from TM clinical parameters (blood pressure and glucose), raised their awareness of their health status and disease control to motivate behaviour change; (2) notification of higher glucose through TM allowed patients to reflect on their recent food consumption and nudged them to select healthier food options; (3) App teleeducation improved health literacy and supported lifestyle changes; (4) cues for action through personalised engagement with TM nurse and via automated reminders and (5) the TM system enhanced self-efficacy by modifying their multifaceted self-care behaviours.

Conclusion

TM heightened understanding among adults with T2DM of their potential for health complications and increased awareness of the benefits of proper diabetes management. It also helped lower the barriers to self-management and further enhanced their self-efficacy in self-care. The system and care team provided users with cues for health which was perceived to lead to adapting their lifestyle in order to achieve better health outcomes.

Clinical Trials registration number

NCT04306770
Effect of multiple counselling contacts along the continuum of care on use of postpartum family planning in a cohort of Ethiopian women: a dose-response analysis
Authors: Pfitzer Anne , Jima Gebi Husein , Sitrin Deborah , Ayalew Firew , Ahmed Saifuddin
Published: December 2024

Objective

Dose-response analysis of the effect of each additional contact where family planning (FP) was discussed during antenatal, delivery, postnatal or immunisation visits on the uptake of postpartum family planning (PPFP) within 12 months.

Design

A cohort where pregnant women were enrolled and reinterviewed approximately 12 months postpartum. Life table analyses examined differentials in probabilities of adopting contraception over 12 months postpartum by level of exposure to FP counselling. Competing risks regression analysis examined the dose effects in HRs by the number of maternal, newborn or child health (MNCH) contacts where FP was discussed, adjusted for confounding covariates.

Setting

Two Arsi zone woredas: Oromia and Ethiopia.

Participants and measures

722 pregnant women enrolled, and 706 successfully reinterviewed 12 months postpartum about each MNCH contact during pregnancy, delivery and later visits, whether these included any PPFP counselling and PPFP use.

Main results

Two-thirds of the cohort delivered at home. The average number of MNCH contacts women received was 7.6, while the average number where FP was discussed was 2.8. The cumulative probability of PPFP uptake was higher for women who received FP information during at least one MNCH contact, regardless of place of delivery. Each additional MNCH contact where FP was discussed increased the likelihood of PPFP uptake by 14% (95% CI 8% to 20%) or 9% (95% CI 5% to 13%), depending on place of birth. PPFP did not increase with additional contacts without FP information.

Conclusions

While PPFP conversations immediately after a facility birth generated the greatest chance of affecting use, integrating at every visit in the continuum had more impact.

Trial registration number

ClinicalTrials.gov,NCT03585361.
Cluster randomised controlled trial of double-dose azithromycin mass drug administration, facial cleanliness and fly control measures for trachoma control in Oromia, Ethiopia: the stronger SAFE trial protocol
Authors: Last Anna R , Shafi Abdurahman Oumer , Greenland Katie , Robinson Ailie , Collin Claire , Czerniewska Alexandra , Etu Edao Sinba , Versteeg Bart , Butcher Robert , Guye Meseret , Legesse Demitu , Nuri Kedir Temam , Shuka Gemeda , Haji Mohammed Yousuf Munira , Dheressa Gaddisa , Dumessa Gebeyehu , Akalu Melesse , Tadesse Mesfin , Adugna Kumsa Dereje , Seife Gebretsadik Fikre , Abashawl Aida , Habtamu Esmael , Sarah Virginia , Alemayehu Wondu , Solomon Anthony , Weiss Helen Anne , Logan James G , Macleod David , Burton Matthew J
Published: December 2024

Introduction

Trachoma is caused by the bacteriumChlamydia trachomatis(Ct). The WHO recommends the SAFE strategy for trachoma elimination: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Multiple rounds of SAFE implementation have proven insufficient to eliminate trachoma in Ethiopia, where over 50% of the global trachoma burden remains. More effective antibiotic treatment schedules and transmission-suppressing approaches are needed. The aim of stronger SAFE is to evaluate the impact of a novel package of interventions to strengthen the A, F and E of SAFE on the prevalence of ocularCtand trachoma in Oromia, Ethiopia.

