bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Road Rehabilitation on Flexible Pavement Performance in Nigeria
Authors: Inyang Enobong , Usanga Idoreyin , Okon Kufre , Saturday Saturday
Published: August 2024

Road rehabilitation is the processes involved in repairing portions of an existing pavement in order to reset the deterioration process. This paper establishes the influence of road rehabilitation on flexible pavement performance in Nigeria. A structured questionnaire was prepared to obtain the primary data for this research. The survey population consisted of 75.7% experts who have been involved in flexible pavement rehabilitation process, the population also included the 24.3% less educated but experienced equipment operators who have reasonable years and wealth of experience in pavement rehabilitation works, hence, confirming their suitability as respondents for this study. Data obtained from the survey were subjected to both descriptive and statistical analysis through one-way analysis of variance (ANOVA) on the survey data using statistical package for social sciences (SPSS) to establish or otherwise the influence of road rehabilitation on flexible pavement performance. The findings revealed that the design factors variable indices under the Likert scale of 5-strongly agree which were 2.15, 2.51, 3.34, and 3.61, likewise the performance variables under the same category which were 0.83, 0,55, 1.64, and 2.63 are the highest which means design factors affect rehabilitation significantly and performance factors affects pavement performance significantly. These category factors were cross-analysed and the results established the significance of the study and confirmed the influence of road rehabilitation on flexible pavement performance in Nigeria. In conclusion, rehabilitation of flexible pavement should be carried out by experts with the intent to achieve the factors of pavement performance.
Improving Primary School Pupils’ Academic Achievement and Retention in Mathematics Using Jigsaw Teaching Method
Authors: Enyinnaya Obilor , Onwuegbu InekweIsrael , Chinyere Ogbonna
Published: August 2024

This study focused on improving primary school pupils’ academic achievement and retention in mathematics using jigsaw teaching method. It was guided by two research questions and two hypotheses. The pretest, posttest quasi experimental research design involving two groups was used for the study. The population of the study comprised of all the primary five (5) pupils of 2022/2023 academic session in Umuahia Education Zone of Abia state. The education zone has 201 primary schools with 4,447 primary five (5) pupils. The Two (2) primary schools with class teachers in primary five (5) that have mathematics background at NCE and Degree levels from Umuahia Educational Zone of Abia State were purposively sampled for the research.Simple random sampling technique was used in determining which school becomes the experimental and control group, 44 pupils participated as a sample for the study (19 males and 25 females). A Mathematics Achievement Test (MAT) and Mathematics Retention Test (MRT) were used for data collection. Research questions were answered using mean and standard deviation while the hypotheses were tested using Analysis of covariance at 0.05 alpha level, with the aid of SPSS version 21. The results showed a significant difference between the academic achievement and retention of the experimental group and control group in favour of the experimental group. It also revealed that there was no significant difference in the academic achievement and retention of male and female pupils taught geometry in the experimental group which implies that the use of the jigsaw teaching method is independent of gender. Based on the findings recommendations were made such as teachers should employ the use of cooperative method of teaching such as jigsaw teaching method in the teaching of geometrical concepts at the primary level of education to enhance pupils’ academic achievement and retention. Finally, workshops and seminars on the use of cooperative method of teaching such as jigsaw Teaching Method should be organized by Ministry of Education for in-service primary school mathematics teachers.
Juvenile Recidivism in Bangladesh: An Exploratory Study on Juvenile Development Center, Gazipur
Authors: Alam Mohammad , Kamruzzaman M.
Published: August 2024

Juvenile Recidivism is relatively new and legal term in modern world which stimulates the repetition of criminal behavior among the juvenile. Juvenile delinquent and juvenile recidivist activity has been increased due to the Development of technology, indiscrimination, unplanned modernization, industrialization, urbanization and over politicization. Juvenile Recidivism mostly incites the future evils younger generation due to severe and heinous effect of consequent juvenile criminal behavior among the juvenile. On the basis of this problem, juvenile recidivism in Bangladesh has been studied to explore what are main causes of juvenile recidivism in Bangladesh and also to identify which social factor is responsible for being to be juvenile recidivism as well as to justify how juvenile become a juvenile recidivist from the early stage of lives. Qualitative method has been used in the study within in-depth interviewing as well as face to face conversation. The major findings of the study is poverty, lack of parental care, bad peer group, living in slum area, engaged with unreported adult criminal, gang and political leader which are directly influence juvenile to commit the criminal activity for this reason juvenile turn into a juvenile recidivist. It had also found that sexual and drugs related offences are committed by the maximum number of juvenile recidivist in Bangladesh. Finally it had found that lack of proper treatment in Development center, inexperienced probation officer and lack of legal juvenile court or juvenile justice system is also increasing juvenile recidivist in Bangladesh.
Examining Failings in Criminal Justice Responses to Sexual Offenses: Focus on Male Victims and Impact of Operation Bluestone
Authors: Dugdale Caitlyn , Hasan Marina , Dippie Aaron
Published: August 2024

