bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Demands and Resources in the Team Context
Authors: Vahle-Hinz Tim , Otto Kathleen , Rigotti Thomas
Published: June 2024

This study adds a social layer to the job demands-resources theory, applying social comparison and social identity theory to investigate the motivational and health impairment paths in the social context of teams. Specifically, within-team, between-team, and congruence/incongruence effects were tested. As predicted by theory, at within-team level, demands were found to be positively related to health impairments, and resources to motivation. At between-team level, only autonomy showed positive health effects. This study contributes to the scarce research on team-level effects, highlighting the role of the team context in shaping employee experiences of health and motivation.
The Presence of Implantable Cardioverter Defibrillators is Rarely Addressed During Code Status Change
Authors: Meda Namratha Seetharam , Makhumalo Watipa , Groninger Hunter , Pettit Clint
Published: June 2024

Background: Implantable Cardioverter Defibrillators (ICDs) are used to prevent sudden cardiac death, but they may provide unwanted shocks during end-of-life care. We aimed to study the frequency at which Do Not Resuscitate (DNR) discussions address ICD preferences in high-risk patients. Methods: A retrospective chart review was performed on patient hospitalizations with the presence of an ICD, a change in code status to DNR, and a subsequent death during that hospitalization. Data collected included demographics, significant comorbidities, if and when ICD was discussed, and who performed code status discussions, and were analyzed for statistical significance. Results: 129 patients met study criteria, and 110 patients (85.3%) did not have a documented discussion addressing ICD deactivation. There were no statistically significant differences in patient characteristics between patients with ICD addressed or not addressed, nor were there differences noted between discussions performed by residents vs staff or with the presence of cardiology, critical care status, or with palliative care consultation. It was noted that specifically discussing intubation or cardioversion was associated with the discussion of ICD deactivation. Conclusion: ICD discussions were rarely documented in our high-risk population, highlighting a potential need for better in-chart visibility of ICDs and for focused education of clinicians who care for these patients at end of life.
An eye-Tracking Study of College Students’ Infographic-Reading Processes
Authors: Wu Chao-Jung , Liu Chia-Yu
Published: June 2024

We know little about how readers, especially readers with various characteristics, incorporate materials with highly synthesized words and graphs like infographics. We collected eye movements from 95 college students as they read infographics and categorized them into high-/low-score groups based on comprehension scores. Participants initially inspected the word areas that corresponded to the graph areas with the highest perceptual salience. The high-score group showed greater total fixation duration (TFD), TFD ratios of graphs, and transition numbers between words and graphs, indicating more processing of infographics. The low-score group showed greater TFD ratios of words and saccade amplitudes, indicating information-searching behavior.
How Does CEO Duality Influence ESG Scores in Hospitality and Tourism Companies? Confounding Roles of Governance Mechanisms and Financial Indicators
Authors: Arici Hasan Evrim , Aladag Omer Faruk , Koseoglu Mehmet Ali
Published: June 2024

Previous studies have yielded inconsistent results about the impact of CEO duality on corporate performance in the hospitality and tourism (H&T) industry. To further delve into this relationship, we investigated the causal relationship between CEO duality and environmental, social, and governance (ESG) performance under various board characteristics and financial indicators. The data from the Thomson Reuters Eikon database were evaluated using a machine learning technique that included targeted maximum likelihood estimation (TMLE), augmented inverse probability weighting (AIPW), and neural network analysis, all of which are doubly robust estimators with cross-fitting. The findings suggest that CEO duality negatively impacts environmental pillar scores but not other outcomes (i.e., governance and social pillar scores). Among the governance practices and financial indicators, policy executive compensation performance, policy executive compensation ESG performance, and return on invested capital (ROIC) have positive relations with total ESG scores. The results have important ramifications for helping H&T companies develop effective boards of directors and governance systems, as well as achieve targeted ESG performance objectives.
Visualisation of Random Forest classification
Authors: Maçãs Catarina , Campos João R , Lourenço Nuno , Machado Penousal
Published: June 2024

Decision Trees (DTs) stand out as a prevalent choice among supervised Machine Learning algorithms. These algorithms form binary structures, effectively dividing data into smaller segments based on distinct rules. Consequently, DTs serve as a learning mechanism to identify optimal rules for the separation and classification of all elements within a dataset. Due to their resemblance to rule-based decisions, DTs are easy to interpret. Additionally, their minimal need for data pre-processing and versatility in handling various data types make DTs highly practical and user-friendly across diverse domains. Nevertheless, when confronted with extensive datasets or ensembles involving multiple trees, such as Random Forests, its analysis can become challenging. To facilitate the examination and validation of these models, we have developed a visual tool that incorporates a range of visualisations providing both an overview and detailed insights into a set of DTs. Our tool is designed to offer diverse perspectives on the same data, enabling a deeper understanding of the decision-making process. This article outlines our design approach, introduces various visualisation models, and details the iterative validation process. We validate our methodology through a telecommunications use case, specifically employing the visual tool to decipher how a DT-based model determines the optimal communication channel (i.e. phone call, email, SMS) for a telecommunication operator to use when contacting a client.
Association between occupational participation and depressive symptoms among middle-aged adults: A cross-sectional study in Hokkaido, Japan
Authors: Yokoyama Kazuki , Shimada Kiyotaka , Morimoto Takafumi , Ishii Takao , Ikeda Nozomu
Published: June 2024

Aim

This study aimed to investigate the association between occupational participation and depressive symptoms among middle-aged adults in Hokkaido, Japan.

