bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the benefits and challenges of using patient preferences as a tool for clinical decision making in oncology MDT meetings within the National Health Service (NHS): A qualitative study
Authors: Naeem Amber , Jacob Wright
Published: January 2025

Introduction: Multidisciplinary Team (MDT) oncology meetings foster collaboration among healthcare practitioners to determine the most appropriate course of action for cancer patient care. Defining what is ‘best’ for a patient is complex, involving clinical guidelines, patient needs, evidence-based practices, and available treatment options. Patient participation offers unique insights into cultural and psycho-social preferences, shifting away from the paternalistic health care model. This study aimed to explore the benefits, barriers, and challenges associated with integrating patient preferences (PPs) into oncology MDT decision making. Methods: Thirty participants from two major UK oncology centers completed questionnaires, with eight participating in the follow-up interviews. Results: The key benefits of incorporating patient preferences included improved patient satisfaction, treatment adherence, and decision-making efficiency. The major barriers were lack of clinical information, insufficient knowledge of preferences, and time constraints. Challenges within MDT meetings include poor attendance of key clinicians, inadequate chairing, and physical constraints. Conclusion: This is the first UK-based study to explore physicians’ perspectives on incorporating patient preferences into oncology decision-making. While patient preferences are valued, integration is often hindered by systemic pressure within the NHS. The findings highlight the complex interplay between patient-centered care ideals and practical implementation challenges, suggesting areas for improvement that incorporate patient voices into cancer care decision-making.
Increased prevalence of antinuclear antibody positivity in central centrifugal cicatricial alopecia patients
Authors: Ong Michael , Singal Amit , Lipner Shari R.
Published: January 2025

Background: Central centrifugal cicatricial alopecia (CCCA) is a primary scarring alopecia predominantly affecting Black women. Autoimmune mechanisms, including antinuclear antibody (ANA) positivity, have been hypothesized to contribute to its pathogenesis but remain underexplored.

Methods: Using the TriNetX database (2004–2024), we identified Black women with CCCA and controls with other primary scarring alopecias. Patients were propensity score matched by current age and age at diagnosis. We compared the prevalence of ANA positivity and autoimmune comorbidities before and after alopecia diagnosis. Statistical significance was defined as an adjusted p-value <0.05.

Results: Among 5,811 CCCA patients and matched controls, CCCA patients were more likely to have positive ANA (11.8% vs. 2.0%, p<0.001) and systemic lupus erythematosus (SLE) post-diagnosis (0.9% vs. 0.3%, p=0.007). They were less likely to have type 1 diabetes (T1DM) pre-diagnosis (2.9% vs. 4.8%, p=0.007) and post-diagnosis (0.8% vs. 1.3%, p=0.024). No significant differences were found in other autoimmune diseases.

Conclusion: CCCA patients had higher prevalence of ANA positivity and SLE, supporting potential autoimmune involvement. However, screening for other autoimmune diseases in asymptomatic CCCA patients may not be necessary. Further research is needed to clarify the interplay between autoimmune and metabolic pathways in CCCA.
Inhaled Aviptadil is a New Hope for Recovery of Lung Damage due to COVID-19
Authors: Esendagli Dorina , Sarı Nuran , Akhan Sıla , Arslan Sonay , Doğan Öntaş İrem Asena , Yılmaz Gürdal , Aksoy Firdevs , Kant Aydın , Kart Yasar Kadriye , Ünlü Esra Canbolat , Akıllı Işıl Kibar , Çelen Mustafa Kemal , Mermutluoğlu Çiğdem , Dayan Saim , Kara Emre , Durhan Gamze , Ünal Serhat , Demirkol Barış , Arafat Levent , Çetinkaya Erdoğan , Çörtük Mustafa , Durmuş Koçak Nagihan , Parmaksız Elif Torun , İnkaya Ahmet Çağkan
Published: January 2025

Objective: We are still in search of new therapeutic options for COVID-19 to prevent new infections, enable fast recovery and reduce the long-lasting symptoms or sequelae. This study aimed to investigate the short- and long-term effects of inhaled aviptadil on hospitalized, adult COVID-19 patients. Methods: A multicenter, prospective, placebo-controlled, comparative, randomized, double-blind clinical trial was conducted. Patients were randomized 1:1 to either inhaled aviptadil or placebo, in addition to the standard care. The primary endpoint is the time from hospitalization to discharge within 30 days of treatment. The secondary endpoints are clinical and radiological score improvements. Results: The study involved 80 patients enrolled from 9 clinical centers. The mean age was 55.8 ± 18.5 years and 27 of them (33.8%) were female. The average time to discharge was 7.8±4.0 days in aviptadil group and 10±5.0 days in placebo (p = 0.049). Modified-Borg Scales were not statistically different on Day 3 (p = 0.090), but significantly lower in the aviptadil group on Day 7 (p = 0.033). The CT lung damage score was not different on Day 1 for both groups (p = 0.962); improvement on Day-28 was significantly greater in the aviptadil group (p = 0.028). The death rate was also lower in the aviptadil group (5.1%) when compared to the placebo (12.2%). There was no drop-out due to side effects. Conclusion: Study shows that inhaled aviptadil is well-tolerated and can be used as a supplementary intervention to fasten the recovery of respiratory manifestations in hospitalized patients for COVID-19 pneumonia.
Fascismo digital e violência escolar: deformação subjetiva do neoliberalismo contemporâneo?
Authors: Rodrigues Marcelo Gonçalves
Published: January 2025

