bluuebunny/crossref_metadata_2025 huggingface dataset:
‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda
Authors: Zhao Yingxi , Mbuthia Daniel , Gathara David , Nzinga Jacinta , Tweheyo Raymond , English Mike
Published: November 2023

Objective

Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors’ internship experiences in Kenya and Uganda.

Methods

Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data.

Findings

Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being ‘treated like we are nobody’.

Conclusion

We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors’ well-being and provide standardised supervision, support systems and conducive learning environments.
Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries
Authors: Zhao Yingxi , Jalloh Sulaiman , Lam Phung Khanh , Kwarshak Yakubu Kevin , Mbuthia Daniel , Misago Nadine , Namedre Mesulame , Phương Nguyễn Thị Bé , Qaloewa Sefanaia , Summers Richard , Tang Kun , Tweheyo Raymond , Wills Bridget , Zhang Fang , Nicodemo Catia , Gathara David , English Mike
Published: November 2023

Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in low-income and middle-income countries (LMICs) where working conditions and resource constraints are challenging. We describe our process developing and validating a ‘medical internship experience scale’ to address this gap, work involving nine LMICs that varied in geographical locations, income-level and internship training models. We used a scoping review of existing tools, content validity discussions with target populations and an expert panel, back-and-forth translations into four language versions and cognitive interviews to develop and test the tool. Using data collected from 1646 interns and junior medical doctors, we assessed factor structure and assessed its reliability and validity. Fifty items about experiences of medical internship were retained from an initial pool of 102 items. These 50 items represent 6 major factors (constructs): (1) clinical learning and supervision, (2) patient safety, (3) job satisfaction, (4) stress and burnout, (5) mental well-being, and (6) fairness and discrimination. We reflect on the process of multicountry scale development and highlight some considerations for others who may use our scale, using preliminary analyses of the 1646 responses to illustrate that the tool may produce useful data to identify priorities for action. We suggest this tool could enable LMICs to assess key metrics regarding intern straining and initial work experiences and possibly allow comparison across countries and over time, to inform better internship planning and management.
Promoting REproductive Planning And REadiness in Diabetes (PREPARED) Study protocol: a clinic-randomised controlled trial testing a technology-based strategy to promote preconception care for women with type 2 diabetes
Authors: Bailey Stacy C , Pack Allison P , Wismer Guisselle , Calderon Norma , Velazquez Evelyn , Batio Stephanie , Ekong Abbey , Eggleston Alice , Wallia Amisha , Wolf Michael S , Schauer Jacob M , Tenfelde Sandi , Liebovitz David M , Grobman William A
Published: November 2023

Introduction

Women with type 2 diabetes (T2DM) are more likely to experience adverse reproductive outcomes, yet preconception care can significantly reduce these risks. For women with T2DM, preconception care includes reproductive planning and patient education on: (1) the importance of achieving glycaemic control before pregnancy, (2) using effective contraception until pregnancy is desired, (3) discontinuing teratogenic medications if pregnancy could occur, (4) taking folic acid, and (5) managing cardiovascular and other risks. Despite its importance, few women with T2DM receive recommended preconception care.

Methods and analysis

We are conducting a two-arm, clinic-randomised trial at 51 primary care practices in Chicago, Illinois to evaluate a technology-based strategy to ‘hardwire’ preconception care for women of reproductive age with T2DM (the PREPARED (Promoting REproductive Planning And REadiness in Diabetes) strategy) versus usual care. PREPARED leverages electronic health record (EHR) technology before and during primary care visits to: (1) promote medication safety, (2) prompt preconception counselling and reproductive planning, and (3) deliver patient-friendly educational tools to reinforce counselling. Post-visit, text messaging is used to: (4) encourage healthy lifestyle behaviours. English and Spanish-speaking women, aged 18–44 years, with T2DM will be enrolled (N=840; n=420 per arm) and will receive either PREPARED or usual care based on their clinic’s assignment. Data will be collected from patient interviews and the EHR. Outcomes include haemoglobin A1c (primary), reproductive knowledge and self-management behaviours. We will use generalised linear mixed-effects models (GLMMs) to evaluate the impact of PREPARED on these outcomes. GLMMs will include a fixed effect for treatment assignment (PREPARED vs usual care) and random clinic effects.

Ethics and dissemination

This study was approved by the Northwestern University Institutional Review Board (STU00214604). Study results will be published in journals with summaries shared online and with participants upon request.

Trial registration number

ClinicalTrials.gov Registry (NCT04976881).
Telehealth-based transitional care management programme to improve access to care
Authors: Elsener Michelle , Santana Felipes Rachel C , Sege Jonathan , Harmon Priscilla , Jafri Farrukh N
Published: November 2023

Background

The transition from hospital to home is a vulnerable time for patients and families that can be improved through care coordination and structured discharge planning.

Local problem

Our organisation aimed to develop and expand a programme that could improve 30-day readmission rates on overall and disease-specific populations by assessing the impact of a telehealth outreach by a registered nurse (RN) after discharge from an acute care setting on 30-day hospital readmission.

Methods

This is a prospective observational design conducted from May 2021 to December 2022 with an urban, non-academic, acute care hospital in Westchester County, New York. Outcomes for patients discharged home following inpatient hospitalisation were analysed within this study. We analysed overall and disease-specific populations (congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia (PNA)) as compared with a 40-month prestudy cohort.

