bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting unusual postoperative vertical downward movement of mandible after surgery-first approach using intraoral vertical ramus osteotomy
Authors: Nam Soo-Hyun , Cha Jung-Yul , Lee Kee-Joon , Lee Sang-Hwy , Choi Sung-Hwan , Yu Hyung-Seog
Published: October 2024

Background

In very rare cases, patients who have undergone surgery-first approach with intraoral vertical ramus osteotomy (IVRO) exhibit unusual downward movements of mandible even up to 1-year post surgery, which makes it difficult for orthodontists to stabilize the occlusion during the postoperative orthodontic period. The aim of this study was to identify factors affecting the unusual downward movement of the mandible 1-year after the surgery-first approach using IVRO, while focusing on cephalometric values.

Methods

This retrospective cohort study sample was divided into two groups based on the amount of vertical movement of the B-point 1-year post surgery (Group S, predictable upward movement; Group U, unpredictable downward movement greater than 2 mm). To evaluate cephalometric changes between the two groups, cephalograms were obtained before surgery, 1 day after surgery, 1 month after surgery, and 1 year after surgery. The data were analyzed using the independent t-test, Mann–Whitney U test with Bonferroni correction, Pearson correlation analysis, and multiple regression analysis.

Results

At the initial examination, Group U showed a shallower anterior overbite. The vertical surgical change in the B-point was statistically different between the two groups (p < 0.001), indicating that group U exhibited more upward movement of the mandible during surgery. Group U showed significant downward movement of the mandible 1 month after surgery, and this finding persisted until 1 year postoperatively. Clockwise rotation of the mandible was also observed. Surgical vertical movement of the B-point showed a strong correlation with postoperative vertical movement of mandible (r = -0.674; p < 0.001) along a linear relationship, indicating that the amount of postoperative vertical downward movement of the mandible increased as the amount of surgical upward movement of the B-point increased (R2 = 0.449; p < 0.001).

Conclusions

This study revealed that unusual downward movement of the mandible after a surgery-first approach using IVRO is correlated with the amount of upward movement during the surgery. When planning surgery, in cases in which a significant upward movement of the mandible is anticipated, orthodontists should prepare for the possibility of subsequent unusual downward movement and a tendency for the anterior overjet to decrease during the postoperative orthodontic period.
A prospective cohort study on the role of surgical mentorship on medical students’ surgical experience and attitudes towards surgery
Authors: Kerdegari Nikki , Tandanu Edelyne , Lee Karen , Zakri Rhana , Dasgupta Prokar , Chandak Pankaj
Published: October 2024

Background

Exposure to surgery during medical school is limited. We ran a mentorship scheme pairing students at a medical school with local surgeons to improve undergraduate insight. We evaluated the effectiveness of mentorship in increasing surgical exposure and drivers for students seeking surgical mentorship.

Methods

35 surgeons across 7 specialties were recruited and matched with 37 students in years 2–4 for 7 months. Quantitative and qualitative evaluation was done with pre-, mid- and post-scheme questionnaires. Students rated confidence across pursuing a career in surgery, surgical exposure, career insight, understanding the application process, contacts, portfolio development, research knowledge and pursuing extra-curricular activities related to surgery using a 5-point Likert scale. Paired t-tests were performed to measure students’ confidence before and after the scheme.

Results

Of students that completed all 3 questionnaires (n = 21), conducting research/audit was most frequently selected as a main goal (81.0%), followed by theatre experience (66.7%) and career progression support (28.6%). The number of students that had assisted in theatre increased by 50.0%. Confidence ratings across all domains increased with 7/8 (87.5%) exhibiting a statistically significant improvement (p < 0.05). The greatest improvement was seen in having adequate contacts in surgery from 2.05 to 3.33 (p = 0.00). 95.2% would recommend the scheme.

Conclusions

Students gained significantly more surgical experience and were better equipped with the knowledge required to pursue a surgical career. Mentorship schemes are invaluable in supplementing the undergraduate curriculum and empowering students.

Trial registration

Ethical clearance granted by King’s College London Research Ethics Committee, Reference Number MRSU-22/23-34530. .
Not taught in medical school but needed for the clinical job – leadership, communication and career management skills for final year medical students
Authors: Behling Felix , Adib Sasan Darius , Haas Patrick , Becker Hannes , Oberle Linda , Weinbrenner Eliane , Nasi-Kordhishti Isabella , Roder Constantin , Griewatz Jan , Tatagiba Marcos
Published: October 2024

Background

Starting the first job as a young physician is a demanding challenge. Certain skills are important to master this transformation that go beyond the theoretical knowledge and practical skills taught in medical school. Competencies such as communication, leadership and career management skills are important to develop as a young physician but are usually not sufficiently taught in medical school in a structured and comprehensive way.

Methods

We performed an online survey among final year medical students regarding how they perceive their current competency level in communication, leadership and career management skills. We also assessed how they rate the importance to acquire these competencies and the current emphasis during their medical school education regarding these topics.

Results

Of 450 final year medical students 80 took part in the voluntary survey and 75 complete datasets were returned (16.7%). The majority of respondents rated different communication skills, leadership skills and career management skills as important or very important for their later clinical work. However, most students felt to be poorly or very poorly prepared by the current medical school curriculum, especially for certain leadership and career management skills. Overall, 90.7% of participants expressed interest in an additional educational course that covers subjects of communication, leadership and career management skills during the later stage of medical school, preferably as a hybrid in-person session that also offers synchronous online participation.

