bluuebunny/crossref_metadata_2025 huggingface dataset:
Rectal adenocarcinoma in the eye: An unexpected destination
Authors: Lahham Elias Edward , Alsahouri Mohammad I , Alsalah Qusai A , Billan Salem , Atrash Fadi
Published: March 2024

Colorectal cancer ranks third in cancer incidence in the United States, commonly metastasizing to the liver and lungs. Despite its high prevalence, colorectal cancer with intraocular metastasis is exceedingly rare, with only a few cases reported in the literature. This study presents a 58-year-old male, previously treated for rectal adenocarcinoma with liver and lung metastases, who developed choroidal metastasis causing visual impairment. Despite radiotherapy, moderate improvement was observed, and subsequent disease progression led to systemic chemotherapy. Intraocular metastasis, primarily affecting the choroid, is infrequent, often originating from breast and lung cancers. The presented case, originating from primary KRAS wild-type rectal cancer, adds to the limited gastrointestinal-tract-related occurrences. This report underscores the importance of recognizing intraocular metastasis in colorectal cancer, contributing valuable insights for improved understanding and potential guidance for future clinical decisions. Choroidal metastasis carries a poor prognosis, emphasizing the need for tailored management strategies.
A case report of a gastric ulcer in a 2.5-month-old infant in Syria: Helicobacter pylori and Aspirin as possible causes
Authors: Martini Nafiza , Al haj Kaddour Maha , Baddoura Mouna , Jarjanazi Mulham , Mahmoud Jaber
Published: March 2024

A gastric ulcer is a tear in the stomach lining that manifests as abdominal pain, nausea, vomiting, and weight loss. Its occurrence is lesser in children as compared to adults and its incidence in children ranges between 2% and 8%. Helicobacter pylori and nonsteroidal anti-inflammatory drugs are the most common causes of gastric ulcers. In our case, we report a 2.5-month-old male who presented with severe pallor, hematemesis, and melena with normal weight gain. The patient’s mother was infected with COVID-19 a month ago and recovered within 5 days but kept using aspirin and nonsteroidal anti-inflammatory drugs for a month during breastfeeding. An upper gastrointestinal endoscopy revealed a gastric ulcer and the Helicobacter pylori antigen was positive in the biopsy. A COVID-19 infection was detected later in the patient. The patient was administered proton pump inhibitor, clarithromycin, and amoxicillin for Helicobacter pylori antigen and symptomatic treatment for COVID-19. This case report shows that a stomach ulcer can appear in infancy, but opportune interventions such as timely diagnosis and treatment can solve the problem. It also marks the pathophysiological connection between Helicobacter pylori and gastric ulcer.
Effect of a Telehealth Navigator Program on Video Visit Scheduling and Completion in Primary Care
Authors: Chen Kevin , Katranji Kenan , Bailey Khera , Rains Michele , Mirzoyan Helena , Zhang Christine , Choxi Shivali , Jackson Hannah B.
Published: March 2024

Introduction:

Patients and clinicians face challenges in participating in video telehealth visits. Patient navigation has been effective in other settings in enhancing patients’ engagement with clinical programs. Our objective was to assess whether implementing a telehealth navigator program to support patients and clinicians affected video visit scheduling, video usage, and non-attendance.

Methods:

This was a quasi-experimental quality improvement project using difference-in-differences. We included data from 17 adult primary care sites at a large, urban public healthcare system from October 1, 2021 to October 31, 2022. Six sites received telehealth navigators and 11 sites were used as comparators. Navigators contacted patients (by phone) with upcoming video visits to assess and address potential barriers to successful video visit completion. They also provided on-site support to patients and clinicians regarding telehealth visits and usage of an electronic patient portal. The primary outcomes were difference-in-differences for the proportion of telehealth visits scheduled and, separately, completed as video visits and non-attendance for visits scheduled as video visits.

Results:

There were 65 488 and 71 504 scheduled telehealth appointments at intervention and non-intervention sites, respectively. The adjusted difference-in-differences for the proportion of telehealth visits scheduled as video was −9.1% [95% confidence interval −26.1%, 8.0%], the proportion of telehealth visits completed as video visits 1.3% [−4.9%, 7.4%], and non-attendance for visits scheduled as video visits −3.7% [−6.0%, −1.4%].

Conclusions:

Sites with telehealth navigators had comparatively lower video visit non-attendance but did not have comparatively different video visit scheduling or completion rates. Despite this, navigators’ on-the-ground presence can help identify opportunities for improvements in care design.
A Pilot Implementation of Affinity Groups for White School Counselors and Its Impact on Antiracist Practice: The Experiences of Group Members
Authors: Dosal-Terminel Daniel , Kim Chang Mia , Carter Hannah , Jiang A. J. , Robertson Adrianne , Mason E. C. M.
Published: March 2024

In this qualitative study, 10 White school counselors were interviewed after they completed a 7-week affinity group designed to address their racial identity development, cultural humility, and antiracist school counseling practice. We conducted two semistructured interviews with each participant and analyzed them using interpretive phenomenological analysis. The analysis revealed five group experiential themes: (a) motivation for joining the affinity group, (b) affinity group experiences, (c) outcomes from the affinity group, (d) antiracism’s influence on identity, and (e) antiracist school counseling practice. We discuss implications for the school counselor preparation, induction, and practice.
A Culturally Responsive Career Development Group for Minoritized Girls of Color
Authors: Rutledge Marsha L. , Mayes Renae D.
Published: March 2024

