bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining Worst-Case-Scenario Thresholds in Soccer: Intensity Versus Volume
Authors: Mandorino Mauro , Lacome Mathieu
Published: June 2024

Purpose: This study aimed to enhance the understanding of soccer match peak demands by describing worst-case scenario (WCS) and time spent above 80% and 90% of the WCS for total distance (TD) and high-speed running (HSR). The investigation considered playing level (first team vs under-19 [U19] team) and playing position (center backs, fullbacks, midfielders, and forwards) to assess how WCS and the time spent above specific thresholds vary across different populations. Methods: Data from 31 players in a professional Italian soccer club were collected during the 2022–23 season. Microtechnology devices tracked physical activity during matches. Players were categorized by position, and WCS was determined using rolling averages over a 1-minute period. Time spent above 80% and 90% of WCS for TD and HSR was calculated. Results: The U19 team exhibited higher HSR WCS compared with the first team (∼63 m·min−1 vs ∼56 m·min−1). Midfielders recorded the highest TD WCS (∼208 m·min−1), and forwards exhibited the highest HSR WCS (∼70 m·min−1). The first team spent significantly more time above 80% (∼6 min) and 90% (∼1 min) of TD WCS. Midfielders spent significantly more time above the 80% (∼7 min) of TD WCS, while forwards above the 80% (∼2 min) of HSR WCS. Conclusions: The study emphasizes that WCS used alone may not sufficiently capture real match intensity. Considering the time spent above specific thresholds provides additional insights (ie, between-levels differences and position). Practitioners should consider both WCS and time spent above thresholds for individualized training prescriptions, reflecting differences in playing roles.
Understanding the Kinematic Profile of 2 Underwater Pullout Breaststroke Techniques
Authors: Santos Catarina C. , Ferreira Francisco A. , Soares Susana , Fernandes Ricardo J. , Vilas-Boas João Paulo , Costa Mário J.
Published: June 2024

Purpose: To compare the kinematic profile of 2 underwater pullout breaststroke techniques. Methods: Sixteen swimmers (9 men, 20.67 [2.71] y old; 7 women, 18.86 [0.83] y old) performed 3 × 25-m breaststroke using 2 pullout breaststroke techniques: Fly-Kick first and Combined. A speedometer was used to assess the peak and the mean velocity during the glide, propulsion, and recovery phases of both techniques, as well as for the total underwater sequence. The underwater distance was retrieved from video footage and was considered for each pullout technique. The range of motion of the knee during the fly-kick was also retrieved, and the time to complete the 25 m was considered the performance outcome, accompanied by the mean velocity, stroke rate, stroke length, and stroke index. Results: Velocity–time series showed different profiles between pullout techniques (P ≤ .05) mostly in the glide and propulsion phases for males and females, respectively. The mean velocity of 25 m was shown to be greater in females when using the Fly-Kick first technique (P = .05, d = 0.36). Greater values in total underwater distance and knee range of motion were also observed for this technique in both cohorts. Conclusions: Female swimmers presented a higher performance when using the Fly-Kick first technique. Different kinematic profiles arise when swimmers use different underwater pullout techniques where the Fly-Kick first may allow them to reach higher kinematical standard.
In silico transcriptome screens identify epidermal growth factor receptor inhibitors as therapeutics for noise-induced hearing loss
Authors: Vijayakumar Sarath , DiGuiseppi Joseph A. , Dabestani Parinaz Jila , Ryan William G. , Quevedo Rene Vielman , Li Yuju , Diers Jack , Tu Shu , Fleegel Jonathan , Nguyen Cassidy , Rhoda Lauren M. , Imami Ali Sajid , Hamoud Abdul-Rizaq Ali , Lovas Sándor , McCullumsmith Robert E. , Zallocchi Marisa , Zuo Jian
Published: June 2024

Noise-induced hearing loss (NIHL) is a common sensorineural hearing impairment that lacks U.S. Food and Drug Administration–approved drugs. To fill the gap in effective screening models, we used an in silico transcriptome-based drug screening approach, identifying 22 biological pathways and 64 potential small molecule treatments for NIHL. Two of these, afatinib and zorifertinib [epidermal growth factor receptor (EGFR) inhibitors], showed efficacy in zebrafish and mouse models. Further tests with EGFR knockout mice and EGF-morpholino zebrafish confirmed their protective role against NIHL. Molecular studies in mice highlighted EGFR’s crucial involvement in NIHL and the protective effect of zorifertinib. When given orally, zorifertinib was found in the perilymph with favorable pharmacokinetics. In addition, zorifertinib combined with AZD5438 (a cyclin-dependent kinase 2 inhibitor) synergistically prevented NIHL in zebrafish. Our results underscore the potential for in silico transcriptome-based drug screening in diseases lacking efficient models and suggest EGFR inhibitors as potential treatments for NIHL, meriting clinical trials.
Structure and dynamics of enterovirus genotype networks
Authors: Dábilla Nathânia , Dolan Patrick T.
Published: June 2024