L'obiettivo di questo articolo è riflettere su come la struttura economica neoliberale e l'ascesa del fascismo digitale influenzino oggettivamente gli attacchi alle scuole. II neoliberismo con le sue politiche di disuguaglianza sociale e di precarizzazione del lavoro, insieme a fattori tecnologici, crea un ambiente favorevole alla radicalizzazione dei giovani vulnerabili. La propagazione di discorsi di odio ed estremismo sulle piattaforme digitali intensifica questa tendenza, formando un tripode di fascismo digitale, struttura economica neoliberale e attacchi scolastici. Con la crescente radicalizzazione online e le culture di odio promosse sui social network, si osserva un preocupante aumento degli atti violenti negli ambienti scolastici nell'utlima decade. Le nuove tecnologie sono diventale un arsenale per la produzione di conflitti permanenti attraverso le contraddizioni del loro oggetto e del loro utilizo, l'aggressione e i sintomi vengono legittimati e potenziati.
Destinos da violência presentes no bullying: relatos de uma intervenção a partir da psicanálise
Authors: Medeiros Camila  Iolanda Frias , Castilho Pedro Teixeira
Published: January 2025

L'articolo propone un'analisi degli aspetti legati al bullismo, basata sulla concezione di questo fenomeno di violenza, concentrandosi su un gruppo di studenti adolescenti delle scuole superiori di una scuola pubblica di Belo Horizonte, utilizzando la metodologia della conversazione. In considerazione di ciò, è essenziale presentare una prospettiva più approfondita sulla questione dell’adolescenza nella contemporaneità, nella quale si trovano i soggetti di questa ricerca, evidenziandone le specificità. Lo scopo qui è quello di evidenziare peculiarità di questo periodo della vita, nei suoi aspetti concettuali, che possono contribuire ad una migliore comprensione del soggetto stesso e delle sue relazioni con gli elementi sociali, per poi coprire l'intervento con gli adolescenti in una comunità scolastica sul periferia di Bosnia-Erzegovina utilizzando la metodologia della conversazione come guida per questo intervento.
O que Winnicott pode nos ensinar sobre o fenômeno TDAH?
Authors: Paixão Rafaela
Published: January 2025

Este trabalho pretende discutir como as principais contribuições winnicottianas sobre a normalidade e a ansiedade na infância podem favorecer uma leitura psicanalítica do que se costuma classificar como TDAH. Para tanto, abordamos as possibilidades interpretativas das expressões sintomáticas de hiperatividade e ansiedade, discutindo as classificações diagnósticas e os ideais de normalidade na infância. Em seguida, estudamos o caminho trilhado por Winnicott no desenvolvimento das principais concepções sobre o mal-estar das crianças, baseando-nos em sua concepção de saúde e doença e na sua hipótese de tolerância ao sintoma. Por fim, promovemos um diálogo entre as teorizações winnicottianas e as interpretações contemporâneas do fenômeno TDAH, com vistas a favorecer modos de intervenção na clínica psicanalítica, atentando para as vicissitudes deste tempo sem, contudo, aderir aos discursos medicalizantes que assolam a infância hoje.
Marshall é a mensagem: uma reflexão sobre a teoria Mcluhiana
Authors: Correia Joana Martins Ferreira , Gonçalves Haroldo Moscheta , Lopes Helio Fernando Barbosa , Anjos Paulo Stoney dos , Meneses Robson Carlos Gomes de , Costa Edwaldo
Published: January 2025

Inesgotáveis, as teorias de Hebert Marshall McLuhan continuam transpondo mudanças tecnológicas ao logo dos anos, confirmando as constatações proféticas do teórico para a Comunicação. Este artigo propõe uma reflexão sobre a obra de McLuhan a partir da visão de importantes pensadores do campo da comunicação, com destaque aos três pilares do universo mcluhiano: “O meio é a Mensagem", "Meios Quentes e Meios Frios" e "Aldeia Global". Seus estudos e conclusões sobre a interconexão estrutural entre o homem, suas culturas, suas necessidades e excentricidades, com o protagonismo inquestionável da tecnologia, permanecem contribuindo na compreensão dos fenômenos comunicacionais da sociedade contemporânea.
Projeção: projeto gráfico de uma revista cultural
Authors: Deleguide Samuel Henrique Gallo
Published: January 2025

Este artigo aborda a representação do jornalismo cultural por meio da produção da revista Projeção, projeto gráfico desenvolvido como trabalho de conclusão do curso de Comunicação Social com habilitação em Jornalismo  do Centro Universitário Barão de Mauá de Ribeirão Preto (SP), durante o segundo semestre de 2021, sob a orientação do professor Márcio Huertas. O jornalismo cultural é uma das áreas de maior leitura da modernidade. No entanto, nos últimos anos tornou-se escravo das agendas artísticas e culturais. Essa produção apresenta elementos gráficos que unem o design com o jornalismo, dando ainda mais prazer à leitura e uma nova sensibilidade e cuidado com o tema abordado.
A oficina epistolográfica de João de Araújo Correia
Authors: Ribeiro Ana
Published: January 2025

