bluuebunny/crossref_metadata_2025 huggingface dataset:
Adnexal torsion: A comprehensive review of types, pathophysiology, diagnosis, and management strategies during pregnancy
Authors: Kayali Amal Mohamed , Dalloul Razan Azmi , Alhartani Mahinar Mamdouh , Ahmad Razan , Shaheen Zainab Mohammad , Yusuf Zainab , Hamisu Aisha Mohammed , Iqbal Mahwish
Published: July 2024

Adnexal torsion is a gynecological surgical emergency which during pregnancy can be associated with high patient morbidity and fetal mortality if not managed promptly. Fertility preservation is an essential concern. The underlying pathophysiology involves ovarian tissue torsion on its pedicle, leading to decreased venous return, stromal edema, internal hemorrhage, and infarction. It can affect females of all age groups, and they present mainly with an acute onset of pelvic pain, followed by nausea and vomiting. Multiple risks can lead to adnexal torsion, including ovulation induction, use of in vitro fertilization, and the presence of an ovarian mass. Early diagnosis is challenging and mainly depends on clinical suspicion, ultrasound, or MRI findings; however, it is necessary to preserve the function of the ovaries and fallopian tubes and prevent the occurrence of infertility. Once adnexal torsion is suspected, surgery or detorsion is the main line of treatment. This review will summarize the most relevant studies on risk factors, radiological findings, and managing maternal adnexal torsion in pregnancy.
Are There Differences in Short-Term Postoperative Outcomes Among Surgical Subspecialists Performing Lower Extremity Flap Procedures? A National Surgical Quality Improvement Project (NSQIP) Analysis of 1324 Patients
Authors: Park Amber , McKegg Phillip C. , Brigode William
Published: July 2024

Introduction: Soft tissue flaps are an integral and versatile tool to help manage soft tissue defects of varying severities. These complex procedures can be done by a variety of specialties and can lead to a variety of postoperative complications. Locoregional flaps are the middle rung of the reconstructive ladder and can be performed by surgeons of various training pathways. The profile of patients and their complications when stratified by surgical specialty is unknown. The purpose of this study was to compare short-term postoperative outcomes between surgical subspecialists performing a locoregional flap of the lower extremity to determine factors influencing complication rates. Methods: The National Surgical Quality Improvement Project (NSQIP) database was queried using Current Procedural Terminology code 15,738 to identify adult patients undergoing a muscle, myocutaneous, or fasciocutaneous lower extremity flap procedure from 2016 to 2019. We examined the primary outcome of a pooled wound complication rate with secondary outcomes including the individual NSQIP wound- and nonwound complications. Results: A total of 1324 patients were identified. Plastic surgeons performed 926 (70%) procedures, general surgeons performed 243 (18%) procedures, orthopedic surgeons performed 89 (7%) procedures, and vascular surgeons performed 66 (5%) procedures. On multivariate analysis, surgical subspecialty was not associated with the primary outcome, but malignancy-related operations and nonelective status were considered significant. Conclusions: Patient characteristics, but not surgeon subspecialty, account for the variation in patient outcomes in lower extremity flap reconstruction. Larger, prospective studies examining these outcomes are needed to further characterize complication risk factors in this patient population.
Analysis of Violent Incidents at Five Regional and Remote Australian Emergency Departments: A Retrospective Descriptive Study
Authors: Thomas Brodie , Jacob Alycia , McCann Damhnat , Buykx Penny , Schultz Rebecca , Kinsman Leigh , O’Meara Peter , Edvardsson Kristina , Spelten Evelien
Published: July 2024

Introduction

Workplace violence is endemic, destructive, and escalating in frequency and severity in healthcare. There is a paucity of research on workplace violence in regional and remote hospital emergency departments (EDs).

Objective

The aim of this study was to identify the perpetrator and situational characteristics associated with violent incidents in the ED across five regional and remote Australian sites.

Method

This study audited hospital summary data, incident reports, and medical records for a 12-month period in 2018 to examine the perpetrator and situational characteristics of workplace violence incidents in five regional and remote Australian EDs.

Results

Violent incidents were evenly spread throughout the week and across shifts. Most incidents were triaged as urgent, occurred within the first 4 hr, and had multidisciplinary involvement. Almost one in every six incidents resulted in an injury. Perpetrators of violence were predominantly young and middle-aged males and almost always patients, with most presenting with mental and behavioral disorders, or psychoactive substance use.