Like all biological populations, viral populations exist as networks of genotypes connected through mutation. Mapping the topology of these networks and quantifying population dynamics across them is crucial to understanding how populations adapt to changes in their selective environment. The influence of mutational networks is especially profound in viral populations that rapidly explore their mutational neighborhoods via high mutation rates. Using a single-cell sequencing method, scRNA-seq–enabled acquisition of mRNA and consensus haplotypes linking individual genotypes and host transcriptomes (SEARCHLIGHT), we captured and assembled viral haplotypes from hundreds of individual infected cells, revealing the complexity of viral population structures. We obtained these genotypes in parallel with host cell transcriptome information, enabling us to link host cell transcriptional phenotypes to the genetic structures underlying virus adaptation. Our examination of these structures reveals the common evolutionary dynamics of enterovirus populations and illustrates how viral populations reach through mutational “tunnels” to span evolutionary landscapes and maintain connection with multiple adaptive genotypes simultaneously.
Electrically weldable conductive elastomers
Authors: Lin Haimen , Zheng Dandan , Wu Xiaoling , He Rubin , He Liu , Zhou Xiangfu , Zuo Haiyan , Yuan Conghui , Zeng Birong , Xu Yiting , Dai Lizong
Published: June 2024

Flexible and stretchable electronic devices are subject to failure because of vulnerable circuit interconnections. We develop a low-voltage (1.5 to 4.5 V) and rapid (as low as 5 s) electric welding strategy to integrate both rigid electronic components and soft sensors in flexible circuits under ambient conditions. This is achieved through the design of conductive elastomers composed of borate ester polymers and conductive fillers, which can be self-welded and generate welding effects to various materials including metals, hydrogels, and other conductive elastomers. The welding effect is generated through the electrochemical reaction–triggered exposure of interfacial adhesive promotors or the cleavage/reformation of dynamic bonds. Our strategy can ensure both mechanical compliance and conductivity at the circuit interfaces and easily produce welding strengths in the kilopascal to megapascal range. The as-designed conductive elastomers in combination with the electric welding technique provide a robust platform for constructing standalone flexible and stretchable electronic devices that are detachable and assemblable on demand.
Unsettled science on social media
Authors: Thorp H. Holden
Published: June 2024

Jonathan Haidt’s new book,
The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness
, is a hot seller that makes the case that smartphones and social media are largely responsible for the current mental health crisis among young people and that restricting their use below certain ages (14 for smartphones and 16 for social media) can have a positive effect on reversing or slowing the problem. A social psychologist at New York University Stern School of Business, Haidt has an ability to capture the public zeitgeist and shape thinking around contentious issues. Last week, the US surgeon general called for parental warning labels on social media platforms because of the potential threat to childhood mental health, a possibility bound to be resisted by Big Tech. A clearer view of the science is more crucial than ever. Haidt’s book, however, has been criticized by colleagues who dispute whether the science supports his strong claims. Meanwhile, Haidt’s ideas are reaching millions—his book has been at or near the top of
The New York Times
Best Sellers list for weeks and covered extensively in major media outlets—while the criticisms and countervailing data mostly appear in scientific journals.
Nab-paclitaxel, cisplatin, and capecitabine versus cisplatin and gemcitabine as first line chemotherapy in patients with recurrent or metastatic nasopharyngeal carcinoma: randomised phase 3 clinical trial
Authors: Liu Guo-Ying , Ye Yan-Fang , Jiang Yao-Fei , Chen Gina Jinna , Xia Wei-Xiong , Huang Yi-Sheng , Gao Tian-Sheng , Liu Yi-Min , Hou Ya-Ting , Li Jian-Fei , Liu Jia-Hao , Lu Nian , Chen Chang-Long , Ke Liang-Ru , Liang Hu , Bei Wei-Xin , Li Wang-Zhong , Dong Shu-Hui , Liu Qin , Xie Changqing , Yao He-Rui , Xiang Yan-Qun
Published: June 2024

Objective

To compare the effectiveness and safety of nab-paclitaxel, cisplatin, and capecitabine (nab-TPC) with gemcitabine and cisplatin as an alternative first line treatment option for recurrent or metastatic nasopharyngeal carcinoma.

Design

Phase 3, open label, multicentre, randomised trial.

Setting

Four hospitals located in China between September 2019 and August 2022.

Participants

Adults (≥18 years) with recurrent or metastatic nasopharyngeal carcinoma.

Interventions

Patients were randomised in a 1:1 ratio to treatment with either nab-paclitaxel (200 g/m
2
on day 1), cisplatin (60 mg/m
2
on day 1), and capecitabine (1000 mg/m
2
twice on days 1-14) or gemcitabine (1 g/m
2
on days 1 and 8) and cisplatin (80 mg/m
2
on day 1).

Main outcome measures

Progression-free survival was evaluated by the independent review committee as the primary endpoint in the intention-to-treat population.

Results

The median follow-up was 15.8 months in the prespecified interim analysis (31 October 2022). As assessed by the independent review committee, the median progression-free survival was 11.3 (95% confidence interval 9.7 to 12.9) months in the nab-TPC cohort compared with 7.7 (6.5 to 9.0) months in the gemcitabine and cisplatin cohort. The hazard ratio was 0.43 (95% confidence interval 0.25 to 0.73; P=0.002). The objective response rate in the nab-TPC cohort was 83% (34/41) versus 63% (25/40) in the gemcitabine and cisplatin cohort (P=0.05), and the duration of response was 10.8 months in the nab-TPC cohort compared with 6.9 months in the gemcitabine and cisplatin cohort (P=0.009). Treatment related grade 3 or 4 adverse events, including leukopenia (4/41 (10%)
v
13/40 (33%); P=0.02), neutropenia (6/41 (15%)
v
16/40 (40%); P=0.01), and anaemia (1/41 (2%)
v
8/40 (20%); P=0.01), were higher in the gemcitabine and cisplatin cohort than in the nab-TPC cohort. No deaths related to treatment occurred in either treatment group. Survival and long term toxicity are still being evaluated with longer follow-up.