João de Araújo Correia (1899-1985), a renowned Portuguese short story writer and chronicler, was also an enthusiastic epistolographer. For around forty years he kept copies of the letters he sent, both handwritten and typed. In the currently available twelve volumes of his correspondence, there are, in some cases, two different versions of the same text. The objective of this study is to understand the author's writing process and the principles that guide it, having as theoretical support Jean-Michel Adam’s work in the field of text linguistics. It appears that rewriting mainly affects the length of the text and linguistic formulation. This process is inseparable from the type of letter in question, resulting from the relationship between the sender and the recipient, due to the self-image that the first wants to transmit to the second and to possible future readers, as well as the image of these that the former has or anticipates.
O Impacto do Microcrédito no Desenvolvimento Rural e na Redução da Pobreza no setor Agrícola em Moçambique: uma análise a partir das experiências e desafios das comunidades de Nacarôa
Authors: Roaneque Nelson Inácio
Published: January 2025

El microcrédito también tiene un impacto en las comunidades rurales en la lucha contra la pobreza y en el impulso del desarrollo rural. Es en esta reflexión que se pretende encontrar mecanismos de implementación en las comunidades del distrito de Nacarôa, provincia de Nampula en Mozambique. La experiencia de las asociaciones de la Unión Campesina Distrital dicta que conocen la inversión agraria, pero no se benefician directamente del crédito rural. Es por ello que el reto es crear líneas de crédito para el sector agropecuario y facilitar el desarrollo de los productos agropecuarios.
A anatomia e a psicologia do genocídio em Gaza: inter-relações
Authors: Zugueib Jamil , Adi Ashjan Sadique , Sahd Fábio Bacila
Published: January 2025

This article presents the main considerations of the report “Anatomy of a genocide”, by Francesca Albanese. We cross it with current and interdisciplinary productions. The emphasis is on the legal concept of apartheid as a necessary interpretative key and on the psychological damage caused to the Palestinian population as a consequence of the colonial and genocidal project. The accuracy of Albanese’s report is noted, but also the need for complementation to ensure a more comprehensive view of the visible damage caused in the Gaza Strip. The unprecedented use of the genocide typification in the document of the special rapporteur appointed by the UN Human Rights Council for the specific case demands and justifies the in-depth analysis proposed here.
The Effects of Prenatal Alcohol Exposure on Structural Brain Connectivity and Early Language Skills in a South African Birth Cohort
Authors: Ghasoub Mohammad , Scholten Chloe , Geeraert Bryce , Long Xiangyu , Joshi Shantanu , Wedderburn Catherine J. , Roos Annerine , Subramoney Sivenesi , Hoffman Nadia , Narr Katherine , Woods Roger , Zar Heather J. , Stein Dan J. , Donald Kirsten , Lebel Catherine
Published: January 2025

Prenatal alcohol exposure (PAE) is associated with various neurological, behavioral and cognitive deficits, including reading and language. Previous studies have demonstrated altered white matter in children and adolescents with PAE and associations with reading and language performance in children aged 3 years and older. However, little research has focused on the toddler years, despite this being a critical period for behavioral and neural development. We aimed to determine associations between structural brain connectivity and early language skills in toddlers, in the context of PAE. Eighty-eight toddlers (2–3 yr, 56 males), 23 of whom had PAE, underwent a diffusion MRI scan in Cape Town, South Africa, with language skills assessed using the Expressive and Receptive Communication subtests from the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Diffusion scans were preprocessed to create a structural network of regions associated with language skills using graph theory analysis. Linear regression models were used to examine moderation effects of PAE on structural network properties and language skills. Toddlers with PAE had higher structural connectivity in language networks than unexposed children. PAE moderated the relationship between structural network properties and Expressive Communication scores. None of the effects survived correction for multiple comparisons. Our findings show weak moderation effects of PAE on structural language network properties and language skills. Our study sheds light on the structural connectivity correlates of early language skills in an understudied population during a critical neurodevelopmental period, laying the foundation for future research.
Storm Peak Laboratory: A Research and Training Facility for the Atmospheric Sciences
Authors: Hallar A. Gannet , McCubbin Ian B. , Borys Randolph , Lowenthal Douglas H. , Wetzel Melanie , Hindman Edward , Brooks Sarah D. , Steenburgh W. James , Gratz Lynne , Hoch Sebastian , Stephens Britton , Horel John D. , Molotch Noah P. , Mace Gerald G. , Bailey Adriana , Pettersen Claire , Andrews Elisabeth , Cziczo Dan J. , Garcia Maria
Published: January 2025

Storm Peak Laboratory, located on the Steamboat Springs Ski Resort in Colorado on the west summit of Mount Werner at 10,532 ft (3220 m) ASL, is an internationally recognized high-elevation atmospheric research station that has been in use for over 40 years. This article provides a brief history of the Storm Peak Laboratory and the major research themes it has supported and discusses opportunities to leverage mountain observatory measurements to advance our understanding of the atmospheric processes.