Conclusions

The results of the survey express the need to address communication, leadership and career management skills in the medical curriculum to be better prepare students for the demands of residency and their further course as physicians. An educational format during the final year of medical school may be suitable to address mentioned topics in the framework of clinical practical exposure.
Large-scale identification of social and behavioral determinants of health from clinical notes: comparison of Latent Semantic Indexing and Generative Pretrained Transformer (GPT) models
Authors: Roy Sujoy , Morrell Shane , Zhao Lili , Homayouni Ramin
Published: October 2024

Background

Social and behavioral determinants of health (SBDH) are associated with a variety of health and utilization outcomes, yet these factors are not routinely documented in the structured fields of electronic health records (EHR). The objective of this study was to evaluate different machine learning approaches for detection of SBDH from the unstructured clinical notes in the EHR.

Methods

Latent Semantic Indexing (LSI) was applied to 2,083,180 clinical notes corresponding to 46,146 patients in the MIMIC-III dataset. Using LSI, patients were ranked based on conceptual relevance to a set of keywords (lexicons) pertaining to 15 different SBDH categories. For Generative Pretrained Transformer (GPT) models, API requests were made with a Python script to connect to the OpenAI services in Azure, using and models. Prediction of SBDH categories were performed using a logistic regression model that included age, gender, race and SBDH ICD-9 codes.

Results

LSI retrieved patients according to 15 SBDH domains, with an overall average PPV $$\ge$$
≥
83%. Using manually curated gold standard (GS) sets for nine SBDH categories, the macro-F1 score of LSI (0.74) was better than ICD-9 (0.71) and GPT-3.5 (0.54), but lower than GPT-4 (0.80). Due to document size limitations, only a subset of the GS cases could be processed by GPT-3.5 (55.8%) and GPT-4 (94.2%), compared to LSI (100%). Using common GS subsets for nine different SBDH categories, the macro-F1 of ICD-9 combined with either LSI (mean 0.88, 95% CI 0.82-0.93), GPT-3.5 (0.86, 0.82-0.91) or GPT-4 (0.88, 0.83-0.94) was not significantly different. After including age, gender, race and ICD-9 in a logistic regression model, the AUC for prediction of six out of the nine SBDH categories was higher for LSI compared to GPT-4.0.

Conclusions

These results demonstrate that the LSI approach performs comparable to more recent large language models, such as GPT-3.5 and GPT-4.0, when using the same set of documents. Importantly, LSI is robust, deterministic, and does not have document-size limitations or cost implications, which make it more amenable to real-world applications in health systems.
Churning the tides of care: when nurse turnover makes waves in patient access to primary care
Authors: Arredondo Kelley , Hughes Ashley M. , Lester Houston F. , Pham Trang N.D. , Petersen Laura A. , Woodard LeChauncy , SoRelle Richard , Jiang Cheng , Oswald Frederick L. , Murphy Daniel R. , Touchett Hilary N. , Hamer Joshua , Hysong Sylvia J.
Published: October 2024

Background

Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.

Objective

This study aims to empirically assess how the stability of RN staffing within team-based primary care affects patient access to care.

Methods

A retrospective database review using clinical and administrative data from the VHA over 24 months. Participants included 5,897 PC PACTs across 152 VHA healthcare facilities in the United States and its territories. The stability of personnel in the RN role was categorized as: RN continuous churn, RN staffing instability and RN vacancy. All 3 categories were compared to teams with RN stability (i.e., same person in the role for the entire 24-month period). Access measures included: average third-next-available appointment, established patient average wait time in days, urgent care utilization, emergency room utilization, and total inbound-to-outbound PC secure messages ratio.

Results

RN continuous churn within PACTs had a significant impact on third-next-available appointment (b = 3.70, p < 0.01). However, RN staffing instability and vacancy had no significant relationship with any of the access measures. Several risk adjustment variables, including team full-time equivalency, team stability, relative team size, and average team size, were significantly associated with access to health care.

Conclusions

Teams are impacted by churn on the team. Adequate staffing and team stability significantly predict patient access primary care services. Healthcare organizations should focus on personnel retention and strategies to mitigate the impact(s) of continuous RN turnover. Future research should examine the relative impact of turnover and stability of other roles (e.g., clerks) and how team members adapt to personnel changes.
Understanding Ixodes ricinus occurrence in private yards: influence of yard and landscape features
Authors: Mazaleyrat Anna , Durand Jonas , Carravieri Irene , Caillot Christophe , Galley Cyril , Capizzi Sandrine , Boué Franck , Frey-Klett Pascale , Bournez Laure
Published: October 2024

Background

Lyme borreliosis is the most frequent zoonotic disease in the northern hemisphere and is transmitted by ticks of the genus Ixodes. Although many people are bitten by ticks in private yards, our understanding of the factors associated with their presence in these areas remains limited. To address this gap, we used a citizen science approach to identify the local and landscape features associated with tick presence in yards.

Methods

This study was conducted near Nancy, a city in northeastern France, from 2020 to 2022. Citizen scientists collected ticks in their yard on a single event (n = 185) and measured 13 yard features. Additionally, we computed 11 features related to the landscape composition and spatial configuration surrounding these yards. Using generalized linear mixed models, we determined the yard and landscape features associated with the presence of ticks and nymphal Ixodes ricinus (hereafter nymphs), the life stage, and species that mostly bite humans.

