bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the impact of an anti‐microbial silver‐impregnated surgical dressing on wound infections and healing: A randomised clinical trial
Authors: Whitley Adam , Baláž Peter , Kavalírek Jan , Hanusová Jitka , Gürlich Robert
Published: December 2023

StopBac is an innovative silver‐impregnated antimicrobial dressing specifically designed to reduce surgical site infections and enhance healing. The primary objective of this study was to compare infection healing rate at 30 days after surgery between primarily closed surgical wounds covered with StopBac and those covered with Cosmorpor, a standard surgical dressing. Between 1.3.2023 and 30.4.2023, we conducted a prospective screening of all patients undergoing surgical operations within a single surgical department. Patients were randomised into either the Cosmopor group or the StopBac group. Outcome measures were superficial and deep surgical site infections and healed wounds. Data concerning patient and surgical factors were prospectively collected and analysed. The analysis comprised 275 patients, divided into two groups: 140 patients in the StopBac group and 135 in the Cosmopor group. The StopBac dressing was associated with a reduced rate of infection, with an odds ratio of 0.288 (p < 0.001), and an increased likelihood of wound healing at 30 days after surgery. The odds ratio for healing at 30 days was 4.661 (p < 0.001). StopBac was associated with a lower incidence of surgical wound infections and a higher probability of healing at 30 days after surgery, when compared with standard dressing.
Alteration of γδ T cell subsets in non‐human primates transplanted with GGTA1 gene‐deficient porcine blood vessels
Authors: Lee Sujin , Chung Yun Shin , Lee Kyo Won , Choi Miran , Sonn Chung Hee , Oh Won Jun , Hong Hun Gi , Shim Joohyun , Choi Kimyung , Kim Sung Joo , Park Jae Berm , Kim Tae Jin
Published: December 2023

Background

αGal‐deficient xenografts are protected from hyperacute rejection during xenotransplantation but are still rejected more rapidly than allografts. Despite studies showing the roles of non‐Gal antibodies and αβ T cells in xenograft rejection, the involvement of γδ T cells in xenograft rejection has been limitedly investigated.

Methods

Six male cynomolgus monkeys were transplanted with porcine vessel xenografts from wild‐type (n = 3) or GGTA1 knockout (n = 3) pigs. We measured the proportions and T cell receptor (TCR) repertoires of blood γδ T cells before and after xenotransplant. Grafted porcine vessel‐infiltrating immune cells were visualized at the end of experiments.

Results

Blood γδ T cells expanded and infiltrated into the graft vessel adventitia following xenotransplantation of α‐Gal‐deficient pig blood vessels. Pre‐ and post‐transplant analysis of γδ TCR repertoire revealed a transition in δ chain usage post‐transplantation, with the expansion of several clonotypes of δ1, δ3, or δ7 chains. Furthermore, the distinctions between pre‐ and post‐transplant δ chain usages were more prominent than those observed for γ chain usages.

Conclusion

γδ TCR repertoire was significantly altered by xenotransplantation, suggesting the role of γδ T cells in sustained xenoreactive immune responses.
PARAMETER OPTIMIZATION FOR HIGH-SPEED END MILLING ON INCONEL 718 USING UNCOATED CARBIDE TOOL
Authors: Hisam Muhammad Juzaili , Suhaimi Mohd Azlan , Sharif Safian , Abd Rahim Erween , S Mohruni Amrifan , Kejia Zhuang
Published: December 2023

Inconel 718 with exceptional characteristics is well known as a difficult-to-cut material especially during high-speed machining process. High cutting temperature further damaged the tool which results in low tool life. To overcome this matter, optimization on cutting parameters needed to be conducted in order to achieve longer tool life and desired cutting finish. Sets of optimized parameters consists of different cutting speed and feed rate were listed out through Research Surface Method (RSM) software which the effects and the output values were observed through high-speed end milling work on a 100 x 100 x 150 mm Inconel 718 block. The lowest cutting force and surface roughness at 776.04 N and 0.195 µm were recorded at the lowest parameter combination, while the highest results of 1,322.89 N and 0.478 µm were obtained from the highest parameter combination. Higher cutting parameter further deteriorate the cutting tool due to high heat and drastic reduction in tool life was observed, from 32 minutes of cutting process to only 2 minutes and 40 seconds. The results were further investigated through optimization work and cutting speed is the dominant factor that affected the results. The final model suggested that by using uncoated carbide tools, the lowest cutting speed and feed rate of 50 m/min and 0.05 mm/tooth can be implemented to obtain the desired cutting responses.
Large sums of high‐order characters
Authors: Mangerel Alexander P.
Published: December 2023

Let be a primitive character modulo a prime , and let . It has previously been observed that if has large order then for some , in analogy with Vinogradov's conjecture on quadratic non‐residues. We give a new and simple proof of this fact. We show, furthermore, that if is squarefree then for any th root of unity the number of such that is whenever . Consequently, when has sufficiently large order the sequence cannot cluster near for any . Our proof relies on a second moment estimate for short sums of the characters , averaged over , that is non‐trivial whenever has no small prime factors. In particular, given any we show that for all but powers , the partial sums of exhibit cancellation in intervals as long as is prime, going beyond Burgess' theorem. Our argument blends together results from pretentious number theory and additive combinatorics. Finally, we show that, uniformly over prime , the Pólya–Vinogradov inequality may be improved for on average over , extending work of Granville and Soundararajan.
Semilinear elliptic Schrödinger equations with singular potentials and absorption terms
Authors: Gkikas Konstantinos T. , Nguyen Phuoc‐Tai
Published: December 2023