Career development plays a crucial role in the overall growth of K–12 students. However, it often lacks an intersectional approach to address students’ diverse needs. Consequently, there is a need for a comprehensive approach that recognizes students’ distinct requirements and offers practical solutions. This conceptual article addresses the unique strengths and challenges minoritized girls of color face in their career development. Given these challenges and others, we propose a group counseling experience that builds on the strengths of minoritized girls of color and fosters culturally responsive career development, including career decision-making self-efficacy.
Visualizing Systemic Change Through Group Counseling: Established and Emerging Approaches
Authors: Steen Sam , Ieva Kara , Beasley Jordon , DeLucia Janice
Published: March 2024

In this editorial, we introduce snapshots of the entire set of published articles in this special issue of Professional School Counseling. We also incorporate our own individual and collective journeys reading, digesting, editing, and reacting to this material. We take the opportunity to present our impressions both visually and narratively to demonstrate how group counseling in schools remains relevant and continues to expand while holding on to salient foundational concepts. In particular, these articles are visually situated in relation to the multitiered systems of support (MTSS) framework as a way to demonstrate the impact groups can have on entire schools and communities. Throughout this introduction, we raise questions that have yet to be answered and challenge scholars to explore others not addressed by this compilation of articles. Finally, we conclude by offering several questions for the reader to consider in their own group counseling practice endeavors.
Literature Review on STEM Education and Its Awareness among Teachers: An Exploration of Issues and Problems with Their Solutions
Authors: Sahito Zafarullah , Wassan Shahid Hussain
Published: March 2024

This study examines and explores the challenges, issues, and problems with their solutions regarding Science, Technology, Engineering, and Mathematics (STEM) education along with the awareness enjoyed by science teachers. The selection of papers for this study was done through systematic literature review techniques. The 11 themes were generated through the thematic analysis of the papers that is, STEM education and its awareness; its challenges, issues, and problems; its curriculum; inquiry and learning environment; technologies; learning and models of integration; a blended learning approach; students’ problem-solving abilities and skills; its implementation and evaluation; it’s research and current trends; and interdisciplinary collaboration and intervention. Policy and planning, infrastructure, and the state of society were found the main factors of the poor conditions of STEM education. STEM research studies suggest that a curriculum with a blended learning approach has to be integrated by interventions of models depicting technological and inquiry-based environments to bring awareness among teachers, which strengthens the students’ problem-solving abilities and skills.
An evidence-based inclusive pedagogical approach in action and its insights for enhancing the professional competence of inclusive education teachers in China
Authors: Luo Yueling , Li Huan
Published: March 2024

Enhancing professional competence of inclusive education teachers is a crucial measure to promote the development of inclusive education. The Inclusive Pedagogical Approach in Action is an evidence-based framework that has demonstrated effectiveness in various countries, providing comprehensive, practical, and specific advantages for enhancing the professional competence of inclusive education teachers. In this study, the formation backgrounds, theoretical connotations, and practical applications of this framework was systematically analyzed to gain insights into enhancing the professional competence of inclusive education teachers in China. The findings suggested that inclusive education teachers should develop evidence-based thinking, respect students’ diversity, uphold their inclusive education beliefs, foster multi-stakeholder collaboration, and tailor solutions to the local contexts. Implementing these measures is expected to promote the high-quality development of inclusive education in China.
Does better accessibility always mean higher house prices?
Authors: Liu Xiang , Chen Xiaohong , Orford Scott , Tian Mingshu , Zou Guojian
Published: March 2024

Numerous studies have explored the correlations between house prices and spatial accessibility, but few have delved into the nonlinearities between both. This study uses Cardiff (UK) as a case study and applies interpretable machine learning algorithms, eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP), to estimate the nonlinear effects of geometric locational accessibility and street network accessibility on house prices. The findings suggest (1) proximity to the CBD, typically the major determinant of land values in hedonic house price models, does not continuously yield higher prices; (2) street closeness centrality, a network-modelling approach to measuring accessibility, exhibits a more generalised pattern with house prices compared proximity to the CBD regardless of analytical spatial scales. The findings challenge the generalizability of Alonso’s bid-rent theory in accurately portraying the relationship between accessibility and house prices in specific urban contexts, highlighting the importance of re-evaluating classical urban theories in different city contexts using novel measures and modelling techniques.
Paranoid psychosis after a single parenteral dose of indomethacin administered for headache diagnosis: A case and review of the literature
Authors: Karsan Nazia , Bose Ray Pyari , Goadsby Peter J
Published: March 2024

Background:

Indomethacin is a non-steroidal anti-inflammatory used to diagnose and treat hemicrania continua and paroxysmal hemicrania. Treatment can be complicated by gastrointestinal adverse effects; less commonly reported are idiosyncratic neuropsychiatric adverse effects with indomethacin.