Intervention(s)

Patients were identified in a non-random fashion meeting criterion of being discharged home after an inpatient admission. Participants received a telephonic outreach by an RN within 72 hours of discharge. Contacted patients were asked questions addressing discharge instructions, medication access, follow-up appointments and social needs. Patients were offered services and resources based on their individual needs in response to the survey.

Results

68.2% of the 24 808 patients were contacted to assess and offer services. Median readmission rates for these patients were 1.2% less than the prestudy cohort (11.0% to 9.8%). Decreases were also noted for disease-specific conditions (CHF (14.3% to 9.1%), COPD (20.0% to 13.4%) and PNA (14.9% to 14.0%)). Among those in the study period, those that were contacted between 24 and 48 hours after discharge were 1.2 times less likely to be readmitted than if unable to be contacted (254/3742 (6.8%) vs 647/7866 (8.2%); p=0.005).

Conclusions

Using a multifaceted telehealth approach to improve patient engagement and access reduced 30-day hospital readmission for patients discharged from the acute care setting.
Talking about falls: a qualitative exploration of spoken communication of patients’ fall risks in hospitals and implications for multifactorial approaches to fall prevention
Authors: McVey Lynn , Alvarado Natasha , Healey Frances , Montague Jane , Todd Chris , Zaman Hadar , Dowding Dawn , Lynch Alison , Issa Basma , Randell Rebecca
Published: November 2023

Background

Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients’ levels of fall risk, but multifactorial approaches are now recommended. These target individual, modifiable fall risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about fall prevention and how this supports multifactorial fall prevention practice.

Methods

Data were collected through semistructured qualitative interviews with 50 staff and ethnographic observations of fall prevention practices (251.25 hours) on orthopaedic and older person wards in four English hospitals. Findings were analysed using a framework approach.

Findings

We observed staff engaging in ‘multifactorial talk’ to address patients’ modifiable risk factors, especially during multidisciplinary meetings which were patient focused rather than risk type focused. Such communication coexisted with ‘categorisation talk’, which focused on patients’ levels of fall risk and allocating nursing supervision to ‘high risk’ patients. Staff negotiated tensions between these different approaches through frequent ‘hybrid talk’, where, as well as categorising risks, they also discussed how to modify them.

Conclusion

To support hospitals in implementing multifactorial, multidisciplinary fall prevention, we recommend: (1) focusing on patients’ individual risk factors and actions to address them (a ‘why?’ rather than a ‘who’ approach); (2) where not possible to avoid ‘high risk’ categorisations, employing ‘hybrid’ communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; and (4) timing meetings to enable staff from different disciplines to participate.
Association between serum high-density lipoprotein cholesterol and lung function in adults: three cross-sectional studies from US and Korea National Health and Nutrition Examination Survey
Authors: Lee Chanho , Cha Youngjae , Bae Soo Han , Kim Young Sam
Published: November 2023

Introduction

Cholesterol is an irreplaceable nutrient in pulmonary metabolism; however, studies on high-density lipoprotein cholesterol (HDL-C) levels have shown conflicting results regarding lung function. Therefore, we investigated the association between lung function and HDL-C levels in three cross-sectional studies conducted in the USA and South Korea.

Methods

US National Health and Nutrition Examination Survey (NHANES) III, US NHANES 2007–2012, and Korea National Health and Nutrition Examination Survey (KNHANES) IV–VII performed spirometry and met the American Thoracic Society recommendations. Multiple linear regression models were used to determine the relationship between serum lipid levels and lung function. The models were adjusted for age, sex, household income, body mass index, smoking pack year, use of lipid-lowering medication and race. Serum HDL-C levels were classified into three groups to assess the dose–response relationship according to the guideline from the National Cholesterol Education Program-Adult Treatment Panel III.

Results

The adult participants of the KNHANES (n=31 288), NHANES III (n=12 182) and NHANES 2007–2012 (n=9122) were analysed. Multivariate linear regression analysis of the serum cholesterol profiles revealed that only serum HDL-C was associated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) in all three studies. A 1 SD increase in the HDL-C level increased the percent predicted FVC by 0.5%–1.5% p, and the per cent predicted FEV1by 0.5%–1.7% p. In terms of HDL-C levels, correlations between the HDL-C groups and the per cent predicted FVC and FEV1showed dose–response relationships. Compared with the normal group, high HDL-C levels increased FVC by 0.75%–1.79% p and FEV1by 0.55%–1.90% p, while low levels led to 0.74%–2.19% p and 0.86%–2.68% p reductions in FVC and FEV1, respectively. Subgroup analyses revealed weaker associations in females from KNHANES and NHANES III.