Methods and analysis

68 clusters were randomised in a 1:1:1:1 ratio to one of (1) standard A/standard F&E (standard SAFE), (2) standard A/enhanced F&E, (3) enhanced A/standard F&E or (4) enhanced A/enhanced F&E (stronger SAFE). Enhanced A includes two height-based doses of oral azithromycin (equivalent to 20 mg/kg) given as single doses 2 weeks apart, as mass drug administration, annually. Enhanced F&E includes fly control measures (permethrin-treated headwear and odour-baited traps) and face-washing hygiene behaviour change implemented at household level in selected communities. The interventions will be implemented and reinforced over 3 years.

The primary outcome is the prevalence of ocularCtby quantitative PCR in children aged 1–9 years at 36 months. A key secondary outcome is the prevalence of active (inflammatory) trachoma in the same children, assessed by validated trachoma graders and conjunctival photography. Laboratory technicians and photo-graders are masked to treatment allocation. Other important secondary analyses include process evaluations, assessment of behaviour change, fly indicators, adherence and coverage of interventions and a cost analysis.

Ethics and dissemination

Study protocols have been approved by the National Research Ethics Review Committee of the Ethiopian Ministry of Science and Higher Education and the London School of Hygiene & Tropical Medicine Ethics Committee. An independent data safety and monitoring board oversees the trial. Results will be disseminated through peer-reviewed publications, presentations and reports.

Trial registration number

ISRCTN40760473.
Point-of-care tests, diagnostic uncertainty and antimicrobial stewardship in the ICU: procalcitonin or PCR to aid antibiotic-stop decisions – an observational cohort study
Authors: Lau Timothy , Nurek Martine , Singhal Archit , Moore Luke , Mughal Nabeela , Singh Suveer
Published: December 2024

Objectives

Intensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/− de-escalation to aid stop decisions. We hypothesised that a direct infection indicator, PCR-POCT, would influence stop judgements more than indirect PCT. Accordingly, we tested antibiotic-stop decisions when presented with a negative PCR-POCT despite borderline-positive PCT.

Designs

Observational prospective study.

Setting

ICU.

Participants

66 ICU clinicians from University hospitals.

Methods

Clinicians saw four scenarios of different clinico-biological trajectories: (1) clear improvement, (2) clear worsening, (3) discordant—clinically better/biologically worse and (4) discordant—clinically worse/biologically better. Participants gave an initial decision (stop/continue/continue–escalate/continue–de-escalate). Then PCR-POCT and/or PCT was offered (accept/decline). After a negative PCR-POCT and borderline-positive PCT result, a final antibiotic decision was taken.

Measures

Proportion of stop decisions before versus after test results per scenario. The association of the final decision with the clinician’s change in confidence, willingness to request the biomarker(s) and the case trajectory was determined.

Results

Fewer clinicians than expected stopped antibiotics versus baseline (36%, 94/264 vs 42%, 110/264, p=0.045). This was so in three of four scenarios, significantly less in the improvement (p<0.001) and the discordant clinically better scenario (p=0.024). PCT was requested more frequently than PCR-POCT (61% vs 53%, p<0.001). PCT requesters (vs declining) were significantly less inclined to stop antibiotics (p<0.001), while PCR-POCT requesting led to more stopping (p<0.001), before knowing the test results.

Conclusions

A negative PCR-POCT result did not increase clinicians’ inclination to stop antibiotics when alongside a borderline-positive PCT. This reflects clinicians’ natural risk aversion. PCT was more popular than PCR-POCT, but PCR-POCT was more likely to aid stop decisions.