Results

Despite a low density, ticks were found in 32% of the yards, including yards in urbanized areas. At the transect level, the likelihood of finding a nymph was nearly three times higher in transects shaded by vegetation compared to those in open areas, with no relationship between nymph occurrence and transect location or grass height. At the yard level, the occurrence of ticks and nymphs was related to both yard and landscape characteristics. Nymph and tick occurrence were more than twice as high in yards with signs of deer and a wood/brush pile compared to those without these characteristics, and increased with the connectivity of vegetation areas and the percentage of forest areas in the landscape.

Conclusions

Our study reveals that private yards across an urbanization gradient are locations of tick exposure with tick presence linked to both yard and landscape factors. These findings emphasize the importance of public awareness regarding tick exposure in yards and provide crucial insights for future public health prevention campaigns.
Insight of autonomic dysfunction in CLN3 disease: a study on episodes resembling paroxysmal sympathetic hyperactivity (PSH)
Authors: Baekmann C. , Handrup M. M. , Molgaard H. , Ejerskov C. , Jensen H. K. , Ostergaard J. R.
Published: October 2024

Background

Recurrent non-epileptic episodes resembling paroxysmal sympathetic hyperactivity (PSH) have been observed in adolescents with Juvenile Ceroid Lipofuscinosis (CLN3-disease) and a possible association to an autonomic dysfunction has been suggested. The objective of the present study was to investigate the dynamics of the autonomic activity up to, during, and in the time after individual attacks. We include all seven suitable CLN3 patients in Denmark ≥ 15 years of age. HRV parameters were assessed from continuous heart rate monitoring during seven consecutive days and a particular focus of HRV parameters was obtained in close temporal context to clinically recurrent PSH-like episodes. In addition, the likelihood of PSH was assessed by caregiver’s description and by video documentation.

Results

Respectively eight and five episodes were recorded in two patients (18 and 20 years of age). The episodes were all safely superior to the cut off values of the clinical assessment score to be considered PSH-like episodes. During all 13 episodes, HRV revealed a statistically significant decrease in root mean square of successive differences (RMSSD) and standard deviation of the Poincaré-Plot interval (SD1) in the minutes prior to the clinical onset of the episodes, both indicating a sudden decrease in parasympathetic activity in advance of the onset. The reduced activity remained low during the episodes, and 15–30 min following the attack cessation, the parasympathetic activity had returned to pre-attacks levels. The sympathetic HRV parameters were unchanged resulting in a sympathetic overactivity during the episodes. In a third participant (32 years of age), in whom severity of PSH-like episodes had been gradually reduced during the last years, five episodes were registered. A similar temporally related reduction of the parasympathetic activity was found, but because the sympathetic activity decreased as well, no sympathetic dominance developed, which most reasonable is the reason to the clinically reduced expression of the episodes.

Conclusion

The documented transient withdrawal of parasympathetic activity leading to a paroxysmal unbalanced sympathetic hyperactivity most probably accounts for the PSH-like episodes occurring in post-adolescent CLN3 patients. The findings shed new light on both aetiology and possible preventative and therapeutic measures.
Prevalence and long-term change in alcohol consumption: results from a population-based cohort in Southern India
Authors: Gowri S. Mahasampath , Belavendra Antonisamy , Vasan Senthil K. , Keerthi S. , Andreasson Sven
Published: October 2024

Background

Alcohol consumption in India is below the global average, with limited data on long-term effects. The current study aims to examine changes over time among alcohol consumers, the pattern of drinking and help-seeking for alcohol problems among South Indian men.

Method

Data on the intake of various alcohol types were collected through standard questionnaires in two adult follow-ups [Baseline: 1998–2002, Follow-up: 2016–2019] from male participants in the Vellore birth cohort (VBC). Alcohol intake was converted to weekly standard drink units for analysis. Data on drinking patterns using the Alcohol Use Disorder Identification Test (AUDIT) and information on help-seeking among problem drinkers were collected during follow-up. Socio-demographic associations with alcohol consumption were determined using logistic regression.

Results

The prevalence of alcohol consumption was 54.5% and 47.7% at the baseline and follow-up, respectively. Over two decades, 12% of men reported to have newly started drinking and 18% quit drinking. Lower education and lower socio-economic status (SES) were the strongest predictors of alcohol consumption. The AUDIT assessment among drinkers reported hazardous drinking of 38.4%, harmful drinking of 4.7% and 3.7% probable alcohol dependence. Among the persons with high AUDIT scores, 25% were concerned about high consumption, and 9% sought help to stop their alcohol consumption.

Conclusion

Our results showed a decline in alcohol consumption in this cohort over two decades. Among drinkers, a high proportion report hazardous and harmful consumption. Low levels of education and SES are significant predictors of alcohol consumption. A low proportion of help-seeking reflects alcohol-related stigma in the community.
Protein profile of extracellular vesicles derived from adult Parascaris spp.
Authors: Manikantan Vishnu , Ripley Nichol E. , Nielsen Martin K. , Dangoudoubiyam Sriveny
Published: October 2024

Background

Parascaris spp. represent a significant threat to equine health worldwide, particularly in foals. The long-term survival of parasites in the host necessitates persistent modulation of the host immune response. Intercellular communication achieved through the exchange of molecules via extracellular vesicles (EVs) released from the parasite could be a crucial factor in this regard. This study aimed to isolate and characterize EVs released by adult male and female Parascaris worms and conduct a proteomic analysis to identify sex-specific proteins and potential immunomodulatory factors.

