bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience perspective on healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis
Authors: Knutsen Glette Malin , Ludlow Kristiana , Wiig Siri , Bates David Westfall , Austin Elizabeth E
Published: September 2023

Objective

To identify, review and synthesise qualitative literature on healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic.

Design

Systematic review with meta-synthesis.

Data sources

Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus.

Eligibility criteria

Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals’ adaptations to changes and challenges resulting from the COVID-19 pandemic.

Data extraction and synthesis

Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis.

Results

Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services.

Conclusion

Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals’ experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.
Healthcare resilience: a meta-narrative systematic review and synthesis of reviews
Authors: Tan Mark Z Y , Prager Gabrielle , McClelland Andrew , Dark Paul
Published: September 2023

Objectives

The COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered ‘resilient’ have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical capacities. This study aims to explore and synthesise evidence about healthcare resilience and present a unified framework for future resilience-building.

Design

Systematic review and synthesis of reviews using a meta-narrative approach.

Setting

Healthcare organisations and systems.

Primary and secondary outcome measures

Definitions, concepts and measures of healthcare resilience. We used thematic analysis across included reviews to summarise evidence on healthcare resilience.

Results

The main paradigms within healthcare resilience include global health, disaster risk reduction, emergency management, patient safety and public health. Definitions of healthcare resilience recognise various hierarchical levels: individual (micro), facility or organisation (meso), health system (macro) and planetary or international (meta). There has been a shift from a focus on mainly disasters and crises, to an ‘all-hazards’ approach to resilience. Attempts to measure resilience have met with limited success. We analysed key concepts to build a framework for healthcare resilience containing pre-event, intra-event, post-event and trans-event domains. Alongside, we synthesise a definition which dovetails with our framework.

Conclusion

Resilience increasingly takes an all-hazards approach and a process-oriented perspective. There is increasing recognition of the relational aspects of resilience. Few frameworks incorporate these, and they are difficult to capture within measurement systems. We need to understand how resilience works across hierarchical levels, and how competing priorities may affect overall resilience. Understanding these will underpin interdisciplinary, cross-sectoral and multi-level approaches to healthcare resilience for the future.

PROSPERO registration number

CRD42022314729.
Smartphone application-based rehabilitation in patients with chronic respiratory and cardiovascular diseases: a randomised controlled trial study protocol
Authors: Chung Chiwook , Kim Ah-Ram , Jang Il-Young , Jo Min-Woo , Lee Seongho , Kim Dongbum , Kwon Hee , Kang Do-Yoon , Lee Sei Won
Published: September 2023

Introduction

Rehabilitation is well known to improve clinical symptoms and decrease the risk of mortality in patients with chronic respiratory or cardiovascular diseases. We will evaluate the efficacy of smartphone application-based rehabilitation programmes in patients with chronic respiratory or cardiovascular diseases.

Methods and analysis

This single-centre single-blind randomised controlled trial will recruit a total of 162 participants from Asan Medical Center (81 patients each for pulmonary and cardiac rehabilitation, respectively). Participants will be assigned to the pulmonary or cardiac rehabilitation groups based on their underlying disease. Participants will be allocated randomly into the intervention or control groups at the ratio of 2:1 (54 and 27 patients). The intervention group will be provided with a smartphone application and undergo smartphone application-based rehabilitation for 12 weeks. The control group will receive the usual outpatient medical treatment without rehabilitation. Participants will be evaluated at baseline and at the end of the rehabilitation. The primary outcomes will be exercise capacity, such as maximal oxygen consumption on cardiopulmonary exercise test for both groups, chronic obstructive pulmonary disease assessment test for the pulmonary rehabilitation group, and Health-related Quality of Life Instrument with 8 Items questionnaires for the cardiac rehabilitation group. The secondary outcomes will include quality of life questionnaires, symptom scores, pulmonary function test and limb muscle test.

Ethics and dissemination

The study protocol was approved by the Institutional Review Board of Asan Medical Center. Written informed consent will be obtained from all participants prior to inclusion. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences.

Trial registration number

NCT05610358.
Efficacy of transcutaneous auricular vagus nerve stimulation on radiotherapy-related neuropathic pain in patients with head and neck cancers (RELAX): protocol for a multicentre, randomised, double-blind, sham-controlled trial
Authors: Zuo Xuzheng , Li Yi , Rong Xiaoming , Yang Xinguang , Zhu Yingying , Pan Dong , Li Honghong , Shen Qing-Yu , Tang Yamei
Published: September 2023

Introduction

Radiotherapy-related neuropathic pain (RRNP) is one of the most distressing complications after radiotherapy for head and neck cancers. Drug therapy is not sufficiently effective and has limitations in terms of dose titration period and side effects. Transcutaneous auricular vagus nerve stimulation (taVNS), which stimulates the auricular branches of the vagus nerve through electrical impulses, has been proven to have analgesic effects in certain diseases. However, it is unknown whether taVNS can relieve RRNP.