Let () be a bounded domain and be a compact, submanifold without boundary, of dimension with . Put in , where and is a parameter. We investigate the boundary value problem (P) in with condition on , where is a nondecreasing, continuous function, and and are positive measures. The complex interplay between the competing effects of the inverse‐square potential , the absorption term and the measure data discloses different scenarios in which problem (P) is solvable. We provide sharp conditions on the growth of for the existence of solutions. When is a power function, namely with , we show that problem (P) admits several critical exponents in the sense that singular solutions exist in the subcritical cases (i.e. is smaller than a critical exponent) and singularities are removable in the supercritical cases (i.e. is greater than a critical exponent). Finally, we establish various necessary and sufficient conditions expressed in terms of appropriate capacities for the solvability of (P).
Birational maps with transcendental dynamical degree
Authors: Bell Jason P. , Diller Jeffrey , Jonsson Mattias , Krieger Holly
Published: December 2023

We give examples of birational selfmaps of , whose dynamical degree is a transcendental number. This contradicts a conjecture by Bellon and Viallet. The proof uses a combination of techniques from algebraic dynamics and diophantine approximation.
Pedagogy of ‘Refusing’ – commentary to Siriwardane-de Zoysa, Sreekanta, Mwambari, Mehta and Majumder
Authors: Dey Sayan
Published: December 2023

This commentary is a critical response to the dialogic essay “The unruly arts of ethnographic refusal: power, politics, performativity” that unpacks the complex performances of hierarchies and violence as performed during ethnographic research works in anthropology. During ethno-graphic research works, the encounter between the researchers and the research participants are often underlaid with tensions that either compel the participants to speak in definite patterns to satisfy the demands of the researchers or force the researchers to conduct field works according to the advisable guidelines of the academic institutions, funding agencies and contact persons. On the basis of my personal experiences and the ethnographic experiences of the authors of the essay, this commentary argues how the performance and acknowledgment of ‘refusal’ can be adopted as a research methodology in anthropology and other academic disciplines to counter the colonial/Eurocentric parameters of knowledge production.
A Monte Carlo Fuel Assembly Model Validation Adopting Post Irradiation Experiment Dataset
Authors: Loi Lorenzo , Lorenzi Stefano , Cammi Antonio , Introini Carolina
Published: December 2023

Within an energy system where nuclear reactors will likely play a critical role, it is fundamental to have access to accurate and reliable computational tools that can predict the plants' behavior under different operating conditions; compared to other energy sources, models and analysis methods for nuclear systems should be able to provide, among other things, detailed information on reactor criticality and fuel evolution. Thanks to the advancements in computational hardware, using three-dimensional codes to obtain a local description of the reactor core has now become feasible, not only for what concerns deterministic codes but also for Monte Carlo (MC) based codes. Those computational methods must be compared with experimental measurements to assess their reliability. For this reason, the 3D Monte Carlo code serpent is currently being validated for light water reactor fuel cycle simulations. This work will compare the isotopic concentrations measured in a Post-Irradiation Experiment (PIE) and the results of the Monte Carlo routine, examining the Takahama-3 fuel assembly test case. Since key information related to the history of the plant under consideration is available, it was possible to follow the depletion cycles of two fuel rods (SF95 and SF97) placed in two separate assemblies. From literature reports, more than 35 nuclide species have been measured at different axial locations by destructive analysis following several radiochemical techniques. A sensitivity analysis, aiming to evaluate the impact of design features on the results, was carried out investigat-ing the cross section libraries, the simulation time Discretization and the imposition of an axial time-varying temperature. During the process, systematic sources of geometry-related errors were analyzed as well. Over-all, the model showed good agreement with the experimental data under an acceptable error threshold. The sensitivity studies also showed how the prediction capability could be increased up to +6%, adopting a realistic temperature mesh for the fuel instead of a uniform temperature approach. Finally, this analysis will focus more deeply on the Antimony-125 evolution, whose concentration is the one with the worst agreement to the experimental dataset not only for this work but also for other benchmarks available in the literature: results will show how the prediction error for this nuclide is systematic for all considered codes, and look for possible causes.
An Additive Manufacturing Testbed to Evaluate Machine Learning-Based Autonomous Manufacturing
Authors: Zhang Zhi , George Antony , Ferdous Alam Md. , Eubel Chris , Prasad Vallabh Chaitanya Krishna , Shtein Max , Barton Kira , Hoelzle David J.
Published: December 2023