Conclusions

Understanding the characteristics of perpetrators of violence can help in seeking to tailor interventions to reduce further violent behaviors. These findings carry implications for optimizing patient care, staff safety and resource management.
The Long Haul Home: The Relationship between Commuting Distance, Work Hours, Work-to-Family Conflict, and Psychological Distress
Authors: Montazer Shirin , Young Marisa
Published: July 2024

Our study reevaluates the impact of commuting on mental health, challenging the prevailing view of commuting solely as a job-related demand or stressor that leads to increased mental health problems. Using the 2011 Neighbourhood Effects on Health and Well-Being Study from Toronto, we explore the dual perspectives of commuting distance as a stressful demand versus a potentially beneficial resource among parents of minor children (n = 299). Multivariate results reveal that commuting distance alone is not significantly linked to mental health as measured by psychological distress. However, the nature of commuting—whether it is viewed as a demand or a resource—depends on other factors in parents’ lives. Specifically, our results indicate that an increase in commuting distance exacerbates the negative effects of work hours on psychological distress while simultaneously buffering against the impact of work-to-family conflict on this outcome irrespective of gender.
Adolescent Facial Attractiveness and Later Life Morbidity, Cognition, and Mortality
Authors: Warren John Robert , Rumore Gina
Published: July 2024

Are associations between ratings of adolescents’ attractiveness and their adult health, cognitive functioning, and longevity plausibly causal, or are they confounded by factors correlated with judgements about attractiveness? How do these processes differ for women and men? Using data from the Wisconsin Longitudinal Study, the authors estimate the impact of judgements about adolescent facial attractiveness on 35 cognitive, health, and mortality outcomes through age 72. Ratings of adolescent facial attractiveness are predictive of later life outcomes among women, but mainly because ratings of young women’s attractiveness are closely connected with women’s socioeconomic standing and body mass in early life. The same is not true for men. People use different standards to evaluate the attractiveness of women and men; these differences induce largely noncausal associations between ratings of young women’s attractiveness and their cognition, morbidity, and mortality.
Physical characteristics of variable thermal conductivity and MHD flow across a continually stretched sheet
Authors: Ganesh Kumar K , Prakasha DG , Praveen MM , Gnaneswara Reddy M , Vasanth KR
Published: July 2024

The primary purpose of this paper is to investigate the flow and thermal properties of a continuously stretching sheet. To determine temperature, variable thermal conductivity is also encountered. Furthermore, the flow problem considers the convective circumstances of heat and mass transfer. By lowering the number of independent components, the governing equations are reduced into non-dimensional types, which are then numerically solved using the RKF-4 method and shooting methodology. A visualization evaluation of the entangled flow properties is done for velocity concentration and temperature distributions. It is found that the fluid concentration is discovered to be more significant in the [Formula: see text] case, followed by the [Formula: see text] and [Formula: see text] cases. Furthermore, the efficiency of the [Formula: see text] the [Formula: see text] parameter’s shifting values control field.
Reversible cerebral vasoconstriction syndrome developed during treatment of Parkinson's disease with rasagiline mesylate: A case report
Authors: Nakaya Akihiko , Kaneko Kimihiko , Matsumoto Arifumi , Matsumoto Yuki , Matsumori Yasuhiko , Nagano Isao
Published: July 2024

Background

Rasagiline mesylate, a monoamine oxidase-B inhibitor, is used in Parkinson's disease (PD) treatment. We report a case of reversible cerebral vasoconstriction syndrome (RCVS) developed after rasagiline mesylate initiation.

Case presentation

A 59-year-old woman was diagnosed with PD at the age of 54 years. She experienced frequent episodes of nausea after increasing the dose of levodopa-carbidopa hydrate, and her nausea worsened with the addition of rasagiline mesylate. Three months later, the patient experienced recurrent thunderclap headaches. Brain imaging revealed subarachnoid hemorrhage with segmental vasoconstriction in the main trunks of multiple cerebral arteries. The subsequent clinical course was consistent with RCVS. Her headache and nausea were completely resolved by the discontinuation of rasagiline mesylate and addition of verapamil hydrochloride.

Discussion

Worsened nausea was the only sign implicating the elevated monoamine levels, potentially linked to the development of RCVS. RCVS should be considered when a patient taking rasagiline mesylate experiences thunderclap headache.
Will the Agency Stand Behind Me? Prosecutorial Guidance and Shifts in Organizational Sentencing in Federal Courts
Authors: Vanhee Alexander J.
Published: July 2024

Prosecutors play a large role in determining sentences and may alter their decision-making based on changes in Department of Justice (DOJ) priorities. Consequently, I use the inhabited institutions perspective to investigate whether and how a series of DOJ memos (Holder memo, Thompson memo, McNulty memo) affected sentencing severity for organizational defendants in federal courts. My analyses consist of multi-level regressions of total fine, probation length, and corporate compliance program orders using the 1992–2013 “Organizations Convicted in Federal District Courts” dataset collected by the United States Sentencing Commission (USSC). The results suggest assistant U.S attorneys adjust their approach based on departmental guidance, with punitiveness being linked towards perceived support from the main office for this behavior.
Milestone of China's Foreign-Related Legislation – A Review of the Law of the People's Republic of China on Foreign Relations
Authors: Huikang Huang
Published: July 2024