Conclusion

In the three nationwide cross-sectional studies, high HDL-C levels were associated with improved FVC and FEV1. However, future studies are needed to confirm this correlation and elucidate the underlying mechanisms.
MDR1-expressing CD4+T cells with Th1.17 features resist to neoadjuvant chemotherapy and are associated with breast cancer clinical response
Authors: Di Roio Anthony , Hubert Margaux , Besson Laurie , Bossennec Marion , Rodriguez Céline , Grinberg-Bleyer Yenkel , Lalle Guilhem , Moudombi Lyvia , Schneider Raphael , Degletagne Cyril , Treilleux Isabelle , Campbell Daniel J , Metzger Séverine , Duhen Thomas , Trédan Olivier , Caux Christophe , Ménétrier-Caux Christine
Published: November 2023

Background

Multidrug resistance-1 (MDR1) transporter limits the intracellular accumulation of chemotherapies (paclitaxel, anthracyclines) used in breast cancer (BC) treatment. In addition to tumor cells, MDR1 is expressed on immune cell subsets in which it confers chemoresistance. Among human T cells, MDR1 is expressed by most CD8+T cells, and a subset of CD4+T helper (Th) cells. Here we explored the expression, function and regulation of MDR1 on CD4+T cells and investigated the role of this population in response to neoadjuvant chemotherapy (NAC) in BC.

Methods

Phenotypic and functional characteristics of MDR1+CD4 Th cells were assessed on blood from healthy donors and patients with BC by flow cytometry. These features were extended to CD4+Th cells from untreated breast tumor by flow cytometry and RNA-sequencing (RNA-seq). We performed in vitro polarization assays to decipher MDR1 regulation on CD4 Th cells. We evaluated in vitro the impact of chemotherapy agents on MDR1+CD4+Th cells. We analyzed the impact of NAC treatment on MDR1+CD4+Th cells from blood and tumors and their association with treatment efficacy in two independent BC cohorts and in a public RNA-seq data set of BC tumor biopsies before and after NAC. Finally, we performed single cell (sc) RNAseq of blood CD4+memory T cells from NAC-treated patients and combined them with an scRNAseq public data set.

Results

MDR1+CD4 Th cells were strongly enriched in Th1.17 polyfunctional cells but also in Th17 cells, both in blood and untreated breast tumor tissues. Mechanistically, Tumor growth factor (TGF)-β1 was required for MDR1 induction during in vitro Th17 or Th1.17 polarization. MDR1 expression conferred a selective advantage to Th1.17 and Th17 cells following paclitaxel treatment in vitro and in vivo in NAC-treated patients. scRNAseq demonstrated MDR1 association with tumor Th1.17 and Th with features of cytotoxic cells. Enrichment in MDR1+CD4+Th1.17 and Th17 cells, in blood and tumors positively correlated with pathological response. Absence of early modulation of Th1.17 and Th17 in NAC-resistant patients, argue for its use as a biomarker for chemotherapy regimen adjustment.

Conclusion

MDR1 favored the enrichment of Th1.17 and Th17 in blood and tumor after NAC that correlated to clinical response.
Unraveling the impact of sialic acids on the immune landscape and immunotherapy efficacy in pancreatic cancer
Authors: Boelaars Kelly , Goossens-Kruijssen Laura , Wang Di , de Winde Charlotte M , Rodriguez Ernesto , Lindijer Dimitri , Springer Babet , van der Haar Àvila Irene , de Haas Aram , Wehry Laetitia , Boon Louis , Mebius Reina E , van Montfoort Nadine , Wuhrer Manfred , den Haan Joke M M , van Vliet Sandra J , van Kooyk Yvette
Published: November 2023

Background

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers. Despite the successful application of immune checkpoint blockade in a range of human cancers, immunotherapy in PDAC remains unsuccessful. PDAC is characterized by a desmoplastic, hypoxic and highly immunosuppressive tumor microenvironment (TME), where T-cell infiltration is often lacking (immune desert), or where T cells are located distant from the tumor islands (immune excluded). Converting the TME to an immune-inflamed state, allowing T-cell infiltration, could increase the success of immunotherapy in PDAC.

Method

In this study, we use the KPC3 subcutaneous PDAC mouse model to investigate the role of tumor-derived sialic acids in shaping the tumor immune landscape. A sialic acid deficient KPC3 line was generated by genetic knock-out of the CMAS (cytidine monophosphate N-acetylneuraminic acid synthetase) enzyme, a critical enzyme in the synthesis of sialic acid-containing glycans. The effect of sialic acid-deficiency on immunotherapy efficacy was assessed by treatment with anti-programmed cell death protein 1 (PD-1) and agonistic CD40.

Result

The absence of sialic acids in KPC3 tumors resulted in increased numbers of CD4+and CD8+T cells in the TME, and reduced frequencies of CD4+regulatory T cells (Tregs) within the T-cell population. Importantly, CD8+T cells were able to infiltrate the tumor islands in sialic acid-deficient tumors. These favorable alterations in the immune landscape sensitized sialic acid-deficient tumors to immunotherapy, which was ineffective in sialic acid-expressing KPC3 tumors. In addition, high expression of sialylation-related genes in human pancreatic cancer correlated with decreased CD8+T-cell infiltration, increased presence of Tregs, and poorer survival probability.