Methods and analysis

This is a multicentre, randomised, double-blind, parallel, sham-controlled trial. We will include adult patients newly diagnosed with neuropathic pain after radiotherapy for head and neck cancers. One hundred and sixteen individuals will be recruited and randomly assigned in a 1:1 ratio to receive taVNS or sham stimulation. The interventions will last for 7 days, twice daily for 30 min each. The primary efficacy outcome is pain reduction on day 7. The secondary outcomes are changes in functional interference, psychological distress, fatigue, quality of life and serum inflammatory factors. The study may provide a new early intervention strategy for RRNP among patients with head and neck cancers.

Ethics and dissemination

This study has been approved by the Medical Research Ethics Committee of Sun Yat-sen University (SYSKY-2022-109-01) and will be conducted in strict accordance with the Declaration of Helsinki. Ethical approvals will be obtained separately for all centres involved in the study. Study results will be published in peer-reviewed academic journals. The database of the study will be available from the corresponding author on reasonable request.

Trial registration number

NCT05543239
Effects of the Education and Training Programme for Excellent Physicians in China on medical students’ academic performance: a cross-sectional study
Authors: Shi Zehua , Li Chunqing , Wu Hongbin
Published: September 2023

Objectives

To evaluate the effect of the Education and Training Programme for Excellent Physicians in China on medical students’ academic performance.

Design

This study is a secondary analysis of data from a cross-sectional survey of China Medical Student Survey (CMSS, 2021) and administrative data of the first-stage Medical Licensing Examination—the Standardised Competence Test for Clinical Medicine Undergraduates (the Test, 2021). CMSS used a stratified sampling process, with all undergraduate clinical medicine students participating voluntarily.

Setting

This programme is implemented at the class level within reformed medical schools, targeting undergraduate students in 5-year clinical medicine in China. The reformed medical schools run pilot classes and traditional classes simultaneously. The analytic sample was a total of 12 243 observations from pilot and traditional classes in 34 medical schools which implemented the reform across 19 provinces in China.

Methods

This study applied the propensity score matching method to estimate the effect of the reform by comparing the scores of the Test between pilot and traditional classes within the same medical schools. We further explored the potential mechanisms driving the effect from two facets of the Test: medical knowledge modules and cognitive levels.

Results

Pilot classes outperformed traditional classes by 0.104 SD on the Test (95% CI 0.037 to 0.171). Improvements were seen in basic medicine and clinical medicine modules (0.109 and 0.101 SD, respectively) and cognitive levels of memorisation and application (0.116 and 0.111 SD, respectively).

Conclusion

These results suggest that the reform had a significant positive impact on medical students’ academic performance. Based on the components of this reform and the potential mechanism analysis of the two facets, this study indicates that curriculum reform in integrated learning and teaching methods reform in the adoption of problem-based learning may have been the possible drivers of this positive impact.
Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial
Authors: Gross Sebastian , Becker Christoph , Beck Katharina , Memma Valentina , Gaab Jens , Schütz Philipp , Leuppi Jörg D , Schaefert Rainer , Langewitz Wolf , Trendelenburg Marten , Breidthardt Tobias , Eckstein Jens , Osthoff Michael , Bassetti Stefano , Hunziker Sabina
Published: September 2023

Objective

Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care.

Design

Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups.

Setting

Three Swiss teaching hospitals.

Participants

Adult patients hospitalised for medical care.

Interventions

We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics.

Primary and secondary outcome measures

The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes.

Results

Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (±14.6) vs 90.2 (±12.1), adjusted difference −2.5 (95% CI −4.28 to −0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient–physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002).

Conclusions

A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients.

Trial registration number

NCT03210987.
Study within a trial of electronic versus paper-based Patient-Reported oUtcomes CollEction (SPRUCE): study protocol for a partially randomised patient preference study
Authors: Philipps Lara , Foster Stephanie , Gardiner Deborah , Gath Jacqui , Gillman Alexa , Haviland Joanne , Hill Elizabeth , King Diana , Manning Georgina , Stiles Morgaine , Hall Emma , Lewis Rebecca
Published: September 2023

Introduction

Patient-reported outcomes (PRO) are currently collected from trial participants using paper questionnaires by the Clinical Trials and Statistics Unit at The Institute of Cancer Research (ICR-CTSU). Streamlining PRO collection using electronic questionnaires (ePRO) may improve data collection and patient experience. Here, we outline our protocol for a Study within a trial of electronic versus paper-based Patient-Reported oUtcomes CollEction (SPRUCE), which investigates the acceptability of ePRO in oncology clinical trials.