Methods

Community-dwelling adults aged 40–64 years were recruited using snowball sampling, and 165 participants who returned the questionnaires and met the selection criteria were included in the analysis. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Occupational participation, including three domains (leisure, productivity, and self-care) and three aspects (occupational control, occupational balance, and satisfaction of performance), was assessed using Self-completed Occupational Performance Index (SOPI) questionnaire.

Results

Multivariate-adjusted regression analysis revealed that depressive symptoms were associated with lower occupational participation in the productivity domain (β = −0.34, p < .001), whereas analysis of each aspect of the SOPI showed a significant association of depressive symptoms with lower occupational control in productivity domain (β = −0.33, p < .001), occupational balance in productivity domain (β = −0.25, p < .001), and satisfaction with performance in leisure domain (β = −0.16, p = .045) and productivity domain (β = −0.35, p < .001).

Conclusion

Depressive symptoms was significantly associated with low occupational participation in productivity domain in middle-aged adults. In the domains of leisure and self-care, significant associations were found only between depression symptoms and satisfaction of performance. Occupational therapy interventions for middle-aged adults targeting the maintenance and improvement of participation in productive activities may help preventing depressive symptoms.
Impact of intensive blood pressure lowering after multiple-attempt endovascular thrombectomy: A secondary analysis of the OPTIMAL-BP trial
Authors: Jung Jae Wook , Kim Kwang Hyun , Yun Jaeseob , Kim Young Dae , Heo JoonNyung , Lee Hyungwoo , Choi Jin Kyo , Lee Hyung , Lim In Hwan , Hong Soon-Ho , Kim Byung Moon , Kim Dong Joon , Shin Na Young , Cho Bang-Hoon , Ahn Seong Hwan , Park Hyungjong , Sohn Sung-Il , Hong Jeong-Ho , Song Tae-Jin , Chang Yoonkyung , Kim Gyu Sik , Seo Kwon-Duk , Lee Kijeong , Chang Jun Young , Seo Jung Hwa , Lee Sukyoon , Baek Jang-Hyun , Cho Han-Jin , Shin Dong Hoon , Kim Jinkwon , Yoo Joonsang , Baik Minyoul , Lee Kyung-Yul , Jung Yo Han , Hwang Yang-Ha , Kim Chi Kyung , Kim Jae Guk , Lee Chan Joo , Park Sungha , Jeon Soyoung , Lee Hye Sun , Kwon Sun U , Young Bang Oh , Heo Ji Hoe , Nam Hyo Suk
Published: June 2024

Background:

Multiple attempts of thrombectomy have been linked to a higher risk of intracerebral hemorrhage and worsened functional outcomes, potentially influenced by blood pressure (BP) management strategies. Nonetheless, the impact of intensive BP management following successful recanalization through multiple attempts remains uncertain.

Aims:

This study aimed to investigate whether conventional and intensive BP managements differentially affect outcomes according to multiple-attempt recanalization (MAR) and first-attempt recanalization (FAR) groups.

Methods:

In this secondary analysis of the OPTIMAL-BP trial, which was a comparison of intensive (systolic BP target: <140 mm Hg) and conventional (systolic BP target = 140–180 mm Hg) BP managements during the 24 h after successful recanalization, we included intention-to-treat population of the trial. Patients were divided into the MAR and the FAR groups. We examined a potential interaction between the number of thrombectomy attempts (MAR and FAR groups) and the effect of BP managements on clinical and safety outcomes. The primary outcome was functional independence at 3 months. Safety outcomes were symptomatic intracerebral hemorrhage within 36 h and mortality within 3 months.

Results:

Of the 305 patients (median = 75 years), 102 (33.4%) were in the MAR group and 203 (66.6%) were in the FAR group. The intensive BP management was significantly associated with a lower rate of functional independence in the MAR group (intensive, 32.7% vs conventional, 54.9%, adjusted odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12–0.90, p = 0.03). In the FAR group, the proportion of patients with functional independence was not significantly different between the BP managements (intensive, 42.5% vs conventional, 54.2%, adjusted OR = 0.73, 95% CI = 0.38–1.40). Incidences of symptomatic intracerebral hemorrhage and mortality rates were not significantly different according to the BP managements in both MAR and FAR groups.