Conclusion

Our results demonstrate that tumor-derived sialic acids mediate T-cell exclusion within the PDAC TME, thereby impairing immunotherapy efficacy. Targeting sialic acids represents a potential strategy to enhance T-cell infiltration and improve immunotherapy outcomes in PDAC.
Head-to-head trial of pegunigalsidase alfa versus agalsidase beta in patients with Fabry disease and deteriorating renal function: results from the 2-year randomised phase III BALANCE study
Authors: Wallace Eric L , Goker-Alpan Ozlem , Wilcox William R , Holida Myrl , Bernat John , Longo Nicola , Linhart Aleš , Hughes Derralynn A , Hopkin Robert J , Tøndel Camilla , Langeveld Mirjam , Giraldo Pilar , Pisani Antonio , Germain Dominique Paul , Mehta Ankit , Deegan Patrick B , Molnar Maria Judit , Ortiz Damara , Jovanovic Ana , Muriello Michael , Barshop Bruce A , Kimonis Virginia , Vujkovac Bojan , Nowak Albina , Geberhiwot Tarekegn , Kantola Ilkka , Knoll Jasmine , Waldek Stephen , Nedd Khan , Karaa Amel , Brill-Almon Einat , Alon Sari , Chertkoff Raul , Rocco Rossana , Sakov Anat , Warnock David G
Published: November 2023

Background

Pegunigalsidase alfa is a PEGylated α-galactosidase A enzyme replacement therapy. BALANCE (NCT02795676) assessed non-inferiority of pegunigalsidase alfa versus agalsidase beta in adults with Fabry disease with an annualised estimated glomerular filtration rate (eGFR) slope more negative than −2 mL/min/1.73 m2/year who had received agalsidase beta for ≥1 year.

Methods

Patients were randomly assigned 2:1 to receive 1 mg/kg pegunigalsidase alfa or agalsidase beta every 2 weeks for 2 years. The primary efficacy analysis assessed non-inferiority based on median annualised eGFR slope differences between treatment arms.

Results

Seventy-seven patients received either pegunigalsidase alfa (n=52) or agalsidase beta (n=25). At baseline, mean (range) age was 44 (18–60) years, 47 (61%) patients were male, median eGFR was 74.5 mL/min/1.73 m2and median (range) eGFR slope was −7.3 (−30.5, 6.3) mL/min/1.73 m2/year. At 2 years, the difference between median eGFR slopes was −0.36 mL/min/1.73 m2/year, meeting the prespecified non-inferiority margin. Minimal changes were observed in lyso-Gb3 concentrations in both treatment arms at 2 years. Proportions of patients experiencing treatment-related adverse events and mild or moderate infusion-related reactions were similar in both groups, yet exposure-adjusted rates were 3.6-fold and 7.8-fold higher, respectively, with agalsidase beta than pegunigalsidase alfa. At the end of the study, neutralising antibodies were detected in 7 out of 47 (15%) pegunigalsidase alfa-treated patients and 6 out of 23 (26%) agalsidase beta-treated patients. There were no deaths.

Conclusions

Based on rate of eGFR decline over 2 years, pegunigalsidase alfa was non-inferior to agalsidase beta. Pegunigalsidase alfa had lower rates of treatment-emergent adverse events and mild or moderate infusion-related reactions.

Trial registration number

NCT02795676.
Serum biomarker levels predict disability progression in patients with primary progressive multiple sclerosis
Authors: Fissolo Nicolás , Benkert Pascal , Sastre-Garriga Jaume , Mongay-Ochoa Neus , Vilaseca-Jolonch Andreu , Llufriu Sara , Blanco Yolanda , Hegen Harald , Berek Klaus , Perez-Miralles Francisco , Rejdak Konrad , Villar Luisa M , Monreal Enric , Alvarez-Lafuente Roberto , Soylu Onder K , Abdelhak Ahmed , Bachhuber Franziska , Tumani Hayrettin , Martínez-Yélamos Sergio , Sánchez-López Antonio J , García-Merino Antonio , Gutiérrez Lucía , Castillo-Trivino Tamara , Lycke Jan , Rosenstein Igal , Furlan Roberto , Filippi Massimo , Téllez Nieves , Ramió-Torrentà Lluís , Lünemann Jan D , Wiendl Heinz , Eichau Sara , Khalil Michael , Kuhle Jens , Montalban Xavier , Comabella Manuel
Published: November 2023

Background

We aimed to investigate the potential of serum biomarker levels to predict disability progression in a multicentric real-world cohort of patients with primary progressive multiple sclerosis (PPMS).

Methods

A total of 141 patients with PPMS from 18 European MS centres were included. Disability progression was investigated using change in Expanded Disability Status Scale (EDSS) score over three time intervals: baseline to 2 years, 6 years and to the last follow-up. Serum levels of neurofilament light chain (sNfL), glial fibrillar acidic protein (sGFAP) and chitinase 3-like 1 (sCHI3L1) were measured using single-molecule array assays at baseline. Correlations between biomarker levels, and between biomarkers and age were quantified using Spearman’s r. Univariable and multivariable linear models were performed to assess associations between biomarker levels and EDSS change over the different time periods.

Results

Median (IQR) age of patients was 52.9 (46.4–58.5) years, and 58 (41.1%) were men. Median follow-up time was 9.1 (7.0–12.6) years. Only 8 (5.7%) patients received treatment during follow-up. sNfL and sGFAP levels were moderately correlated (r=0.43) and both weakly correlated with sCHI3L1 levels (r=0.19 and r=0.17, respectively). In multivariable analyses, levels of the three biomarkers were associated with EDSS changes across all time periods. However, when analysis was restricted to non-inflammatory patients according to clinical and radiological parameters (n=64), only sCHI3L1 levels remained associated with future EDSS change.