Conclusion

The nab-TPC regimen showed a superior antitumoural efficacy and favourable safety profile compared with gemcitabine and cisplatin for recurrent or metastatic nasopharyngeal carcinoma. Nab-TPC should be considered the standard first line treatment for recurrent or metastatic nasopharyngeal carcinoma. Longer follow-up is needed to confirm the benefits for overall survival.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900027112.
Diagnosis and management of resistant hypertension
Authors: Schiffrin Ernesto L , Fisher Naomi D L
Published: June 2024

Resistant hypertension is defined as blood pressure that remains above the therapeutic goal despite concurrent use of at least three antihypertensive agents of different classes, including a diuretic, with all agents administered at maximum or maximally tolerated doses. Resistant hypertension is also diagnosed if blood pressure control requires four or more antihypertensive drugs. Assessment requires the exclusion of apparent treatment resistant hypertension, which is most often the result of non-adherence to treatment. Resistant hypertension is associated with major cardiovascular events in the short and long term, including heart failure, ischemic heart disease, stroke, and renal failure. Guidelines from several professional organizations recommend lifestyle modification and antihypertensive drugs. Medications typically include an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, a calcium channel blocker, and a long acting thiazide-type/like diuretic; if a fourth drug is needed, evidence supports addition of a mineralocorticoid receptor antagonist. After a long pause since 2007 when the last antihypertensive class was approved, several novel agents are now under active development. Some of these may provide potent blood pressure lowering in broad groups of patients, such as aldosterone synthase inhibitors and dual endothelin receptor antagonists, whereas others may provide benefit by allowing treatment of resistant hypertension in special populations, such as non-steroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease. Several device based approaches have been tested, with renal denervation being the best supported and only approved interventional device treatment for resistant hypertension.
Uptake, safety and effectiveness of inactivated influenza vaccine in inflammatory bowel disease: a UK-wide study
Authors: Nakafero Georgina , Grainge Matthew J , Card Tim , Mallen Christian D , Nguyen Van-Tam Jonathan S , Abhishek Abhishek
Published: June 2024

Objective

To investigate (1) the UK-wide inactivated influenza vaccine (IIV) uptake in adults with inflammatory bowel disease (IBD), (2) the association between vaccination against influenza and IBD flare and (3) the effectiveness of IIV in preventing morbidity and mortality.

Design

Data for adults with IBD diagnosed before the 1 September 2018 were extracted from the Clinical Practice Research Datalink Gold. We calculated the proportion of people vaccinated against seasonal influenza in the 2018–2019 influenza cycle. To investigate vaccine effectiveness, we calculated the propensity score (PS) for vaccination and conducted Cox proportional hazard regression with inverse-probability treatment weighting on PS. We employed self-controlled case series analysis to investigate the association between vaccination and IBD flare.

Results

Data for 13 631 people with IBD (50.4% male, mean age 52.9 years) were included. Fifty percent were vaccinated during the influenza cycle, while 32.1% were vaccinated on time, that is, before the seasonal influenza virus circulated in the community. IIV was associated with reduced all-cause mortality (aHR (95% CI): 0.73 (0.55,0.97) but not hospitalisation for pneumonia (aHR (95% CI) 0.52 (0.20–1.37), including in the influenza active period (aHR (95% CI) 0.48 (0.18–1.27)). Administration of the IIV was not associated with IBD flare.

Conclusion

The uptake of influenza vaccine was low in people with IBD, and the majority were not vaccinated before influenza virus circulated in the community. Vaccination with the IIV was not associated with IBD flare. These findings add to the evidence to promote vaccination against influenza in people with IBD.
Rising caesarean section rates and factors affecting women’s decision-making about mode of birth in Indonesia: a longitudinal qualitative study
Authors: Zahroh Rana Islamiah , Hazfiarini Alya , Martiningtyas Moya AD , Ekawati Fitriana Murriya , Emilia Ova , Cheong Marc , Betran Ana Pilar , Homer Caroline SE , Bohren Meghan A
Published: June 2024

Introduction

Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women’s preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women’s preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth.

Methods

We conducted a longitudinal qualitative study using in-depth interviews with 28 women accessing private and public health facilities in Jakarta, the region with the highest CS rates. Interviews were conducted two times: during the woman’s third trimester of pregnancy and in the postpartum period, between October 2022 and March 2023. We used a reflexive thematic approach for analysis.

Results

We generated three themes: (1) preferences about the mode of birth, (2) decision-making about the mode of birth and (3) regrets about the actual mode of birth. Most women preferred vaginal birth. However, they were influenced by advertisements promoting enhanced recovery after CS (ERACS) as an ‘advanced technique’ of CS, promising a comfortable, painless and faster recovery birth. This messaging influenced women to perceive CS as equivalent or even superior to vaginal birth. Where women’s preferences for mode of birth shifted around the time of birth, this was primarily due to the obstetricians’ discretion. Women felt they did not receive adequate information from obstetricians on the benefits and risks of CS and vaginal birth and felt disappointed when their actual mode of birth was not aligned with their preferences.