This paper details the design and operation of a testbed to evaluate the concept of autonomous manufacturing to achieve a desired manufactured part performance specification. This testbed, the autonomous manufacturing system for phononic crystals (AMSPnC), is composed of additive manufacturing, material transport, ultrasonic testing, and cognition subsystems. Critically, the AMSPnC exhibits common manufacturing deficiencies such as process operating window limits, process uncertainty, and probabilistic failure. A case study illustrates the AMSPnC function using a standard supervised learning model trained by printing and testing an array of 48 unique designs that span the allowable design space. Using this model, three separate performance specifications are defined and an optimization algorithm is applied to autonomously select three corresponding design sets to achieve the specified performance. Validation manufacturing and testing confirms that two of the three optimal designs, as defined by an objective function, achieve the desired performance, with the third being outside the design window in which a distinct bandpass is achieved in phononic crystals (PnCs). Furthermore, across all samples, there is a marked difference between the observed bandpass characteristics and predictions from finite elements method computation, highlighting the importance of autonomous manufacturing for complex manufacturing objectives.
Biosynthesis mechanisms of medium-chain carboxylic acids and alcohols in anaerobic microalgae fermentation regulated by pH conditions
Authors: Shi Xingdong , Wei Wei , Wu Lan , Huang Yuhan , Ni Bing-Jie
Published: December 2023

Valorization of microalgae into high-value products and drop-in chemicals can reduce our dependence on non-renewable fossil fuels in an environmentally sustainable way. Among the valuable products, medium-chain carboxylic acids (MCCAs) and alcohols are attractive building blocks as fuel precursors. However, the biosynthetic mechanisms of MCCAs and alcohols in anaerobic microalgae fermentation and the regulating role of pH on the microbial structure and metabolism interaction among different functional groups have never been documented. In this work, we systematically investigated the roles of pH (5, 7, and 10) on the production of MCCAs and alcohols in anaerobic microalgae fermentation. The gene-centric and genome-centric metagenomes were employed to uncover the dynamics and metabolic network of the key players in the microbial communities. The results indicated that the pH significantly changed the product spectrum. The maximum production rate of alcohol was obtained at pH 5, while pH 7 was more beneficial for MCCA production. Metagenomic analysis reveals that this differential performance under different pH is attributed to the transformation of microbial guild and metabolism regulated by pH. The composition of various functional groups for MCCA and alcohol production also varies at different pH levels. Finally, a metabolic network was proposed to reveal the microbial interactions at different pH levels and thus provide insights into bioconversion of microalgae to high-value biofuels.

IMPORTANCE

Carboxylate platforms encompass a biosynthesis process involving a mixed and undefined culture, enabling the conversion of microalgae, rich in carbohydrates and protein, into valuable fuels and mitigating the risks associated with algae blooms. However, there is little known about the effects of pH on the metabolic pathways of chain elongation and alcohol production in anaerobic microalgae fermentation. Moreover, convoluted and interdependent microbial interactions encumber efforts to characterize how organics and electrons flow among microbiome members. In this work, we compared metabolic differences among three different pH levels (5, 7, and 10) in anaerobic microalgae fermentation. In addition, genome-centric metagenomic analysis was conducted to reveal the microbial interaction for medium-chain carboxylic acid and alcohol production.
Multifactorial resistance of
Bacillus subtilis
spores to low-pressure plasma sterilization
Authors: Muratov Erika , Rosenbaum Florian P. , Fuchs Felix M. , Ulrich Nikea J. , Awakowicz Peter , Setlow Peter , Moeller Ralf
Published: December 2023

Common sterilization techniques for labile and sensitive materials have far-reaching applications in medical, pharmaceutical, and industrial fields. Heat inactivation, chemical treatment, and radiation are established methods to inactivate microorganisms, but pose a threat to humans and the environment and can damage susceptible materials or products. Recent studies have demonstrated that cold low-pressure plasma (LPP) treatment is an efficient alternative to common sterilization methods, as LPP’s levels of radicals, ions, (V)UV-radiation, and exposure to an electromagnetic field can be modulated using different process gases, such as oxygen, nitrogen, argon, or synthetic (ambient) air. To further investigate the effects of LPP, spores of the Gram-positive model organism
Bacillus subtilis
were tested for their LPP susceptibility including wild-type spores and isogenic spores lacking DNA-repair mechanisms such as non-homologous end-joining (NHEJ) or abasic endonucleases, and protective proteins like α/β-type small acid-soluble spore proteins (SASP), coat proteins, and catalase. These studies aimed to learn how spores resist LPP damage by examining the roles of key spore proteins and DNA-repair mechanisms. As expected, LPP treatment decreased spore survival, and survival after potential DNA damage generated by LPP involved efficient DNA repair following spore germination, spore DNA protection by α/β-type SASP, and catalase breakdown of hydrogen peroxide that can generate oxygen radicals. Depending on the LPP composition and treatment time, LPP treatment offers another method to efficiently inactivate spore-forming bacteria.