The Law of the People's Republic of China on Foreign Relations is China's first foundational and comprehensive law in the field of foreign relations. This law promotes the rule of law both domestically and internationally in a coordinated manner, significantly enhancing the legal framework governing China's conduct of foreign affairs. It also makes substantial progress in the strategic development of foreign-related legislation, advancing the overall foreign-related legal system and integrity, quality and timeliness of specific legislation. Bearing distinct Chinese characteristics and reflecting the ethos of our era, this law stands as a milestone in the legislative history of China.
Class II ferroptosis inducers are a novel therapeutic approach for t(4;14)-positive multiple myeloma
Authors: Zhang Jiasi , Liu Yuxi , Zuo Liping , Fan Fengjuan , Yan Han , Zhao Fei , Li Junying , Ma Chi , Li Qun , Xu Aoshuang , Xu Jian , Zhang Bo , Hu Yu , Sun Chunyan
Published: July 2024

Multiple myeloma (MM) is a clonal plasma cell malignancy that is characterized by genetic heterogeneity. The cytogenetic abnormality t(4;14) strongly predicts poor outcome in patients with MM, even in the era of novel drugs. Ferroptosis is a new approach to antitumor therapy, but the relationship between ferroptosis and MM cytogenetic abnormalities remains largely unclear. In this study, we show that t(4;14)-positive but not t(4;14)-negative MM cells are susceptible to class II ferroptosis inducers (FINs) in a preclinical setting, which is dependent on the significant upregulation of the MM SET domain-containing protein (MMSET). Mechanistically, MMSET upregulates acyl-coenzyme A synthetase long-chain family member 4 transcription by binding to its promoter region, leading to increased polyunsaturated fatty acid (PUFA) levels and enhanced sensitivity of t(4;14)-positive MM cells to ferroptosis. Supplementation with PUFAs efficiently restores the susceptibility of t(4;14)-negative MM cells to ferroptosis. In addition, combining class II FIN treatment with bortezomib in t(4;14)-positive MM cells attenuates cellular glutathione and induces both apoptosis and ferroptosis levels by inhibiting the increase in solute carrier family 7 member 11, demonstrating synergistic antitumor activity in vitro and in a xenograft model. Taken together, our findings suggest that targeting ferroptosis with class II FINs is a novel and promising therapeutic approach to improve the outcome of t(4;14)-positive patients with MM.
Effect of rabbit ATG PK on outcomes after TCR-αβ/CD19–depleted pediatric haploidentical HCT for hematologic malignancy
Authors: Dvorak Christopher C. , Long-Boyle Janel R. , Holbrook-Brown Lucia , Abdel-Azim Hisham , Bertaina Alice , Vatsayan Anant , Talano Julie-An , Bunin Nancy , Anderson Eric , Flower Allyson , Lalefar Nahal , Higham Christine S. , Kapoor Neena , Klein Orly , Odinakachukwu Maryanne C. , Cho Soohee , Jacobsohn David A. , Collier Willem , Pulsipher Michael A.
Published: July 2024

We hypothesized that the inferior disease-free survival (DFS) seen in older patients who underwent αβ-T-cell/CD19–depleted (AB-TCD) haploidentical hematopoietic cell transplantation (HCT) for hematologic malignancies is caused by excessive exposure to rabbit antithymocyte globulin (rATG; Thymoglobulin). Between 2015 and 2023, 163 patients with a median age of 13 years (range, 0.4-27.4) underwent AB-TCD haploidentical HCT for the treatment of acute lymphoblastic leukemia (n = 98), acute myeloid leukemia/myelodysplastic syndrome (n = 49), or other malignancies (n = 16) at 9 centers in 2 prospective trials. Exposures to rATG before and after HCT were predicted using a validated pharmacokinetic model. Receiver operating characteristic curves were used to identify the optimal target windows for rATG exposure in terms of outcomes. We identified 4 quadrants of rATG exposure, namely quadrant 1 (n = 52) with a high pre-HCT area under curve (AUC; ≥50 arbitrary units [AU] per day per milliliter) and a low post-HCT AUC (<12 AU per day per liter); quadrant 2 (n = 47) with a low pre- and post-HCT AUC; quadrant 3 (n = 13) with a low pre-HCT and a high post-HCT AUC; and quadrant 4 (n = 51) with a high pre- and post-HCT AUC. Quadrant 1 had a 3-year DFS of 86.5%, quadrant 2 had a DFS of 64.6%, quadrant 3 had a DFS of 32.9%, and for quadrant 4 it was 48.2%. An adjusted regression analysis demonstrated additional factors that were associated with an increased hazard for worse DFS, namely minimal residual disease (MRD) positivity and cytomegalovirus (CMV) R+/D− serostatus. Nonoptimal rATG exposure exhibited the strongest effect in unadjusted and adjusted (MRD status or CMV serostatus) analyses. High exposure to rATG after HCT was associated with inferior DFS following AB-TCD haploidentical HCT for pediatric patients with hematologic malignancies. Model-based dosing of rATG to achieve optimal exposure may improve DFS. These trials were registered at www.ClinicalTrials.gov as #NCT02646839 and #NCT04337515.
Endoplasmic reticulum stress signaling modulates ischemia/reperfusion injury in the aged heart by regulating mitochondrial maintenance
Authors: Zhang Ji , Zhao Yuanyuan , Gong Nianqiao
Published: July 2024