Conclusion

Our study shows that despite rising CS rates, Indonesian women prefer vaginal birth. This highlights the need for better communication strategies and evidence-based information from healthcare providers. Given the rising popularity of ERACS, more work is urgently needed to standardise and regulate its use.
Leveraging data science and machine learning for urban climate adaptation in two major African cities: a HE2AT Center study protocol
Authors: Jack Christopher , Parker Craig , Kouakou Yao Etienne , Joubert Bonnie , McAllister Kimberly A , Ilias Maliha , Maimela Gloria , Chersich Matthew , Makhanya Sibusisiwe , Luchters Stanley , Makanga Prestige Tatenda , Vos Etienne , Ebi Kristie L , Koné Brama , Waljee Akbar K , Cissé Guéladio
Published: June 2024

Introduction

African cities, particularly Abidjan and Johannesburg, face challenges of rapid urban growth, informality and strained health services, compounded by increasing temperatures due to climate change. This study aims to understand the complexities of heat-related health impacts in these cities. The objectives are: (1) mapping intraurban heat risk and exposure using health, socioeconomic, climate and satellite imagery data; (2) creating a stratified heat–health forecast model to predict adverse health outcomes; and (3) establishing an early warning system for timely heatwave alerts. The ultimate goal is to foster climate-resilient African cities, protecting disproportionately affected populations from heat hazards.

Methods and analysis

The research will acquire health-related datasets from eligible adult clinical trials or cohort studies conducted in Johannesburg and Abidjan between 2000 and 2022. Additional data will be collected, including socioeconomic, climate datasets and satellite imagery. These resources will aid in mapping heat hazards and quantifying heat–health exposure, the extent of elevated risk and morbidity. Outcomes will be determined using advanced data analysis methods, including statistical evaluation, machine learning and deep learning techniques.

Ethics and dissemination

The study has been approved by the Wits Human Research Ethics Committee (reference no: 220606). Data management will follow approved procedures. The results will be disseminated through workshops, community forums, conferences and publications. Data deposition and curation plans will be established in line with ethical and safety considerations.
What is the association between the microbiome and cognition? An umbrella review protocol
Authors: Goldenberg Joshua Z , Wright Traver J , Batson Richard D , Wexler Ryan S , McGovern Kristen A , Venugopal Navneet K , Ward Weston W , Randolph Kathleen M , Urban Randall J , Pyles Richard B , Sheffield-Moore Melinda
Published: June 2024

Introduction

Cognitive impairment is reported in a variety of clinical conditions including Alzheimer’s disease, Parkinson’s and ‘long-COVID’. Interestingly, many of these clinical conditions are also associated with microbial dysbiosis. This comanifestation of cognitive and microbiome findings in seemingly unrelated maladies suggests that they could share a common mechanism and potentially presents a treatment target. Although a rapidly growing body of literature has documented this comorbid presentation within specific conditions, an overview highlighting potential parallels across healthy and clinical populations is lacking. The objective of this umbrella review, therefore, is to summarise and synthesise the findings of these systematic reviews.

Methods and analysis

On 2 April 2023, we searched MEDLINE (Pubmed), Embase (Ovid), the Web of Science (Core Collection), the Cochrane Library of Systematic Reviews and Epistemonikos as well as grey literature sources, for systematic reviews on clinical conditions and interventions where cognitive and microbiome outcomes were coreported. An updated search will be conducted before completion of the project if the search-to-publication date is >1 year old. Screening, data abstraction and quality assessment (AMSTAR 2, A MeaSurement Tool to Assess systematic Reviews) will be conducted independently and in duplicate, with disagreements resolved by consensus. Evidence certainty statements for each review’s conclusions (eg, Grading of Recommendations Assessment, Development and Evaluation (GRADE)) will be extracted or constructed de novo. A narrative synthesis will be conducted and delineated by the review question. Primary study overlap will be visualised using a citation matrix as well as calculated using the corrected covered area method.

Ethics and dissemination

No participant-identifying information will be used in this review. No ethics approval was required due to our study methodology. Our findings will be presented at national and international conferences and disseminated via social media and press releases. We will recruit at least one person living with cognitive impairment to collaborate on writing the plain language summary for the review.

PROSPERO registration number

CRD42023412903
Cost-effectiveness of strength exercise or aerobic exercise compared with usual care for patients with knee osteoarthritis: secondary results from a multiarm randomised controlled trial in Norway
Authors: Killingmo Rikke Munk , Øiestad Britt Elin , Risberg May-Arna , Maas Esther , Grotle Margreth
Published: June 2024

Objectives

To evaluate the 1-year cost-effectiveness of strength exercise or aerobic exercise compared with usual care for patients with symptomatic knee osteoarthritis (OA), from a societal and healthcare perspective.

Design

Cost-effectiveness analysis embedded in a three-arm randomised controlled trial.

Participants and setting

A total of 161 people with symptomatic knee OA seeking Norwegian primary or secondary care were included in the analyses.