This article highlights the failings of the criminal justice system in offering support to the victims of sexual violence, and keeping the focus particularly on male victims of sexual abuse. The article also investigates the overall experiences of all victims and the current procedures and policies in place. Men are treated as non-deserving victims, because the definition of rape under the Sexual Offences Act 2003 defines rape as “penetration with penis” and does not take male victims into account. Male victims are also not treated the same way as female victims, however both experience rape myths such as males not being ‘man enough’ and females with vulnerabilities, such as alcohol consumption, not being believed. Furthermore, it is increasingly difficult to bring forward rape charges by the crown prosecution service and the victims withdrawal rate in 2019-20 remains at 57%, indicating failings within CJS. Moreover, the negative attitudes of officers dealing with rape cases, and officers abusing their powers to sexually assault victims, raised serious questions around the systematic failure within the CJS. There is a lack of support for rape victims, and the impact of Operation Bluestone, which was created to improve rape case procedures, shows that the number of cases making it to court has increased with the project, but conviction rates remain very low. This was impacted by rape myth culture, which was a consistent theme throughout the research.
Thriving among Pakistani physicians: A qualitative study
Authors: Sohail Malik Muhammad , Nawaz Kinza , Doolittle Benjamin
Published: August 2024

Objective

Burnout among physicians negatively impacts the quality of patient care and provider’s mental health. While many studies have evaluated burnout, factors associated with physician thriving are not well-defined. This study involved a qualitative exploration of thriving and career satisfaction among physicians in Pakistan.

Methods

A snowball sampling technique was used to recruit participants who completed a measure of job satisfaction, life satisfaction, and burnout between December 2022 and February 2023. Semi-structured interviews were conducted to explore factors associated with burnout and thriving. Participants were physicians working in public and private hospitals in North Punjab.

Results

Twenty-four physicians were interviewed. Six themes emerged that might help to explain factors involved in thriving: patient’s affirmation, serving humanity, social support, spiritual connection, occupational prestige, and activities outside of work. Two themes were identified as challenges to thriving: excessive workload and lack of resources.

Conclusion

Improving the well-being of primary care practitioners requires a multi-modal approach, which includes cultivating intrinsic virtues, such as resilience and spiritual resources, as well as improving social support and the workplace environment.
Language preferences of youth with visual impairments
Authors: Lepore-Stevens Maria , Donnelly Bri
Published: August 2024

Both identity-first and person-first language can be appropriate when writing about disability. Identity-first language (IFL) places the disability identifier first in the syntax of the sentence (visually impaired athlete), while person-first language (PFL) places the descriptor of the person before the descriptor of the disability (athlete with a visual impairment). The extent to which individuals with disabilities identify with a disability culture is affected by the development of their own identity in relation to their disability, and may impact language choices. Furthermore, the stage with which an individual is at concerning their disability identity development could impact their decision on PFL versus IFL. Whether the disability is congenital or acquired and whether the condition is temporary, permanent, or progressive are additional considerations impacting identity formation and language preferences. Current tensions exist regarding the use of IFL versus PFL, particularly between practitioners and disabled individuals.
Exploring the Mediating Role of Multiple Organ Dysfunction in Sepsis-Induced Disseminated Intravascular Coagulation and Its Impact on Worsening Prognosis
Authors: Wang Guangjie , Hao Chenxiao , Yao Sun , Wang Yiqin , Xu Zongtao , Zhao Huiying , An Youzhong
Published: August 2024

Disseminated intravascular coagulation (DIC) poses a high mortality risk, yet its exact impact remains contentious. This study investigates DIC's association with mortality in individuals with sepsis, emphasizing multiple organ function. Using data from the Peking University People's Hospital Investigation on Sepsis-Induced Coagulopathy database, we categorized patients into DIC and non-DIC groups based on DIC scores within 24 h of ICU admission (< 5 cutoff). ICU mortality was the main outcome. Initial data comparison preceded logistic regression analysis of mortality factors post-propensity score matching (PSM). Employing mediation analysis estimated direct and indirect associations. Of 549 participants, 131 were in the DIC group, with the remaining 418 in the non-DIC group. Following baseline characteristic presentation, PSM was conducted, revealing significantly higher nonplatelet sequential organ failure assessment (nonplt-SOFA) scores (6.3 ± 2.7 vs 5.0 ± 2.5, P < 0.001) and in-hospital mortality rates (47.3% vs 29.5%, P = 0.003) in the DIC group. A significant correlation between DIC and in-hospital mortality persisted (OR 2.15, 95% CI 1.29–3.59, P = 0.003), with nonplt-SOFA scores (OR 1.16, 95% CI 1.05-1.28, P = 0.004) and hemorrhage (OR 2.33, 95% CI 1.08-5.03, P = 0.032) as predictors. The overall effect size was 0.1786 (95% CI 0.0542-0.2886), comprising a direct effect size of 0.1423 (95% CI 0.0153-0.2551) and an indirect effect size of 0.0363 (95% CI 0.0034-0.0739), with approximately 20.3% of effects mediated. These findings underscore DIC's association with increased mortality risk in patients with sepsis, urging anticoagulation focus over bleeding management, with organ dysfunction assessment recommended for anticoagulant treatment efficacy.
Mental health and exercise during the COVID-19 pandemic: A Twitter sentiment analysis
Authors: Tokac Umit , McKeever Michael , Razon Selen
Published: August 2024