Conclusions:

Among stroke patients who received multiple attempts of thrombectomy, intensive BP management for 24 h resulted in a reduced chance of functional independence at 3 months and did not reduce symptomatic intracerebral hemorrhage following successful reperfusion.
Multimodal dynamic ultrasound approach as predictor of response in patients with Crohn’s disease treated with ustekinumab
Authors: Ainora Maria Elena , Liguori Antonio , Mignini Irene , Cintoni Marco , Galasso Linda , Laterza Lucrezia , Lopetuso Loris Riccardo , Garcovich Matteo , Riccardi Laura , Gasbarrini Antonio , Scaldaferri Franco , Zocco Maria Assunta
Published: June 2024

Background:

The approval of ustekinumab (UST) has opened new options for the treatment of Crohn’s disease (CD), but potential markers predicting the efficacy of this interleukin-12/23 inhibitor are lacking. Contrast-enhanced ultrasound (CEUS) is non-invasive alternative to endoscopy, demonstrating early transmural changes after treatment induction.

Objectives:

We conducted a prospective monocentric study aiming to explore the value of multimodal intestinal ultrasound (IUS) in predicting the response to UST in patients with active CD who have been previously exposed to anti-tumour necrosis factor α (TNFα).

Design and methods:

Consecutive patients with moderate-to-severe CD involving the terminal ileum who were scheduled to begin UST therapy were enrolled between January 2020 and October 2021 in the inflammatory bowel diseases outpatient centre. A complete IUS evaluation, including B-mode, Doppler, dynamic CEUS and elastography, was performed at the time of induction (T0) and after 8 (T1), 16 (T2), 24 (T3) and 48 (T4) weeks of therapy. Each IUS parameter and their variations from baseline were correlated with endoscopic response and mucosal healing after 1 year.

Results:

A total of 52 patients were included, 29 (55.8%) of which reached endoscopic response at T4. The univariate analysis revealed that, between T3 and T0, the percentage changes of bowel wall thickness, Limberg score, mean signal intensity, rise time, wash-in rate, C reactive protein and Harvey–Bradshaw Index were associated with long-term therapeutic outcome. Based on the above parameters, we developed an IUS score that showed a good performance in predicting 1 year-endoscopic response (area under the curve: 0.91).

Conclusion:

Multimodal ultrasound could be helpful to predict long-term therapeutic outcome in patients with CD treated with UST.

Registration:

NCT05987501.
A qualitative study on informed consent decision-making at two tertiary hospitals in Uganda: Experiences of patients undergoing emergency surgery and their next of kin
Authors: Kituuka Olivia , Mwaka Erisa Sabakaki , Munabi Ian Guyton , Galukande Moses , Sewankambo Nelson
Published: June 2024

Background:

In emergency situations, patients and their next of kin must make complex medical and ethical decisions in a quick and timely way.

Objectives:

To describe the decision-making process during informed consent for emergency surgery among patients and the next of kin of patients who have undergone emergency surgery.

Methods:

Consecutive sampling of 39 participants and in-depth semi-structured interviews were conducted at two tertiary teaching hospitals in Uganda. There were 22 patients and 17 next of kin of patients who had undergone emergency surgery within 24–72 h. Responses about decision-making were coded into themes using the social constructivist theory and phenomenological approach

Results:

There were four emergent themes; decision-makers, people consulted, documentation of the consent and factors influencing decision-making. Most patients and next of kin made decisions on their own and documented the consent for themselves. Other family members and doctors were consulted during the decision-making process. Decision-making was influenced by reassurance of good outcomes of surgery and disclosure by the doctors.

Conclusion:

Decisions were made collaboratively with the patient at the center but with input of health personnel, the next of kin and other family members. A communitarian approach combined with shared decision-making between the doctor and the patient and next of kin with adequate discussion and disclosure of information in simple language would improve decision-making for patients and their next of kin.
Laparoscopic excision of a large retroperitoneal cyst: Case report and literature review
Authors: Sabir Alifa , Rafique Anam , Adil Maham Leeza , Idrees Aiman , Khan Huma Sabir , Hanif Muhammad
Published: June 2024

Retroperitoneal cysts, a rare surgical phenomenon, present diagnostic challenges due to their typically asymptomatic nature. A 62-year-old male presented with a 4-month history of abdominal distension and increased burping. Upon clinical examination, a soft, distended, nontender abdomen with a palpable mass extending from the epigastric region to 3 cm below the umbilicus was revealed. Imaging revealed a 14.6 cm × 15.8 cm × 16.4 cm nonenhancing retroperitoneal lesion, compressing the right ureter and causing mild right hydronephrosis. Multiple gall bladder calculi, an umbilical hernia, and lipomatous lesions associated with adrenal glands were also discovered. Laparoscopic retroperitoneal cystectomy, cholecystectomy, and umbilical hernia repair were performed. Intraoperatively, 150 ml ascitic fluid and 1200 ml cystic fluid were found. This case highlights the intricate clinical presentation of a retroperitoneal cyst, emphasizing the need for surgical exploration. Successful laparoscopic management contributes to the evolving understanding of optimal treatment strategies.
Determining Variables that Affect Innovative Work Behavior: An Empirical Study at the Ministry of Marine Affairs and Fisheries
Authors: Safrizal Helmi Buyung Aulia , Eliyana Anis , Sridadi Ahmad Rizki , Hasib Fatin Fadhilah , Pratama Andika Setia , Dewi Rina , Kamil Nurul Liyana Mohd
Published: June 2024