This facility provides long-term measurements of meteorology, clouds, aerosols, snow hydrology and atmospheric gases, and serves as a “proving ground” for instrument development and testing. Storm Peak Laboratory is part of multiple national and international observational networks. Due to the unique capabilities of Storm Peak Laboratory, there is a long history of targeted field campaigns primarily within the following research areas: mixed phase cloud microphysics, atmospheric chemistry pertaining to the formation, characterization, and hygroscopicity of aerosols; and transport and transformation of atmospheric mercury. Research training has been central to the mission of SPL over the last 40 years. Currently, SPL hosts both undergraduate and graduate level courses in atmospheric science and snow hydrology organized by numerous institutions. Examples of these unique research training opportunities are provided.
Finite-time control of networked stochastic systems with disturbances and false data injection attacks
Authors: Sun Yuexuan , Wei Xinjiang , Zhang Huifeng , Hu Xin
Published: January 2025

In this paper, networked stochastic systems (NSSs) subjected to disturbances and false data injection attacks (FDIAs) is studied, which have been extensively utilized in practical engineering. To fully utilize the disturbance information, a stochastic disturbance observer (SDO) is introduced to estimate the exogenous disturbance; since the state of the system is often unavailable under the FDIAs, an output observer is designed to obtain the estimation of the state. On these basis, the finite-time controller is constructed to compensate the disturbance and attenuate the FDIAs simultaneously, which can ensure the stability of the systems, and the convergence time can be restricted to a certain period of time. Finally, the effectiveness of the proposed scheme is verified by simulations.
Sexual Orientation Disclosure and Strategic Navigation of Interpersonal Invisibility
Authors: Schwartzman Emily , Neel Rebecca
Published: January 2025

People with concealable stigmatized identities may strategically share or hide cues to their identity. They may likewise seek or avoid interpersonal invisibility (i.e., being ignored). Despite semantic similarities, identity concealment and invisibility are conceptually distinct, but existing empirical work has not explored whether they are independent—that is, whether people may sometimes reveal to be invisible, or conceal to be visible. To evaluate this distinction, we collected lesbian, gay, and bisexual (LGB) participants’ free-response descriptions of situations where they revealed or concealed their sexual orientation to be visible or invisible (Study 1). Other LGB participants imagined social interactions in which they revealed or concealed their sexual orientation to be visible or invisible and rated their expected emotions in this situation (Study 2). We find that concealment and invisibility can occur independently of one another with separate effects on emotions, and that LGB people use identity disclosure and concealment to strategically navigate interpersonal invisibility.
Empirical Insights into Centroid Optimization in Transportation Planning: A Novel Approach
Authors: Adalıoğlu İsmail , Ergün Murat
Published: January 2025

In complex urban environments, sophisticated analytical techniques are essential to improve the accuracy of transportation modeling and the precision of travel time predictions. This research endeavors to critically examine various multi-zone centroid positioning strategies, with the goal of unveiling the method that most authentically represents the dynamics of urban travel. Anchored by a comprehensive case study of the city of Istanbul in Turkey, the investigation utilizes various analytical tools meticulously tailored to account for the intricate interplay of demographic and geographic variables. This methodical approach enables the identification of optimal centroid locations by evaluating various methods, including a novel approach called kernel density estimation (KDE), as well as five other established other methods. The results are then aligned with real-world travel time data through rigorous statistical analysis to ensure accurate predictions of travel times. The KDE method demonstrated its more acceptable correlation coefficient and lower mean absolute error, root mean square error, and mean absolute percentage error metrics, establishing its superiority in model performance. By highlighting the paramount importance of accurately placed centroids within urban transportation models, this research’s findings contribute significantly to the evolution of transportation planning methodologies and the advancement of urban mobility models through a comparative analysis of optimal methods.
Platelet activation and signaling in thrombus formation
Authors: Swieringa Frauke , Heemskerk Johan W.M. , Assinger Alice
Published: January 2025

In thrombosis and hemostasis, the formation of a platelet-fibrin thrombus or clot is a highly controlled process that varies, depending on the pathological context. Major signaling pathways in platelets are well established. However, studies with genetically modified mice have identified the contribution of hundreds of additional platelet-expressed proteins in arterial thrombus formation and bleeding. Using phenotype information of 540 mouse genes, involved in arterial thrombosis and hemostasis, we review current insights into established and novel platelet signaling mechanisms. We discuss pathways involved in platelet adhesion, shape change, integrin activation, intracellular vesicle trafficking and protein processing, granule secretion, aggregate formation and procoagulant activity. Specific attention is paid to the signaling routes used by ITAM-linked, ITIM-linked and G protein-coupled receptors, as well as downstream events feeding into GTPase regulation and protein kinase activation. We further summarize known alterations in platelet responses under conditions of venous, inflammatory and infection-dependent thrombosis, taking into account interactions of platelets with the endothelium, leukocytes and red blood cells. Understanding the genes and proteins involved in platelet signaling in the context of hemostasis, thrombosis and inflammation may lead to improved therapies to prevent and treat thrombotic disorders.
Frontline treatment of follicular lymphoma: What will it take to change current practice?
Authors: Bachy Emmanuel , Linton Kim
Published: January 2025