Aging is associated with an increased risk of myocardial ischemia/reperfusion injury (IRI). With an increasing prevalence of cardiovascular diseases such as coronary arteriosclerosis in older people, there has been increasing interest in understanding the mechanisms of myocardial IRI to develop therapeutics that can attenuate its damaging effects. Previous studies identified that abnormal mitochondria, involved in cellar senescence and oxidative stress, are the master subcellular organelle that induces IRI. In addition, endoplasmic reticulum (ER) stress is also associated with IRI. Cellular adaptation to ER stress is achieved by the activation of ER molecular chaperones and folding enzymes, which provide an important link between ER stress and oxidative stress gene programs. In this review, we outline how these ER stress-related molecules affect myocardial IRI via the crosstalk of ER stress and mitochondrial homeostasis and discuss how these may offer promising novel therapeutic targets and strategies against age-related cardiovascular diseases.
Choices of measures of association affect the visualisation and composition of the multimorbidity networks
Authors: Baneshi Mohammad Reza , Dobson Annette , Mishra Gita D.
Published: July 2024

Background

Network analysis, commonly used to describe the patterns of multimorbidity, uses the strength of association between conditions as weight to classify conditions into communities and calculate centrality statistics. Our aim was to examine the robustness of the results to the choice of weight.

Methods

Data used on 27 chronic conditions listed on Australian death certificates for women aged 85+. Five statistics were calculated to measure the association between 351 possible pairs: odds ratio (OR), lift, phi correlation, Salton cosine index (SCI), and normalised-joint frequency of pairs (NF). Network analysis was performed on the 10% of pairs with the highest weight according to each definition, the ‘top pairs’.

Results

Out of 56 ‘top pairs’ identified, 13 ones were consistent across all statistics. In networks of OR and lift, three of the conditions which did not join communities were among the top five most prevalent conditions. Networks based on phi and NF had one or two conditions not part of any community. For the SCI statistics, all three conditions which did not join communities had prevalence below 3%. Low prevalence conditions were more likely to have high degree in networks of OR and lift but not SCI.

Conclusion

Use of different statistics to estimate weights leads to different networks. For exploratory purposes, one may apply alternative weights to identify a large list of pairs for further assessment in independent studies. However, when the aim is to visualise the data in a robust and parsimonious network, only pairs which are selected by multiple statistics should be visualised.
The expression analysis of long noncoding RNAs PCAT-1, PCAT-29, and MER11C in bipolar disorder
Authors: Dini Niloofar , Taheri Mohammad , Shirvani-Farsani Zeinab
Published: July 2024

Long non-coding RNAs (lncRNAs) are transcripts with a length of usually more than 200 nucleotides (nt) that have promised functions in varied biological processes. lncRNAs participate in the regulation of differentiation, development, and function of the brain. Thus, their dysregulation might play important roles in the etiology of neurological disorders such as BD. In this study, the expression level of PCAT-1, PCAT-29, and MER11C lncRNAs was evaluated in the blood of BD patients compared to the control group. Peripheral blood mononuclear cells of 50 BD type I patients and 50 healthy individuals were isolated. The RNAs were extracted and cDNA was synthesized. Then, the expression level of the desired lncRNAs was measured through Real-Time PCR. The expression levels of PCAT-29 and MER11C lncRNAs were significantly lower in BD patients compared to controls. However, the expression level of PCAT-1 was not significantly different between these two sets of samples. According to the ROC curve, PCAT-29 and MER11C had significant diagnostic power for the differentiation of BD patients from controls. Taken together, our results indicate dysregulation of two lncRNAs in patients with BD and the possible roles of these lncRNAs in the neuropathology of bipolar disorder.
The multiple mediating effects of self-efficacy and resilience on the relationship between social support and procrastination among vocational college students: a cross-sectional study
Authors: Zhang Yanting , Guo Hongyu , Ren Mei , Ma Haili , Chen Yingying , Chen Cancan
Published: July 2024

Background

Previous research has revealed a negative association between social support and procrastination. However, few studies have investigated the mechanism underlying this relationship among vocational college students.

Objective

Based on the social cognitive theory, this study was intended to investigate the multiple mediating effects of self-efficacy and resilience on the relationship between social support and procrastination among vocational college students.

Methods

This study employed a cross-sectional design involving a sample of 1,379 students from a vocational college in China. Data were collected using the General Procrastination Scale, the Multidimensional Scale of Perceived Social Support, the General Self-Efficacy Scale, and the Resilience Scale-14. The PROCESS macro for SPSS was used to examine the multiple mediation model.