Methods and analysis

SPRUCE was developed alongside patient and public contributors. SPRUCE runs in multiple host trials with a partially randomised patient preference design, allowing participants to be randomised or choose their preference of electronic or paper questionnaires. Questionnaires are scheduled in accordance with host trial follow-up. The primary objective will assess differences in return rates (compliance) between ePRO and paper PROs at the first timepoint post-host trial intervention in the randomised group. Paper PRO compliance is expected to be 90%. 244 randomised participants are required to exclude ≤80% compliance rates with ePRO (10% non-inferiority margin, with 80% power and one-sided alpha=0.05). SPRUCE aims to assess acceptability of ePRO in oncology clinical trials, establish whether ePRO is acceptable to ICR-CTSU trial participants and can capture complete PRO data, consistent with paper PROs.

Ethics and dissemination

The SPRUCE protocol (ICR-CTSU/2021/10074) was approved by the Coventry and Warwick Central Research Ethics Committee (21/WM/0223) on 21 October 2021. Results will be disseminated via presentations, publications and lay summaries. No participant identifiable data will be included.

Trial registration

SWAT169.
Prevalence of psychological distress and associated factors among Omani women diagnosed with breast cancer: a single-centre, cross-sectional study
Authors: Al-Fahdi Amal , Chan Moon Fai , Al-Siyabi Wedad , Al-Yafai Entesar , Al-Khatri Mariya , Al-Azri Mohammed
Published: September 2023

Objectives

To determine the prevalence of psychological distress (ie, anxiety and depressive symptoms) among Omani women diagnosed with breast cancer (BC) and to investigate associations with socio-demographic factors.

Design

A cross-sectional, self-administered survey was conducted between September 2021 and June 2022.

Setting

Sultan Qaboos Comprehensive Cancer Care and Research Centre (Muscat, Oman).

Participants

Adult Omani women diagnosed with BC during the study period.

Outcome measures

Data regarding anxiety and depressive symptoms were collected using an Arabic version of the Hospital Anxiety and Depression Scale (HADS). Socio-demographic and clinical information was obtained from the participants and their hospital medical records.

Results

190 Omani women diagnosed with BC were invited to participate in the study, of whom 171 participated (response rate: 90.0%). The mean age was 50.3±10.9 years. 52.3% of participants had been diagnosed with BC at stages III or IV and 28.9% had metastasis. 29 women (17.0%) exhibited depressive symptoms (HADS-D score: ≥8), while 37 (21.6%) exhibited anxiety symptoms (HADS-A score: ≥8). Women with anxiety symptoms were almost 15-times more likely to have depressive symptoms than those without anxiety symptoms (OR: 14.87, p<0.001). Younger women were less likely to exhibit depressive symptoms than older women (≤39 vs ≥60 years, p=0.050; 40–59 vs ≥60 years, p=0.005). Women at the school/diploma education level were less likely to have depressive symptoms than those at college/university level (OR: 0.19, p=0.017).

Conclusions

More than half of the women surveyed had been diagnosed at an advanced stage, with up to 21.6% presenting with symptoms of anxiety and depression. Healthcare professionals in Oman should consider additional screening for anxiety and depressive symptoms in this group and encourage patients with BC to disclose emotional information during consultations, particularly for those aged ≥60 years.
Protocol for development and validation of a prediction model for post-induction hypotension in elderly patients undergoing non-cardiac surgery: a prospective cohort study
Authors: Hu Jing-Hui , Xu Ning , Bian Zhen , Shi Hai-Jing , Ji Fu-Hai , Peng Ke
Published: September 2023

Introduction

Post-induction hypotension (PIH) is a common event in elderly surgical patients and is associated with increased postoperative morbidity and mortality. This study aims to develop and validate a PIH prediction model for elderly patients undergoing elective non-cardiac surgery to identify potential PIH in advance and help to take preventive measures.

Methods and analysis

A total of 938 elderly surgical patients (n=657 for development and internal validation, n=281 for temporal validation) will be continuously recruited at The First Affiliated Hospital of Soochow University in Suzhou, China. The main outcome is PIH during the first 15 min after anaesthesia induction or before skin incision (whichever occurs first). We select candidate predictors based on published literature, professional knowledge and clinical expertise. For model development, we will use the least absolute shrinkage and selection operator regression analysis and multivariable logistic regression. For internal validation, we will apply the bootstrapping technique. After model development and internal validation, temporal validation will be conducted in patients recruited in another time period. We will use the discrimination, calibration and max-rescaled Brier score in the temporal validation cohort. Furthermore, the clinical utility of the prediction model will be assessed using the decision curve analysis, and the results will be presented in a nomogram and a web-based risk calculator.