The Ministry of Maritime Affairs and Fisheries plays an important role in making the sea the future of the nation with three mission pillars, namely the mission of sovereignty, sustainability, and welfare. To realize this missions, the ministry carries out bureaucratic reform and innovates in community service, which depends on the innovative work behavior of its middle managers. This study analyzes the direct effect of transformational leadership and self-determination on innovative work behavior. The mediation roles of person-organization fit and social media usage are also tested. One hundred thirty middle managers were selected as respondents and completed the questionnaire online. The analyzing of this research data was carried out with structural equation modeling. This research output clearly shows innovative work behavior improvement among middle managers. It can be used as a basis for consideration for middle managers in formulating policies related to innovative work behavior by focusing on more appropriate transformational leadership and self-determination, as well as the involvement of person-organization fit and social media usage.
The dilemma and breakthrough of practical teaching of preschool education major in Chinese colleges and universities (based on the professional accreditation perspective)
Authors: Wu Wei , Adylbek kyzy Gulnaz , Liu Chun huan
Published: June 2024

Reforming the means and approaches to teaching the specialty of preschool education leads to gaps that require prompt resolution. Accordingly, the dilemma remains relevant, which consists in the lagging behind the content of education from the real conditions of kindergarten activities and the distribution of resources, which is reflected in the competence of teachers. The purpose of the work was to study the problems in the implementation of teaching practice in the specialty “Preschool Education” in the context of standardisation and ways to solve these problems. The article used the methods of analysis, comparison, deduction, and generalisation. As part of the competition for the quality development of the “Preschool Education” specialty, the accreditation of the “Preschool Education” specialty was launched based on the concepts of “student-centred”, “outcome-based education” and “continuous quality improvement”. Accreditation standards, along with three program documents, Curriculum Standards and Professional Standards, guide the practice of early childhood education in colleges and universities. In view of the dilemma of insufficient integration of the goals of practical training in preschool education, the content lags behind the real situation in kindergartens, the distribution of resources cannot meet the needs of practical training, and the mechanism of collaborative education is incomplete, it is necessary to take the “Standards” as coordinates, deepen the reform of practical training, and build a scientifically advanced system of practical training, starting with the concepts, goals, content and protection system of practical training, which is the basis of “Standards”. The obtained results should be used during the improvement of the means and principles on the basis of which the practical training of student teachers in preschool education institutions is carried out.
Communities as Fraught Spaces
Authors: Frierson Michelle , Hand Victoria , Mendoza Elizabeth , Yoon Jihee
Published: June 2024

Collaborations between education stakeholders are increasingly prevalent due to the need for diverse perspectives on issues of justice in education. Less is known, however, about how stakeholders form heterogeneous communities where people from different backgrounds learn and take action together. This study examined the contours of a community that emerged from a three-year partnership between mathematics teachers, community educators, and university scholars. This racially- and gender-diverse community was marked by contention and affirmation, which illuminates the complex and politicized nature of the joint work. This study illuminates tensions across dimensions of the community including spaces as affirming and fraught, goals as shared and contested, belonging as ebbing and flowing, relationships as personal and political, and roles as imposed and amorphous.
Unexplained Acute Total Loss of Vision After Primary Scleral Buckle Surgery
Authors: Budoff Greg , Dillon Alexander B. , Au Adrian , Krieger Allan E. , Schwartz Steven D.
Published: June 2024

Purpose: To present 2 cases of acute total loss of vision after scleral buckle surgery for rhegmatogenous retinal detachment. Methods: A retrospective chart review of 2 cases and an analysis of the literature were performed. Results: An 18-year-old woman and a 67-year-old woman suffered complete loss of vision in their operative eye after primary scleral buckle surgery with encircling bands. Conclusions: Profound ocular ischemia resulting in total acute vision loss is a rare and devastating outcome of primary scleral buckle procedures and may be caused by strangulation of the eye with an encircling band. Attention paid to the key tenets of this often successful and useful surgical technique may lower the risk for this complication.
Does a high threshold of sensory responsiveness affect the development of pretend play in children on the autism spectrum?
Authors: Krzysztofik Karolina
Published: June 2024

Background

Among the current avenues of research into the origins and development of the autism spectrum, those concerning atypical levels of sensory responsiveness are gaining increasing relevance. Researchers note the relationship of sensory responsiveness in children on the autism spectrum to their motor, cognitive and social development. Current research reports combines the responsiveness to sensory stimuli also with the development of pretend play. Aim of this study was to verify the relationship between the level of development of pretend play and the level of sensory responsiveness in children on the autism spectrum.