Beyond its immediate health consequences, the COVID-19 pandemic led to an exacerbation in the mental health of the global population. Regular exercise and its lack thereof are also known to affect mental health. Tweets and their content analysis can provide information about aspects of users’ lives including their health habits and mental health. The purpose of this study was to examine individuals’ exercise habits and mental health during the pandemic by means of sentiment and correlational analyses. These results indicate that, while exercise and mental health tweets were more COVID-focused in the first 12 months of the pandemic, exercise tweets became more exercise-focused, and mental health tweets became more mental-health-focused eventually during the pandemic. Efforts to increase exercise participation in individuals may prove beneficial. Further research needs to examine the effects of exercise on mental health in the aftermath of COVID-19.
Feasibility of a Novel Surface-Guided Setup Technique to Reproduce Neck Curvature Using two Regions of Interest
Authors: Li Guang , Yu Victoria , Ryan Kaitlyn , Gil Mary , Biancia Cesar Della
Published: August 2024

Purpose

To improve the setup reproducibility of neck curvature using real-time optical surface imaging (OSI) guidance on 2 regions of interest (ROIs) to infer cervical spine (c-spine) curvature for surface-guided radiotherapy (SGRT) of head-and-neck (HN) and c-spine cancer.

Methods

A novel SGRT setup approach was designed to reproduce neck curvature with 2 ROIs: upper-chest ROI and open-face ROI. It was hypothesized that the neck curvature could be reproduced if both ROIs were aligned within ±3 mm/2˚ tolerance. This was tested prospectively in 7 volunteers using real-time 3D-OSI guidance and lateral 2D-photography verification after the 3D and 2D references were captured from the initial conventional setup. Real-time SGRT was performed to align chest-ROI and face-ROI, and the longitudinal distance between them was adjustable using a head-support slider. Verification of neck curvature anteriorly and posteriorly was achieved by overlaying edge-extracted lateral pictures. Retrospectively, the relationship between anterior surface and spinal canal alignment was checked in 11 patients using their simulation CT (simCT) and setup cone-beam CT (CBCT). After the anterior surface was rigidly aligned, the spinal canal alignment was checked and quantified using the mean-distance-to-agreement (MDA) and DICE similarity index, and surface-to-spine correlation was calculated.

Results

The reproducibility of neck curvatures using the 2xROI SGRT setup is verified and the mean neck-outline-matching difference is within ±2 mm in lateral photographic overlays. The chest-ROI alignment takes 110 ± 58 s and the face-ROI takes 60 ± 35 s. When the anterior body surface is aligned (MDA = 1.1 ± 0.6 mm, DICE = 0.96 ± 0.02,) the internal spinal canal is also aligned (MDA = 1.0 ± 0.3 mm, DICE = 0.84 ± 0.04) in 11 patients. The surface-to-spine correlation is c = 0.90 (MDA) and c = 0.85 (DICE).

Conclusion

This study demonstrates the feasibility of the novel 2-ROI SGRT setup technique to achieve reproducible neck and c-spine curvature regardless of neck visibility and availability as ROI. Staff training is needed to adopt this unconventional SGRT technique to improve patient setup.
TikTok is an effective platform for bicycle safety injury prevention education
Authors: Witte Michelina M , McEvoy Joey M , Hotz Gillian A
Published: August 2024

Social media is an efficient way to spread information, given its widespread daily use by the general population. While it has been shown that public health information can be rapidly disseminated, whether the newer social media platform, TikTok, is effective for this purpose has yet to be explored. The goal of this study is to determine the effectiveness of TikTok for the public health topic of injury prevention, specifically with regards to bicycling-related safety education. The TikTok account “iBikeSafe” was created to disseminate injury prevention information related to bicycle safety. Data collected was both qualitative (video classification, comment categorization) and quantitative (likes, views, comments). Performance data was compared between TikTok and another video-sharing social media platform (YouTube). Posts that were didactic (or educational) in nature yielded more views, likes, and comments than posts that were fun or casual in nature. Almost half (46%) of comments made by users on iBikeSafe’s TikTok videos were made to constructively further the discussion and to educate others with accurate injury prevention information. Five of the six videos that were adapted from the iBikeSafe YouTube channel for use on TikTok garnered exponentially more views on TikTok (from 118% to 2057%) than on YouTube, despite having less followers/subscribers (759 TikTok vs 977 YouTube) and being in existence for less time (11 months vs 8 years). TikTok is an effective platform for injury prevention education. Didactic posts best provide users with the ability to engage with content and to discuss takeaways, while fun posts keep users active within the platform. Both educational and fun types of videos play an integral role in the effective use of this platform for bicycle safety education. Consideration should be taken into account for the appropriate ratio of didactic versus fun posts for information dissemination in any public health educational campaign making use of this platform.
Empowering Agricultural Workers Through Community Health Worker-Led Pesticide Safety Workshops in Washington State
Authors: Ponce-González Ileana María , Arias Griselda , Diaz Elmer , Parchman Michael L.
Published: August 2024

Background

It is difficult to reach migrant or refugee agricultural workers about pesticide exposure prevention. Here, we describe a community health worker (CHW)-led pesticide exposure prevention workshop and the impact of this program among migrant and refugee workers in Washington state.

