bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician, know thyself: Applying brand management principles to professional identity in academic medicine
Authors: Branzetti Jeremy , Gisondi Michael A. , Hopson Laura R. , Regan Linda , Botti Simona
Published: December 2024

Context

A career in medicine is a journey of countless opportunities, challenges and choices. Determining the “right” decision for any given career choice ultimately must come from within; thus, a clear understanding of a physician's core professional identity is critical. Existing conceptualizations of professional identity within medicine focus primarily on medical training; however, it is clear that professional identity evolves throughout one's career. We propose the use of brand management principles as a novel means of understanding and expressing a physician's evolving professional identity throughout their career.

Methods

We propose a conceptual framework for managing academic physician professional identity based upon brand management principles derived from marketing and consumer research literature. The four key framework elements include brand identity (“Who am I?”), brand delivery (“What actions do I choose to present myself to others”), brand experience (“How are my actions experienced by others?”) and brand image (“How do others see me?”). Successful management of one's brand starts with understanding the core professional brand identity, then determining the best way to deliver this identity through specific actions experienced by target audiences (e.g., patients, collaborators, colleagues, employers, learners, promotion committees, etc.), and ends with the target audience having a clear and compelling brand image that reflects the underlying professional identity. Alignment of these components results in an array of benefits; misalignment can result in feelings of burnout or career stalling.

Conclusions

We contend that physicians can and should see themselves as their own unique brand. Though often confused with naked self‐promotion, developing a professional brand is an identity exploration and reflection experience that allows individuals to better control the course of their careers. A strong personal brand has numerous practical applications; three key examples presented herein include navigating promotion through the professoriate, managing one's reputation and achieving professional fulfilment.
ADAPTing to participant distress: A protocol for applied improvisation in healthcare
Authors: Whitney Clare , Bojsza Elizabeth , Besch Shaun , Preis Heidi , Zheng Xia , Pati Susmita
Published: December 2024

Introduction

Applied improvisation (improv) is an emerging innovative approach to clinical education and requires the cultivation of a highly engaged learning environment. With highly interactive and engaging forms of learning, it is critical to address participant distress and psychological safety in an improv learning environment in order to prevent damage to the learning capacities of individual participants as well as the group as a whole. However, little is available to guide applied improv practitioners to navigate the socially complex dynamics of participant distress during an improv session. The purpose of this project was to develop a distress protocol, tailored for improvisation‐based interprofessional clinical communication training curricula, aiming to characterise, anticipate, prevent and address participant distress during sessions.

Methods

Using an interpretive descriptive approach, we analysed qualitative data including previously collected interview data and primary field notes taken during improv simulations in order to develop the Addressing Distress in Applied Improvisation Participants Tool (ADAPT).

Results

Analysis revealed two key distress manifestations (resistant distress and reactive distress) as well as three distress profiles (primary distress, secondary distal distress and secondary proximal distress) that may occur during an improv session. The ADAPT guides facilitators through four phases of attending to participant distress during applied improvisation sessions. These four phases include Redirecting the Spotlight, Responding to Distress, Reintegrating the Group and Reflecting on the Distress.

Discussion

The ADAPT is the first of its kind as a general guide for addressing participant distress and can be customised and tailored to other applied improv curricula and experiential learning activities. Future inquiry should evaluate the utility and effectiveness of the ADAPT for responding to in situ participant distress in applied improv or other similar active learning environments.
Demographic and Pathogen Profiles of Superficial Fungal Infections—A Single‐Centre Observational Study in Poland
Authors: Jaworek Andrzej Kazimierz , Hałubiec Przemysław , Sroka Damian , Grabarczyk Iga , Kachnic Natalia , Wojas‐Pelc Anna , Szepietowski Jacek Cezary
Published: December 2024

Background

Superficial fungal infections (SFI) are contagious conditions affecting the skin and its appendages, caused by various fungal species. Monitoring the distribution of common pathogens and identifying at‐risk patient groups are essential for effective management and prevention.

Objectives

This study investigates the characteristics of SFI in Poland's Malopolska region from 2017 to 2019, focusing on etiological agents, infection sites and risk factors.

Patients/Methods

A retrospective analysis was conducted on 4522 mycological cultures from 3594 patients, incorporating demographic data (age, sex), sample sites and mycological test results.

Results

Among the 1175 positive mycological tests recorded from 959 patients, Trichophyton rubrum—primarily affecting toenails and feet—and Candida albicans—mainly targeting fingernails—were the most common pathogens across all age groups. Children exhibited a higher incidence of infections caused by Microsporum canis, Malassezia furfur and T. mentagrophytes. In contrast, Scopulariopsis brevicaulis was more frequently identified in individuals over 60 years old.