Methods

A study was conducted in a group of 63 children with a diagnosis of autism spectrum aged from 3 years and 7 months to 9 years and 3 months using: Pretend Play subscale from the Theory of Mind Mechanism Scale and Sensory Experiences Questionnaire version 2.1.

Results

The results revealed that elevated sensory hyporesponsiveness predicted low pretend play skills in the group of participating children.

Conclusion

The study verified the contribution of the level of sensory hyporesponsiveness to explaining the atypical development of pretend play in children on the autism spectrum.
Lectin Receptor-Like Protein Kinase OsNRFG6 is Required for Embryo Sac Development and Fertilization in Neo-Tetraploid Rice
Authors: Zhao Chongchong , Li Qihang , Ge Qi , Chen Rou , Yu Hang , Wu Jinwen , Liu Xiangdong , Lu Zijun
Published: June 2024

Great yield-enhancing prospects of autotetraploid rice was restricted by various polyploidy-induced reproductive dysfunction. To surmount these challenges, our group has generated a series of valuable fertile tetraploid lines (denoted as neo-tetraploid rice) through 20-year efforts. With this context, a G-type lectin receptor-like kinase, OsNRFG6, was identified as a pivotal factor associated with reproductive regulation in neo-tetraploid rice. Nevertheless, it is still elusive about a comprehensive understanding of its precise functional roles and underlying molecular mechanisms during reproduction of neo-tetraploid rice. Here, we demonstrated that OsNRFG6 executed a constitutive expression pattern and encoded proteins localizing in perinucleus and endoplasmic reticulum. Subsequently, four independent mutant lines of OsNRFG6 within neo-tetraploid rice background were further identified, all displaying low seed-setting rate due to abortive embryo sacs and defective double fertilization. RNA-seq and RT-qPCR revealed a significant down-regulation of OsNRFG6 and female reproductive genes such as OsMEL1 and LOG in ovaries prior to and post-fertilization, attributing this effect to OsNRFG6 mutation. Furthermore, through yeast-two hybrids, bimolecular fluorescence complementation assays, and luciferase complementation imaging assays, it was determined that OsNRFG6 could interact with itself and two female reproductive proteins (LOG and OsDES1) to form protein complexes. These results elucidate the reproductive functions and molecular pathway governed by OsNRFG6 in regulating fertility of neo-tetraploid rice, offering insights into molecular understanding of fertility improvement in polyploid rice.
Europe-wide spatial trends in copper and imidacloprid sensitivity of macroinvertebrate assemblages
Authors: Jupke Jonathan F. , Sinclair Thomas , Maltby Lorraine , Aroviita Jukka , Barešová Libuše , Bonada Núria , Elexová Emília Mišíková , Ferreira M. Teresa , Lazaridou Maria , Lešťáková Margita , Panek Piotr , Pařil Petr , Peeters Edwin T. H. M. , Polášek Marek , Sandin Leonard , Schmera Dénes , Straka Michal , Schäfer Ralf B.
Published: June 2024

Exposure to synthetic chemicals, such as pesticides and pharmaceuticals, affects freshwater communities at broad spatial scales. This risk is commonly managed in a prospective environmental risk assessment (ERA). Relying on generic methods, a few standard test organisms, and safety factors to account for uncertainty, ERA determines concentrations that are assumed to pose low risks to ecosystems. Currently, this procedure neglects potential variation in assemblage sensitivity among ecosystem types and recommends a single low-risk concentration for each compound. Whether systematic differences in assemblage sensitivity among ecosystem types exist or their size, are currently unknown. Elucidating spatial patterns in sensitivity to chemicals could therefore enhance ERA precision and narrow a fundamental knowledge gap in ecology, the Hutchinsonian shortfall. We analyzed whether taxonomic turnover between field-sampled macroinvertebrate assemblages of different broad river types across Europe results in systematic differences in assemblage sensitivity to copper and imidacloprid. We used an extensive database of macroinvertebrate assemblage compositions throughout Europe and employed a hierarchical species sensitivity distribution model to predict the concentration that would be harmful to 5% of taxa (HC5) in each assemblage. Predicted $$H{C}_{5}$$

H

C
5

values varied over several orders of magnitude. However, variation within the 95% highest density intervals remained within one order of magnitude. Differences between the river types were minor for imidacloprid and only slightly higher for copper. The largest difference between river-type-specific median $$H{C}_{5}$$

H

C
5

values was a factor of 3.1. This level of variation is below the assessment factors recommended by the European Food Safety Authority and therefore would be captured in the current ERA for plant protection products. We conclude that the differences in taxonomic composition between broad river types translate into relatively small differences in macroinvertebrate assemblage sensitivity toward the evaluated chemicals at the European scale. However, systematic differences in bioavailability and multi-stressor context were not evaluated and might exacerbate the differences in the ecological effects of chemicals among broad river types in real-world ecosystems.
Venous retrograde approach for endovascular angioplasty in chronic total pulmonary vein occlusion -a case report
Authors: Li Bo , Zhu Hai , Jia Mengfei , Song Jinrui , Carl Tanba , Koybasi Gizem , Qi Guanming , Su Hongling , Cao Yunshan
Published: June 2024

Introduction

Fibrosing mediastinitis (FM) is a rare disease characterized by excessive proliferation of fibrous tissue in the mediastinum and can cause bronchial stenosis, superior vena cava obstruction, pulmonary artery and vein stenosis, etc.