Conclusions

Levels of sNfL, sGFAP and sCHI3L1 are prognostic biomarkers associated with disability progression in patients with PPMS, being CHI3L1 findings less dependent on the inflammatory component associated with disease progression.
Comparative cardiovascular outcomes of novel drugs as an addition to conventional triple therapy for heart failure with reduced ejection fraction (HFrEF): a network meta-analysis of randomised controlled trials
Authors: Suebsaicharoen Thanakit , Chunekamrai Puri , Yingchoncharoen Teerapat , Tansawet Amarit , Issarawattana Thanaphruet , Numthavaj Pawin , Thakkinstian Ammarin
Published: November 2023

Background

Currently, there is no head-to-head comparison of novel pharmacological treatments for heart failure with reduced ejection fraction (HFrEF). A network meta-analysis aimed to compare effects of both conventional and alternative drug combinations on time to develop primary composite outcome of cardiovascular death or heart failure hospitalisation (PCO).

Methods

Randomised controlled trials (RCTs) were identified from Medline, Scopus up to June 2021. The RCTs were included if comparing any single or combination of drugs, that is, ACE inhibitors (ACEI), angiotensin receptor blockers, beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), ivabradine (IVA), angiotensin receptor blocker/neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), soluble guanylyl cyclase and omecamtiv mecarbil and reporting PCO. Data were extracted from Kaplan-Meier curves, individual patient data were generated. A mixed-effect Weibull regression was applied. Median time to PCO, HRs with 95% CI were estimated accordingly. Our findings suggested that ACEI+BB+MRA+SGLT2i, BB+MRA+ARNI, and ACEI+BB+MRA+IVA had lower probability of PCOs than the conventional triple therapy (ACEI+BB+MRA).

Results

Median time to PCOs of ACEI+BB+MRA was 57.7 months whereas median times to those new combinations were longer than 57.7 months. In addition, the three new regimens had a significantly lower PCO risks than ACEI+BB+MRA, with the HRs (95% CI) of 0.51 (0.43 to 0.61), 0.55 (0.46 to 0.65) and 0.56 (0.47 to 0.67), accordingly.

Conclusion

This study suggested that SGLT2i, ARNI and IVA in addition to ACEI+BB+MRA may be better in prolonging time to develop PCO in HFrEF patients.
Impact of a Transitional Pain Service on postoperative opioid trajectories: a retrospective cohort study
Authors: Ladha Karim S , Vachhani Kathak , Gabriel Gretchen , Darville Rasheeda , Everett Karl , Gatley Jodi M , Saskin Refik , Wong Dorothy , Ganty Praveen , Katznelson Rita , Huang Alexander , Fiorellino Joseph , Tamir Diana , Slepian Maxwell , Katz Joel , Clarke Hance
Published: November 2023

Introduction

It has been well described that a small but significant proportion of patients continue to use opioids months after surgical discharge. We sought to evaluate postdischarge opioid use of patients who were seen by a Transitional Pain Service compared with controls.

Methods

We conducted a retrospective cohort study using administrative data of individuals who underwent surgery in Ontario, Canada from 2014 to 2018. Matched cohort pairs were created by matching Transitional Pain Service patients to patients of other academic hospitals in Ontario who were not enrolled in a Transitional Pain Service. Segmented regression was performed to assess changes in monthly mean daily opioid dosage.

Results

A total of 209 Transitional Pain Service patients were matched to 209 patients who underwent surgery at other academic centers. Over the 12 months after surgery, the mean daily dose decreased by an estimated 3.53 morphine milligram equivalents (95% CI 2.67 to 4.39, p<0.001) per month for the Transitional Pain Service group, compared with a decline of only 1.05 morphine milligram equivalents (95% CI 0.43 to 1.66, p<0.001) for the controls. The difference-in-difference change in opioid use for the Transitional Pain Service group versus the control group was −2.48 morphine milligram equivalents per month (95% CI −3.54 to −1.43, p=0.003).

Discussion

Patients enrolled in the Transitional Pain Service were able to achieve opioid dose reduction faster than in the control cohorts. The difficulty in finding an appropriate control group for this retrospective study highlights the need for future randomized controlled trials to determine efficacy.
Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge
Authors: Pierce John P , Luo Man , McMenamin Sara B , Stone Matthew D , Leas Eric C , Strong David , Shi Yuyan , Kealey Sheila , Benmarhnia Tarik , Messer Karen
Published: November 2023

Objective

To compare trends in cigarette smoking and nicotine vaping among US population aged 17–18 years and 18–24 years.

Methods

Regression analyses identified trends in ever and current use of cigarettes and e-cigarettes, using three US representative surveys from 1992 to 2022.

Results

From 1997 to 2020, cigarette smoking prevalence among those aged 18–24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17–18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17–18 years, however there was no increase among those aged 18–24 years. Regression models demonstrated that the surge in vaping was independent of the decline in cigarette smoking. In the 24 most populous US states, exclusive vaping did increase among those aged 18–24 years, from 1.7% to 4.0% to equivalent to 40% of the decline in cigarette smoking between 2014–15 and 2018–19. Across these US states, the correlation between the changes in vaping and smoking prevalence was low (r=0.11). In the two US states with >US$1/fluid mL tax on e-cigarettes in 2017, cigarette smoking declined faster than the US average.