Methods:

A 50-year-old male with lateralized brief attacks of headache associated with cranial autonomic symptoms was administered a single 200 mg dose of intramuscular indomethacin. Within an hour, he developed acute psychosis, with paranoid delusions and verbal and physical aggression lasting 5 h, followed by recovery to baseline. We used search terms “indomethacin psychosis,” “indomethacin psychiatric,” “indomethacin side effects,” “non-steroidal anti-inflammatory psychosis,” and “non-steroidal anti-inflammatory psychiatric” within PubMed to identify previous reports and literature in this area.

Results:

Neuropsychiatric adverse effects of indomethacin have been reported since 1965 in a dose-dependent manner, usually with oral courses. They may be more common in the elderly, postpartum women and postoperative patients.

Conclusion:

Neuropsychiatric adverse effects should be considered in headache medicine, particularly in at-risk groups when indomethacin is administered. Patients, particularly those at highest risk, should be counseled about the risk of neuropsychiatric side effects on indomethacin which may be dose-dependent and are generally reversible on stopping the drug.
Pushing the Boundaries: Societies as Catalysts for Advancing Coronary Surgery
Authors: Sajja Lokeswara Rao , Kamtam Devanish Narasimhasanth , Narayan Pradeep
Published: March 2024

Coronary artery disease (CAD) stands as the prevailing global cause of death, and coronary artery bypass grafting (CABG) remains the optimal revascularization method for severe CAD. While surgical management has progressed significantly, the implementation of these advancements requires acceleration. The impetus for this acceleration can be bolstered through specialized coronary surgery societies, which can concentrate research efforts, synthesize evidence, and contribute to the formulation of practice guidelines. Cross-continental collaborations among national and international societies, such as the International Society for Coronary Artery Surgery, Japanese Association for Coronary Artery Surgery, and Society of Coronary Surgeons (India), can address knowledge gaps, drive innovation, standardize training, and improve adherence to practice guidelines. Dedicated coronary societies have the potential to revolutionize coronary surgery and enhance patient outcomes.
Access and use of immunoglobulins in supportive cancer care: A thematic analysis of a systematic review data set
Authors: Counihan Muireann , Cervenakova Larisa , Misztela Dominika , Van Baelen Maarten , D.Naughton Bernard
Published: March 2024

Background:

Secondary immunodeficiency (SID) disorders are known to occur in patients with haematological malignancies (HM) due to immunosuppressive treatments. Recurring infections causing subsequent morbidity and mortality commonly occur in this patient cohort. Immunoglobulin replacement therapy (IgRT) benefits patients with primary antibody deficiencies. However, evidence supporting their therapeutic role is not as explicit in SID-associated antibody deficiencies, which raises the questions regarding its use in SID and the knock-on effects of this use on its access and availability more generally.

Objectives:

This study aimed to learn about the use of immunoglobulins in SID, identify themes concerning its use and access and suggest methods for improving access.

Design:

This study included a thematic analysis of a published data set of 43 articles concerning immunoglobulin use and access in SID.

Data Sources and Methods:

The data set used to perform the thematic analysis is based on research articles identified from Excerpta Medica Database (EMBASE) and PubMed databases, published as part of a systematic review and part 1 of this two-part publication series.

Results:

A thematic synthesis was conducted to identify recurrent themes. The three primary themes included (1) the context for IgRT prescription, which included patient characteristics and cost burden of IgRT administration, and its use in different countries; (2) factors contributing to inappropriate IgRT use, including health care professionals’ awareness of IgRT, disparity between guidelines and actual clinical practice, and the effect of shortages on prescription and chemotherapy-induced hypogammaglobulinemia (HGG); and (3) measures identified to improve IgRT use and access, which included multidisciplinary involvement, improved diagnostic tools and safer withdrawal and stewardship protocols.

Conclusions:

IgRT use is increasing in HM as a supportive therapy but without comprehensive clinical guidelines and appropriate prescribing recommendations, medication wastage may occur with consequences for immunoglobulin access.
Unraveling MCL biology to understand resistance and identify vulnerabilities
Authors: Sarkozy Clémentine , Tessoulin Benoit , Chiron David
Published: March 2024

Mantle cell lymphoma (MCL) is a rare (5%-7%), aggressive B-cell non-Hodgkin lymphoma with well-defined hallmarks (eg, cyclin D1, SOX11), and its expansion is highly dependent on the tumor microenvironment (TME). Parallel drastic progress in the understanding of lymphomagenesis and improved treatments led to a paradigm shift in this B-cell malignancy with now prolonged disease-free survival after intensive chemotherapy and anti-CD20-based maintenance. However, this toxic strategy is not applicable in frail or older patients, and a small but significant part of the cases present a refractory disease representing unmet medical needs. Importantly, the field has recently seen the rapid emergence of targeted and immune-based strategies with effective combinations relying on biological rationales to overcome malignant plasticity and intratumor heterogeneity. In this review, we expose how unraveling the biology of MCL allows to better understand the therapeutic resistances and to identify neo-vulnerabilities in tumors, which are essential to offer efficient novel strategies for high-risk patients. We first highlight the tumor intrinsic resistance mechanisms and associated Achilles heels within various pathways, such as NF-κB, mitochondrial apoptosis, DNA repair, and epigenetic regulators. We then place the tumor in its complex ecosystem to decipher the dialog with the multiple TME components and show how the resulting protumoral signals could be disrupted with innovative therapeutic strategies. Finally, we discuss how these progresses could be integrated into a personalized approach in MCL.
Abdominal abscess caused by Raoultella ornithinolytica secondary to postoperative gastric fistula: case report and review of literature
Authors: Huang Qiuxia , Zhang Jihong , Liao Gang
Published: March 2024

Background

In recent years, Raoultella ornithinolytica (R. ornithinolytica) have attracted clinical attention as a new type of pathogen. A wide range of infections with these germs is reported, and commonly found in urinary tract infections, respiratory infections, and bacteremia.