Case presentation

An aging patient with intermittent chest tightness and shortness of breath was diagnosed with FM associated pulmonary hypertension (FM-PH) by echocardiography and enhanced CT of the chest, and CT pulmonary artery (PA)/ pulmonary vein (PV) imaging revealed PA and PV stenosis. Selective angiography revealed complete occlusion of the right upper PV, and we performed endovascular intervention of the total occluded PV. After failure of the antegrade approach, the angiogram revealed well-developed collaterals of the occluded RSPV-V2b, so we chose to proceed via the retrograde approach. We successfully opened the occluded right upper PV and implanted a stent.

Conclusions

This report may provide new management ideas for the interventional treatment of PV occlusion.
Learning debiased graph representations from the OMOP common data model for synthetic data generation
Authors: Schulz Nicolas Alexander , Carus Jasmin , Wiederhold Alexander Johannes , Johanns Ole , Peters Frederik , Rath Natalie , Rausch Katharina , Holleczek Bernd , Katalinic Alexander ,   the AI-CARE Working Group, Nennecke Alice , Kusche Henrik , Heinrichs Vera , Eberle Andrea , Luttmann Sabine , Abnaof Khalid , Kim-Wanner Soo-Zin , Handels Heinz , Germer Sebastian , Halber Marco , Richter Martin , Pinnau Martin , Reiner David , Schaaf Jannik , Storf Holger , Hartz Tobias , Goeken Nils , Bösche Janina , Stein Alexandra , Weitmann Kerstin , Hoffmann Wolfgang , Labohm Louisa , Rudolph Christiane , Gundler Christopher , Ückert Frank , Gundler Christopher
Published: June 2024

Background

Generating synthetic patient data is crucial for medical research, but common approaches build up on black-box models which do not allow for expert verification or intervention. We propose a highly available method which enables synthetic data generation from real patient records in a privacy preserving and compliant fashion, is interpretable and allows for expert intervention.

Methods

Our approach ties together two established tools in medical informatics, namely OMOP as a data standard for electronic health records and Synthea as a data synthetization method. For this study, data pipelines were built which extract data from OMOP, convert them into time series format, learn temporal rules by 2 statistical algorithms (Markov chain, TARM) and 3 algorithms of causal discovery (DYNOTEARS, J-PCMCI+, LiNGAM) and map the outputs into Synthea graphs. The graphs are evaluated quantitatively by their individual and relative complexity and qualitatively by medical experts.

Results

The algorithms were found to learn qualitatively and quantitatively different graph representations. Whereas the Markov chain results in extremely large graphs, TARM, DYNOTEARS, and J-PCMCI+ were found to reduce the data dimension during learning. The MultiGroupDirect LiNGAM algorithm was found to not be applicable to the problem statement at hand.

Conclusion

Only TARM and DYNOTEARS are practical algorithms for real-world data in this use case. As causal discovery is a method to debias purely statistical relationships, the gradient-based causal discovery algorithm DYNOTEARS was found to be most suitable.
Quantitative assessment of baseline imbalances in evolocumab and alirocumab trials: a meta-epidemiological study
Authors: van Bruggen F. H. , Zuidema S. U. , Luijendijk H. J.
Published: June 2024

Background

Baseline imbalances have been identified in randomized trials of evolocumab and alirocumab. Our aim was to quantitatively assess (1) the presence of systematic baseline differences, and (2) the relationship of baseline differences with effects on low-density lipoprotein-cholesterol (LDL-c) and clinical outcomes in the trials.

Methods

We performed a meta-epidemiological study. PubMed, Embase, regulatory reports, ClinicalTrials.gov and company websites were searched for trials. Seven baseline characteristics (mean age, LDL-c, BMI, percentage males, diabetics, smokers, and hypertensives) and five outcomes (LDL-c, major adverse cardiac events, serious adverse events, any adverse events, all-cause mortality) were extracted. We calculated (1) range and distribution of baseline imbalances (sign-test), (2) pooled baseline differences and heterogeneity (meta-analysis), (3) differences in SDs around continuous variables (sign-test and pooling), and (4) the relationship of baseline differences with outcomes (meta-regression). The comparisons of PCSK9-inhibitor groups with either placebo or ezetimibe were analysed separately and combined.