Ethics and dissemination

Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Soochow University (Approval No. 2023-012). This PIH risk prediction model will be published in a peer-reviewed journal.

Trial registration number

ChiCTR2200066201.
Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students’ longitudinal experiences in primary care
Authors: Brown Megan E L , Parekh Ravi , Collin Victoria , Sivam Vanessa , Ahuja Neha , Kumar Sonia
Published: September 2023

Objective

Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school.

Design

We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis.

Setting

One research-intensive medical school based in the UK. Data collection occurred in 2021–2022.

Participants

12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year.

Results

We constructed four themes capturing insights on how hidden curricula influenced students’ experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning.

Conclusions

The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.
Exploring experiences of times without care and encounters in dementia: protocol for a living and adaptive evidence map
Authors: Hirt Julian , Adlbrecht Laura , Maurer Carola , Beer Thomas
Published: September 2023

Introduction

Individuals with dementia spend most of the day without care, without encounters, and usually without activity. Although this has been proven in studies, there is a knowledge gap on how individuals with dementia experience these periods of time. Such knowledge would be highly relevant for health professionals and relatives to develop adequate strategies for dealing with these periods of time. TheFreiZeitstudy aims to reconstruct periods of time without care and encounters from the perspective of individuals with dementia and formal and informal carers. The specific objective of this review is to provide a continuously updated overview of the topical evidence that may be used to guide data synthesis and interpretation within theFreiZeitstudy.

Methods and analysis

We conduct a living evidence map, based on a comprehensive systematic literature search in MEDLINE/PubMed, CINAHL, PsycINFO/Ovid and Web of Science Core Collection, citation-based searches and web searches. We include studies on times without care and encounters of individuals with dementia from the perspective of individuals with dementia themselves and formal or informal caregivers of any observational study design that were conducted in the institutional and domestic long-term care setting and published as journal article in English, French or German language without any restriction of the publication year. One reviewer screens titles, abstracts and full texts and extracts data. Key characteristics and results of the included studies are charted in a tabular format. The searches will be run and continuously updated throughout the duration of the overarchingFreiZeitstudy (every 6 months for 2 years from 2023 to 2025).

Ethics and dissemination

Ethics approval is not required for this evidence map. We disseminate our findings via journal articles and conference proceedings as well as other formats.

Registration details

This review protocol is uploaded on Open Science Framework (OSF; DOI 10.17605/OSF.IO/GDYZ9).
Psychosocial patient perspectives following major lower-limb amputation due to vascular aetiology: a protocol for a systematic meta-aggregation study
Authors: Laursen Sisse Heiden , Rasmussen Helle Lund , Seidelin Dinnie , Pedersen Peter Hørslev , Chræmmer Tanja Mortensen
Published: September 2023

Introduction

Persistent psychosocial problems in people with lower-limb amputation due to vascular aetiology indicate a great need for long-lasting holistic rehabilitation. An in-depth understanding of the psychosocial problems is essential for the guidance of health professionals in meeting and normalising patients’ experiences and emotions. Furthermore, identifying the psychological problems may help develop effective rehabilitation and counselling programmes. This meta-aggregation study aims to explore the psychosocial perspectives of individuals who have undergone a major lower-limb amputation due to vascular aetiology during the post-discharge rehabilitation phase.

Methods and analysis

A systematic meta-aggregation study will be performed to identify full-text, peer-reviewed journal articles reporting on patients’ psychosocial perspectives on major lower-limb amputation due to vascular aetiology from post-discharge to several years afterward. The databases Embase, CINAHL Ultimate, APA PsycInfo, PubMed and Scopus will be searched with no limitations regarding the publication year. Studies that satisfy the eligibility criteria will be critically appraised using an acknowledged checklist and synthesised using the Joanna Briggs Institute three-phase approach for the synthesis of meta-aggregation studies. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation- Confidence in Evidence from Reviews of Qualitative research) tool will be used to determine the level of confidence in the qualitative evidence, and the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) reporting guidelines will be followed throughout the review process.

Ethics and dissemination

Ethical approval is not required for the study, as the review is built on pre-existing available data in the literature. Findings from the review will be disseminated through publication in a peer-review journal.