Methods

Live adult Parascaris worms were collected, and EVs were isolated from spent culture media using differential ultracentrifugation. Nanoparticle tracking analysis and transmission electron microscopy confirmed the size, concentration, and morphology of the isolated EVs. Proteins within the isolated EVs were analyzed using mass spectrometry-based proteomics (LC–MS/MS).

Results

Proteomic analysis revealed a total of 113 proteins in Parascaris EVs, with several proteins showing homology to known helminth exosome proteins and exhibiting immunomodulatory functions. Sex-specific differences in EV protein composition were observed, with a distinct abundance of C-type lectins in female EVs, suggesting potential sex-specific roles or regulation. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed metabolic pathways shared between male and female Parascaris EVs, as well as differences in signal transduction, and cell growth and death pathways, indicating sex-specific variations.

Conclusions

These findings imply that Parascaris EVs and their protein cargo are complex. This data potentially opens avenues for discovering innovative approaches to managing and understanding helminth infection.

Graphical Abstract
Equine coronavirus infection and replication in equine intestinal enteroids
Authors: Kambayashi Yoshinori , Nemoto Manabu , Ochi Akihiro , Kishi Daiki , Ueno Takanori , Tsujimura Koji , Bannai Hiroshi , Kawanishi Nanako , Ohta Minoru , Suzuki Tohru
Published: October 2024

In this study, equine intestinal enteroids (EIEs) were generated from the duodenum, jejunum, and ileum and inoculated with equine coronavirus (ECoV) to investigate their suitability as in vitro models with which to study ECoV infection. Immunohistochemistry revealed that the EIEs were composed of various cell types expressed in vivo in the intestinal epithelium. Quantitative reverse-transcription PCR (qRT-PCR) and virus titration showed that ECoV had infected and replicated in the EIEs. These results were corroborated by electron microscopy. This study suggests that EIEs can be novel in vitro tools for studying the interaction between equine intestinal epithelium and ECoV.
Behavioral responses of predatory flies of the genus Medetera Fischer von Waldheim (Diptera: Dolichopodidae) and the tree-killing beetle Ips typographus L. (Coleoptera: Scolytinae) to odor compound blends
Authors: Sousa Maria , Andersson Artur , Englund Jan-Eric , Flöhr Adam , Pollet Marc , Karlsson Green Kristina , Birgersson Göran , Becher Paul G.
Published: October 2024

Key Message

Medetera (Fischer von Waldheim) flies, natural enemies of the spruce bark beetle Ips typographus (L.), were attracted to synthetic blends of compounds produced by infested spruce trees. A subset of trapped specimens revealed sixteen Medetera species. Most abundant were M. signaticornis, M. infumata, and M. prjachinae. Only blends containing beetle-produced compounds significantly attracted Medetera spp. and I. typographus.

Context

Fly species of the genus Medetera (Fischer von Waldheim) (Diptera: Dolichopodidae) represent one of the most important groups of natural enemies of the Eurasian bark beetle Ips typographus (L.), which infests Norway spruce Picea abies (L.) Karst. In a previous study, we showed that adult Medetera flies exploit semiochemicals to find beetle-infested trees however, the exact nature of those attractive compounds has not yet been determined.

Aims

The aim of this follow-up study was to investigate the behavioral responses of Medetera spp. and I. typographus, to different combinations of semiochemicals.

Methods

In this study, 22 volatile compounds identified from I. typographus-infested Norway spruce were divided into five groups (A–E) based on being primarily produced by the bark beetle I. typographus (group A), bark beetle-associated microorganisms (groups B and C), or spruce tree (groups D and E). The effect of the compounds in these groups in the attraction of Medetera species and I. typographus was tested in two different subtractive field trapping assays.

Results

In the first subtractive assay, the full blend (ABCDE), and the blends lacking microbial compounds of group C, or spruce tree compounds of group D led to significant attraction of Medetera flies. Morphological identification of a subset of the specimens collected revealed that sixteen species were attracted to the synthetic blends, with M. signaticornis Loew being the most abundant. In the second subtractive assay, high attraction of Medetera flies and I. typographus was found for a 12-component synthetic blend.

Conclusion

The insights gained provide a basis for developing synthetic attractants to facilitate monitoring of Medetera flies. Future testing and optimization of these attractants will enhance our ability to monitor, conserve and utilize Medetera flies, thereby enabling us to better protect forests from the damaging effects of spruce bark beetles.
Development of the Compassionate Technology Scale for Professionals (CTS-P): value driven evaluation of digital mental health interventions
Authors: van Lotringen Charlotte M. , ten Klooster Peter M. , Austin Judith , Westerhof Gerben J. , Kelders Saskia M. , Noordzij Matthijs L.
Published: October 2024

Background

Compassion is an essential and beneficial value in mental healthcare. However, how digital mental health interventions influence compassion in treatment has not been systematically investigated, due to the lack of appropriate measurement instruments. To address this gap, we developed the Compassionate Technology Scale for Professionals (CTS-P), aimed at mental health professionals.

Methods

We used Q-methodology, a method that combines quantitative and qualitative analysis to explore shared viewpoints on a particular topic, to select and refine items. Participants were 15 professionals from different areas of mental healthcare. In individual sessions, while thinking aloud, they sorted 35 statements on relevance for evaluating technology use on compassion. The statements were based on a scientific conceptualization of compassion with five elements. The sorting task was followed by a short interview to explore participants’ associations with compassion and technology.