Case presentation

We report the case of an elderly woman with liver abscess, choledocholithiasis and cholangitis, who developed gastric fistula and abdominal abscess after underwent choledocholithotomy, and R. ornithinolytica were isolated from the abdominal drainage fluid. The patient was treated with meropenem and levofloxacin and had a good outcome.

Conclusions

To the best of our knowledge, case of isolating R. ornithinolytica from a patient with non-viscerally abdominal abscess was extremely rare. We share a case of a woman with non-viscerally abdominal abscess secondary to postoperative gastric fistula, R. ornithinolytica was isolated from the patient’s pus, and the pathogenic bacteria may originate from the gastrointestinal tract. Based on this case, We should be cautious that invasive treatment may greatly increase the probability of infection with this pathogenic bacterium.
mFOLFIRINOX versus mFOLFOX 6 as adjuvant treatment for high-risk stage III colon cancer - the FROST trial: study protocol for a multicenter, randomized controlled, phase II trial
Authors: Lee Kyung-Ha , Yang In Jun , Ha Gi Won , Lee Jaeim , Park Youn Young , Lee Suk Hwan , Lee Jong Min , Bae Jung Hoon , Park Eun Jung , Kim Hyungjin , Kim Keun Young , An Sanghyung , Kim Ik Yong , Kim Ji Yeon
Published: March 2024

Background

High-risk stage III colon cancer has a considerably poorer prognosis than stage II and low-risk stage III colon cancers. Nevertheless, most guidelines recommend similar adjuvant treatment approaches for all these stages despite the dearth of research focusing on high-risk stage III colon cancer and the potential for improved prognosis with intensive adjuvant treatment. Given the the proven efficacy of triplet chemotherapy in metastatic colorectal cancer treatment, the goal of this study is to evaluate the oncologic efficacy and safety of mFOLFIRINOX in comparison to those of the current standard of care, mFOLFOX 6, as an adjuvant treatment for patients diagnosed with high-risk stage III colon cancer after radical resection.

Methods

This multicenter, randomized (1:1), open-label, phase II trial will assess and compare the effectiveness and toxicity of mFOLFIRINOX and mFOLFOX 6 in patients with high-risk stage III colon cancer after radical resection. The goal of the trial is to enroll 312 eligible patients, from 11 institutes, aged between 20 and 70 years, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2, or between 70 and 75 with an ECOG performance status of 0. Patients will be randomized into two arms - Arm A, the experimental arm, and Arm B, the reference arm - and will receive 12 cycles of mFOLFIRINOX and mFOLFOX 6 every 2 weeks, respectively. The primary endpoint of this study is the 3-year disease-free survival, and secondary endpoints include the 3-year overall survival and treatment toxicity.

Discussion

The Frost trial would help determine the oncologic efficacy and safety of adjuvant triplet chemotherapy for high-risk stage III colon cancers and ultimately improve prognoses.

Trial registration

ClinicalTrials.gov NCT05179889, registered on 17 December 2021.
Proximity to public green spaces and depressive symptoms among South African residents: a population-based study
Authors: Shezi Busisiwe , Mendoza Hilbert , Govindasamy Darshini , Casas Lidia , Balakrishna Yusentha , Bantjes Jason , Street Renée
Published: March 2024

Background

Exposure to green spaces has been suggested to improve mental health and may reduce the risk of depression. However, there is generally limited evidence on the association between green spaces and depression originating from low-and middle-income countries and Africa in particular. Here, we investigate the association between proximity to public green spaces and depressive symptoms among residents of Gauteng Province, South Africa.

Methods

We used data from the 2017/2018 Gauteng quality of life survey. We included all individuals aged 18 years or older residing in the nine municipalities of Gauteng Province that completed the survey (n = 24,341). Depressive symptoms were assessed using the Patient Health Questionnaire-2. Proximity to public green spaces was defined as self-reported walking time (either less or greater than 15 min) from individuals’ homes to the nearest public green space. To assess the association between access to public green spaces and depressive symptoms, we used mixed-effects models, adjusted for age, sex, population group (African, Indian/Asian, Coloured (mixed race), and White), educational attainment, and municipality. We additionally performed stratified analyses by age, sex, educational attainment, and population group to evaluate whether associations differed within subgroups. Associations are expressed as prevalence ratios (PR) and their 95% confidence intervals (95% CI).

Results

We observed a 6% (PR = 0.94, 95%CI = 0.92–0.96) prevalence reduction in depressive symptoms for individuals who reported that the nearest public green space was less than 15 min from their homes as compared to those who reported > 15 min. After stratification, this inverse association was stronger among females, individuals aged 35–59 years,those with higher levels of educational attainment, and Coloured individuals as compared to their counterparts.