Methods

A focus group of migrants and refugees participated in the development of a CHW-led Spanish language pesticide exposure prevention mobile phone app and workshop. Pre- and post-workshop surveys assessed pesticide training, knowledge, and characteristics.

Results

Community health workers facilitated 28 workshops attended by 263 participants from 49 agricultural communities. Approximately 79% of participants reported no prior pesticide training. Significant improvements were observed in the proportion familiar with illnesses associated with pesticides, knowledge about pesticide definition, ability to correctly identify the content of pesticide labels, and the correct method to wash fruits and vegetables.

Conclusions

Community health workers are effective in addressing the gaps in pesticide safety education and awareness among migrant and refugee communities. Further work is needed to assess how to better integrate a mobile phone app into this training and subsequent use of the knowledge.
Canine hyper-sociability structural variants associated with altered three-dimensional chromatin state
Authors: Tandon Dhriti , Kubinyi Enikő , Sándor Sára , Faughnan Hannah , Miklósi Ádám , vonHoldt Bridgett M.
Published: August 2024

Strong selection on complex traits can lead to skewed trait means and reduced trait variability in populations. An example of this phenomenon can be evidenced in allele frequency changes and skewed trait distributions driven by persistent human-directed selective pressures in domesticated species. Dog domestication is linked to several genomic variants; however, the functional impacts of these variants may not always be straightforward when found in non-coding regions of the genome. Four polymorphic transposable elements (TE) found within non-coding sites along a 5 Mb region on canine CFA6 have evolved due to directional selection associated with heightened human-directed hyper-sociability in domesticated dogs. We found that the polymorphic TE in intron 17 of the canine GTF2I gene, which was previously reported to be negatively correlated with canid human-directed hyper-sociability, is associated with altered chromatin looping and hence distinct cis-regulatory landscapes. We reported supporting evidence of an E2F1-DNA binding peak concordant with the altered loop and higher expression of GTF2I exon 18, indicative of alternative splicing. Globally, we discovered differences in pathways regulating the extra-cellular matrix with respect to TE copy number. Overall, we reported evidence suggesting an intriguing molecular convergence between the emergence of hypersocial behaviors in dogs and the same genes that, when hemizygous, produce human Williams Beuren Syndrome characterized by cranio-facial defects and heightened social behaviors. Our results additionally emphasize the often-overlooked potential role of chromatin architecture in social evolution.
Learning curve of ultrasound-guided percutaneous central venous port placement in children
Authors: Jeon Ho Jong , Ihn Kyong , Ho In Geol
Published: August 2024

Background

Although percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon.

Methods

Data from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed.

Results

Cumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator’s position from the patient’s right side to the patient’s head (p = 0.005).

Conclusions

Ultrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.
Prevalence of asthma among children and adolescents in WHO’s Eastern Mediterranean Region: a meta-analysis of over 0.5 million participants
Authors: Taherian Mohammad Reza , Fatemian Farbod , Halimi Aram , Soleimani Yaser , Jorjani Goljamal , Nozari Parisa , Mosavi Jarrahi Alireza , Nazari Seyed Saeed Hashemi , Al-Yateem Nabeel , Al-Marzouqi Amina , Humid Aysha , Rahman Syed Azizur
Published: August 2024

Objective

This study aims to evaluate the epidemiology of asthma among children and adolescents in the Eastern Mediterranean Region.

Methods

Exhaustive searches were conducted across databases, including PubMed, Scopus, Web of Knowledge Core Collection, Embase, and Google Scholar. The selection criteria included studies reporting asthma prevalence in individuals aged 0 to 19 years, using validated questionnaires. Data were extracted and synthesized using the DerSimonian and Laird random effects model.

Results

The overall prevalence of asthma in Eastern Mediterranean Regional Office (EMRO) countries, among the 514,468 children and adolescents included in this meta-analysis, was 10.61%, synthesized from 95 studies. Among the countries studied, Qatar exhibited the highest prevalence at 16.69%, followed by Saudi Arabia at 16.57%, Iraq at 16.22%, Oman at 15.20%, and Afghanistan at 14.90%. Adolescents showed a slightly higher prevalence of asthma at 10.10% compared to children at 9.70%. Boys exhibited a higher prevalence at 11.48% compared to girls at 9.75%. Urban areas demonstrated a higher prevalence at 11.27% than rural areas at 8.29%.