Results

Our findings indicate significant negative correlations between social support, self-efficacy, resilience, and procrastination. The multiple mediation analysis showed that social support did not have a significant direct impact on procrastination. Instead, the relationship between social support and procrastination was fully mediated by self-efficacy (indirect effect: -0.017; 95% CI: -0.032, -0.004) and resilience (indirect effect: -0.047; 95% CI: -0.072, -0.025), and sequentially mediated by both factors (indirect effect: -0.013; 95% CI: -0.020, -0.007).

Conclusions

The results emphasise the importance of enhancing self-efficacy and resilience in initiatives aimed at preventing and intervening in case of procrastination among vocational college students. Additionally, strengthening social support may also be crucial to preventing or reducing procrastination among this population.
The impact of smartphone use duration and posture on the prevalence of hand pain among college students
Authors: Banadaki Faeze Dehghan , Rahimian Benyamin , Moraveji Fatemeh , Varmazyar Sakineh
Published: July 2024

Background

Excessive smartphone usage among students can lead to discomfort in their hands and fingers. This study investigates the impact of smartphone holding posture, duration of usage, and the prevalence of wrist and finger pain among university students.

Methods

This cross-sectional study involved 213 university students who were selected based on inclusion criteria. Data was collected through a demographic information questionnaire. Participants self-reported five different postures for holding and interacting with a smartphone. The prevalence, frequency, severity, and interference of wrist and finger discomfort were assessed using the Cornell Hand Discomfort Questionnaires (CHDQ).

Results

The study revealed that the average age of participants was 21.3 ± 2.2 years. On average, they had been using smartphones for 7.9 ± 3.1 years and spent an average of 4.9 ± 2.5 h daily holding them in their hands. In terms of discomfort, more than 25% of students reported pain in areas C (thumb finger), E (Palm Pollicis), and F (wrist) of the right hand, which was significantly related to the duration of holding the smartphone in that hand. Additionally, smartphone holding duration significantly affected areas D (palm) and F of the left hand, with over 11% of students experiencing discomfort. The most prevalent posture among students (41% of participants) involved holding the smartphone with the right hand only, with the thumb touching the screen. Notably, areas B (χ2 = 21.7), C (χ2 = 10.27), D (χ2 = 65.54), and E (χ2 = 59.49) of the right hand, as well as areas C (χ2 = 6.58) and E (χ2 = 44.28) of the left hand, exhibited significant associations with the postures of holding the smartphone.

Conclusions

The duration of smartphone use and the postures in which it is held contribute to the prevalence of discomfort in the thumb area and related muscles among right-handed students.
Reviewing the current state of virtual reality integration in medical education - a scoping review
Authors: Mergen Marvin , Graf Norbert , Meyerheim Marcel
Published: July 2024

Background

In medical education, new technologies like Virtual Reality (VR) are increasingly integrated to enhance digital learning. Originally used to train surgical procedures, now use cases also cover emergency scenarios and non-technical skills like clinical decision-making. This scoping review aims to provide an overview of VR in medical education, including requirements, advantages, disadvantages, as well as evaluation methods and respective study results to establish a foundation for future VR integration into medical curricula.

Methods

This review follows the updated JBI methodology for scoping reviews and adheres to the respective PRISMA extension. We included reviews in English or German language from 2012 to March 2022 that examine the use of VR in education for medical and nursing students, registered nurses, and qualified physicians. Data extraction focused on medical specialties, subjects, curricula, technical/didactic requirements, evaluation methods and study outcomes as well as advantages and disadvantages of VR.

Results

A total of 763 records were identified. After eligibility assessment, 69 studies were included. Nearly half of them were published between 2021 and 2022, predominantly from high-income countries. Most reviews focused on surgical training in laparoscopic and minimally invasive procedures (43.5%) and included studies with qualified physicians as participants (43.5%). Technical, didactic and organisational requirements were highlighted and evaluations covering performance time and quality, skills acquisition and validity, often showed positive outcomes. Accessibility, repeatability, cost-effectiveness, and improved skill development were reported as advantages, while financial challenges, technical limitations, lack of scientific evidence, and potential user discomfort were cited as disadvantages.

Discussion

Despite a high potential of VR in medical education, there are mandatory requirements for its integration into medical curricula addressing challenges related to finances, technical limitations, and didactic aspects. The reported lack of standardised and validated guidelines for evaluating VR training must be overcome to enable high-quality evidence for VR usage in medical education. Interdisciplinary teams of software developers, AI experts, designers, medical didactics experts and end users are required to design useful VR courses. Technical issues and compromised realism can be mitigated by further technological advancements.
Second opinion machine learning for fast-track pathway assignment in hip and knee replacement surgery: the use of patient-reported outcome measures
Authors: Campagner Andrea , Milella Frida , Banfi Giuseppe , Cabitza Federico
Published: July 2024

Background

The frequency of hip and knee arthroplasty surgeries has been rising steadily in recent decades. This trend is attributed to an aging population, leading to increased demands on healthcare systems. Fast Track (FT) surgical protocols, perioperative procedures designed to expedite patient recovery and early mobilization, have demonstrated efficacy in reducing hospital stays, convalescence periods, and associated costs. However, the criteria for selecting patients for FT procedures have not fully capitalized on the available patient data, including patient-reported outcome measures (PROMs).