Follicular lymphoma is the most common subtype of indolent lymphoma. Despite multiple trials over the past decade showing improved progression-free survival with new first-line therapeutic strategies -such as anti-CD20 maintenance therapy and new glycoengineered anti-CD20 antibodies- no standardized approach has been widely adopted in routine clinical practice. Several factors may explain this, including the increased incidence of infectious adverse events associated with these therapies, particularly during the COVID-19 pandemic, and the lack of overall survival benefit despite long-term follow-up. A general consensus has emerged acknowledging the high prognostic variability of follicular lymphoma, which complicates the adoption of a one-size-fits-all first-line treatment strategy. A plethora of prognostic scores (FLIPI, FLIPI2, PRIMA-PI, m7-FLIPI, FLEX, 23-gene score, etc) has been proposed but none can reliably identify the ~20% of patients that will die within 10 years of first-line immunochemotherpay and for whom a critical medical need remains despite recent therapeutic improvements. Consequently, current prognostic models mainly serve as tools to cross-compare and stratify clinical trials. In this review, we highlight current and future strategies aimed at reshaping frontline treatment paradigms to improve outcomes, including tailored approaches based on risk- or response-adapted designs, development of new predictive -rather than prognostic- tools, approaches to reduce adverse events to enhance health-related quality of life, and the potential use of T-cell-engaging therapies to improve survival in the highest risk patients.
Factors influencing compassion satisfaction and compassion fatigue among nurses: a study in a tertiary hospital
Authors: Nadarajan Sarah Sharmala , Chui Ping Lei , Lee Wan Ling , Zaini Noor Hanita
Published: January 2025

Background

Nursing is a caring profession for which compassion is a core value. Increasing stress and declining job satisfaction are among the major challenges in nursing. Demographic and work-related factors may influence nurses’ compassion satisfaction and compassion fatigue (i.e., burnout and secondary traumatic stress) levels. In this study, the level of compassion fatigue and compassion satisfaction and their associated factors were examined among nurses in a tertiary hospital.

Methods

A cross-sectional study was conducted at a tertiary hospital in Malaysia. The data were collected over a period of 6 months via online distribution of the Personal Information Form, Copenhagen Psychosocial Questionnaire (COPSOQ) version III and Professional Quality of Life (ProQOL) version V questionnaires. The Cronbach’s alpha internal consistency of the questionnaire scales was mostly acceptable and above 0.75. Descriptive statistics were used to summarize the sociodemographic and rank domains of work environment-related factors for nurses and their levels of compassion satisfaction and compassion fatigue. Relationships between sociodemographic factors and the levels of compassion fatigue, compassion satisfaction, and burnout were assessed by bivariate analyses. A p value < 0.05 was considered to indicate statistical significance.

Results

A total of 323 registered nurses participated in this study. A majority of the participants were female (91%, n = 294), and the mean age of the participants was 33.01 ± 8.50 years. The majority of the participants had moderate levels of compassion satisfaction (71%, n = 229); 46% (n = 148) had moderate levels of burnout, and 45% (n = 147) had moderate levels of secondary traumatic stress. Hierarchical multiple regression analysis revealed that the health and well-being and demands at work domain were significantly associated with compassion satisfaction, burnout and secondary traumatic stress levels among nurses.

Conclusions

In this study, the majority of the nurses reported decreased compassion satisfaction and increased burnout. These findings provide valuable insights, as there may be detrimental effects on the healthcare industry and retention of nurses if no action is taken to combat compassion fatigue. Recommendations to motivate nurses and reduce demands at work should be explored by healthcare organizations to increase nurses’ performance and job satisfaction.
A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles
Authors: Stolldorf Deonni P. , Storrow Alan B. , Liu Dandan , Jenkins Cathy A. , Hilton Rachel A. , Miller Karen F. , Kim Joy , Boopathy Deepika , Gunaga Satheesh , Kea Bory , Miller Joseph , Collins Sean P.
Published: January 2025

Background

Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) toolkit aims to improve AHF self-care and facilitate safer transitions in care for these patients. We describe implementation barriers and facilitators, and the selection and refinement of implementation strategies, to facilitate future GUIDED-HF implementation.

Methods

A mixed-methods cross-sectional observational study was conducted in four United States EDs in two diverse healthcare systems in the Pacific West and Midwest. Data were collected using a survey and interviews with ED providers, nurses, and leaders. The survey assessed the ED context using the context scale of the Organizational Readiness to Change Assessment (ORCA). The Consolidated Framework for Implementation Research informed interviews. Quantitative data were summarized using medians (interquartile ranges) or percentages (frequencies). Wilcoxon rank-sum tests and Kruskal–Wallis tests were used to assess differences in the healthcare system and profession. Qualitative data were analyzed and summarized using rapid qualitative analysis. Convergence of quantitative and qualitative data was used to inform specific refining of implementation strategies to the local context (e.g., who should serve as champions, how best practice alerts should be implemented).