PROSPERO registration number

CRD42022377114.
Handling missing values in the analysis of between-hospital differences in ordinal and dichotomous outcomes: a simulation study
Authors: van Linschoten Reinier C A , Amini Marzyeh , van Leeuwen Nikki , Eijkenaar Frank , den Hartog Sanne J , Nederkoorn Paul J , Hofmeijer Jeannette , Emmer Bart J , Postma Alida A , van Zwam Wim , Roozenbeek Bob , Dippel Diederik , Lingsma Hester F
Published: September 2023

Missing data are frequently encountered in registries that are used to compare performance across hospitals. The most appropriate method for handling missing data when analysing differences in outcomes between hospitals with a generalised linear mixed model is unclear. We aimed to compare methods for handling missing data when comparing hospitals on ordinal and dichotomous outcomes. We performed a simulation study using data from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry, a prospective cohort study in 17 hospitals performing endovascular therapy for ischaemic stroke in the Netherlands. The investigated methods for handling missing data, both case-mix adjustment variables and outcomes, were complete case analysis, single imputation, multiple imputation, single imputation with deletion of imputed outcomes and multiple imputation with deletion of imputed outcomes. Data were generated as missing completely at random (MCAR), missing at random and missing not at random (MNAR) in three scenarios: (1) 10% missing data in case-mix and outcome; (2) 40% missing data in case-mix and outcome; and (3) 40% missing data in case-mix and outcome with varying degree of missing data among hospitals. Bias and reliability of the methods were compared on the mean squared error (MSE, a summary measure combining bias and reliability) relative to the hospital effect estimates from the complete reference data set. For both the ordinal outcome (ie, the modified Rankin Scale) and a common dichotomised version thereof, all methods of handling missing data were biased, likely due to shrinkage of the random effects. The MSE of all methods was on average lowest under MCAR and with fewer missing data, and highest with more missing data and under MNAR. The ‘multiple imputation, then deletion’ method had the lowest MSE for both outcomes under all simulated patterns of missing data. Thus, when estimating hospital effects on ordinal and dichotomous outcomes in the presence of missing data, the least biased and most reliable method to handle these missing data is ‘multiple imputation, then deletion’.
Reduced long-term mortality after successful resective epilepsy surgery: a population-based study
Authors: Granthon Cecilia , Tranberg Anna Edelvik , Malmgren Kristina , Strandberg Maria Compagno , Kumlien Eva , Redfors Petra
Published: September 2023

Background

We investigated all-cause and epilepsy-related mortality in patients operated with resective epilepsy surgery and in non-operated patients with drug-resistant epilepsy. Our hypothesis was that patients who proceed to surgery have lower mortality over time compared with non-operated patients.

Method

Data from 1329 adults and children from the Swedish National Epilepsy Surgery Register and 666 patients with drug-resistant epilepsy who had undergone presurgical work-up but not been operated were analysed. The operated patients had follow-ups between 2 and 20 years. We used the Swedish Cause of Death Register to identify deaths. Autopsy reports were collected for patients with suspected sudden unexpected death in epilepsy (SUDEP). Kaplan-Meier and Cox regression analyses were performed to identify predictors for mortality and SUDEP.

Results

SUDEP accounted for 30% of all deaths. Surgery was associated with lower all-cause mortality (HR 0.7, 95% CI 0.5 to 0.9), also when adjusted for age, sex and tonic–clonic seizures at inclusion. The benefit of surgery seemed to persist and possibly even increase after 15 years of follow-up. Risk factors of mortality for operated patients were persisting seizures and living alone. Of the operated patients, 37% had seizures, and these had a higher risk of mortality (HR 2.1, 95% CI 1.4 to 3.0) and SUDEP (HR 3.5, 95% CI 1.7 to 7.3) compared with patients with seizure freedom at last follow-up.

Conclusions

In this large population-based epilepsy surgery cohort, operated patients had a lower all-cause mortality compared with non-operated patients with drug-resistant epilepsy. Seizure freedom was the most important beneficial factor for both all-cause mortality and SUDEP among operated patients.
Comparative effectiveness of pharmacological interventions for hand osteoarthritis: a systematic review and network meta-analysis of randomised trials
Authors: Døssing Anna , Nielsen Sabrina Mai , Kroon Féline PB , Balsby Ida Maria , Tarp Simon , Kloppenburg Margreet , Stamp Lisa , Haugen Ida K , Altman Roy D , Henriksen Marius , Boesen Mikael , Bliddal Henning , Berg Søren , Christensen Robin
Published: September 2023

Objective

To explore the comparative effectiveness of pharmacological interventions for hand osteoarthritis (OA).

Methods

We systematically searched Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception until 26 December 2021, for randomised trials of pharmacological interventions for people with hand OA. Two reviewers independently extracted study data and assessed the risk of bias. We calculated the effect sizes for pain (standardised mean differences) using Bayesian random effects models for network meta-analysis (NMA) and pairwise meta-analysis. Based on a pre-specified protocol, we prospectively registered the study at PROSPERO, CRD42021215393.