Methods

Our study focused on developing machine learning (ML) models to support decision making in assigning patients to FT procedures, utilizing data from patients’ self-reported health status. These models are specifically designed to predict the potential health status improvement in patients initially selected for FT. Our approach focused on techniques inspired by the concept of controllable AI. This includes eXplainable AI (XAI), which aims to make the model’s recommendations comprehensible to clinicians, and cautious prediction, a method used to alert clinicians about potential control losses, thereby enhancing the models’ trustworthiness and reliability.

Results

Our models were trained and tested using a dataset comprising 899 records from individual patients admitted to the FT program at IRCCS Ospedale Galeazzi-Sant’Ambrogio. After training and selecting hyper-parameters, the models were assessed using a separate internal test set. The interpretable models demonstrated performance on par or even better than the most effective ‘black-box’ model (Random Forest). These models achieved sensitivity, specificity, and positive predictive value (PPV) exceeding 70%, with an area under the curve (AUC) greater than 80%. The cautious prediction models exhibited enhanced performance while maintaining satisfactory coverage (over 50%). Further, when externally validated on a separate cohort from the same hospital-comprising patients from a subsequent time period-the models showed no pragmatically notable decline in performance.

Conclusions

Our results demonstrate the effectiveness of utilizing PROMs as basis to develop ML models for planning assignments to FT procedures. Notably, the application of controllable AI techniques, particularly those based on XAI and cautious prediction, emerges as a promising approach. These techniques provide reliable and interpretable support, essential for informed decision-making in clinical processes.
The relationship between organizational justice and bullying behaviors among nurses: the role of nurse managers’ caring behaviors
Authors: Abou Hashish Ebtsam Aly , Alsayed Sharifa , Alnajjar Hend Abdu , Bakar Siti Awa Abu
Published: July 2024

Background

Organizational justice is pivotal in fostering a fair and supportive workplace culture, which strengthens the connections between managers and nurses, among nurses themselves, and ultimately, between nurses and their patients. Assessing the perceived levels of organizational justice and managerial behaviors can identify key areas for improving nurses’ commitment and loyalty, while simultaneously reducing incidents of workplace bullying.

Purpose

This study aims to investigate how bedside nurses perceive organizational justice, nurse managers’ caring behaviors, and their exposure to workplace bullying. Additionally, it seeks to explore the relationship between organizational justice, nurse managers’ caring behaviors, and nurses’ perceived exposure to workplace bullying.

Methods

A descriptive-correlational study was conducted in the inpatient care unit of a Saudi hospital. A convenience sample of 256 nurses participated, completing the Organizational Justice Questionnaire (OJQ), the Caring Factor Survey: Caring of the Manager (CFS-CM), and the Negative Acts Questionnaire-Revised (NAQ-R). The collected data were analyzed using descriptive statistics and regression analysis.

Results

Descriptive statistics revealed moderate levels of perceived organizational justice and managerial caring behaviors among nurses, alongside low reported exposure to workplace bullying. Significant correlations were found among the studied variables, indicating that higher perceived organizational justice was associated with higher managerial caring and lower workplace bullying (p < 0.05). Mediation analysis demonstrated a significant indirect effect of organizational justice on workplace bullying through the mediating role of nurse managers’ caring behaviors (a×b = -0.0652, p < 0.001). Furthermore, the direct effect of organizational justice on workplace bullying remained significant even when accounting for the mediator (c = -0.5509, p < 0.001).

Conclusion

This study highlights the vital role of organizational justice and managerial caring in cultivating a positive work environment and mitigating workplace bullying. Implementing clear policies and procedures while promoting fairness and equality in resource allocation, decision-making processes, and interactions are essential strategies for fostering positive attitudes and work behaviors among nurses.
Impact of coronavirus disease 2019 on the utilization of hospital services and development of optimal pandemic control strategy in Chinese tertiary hospitals during the Omicron wave
Authors: Yu Dan , Wang Dong , Chen Yi , Dong Ting , Zhang Yinchu , Huang Mengjun , Wu Anhua , Ouyang Yi , Chen Wendong , Qian Zhaoxin
Published: July 2024

Background

This study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on hospital service utilization and revenue in Chinese tertiary hospitals and develop an optimal pandemic control strategy (OPCS) for the peak period of the Omicron wave.

Methods

Retrospective data from three Chinese tertiary hospitals (provincial, city, and county level) were analyzed for three phases: pre-outbreak (Jan-Apr 2019), outbreak (Jan-Apr 2020), and post-outbreak (Jan-Apr 2021). OPCS was developed under the guidance of the China government pandemic control policy during post-break phase of COVID-19. A decision-tree model was constructed to compare OPCS to strict pandemic control strategy during outbreak phase for the hospital service utilization and hospital revenue in a provincial tertiary hospital during the Omicron wave.