Their comparison, role, utility and selective deployment for influencing antibiotic-stop decisions more effectively require a large randomised controlled trial.
Transforming Households with Refraction and Innovative Financial Technology (THRIFT): study protocol for a randomised controlled trial of vision interventions and online banking among the elderly in Kurigram
Authors: Shitol Sharmin Akter , Aftab Ishrat Binte , Piyasena Prabhath , Lohfeld Lynne , Rayasam Sridevi , Challa Nagamani , Sangani Payal , Sigwadhi Lovemore Nyasha , Rahman H M Masudur , Khanna Rohit C , Chan Ving Fai , Barua Mrittika , Pant Sonia , Adhvaryu Achyuta , Nyshadham Anant , Sarker Malabika , Mettla Asha Latha , Haque Enam , MacKenzie Graeme , Alam Sadiq , Gudwin Ella , Clarke Mike , Shonchoy Abu , Rabbani Atonu , Congdon Nathan
Published: December 2024

Introduction

Presbyopia, difficulty in seeing close-ups, affects a billion people globally. Mobile financial services (MFS) have been mandated since January 2021 for Bangladesh government social safety net payments, including old age allowance (OAA) and widow allowance (WA). We report the protocol for the Transforming Households with Refraction and Innovative Financial Technology randomised trial assessing the impact on the use of online banking of providing presbyopic safety net beneficiaries with reading glasses, and brief smartphone and mobile banking app training.

Methods and analyses

Eligible participants (n=484) are OAA (men aged 65–70 years; women aged 62–70) or WA recipients (women aged 48–60) with presbyopia as their only vision problem, passing a smartphone-based test of numeracy, cognition and dexterity, and not currently owning a smartphone or independently using MFS. All participants receive smartphones loaded with a mobile banking app and a transaction-tracking app and are randomised 1:1 to receive immediate free near-vision glasses and half-day training for smartphone and banking app use (intervention), or glasses and training 12 months later (control). The primary outcome is the mean quarterly number of mobile bank transactions over the 12-month follow-up period, comparing study groups, with and without adjustment. Secondary outcomes include food security, healthcare access and social connectedness.

Ethics and dissemination

The protocol was approved by ethics committees at Queen’s University Belfast (reference #MHLS22_69) and BRAC James P Grant School of Public Health (reference #IRB-21 August’22-028). The trial is conducted in accordance with the Declaration of Helsinki and national regulations in Bangladesh, and results will be published in open-access, peer-reviewed journals.

Trial registration number

NCT05510687; ClinicalTrials.gov.
Digital health technologies for metabolic disorders in older adults: a scoping review protocol
Authors: Huynh Panitda , Fleisch Elgar , Brändle Michael , Kowatsch Tobias , Jovanova Mia
Published: December 2024

Introduction

Metabolic disorders (type 2 diabetes, insulin resistance, hyperglycaemia, obesity, hyperlipidaemia, hypertension, non-alcoholic fatty liver disease and metabolic syndrome) are leading causes of mortality and disability worldwide. These disorders disproportionately affect older adults relative to those younger. Digital health technologies (DHTs), such as patient monitoring, digital diagnostics and digital therapeutics, emerge as promising tools for health promotion in day-to-day life. However, their role in targeting metabolic disorders, particularly among a key demographic of older adults, is not yet fully understood. Thus, this study aims to scope the use of DHTs in managing metabolic health disorders among older adults. To our knowledge, this is the first review to categorise DHTs for older adults with metabolic disorders, contributing to the growing literature in the intersection of metabolic disorders and DHTs.

Methods and analysis

We will conduct a scoping review following the recommended framework by Arksey and O’Malley. Our search will focus on three primary concepts: metabolic disorders, DHTs and older adults. We plan to search five online databases (Cochrane, ScienceDirect, PubMed, Scopus and Web of Science) to identify original research articles published between January 2014 and January 2024. Two independent reviewers will screen articles based on predefined eligibility criteria, with a third reviewer resolving conflicts. Data will be extracted using a standardised form, and results will be synthesised qualitatively and quantitatively. The database searches, data collection and analysis are planned and have not been conducted.