Results

With by-person factor analysis, we found three different viewpoints among participants, all with eigenvalues > 1 and with a total explained variance of 63.02%. We selected prioritized items of each viewpoint and for each theoretical element of compassion, resulting in a full scale (15 items) and a short scale (3 items). Based on qualitative input from participants, the scale was adapted to clarify its focus and the wording of items. While thinking aloud, participants shared benefits and critical notes regarding technology and compassion.

Discussion

Together with key stakeholders, we developed the CTS-P. Most participants prioritized the potential of technology to obtain more information and be closer to their client in facilitating compassion. The main critical note participants had was that technology is not necessary to support compassion at the therapist’s experiential level. This emphasizes the need to further explore how mental health professionals and technology can complement each other in a system of compassionate care. Future research should explore the factor structure, validity, and reliability of the scale through psychometric validation.

Conclusions

The CTS-P can make the extent to which technology for mental healthcare influences elements of compassion measurable and comparable. The scale can prove useful for prioritizing the value of compassion in both the development and use of digital mental health interventions.
Projections of anxiety disorder prevalence during and beyond the COVID-19 pandemic in Germany using the illness–death model
Authors: Ito Chisato , Baune Bernhard T. , Kurth Tobias , Brinks Ralph
Published: October 2024

Background

Although there is now substantial evidence on the acute impacts of the COVID-19 pandemic on anxiety disorders, the long-term population impact of the pandemic remains largely unexplored.

Aims

To quantify a possible longitudinal population-level impact of the pandemic by projecting the prevalence of anxiety disorders through 2030 among men and women aged up to 95 years in Germany under scenarios with varying impacts of the pandemic on the incidence of anxiety disorders.

Method

We used a three-state illness–death model and data from the Global Burden of Disease Study to model historical trends of the prevalence and incidence of anxiety disorders. The German population projections determined the initial values for projections. The COVID-19 incidence rate data informed an additional incidence model, which was parameterised with a wash-in period, delay, wash-out period, incidence increase level and decay constant.

Results

When no additional increase in the incidence during the pandemic waves during 2020–2022 was assumed, it was estimated that 3.86 million women (9.96%) and 2.13 million men (5.40%) would have anxiety disorders in 2030. When increases in incidence following pandemic waves were assumed, the most extreme scenario projected 5.67 million (14.02%) women and 3.30 million (8.14%) men with the mental disorder in 2030.

Conclusions

Any increased incidence during the pandemic resulted in elevated prevalence over the projection period. Projection of anxiety disorder prevalence based on the illness–death model enables simulations with varying assumptions and provides insight for public health planning. These findings should be refined as trend data accumulate and become available.
Investigating inequalities in patient outcomes for first-episode psychosis
Authors: Nicholls Dasha , Budd Jobie , Nunn Philippa , French Paul , Smith Jo , Gupta Veenu , Holdship Jonathan , Quirk Alan
Published: October 2024

Background

Understanding inequalities in outcomes between demographic groups is a necessary step in addressing them in clinical care. Inequalities in treatment uptake between demographic groups may explain disparities in outcomes in people with first-episode psychosis (FEP).

Aims

To investigate disparities between broad demographic groups in symptomatic improvement in patients with FEP and their relationship to treatment uptake.

Method

We used data from 6813 patients from the 2021–2022 National Clinical Audit of Psychosis data-set. Data were grouped by category type to obtain mean outcomes before adjustment to see whether disparities in outcomes remained after differences in treatment uptake had been accounted for. After matching, the average effect of each demographic variable in terms of outcome change was calculated. Moderator effects on specific treatments were investigated using interaction terms in a regression model.

Results

Observational results showed that patients aged 18–24 years were less likely to improve in outcome, unless adjusted for intervention uptake. Patients classified as Black and Black British were less likely to improve in outcome (moderation effect 0.04, 95% CI 0–0.07) after adjusting for treatment take-up and demographic factors. Regression analysis showed the general positive effect of supported employment interventions in improving outcomes (coefficient −0.13, 95% CI −0.07 to −0.18, P < 0.001), and moderator analysis suggested targeting particular groups for interventions.

Conclusions

Inequalities in treatment uptake and psychotic symptom outcome of FEP by social and demographic factors require monitoring over time. Our analysis provides a framework for monitoring health inequalities across national clinical audits in the UK.
Barriers to Follow-Up of an Abnormal Clinical Breast Examination in Uttar Pradesh, India: A Qualitative Study
Authors: Liebermann Erica , Patwardhan Vaibhav , Usmanova Gulnoza , Aktar Nadeem , Agrawal Shivani , Bhamare Parag , McCarthy Maura , Ginsburg Ophira , Kumar Somesh
Published: October 2024

PURPOSE

To understand key barriers to diagnostic follow-up for women with an abnormal clinical breast examination (CBE) at the primary care level in the Uttar Pradesh state in India. We also explored acceptability of mobile phones to address barriers to CBE follow-up for women.

MATERIALS AND METHODS

We conducted 28 semistructured in-depth interviews with 12 women with an abnormal CBE at the primary health facility who did not have diagnostic follow-up, four community health workers, nine health care providers from health facilities in rural and urban settings, and three state-level decision makers. Interviews were audiorecorded, transcribed verbatim, and translated from Hindi to English. Thematic analysis was conducted using Dedoose qualitative software. Themes were organized by multilevel barriers to follow-up.