Conclusion

Our findings suggest that public green spaces close to residential homes may be associated with a reduction in the occurrence of depressive symptoms among urban populations in resource-constrained settings like South Africa.
Plant a seed series: the impact of an online outreach package on school pupils’ knowledge, skills, and attitudes to medicine
Authors: Hawwash Nadin , Haque Enam
Published: March 2024

Background

Medicine is one of the most inaccessible professions in the United Kingdom (UK). The Plant a Seed (PAS) series was created to address this; it is an online pre-recorded three-part video series to “Inspire”, “Educate” and “Motivate” pupils from widening participation backgrounds on Medicine. We explored the impact of PAS on pupils’ knowledge, skills and attitude to Medicine.

Methods

We conducted a national pretest-posttest study of Years 7–9 pupils in the UK. 503 schools were invited to PAS, following ethics approval. Consented pupils viewed all three episodes asynchronously and completed a pre-and post-series Likert scale confidence questionnaire, which evaluated their knowledge, skills and attitudes to a medical career. A Shapiro-Wilk test showed the lack of a normal distribution (p < 0.05); therefore, a Wilcoxon signed-rank test statistically compared pretest-posttest results of each pupil.

Results

70 pupils in Years 7–9 from 2 schools participated in this study. PAS was shown to significantly increase pupils’ knowledge of the role and life of a doctor, medicine as a degree, admissions requirements, and careers in medicine (p < 0.05). There was a significant increase in pupils believing they could study medicine. The intervention did not significantly increase the desire for pupils to study medicine (p = 0.187).

Conclusion

PAS significantly improved pupils’ knowledge, skills and confidence demonstrating the need and benefit to enrolment of the programme at scale. It did not significantly increase the number of pupils wishing to study medicine. Analysis at scale is required to evaluate the effectiveness of PAS as a key intervention to break down barriers to medicine.
Post-surgery survival and associated factors for cardiac patients in Ethiopia: applications of machine learning, semi-parametric and parametric modelling
Authors: Tadege Melaku , Tegegne Awoke Seyoum , Dessie Zelalem G.
Published: March 2024

Introduction

Living in poverty, especially in low-income countries, are more affected by cardiovascular disease. Unlike the developed countries, it remains a significant cause of preventable heart disease in the Sub-Saharan region, including Ethiopia. According to the Ethiopian Ministry of Health statement, around 40,000 cardiac patients have been waiting for surgery in Ethiopia since September 2020. There is insufficient information about long-term cardiac patients’ post-survival after cardiac surgery in Ethiopia. Therefore, the main objective of the current study was to determine the long-term post-cardiac surgery patients’ survival status in Ethiopia.

Methods

All patients attended from 2012 to 2023 throughout the country were included in the current study. The total number of participants was 1520 heart disease patients. The data collection procedure was conducted from February 2022- January 2023. Machine learning algorithms were applied. Gompertz regression was used also for the multivariable analysis report.

Results

From possible machine learning models, random survival forest were preferred. It emphasizes, the most important variable for clinical prediction was SPO2, Age, time to surgery waiting time, and creatinine value and it accounts, 42.55%, 25.17%,11.82%, and 12.19% respectively. From the Gompertz regression, lower saturated oxygen, higher age, lower ejection fraction, short period of cardiac center stays after surgery, prolonged waiting time to surgery, and creating value were statistically significant predictors of death outcome for post-cardiac surgery patients’ survival in Ethiopia.

Conclusion

Some of the risk factors for the death of post-cardiac surgery patients are identified in the current investigation. Particular attention should be given to patients with prolonged waiting times and aged patients. Since there were only two fully active cardiac centers in Ethiopia it is far from an adequate number of centers for more than 120 million population, therefore, the study highly recommended to increase the number of cardiac centers that serve as cardiac surgery in Ethiopia.
Rural-urban differences in use of health services before and after dementia diagnosis: a retrospective cohort study
Authors: Kosteniuk Julie , Osman Beliz Acan , Osman Meric , Quail Jacqueline , Islam Naorin , O’Connell Megan E. , Kirk Andrew , Stewart Norma , Karunanayake Chandima , Morgan Debra
Published: March 2024

Background

Rural-urban differences in health service use among persons with prevalent dementia are known. However, the extent of geographic differences in health service use over a long observation period, and prior to diagnosis, have not been sufficiently examined. The purpose of this study was to examine yearly rural-urban differences in the proportion of patients using health services, and the mean number of services, in the 5-year period before and 5-year period after a first diagnosis of dementia.

Methods

This population-based retrospective cohort study used linked administrative health data from the Canadian province of Saskatchewan to investigate the use of five health services [family physician (FP), specialist physician, hospital admission, all-type prescription drug dispensations, and short-term institutional care admission] each year from April 2008 to March 2019. Persons with dementia included 2,024 adults aged 65 years and older diagnosed from 1 April 2013 to 31 March 2014 (617 rural; 1,407 urban). Matching was performed 1:1 to persons without dementia on age group, sex, rural versus urban residence, geographic region, and comorbidity. Differences between rural and urban persons within the dementia and control cohorts were separately identified using the Z-score test for proportions (p < 0.05) and independent samples t-test for means (p < 0.05).