IMPORTANCE

Surface-associated contamination by endospore-forming bacteria poses a major challenge in sterilization, since the omnipresence of these highly resistant spores throughout nature makes contamination unavoidable, especially in unprocessed foods. Common bactericidal agents such as heat, UV and γ radiation, and toxic chemicals such as strong oxidizers: (i) are often not sufficient to completely inactivate spores; (ii) can pose risks to the applicant; or (iii) can cause unintended damage to the materials to be sterilized. Cold low-pressure plasma (LPP) has been proposed as an additional method for spore eradication. However, efficient use of LPP in decontamination requires understanding of spores’ mechanisms of resistance to and protection against LPP.
Host serine protease ACOT2 assists DENV proliferation by hydrolyzing viral polyproteins
Authors: Ma Sen , Shi Sai , Xu Binghong , Liu Meijun , Xie Lei , Su Yang , Li Jiachen , Liang Qinqin , Ye Sheng , Wang Yaxin
Published: December 2023

Dengue fever is a mosquito-borne tropical disease caused by the dengue virus (DENV). The replication of DENV relies on the processing of its genome-encoded polyprotein by both viral protease NS3 (NS3
pro
) and host proteases. However, the impact of host proteases on DENV proliferation is not well understood. In this study, we utilized fluorophosphonate-based probes (FPs) to investigate the up-regulation of host serine proteases during DENV infection in detail. Among the identified proteases, acyl-CoA thioesterase 2 (ACOT2), an enzyme that hydrolyzes acyl-CoA molecules to generate fatty acids and free CoA, exhibited cleavage activity against DENV polypeptide substrates. Enzymatic assays and virological experiments confirmed that ACOT2 contributes to DENV propagation during the replication stage by cleaving the viral polyprotein. Docking models provided insights into the binding pocket of viral polypeptides and the catalytic mechanism of ACOT2. Notably, this study is the first to demonstrate that ACOT2 functions as a serine protease to hydrolyze protein substrates. These findings offer novel insights into DENV infection, host response, as well as the potential development of innovative antiviral strategies.

IMPORTANCE

DENV, one of the major pathogens of Dengue fever, remains a significant public health concern in tropical and subtropical regions worldwide. How DENV efficiently hijacks the host and accesses its life cycle with delicate interaction remains to be elucidated. Here, we deconvoluted that the host protease ACOT2 assists the DENV replication and characterized the ACOT2 as a serine protease involved in the hydrolysis of the DENV polypeptide substrate. Our results not only further the understanding of the DENV life cycle but also provide a possibility for the usage of activity-based proteomics to reveal host-virus interactions.
Effect of a doctor working during the festive period on population health: natural experiment using 60 years of
Doctor Who
episodes (the TARDIS study)
Authors: Riley Richard D
Published: December 2023

Objective

To examine the effect of a (fictional) doctor working during the festive period on population health.

Design

Natural experiment.

Setting

England, Wales, and the UK.

Main outcome measures

Age standardised annual mortality rates in England, Wales, and the UK from 1963, when the BBC first broadcast
Doctor Who
, a fictional programme with a character called the Doctor who fights villains and intervenes to save others while travelling through space and time. Mortality rates were modelled in a time series analysis accounting for non-linear trends over time, and associations were estimated in relation to a new
Doctor Who
episode broadcast during the previous festive period, 24 December to 1 January. An interrupted time series analysis modelled the shift in mortality rates from 2005, when festive episodes of
Doctor Who
could be classed as a yearly Christmas intervention.

Results

31 festive periods from 1963 have featured a new
Doctor Who
episode, including 14 broadcast on Christmas Day. In time series analyses, an association was found between broadcasts during the festive period and subsequent lower annual mortality rates. In particular, episodes shown on Christmas Day were associated with 0.60 fewer deaths per 1000 person years (95% confidence interval 0.21 to 0.99; P=0.003) in England and Wales and 0.40 fewer deaths per 1000 person years (0.08 to 0.73; P=0.02) in the UK. The interrupted time series analysis showed a strong shift (reduction) in mortality rates from 2005 onwards in association with the
Doctor Who
Christmas intervention, with a mean 0.73 fewer deaths per 1000 person years (0.21 to 1.26; P=0.01) in England and Wales and a mean 0.62 fewer deaths per 1000 person years (0.16 to 1.09; P=0.01) in the UK.

Conclusions

A new
Doctor Who
episode shown every festive period, especially on Christmas Day, was associated with reduced mortality rates in England, Wales, and the UK, suggesting that a doctor working over the festive period could lower mortality rates. This finding reinforces why healthcare provision should not be taken for granted and may prompt the BBC and Disney+ to televise new episodes of
Doctor Who
every festive period, ideally on Christmas Day.
Analysis of Barbie medical and science career dolls: descriptive quantitative study
Authors: Klamer Katherine
Published: December 2023

Objectives

To identify Barbie brand dolls that had medicine and science themed professions in comparison with other career dolls and to determine their accuracy in meeting clinical and laboratory safety standards.

Design

Descriptive quantitative study.

Setting

Visual and data analysis of web searches.

Main outcome measures

To identify the kinds of medical and scientific subspecialties that the Barbie dolls (and a comparison doll group) worked in; and to determine whether these medical professional and scientist dolls met laboratory and clinical safety standards. Additional data about doll demographics (ie, age, ethnic group, and sex) were also collected.

Participants

92 Barbie brand dolls were analyzed: doctor (n=53), scientist (n=10), science educator (n=2), nurse (n=15), dentist (n=11), and paramedic (n=1). 65 non-Barbie brand dolls were also analyzed for comparison purposes: doctor (n=26), scientist (n=27), nurse (n=7), dentist (n=2), engineer (n=2), and magnetic resonance imaging (MRI) technician (n=1) dolls.