Conclusion

Efforts to reduce asthma prevalence in Arab countries and address underdiagnosis in African nations within the EMRO are crucial. Targeted interventions should focus on addressing environmental triggers and improving access to healthcare. Enhanced diagnostic capabilities and healthcare infrastructure are necessary in African countries. Collaborative action is essential to alleviate the asthma burden and promote respiratory health across the EMRO region.
Keep it CooL! Results of a two-year CooL-intervention: a descriptive case series study
Authors: Philippens Nicole , Janssen Ester , Kremers Stef , Crutzen Rik
Published: August 2024

Background

Coaching on Lifestyle (CooL) is a two-year healthcare intervention for people with overweight or obesity, stimulating weight reduction by promoting sustained healthier behavior. The objective of this study is to investigate the effects of CooL on participants’ anthropometrics, personal factors and behavioral factors over the two-year timeframe of CooL.

Methods

A descriptive case series study, using a broad set of routinely collected data on anthropometrics, personal factors and behavioral factors of adults living across the Netherlands. The data were collected between November 2018 and December 2021 among participants of CooL (N = 746) at three moments during the intervention: at baseline (T0), at 8 months (T1) after completion of phase 1 and at 24 months (T2) after ending CooL. Changes over time were analyzed using paired t-tests comparing baseline to T1 and baseline to T2. In addition, potential differences on outcomes in subgroups based on education level, weight status and group size were examined using paired t-tests and ANOVA-tests.

Results

The results showed positive changes on all outcomes at 24 months compared to baseline. The largest effects were on perceived health, attentiveness towards meal size and meal composition (large effect size). Mean weight loss was 4.13 kg (SD 7.54), and mean waist circumference decreased with 4.37 centimeters (SD 8.59), indicating a medium to large effect size. Changes were consistent across subgroups varying in educational level, BMI at baseline and group size.

Conclusion

The study demonstrated sustained weight-related effects of CooL over 24 months supporting its two-year duration. The results indicate that CooL, though not for every individual, is in general appropriate and effective for different group sizes and for a wide variety of participants regardless of level of education, or BMI at baseline.

Trial registration

Dutch Trial Register NTRNL6061 (13-01-2017). Registered at Overview of Medical Research in the Netherlands (OMON), via https://www.onderzoekmetmensen.nl/.
Towards inclusive healthcare: evaluating knowledge, confidence and awareness of LGBTQ + health among Internal Medicine Trainees in London
Authors: Crowe Andrew , Hogan Patrick , Morrison Christoper , Meads Catherine , Bailey Daniel
Published: August 2024

Background

Patients from the lesbian, gay, bisexual, transgender, queer plus (LGBTQ +) community face various health inequalities and report poor healthcare experiences. Little is known about how knowledgeable and confident UK doctors are around LGBTQ + health, and previous research demonstrates that UK medical schools rarely deliver teaching in this area. This research evaluated the level of knowledge, awareness and confidence of LGBTQ + health among Internal Medical Trainees (IMTs) in London.

Methods

London IMTs were invited to complete an online questionnaire evaluating knowledge, awareness and confidence in LGBTQ + health. Stratified analysis of results by demographics was performed.

Results

Three hundred and fifteen surveys were analysed from 796 eligible trainees (40%). Confidence in caring for LGBTQ + patients was variable. Confidence in discussing gender identity was lower than for sexual orientation. Knowledge of health issues affecting LGBTQ + patients varied. Most participants had never received training on LGBTQ + health at undergraduate (n = 201, 64%) or postgraduate level (n = 252, 80%), but the majority of participants felt that training would be useful (n = 233, 74%). Stratified analysis revealed that IMTs who received previous LGBTQ + teaching at undergraduate or postgraduate level were considerably more confident discussing sexual orientation with patients, compared to those who received no previous teaching.

Conclusions

There is a clear need for education on LGBTQ + health, given the varied levels of knowledge and confidence identified. A significant majority of IMTs in London have never received teaching on LGBTQ + health, although there exists a strong desire for this. LGBTQ + health topics should be integrated into undergraduate and postgraduate training and examinations for IMTs. This would support IMTs in delivering high quality and inclusive care for all patients, particularly those of sexual orientation and gender identity minorities. There are relatively few published studies exploring competency in LGBTQ + health among doctors, and this is the first among UK Internal Medicine Trainees.
Current status, challenges, and future career pathways of diploma-prepared nurses from the stakeholders’ perspective: a qualitative study
Authors: Nasser Seema
Published: August 2024

Background

The global shortage of nurses is a pressing issue affecting healthcare quality and patient outcomes. Nurse turnover is driven by work-related stress, and job dissatisfaction is persistent. In Saudi Arabia, many diploma-prepared nurses need more bridging programs to convert their diplomas into bachelor’s degrees. Educational and organizational issues can limit the provision of quality nursing care. Differences in educational preparation influence nurses’ interpretations of patient safety and their roles within healthcare systems. Addressing the need for more policies and regulations regarding nurse turnover and the retention of diploma-prepared nurses is crucial. Thus, a comprehensive exploration of barriers and incentives for diploma-prepared nurses to complete their Bachelor of Science in Nursing (BSN) can lead to transformative institutional strategies, such as tuition compensation and clinical-academic collaborations. This study aims to fill this gap by understanding the current challenges, future trends, and solutions from stakeholders’ perspectives and developing tailored career pathways for diploma-prepared Nurses from the stakeholders’ perspective. Thus, it contributes to policy development and improved healthcare delivery and fosters a promising future for healthcare.