Conclusions

Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017–19 adolescent surge in past 30-day e-cigarette vaping. Further research is needed to assess whether the 2014–15 to 2018–19 increase in exclusive vaping in those aged 18–24 years is a cohort effect from earlier dependence on e-cigarette vaping as adolescents.
Effects of ‘Ice’ flavoured e-cigarettes with synthetic cooling agent WS-23 or menthol on user-reported appeal and sensory attributes
Authors: Tackett Alayna P , Han Dae Hee , Peraza Natalia , Whaley Reid C , Mason Tyler , Cahn Rael , Hong Kurt , Pang Raina , Monterosso John , Page Michelle K , Goniewicz Maciej Lukasz , Leventhal Adam M
Published: November 2023

Background

This clinical experiment tested the effects of exposure to e-cigarettes with WS-23 or menthol cooling additives on user appeal and sensory attributes, and, secondarily, whether WS-23 effects generalised across base characterising flavour, nicotine concentration, or nicotine/tobacco product use status.

Methods

In this within-participant double-blind experiment, adult tobacco/nicotine users administered standardised puffs of 18 different e-cigarette solutions in randomised sequences using a pod-style device. Each of three base characterising e-cigarette flavour solutions (‘bold tobacco’, ‘mango,’ ‘wintergreen’) in both 2% and 4% concentrations of nicotine benzoate salt were manipulated by adding either: (1) Menthol (0.5%), (2) WS-23 (0.75%) or (3) No cooling agent. After each administration, participants rated 3 appeal and 5 sensory attributes (0–100 scales).

Results

Participants (n=84; M(SD)=38.6 (13.6) years old) were either exclusive e-cigarette (25.0%), cigarette (36.9%) or dual (38.1%) users. WS-23 versus no coolant products produced higher liking, willingness to use again, smoothness, and coolness and lower disliking, bitterness, and harshness ratings (|B|differencerange: 4.8 to 20.1; ps<0.005). Menthol (vs no coolant) increased willingness to use again and reduced harshness and coolness (ps<0.05). Flavours with WS-23 (vs menthol) were rated as smoother, cooler and less harsh (ps<0.05). Coolant effects did not differ by base flavour, nicotine concentration, or tobacco use status.

Conclusions

Adding synthetic coolant WS-23 to e-cigarettes appears to make the vaping user experience more appealing, regardless of characterising base flavour. Regulatory agencies should be aware that the manufacturing process of adding synthetic coolants may increase the attractiveness of various e-cigarette products.Cite Now
Correction functions for soil–water characteristics curves extending the principles of thermodynamics
Authors: Li Yao , Vanapalli Sai K.
Published: November 2023

The soil–water characteristics curve (SWCC) that is typically measured from laboratory tests is fit using mathematical models that are based on capillary law and used along with the saturated soil properties for predicting the hydro-mechanical behavior of unsaturated soils. Such SWCC models are valid for coarse-grained soils. However, the same models are also extended for modeling the SWCC of fine-grained soils over suction range from 0 to 106 kPa with a correction function. Due to this reason, SWCC models with correction functions have limitations in rigorous analyses of complex thermo-hydro-mechanical-chemo (THMC) behaviors of unsaturated soils, especially in the high suction range. In the present study, a correction function is proposed for modeling the SWCC behavior using two widely models based on a theoretical framework extending the principles of thermodynamics. The relationships between the traditional and the proposed correction functions are discussed. Finally, comparisons are provided between the proposed and the traditional correction functions on the SWCC behavior to highlight their differences. In addition, the effects of temperature and salinity on the SWCC with correction functions are also summarized. The proposed correction function is a valuable tool for rigorous analyses and reliable prediction of the complex THMC behaviors of unsaturated soils.
Benzimidazolium ionic liquid functionalized star-polycaprolactone stationary phase for capillary gas chromatography
Authors: Chen Ruonan , Yang Hongbing , Huang Qiuchen , Ba Mengyi , Li Wen , Song Yanli , Cai Zhiqiang , Sun Tao , Feng Qiaoqiao , Li Shuai
Published: November 2023

In this work, an innovative ionic liquid functionalized star-shaped polymer is synthesized by coupling star-polycaprolactone with benzimidazolium (star-PCL-Bim), and statically coated into a capillary column for gas chromatographic (GC) separations. The fabricated star-PCL-Bim capillary column with moderate-polar nature reveals a high column efficiency of 3598 plates/m for n-dodecane at 120 °C, and advantageous distinguishing ability ( R > 1.5) for 9 aromatic isomer mixtures and 12 cis-/ trans -isomers. Its excellent resolving capacity can be credited to the architecture of star-PCL-Bim, the PCL arms, and π-electron-rich benzimidazolium cations, and it results in a quite different retention behavior of star-PCL-Bim from that of star-PCL and commercial HP-35 columns, with “dual-nature” selectivity in separating a mixture including 29 compounds. These favorable chromatographic characteristics demonstrate the great application potential of this material in GC, and provide a prospective strategy to obtain high-performance stationary phases.
Strong gravitational lensing by loop quantum gravity motivated rotating black holes and EHT observations
Authors: Kumar Jitendra , Islam Shafqat Ul , Ghosh Sushant G.
Published: November 2023