Results

We included 72 trials with 7609 participants. 65 trials (n=5957) were eligible for the quantitative synthesis, investigating 29 pharmacological interventions. Oral non-steroidal anti-inflammatory drugs (NSAIDs) and oral glucocorticoids’ NMA effect sizes were −0.18 (95% credible interval −0.36 to 0.02) and −0.54 (−0.83 to −0.24), respectively, compared with placebo, and the result was consistent when limiting evidence to the pairwise meta-analysis of trials without high risk of bias. Intra-articular hyaluronate, intra-articular glucocorticoids, hydroxychloroquine, and topical NSAIDs’ NMA effect sizes were 0.22 (−0.08 to 0.51), 0.25 (0.00 to 0.51), −0.01 (−0.19 to 0.18), and −0.14 (−0.33 to 0.08), respectively, compared with placebo. Oral NSAIDs were inferior to oral glucocorticoids with an NMA effect size of 0.36 (0.01 to 0.72). No intervention was superior to placebo when stratifying for thumb and finger OA.

Conclusion

Oral NSAIDs and glucocorticoids are apparently effective pharmacological interventions in hand OA. Intra-articular therapies and topical NSAIDs were not superior to placebo.
The particle surface of spinning test particles
Authors: Song Yong , Cen Yiting , Tang Leilei , Hu Jiabao , Diao Kai , Zhao Xiaofeng , Shi Shunping
Published: September 2023

In this work, inspired by the definition of the photon surface given by Claudel, Virbhadra, and Ellis, we give an alternative quasi-local definition to study the circular orbits of single-pole particles. This definition does not only apply to photons but also to massive point particles. For the case of photons in spherically symmetric spacetime, it will give a photon surface equivalent to the result of Claudel, Virbhadra, and Ellis. Meanwhile, in general static and stationary spacetime, this definition can be regarded as a quasi-local form of the effective potential method. However, unlike the effective potential method which can not define the effective potential in dynamical spacetime, this definition can be applied to dynamical spacetime. Further, we generalize this definition directly to the case of pole–dipole particles. In static spherical symmetry spacetime, we verify the correctness of this generalization by comparing the results obtained by the effective potential method.
Lorentzian wormhole in the framework of loop quantum cosmology
Authors: Sengupta Rikpratik , Ghosh Shounak , Kalam Mehedi
Published: September 2023

In this paper, we construct a traversable static Lorentzian wormhole in the effective scenario of Loop Quantum Cosmology (LQC), where the field equations are modified due to the ultraviolet (UV) corrections introduced at large space-time curvatures. A stable wormhole can be constructed in the effective scenario without the violation of Null energy condition (NEC) by physical matter at the throat. The NEC is effectively violated due to the corrections in the field equations from LQC, resolving the Weyl curvature singularity at the throat. However, the physical matter does violate the Strong energy condition (SEC), suggesting the interesting possibility that dark energy can be harnessed into a wormhole. A possible explanation for this is the presence of inherent pressure isotropy in the UV-corrected field equations (discussed and compared to braneworld wormholes in the discussion). No additional exotic ingredient (violating NEC) is required, avoiding quantum instabilities. The tidal forces at the throat do not diverge and also the throat is found to be stable. The wormhole features an attractive geometry. LQC can resolve both types of curvature singularities appearing at the black hole centre and wormhole throat, without exotic matter.
A UNIFORM PLACEMENT OF ALTERS ON SPHERICAL SURFACE (U-PASS) FOR EGO-CENTRIC NETWORKS WITH COMMUNITY STRUCTURE AND ALTER ATTRIBUTES
Authors: HUANG EMILY CHAO-HUI , PHOA FREDERICK KIN HING
Published: September 2023

An ego-centric network consists of a particular node (ego) that has relationships to all neighboring nodes (alters) in the network. Such network serves as an important tool to study the network structure of alters of the ego, and it is essential to present such network with good visualization. This work aims at introducing an efficient method, namely the Uniform Placement of Alters on Spherical Surface (U-PASS), to represent an ego-centric network so that all alters are scattered on the surface of the unit sphere uniformly. Unlike other simple uniformity that considers to maximize Euclidean distances among nodes, U-PASS is a three-stage method that spreads the alters with the consideration of existing edges among alters, no overlapping of node clusters, and node attribute information. Particle swarm optimization is employed to improve efficiency in node allocations. To guarantee the uniformity, we show the connection between our U-PASS to the minimum energy design on a two-dimensional flat plane with a specific gradient. Our simulation study shows good performance of U-PASS in terms of some distance statistics when compared to four state-of-the-art methods via self-organizing maps and force-driven approaches. We use a Facebook network to illustrate how this ego-centric network looks different after the alter nodes are allocated via our U-PASS.
A dilated convolution-based feature adaptation method for detection of high aspect ratio objects in aerial images
Authors: Liu Shaobo , Xia Tian , Chen Xiaodong , Li Hui , Yuan Guanghui , Yang Dong
Published: September 2023