Interventions

Participants were randomised to either 12 weeks of strength exercise (n=54), 12 weeks of aerobic exercise (n=53) or usual care (n=54).

Outcome measures

Quality-adjusted life-years (QALYs) estimated by the EuroQol-5 Dimensions-5 Levels, and costs related to healthcare utilisation and productivity loss estimated in euros (€), aggregated for 1 year of follow-up. Cost-effectiveness was expressed with mean incremental cost-effectiveness ratios (ICERs). Bootstrapping was used to estimate ICER uncertainty.

Results

From a 1-year societal perspective, the mean cost per patient was €7954, €8101 and €17 398 in the strength exercise, aerobic exercise and usual care group, respectively. From a 1-year healthcare perspective, the mean cost per patient was €848, €2003 and €1654 in the strength exercise, aerobic exercise and usual care group, respectively. Mean differences in costs significantly favoured strength exercise and aerobic exercise from a 1-year societal perspective and strength exercise from a 1-year healthcare perspective. There were no significant differences in mean QALYs between groups. From a 1-year societal perspective, at a willingness-to-pay threshold of €27 500, the probability of strength exercise or aerobic exercise being cost-effective was ≥98%. From a 1-year healthcare perspective, the probability of strength exercise or aerobic exercise being cost-effective was ≥97% and ≥76%, respectively.

Conclusion

From a 1-year societal and healthcare perspective, a 12-week strength exercise or aerobic exercise programme is cost-effective compared with usual care in patients with symptomatic knee OA.

Trial registration number

NCT01682980.
Facilitators and barriers to optimum uptake of multimonth dispensing of antiretroviral treatment in Morogoro, Tanzania: a qualitative study
Authors: Machumu Neema , Frumence Gasto , Anaeli Amani
Published: June 2024

Objectives

Aimed at determining facilitators and barriers to optimum uptake of multimonth dispensing (MMD) of antiretroviral treatment (ART).

Design

Qualitative study conducted through in-depth interviews.

Setting

An explorative qualitative approach conducted at three high-volume care and treatment clinics in Morogoro Municipality, Tanzania.

Participants

Data were collected from a purposefully selected sample of 22 participants. Of them, 9 were healthcare providers and 12 were clients on ART receiving MMD. Audio records from the interviews were transcribed, translated, and thematically analysed.

Results

Evidence showed that multimonth dispensing can be improved through strengthened health system barriers such as having proper guidelines and involving stakeholders. Other facilitators included service providers’ ability to identify eligible clients, fast-tracking of services, quality improvement implementation, peer-to-peer inspiration and clients’ satisfaction and awareness. Identified barriers to effective multimonth dispensing included inadequate drug supply, prolonged turn-around time of HIV viral load results, delayed integrated Tuberculosis (TB) preventive therapy initiation, stigma and retention challenges.

Conclusion

Multimonth dispensing has the potential to address the health system challenges in Tanzania if guidelines are well informed to stakeholders, and facets of quality of care are improved. Addressing the earmarked barriers such as ensuring medicine, supplies and diagnostics, while addressing retention challenges and stigma.
Whole-course quality of tuberculosis (TB) care in rural China: a retrospective study based on chart abstraction
Authors: Li Mingyue , Zhang Xiaotian , Cheng Haozhe , Zhang Baisong , Wei Tiantian , Cheng Xiaoran , Jiang Shiwen , Liu Xiaoyun
Published: June 2024

Objectives

The aim of this study was to assess the quality of tuberculosis (TB) care for the whole course and assess factors that affect completing treatment.

Design

This is an observational retrospective study using chart abstraction for the whole course of TB care conducted at two underserved provinces in China.

Setting

The study was conducted from June 2021 to July 2021. All medical records (outpatient and inpatient) for the whole course (6–8 months) of patients with TB newly registered from July 2020 to December 2020 were reviewed and abstracted using predetermined checklists.

Participants

A total of 268 outpatient medical records and 126 inpatient records were included.

Primary and secondary outcome measures

The primary outcome included diagnostic quality, treatment quality and management quality. The secondary outcome was completing treatment.

Results

For diagnostic quality, 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. 85.1% of the inpatients prescribed with second-line drugs were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments, but only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were 1.8 times more likely to complete treatment (p=0.011).

Conclusion

Patients with TB received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.
How accurate is clinical prognostication by oncologists during routine practice in a general hospital and can it be improved by a specific prognosis training programme: a prospective interventional study
Authors: Kupf Irma , Thanner Gabriele , Gerken Michael , Crispin Alexander , Braess Jan
Published: June 2024

Objectives

Oncologists need competence in clinical prognostication to deliver appropriate care to patients with cancer. Most studies on prognostication have been restricted to patients in palliative care settings. This paper investigates (1) the prognostic accuracy of physicians regarding a broad cohort of patients with cancer with a median life expectancy of >2 years and (2) whether a prognosis training can improve prognostication.

Design

Prospective single-centre study comprising 3 phases, each lasting 1 month.

Setting

Large teaching hospital, department of oncology and haematology, Germany.

Participants

18 physicians with a professional experience from entry level to 34 years. 736 patients with oncological and malignant haematological diseases.