Results

Outpatient, emergency room (ER) visits, hospitalizations, and intensive care admissions dropped by 33.8–53.4% during the outbreak, with the provincial hospital being the most affected. Hospital revenue also declined, especially for the provincial hospital (40.1%). Post-outbreak, most services recovered, but ER visits remained lower (11.6% decrease for provincial hospital, 46.5% for county hospital). Total income and expenditure decreased, with the provincial hospital experiencing the most significant revenue reduction (45.7%). OPCS showed greater utilization of medical services (31.6 times more outpatient visits; 1.7 times more inpatient days; 3.4% more surgery volume) and higher revenue (¥220.8 million more) compared to the strict pandemic control strategy.

Conclusions

COVID-19 measures were associated with less hospital service utilization and revenue in Chinese tertiary hospitals. The developed OPCS in Chinese tertiary hospitals, focusing on isolating infected inpatients but not shutting down the hospital facilities exposed to virus, could be effective in optimizing hospital service utilization and hospital revenue during the Omicron wave.
Gender inequalities in secondary prevention of cardiovascular disease: a scoping review
Authors: López Ferreruela Irene , Obón Azuara Blanca , Malo Fumanal Sara , Rabanaque Hernández María José , Aguilar-Palacio Isabel
Published: July 2024

Background

Despite significant progress in cardiovascular disease (CVD) management, it remains a public health priority and a global challenge. Within the disease process, health care after a cardiovascular event (secondary prevention) is essential to prevent recurrences. Nonetheless, evidence has suggested the existence of gender disparities in CVD management, leaving women in a vulnerable situation. The objective of this study is to identify all available evidence on the existence of gender differences in health care attention after a major adverse cardiovascular event.

Methods

A scoping review following the structure of PRISMA-ScR was conducted. To define the inclusion criteria, we used Joanna Briggs Institute (JBI) population, concept, context framework for scoping reviews. A systematic search was performed in MEDLINE (PubMed), EMBASE and Cochrane. The methods of this review are registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) (INPLASY202350084).

Results

The initial search retrieved 3,322 studies. 26 articles were identified manually. After the reviewing process, 93 articles were finally included. The main intervention studied was the pharmacological treatment received (n = 61, 66%), distantly followed by guideline-recommended care (n = 26, 28%) and cardiac rehabilitation (CR) referral (n = 16)”. Literature described gender differences in care and management of secondary prevention of CVD. Women were less frequently treated with guideline-recommended medications and seem more likely to be non-adherent. When analysing guideline recommendations, women were more likely to make dietary changes, however, men were more likely to increase physical activity. Studies also showed that women had lower rates of risk factor testing and cholesterol goals attainment. Female sex was associated with lower rates of cardiac rehabilitation referral and participation.

Conclusions

This review allowed us to compile knowledge on the existence of gender inequalities on the secondary prevention of CVD. Additional research is required to delve into various factors influencing therapeutic disparities, referral and non-participation in CR programs, among other aspects, in order to improve existing knowledge about the management and treatment of CVD in men and women. This approach is crucial to ensure the most equitable and effective attention to this issue.
Influenza virus infection activates TAK1 to suppress RIPK3-independent apoptosis and RIPK1-dependent necroptosis
Authors: Sun Yuling , Ji Lei , Liu Wei , Sun Jing , Liu Penggang , Wang Xiaoquan , Liu Xiufan , Xu Xiulong
Published: July 2024

Many DNA viruses develop various strategies to inhibit cell death to facilitate their replication. However, whether influenza A virus (IAV), a fast-replicating RNA virus, attenuates cell death remains unknown. Here, we report that IAV infection induces TAK1 phosphorylation in a murine alveolar epithelial cell line (LET1) and a murine fibroblastoma cell line (L929). The TAK1-specific inhibitor 5Z-7-Oxzeneonal (5Z) and TAK1 knockout significantly enhance IAV-induced apoptosis, as evidenced by increased PARP, caspase-8, and caspase-3 cleavage. TAK1 inhibition also increases necroptosis as evidenced by increased RIPK1S166, RIPK3T231/S232, and MLKLS345 phosphorylation. Mechanistically, TAK1 activates IKK, which phosphorylates RIPK1S25 and inhibits its activation. TAK1 also activates p38 and its downstream kinase MK2, which phosphorylates RIPK1S321 but does not affect RIPK1 activation. Further investigation revealed that the RIPK1 inhibitor Nec-1 and RIPK1 knockout abrogate IAV-induced apoptosis and necroptosis; re-expression of wild-type but not kinase-dead (KD)-RIPK1 restores IAV-induced cell death. ZBP1 knockout abrogates IAV-induced cell death, whereas RIPK3 knockout inhibits IAV-induced necroptosis but not apoptosis. 5Z treatment enhances IAV-induced cell death and slightly reduces the inflammatory response in the lungs of H1N1 virus-infected mice and prolongs the survival of IAV-infected mice. Our study provides evidence that IAV activates TAK1 to suppress RIPK1-dependent apoptosis and necroptosis, and that RIPK3 is required for IAV-induced necroptosis but not apoptosis in epithelial cells.
Tumor necrosis factor regulates leukocyte recruitment but not bacterial persistence during Staphylococcus aureus craniotomy infection
Authors: Van Roy Zachary , Kielian Tammy
Published: July 2024