We investigate gravitational lensing in the strong deflection regime by loop quantum gravity (LQG)-motivated rotating black hole (LMRBH) metrics with an additional parameter l besides mass M and rotation a. The LMRBH spacetimes are regular everywhere, asymptotically encompassing the Kerr black hole as a particular case and, depending on the parameters, describe black holes with one horizon only (BH-I), black holes with an event horizon and a Cauchy horizon (BH-II), black holes with three horizons (BH-III), or black holes with no horizons (NH) spacetime. It turns out that as the LQG parameter l increases, the unstable photon orbit radius $$x_{ps}$$

x

ps

, the critical impact parameter $$u_{ps}$$

u

ps

, the deflection angle $$\alpha _D(\theta )$$

α
D

(
θ
)

and angular position $$\theta _{\infty }$$

θ
∞

also increases. Meanwhile, the angular separation s decreases, and relative magnitude $$r_{mag}$$

r

mag

increases with increasing l for prograde motion but they show opposite behaviour for the retrograde motion. Using supermassive black holes (SMBH) Sgr A* and M87* as lenses, we compare the observable signatures of LMRBH with those of Kerr black holes. For Sgr A*, the angular position $$\theta _{\infty }$$

θ
∞

$$\in $$
∈
(16.4, 39.8) $$\upmu $$
μ
as, while for M87* $$\in $$
∈
(12.33, 29.9) $$\upmu $$
μ
as. The angular separation s, for SMBHs Sgr A* and M87*, differs significantly, with values ranging $$\in $$
∈
(0.008–0.376) $$\upmu $$
μ
as for Sgr A* and $$\in $$
∈
(0.006–0.282) $$\upmu $$
μ
as for M87*. The deviations of the lensing observables $$\Delta \theta _{\infty }$$

Δ

θ
∞

and $$\Delta s$$

Δ
s

for LMRBH ($$a=0.80,l=2.0$$

a
=
0.80
,
l
=
2.0

) from Kerr black holes can reach up to $$10.22\,\upmu $$

10.22

μ

as and $$0.241~\upmu $$

0.241

μ

as for Sgr A*, and $$7.683~\upmu $$

7.683

μ

as and $$0.181~\upmu $$

0.181

μ

as for M87*. The relative magnitude $$r_{mag}$$

r

mag

$$\in $$
∈
(0.047, 1.54). We estimate the time delay between the first and second relativistic images using twenty supermassive galactic centre black holes as lenses to find, for example, the time delay for Sgr A* and M87* can reach approximately 23.26 min and 33,261.8 min, respectively. Our analysis concludes that, within the $$1 \sigma $$

1
σ

region, a significant portion of the BH-I and BH-II parameter space agrees with the EHT results of M87* and Sgr A*. The possibility of LMRBH being a BH-III with three horizons has been almost ruled out, except for a small portion of parameter space, by $$\theta _{sh}$$

θ

sh

bounds of Sgr A* and M87* measured by EHT. In contrast, NH without a horizon is completely ruled out. We discover that the EHT results of Sgr A* place more stringent limits on the parameter space of LMRBH black holes than those established by the EHT results of M87*.
Artificial Intelligence Competencies in Logistics Management: An Empirical Insight from Bahrain
Authors: Shatat Ahmad Saleh , Shatat Abdallah Saleh
Published: November 2023

This research seeks to examine the artificial intelligence (AI) competencies in logistics management by reviewing its capabilities, challenges and benefits. To increase the use of AI in logistics management, this study addresses the issues of the current technology in AI adoption in logistics management. This goal was accomplished using a systematic methodology. First, a detailed review was conducted to look at the advantages, challenges and current AI competencies. Using a survey instrument and a simple random sampling technique, the required data was collected from 44 businesses which effectively use AI in their logistical operations. The collected data gave insightful information on how AI is currently being used in logistics management. The outcome of this study shows that AI significantly affects logistics management. The study reveals notable competencies, significant challenges and major advantages of AI in managing logistics activities through the systematic analysis and synthesis of the obtained data. These findings demonstrate how AI has the potential to improve operational effectiveness, resource allocation, decision-making processes and supply chain operations in logistics management. A potential recommendation is to establish strategies and guidelines for efficient implementation and integration of AI technologies in logistics management based on the observed technology gap and the research’s findings. This will minimise the current gap and optimise the advantages of the industry’s use of AI, resulting in higher performance, cost savings and increased competitiveness for logistics business organisations.
Effect of Kinesio taping versus mechanical cervical traction combined with physiotherapy program on chronic neck pain in young female university students
Authors: Abd-Eltawab Amany E. , Ameer Mariam A.
Published: November 2023

Background: Mechanical neck pain is common among young female university students and can lead to disability and reduced physical activity.

Objectives: The aim of this study was to compare the effect of Kinesio taping (KT) to mechanical cervical traction (MCT) on young female university students with chronic neck pain.