RESULTS

Key barriers to CBE follow-up included knowledge, fear, and stigma about breast cancer; women's health not being prioritized in the family; discomfort seeing male providers; and difficulty navigating the diagnostic facility. Despite community education and outreach efforts by community health workers (known as Accredited Social Health Activists), lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Despite widespread access to mobile phones, perceived acceptability varied among stakeholders regarding mobile phone use for breast health education and communication with clients.

CONCLUSION

Knowledge, cultural, and health system barriers challenge women's ability to follow recommendations for diagnostic follow-up of an abnormal CBE. Multilevel and gender-responsive strategies are needed to address these barriers. Our results suggest that mobile phones could be used to further improve breast health awareness, patient navigation, and tracking, and further research is needed.
Breast Cancer and Risk of Depression: A Comparative Cross-Sectional Study Among Women With and Without Breast Cancer in Addis Ababa, Ethiopia
Authors: Gebremariam Alem , Addissie Adamu , Dereje Nebiyu , Assefa Mathewos , Jemal Ahmedin
Published: October 2024

PURPOSE

The extent of symptoms of depression among patients with breast cancer compared with those without the disease is not well documented in Ethiopia and other sub-Saharan African countries.

MATERIALS AND METHODS

This study examines the prevalence of symptoms of depression in women with breast cancer (n = 436) compared with those without breast cancer (n = 856) in Addis Ababa, Ethiopia, through a comparative cross-sectional study using a validated questionnaire, the Patient Health Questionnaire-9. The association between breast cancer diagnosis and symptoms of depression was evaluated using a multivariable binary logistic regression model.

RESULTS

About 39.2% of women with breast cancer had some level of symptoms of depression compared with 23.8% of women without the disease. By severity of symptoms of depression, 13.1% of women with breast cancer reported moderate to severe symptoms of depression compared with 6.8% of women without the disease. Sixty-three percent of women with breast cancer reported difficulties performing routine daily activities, compared with 36.7% of women without the disease. In the multivariable-adjusted model, women with breast cancer were 2 times (adjusted odds ratio, 2.26 [95% CI, 1.49 to 3.44]) more likely to report symptoms of depression compared with those without the disease. Likewise, women with breast cancer were 4.78 (95% CI, 3.51 to 6.52) times more likely to report difficulty in performing routine daily activities compared with women without the disease.

CONCLUSION

Four in 10 women with breast cancer in Addis Ababa reported having symptoms of depression, which was considerably higher than women in the general population. This finding emphasizes the importance of addressing psychosocial needs among women with breast cancer to enhance quality of life and potentially extend longevity.
Importance of environmental signals for cardiac morphological development in Atlantic salmon
Authors: Vindas Marco A. , Engdal Vilde Arntzen , Kavaliauskiene Simona , Folkedal Ole , Höglund Erik , Moyano Marta , Øverli Øyvind , Frisk Michael , Johansen Ida B.
Published: October 2024

The hearts of salmonids display remarkable plasticity, adapting to various environmental factors that influence cardiac function and demand. For instance, in response to cold temperature, the salmonid heart undergoes growth and remodeling to counterbalance the reduced contractile function associated with dropping temperatures. Alongside heart size, the distinct pyramidal shape of the wild salmonid heart is essential for optimal cardiac performance, yet the environmental drivers behind this optimal cardiac morphology remain to be fully understood. Intriguingly, farmed salmonids often have rounded, asymmetrical ventricles and misaligned bulbi from an early age. These deformities are noteworthy given that farmed salmon are often not exposed to natural cues, such as a gradual temperature increase and changing day lengths, during critical developmental stages. In this study, we investigated whether natural environmental conditions during early life stages are pivotal for proper cardiac morphology. Atlantic salmon were raised under simulated natural conditions (low temperature with a natural photoperiod; SimNat) and compared with those reared under simulated farming conditions (SimFarm). Our findings reveal that the ventricle shape and bulbus alignment in SimNat fish closely resemble those of wild salmon, while functional analyses indicate significant differences between SimNat and SimFarm hearts, suggesting diastolic dysfunction and higher cardiac workload in SimFarm hearts. These findings highlight the profound influence of environmental factors such as water temperature and photoperiod on the structural development of the salmonid heart, underscoring the importance of early environmental conditions for cardiac health.
Hypertonic water reabsorption with a parallel-current system via the glandular and saccular renal tubules of Ruditapes philippinarum
Authors: Seo Eriko , Seo Yoshiteru
Published: October 2024

We investigated the renal function of the brackish water clam, Ruditapes philippinarum, employing magnetic resonance imaging (MRI). The R. philippinarum kidney consists of two renal tubules, a glandular (GT) and a saccular (ST) tubule. After exposure to seawater containing manganese ion (Mn2+) at 20°C, the intensity of the T1-weighted MRI and longitudinal relaxation rates (1/T1=R1) of the kidney were increased. In the ST, haemolymph containing Mn2+ entered directly from the auricle, and the Mn2+ concentration ([Mn2+]) increased in the initial part of the ST. Thereafter, [Mn2+] was almost constant until the posterior end of the kidney. The GT received haemolymph from the pedal sinus via the visceral sinus. The GT runs parallel inside the ST, and [Mn2+] increased progressively until it merged with the ST. In a range of seawater with [Mn2+] from 1 to 30 µmol l−1, the [Mn2+] increased 12-fold in the posterior part of the ST, compared with the ambient [Mn2+]. Based on these results, the epithelium of the initial part of the ST reabsorbs water from luminal fluid, building up a higher osmotic pressure. Using this osmotic gradient, hypertonic water is reabsorbed via the epithelium of the GT to the ST, and then transferred to the haemolymph via the epithelium of the ST. Excess water is excreted as urine. This model was supported by the increases in [Mn2+] in the ST when the clams were exposed to seawater containing Mn2+ at salinity from 26.0 to 36.0‰, showing that the parallel-current system works in hypotonic seawater.
Effect of high-flow oxygen on exercise performance in COPD patients
Authors: Μπίτος Κωνσταντίνος
Published: October 2024