Results

Barbie brand medical professional dolls (n=80) largely treated children (66%, n=53/80), with only three (4%) medical professional dolls being directly depicted working with adults. Of the 12 scientist Barbie brand dolls, none met all proper personal protective equipment requirements related to hair and clothing. Barbie brand dolls often came with items, such as laboratory coats, microscopes, stethoscopes, and glasses, that children stereotypically associate with doctors and scientists. While comparison dolls offered a wider range of age and ethnic groups than the Barbie doll group did, the dolls similarly struggled to portray a wide range of medical and scientific subfields and most comparison dolls did not wear proper personal protective equipment.

Conclusions

Medicine and science themed dolls help to inspire tomorrow’s medical professionals and scientists. All toy companies should ensure that future medical professional and scientist dolls meet clinical and laboratory safety standards and diversify the types of medical and scientific professions represented (especially among male dominated fields). For young girls’ sakes as much as her own, Barbie must keep shattering glass ceilings.
Kenya’s experience implementing event-based surveillance during the COVID-19 pandemic
Authors: Ndegwa Linus , Ngere Philip , Makayotto Lyndah , Patel Neha N , Nzisa Liku , Otieno Nancy , Osoro Eric , Oreri Eunice , Kiptoo Elizabeth , Maigua Susan , Crawley Adam , Clara Alexey W , Arunmozhi Balajee S. , Munyua Peninah , Herman-Roloff Amy
Published: December 2023

Event-based surveillance (EBS) can be implemented in most settings for the detection of potential health threats by recognition and immediate reporting of predefined signals. Such a system complements existing case-based and sentinel surveillance systems. With the emergence of the COVID-19 pandemic in early 2020, the Kenya Ministry of Health (MOH) modified and expanded an EBS system in both community and health facility settings for the reporting of COVID-19-related signals. Using an electronic reporting tool, m-Dharura, MOH recorded 8790 signals reported, with 3002 (34.2%) verified as events, across both community and health facility sites from March 2020 to June 2021. A subsequent evaluation found that the EBS system was flexible enough to incorporate the addition of COVID-19-related signals during a pandemic and maintain high rates of reporting from participants. Inadequate resources for follow-up investigations to reported events, lack of supportive supervision for some community health volunteers and lack of data system interoperability were identified as challenges to be addressed as the EBS system in Kenya continues to expand to additional jurisdictions.
Preventing chronic malnutrition in children under 2 years in rural Angola (MuCCUA trial): protocol for the economic evaluation of a three-arm community cluster randomised controlled trial
Authors: Martin-Cañavate Rocio , Custodio Estefania , Trigo Elena , Romay-Barja María , Herrador Zaida , Aguado Isabel , Ramirez Ferran , Faria Lourdes Maria , Silva-Gerardo Ana , Lima Jose Carlos , Iráizoz Eva , Marques Tayná , Vargas Antonio , Gomez Amador , Puett Chloe , Molina Israel
Published: December 2023

Introduction

Chronic malnutrition is a serious problem in southern Angola with a prevalence of 49.9% and 37.2% in the provinces of Huila and Cunene, respectively. The MuCCUA (Mother and Child Chronic Undernutrition in Angola) trial is a community-based randomised controlled trial (c-RCT) which aims to evaluate the effectiveness of a nutrition supplementation plus standard of care intervention and a cash transfer plus standard of care intervention in preventing stunting, and to compare them with a standard of care alone intervention in southern Angola. This protocol describes the planned economic evaluation associated with the c-RCT.

Methods and analysis

We will conduct a cost-efficiency and cost-effectiveness analysis nested within the MuCCUA trial with a societal perspective, measuring programme, provider, participant and household costs. We will collect programme costs prospectively using a combined calculation method including quantitative and qualitative data. Financial costs will be estimated by applying activity-based costing methods to accounting records using time allocation sheets. We will estimate costs not included in accounting records by the ingredients approach, and indirect costs incurred by beneficiaries through interviews, household surveys and focus group discussions. Cost-efficiency will be estimated as cost per output achieved by combining activity-specific cost data with routine data on programme outputs. Cost-effectiveness will be assessed as cost per stunting case prevented. We will calculate incremental cost-effectiveness ratios comparing the additional cost per improved outcome of the different intervention arms and the standard of care. We will perform sensitivity analyses to assess robustness of results.

Ethics and dissemination

This economic evaluation will provide useful information to the Angolan Government and other policymakers on the most cost-effective intervention to prevent stunting in this and other comparable contexts. The protocol was approved by the República de Angola Ministério da Saúde Comité de Ética (27C.E/MINSA.INIS/2022). The findings of this study will be disseminated within academia and the wider policy sphere.

Trial registration number

ClinicalTrials.gov Registry (NCT05571280).
Thirty-day hospital readmission predictors in older patients receiving hospital-at-home: a 3-year retrospective study in France
Authors: de Stampa Matthieu , Georges Alexandre , Grino Michel , Cerase Valerie , Baudouin Édouard , Vedel Isabelle
Published: December 2023

Objective

This study described older patients receiving hospitalisation-at-home (HaH) services and identified factors associated with 30-day hospital readmission.

Design

3-year retrospective study in 2017–2019 in France.