Methods: Sixty young female university students with mechanical neck pain participated in this study; their ages ranged from 19 years to 23 years. They were assigned to three equal groups: the control group (A) received infrared, massage, stretching, and strengthening exercises three days per week for 6 weeks. Experimental group B received cervical traction in addition to the same program as the control, and experimental group C received KT in addition to the same program as the control group. Absolute pain intensity by the visual analogue scale (VAS) and neck disability index (NDI) were measured pre-and post-treatment intervention. Data were gathered at baseline, and after 6 weeks of intervention for three groups.

Results: The MANOVA test showed a significant reduction in NDI and pain level after 6 weeks between pre-and post-treatment intervention in group B ([Formula: see text] and [Formula: see text], respectively). There was a significant reduction in pain after 6 weeks in group C. There was also a significant reduction in NDI and pain level after 6 weeks in group B versus control group ([Formula: see text] and [Formula: see text], respectively). In addition, a significant reduction in pain level and NDI after 6 weeks was detected in group B compared to group C ([Formula: see text], [Formula: see text], respectively) while a significant reduction in pain level only between the control group (A) and group C was detected ([Formula: see text]).

Conclusion: In young female university students with mechanical neck pain, cervical traction combined with physiotherapy program was found to be more effective than KT with physiotherapy program or physiotherapy program alone in reducing pain and enhancing functional abilities after 6 weeks. This will help physiotherapists make more informed decisions concerning the clinical effects of MCT.
Income Redistributive Propensities of Self-Employment, ICT and Remittances: Panel Quantile Regression with Nonadditive Fixed Effects Perspective
Authors: Uche Emmanuel , Ngepah Nicholas
Published: November 2023

This study provides updated modalities for ensuring equitable income distributions in developing countries. This was achieved through the lens of self-employment, information and communication technologies (ICT), and remittances. To circumvent the dark spots in prior studies, this study harnesses annual panel series for 52 African countries. The study engaged both the system generalized method of moments (sGMM) and the panel quantile regression with nonadditive fixed effects (QRPD) techniques to elicit updated insights. Meanwhile, three metrics of income inequality, the Gini coefficient, the Atkinson index, and the Palma ratio, were explored for robust insights. A key discovery from both panel computations is the self-exacerbating inclinations of income disparities in the continent. Furthermore, it was discovered that both self-employment and ICT are significant income equalization factors. However, their influence is most effective at the upper quantiles of inequality. The influence of remittance inflows is predominantly unfavorable for equitable income distribution. Both financial inclusion and government effectiveness provided varying inequality-reducing effects. Notably, their influence is more formidable at the upper quantiles. Human capital development provides some noticeable income equalization effects, particularly at the lower quantiles. Policy insights for minifying income inequality in the continent are highlighted herein.
Predicting Business Bankruptcy in Colombian SMEs: A Machine Learning Approach
Authors: Correa Alexander
Published: November 2023

In this research paper, we address the challenge of predicting business bankruptcy in small and medium-sized enterprises (SMEs) in Colombia. We analyze various financial and non-financial factors that influence the likelihood of bankruptcy and employ machine learning techniques to improve prediction accuracy. We construct a database of 62,500 SMEs for the period 2017–2021 and compare two estimation methods: logistic regression and the eXtreme Gradient Boosting (XGBoost) algorithm. The findings demonstrate that the XGBoost algorithm outperforms in bankruptcy prediction. Key financial variables such as profitability and access to working capital, as well as non-financial variables such as geographic location, are identified as influencing bankruptcy risk. These findings provide valuable insights for stakeholders such as managers, financial intermediaries, and governmental decision-makers in their efforts to support and finance SMEs in Colombia, aiming to reduce bankruptcy rates and promote their economic success.
The Bowland Shale Formation in the Blacon Basin: syngenetic processes, stacking patterns and heat productivity
Authors: Emmings Joseph F. , Hennissen Jan A. I. , Vane Christopher H. , Damaschke Magret , Marvin Lin , Moss-Hayes Vicky , Lamb Angela , Lacey Jack , Leng Melanie J. , Riley Nick J.
Published: November 2023

We conducted a high-resolution multi-disciplinary analysis of two core sections in the borehole Ellesmere Port-1, Cheshire, UK. Biostratigraphic analysis indicates that the core sections are Kinderscoutian and late Arnsbergian–Chokierian in age, respectively. Both cores are assigned to the Bowland Shale Formation (Holywell Shale). Coupled core scan and discrete geochemical analysis enables interpretation of syngenetic processes at a high stratigraphic resolution. Both cores exhibit the classic cyclicity of limestones, calcareous to non-calcareous mudstones and siltstones, interpreted to represent sediment deposition during fourth-order sea-level fluctuation. Machine learning of the well log data coupled to the core scan data enabled prediction of the key lithofacies through the entire Bowland Shale interval in Ellesmere Port-1. The machine predictions show that the Bowland Shale is interfingered with three turbiditic leaves of the Cefn-y-Fedw Sandstone Formation and contains at least 12 complete fourth-order cycles. The Bowland Shale exhibits high radiogenic heat productivity in comparison with other sedimentary rocks, due primarily to relative U enrichment under intermittently euxinic conditions. Thermal modelling, however, shows that the radiogenic heat productivity of the Bowland Shale contributes a negligible source of additional heat at the scale of hundreds of metres.