Results

Participants were predominately white (76%) with median (IQR) age 37.0 (32.0, 41.0). ED leaders/administrators, providers, and nurses comprised 15%, 55%, and 29% of participants, respectively. Sites reported an ORCA context scale score of 3.7 [3.4, 4.0] (scale of 1 = strongly disagree to 5 = strongly agree). Comparison of scores by profession showed a significant difference in the context score among providers (3.9 [3.5, 4.0]), leaders (3.7 [3.5, 4.0]), and nurses (3.6 [3.0, 3.9]) (p = 0.048). Qualitative data indicated implementation barriers (e.g., resource limitations, patient health literacy), facilitators (e.g., GUIDED-HF is patient-centric; site and intervention congruent values, norms, and goals), and site-specific needs due to contextual factors (e.g., education needs, feedback mechanisms, champions).

Conclusions

Specific determinants of implementation exist in ED settings and require the refining of implementation strategies to overcome site-specific barriers and enhance facilitators.

Trial registration

n/a.
Habitual sleep duration, healthy eating, and digestive system cancer mortality
Authors: Nôga Diana A. , Meth Elisa M. S. , Pacheco André P. , Cedernaes Jonathan , Xue Pei , Benedict Christian
Published: January 2025

Background

Lifestyle choices, such as dietary patterns and sleep duration, significantly impact the health of the digestive system and may influence the risk of mortality from digestive system cancer.

Methods

This study aimed to examine the associations between sleep duration, dietary habits, and mortality from digestive system cancers. The analysis included 406,584 participants from the UK Biobank cohort (54.1% women; age range: 38–73 years), with sleep duration classified as short (≤ 6 h, 24.2%), normal (7–8 h, 68.4%), and long (≥ 9 h, 7.4%). Healthy eating habits were defined as a daily intake of at least 25 g of fibre, seven portions of fruits and vegetables, and fewer than four servings of meat per week. These dietary factors were combined into a score ranging from 0 (least healthy) to 3 (healthiest). Cox proportional hazards regression analyses were conducted, with a median follow-up period of 12.6 years, ending on September 30, 2021.

Results

3949 participants died from cancer of the digestive system. Both short and long sleep duration were associated with an increased risk of mortality from cancer of the digestive system (1.09 (1.01–1.18) and 1.14 (1.03–1.27), respectively). Additionally, a diet score ≥ 1 was linked to a lower cancer risk (0.72–0.91 (0.59–0.96)). Adjusting for smoking, type 2 diabetes, and body mass index (BMI) status eliminated the association between sleep duration and digestive cancer mortality. The association between healthy dietary patterns and the risk of digestive system cancer mortality did not vary by sleep duration.

Conclusions

Aberrant sleep durations may increase the risk of mortality from digestive system cancer, potentially through smoking, higher BMI, and type 2 diabetes. However, aberrant sleep durations do not seem to reduce the protective effects of a healthy dietary pattern.
Efficacy and safety of SHEN26, a novel oral small molecular RdRp inhibitor for COVID-19 treatment: a multicenter, randomized, double-blinded, placebo-controlled, phase II clinical trial
Authors: Bai Jiangtao , Asakawa Tetsuya , Yuan Wenfang , Lin Yuanlong , Ju Hao , Xu Dandan , Yang Mingming , Li Shuo , Li Guanguan , Guo Deyin , Lu Hongzhou , Zhang Xumu
Published: January 2025

Background

SHEN26 (ATV014) is an oral RNA-dependent RNA polymerase (RdRp) inhibitor with potential anti-SARS-CoV-2 activity. Safety, tolerability, and pharmacokinetic characteristics were verified in a Phase I study. This phase II study aimed to verify the efficacy and safety of SHEN26 in COVID-19 patients.

Methods

This was a multicenter randomized double-blind placebo-controlled study. Mild-to-moderate adult patients with COVID-19 were recruited and randomly assigned to the high-dose (400 mg), low-dose (200 mg), or placebo groups (1:1:1). The primary outcome measure was “changes in RNA levels on Day seven (D7)”. The second outcome measures were “changes of RNA levels on D3, D5, D10, D28,” “Time of clearance of virus.”

Results

A total of 91 patients were recruited in this study between December 08, 2022, and January 27, 2023. Twelve patients dropped out due to a lack of examination results. Finally, the data of 79 patients (24 in the placebo group, 31 in the 200 mg group, and 24 in the 400 mg group) were analyzed. No significant differences in the baseline data were observed between the groups. The changes of viral load were significantly higher on D3 (P = 0.0119), and D5 (P = 0.0120) in 400 mg group (vs. placebo group), and the difference value achieved 1.06 log10 copies/mL on D3 and 1.21 log10 copies/mL on D5. No significant difference was found in the viral clearance time between SHEN26 administrating groups and placebo groups. Administration of SHEN26 did not enhance drug-related ADEs and did not induce ADEs, and ADE inducing drug withdrawal, dose reduction, or death. Moreover, SHEN26 did not worsen the renal function.