In real scenarios, objects with high aspect ratios are actually very common, and such objects hold significant importance in the field of object detection. However, most of the existing object detection algorithms tend to overlook this specific type of object. After analyzing the statistical data, we observed a substantial decrease in mAP (mean Average Precision) for classical object detection algorithms when they are tasked with detecting only high aspect ratio objects. Therefore, we conducted an analysis of the factors that influence the detection performance of these objects and made the following improvements: (1) We introduced large-kernel attention convolution between the backbone network layers. This addition allows each position feature to have a larger receptive field, facilitating better feature learning; (2) By incorporating multiple sets of deformable convolutions for feature-adaptive processing, we were able to enhance the learning of characteristic information specific to the object itself. This approach also promotes network convergence. The proposed method yielded a significant improvement in accuracy, approximately 5[Formula: see text] higher than the baseline, when evaluated on the FGSD2021 dataset. Furthermore, our method outperformed the current best method by approximately 0.5[Formula: see text].
The 3-forced 2-structures
Authors: Boussaïri Abderrahim , Ille Pierre
Published: September 2023

Given sets [Formula: see text] and [Formula: see text], a labeled 2-structure is a function [Formula: see text] from [Formula: see text] to [Formula: see text]. The set [Formula: see text] is called the vertex set of [Formula: see text] and denoted by [Formula: see text]. The label set of [Formula: see text] is the set [Formula: see text] of [Formula: see text] such that [Formula: see text] for some [Formula: see text]. Given [Formula: see text], the 2-substructure [Formula: see text] of [Formula: see text] is denoted by [Formula: see text]. The dual [Formula: see text] of [Formula: see text] is defined on [Formula: see text] as follows. For distinct [Formula: see text], [Formula: see text]. A labeled 2-Structure [Formula: see text] is reversible provided that for [Formula: see text] such that [Formula: see text] and [Formula: see text], if [Formula: see text], then [Formula: see text]. We only consider reversible labeled 2-structures whose vertex set is finite.

Let [Formula: see text] and [Formula: see text] be 2-structures such that [Formula: see text]. Given [Formula: see text], [Formula: see text] and [Formula: see text] are [Formula: see text]-hemimorphic if for every [Formula: see text] such that [Formula: see text], [Formula: see text] is isomorphic to [Formula: see text] or [Formula: see text]. Furthermore, let [Formula: see text] be a 2-structure. Given [Formula: see text], [Formula: see text] is [Formula: see text]-forced if [Formula: see text] and [Formula: see text] are the only 2-structures [Formula: see text]-hemimorphic to [Formula: see text]. We characterize the [Formula: see text]-forced 2-structures. Last, we provide a large class of [Formula: see text]-forced 2-structures.
Hamilton cycles in generalized Mycielski graphs
Authors: Panneerselvam L. , Ganesamurthy S. , Muthusamy A.
Published: September 2023

Let [Formula: see text] denote the generalized Mycielski graph of [Formula: see text]. In this paper, it is proved that for [Formula: see text], if [Formula: see text] has [Formula: see text] pairwise edge-disjoint Hamilton cycles, then [Formula: see text] has [Formula: see text] Hamilton cycles which are pairwise edge-disjoint. Further, it is shown that if [Formula: see text] has [Formula: see text] pairwise edge-disjoint Hamilton cycles with [Formula: see text] for [Formula: see text] and [Formula: see text] for [Formula: see text], then [Formula: see text] has [Formula: see text] pairwise edge-disjoint Hamilton cycles. Finally it is shown that [Formula: see text] is hamiltonian even when [Formula: see text] is non-hamiltonian with a specified [Formula: see text]-factor. Consequently, the Mycielski graph of Flower Snark graph [Formula: see text], for all odd [Formula: see text], is Hamiltonian.
Effect of Defects on the Characteristics of CoFeB–MgO-Based MRAM Structure
Authors: Zhang Bosen , Chen Jieyao , Wang Junlin , Li Wenjia , Tong Kaiyu , Li Guanqi , Ma Jun , Wu Jing , Xu Yongbing
Published: September 2023

Magnetic random-access memory (MRAM) is one of the most promising next-generation purpose memory devices for nonvolatile storage and in-memory computing. However, material defects can affect the performance of the MRAM device. Here, the relationship between the material defects and the properties of CoFeB–MgO-based MRAM have been studied with micromagnetic simulations. The results show that the coercivity and the switching speed are strongly influenced by the material defects. This work provides a useful guideline for the fabrication of the MARM devices.
Design of Micro-drone Autopilot Architecture with Static Scheduling Optimization
Authors: Hattenberger Gautier , Bonneval Fabien , Ladeira Matheus , Grolleau Emmanuel , Ouhammou Yassine
Published: September 2023