Methods

This qualitative study employed a thematic analysis and grounded theory methodology as we delved into stakeholders’ perspectives to generate a substantive framework for overcoming obstacles and cultivating tailored career pathways for diploma-prepared nurses. A purposive sampling technique was used to choose participants, ensuring their rich, relevant, and diverse information based on their expertise, experience, and ability to provide valuable insights. Data were collected using one-on-one semi-structured questions for in-depth interviews.

Results

Our findings revealed key concepts that were evident in the data. These concepts formed three main themes and several subthemes essential to understanding the current status of, challenges faced by, and career pathways for diploma-prepared nurses. The three main themes have emerged, and core categories have emerged under each theme accordingly. The results generated a practical framework, offering tangible solutions to overcome challenges and develop career pathways for diploma-prepared nurses.

Conclusions

The findings significantly affect policy development and healthcare delivery improvement. This suggests the need for policies that support diploma-prepared nurses in completing their BSN and the development of tailored career pathways that align with their educational background and career goals and the Kingdom’s 2030 Vision.
Management training programs in healthcare: effectiveness factors, challenges and outcomes
Authors: Giovanelli Lucia , Rotondo Federico , Fadda Nicoletta
Published: August 2024

Background

Different professionals working in healthcare organizations (e.g., physicians, veterinarians, pharmacists, biologists, engineers, etc.) must be able to properly manage scarce resources to meet increasingly complex needs and demands. Due to the lack of specific courses in curricular university education, particularly in the field of medicine, management training programs have become an essential element in preparing health professionals to cope with global challenges. This study aims to examine factors influencing the effectiveness of management training programs and their outcomes in healthcare settings, at middle-management level, in general and by different groups of participants: physicians and non-physicians, participants with or without management positions.

Methods

A survey was used for gathering information from a purposive sample of professionals in the healthcare field attending management training programs in Italy. Factor analysis, a set of ordinal logistic regressions and an unpaired two-sample t-test were used for data elaboration.

Results

The findings show the importance of diversity of pedagogical approaches and tools and debate, and class homogeneity, as effectiveness factors. Lower competencies held before the training programs and problems of dialogue and discussion during the course are conducive to innovative practice introduction. Interpersonal and career outcomes are greater for those holding management positions.

Conclusions

The study reveals four profiles of participants with different gaps and needs. Training programs should be tailored based on participants’ profiles, in terms of pedagogical approaches and tools, and preserve class homogeneity in terms of professional backgrounds and management levels to facilitate constructive dialogue and solution finding approach.
Interactive effects of water temperature and dietary protein on Nile tilapia: growth, immunity, and physiological health
Authors: Hamed Sara , El-Kassas Seham , Abo-Al-Ela Haitham G. , Abdo Safaa E. , Al Wakeel Rasha A. , Abou-Ismail Usama A. , Mohamed Radi A.
Published: August 2024

Optimizing fish performance depends on several factors, with dietary protein levels and rearing temperature playing important roles. In this study, Nile tilapia fingerlings (Oreochromis niloticus) weighing an average of 20.00 ± 1.26 g were divided into nine groups (in three replicates). Each group was subjected to different water temperatures (26 °C, 28 °C, and 30 °C) and received one of three dietary protein levels (20%, 25%, and 30%) for two months. Our findings indicate that higher temperatures, particularly at 30 °C, increased water electrical conductivity and total dissolved salts, especially noticeable in fish fed 25% or 30% crude protein (CP). Lower total ammonia nitrogen levels were observed at 28 °C with 25% CP, 30 °C with 30% CP, and 26 °C with 30% CP. Hepatic growth hormone receptor 1 and insulin-like growth factor 1 expression gradually rose with higher dietary CP percentages in fish at 26 °C but declined in those at 30 °C, albeit remaining higher than in the 28 °C groups with 25% CP. Fish at 28 °C showed the best final body weights and growth performance when fed 20% or 25% CP, with no significant difference between these groups. Hepatic leptin expression did not differ significantly among groups, but hepatic fatty acid binding protein expression notably increased in fish fed 30% CP at both 26 °C and 30 °C compared to those at 28 °C with 25% CP. Within the same temperature group, fish fed 30% CP exhibited higher globulin levels, particularly thriving at 28 °C or 30 °C. Hepatic mucin-like protein expression significantly increased across all groups, especially in fish at 30 °C with 30% CP compared to those at 28 °C with 25% CP. Hepatic lysozyme expression also increased notably in fish at 30 °C with 30% CP. Notable changes in superoxide dismutase, catalase, and glutathione peroxidase expression were observed, with the highest serum superoxide dismutase and catalase activities recorded in fish at 30 °C with 25% CP. Overall, dietary protein levels of 25% and 30%, combined with temperatures of 28 °C and 30 °C, yielded favorable outcomes, particularly favoring 28 °C with 25% protein.
Effects of increasing tidal volume and end-expiratory lung volume on induced bronchoconstriction in healthy humans
Authors: Gobbi Alessandro , Antonelli Andrea , Dellaca Raffaele , Pellegrino Giulia M. , Pellegrino Riccardo , Fredberg Jeffrey J. , Solway Julian , Brusasco Vito
Published: August 2024