Results

Rural compared to urban persons with dementia had a lower average number of FP visits during 1-year and 2-year preindex and between 2-year and 4-year postindex (p < 0.05), a lower likelihood of at least one specialist visit and a lower average number of specialist visits during each year (p < 0.05), and a lower average number of all-type prescription drug dispensations for most of the 10-year study period (p < 0.05). Rural-urban differences were not observed in admission to hospital or short-term institutional care (p > 0.05 each year).

Conclusions

This study identified important geographic differences in physician services and all-type prescription drugs before and after dementia diagnosis. Health system planners and educators must determine how to use existing resources and technological advances to support care for rural persons living with dementia.
Is the national health insurance scheme a pathway to sustained access to medicines in Nigeria?
Authors: Uguru Nkolika , Ogu Udochukwu , Uguru Chibuzo , Ibe Ogochukwu
Published: March 2024

Objective

The debate surrounding access to medicines in Nigeria has become increasingly necessary due to the high cost of essential medicine drugs and the prevalence of counterfeit medicines in the country. The Nigerian government has proposed the implementation of the National Health Insurance Scheme (NHIS) to address these issues and guarantee universal access to essential medicines. Access was investigated using the 3 A’s (accessibility, affordability, and availability). This paper investigates whether the NHIS is a viable pathway to sustained access to medicines in Nigeria.

Design

This was a cross-sectional study using a mixed-methods design. Both qualitative and quantitative methods were utilized for the study.

Setting

This study was conducted at NHIS-accredited public and private facilities in Enugu State.

Participants

296 randomly selected enrollees took part in the quantitative component, while, 6 participants were purposively selected for the qualitative component, where in-depth interviews (IDIs) were conducted face-to-face with NHIS desk officers in selected public and private health facilities.

Results

The quantitative findings showed that 94.9% of respondents sought medical help. Our data shows that 78.4% of the respondents indicated that the scheme improved their access to care (accessibility, affordability, and availability). The qualitative results from the NHIS desk officers showed that respondents across all the socio-economic groups reported that the NHIS had marginally improved access to medicine over the years. It was also observed that most of the staff in NHIS-accredited facilities were not adequately trained on the scheme’s requirements and that most times, essential drugs were not readily available at the accredited facilities.

Conclusion

The study findings revealed that although the NHIS has successfully expanded access to medicines, there remain several challenges to its effective implementation and sustainability. Additionally, the scheme’s coverage of essential medicines is could be improved even more, leading to reduced access to needed drugs for many Nigerians. A focus on the 3As for the scheme means that all facility categories (private and public) and their interests (where necessary) must be considered in further planning of the scheme to ensure that things work out well.
Enhanced predictive validity of integrative models for refractory hyperthyroidism considering baseline and early therapy characteristics: a prospective cohort study
Authors: Wang Xinpan , Li Tiantian , Li Yue , Wang Qiuyi , Cai Yun , Wang Zhixiao , Shi Yun , Yang Tao , Zheng Xuqin
Published: March 2024

Background

A subset of Graves’ disease (GD) patients develops refractory hyperthyroidism, posing challenges in treatment decisions. The predictive value of baseline characteristics and early therapy indicators in identifying high risk individuals is an area worth exploration.

Methods

A prospective cohort study (2018–2022) involved 597 newly diagnosed adult GD patients undergoing methimazole (MMI) treatment. Baseline characteristics and 3-month therapy parameters were utilized to develop predictive models for refractory GD, considering antithyroid drug (ATD) dosage regimens.

Results

Among 346 patients analyzed, 49.7% developed ATD-refractory GD, marked by recurrence and sustained Thyrotropin Receptor Antibody (TRAb) positivity. Key baseline factors, including younger age, Graves’ ophthalmopathy (GO), larger goiter size, and higher initial free triiodothyronine (fT3), free thyroxine (fT4), and TRAb levels, were all significantly associated with an increased risk of refractory GD, forming the baseline predictive model (Model A). Subsequent analysis based on MMI cumulative dosage at 3 months resulted in two subgroups: a high cumulative dosage group (average ≥ 20 mg/day) and a medium–low cumulative dosage group (average < 20 mg/day). Absolute values, percentage changes, and cumulative values of thyroid function and autoantibodies at 3 months were analyzed. Two combined predictive models, Model B (high cumulative dosage) and Model C (medium–low cumulative dosage), were developed based on stepwise regression and multivariate analysis, incorporating additional 3-month parameters beyond the baseline. In both groups, these combined models outperformed the baseline model in terms of discriminative ability (measured by AUC), concordance with actual outcomes (66.2% comprehensive improvement), and risk classification accuracy (especially for Class I and II patients with baseline predictive risk < 71%). The reliability of the above models was confirmed through additional analysis using random forests. This study also explored ATD dosage regimens, revealing differences in refractory outcomes between predicted risk groups. However, adjusting MMI dosage after early risk assessment did not conclusively improve the prognosis of refractory GD.