This paper presents the internal architecture of a Modifiable Off-the-Shelf (MOTS) open-source autopilot. The analysis of a set of functional and hardware requirements reveals that the core of the autopilot can be implemented as a single-threaded system, with a main loop acting as a non-preemptive static scheduler, provided that the internal structure is well-organized. We discuss how the type of bus used for sensor communication influences the nature of the events received from the sensors, whether they are solicited or unsolicited. We demonstrate that, depending on the workload that a main loop iteration must handle, the execution time of a single iteration can exceed the defined period, potentially causing delays in attitude correction. Finally, we explore the degrees of freedom available to mitigate the impact of such overloads by smoothing out the periodic workload.
Adversarial Attacks on Deep Reinforcement Learning-based Traffic Signal Control Systems with Colluding Vehicles
Authors: Qu Ao , Tang Yihong , Ma Wei
Published: September 2023

The rapid advancements of Internet of Things (IoT) and Artificial Intelligence (AI) have catalyzed the development of adaptive traffic control systems (ATCS) for smart cities. In particular, deep reinforcement learning (DRL) models produce state-of-the-art performance and have great potential for practical applications. In the existing DRL-based ATCS, the controlled signals collect traffic state information from nearby vehicles, and then optimal actions (e.g., switching phases) can be determined based on the collected information. The DRL models fully “trust” that vehicles are sending the true information to the traffic signals, making the ATCS vulnerable to adversarial attacks with falsified information. In view of this, this article first time formulates a novel task in which a group of vehicles can cooperatively send falsified information to “cheat” DRL-based ATCS in order to save their total travel time. To solve the proposed task, we develop
CollusionVeh
, a generic and effective vehicle-colluding framework composed of a road situation encoder, a vehicle interpreter, and a communication mechanism. We employ our framework to attack established DRL-based ATCS and demonstrate that the total travel time for the colluding vehicles can be significantly reduced with a reasonable number of learning episodes, and the colluding effect will decrease if the number of colluding vehicles increases. Additionally, insights and suggestions for the real-world deployment of DRL-based ATCS are provided. The research outcomes could help improve the reliability and robustness of the ATCS and better protect the smart mobility systems.
Pharmacological inhibition of the mixed lineage leukemia 1-menin interaction aggravates acute kidney injury induced by folic acid and ischemia-reperfusion in mice
Authors: Hou Xiying , Cui Binbin , Qiu Andong , Liu Na , Zhuang Shougang
Published: September 2023

Mixed lineage leukemia 1 (MLL1) is a methyltransferase that induces histone H3 lysine 4 trimethylation and exerts its functional roles by interacting with multiple subunits. In this study, we demonstrated that inhibition of MLL1 activity by MI503 or MM102 aggravated renal injury and apoptosis and suppressed renal tubular cell dedifferentiation and proliferation, suggesting that MLL1 activation during acute kidney injury acts as an intrinsic protective mechanism to mediate renal tubular cell survival and regeneration.
Assumptions about the cross-sectional shape of skinned muscle fibers can distort the relationship between muscle force and cross-sectional area
Authors: Smith Ian C. , Herzog Walter
Published: September 2023

Comparisons of muscle force output are often performed after normalization to muscle physiological cross-sectional area (CSA). Differences in force per CSA (i.e., specific force) suggest the presence of physiological differences in contractile function. Permeabilized mammalian skeletal muscle fibers frequently exhibit substantial declines in specific force with increasing CSA, suggesting that smaller fibers are intrinsically stronger than larger fibers of the same group. However, the potential for CSA assessment error to account for CSA-dependent differences in specific force has not received adequate attention. Assessment of fiber CSA typically involves measurement of fiber width and perhaps also height, and CSA is calculated by assuming the cross sections are either circular or elliptical with major and minor axes aligned with the optical measurement system. Differences between the assumed and real cross-sectional shapes would cause variability in the ratio of assessed CSA (aCSA) to real CSA (rCSA). This variability can insidiously bias aCSA such that large aCSAs typically overstate rCSAs of the fibers they represent, and small aCSAs typically understate the rCSAs of the fibers they represent. As aCSA is the denominator for the specific force calculation, scatterplots of specific force versus aCSA would be expected to show declines in specific force as aCSA increases without a corresponding effect in a scatterplot of specific force versus rCSA. When comparing active and passive muscle forces between data subsets defined by aCSA, the impact of CSA assessment error should be considered before exploring other physiological mechanisms.