Background

Increasing functional residual capacity (FRC) or tidal volume (VT) reduces airway resistance and attenuates the response to bronchoconstrictor stimuli in animals and humans. What is unknown is which one of the above mechanisms is more effective in modulating airway caliber and whether their combination yields additive or synergistic effects. To address this question, we investigated the effects of increased FRC and increased VT in attenuating the bronchoconstriction induced by inhaled methacholine (MCh) in healthy humans.

Methods

Nineteen healthy volunteers were challenged with a single-dose of MCh and forced oscillation was used to measure inspiratory resistance at 5 and 19 Hz (R5 and R19), their difference (R5-19), and reactance at 5 Hz (X5) during spontaneous breathing and during imposed breathing patterns with increased FRC, or VT, or both. Importantly, in our experimental design we held the product of VT and breathing frequency (BF), i.e, minute ventilation (VE) fixed so as to better isolate the effects of changes in VT alone.

Results

Tripling VT from baseline FRC significantly attenuated the effects of MCh on R5, R19, R5-19 and X5. Doubling VT while halving BF had insignificant effects. Increasing FRC by either one or two VT significantly attenuated the effects of MCh on R5, R19, R5-19 and X5. Increasing both VT and FRC had additive effects on R5, R19, R5-19 and X5, but the effect of increasing FRC was more consistent than increasing VT thus suggesting larger bronchodilation. When compared at iso-volume, there were no differences among breathing patterns with the exception of when VT was three times larger than during spontaneous breathing.

Conclusions

These data show that increasing FRC and VT can attenuate induced bronchoconstriction in healthy humans by additive effects that are mainly related to an increase of mean operational lung volume. We suggest that static stretching as with increasing FRC is more effective than tidal stretching at constant VE, possibly through a combination of effects on airway geometry and airway smooth muscle dynamics.
Trends in prognosis and use of SGLT2i and GLP-1 RA in patients with diabetes and coronary artery disease
Authors: Ritsinger Viveca , Avander Kamila , Lagerqvist Bo , Lundman Pia , Norhammar Anna
Published: August 2024

Objective

To explore trends in prognosis and use of glucose-lowering drugs (GLD) in patients with diabetes and coronary artery disease (CAD).

Research design and methods

All patients with diabetes and CAD undergoing a coronary angiography between 2010 and 2021 according to the Swedish Angiography and Angioplasty Registry were included. Information on GLD (dispended 6 months before or after coronary angiography) was collected from the Swedish Prescribed Drug Registry. Data on major cardiovascular events (MACE; mortality, myocardial infarction, stroke, heart failure) through December 2021 were obtained from national registries. Cox proportional survival analysis was used to assess outcomes where cardioprotective GLD (any of Sodium Glucose Lowering Transport 2 receptor inhibitors [SGLT2i] and Glucagon Like Peptide Receptor Agonists [GLP-1 RA]) served as a reference.

Results

Among all patients (n = 38,671), 31% had stable CAD, and 69% suffered an acute myocardial infarction. Mean age was 69 years, 67% were male, and 81% were on GLD. The use of cardioprotective GLD increased rapidly in recent years (2016–2021; 7–47%) and was more common in younger patients (66 vs. 68 years) and men (72.9% vs. 67.1%) than other GLD. Furthermore, compared with other GLD, the use of cardioprotective GLD was more common in patients with a less frequent history of heart failure (5.0% vs. 6.8%), myocardial infarction (7.7% vs. 10.5%) and chronic kidney disease (3.7% vs. 5.2%). The adjusted hazard ratio (HR) (95% CI) for MACE was greater in patients on other GLD than in those on cardioprotective GLD (1.10; 1.03–1.17, p = 0.004). Trend analyses for the years 2010–2019 revealed improved one-year MACE in patients with diabetes and CAD (year 2019 vs. 2010; 0.90; 0.81-1.00, p = 0.045), while 1-year mortality was unchanged.