Conclusion

Integrating baseline and early therapy characteristics enhances the predictive capability for refractory GD outcomes. The study provides valuable insights into refining risk assessment and guiding personalized treatment decisions for GD patients.
Solvability of a nonlinear second order m-point boundary value problem with p-Laplacian at resonance
Authors: Liu Meiyu , Pei Minghe , Wang Libo
Published: March 2024

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The Heterogeneous Effects of Social Assistance and Unemployment Insurance: Evidence from a Life Cycle Model of Family Labor Supply and Savings
Authors: Haan Peter , Prowse Victoria
Published: March 2024

We empirically analyze the heterogeneous welfare effects of unemployment insurance and social assistance. We estimate a structural life cycle model of singles’ and married couples’ labor supply and savings decisions. The model includes heterogeneity by age, education, wealth, sex, and household composition. In aggregate, social assistance dominates unemployment insurance; however, the opposite holds true for married men, whose leisure time declines more than that of their spouses when unemployment insurance is reduced. A revenue-neutral rebalancing of social support away from unemployment insurance and toward social assistance increases aggregate welfare. Income pooling in married households decreases the welfare value of social assistance. (JEL D13, D15, G51, I38, J22, J64, J65)
Inequality, Taxation, and Sovereign Default Risk
Authors: Deng Minjie
Published: March 2024

Income inequality and worker migration significantly affect sovereign default risk. Governments often impose progressive taxes to reduce inequality, which redistribute income but discourage labor supply and induce emigration. Reduced labor supply and a smaller high-income workforce erode the current and future tax base, reducing government’s ability to repay debt. I develop a sovereign default model with endogenous nonlinear taxation and heterogeneous labor to quantify this effect. In the model, the government chooses the optimal combination of taxation and debt, considering its impact on workers’ labor and migration decisions. Income inequality accounts for one-fifth of the average US state government spread. (JEL D31, F34, H21, H23, H74, J61, R23)
Διερευνώντας την προώθηση της δημιουργικότητας στην διδασκαλία λογοτεχνικών κειμένων στα μουσικά σχολεία (Γ γυμνασίου) μέσα από την διασύνδεσή της λογοτεχνίας με τη μουσική
Authors: Καρούσου Κυριακή
Published: March 2024

Στην παρούσα διατριβή, επιχειρείται μια συστηματική διερεύνηση της προώθησης της δημιουργικότητας στη διδασκαλία της λογοτεχνίας, μέσω μιας διακαλλιτεχνικού τύπου προσέγγισης των λογοτεχνικών κειμένων. Πιο συγκεκριμένα, μέσα από επαναλαμβανόμενες δοκιμές και αναθεωρήσεις, επιδιώκεται η σταδιακή βελτίωση και επαρκής διαμόρφωση ενός καινοτόμου διδακτικού σχεδίου – παρέμβασης για τη διδασκαλία της Λογοτεχνίας στη Γ΄ τάξη Μουσικού Γυμνασίου, το οποίο εμπλέκει συστηματικά τη μουσική στη διδασκαλία της Λογοτεχνίας, με κύριο στόχο την ενίσχυση της δημιουργικότητας των εμπλεκόμενων μαθητών και διδασκόντων. Η διερεύνηση αυτή στηρίζεται στις θεωρίες για τη Δημιουργικότητα και τη Δημιουργική Παιδαγωγική, και κυρίως σ’ αυτές που αφορούν στη δημιουργικότητα καλλιτεχνικού και συνδυαστικού τύπου. Σε δεύτερο επίπεδο, στηρίζεται στη Διακαλλιτεχνική Θεωρία και Πράξη, όσον αφορά στη συσχέτιση της Λογοτεχνίας με τη Μουσική τέχνη. Η σύζευξη των δύο αυτών επιστημονικών πεδίων δημιουργεί προοπτικές για την ανάπτυξη μιας Δημιουργικής Παιδαγωγικής διακαλλιτεχνικού τύπου και, ειδικότερα, της διακαλλιτεχνικής πτυχής της Δημιουργικής Διδακτικής της Λογοτεχνίας, κλάδοι που χρήζουν περαιτέρω τεκμηρίωσης και θεωρητικής θεμελίωσης μέσα από ερευνητικά δεδομένα. Στη βάση αυτού του παράλληλα με την έρευνα διαμορφούμενου θεωρητικού πλαισίου και με γνώμονα κάποιες προκαθορισμένες ενδείξεις δημιουργικής σκέψης και συμπεριφοράς – τη σκέψη συνδετικού τύπου, την πρωτοτυπία, τη φαντασία, την ενσυνειδητότητα και την αισθητική αντίληψη – διενεργήθηκε μια ερευνητική διαδικασία ποιοτικού χαρακτήρα, κατά την οποία ακολουθήθηκαν τα στάδια της στρατηγικής Design – based Research. Μετά από δύο φάσεις (αρχική κι επαναληπτική) ερευνητικών διδασκαλιών στη Γ΄ γυμνασίου σε Μουσικό Σχολείο της Αττικής, τα δεδομένα που συγκεντρώθηκαν αναλύθηκαν, με τη μέθοδο της θεματικής ανάλυσης, και τα αποτελέσματα – θέματα παρουσιάζονται σε αντιστοιχία με τα ζητούμενα των ερευνητικών ερωτημάτων. Στην αποτίμηση της έρευνας, επισημαίνεται ότι, παρά τους περιορισμούς και τις δυσκολίες της ερευνητικής διαδικασίας, προκύπτουν κάποια ευρήματα με πρακτική αλλά και θεωρητική σημασία για τη διακαλλιτεχνική πτυχή της Δημιουργικής Διδακτικής της Λογοτεχνίας.
On Statistical Discrimination as a Failure of Social Learning: A Multiarmed Bandit Approach
Authors: Komiyama Junpei , Noda Shunya
Published: March 2024

We analyze statistical discrimination in hiring markets using a multiarmed bandit model. Myopic firms face workers arriving with heterogeneous observable characteristics. The association between the worker’s skill and characteristics is unknown ex ante; thus, firms need to learn it. Laissez-faire causes perpetual underestimation: minority workers are rarely hired, and therefore, the underestimation tends to persist. Even a marginal imbalance in the population ratio frequently results in perpetual underestimation. We demonstrate that a subsidy rule that is implemented as temporary affirmative action effectively alleviates discrimination stemming from insufficient data.