Results

We identified 43 trials with 63,193 participants. Baseline characteristics were frequently missing. Many trials showed small baseline imbalances, but some large imbalances. Only baseline BMI showed a statistically significant lower pooled mean for the drug versus placebo groups (MD -0.16; 95% CI -0.24 to -0.09). Heterogeneity in baseline imbalances was present in six placebo- and five ezetimibe-comparisons. Heterogeneity was statistically significant for BMI, males, diabetics and hypertensives in the combined comparisons. There was a statistically significant preponderance for larger SDs in the PCSK9-inhibitor versus control groups (sign-test age 0.014; LDL-c 0.014; BMI 0.049). Meta-regression showed clinically relevant relationships of baseline imbalances in age, BMI and diabetics with the risk of any adverse events and the risk of mortality. Two relationships were statistically significant: A higher mean BMI in the drug versus control group with a decreased risk of mortality (beta − 0.56; 95% CI -1.10 to -0.02), and a higher proportion of diabetics with an increased risk of any adverse events (beta 0.02; 95% 0.01 to 0.04).

Conclusions

Heterogeneous baseline imbalances and systematically different SDs were present in evolocumab and alirocumab trials, so study groups cannot be assumed to be comparable. These findings raise concerns about the design and conduct of the randomization procedures.
Global patterns of rebound to normal RSV dynamics following COVID-19 suppression
Authors: Thindwa Deus , Li Ke , Cooper-Wootton Dominic , Zheng Zhe , Pitzer Virginia E , Weinberger Daniel M
Published: June 2024

Background

Annual epidemics of respiratory syncytial virus (RSV) had consistent timing and intensity between seasons prior to the SARS-CoV-2 pandemic (COVID-19). However, starting in April 2020, RSV seasonal activity declined due to COVID-19 non-pharmaceutical interventions (NPIs) before re-emerging after relaxation of NPIs. We described the unusual patterns of RSV epidemics that occurred in multiple subsequent waves following COVID-19 in different countries and explored factors associated with these patterns.

Methods

Weekly cases of RSV from twenty-eight countries were obtained from the World Health Organisation and combined with data on country-level characteristics and the stringency of the COVID-19 response. Dynamic time warping and regression were used to cluster time series patterns and describe epidemic characteristics before and after COVID-19 pandemic, and identify related factors.

Results

While the first wave of RSV epidemics following pandemic suppression exhibited unusual patterns, the second and third waves more closely resembled typical RSV patterns in many countries. Post-pandemic RSV patterns differed in their intensity and/or timing, with several broad patterns across the countries. The onset and peak timings of the first and second waves of RSV epidemics following COVID-19 suppression were earlier in the Southern than Northern Hemisphere. The second wave of RSV epidemics was also earlier with higher population density, and delayed if the intensity of the first wave was higher. More stringent NPIs were associated with lower RSV growth rate and intensity and a shorter gap between the first and second waves.

Conclusion

Patterns of RSV activity have largely returned to normal following successive waves in the post-pandemic era. Onset and peak timings of future epidemics following disruption of normal RSV dynamics need close monitoring to inform the delivery of preventive and control measures.
The causal relationship between blood cell indices and 28-day mortality in sepsis: a retrospective study and bidirectional Mendelian randomization analysis
Authors: Zeng Tao , Sun Yina , Chen Shuru , Pang Jiahui , Wang Heping , Cai Xianghao , Liao Yingying , Xiao Xiaolong , Zhang Yibo , Chong Yutian , Gong Jiao , Li Xinhua
Published: June 2024

Background

Despite emerging evidence linking blood cell indices (BCIs) to sepsis mortality, the inconsistency of observational studies obscures the clarity of these associations. This study aims to clarify the causal influence of BCIs on 28-day mortality rates in sepsis patients.

Methods

Utilizing univariable and multivariable Mendelian randomization (MR) analyses, we examined the impact of BCIs on sepsis mortality by analyzing data from extensive genome-wide association studies. The inverse-variance weighted (IVW) method was our primary analytic tool, complemented by several robustness checks to mitigate pleiotropy, including weighted median, mode-based estimates, MR-Egger regression, and MR-PRESSO. Subsequently, we conducted a retrospective study to further explore the correlation between platelet indices and 28-day mortality of sepsis using real-world data.

Results

Our findings highlight a significant causal relationship between platelet distribution width (PDW) and 28-day mortality in sepsis, with the univariable Mendelian randomization approach yielding an odds ratio of 1.12 (95% CI, 1.06–1.26; P < 0.05). Multivariable analysis further substantiated PDW’s robust association with mortality risk (OR 1.23; 95% CI, 1.03–1.48; P < 0.05). Conversely, our analysis did not uncover significant correlations between the genetic predispositions to other BCIs—including red blood cell count, erythrocyte distribution width, platelet count, mean platelet volume, white blood cell count, neutrophil count, neutrophil percentage, lymphocyte count, and lymphocyte percentage—and 28-day mortality in sepsis. Additionally, an inverse MR analysis did not establish a causal impact of 28-day mortality in sepsis on PDW (OR 1.00; 95% CI, 1.00—1.07; P = 0.29). Moreover, a similar result was observed in the retrospective study.