Participants

75 108 patients aged 75 years and older who were discharged from hospital medical wards (internal medicine and geriatric units) and admitted to HaH.

Primary outcome measure

30-day hospital readmission.

Results

The mean age of patients was 83.4 years (SD 5.7), 52.3% were male and 88.4% lived in a private household. Patients were primarily discharged from the internal medicine unit (85.3%). The top four areas of care in the HaH were palliative care, complex dressing, intravenous therapy and complex nursing care. Overall, 23.5% of patients died during their HaH stay and 27.8% were readmitted to the hospital at 30 days. In the multivariate model, male (OR 1.19, 95% CI 1.16 to 1.23), supportive cancer HaH care (OR 1.78, 95% CI 1.51 to 2.11) and very high intensity care during the previous in-person hospitalisation (OR 1.45, 95% CI 1.34 to 1.57) increased the risk of hospital readmission at 30 days. Older age (OR 0.97, 95% CI 0.97 to 0.98), living in a nursing home (OR 0.51, 95% CI 0.48 to 0.54), postsurgery HaH care (OR 0.49, 95% CI 0.41 to 0.58) and having been previously hospitalised in a geriatric unit (OR 0.81, 95% CI 0.77 to 0.85) decreased the risk of hospital readmission at 30 days.

Conclusions

HaH provides complex care to very old patients, which is associated with high mortality. Several factors are associated with rehospitalisation within 30 days that could be avoided with better integration of different services with higher geriatric skills.

Trial registration number

CNIL:2228861.
Identifying factors associated with child malnutrition in Ghana: a cross-sectional study using Bayesian multilevel ordinal logistic regression approach
Authors: Iddrisu Wahab Abdul , Gyabaah Opoku
Published: December 2023

Objective

In developing countries, malnutrition is a noteworthy concern related to the well-being of people, and this study aimed to determine the factors that affect malnutrition among children below 5 years in Ghana.

Design

The study used a secondary data source, specifically the Ghanaian Multiple Indicator Cluster Survey Six (MICS 6), which was conducted by the Ghana Statistical Service in 2017–2018. The MICS data are hierarchical, as children are categorised within households, and households are further grouped within a higher cluster, violating the independence assumption that must be addressed in the analyses. This study used a Bayesian multilevel ordinal logistic regression to model, identify and analyse the factors linked to child malnutrition in Ghana.

Setting

The setting of the study was the household level across the previous 10 administrative regions in Ghana.

Participants

Data for 8875 children under 5 years were used for the study. The data were gathered from households in all 10 administrative regions of Ghana using a sampling procedure consisting of stratification and random selection to ensure national representation.

Results

The results showed that the Northern Region of Ghana had the highest occurrence rate of severe and moderate malnutrition, and factors such as the count of children’s books or picture books, whether the child experienced fever in the last 2 weeks, age and sex of the child, and the child’s household wealth index quintile were strongly linked to malnutrition among Ghanaian children.

Conclusion

These findings underscore the intricate interplay of factors contributing to child nutrition in Ghana and suggest that addressing malnutrition necessitates a comprehensive approach that considers factors such as access to healthcare and reading materials, household wealth, and other social and environmental factors.
Optimal treatment of asymptomatic patients with severe aortic stenosis: protocol of a prospective, multicentre, registry study
Authors: Xia Congying , Li Yi-Ming , Xiong Wei , Ma Liqiao , Xiong Tian-Yuan , Zhao Zhen-Gang , Peng Yong , Wei Jiafu , Feng Yuan , Chen Mao
Published: December 2023

Introduction

Decisions regarding the optimal timing of intervention for asymptomatic aortic stenosis (AS) are controversial. The study aims to identify potential risk factors for asymptomatic patients with severe AS that are associated with worse prognosis and to evaluate the benefits of early interventions for asymptomatic patients presenting with one or more additional risk factors.

Methods and analysis

This is a non-interventional, prospective, open-label, multicentre registry study across China. A total of 1000 patients will be enrolled and categorised as symptomatic or asymptomatic. The primary endpoint is the occurrence of all-cause mortality, stroke, acute myocardial infarction and heart failure-related hospitalisation at 1-year follow-up. In asymptomatic severe AS patients presenting with one or more risk factors, the occurrence rate of the primary endpoint between those who undergo transcatheter aortic valve replacement (TAVR) and those who do not will be compared. We will also compare the occurrence rate of the primary endpoint for asymptomatic severe AS patients with additional risk factors who undergo TAVR with those presenting with symptoms. This study is believed to provide additional evidence to help clinicians identify and refer severe AS patients who are asymptomatic but present with additional risk factors for early intervention of TAVR.

Ethics and dissemination

The study protocol has been approved by the local ethics committee of each participating site: West China Hospital, Sichuan University; Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Second Hospital of Hebei Medical University; Tianjin Chest Hospital; and First Affiliated Hospital of Nanchang University. All participants will provide written informed consent. Study results will be published through academic conferences and peer-reviewed journals.