This paper was accepted by Nicolas Stier-Moses, Management Science Special Issue on The Human-Algorithm Connection.

Funding: This work was supported by the Social Sciences and Humanities Research Council of Canada [Grant 430-2020-00088] and JST ERATO [Grant JPMJER2301], Japan.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.00893 .
Subsidy Allocation Problem with Bus Frequency Setting Game: A Trilevel Formulation and Exact Algorithm
Authors: Mo Pengli , Liu Zhiyuan , Tan Zhijia , Yi Wen , Liu Pan
Published: March 2024

Typically, governments subcontract the operation of urban bus systems to several bus operators. In particular, the government aims to promote the service quality for passengers by introducing competition among bus operators and subsidizes bus operations to ensure affordable fares. However, most existing studies about subsidy allocation typically do not account for the competitive factors among bus operators and thus may underestimate the associated benefits. In this study, we investigate how the government allocates subsidies to minimize social costs, taking into account the competition among bus operators and passenger route decisions. We describe this problem as a trilevel optimization model and use a game-theoretic approach to characterize the market equilibrium of bus operators. Next, we transform the trilevel model into a mixed-integer programming problem with quadratic constraints and solve it using an exact algorithm with acceleration techniques. The results of numerical experiments demonstrate the computational efficiency of the proposed algorithm. Several valuable insights are derived: First, lines served by competing bus operators typically do not require subsidies. Second, competitive behavior decreases social costs (including bus operating costs and passenger travel costs) more effectively in cities in which the passengers assign higher value to time. Third, the competitive behavior may be guided by exogenous parameters, such as ticket prices, to approximate the optimum of urban bus systems.

Funding: This work was supported by the Key Project [Grant 52131203], Youth Program [Grant 72301065], and Project of International Cooperation and Exchanges [Grant 72361137006] of the National Natural Science Foundation of China.
Yozgat yöresi kadın ağzı türkülerinde sözlü anlatımlar ve müzikal yapıların incelenmesi
Authors: İncetaş Çiğdem , Kurtaslan Hazan
Published: March 2024

Müzik folklorik özelliği ile türküler içinde oluştuğu topluma dair bilgileri barındırması ve kültürel aktarım aracı olması açısından önemlidir. Türküler, gerek sözleri gerekse melodik yapısı ile bölgeler arasında farklılıklar göstermektedir. Türküler sayesinde toplumsal yapıda yer alan önemli öğeler hakkında etnografik ve sosyolojik çıkarımlar yapmak mümkündür. Türk müzik folkloründe kadın ağzı türküler bu açıdan zengin bir bilgi kaynağıdır. Bu araştırmada kadın ağzı türküleri sözlü anlatımlar (konuları ile aktarılan duygu durumları ve türkü sözlerinde yer alan yöresel ifadeler) ve müzikal yapıları (form yapıları, ritmik yapıları, makamsal dizi yapıları ve ses genişlikleri) açısından incelenmesi amaçlanmıştır. Bu araştırmada nitel araştırma türlerinden durum çalışması modelinin kullanıldığı bir araştırmadır. Araştırmada, amaçlı örnekleme yöntemiyle incelemeye alınan müzik eserlerinin kadınlar tarafından söylenenleri (kadın ağzı türküleri) seçilmiştir. Buna göre Yozgat yöresine ait 78 kadın ağzı türküsü incelemeye alınmıştır. Doküman analizi tekniğine göre sözlü anlatımlar ve müzikal yapılar açısından analize tabi tutulmuştur. Araştırma sonucunda, türkülerdeki temaların çoğunlukla aşk, sevda, ölüm, ağıt, gurbet, kına-düğün, ayrılık, asker-askerlik, dua, beddua, imece, iş, mizah gibi konular olduğu belirlenmiştir. İncelenen otuz üç türküde bölgeye ait yetmiş beş yöresel ifadenin yer aldığı belirlenmiştir. Kadın ağzı türkülerinin müzikal analizinde; kırık ve uzun hava formunda, ritmik açıdan 4/4, 2/4, 6/4, 3/4, 12/8, 7/4, 8/8, 9/8, 10/8 ve 14/8’lik yapıda, hüseyni, uşşak, segah, hicaz, çargah, saba, kürdi, buselik, acemaşiran gibi makamsal dizilerde ve 3’lü, 4’lü, 5’li, 6’lı, 7’li, 8’li, 9’lu ve 10’lu aralıktan oluşan ezgiler oldukları belirlenmiştir. İlerideki çalışmalarda kadın ağzı türkülerinin disiplinlerarası bağlamda (sosyolojik, antropolojik gibi) incelenmesi yapılabilir.