Conclusions

Our findings indicate a better efficacy of a high dose (400 mg) for COVID-19 treatment. These preliminary data on the efficacy and safety provide useful information and a working basis for further verification and development of SHEN26 as a novel oral small-molecule antiviral drug for treating COVID-19.
Significant room for improvement in the prehospital assessment and treatment of acute abdominal pain: a retrospective observational study
Authors: Bjerén Rasmus , Magnusson Carl , Herlitz Johan , Bäckström Denise
Published: January 2025

Background

Acute abdominal pain (AAP) is a common reason for calling emergency medical services (EMS). Despite the widely acknowledged importance of effective prehospital pain management, described by patients as crucial regardless of any other factor, studies on prehospital pain management in AAP patients are limited and suggest room for improvement. This is particularly relevant given the long-standing controversy surrounding the use of analgesia in AAP patients before a final diagnosis is made, which may still influence the prehospital pain management.

Methods

A retrospective cohort study of pain management in EMS patients with AAP in a central Swedish region. The region had a population density of 15.7 inhabitants per square kilometer spread over a mix of small urban and rural settings. Patient records were manually reviewed and scanned for written assessments or numeric ratings of pain. The analysis focused on proportions of assessment, treatment and reassessment of pain as well as median pain intensity, pain reduction and proportion of patients with a low last recording of pain.

Results

816 patients were included. Pain was assessed in 55% (n = 447) of all cases. The median initial pain intensity was eight units (IQR 6.0–9.0) on the Numerical Rating Scale (NRS), and 90% (n = 403) of the assessed patients experienced moderate or severe pain. Of those, 62% (n = 249) received pharmacological treatment. In 50% (n = 158) of all cases receiving treatment, pain was reassessed afterwards. The median pain reduction was four units (IQR 2.0–5.0) on the NRS scale. Among all cases, 10% (n = 84) had a last recorded pain assessment indicating low pain.

Conclusions

Significant room for improvement in the prehospital management of acute abdominal pain was found. The proportions of pain assessment, treatment and reassessment were low with nine out of ten patients leaving prehospital care with unknown, moderate or severe pain. Among the cases where pain assessment, treatment and reassessment were made and recorded, four out of five patients experienced significant pain relief, indicating the potential of better prehospital pain management.
Specialized pediatric palliative care in Italy: where are we going? The Palliped 2022–2023 study
Authors: Benini Franca , Mercante Anna , Di Nunzio Sara , Papa Simonetta ,   the PalliPed 2022-2023 Working Group, Amarri Sergio , Barrocu Laura , Bolognani Marco , Calì Monica , Catalano Gaetano , Celentano Loredana , De Zen Lucia , Lazzarin Pierina , Lijoi Stefano , Manfredini Luca , Molinaro Grazia , Moliterni Paola , Orofino Rocco , Pellegatta Federico , Pizzi Simone , Raspi Marina , Salata Michele , Tornesello Assunta , Vezzoli Cesare
Published: January 2025

Background

The PalliPed project is a nationwide, observational, cross-sectional study designed with the aim of providing a constantly updated national database for the census and monitoring of specialized pediatric palliative care (PPC) activities in Italy. This paper presents the results of the first monitoring phase of the PalliPed project, which was developed through the PalliPed 2022–2023 study, to update current knowledge on the provision of specialized PPC services in Italy.

Methods

Italian specialized PPC centers/facilities were invited to participate and asked to complete a self-reporting, ad-hoc, online survey regarding their clinical activity in 2022–2023, in the revision of the data initially collected in the first PalliPed study of 2021.

Results

18 specialized PPC centers/facilities from 14 Italian regions and two autonomous provinces participated; 13 were identified as regional referral centers (72.2%), with the acquisition of three new centers in comparison to 2021. Full coverage of the regional territory was reported by 54% of them, compared with 45% in 2021, while a 24/7 service was offered by 23%, compared with 27% in 2021. Eight of 13 referral centers (61%) had a dedicated team, compared with 91% in 2021. Also, an overall increase in the number of followed patients was observed, rising from 1,209 (2019) to 2,734 (2023). In line with previous data, most PPC healthcare providers were nurses (n = 181) and physicians (n = 89), with an overall increased number of PPC providers from 2021.

Conclusions

The nationwide PalliPed project established the first comprehensive overview and monitoring of the state of specialized PPC in Italy. Data reported within the PalliPed 2022–2023 monitoring study suggest a general improving trend in the availability of the specialized PPC service in Italy, compared with data collected in 2021. At the same time, the need for a greater effort to provide better care models and resources for specialized PPC remains, especially considering that the number of children needing PPC is constantly increasing.
A meta-analysis of sex differences in neonatal rodent ultrasonic vocalizations and the implication for the preclinical maternal immune activation model
Authors: Randell Alison M. , Salia Stephanie , Fowler Lucas F. , Aung Toe , Puts David A. , Swift-Gallant Ashlyn
Published: January 2025