Background

Craniotomy is a common neurosurgery used to treat intracranial pathologies. Nearly 5% of the 14 million craniotomies performed worldwide each year become infected, most often with Staphylococcus aureus (S. aureus), which forms a biofilm on the surface of the resected bone segment to establish a chronic infection that is recalcitrant to antibiotics and immune-mediated clearance. Tumor necrosis factor (TNF), a prototypical proinflammatory cytokine, has been implicated in generating protective immunity to various infections. Although TNF is elevated during S. aureus craniotomy infection, its functional importance in regulating disease pathogenesis has not been explored.

Methods

A mouse model of S. aureus craniotomy infection was used to investigate the functional importance of TNF signaling using TNF, TNFR1, and TNFR2 knockout (KO) mice by quantifying bacterial burden, immune infiltrates, inflammatory mediators, and transcriptional changes by RNA-seq. Complementary experiments examined neutrophil extracellular trap formation, leukocyte apoptosis, phagocytosis, and bactericidal activity.

Results

TNF transiently regulated neutrophil and granulocytic myeloid-derived suppressor cell recruitment to the brain, subcutaneous galea, and bone flap as evident by significant reductions in both cell types between days 7 to 14 post-infection coinciding with significant decreases in several chemokines, which recovered to wild type levels by day 28. Despite these defects, bacterial burdens were similar in TNF KO and WT mice. RNA-seq revealed enhanced lymphotoxin-α (Lta) expression in TNF KO granulocytes. Since both TNF and LTα signal through TNFR1 and TNFR2, KO mice for each receptor were examined to assess potential redundancy; however, neither strain had any impact on S. aureus burden. In vitro studies revealed that TNF loss selectively altered macrophage responses to S. aureus since TNF KO macrophages displayed significant reductions in phagocytosis, apoptosis, IL-6 production, and bactericidal activity in response to live S. aureus, whereas granulocytes were not affected.

Conclusion

These findings implicate TNF in modulating granulocyte recruitment during acute craniotomy infection via secondary effects on chemokine production and identify macrophages as a key cellular target of TNF action. However, the lack of changes in bacterial burden in TNF KO animals suggests the involvement of additional signals that dictate S. aureus pathogenesis during craniotomy infection.
A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective
Authors: Mabetha Khuthala , Soepnel Larske M. , SSewanyana Derrick , Draper Catherine E. , Lye Stephen , Norris Shane A.
Published: July 2024

Background

Pregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18–28 years, and ii) factors characterising the decision to terminate.

Methods

In-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.

Results

An application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants’ decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation.

Conclusions

Amongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.
Maternal dietary diversity and its association with infant birth weight: a healthcare centre based cross-sectional study
Authors: Javadi Maryam , Saffari Fatemeh , Amerzadeh Mohammad , Rafiei Sima
Published: July 2024

Background

Maternal nutrition during pregnancy is essential to fetal growth and producing a healthy child. This study aims to investigate the relationship between maternal dietary diversity and neonatal weight among pregnant women referred to health centers in Qazvin.

Methods

This was a cross-sectional study of 1076 pregnant women referred to healthcare centers affiliated by Qazvin University of Medical Sciences from April to June 2019. The dietary information of study participants was collected by a food frequency questionnaire. It was used to determine their dietary patterns by applying a factor analysis with a varimax rotation using SPSS software, version 20. Regarding the women's Dietary Diversity Score (DDS), women were categorized into two groups: inadequate (DDS < 4) and adequate (DDS ≥ 4) dietary diversity. The primary outcome was birth weight, and a log-binomial model was run to test the association between DSS and birth outcomes in the study population. The analysis was performed using SPSS Statistics for Windows version 20.0.

Results

Study findings revealed that mothers with higher dietary diversity scores were those with normal BMI and normal levels of hemoglobin who had 8–10.9 kg maternal weight gain and were headed by an employed husband (P < 0.05). Furthermore, the risk of low birth weight in newborns of mothers with inadequate dietary patterns was 2.6 times higher (ARR = 95% CI 2.6, 1.4, 5.12) compared to the newborns from mothers with adequate diets.

Conclusion

Insufficient intake of dietary diversity during pregnancy can potentially increase the likelihood of low birth weight in newborns. Thus, we recommend that health system authorities prioritize the planning for healthy nutrition of pregnant mothers in different geographical regions, specifically remote, rural, and deprived areas of the country.