Trial registration

This study was registered at the Chinese Clinical Trial Registry (https:// www.chictr.org.cn), with the registration number ChiCTR2200064853.
Prevalence of and factors associated with symptoms consistent with a diagnosis of irritable bowel syndrome among resident physicians in standardised training in China: a cross-sectional study
Authors: Zhao Jun , Li Xia , Yang Jiayi , Hao Xin , Tian Junjian , Wang Xin , Wang Xuefei , Li Ning , Li Zhigang
Published: December 2023

Objectives

This study aims to investigate the incidence of and factors associated with irritable bowel syndrome (IBS) among resident physicians in standardised training at eight traditional Chinese medicine (TCM) hospitals in China.

Design

A cross-sectional survey was administered to resident physicians in their first to third years of standardised training at eight TCM hospitals.

Participants and setting

A total of 514 resident physicians in standardised training were included.

Measures

The questionnaire consisted of two sections, namely: section A collected basic information, and section B included the four-item Perceived Stress Scale (PSS-4), the Patient Health Questionnaire-4 (PHQ-4), the Pittsburgh Sleep Quality Index (PSQI) and the Rome IV criteria for IBS. Univariate and multivariate logistic regression models were constructed to assess the associations of age, sex, body mass index, stress, depression, anxiety, sleep quality and IBS.

Results

Of the included resident doctors, 77.2% were female, 20.4% were obese or underweight and 8.6% had symptoms consistent with a diagnosis of IBS. There were no statistically significant differences in lifestyle factors (night shift work, overtime work or working efficiency during the COVID-19 pandemic) between patients with IBS and participants without IBS (hereafter, non-IBS participants) (p=0.429, p=0.572 or p=0.464, respectively). Notably, compared with non-IBS participants, patients with IBS had significantly higher mean scores on the PSS-4 and PHQ-4 (p=0.028 and p=0.012, respectively); however, there was not a significant difference in PSQI scores between these two groups (p=0.079). Depression symptoms were significantly associated with IBS (unadjusted OR 0.498, 95% CI 0.265 to 0.935, p=0.030).

Conclusion

These findings suggest that IBS is common among resident physicians in standardised training. Future studies should investigate emotional distress, especially stress and depression, in the development of prevention or treatment of IBS.
Opportunities to improve opioid use disorder care for hospitalised patients with endocarditis
Authors: French Rachel , Compton Peggy , Clapp Justin , Buttenheim Alison , Schachter Allison , Uhley Olivia , Mandell David
Published: December 2023

Background

Driven by increased injection opioid use, rates of hospitalisation for infective endocarditis, an infection associated with injection drug use, are increasing. In the USA, 1 in 10 hospitalised patients for opioid use disorder-associated infective endocarditis (OUD-IE) die in the hospital and 1 in 20 have a patient-directed discharge. Emerging models of care reveal opportunities for healthcare systems to meet the complex care needs of these patients. We characterised promising practices of staff who care for these patients and identified areas for improvement.

Methods

We conducted a qualitative study with 1-hour semistructured virtual interviews between October 2021 and March 2022. Participants included 26 healthcare staff who care for patients with OUD-IE at the Hospital of the University of Pennsylvania. We used thematic analysis of interviews guided by an abductive approach. Interviews were digitally recorded and transcribed and analysed using NVivo software.

Results

Interviews were characterised by three major themes: (1) care rooted in interdisciplinary collaboration; (2) managing OUD and its sequelae in a setting not designed to treat OUD; and (3) clinician needs and barriers to change.

Conclusions

These findings highlight the facilitators of high-quality treatment for patients with OUD-IE, as well as the key areas for improvement. Findings add context to the complexity that both the healthcare staff and patients navigate during and following hospitalisation for OUD-IE. Needed changes include training staff to talk with patients about preparing for a return to drug use following hospitalisation, and changing discharge facilities’ practices that hinder access for patients with OUD-IE.
Multicentre positive deviance seminar to generate best practice recommendations to reduce anastomotic leak and length of stay for patients undergoing oesophagectomy
Authors: Jones Daniel , Gingrich Molly , Anstee Caitlin , Najmeh Sara , Safieddine Najib , Darling Gail , Malthaner Richard , Finley Christian , French Daniel G , Ferri Lorenzo , Seely Andrew
Published: December 2023

Background

We describe a novel process using positive deviance (PD) with the Canadian Association of Thoracic Surgeons members, to identify perioperative best practice to minimise anastomotic leak (AL) and length of stay (LOS) following oesophagectomy. To our knowledge, this is the first National combination of level 1 evidence with expert opinion (ie, PD seminar) aimed at reducing AL and LOS in oesophageal surgery. Our primary hypothesis is that a multicentre National PD seminar is feasible, and could lead to the generation of best practices recommendations aimed at reducing AL and LOS in patients with oesophageal cancer.

Methods

Adverse events, LOS and AL incidence/severity following oesophagectomy were prospectively collected from seven Canadian thoracic institutions using Thoracic Morbidity and Mortality classification system (2017–2020). Anonymised display of centre’s data were presented, with identification of centres demonstrating PD. Surgeons from PD sites discussed principles of care, culminating in the consensus recommendations, anonymously rated by all (5-point Likert scale).