As the earliest measure of social communication in rodents, ultrasonic vocalizations (USVs) in response to maternal separation are critical in preclinical research on neurodevelopmental disorders (NDDs). While sex differences in both USV production and behavioral outcomes are reported, many studies overlook sex as a biological variable in preclinical NDD models. We aimed to evaluate sex differences in USV call parameters and determine if USVs are differently impacted based on sex in the preclinical maternal immune activation (MIA) model. Results indicate that sex differences in USVs vary with developmental stage and are more pronounced in MIA offspring. Specifically, developmental stage is a moderator of sex differences in USV call duration, with control females emitting longer calls than males in early development (up to postnatal day [PND] 8), but this pattern reverses after PND8. MIA leads to a reduction in call numbers for females compared to same-sex controls in early development, with a reversal post-PND8. MIA decreased call duration and increased total call duration in males, but unlike females, developmental stage did not influence these differences. In males, MIA effects varied by species, with decreased call numbers in rats but increased call numbers in mice. MIA timing (gestational day ≤ 12.5 vs. > 12.5) did not significantly affect results. Our findings highlight the importance of considering sex, developmental timing, and species in USVs research. We discuss how analyzing USV call types and incorporating sex as a biological variable can enhance our understanding of neonatal ultrasonic communication and its translational value in NDD research.
Extremely early initiation of vasopressors might not decrease short-term mortality for adults with septic shock: a systematic review and meta-analysis
Authors: Ma Cheng-Hsin , Healy Jack , Kinteh Ebrima , Ma Cheng-Chin , Tzeng Ching-Fang Tiffany , Chou Eric H. , Wu Chin-Chieh , Shao Shih-Chieh , Chen Kuan-Fu
Published: January 2025

Background

The optimal timing for initiating vasopressor therapy in patients with septic shock remains unclear. This study aimed to assess the impact of early versus late vasopressor initiation on clinical outcomes.

Methods

A systematic review and meta-analysis were conducted by searching PubMed, Embase, and Cochrane databases. Studies comparing early and late vasopressor administration in septic shock patients were included. The primary outcome was short-term mortality, and subgroup analyses were performed based on different initiation timings.

Results

Eleven studies with 6,661 patients were included. Different studies define the ‘early administration’ timeframe variously, ranging from one to seven hours. No significant difference in short-term mortality was observed between early and late administration in the combined analysis of 3,757 patients from two RCTs and three quasi-experimental studies (OR: 0.66, 95% CI: [0.36, 1.19], I²: 82%). However, lower mortality was found in subgroups with early but not extremely early initiation (one to three hours, OR: 0.70, 95% CI: [0.60, 0.82], I²: 0%), and those using septic shock diagnosis as time zero (OR: 0.64, 95% CI: [0.48, 0.85], I²: 39%).

Conclusion

Our findings found that earlier initiation of vasopressor therapy, particularly within one to three hours after the diagnosis of septic shock, may be associated with reduced short-term mortality in certain subgroups. However, due to the heterogeneity in study definitions and potential confounding factors, these results should be interpreted cautiously. Further standardized investigations are warranted to precisely determine the optimal timing for vasopressor initiation to maximize survival outcomes in patients with septic shock.
Financial inclusion and fintech: a state-of-the-art systematic literature review
Authors: Ha Dao , Le Phuong , Nguyen Duc Khuong
Published: January 2025

This study presents an all-inclusive analysis of the literature on the augmentation of financial inclusion through fintech. Ninety-six papers were selected from the 2951 articles in the Web of Science, Scopus, and EBSCO databases. This study uses bibliometric and content analysis techniques to illuminate the underexplored aspects of fintech’s impact on financial inclusion. Unlike previous studies, this study consolidates a significant amount of the literature on financial inclusion by systematically contextualizing theories and viewpoints from the fintech sector. The key findings include the identification of three main research clusters: (1) the advent of novel services, (2) the transformation of the market landscape, and (3) the roles of stakeholders in the fintech ecosystem. The analysis reveals gaps in the existing research, such as the need for more studies on the tangible impact of fintech on financial inclusion and regulation. This study concludes by highlighting potential directions for future research and emphasizing the importance of policymakers paying greater attention to fintech’s implications for financial inclusion.
Perceptions of social interactions and second language willingness to communicate in different activities
Authors: Han He , Li Bing
Published: January 2025

This study examined whether students’ perceived social interactions within different learning activities predicted their willingness to communicate (WTC) in second language (L2) classrooms. The sample was 932 undergraduate students from 8 universities learning English as a foreign language. Data of student-perceived social interactions in classrooms including teacher-student relationships, peer relationships, cooperation and equity, and data of WTC including overall WTC, WTC in meaning-focused activities, and WTC in form-focused activities were collected through online questionnaires. Data analysis using Structural Equation Modelling showed that (1) teacher-student relationships, peer relationships and cooperation positively predicted overall WTC; (2) teacher-student relationships, peer relationships, cooperation and equity positively predicted WTC in meaning-focused activities; (3) cooperation positively but equity negatively predicted WTC in form-focused activities. The results suggested that students’ perceived social interactions had predictive effects on L2 WTC but such effects differed in line with learning activity types. Implications for enhancing WTC in L2 instruction were also discussed.