Εισαγωγή: Η οξυγονοθεραπεία υψηλής ροής (high-flow oxygen therapy, HFOT) παρέχει εμπλουτισμένο με οξυγόνο, θερμαινόμενο αέρα σε υψηλούς ρυθμούς ροής μέσω ειδικής ρινικής κάνουλας. Θα μπορούσε να αποτελέσει εναλλακτική λύση στη θεραπεία οξυγόνου χαμηλής ροής (low-flow oxygen therapy, LFOT), η οποία χρησιμοποιείται συνήθως από ασθενείς με χρόνια αποφρακτική πνευμονοπάθεια (ΧΑΠ) κατά τη διάρκεια της σωματικής άσκησης. Ερευνητική υπόθεση: Στην παρούσα μελέτη αξιολογήσαμε την υπόθεση ότι η HFOT βελτιώνει την αντοχή στην άσκηση σε ασθενείς με ΧΑΠ σε σύγκριση με την LFOT. Μεθοδολογία: Ασθενείς με σταθερή ΧΑΠ, εξαναγκασμένο εκπνευστικό όγκο σε ένα δευτερόλεπτο (FEV1) 40-80% προβλεπόμενου, κορεσμό οξυγόνου μέσω παλμικής οξυμετρίας (SpO2) στην ηρεμία ≥92%, πραγματοποίησαν δύο δοκιμασίες κόπωσης σε εργομετρικό ποδήλατο με σταθερό έργο, ίσο με το 75% του μέγιστου προβλεπόμενου έργου, μέχρι εξάντλησης σε δύο διαφορετικές ημέρες, χρησιμοποιώντας LFOT (3 L/min) και HFOT (60 L/min, FiO2 0,45) με τυχαία σειρά σύμφωνα στα πλαίσια της μελέτης διασταυρούμενης μετάβασης (cross-over). Η κύρια μελετώμενη έκβαση ήταν ο χρόνος αντοχής στην άσκηση. Περαιτέρω αναλύθηκαν αποτελέσματα σχετικά με τον SpO2, την αναπνευστική συχνότητα και την εμφάνιση δύσπνοιας. Αποτελέσματα: Συνολικά 79 ασθενείς συμπεριλήφθηκαν και τυχαιοποιήθηκαν στη μελέτη, με ηλικία (μέση τιμή ± σταθερή απόκλιση) 58 ± 9 έτη, FEV1 63 ± 9% προβλεπόμενου, στάδιο ΧΑΠ GOLD 2-3 και PaO2 ηρεμίας 9,4 ± 1,0 kPa. Η ανάλυση «πρόθεσης για θεραπεία» (intention-to-treat analysis) ανέδειξε χρόνο αντοχής 688 ± 463 s με LFOT και 773 ± 471 s με HFOT, μέση διαφορά 85 s (95% CI: 7 έως 164, P = 0,034), που αντιστοιχεί σε σχετική αύξηση 13% (95% CI: 1 έως 28) με HFOT. Στο σημείο ισόχρονης κόπωσης (isotime), οι ασθενείς είχαν χαμηλότερη αναπνευστική συχμότητα και υψηλότερο SpO2 με HFOT. Στο τέλος της άσκησης, ο SpO2 ήταν υψηλότερος κατά 2% (95% CI: 2 έως 2) και οι τιμές στην κλίμακα δύσπνοιας Borg CR10 ήταν χαμηλότερες κατά 0,8 μονάδες (95% CI: 0,3 έως 1,2) σε σύγκριση με την LFOT. Συμπέρασμα: Σε ασθενείς με ήπια υποξαιμία με ΧΑΠ, η οξυγονοθεραπεία υψηλής ροής βελτίωσε τον χρόνο αντοχής σε συνδυασμό με υψηλότερο κορεσμό αρτηριακού οξυγόνου, μειωμένη αναπνευστική συχνότητα και ηπιότερη δύσπνοια σε σύγκριση με την LFOT. Επομένως, η HFOT είναι πολλά υποσχόμενη για την ενίσχυση της απόδοσης κατά την άσκηση στη ΧΑΠ.Καταχώρηση κλινικής δοκιμής: www.ClinicalTrials.gov, NCT03955770.
The legal obstacles to the work and life of human rights defenders
Authors: Κούλα Αικατερίνη-Χριστίνα
Published: October 2024