Interventions

Baseline prognostication abilities were recorded during an ‘untrained’ phase 1. As an intervention, a specific prognosis-training programme was implemented prior to phases 2 and 3. In phase 3, physicians had to provide additional estimates with the inclusion of electronic prognostic tools.

Outcome measures

Prognostic estimates (PE) were collected using ‘standard’ surprise question (SQ), ‘probabilistic’ SQ (both for short-term prognostication up to 6 months) and clinician prediction of survival (CPS) (for long-term prognostication). Estimated prognoses were compared with observed survival. Phase 1 was compared with phases 2 and 3.

Results

We included 2427 PE for SQ, 1506 for CPS and 800 for probabilistic SQ. Median OS was 2.5 years. SQ accuracy improved significantly (p<0.001) from 72.6% in phase 1 to 84.3% in phase 3. Probabilistic SQ in phase 3 showed 83.1% accuracy. CPS accuracy was 25.9% and could not be significantly improved. (Electronic) prognostic tools—used alone—performed significantly worse (p<0.0005) than physicians and—used by the clinicians—did not improve their performance.

Conclusion

A specific prognosis-training programme could improve short-term and intermediate-term prognostication. Improvement of long-term prognostication was not possible. Inexperienced residents as well as experienced oncologists benefited from training.
Structured medication reviews for adults with multimorbidity and polypharmacy in primary care: a systematic review protocol
Authors: Lammila-Escalera Elena , Greenfield Geva , Aldakhil Reham , Zaman Hadar , Neves Ana Luisa , Majeed Azeem , WJ Hayhoe Benedict
Published: June 2024

Introduction

Polypharmacy is common among individuals with multimorbidity, often leading to inappropriate medication use and is associated with an increased risk of frailty, hospitalisation and mortality. Structured medication reviews (SMRs) have emerged as a promising method for optimising medication use. However, research examining their efficacy is limited. This review aims to evaluate the impact of SMRs on improving outcomes for adults with multimorbidity and polypharmacy in primary care settings. Additionally, this review seeks to identify prevailing patterns and trends in the mode of delivery of SMRs.

Methods and analysis

A systematic review will be conducted using Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL (1997–present). Primary outcomes will include medication-related measures such as dose, frequency and dosage form. Secondary outcomes under investigation will include physical, mental, functional and health service outcomes, as reported. Two independent reviewers will conduct the screening and data extraction, resolving disagreements through discussion. Once eligible studies are identified, the extracted data will be summarised in tabular format. The risk of bias in the articles will be assessed using either the Cochrane Risk of Bias 2 tool or the Newcastle-Ottawa scale, depending on the design of the studies retrieved. Subgroup analysis will be performed using demographic variables and modes of delivery where the data supports. If appropriate, a meta-analysis of the data extracted will be conducted to determine the impact of the SMRs on reported outcomes. If a meta-analysis is not possible due to heterogeneity, a narrative synthesis approach will be adopted.

Ethics and dissemination

This proposed review is exempt from ethical approval as it aims to collate and summarise peer-reviewed, published evidence. This protocol and the subsequent review will be disseminated in peer-reviewed journals, conferences and patient-led lay summaries.

PROSPERO registration number

CRD42023454965.
Can digital innovation transform rural primary health care? A systematic review protocol
Authors: Nasir Bushra F , Leedie Floyd , Fox Jordan , Martin Priya , Alam Khorshed , Wallis Katharine , McGrail Matthew R , Kondalsamy-Chennakesavan Srinivas
Published: June 2024

Introduction

Digital technology is increasingly being adopted within primary healthcare services to improve service delivery and health outcomes; however, the scope for digital innovation within primary care services in rural areas is currently unknown. This systematic review aims to synthesise existing research on the use and integration of digital health technology within primary care services for rural populations across the world.

Methods and analysis

A systematic approach to the search strategy will be conducted. Relevant medical and healthcare-focused electronic databases will be searched using key search terms between January 2013 and December 2023. Searches will be conducted using specific inclusion and exclusion criteria. A systematic study selection and data extraction process will be implemented, using standardised templates. Outcomes will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses- Protocol statement guidelines. Quality assessment and risk of bias appraisal will be conducted using the Mixed Methods Appraisal Tool.

Ethics and dissemination

Ethical approval will not be required because there is no individual patient data collected or reviewed. The finding of this review will be disseminated through peer-reviewed publications and conference presentations. Outcomes will help to understand existing knowledge and identify gaps in delivering digital healthcare services, while also providing potential future practice and policy recommendations.

PROSPERO registration number

CRD42023477233.
Association of different doses of antenatal corticosteroids exposure with early major outcomes and early weight loss percentage in extremely preterm infants or extremely low birthweight infants: a multicentre cohort study
Authors: Li Shuaijun , Feng Qi , Huang Xiaofang , Tian Xiuying , Zhou Ying , Ji Yong , Zhai Shufen , Guo Wei , Zheng Rongxiu , Wang Haijun
Published: June 2024

Objectives

To determine the dose-dependent associations between antenatal corticosteroids (ANS) exposure and the rates of major morbidities, and the early weight loss percentage (EWLP) in hospital among extremely preterm infants (EPI) or extremely low birthweight infants (ELBWI).

Methods

A multicentre, retrospective cohort study of EPI or ELBWI born between 2017 and 2018 was conducted. Infants were classified into no ANS, partial ANS and complete ANS exposure group; three subgroups were generated by gestational age and birth weight. Multiple logistic regression and multiple linear regression were performed.