Conclusions

The prescription pattern of diabetes medication is changing quickly in patients with diabetes and CAD; however, there are worrying signals of inefficient use prioritizing cardioprotective GLD to younger and healthier individuals at lower cardiovascular risk. Despite this, there are improving trends in 1-year morbidity.
Pediatric suicide attempts lagged during the COVID-19 pandemic: a European multicenter study
Authors: Moscoso Ana , Cousien Anthony , Serra Giulia , Erlangsen Annette , Vila Mar , Paradžik Ljubica , Pires Sandra , Villar Francisco , Bogadi Marija , da Silva Pedro Caldeira , Vicari Stefano , Krantz Mette Falkenberg , Delorme Richard ,   & the ACE-COVID study group, do Amaral Sarah , Andracchio Elisa , Apicell Massimo , Bilić Ivana , Chieppa Fabrizia , Duarte Nuno Araújo , Faustino Iolanda , Rodrigues Madalena Ferro , Guidetti Clotilde , Hjorthøj Carsten , Iannoni Maria Elena , Kordić Ana , Lombardini Federica , Maglio Gino , Moro Marianna , Nascimento Catarina M , Nordentoft Merete , de Oliveira Tareco Maria , Pennanec’h Elise , Silva David Antonio , Trasolini Monia , Trebossen Vincent
Published: August 2024

Background

Elevated rates of suicidal behavior were reported during the COVID-19 pandemic. However, information is scarce on patients’ profiles during this period. Studies evoke the potential adverse effects of the mandatory lockdown, but they remain relatively speculative.

Methods

We monitored fluctuations in suicide attempts (SA) in six European countries. We gathered data, retrospectively for under 18-year-old SA episodes (1 January 2018 to 31 December 2021), through records of psychiatric emergency services. We collected clinical profiles individually. We extracted environmental indicators by month, as provided by Oxford COVID-19 Government Response Tracker (OxCGRT). We used the Pruned Exact Linear Time (PELT) method to identify breakpoints in SA episodes reported for each country, and logistic regressions to estimate changes in patients’ characteristics after the breakpoints. Finally, we used a univariate and multivariate negative binomial model to assess the link between SA and OxCGRT indicators, accounting for the delay (lag) between the interventions and their impact on SA.

Results

The study comprised 2,833 children and adolescents (mean age = 15.1 years (SD 1.6); M: F sex-ratio = 1:5.4). A significant increase in SA was found either 6 or 10 months after the beginning of the pandemic, varying by country. Patients were more likely to be girls (aOR = 1.77 [1.34; 2.34]) and used SA methods “other than self-poisoning” (aOR = 1.34 [1.05; 1.7]). In the multivariate model, an association was found between SA and the contact tracing indicator with an 11 months delay, and the number of COVID-19 deaths with a 3-months delay.

Conclusions

Findings confirmed a delayed increase in SA during the COVID-19 pandemic in children and adolescents as well as changes in patients’ profiles. The duration and severity of the pandemic emerged as the strongest predictor in the rise of SA. If faced with a similar pandemic in the future, the gap between the onset of pandemic and the increase in suicide attempts presents an opportunity for prevention.
Oral aripiprazole in the treatment of tic disorders in China: a cost-effectiveness analysis based on a mapping algorithm derived from a Chinese children and adolescents population
Authors: Chen Chaoxin , Chen Tingting , Ke Zhongling , Wu Yi , Liu Maobai , Chen Yanhui , Zheng Bin
Published: August 2024

Background

Oral aripiprazole exhibits favorable clinical efficacy and safety in the suppression of tics in children and adolescents with tic disorders. This study aims to evaluate and compare the cost-effectiveness of high-dose and low-dose aripiprazole in children and adolescents with tic disorders from the perspective of the Chinese healthcare system.

Methods

A questionnaire survey was conducted on 146 patients with tic disorders, of whom 144 completed EQ-5D-Y and YGTSS. Four models were built to convert YGTSS onto EQ-5D-Y utility using two mapping algorithms. We constructed a decision tree model containing efficacy and safety to compare the cost-effectiveness of high-dose and low-dose aripiprazole based on our mapping function.

Results

The GLM with model 1 (YGTSS total tic scores) was selected as the preferred function in our decision tree model. The base case cost-effectiveness analysis showed that compared to low-dose aripiprazole, high-dose aripiprazole improves effectiveness by 0.001QALYs and increases the overall cost by $197.99, resulting in an ICER of $174339.22 per QALY, which exceeds three times the gross domestic product per capita. Hence, high-dose aripiprazole is not likely to be a cost-effective option for child patients with tic disorders. One-way sensitivity analysis and probabilistic sensitivity analysis showed that these results is robust.

Conclusion

On the basis of currently available data, low-dose aripiprazole may be a safe, effective, and economical dosage for children and adolescents with tic disorders.

Limitations

The main limitation of our study is the lack of utility directly used for cost-effectiveness analysis. We obtained the utility of patients with tic disorders indirectly by the mapping function. This may introduce some bias and uncertainty. And it is a limitation to use the direct medical costs of Germany in our model. Although we converted it to the equivalent value of China using purchasing power parities, caution should be exercised when interpreting the results of this study.