Η διατριβή ασχολείται με τα νομικά εμπόδια στη ζωή των ατόμων που αγωνίζονται για την πραγμάτωση των ανθρωπίνων δικαιωμάτων και είναι γνωστοί ως Υπερασπιστές Ανθρωπίνων Δικαιωμάτων (ΥΑΔ). Υποστηρίζει ότι, ως συνέπεια του αγώνα τους για τα ανθρώπινα δικαιώματα και τη δικαιοσύνη, οι ΥΑΔ αντιμετωπίζουν πολυάριθμα εμπόδια στο έργο τους, τα οποία επηρεάζουν τη δραστηριότητά τους και μπορεί να επιφέρουν σοβαρές συνέπειες για τα ανθρώπινα δικαιώματα γενικότερα. Ειδικότερα, η διατριβή εντοπίζει τρία κύρια νομικά εμπόδια: την έλλειψη σαφούς ορισμού, την ποινικοποίηση των ΥΑΔ και την ατιμωρησία για εγκλήματα που διαπράττονται εναντίον τους, δίνοντας ιδιαίτερη έμφαση στην αποτυχία του διεθνούς δικαίου ανθρωπίνων δικαιωμάτων να παράσχει αποτελεσματική προστασία στους ΥΑΔ. Βάσει αυτών, εξετάζει επίσης εάν το διεθνές προσφυγικό δίκαιο μπορεί να λειτουργήσει ως εναλλακτικός τρόπος προστασίας, δεδομένου ότι ένας ΥΑΔ μπορεί να πληροί τις προϋποθέσεις του όρου «πρόσφυγας». Ωστόσο, απορρίπτει αυτή την ιδέα, τονίζοντας την ανάγκη για ένα σύστημα προστασίας των ΥΑΔ εντός του κράτους προέλευσης, δεδομένης της επιθυμίας των ΥΑΔ να παραμείνουν στις χώρες τους, καθώς και της κρίσης του προσφυγικού και ασύλου. Συνεπώς, διατυπώνονται συστάσεις που θα μπορούσαν να ανταποκριθούν σε καθένα από τα προσδιορισμένα εμπόδια, ενώ αντλώντας από προτάσεις για την ενίσχυση της εφαρμογής των ανθρωπίνων δικαιωμάτων γενικά, προτείνει επίσης εναλλακτικές λύσεις, που δεν σχετίζονται αυστηρά με το διεθνές δίκαιο ανθρωπίνων δικαιωμάτων, οι οποίες θα μπορούσαν να συμβάλουν στην προστασία των ΥΑΔ και στην εφαρμογή των ανθρωπίνων δικαιωμάτων συνολικά. Η μεθοδολογική προσέγγιση της διατριβής θεωρείται «κοινωνικο-νομική», καθώς εξετάζει διάφορους παράγοντες που σχετίζονται με τη δραστηριότητα των ΥΑΔ, οι οποίοι επηρεάζονται και επηρεάζουν το δίκαιο και συμπληρώνουν την νομική ανάλυση. Το πιο σημαντικό, χρησιμοποιεί εμπειρική έρευνα με σκοπό να δώσει τη δυνατότητα στον αναγνώστη να κατανοήσει το ζήτημα μέσα από την οπτική των εμπλεκόμενων ατόμων και να διερευνήσει τον αντίκτυπο των εμποδίων στις ζωές των συμμετεχόντων. Δεδομένης της έλλειψης εμπειρικής έρευνας σχετικά με τους ΥΑΔ, αυτή η προσέγγιση καλύπτει ένα σημαντικό κενό στην ακαδημαϊκή βιβλιογραφία.
Computer simulation of the operability of finishing procedures and parasitic elements in the hardware and software complex of chip design
Authors: Yagodkin A. , Litvinov Nikolay , Ivanin Pavel , Groshev Artem
Published: October 2024

The constant intensive development of productive forces and industrial relations is closely related to the needs of the na-tional economy in the creation of new increasingly complex machines, mechanisms and integrated circuits. Ensuring the solution of the development issue is conditioned by contra-dictory requirements: reducing the set deadlines for project development and improving its quality indicators. By in-creasing the number of designers, it is not possible to meet these requirements. The solution of the tasks set is possible through comprehensive automation of design work, the creation of a new design methodology, the widespread use of mathematical modeling methods, robotization of the manu-facturing process and the manufacture of finished products. This article is devoted to the issue of the automatic design system. The article shows that the set of programs used in the prototype of the CAD package allows you to perform work on creating an electronic component database. The testing of the compiled set of computer-aided design tools took place as part of the implementation of work on the design of digital and analog circuits along the full route of the Cadence computer-aided design system. The article at-tempts to demonstrate the problem of big data processing based on the methods of performing design procedures for building design routes for modern element databases
Optimization of test methods and algorithms for assessing the resistance of field-effect transistors to various types of radiation using promising test equipment
Authors: Vatuev Alexaendr , Sharapov A , Ozerov Alexander
Published: October 2024

Field-effect transistors are subject to various effects when exposed to ionizing radiation. These effects are associated with both ionization of semiconductor layers – channel and substrate regions, drain and source pockets, and dielectric ones. Obtaining a sufficient set of data on sensitivity to these effects is an extensive task in terms of time and labor costs due to the performance of installations reproducing the spectral characteristics of various types of radiation expo-sure, which makes it urgent to optimize test procedures, including using various (including simulating) installations. This paper provides an overview of the features of the prep-aration and conduct of tests for resistance to single radiation effects using a high-performance laser installation, as well as a comparative analysis of experimental procedures and re-sults with those obtained using a TKP accelerator. It is shown that the results of determining the resistance of field-effect transistors to the manifestation of the SEB effect, ob-tained using a high-frequency accelerator and a focused LIE installation, have sufficient convergence in terms of satura-tion cross-section values. Based on the results of the field-effect transistor tests and the analysis carried out, it is con-cluded that the use of laser test facilities has a number of significant advantages that allow optimizing test procedures