Results

There were 725 infants included from 32 centres. Among no ANS, partial ANS and complete ANS exposure, there were significant differences in the proportions of bronchopulmonary dysplasia (BPD) (24.5%, 25.4% and 16.1%), necrotising enterocolitis (NEC) (6.7%, 2.0% and 2.0%) and death (29.6%, 18.5% and 13.5%), and insignificant differences in the proportions of intraventricular haemorrhage (IVH) (12.5%, 13.2% and 12.2%), and extrauterine growth restriction (EUGR) (50.0%, 56.6% and 59.5%). In the logistic regression, compared with no ANS exposure, complete ANS reduced the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91), NEC (OR 0.21, 95% CI 0.08 to 0.57) and death (OR 0.36, 95% CI 0.23 to 0.56), and partial ANS reduced the risk of NEC (OR 0.23, 95% CI 0.07 to 0.72) and death (OR 0.54, 95% CI 0.34 to 0.87). Compared with partial ANS exposure, complete ANS decreased the risk of BPD (OR 0.58, 95% CI 0.37 to 0.91). There were insignificant associations between ANS exposure and IVH, EUGR. In the multiple linear regression, partial and complete ANS exposure increased EWLP only in the ≥28 weeks (w) and <1000 g subgroup (p<0.05).

Conclusions

Different doses of ANS (dexamethasone) exposure were protectively associated with BPD, NEC, death in hospital, but not EUGR at discharge among EPI or ELBWI. Beneficial dose-dependent associations between ANS (dexamethasone) exposure and BPD existed. ANS exposure increased EWLP only in the ≥28 w and<1000 g subgroup. ANS administration, especially complete ANS, is encouraged before preterm birth.

Trial registration number

NCT06082414.
What do clinical practice guidelines say about deprescribing? A scoping
review
Authors: Langford Aili Veronica , Warriach Imaan , McEvoy Aisling M , Karaim Elisa , Chand Shyleen , Turner Justin P , Thompson Wade , Farrell Barbara J , Pollock Danielle , Moriarty Frank , Gnjidic Danijela , Ailabouni Nagham J , Reeve Emily
Published: June 2024

Introduction

Deprescribing (medication dose reduction or
cessation) is an integral component of appropriate
prescribing. The extent to which deprescribing recommendations are
included in clinical practice guidelines is unclear. This scoping review
aimed to identify guidelines that contain deprescribing recommendations,
qualitatively explore the content and format of deprescribing
recommendations and estimate the proportion of guidelines that contain
deprescribing recommendations.

Methods

Bibliographic databases and Google were searched for guidelines
published in English from January 2012 to November 2022. Guideline
registries were searched from January 2017 to February 2023. Two
reviewers independently screened records from databases and Google for
guidelines containing one or more deprescribing recommendations. A 10%
sample of the guideline registries was screened to identify eligible
guidelines and estimate the proportion of guidelines containing a
deprescribing recommendation. Guideline and recommendation
characteristics were extracted and language features of deprescribing
recommendations including content, form, complexity and readability were
examined using a conventional content analysis and the SHeLL Health
Literacy Editor tool.

Results

80 guidelines containing 316 deprescribing recommendations were
included. Deprescribing recommendations had substantial variability in
their format and terminology. Most guidelines contained recommendations
regarding forwho(75%, n=60),
what(99%, n=89) andwhen or
why(91%, n=73) to deprescribe, however, fewer
guidelines (58%, n=46) contained detailed guidance
onhowto deprescribe. Approximately 29% of
guidelines identified from the registries sample (n=14/49) contained one
or more deprescribing recommendations.

Conclusions

Deprescribing recommendations are increasingly being incorporated
into guidelines, however, many guidelines do not contain clear and
actionable recommendations onhowto
deprescribe which may limit effective implementation in clinical
practice. A co-designed template or best practice guide, containing
information on aspects of deprescribing recommendations that are
essential or preferred by end-users should be developed and
employed.

Trial registration number

osf.io/fbex4.
‘Delivering effective Defence Healthcare Engagement during Short-Term Training Team deployments: Guidance from on-the-ground Practitioners’
Authors: Heil Kieran , Stevens J , Smith B
Published: June 2024

Defence Engagement (DE) has grown to become one of the key operational outputs of UK Defence. Defence Engagement (Health) (DE(H)) is a subcategory of DE, in which Defence Medical Services (DMS) personnel and assets are used to achieve influence and promote the UK’s national interests. For most DMS personnel, their involvement in DE(H) will be as part of a Short-Term Training Team (STTT). STTTs are deployed to Host Nations (HNs) to work alongside a Partner Force, training, mentoring and supporting them to enhance their own capabilities. This article aims to guide junior members of the DMS in how they might approach an STTT from a DE(H) perspective. The article will draw primarily on the recent operational experiences of the authors across multiple STTTs in a variety of HNs.
Psychological aspects of the longest, solo, unsupported one-way polar ski expedition in Antarctica by a female adventurer
Authors: Scheer Volker , Chandi H , Valero Burgos E , Thuany M , Knechtle B , Steinach M
Published: June 2024

Introduction

Antarctic expeditions present exceptional physiological and mental challenges. Research data are lacking on psychological aspects of such endeavours. The aim of our study is to provide data on changes in mood, well-being, personality traits and personal experiences during an Antarctica crossing.