Ethics and dissemination

No ethics approval is required for this protocol and scoping review. Data will be used only from published studies with appropriate ethics approval. Results will be disseminated in a peer-reviewed publication.
Move to improve - Prescribing physical activity and deprescribing paracetamol for low back pain: Protocol for a hybrid type III feasibility study
Authors: Comachio Josielli , Halliday Mark , Ferreira Paulo H , Patterson Thomas , Roberts David , Ho Emma Kwan-Yee , Beckenkamp Paula R
Published: December 2024

Introduction

People experiencing low back pain (LBP) could potentially benefit from multimedia educational resources that integrate self-management strategies and improve awareness of the benefits of staying active and about medications that offer limited benefits, such as paracetamol. Primary care waiting rooms are potential spaces for presenting health promotion resources to improve health literacy through the dissemination of easily accessible health information. This feasibility study aims to explore the feasibility of conducting a large-scale trial to investigate the benefits of multimedia educational resources delivered at outpatient physiotherapy waiting rooms of public hospitals to support patients to participate in physical activity and reduce paracetamol intake for LBP.

Methods and analysis

A hybrid type III feasibility study will be conducted at a public hospital in Sydney, Australia, from March to September 2024. The multimedia strategy development (pre-implementation) involves collaborative planning among healthcare professionals, policymakers and community stakeholders in physiotherapy practice. Phase II (implementation) will evaluate the acceptability and implementation processes of delivering the multimedia educational resources in the physiotherapy waiting room following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. Findings from the quantitative data will be reported descriptively, and categorical data by counts and percentages. Qualitative (open-ended questions) will be integrated with the feasibility trial outcomes to inform the design of a full-scale randomised controlled trial.

Ethics and dissemination

This study has ethical approval from the Sydney Local Health District Human Research Ethics Committee (2023/ETH02683). The findings will be disseminated via peer-reviewed publications, articles in relevant newsletters and presentations at national and international conferences. Social media platforms including X will also be used to generate awareness.
Methods for extrapolating costs and effects in economic evaluations of telehealth interventions: a scoping review protocol
Authors: Raunbak Sabine Michelsen , Weinreich Ulla Møller , Johnsen Søren Paaske , Udsen Flemming Witt
Published: December 2024

Introduction

Reviews of economic evaluations of telehealth interventions found that the current evidence is inconsistent with standard guidelines for conducting economic evaluation. The reviews conclude that most economic evaluations of telehealth interventions are small-scale and short-term. The choice of time horizon in economic evaluation, in general, is an important part. When using longer time horizons, it often involves extrapolating costs and effects, where assumptions are taken. Different tools for extrapolating cost and effects in economic evaluations exist. However, there is a heterogeneity in the methods used, which can create different results. Therefore, this study aims to review the design and conduct of existing long-term economic evaluations of telehealth interventions using extrapolation methods. Furthermore, the aim is to map the methods used for extrapolation.

Methods and analysis

A scoping review is conducted to investigate the aim of this study. To identify relevant studies for inclusion in the scoping review, a systematic literature search will be conducted in the electronic databases: Embase (Elsevier), PubMed (National Library of Medicine), EconLit (ProQuest), Web of Science (Clarivate), NHS Economic Evaluation Database (NHS Centre for Reviews and Dissemination) and CINAHL (EBSCO Industries). A grey literature search will be conducted in Google Scholar. The search will be supplemented with studies identified by reviewing the references in the included studies and reviewing the citations of the included studies. The extracted data from the studies in the scoping review will be presented in relevant descriptive tables and summarising descriptions. The results will be reported in correspondence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.

Ethics and dissemination

Hence, the methodology used is a scoping review of the existing literature; no ethical or safety considerations are identified for this study. The plan for dissemination includes a peer-reviewed publication and possible poster or oral presentations.