Results

Data from 795 esophagectomies were included, with 25 surgeons participating. Two centres were identified as having the lowest AL rates 44/395 (11.1%) (vs five centres 71/400 (17.8%) (p<0.01)) and shortest LOS 8 days 45 (IQR: 6–14) (vs 10 days (IQR: 8–18) (p<0.001)). Recommendations included preoperative (prehabilitation, smoking cessation, chemotherapy for patients with dysphagia, minimise stents/feeding tubes), intraoperative (narrow gastric conduit, intrathoracic anastomosis, avoid routine jejunostomy, use small diameter closed-suction drains), postoperative day (POD) (early (POD 2–3) enteral feeding initiation, avoid routine barium swallow studies, early removal of tubes/drains (POD 2–3)). All ranked above 80% (4/5) in agreement to implement recommendations into their practice.

Conclusion

We report the feasibility of a National multicentre PD seminar with the generation of best practice recommendations aimed at reducing AL and LOS following oesophagectomy. Further research is required to demonstrate whether National PD seminars can be an effective quality improvement tool.
Impact of an injury hospital admission on childhood academic performance: a Welsh population-based data linkage study
Authors: Dipnall Joanna F , Lyons Jane , Lyons Ronan A , Ameratunga Shanthi , Brussoni Mariana , Lecky Fiona E , Beck Ben , Schneeberg Amy , Harrison James E , Gabbe Belinda J
Published: December 2023

Background

While injuries can impact on children’s educational achievements (with threats to their development and employment prospects), these risks are poorly quantified. This population-based longitudinal study investigated the impact of an injury-related hospital admission on Welsh children’s academic performance.

Methods

The Secure Anonymised Information Linkage databank, 55 587 children residing in Wales from 2006 to 2016 who had an injury hospital admission (58.2% males; 16.8% born in most deprived Wales area; 80.1% one injury hospital admission) were linked to data from the Wales Electronic Cohort for Children. The primary outcome was the Core Subject Indicator reflecting educational achievement at key stages 2 (school years 3–6), 3 (school years 7–9) and 4 (school years 10–11). Covariates in models included demographic, birth, injury and school characteristics.

Results

Educational achievement of children was negatively associated with: pedestrian injuries (adjusted risk ratio, (95% CIs)) (0.87, (0.83 to 0.92)), cyclist (0.96, (0.94 to 0.99)), high fall (0.96, (0.94 to 0.97)), fire/flames/smoke (0.85, (0.73 to 0.99)), cutting/piercing object (0.96, (0.93 to 0.99)), intentional self-harm (0.86, (0.82 to 0.91)), minor traumatic brain injury (0.92, (0.86 to 0.99)), contusion/open wound (0.93, (0.91 to 0.95)), fracture of vertebral column (0.78, (0.64 to 0.95)), fracture of femur (0.88, (0.84 to 0.93)), internal abdomen/pelvic haemorrhage (0.82, (0.69 to 0.97)), superficial injury (0.94, (0.92 to 0.97)), young maternal age (<18 years: 0.91, (0.88 to 0.94); 19–24 years: 0.94, (0.93 to 0.96)); area based socioeconomic status (0.98, (0.97 to 0.98)); moving to a more deprived area (0.95, (0.93 to 0.97)); requiring special educational needs (0.46, (0.44 to 0.47)). Positive associations were: being female (1.04, (1.03 to 1.06)); larger pupil school sizes and maternal age 30+ years.

Conclusion

This study highlights the importance on a child’s education of preventing injuries and implementing intervention programmes that support injured children. Greater attention is needed on equity-focused educational support and social policies addressing needs of children at risk of underachievement, including those from families experiencing poverty.

VIBES-Junior Study protocol

http://dx.doi.org/10.1136/bmjopen-2018-024755
As low as reasonably practicable (ALARP): a moral model for clinical risk management in the setting of technology dependence
Authors: Turnham Helen Lynne , Bowen Sarah-Jane , Ramdas Sitara , Smith Andrew , Wilkinson Dominic , Harrop Emily
Published: December 2023

Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited, can considered to be a harm in of itself. Discharge home offers the possibility for an improved quality of life for the child and their family but comes with significant medical risks.

When making decisions for children, two ethical models predominate, the promotion of the child’s best interests or the avoidance of harm. However, in some circumstances, particularly for children with life-limiting and/or life-threatening illness, all options may be associated with risk. There are no good options, only potentially harmful choices.

In this paper, we explore decisions made by one family in such circumstances. We describe a model adopted from risk management programmes beyond medicine, which offers a potential framework for identifying risks to the child that are morally permissible. Some risks and harms to a child, not ordinarily permitted, may be acceptable when undertaken in the pursuit of a specified desired good, so long as they are as low as reasonably practicable.
Management of war-related facial wounds in Ukraine: the Lviv military hospital experience
Authors: Sinyuk Mikola , Polishchuk V , Yuschak P , Burachok I
Published: December 2023

The Lviv Military Medical Centre is the main hospital responsible for the management of wounded military personnel in Western Ukraine. Since the full-scale invasion of our country in 2022, we have had to rapidly adapt our department to managing a large influx of complex facial battle injuries. These wounds are generally from large explosive fragments such as from shells and commonly produce avulsive defects of the facial bones and overlying soft tissues. Using representative cases, we aim to discuss management of these extensive injuries and guide the future direction of our service, particularly in surgical training such as microvascular anastomosis.