Methods

This is a study of a 33-year-old female British Army officer (height 175 cm; weight 75 kg; body mass index 24.49 kg/m2; VO2max49 mL/kg/min) who completed the longest, solo, unsupported, one-way polar ski expedition. The expedition started at Hercules Inlet and finished at Ross Ice Shelf, lasting 70 days and 16 hours covering 1484.53 km, with temperatures estimating from −12°C to −50°C and wind speeds of up to 60 miles per hour. The adventurer pulled all equipment and nutrition in a pulk (sled), weighing approximately 120 kg. Five psychometric questionnaires were completed pre post and during the expedition, including the International Personality Item Pool – Neuroticism, Extraversion and Openness-60, Brief Assessment of Mood, Positive and Negative Affective Schedule, Profile of Mood States, Wellness questionnaire, as well as an unstructured open questionnaire.

Results

Mood generally deteriorated, particularly positive affective mood. Scores for fatigue and muscle soreness increased, with a reduction in sleep times. Personality traits of openness, agreeableness, and conscientiousness remained stable throughout the expedition, with some reduction in extraversion and an increase in neuroticism. Personal accounts give a unique insight into the increasing demands on the mental and physical impact of the expedition.

Conclusions

Meticulous preparation and planning may have led to a successful expedition, including physical preparation, prior on-field experience, and psychological preparedness and resiliance. Some of these strategies may be applicable to a range of settings, including future Antarctic expeditions, expeditions in extreme environments, or missions within a military context.
Spatial genetic patterns of a long-lived tree species: the case of Pinus leiophylla in a human-altered landscape of central Mexico
Authors: Pérez-Alva Braulio R. , Galindo-Flores Gema L. , Navarro-Noya Yendi E. , Estrada-Torres Arturo , Flores-Manzanero Alejandro , Pérez-Flores Guillermo A. , Cruz-Salazar Bárbara
Published: June 2024

In long-lived species, deforestation can modify the genetic diversity patterns of recent populations. The spatial-structure genetics of Pinus leiophylla Schiede ex Schltdl. & Cham. was investigated in adults and seedlings of remnant populations from central Mexico. Two chloroplast intergenic regions were sequenced of two cohorts (adults and seedlings) of 121 individuals of P. leiophylla from three localities. Higher genetic differentiation was found in adults ( ФST = 0.09) than in seedlings ( ФST = 0.03). The discriminant analysis of principal components detected four genetic clusters and the Mantel test found a weak but significant isolation by distance pattern ( r2 = 0.05, p = 0.002). Sixteen percent of genetic variation was explained by the spatial component according to the genetic neighborhood analysis. And the effect of three landscape features, i.e., elevation, aspect (sine and cosine), and land use, explored with ResistanceGA, detected that land use significantly restricts gene flow between populations, mostly in the farming category. This study emphasizes the critical role of preserving forest cover to maintain connectivity among remnants of P. leiophylla. Insights of this study will contribute to the conservation of conifers in Mexican temperate forests, especially within landscapes heavily altered by human activities.
Pulsar as a Weber detector of gravitational waves and a probe to its internal phase transitions
Authors: Bagchi Partha , Ganguly Oindrila , Layek Biswanath , Sarkar Anjishnu , Srivastava Ajit M.
Published: June 2024

It is believed that cores of neutron stars provide a natural laboratory where exotic high baryon density phases of quantum chromo dynamics (QCD) may exist. In fact, the theoretically well-established neutron superfluid phase is also believed to be found only inside neutron stars. Focus on neutrons stars has tremendously intensified in recent years with the direct detection of gravitational waves (GWs) by LIGO/Virgo from binary neutron star (BNS) merger events which has allowed the possibility of directly probing the properties of the interior of a neutron star. A truly remarkable phenomenon manifested by rapidly rotating neutron stars is in their avatar as Pulsars. The accuracy of pulsar timing can reach the level of one part in 10[Formula: see text], comparable to that of atomic clocks. Indeed, it was such a great accuracy which had allowed the first indirect detection of GWs from a BNS system. Such an incredible accuracy of pulse timings points to a very interesting possibility. Any deformation of the pulsar, even if it is extremely tiny, has the potential of leaving its imprints on the pulses through introduction of tiny perturbations in the entire moment of inertia (MI) tensor. While, the diagonal components of perturbed MI tensor affect the pulse timings, the off-diagonal components lead to wobbling of pulsar, directly affecting the pulse profile. This opens up a new window of opportunity for exploring various phase transitions occurring inside a pulsar core, through induced density fluctuations, which may be observable as perturbations in the pulse timing as well as its profile. Such perturbations also naturally induce a rapidly changing quadrupole moment of the star, thereby providing a new source of GW emission. Another remarkable possibility arises when we consider the effect of an external GW on neutron star. With the possibility of detecting any minute changes in its configuration through pulse observations, the neutron star has the potential of performing as a Weber detector of GW. This brief review will focus on these specific aspects of a pulsar. Specifically, the focus will be on the type of physics which can be probed by utilizing the effect of changes in the MI tensor of the pulsar on pulse properties.