Conclusions

The study underscores the independent causal role of PDW in predicting 28-day mortality in sepsis, suggesting its potential utility in early patient assessment, risk stratification, and tailoring of therapeutic interventions.
Prognostic significance of platelet‑to‑albumin ratio in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy: a retrospective study of 858 cases
Authors: Hua Xin , Xu Fei , Shi Wei , Long Zhi-Qing , Huang Xin , Duan Fang-Fang , Wang Si-Fen , Zhang Chao , Wang Meng-Di , Ni Wei-Qiong , Xia Wen , Chen Jia-Yi , Gao Yun-Sheng
Published: June 2024

Background

Despite evidence supporting the high correlation of the novel platelet-to-albumin ratio (PAR) with survival in diverse malignancies, its prognostic relevance in nasopharyngeal carcinoma (NPC) remains underexplored. This study aimed to examine the link between PAR and overall survival (OS) in NPC and to establish a predictive model based on this biomarker.

Methods

We retrospectively assembled a cohort consisting of 858 NPC patients who underwent concurrent chemoradiotherapy (CCRT). Utilizing the maximally selected log-rank method, we ascertained the optimal cut-off point for the PAR. Subsequently, univariate and multivariate Cox proportional hazards models were employed to discern factors significantly associated with OS and to construct a predictive nomogram. Further, we subjected the nomogram’s predictive accuracy to rigorous independent validation.

Results

The discriminative optimal PAR threshold was determined to be 4.47, effectively stratifying NPC patients into two prognostically distinct subgroups (hazard ratio [HR] = 0.53; 95% confidence interval [CI]: 0.28–0.98, P = 0.042). A predictive nomogram was formulated using the results from multivariate analysis, which revealed age greater than 45 years, T stage, N stage, and PAR score as independent predictors of OS. The nomogram demonstrated a commendable predictive capability for OS, with a C-index of 0.69 (95% CI: 0.64–0.75), surpassing the performance of the conventional staging system, which had a C-index of 0.56 (95% CI: 0.65–0.74).

Conclusions

In the context of NPC patients undergoing CCRT, the novel nutritional-inflammatory biomarker PAR emerges as a promising, cost-efficient, easily accessible, non-invasive, and potentially valuable predictor of prognosis. The predictive efficacy of the nomogram incorporating the PAR score exceeded that of the conventional staging approach, thereby indicating its potential as an enhanced prognostic tool in this clinical setting.
Construction and evaluation of a practical model for measuring health-adjusted life expectancy (HALE) in China
Authors: Chen San Qian , Cao Yu , Ma Jing Jie , Zhang Xing Chao , Hu Song Bo
Published: June 2024

Background

HALE is now a regular strategic planning indicator for all levels of the Chinese government. However, HALE measurements necessitate comprehensive data collection and intricate technology. Therefore, effectively converting numerous diseases into the years lived with disability (YLD) rate is a significant challenge for HALE measurements. Our study aimed to construct a simple YLD rate measurement model with high applicability based on the current situation of actual data resources within China to address challenges in measuring HALE target values during planning.

Methods

First, based on the Chinese YLD rate in the Global Burden of Disease (GBD) 2019, Pearson correlation analysis, the global optimum method, etc., was utilized to screen the best predictor variables from the current Chinese data resources. Missing data for predictor variables were filled in via spline interpolation. Then, multiple linear regression models were fitted to construct the YLD rate measurement model. The Sullivan method was used to measure HALE. The Monte Carlo method was employed to generate 95% uncertainty intervals. Finally, model performances were assessed using the mean absolute error (MAE) and mean absolute percentage error (MAPE).

Results

A three-input-parameter model was constructed to measure the age-specific YLD rates by sex in China, directly using the incidence of infectious diseases, the incidence of chronic diseases among persons aged 15 and older, and the addition of an under-five mortality rate covariate. The total MAE and MAPE for the combined YLD rate were 0.0007 and 0.5949%, respectively. The MAE and MAPE of the combined HALE in the 0-year-old group were 0.0341 and 0.0526%, respectively. There were slightly fewer males (0.0197, 0.0311%) than females (0.0501, 0.0755%).

Conclusion

We constructed a high-accuracy model to measure the YLD rate in China by using three monitoring indicators from the Chinese national routine as predictor variables. The model provides a realistic and feasible solution for measuring HALE at the national and especially regional levels, considering limited data.
Barriers and enablers to promoting grandchildren’s physical activity and reducing screen time: a qualitative study with Australian grandparents
Authors: Budden Timothy , Coall David A , Jackson Ben , Christian Hayley , Nathan Andrea , Jongenelis Michelle I
Published: June 2024

Background

With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children’s engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children’s physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children’s physical activity and reducing screen time. The present study sought to explore these perceptions.

Methods

Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis.

Results

Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents’ age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children’s fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view).

Conclusions

Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents’ age and health status, as well as any environmental barriers, are likely to be well-received.