Conclusions

The observed trends in SFI characteristics at our centre during the pre‐pandemic period align with global epidemiological data. However, further studies are warranted to address existing gaps in understanding the epidemiology of SFI and to refine preventive and therapeutic strategies.
Coronectomy Versus Surgical Extraction for Mandibular Third Molars—A Pilot Study Assessing Patient Reported Outcome Measures for Post‐Operative Recovery
Authors: Radia Shenal , Pindoria Anushri , Stagnell Sami
Published: December 2024

Introduction

Surgical extraction of impacted Mandibular Third Molars (M3M) is one of the most common oral surgery procedures. Coronectomy procedures provide an alternative technique in cases of high‐risk inferior alveolar nerve damage. Recovery from both treatments can impact quality of life and may influence patient decisions.

Aim

To improve information provision on recovery and post‐operative effects of surgery during patient decision‐making for coronectomies and surgical extractions of M3M.

Method

Twenty patients receiving coronectomies and 20 patients receiving surgical extractions were surveyed on postoperative days 1, 3, 7 and 14. The following parameters were assessed: pain, swelling, disturbed sleep, feeling unwell, difficulty carrying out day‐to‐day tasks, difficulty eating, difficulty brushing/cleaning the back of the mouth, difficulty opening the mouth, and return to work/social activities. A two‐way repeated measures ANOVA test was carried out.

Results

Days 1 and 3 exhibited the most severe symptoms across all parameters for both cohorts. Statistical analysis revealed no significant differences in scores among the parameters and across all days for both treatments. Social limitations were similar for both groups, with 30% of patients returning to work/social activities on day 1 and 100% on day 14. Type of impaction did not appear to influence the severity scores in either group.

Conclusion

While the subjective nature of the results should be considered, the immediate and short‐term postoperative recovery is comparable for coronectomies and surgical extractions of M3M.
Anthelmintic Treatment Reveals Sex‐Dependent Worm–Gut Microbiota Interactions
Authors: Sabey Kate A. , Castro Avina , Song Se Jin , Knight Rob , Ezenwa Vanessa O.
Published: December 2024

Gastrointestinal helminths interact with the gut microbiota in ways that shape microbiota structure and function, but these effects are highly inconsistent across studies. One factor that may help explain variation in parasite–microbiota interactions is host sex since helminths can induce sex‐specific changes in feeding behaviour and diet that might cascade to shape gut microbial communities. We tested this idea using an anthelmintic treatment experiment in wild Grant's gazelles (Nanger granti). We found that in males, anthelmintic treatment induced short‐term shifts in microbial diversity and structure within ~40–70 days, but in females, treatment had effects on microbiota structure that emerged over a longer period of ~500 days. Long‐term effects of treatment on the microbiota of females were potentially due to sex‐specific changes in feeding behaviour since deworming nearly doubled the time females spent feeding, but did not affect feeding time in males. In support of this idea, anthelmintic treatment eliminated associations between microbial diversity and diet in females, and treated females maintained a more stable abundance of microbial taxa and predicted functions. Together, these findings suggest that accounting for host traits can help uncover mechanisms, such as changes in diet, by which helminths interact with the microbiota.
Erosive tooth wear, dental decay, and periodontal health in obese and normal weight children and adolescents
Authors: Soğukpınar Önsüren Aslı , Çetin Özdemir Eda , Temiz Fatih
Published: December 2024

Aim

This study aimed to compare the oral health status between normal weight (NW) and obese weight (OW) children/adolescents.

Methods

Eighty‐two participants aged 6–16 years were included in this cross‐sectional study. The children/adolescents were classified according to the body mass index (BMI): NW (n = 41) and OW (n = 41). Caries experience was assessed by the International Caries Detection and Assessment System (ICDAS‐II), decay, missing, filling teeth (dmft) for the primary teeth and (DMFT) for the permanent teeth, erosive tooth wear using Basic Erosive Wear Examination (BEWE), Plaque Index (PI) and Gingival Index (GI), probing depth (PD). Also, the relationship between procalcitonin (PCT), C‐reactive protein (CRP), parathyroid hormone (PTH), and 25(OH)D blood biochemistry and oral health was evaluated in obese children/adolescents.

Results

Evaluation was made of a sum of 82 children/adolescents, comprising 43 females and 39 males, with a median age of 14 years in the obese group and 13 years in the NW group. Significant differences were determined between patients with NW and those who were obese, particularly in BMI, family income level, and tooth brushing habits. The results of the study indicate that individuals with obesity tend to exhibit significantly higher scores for PI, and GI as compared to those with NW (p < .05)

Conclusion

Oral hygiene in children with systemic diseases should be treated with a multidisciplinary approach and under regular control by a pediatrician and pediatric dentist, as it may also affect the medical health of the children/adolescents.
Testing the viability of normal seawater dolomitization in lower Cambrian carbonates using clumped isotopes
Authors: Lu Chaojin , Hao Fang , Zou Huayao , Koeshidayatullah Ardiansyah , Manche Cameron J. , Li Pingping , Swart Peter K.
Published: December 2024

While dolomitization by normal seawater has been commonly used to explain the formation of Cenozoic dolomites, ancient platform‐scale dolostones are normally interpreted as being products of either evaporative brines or mixed fresh and marine fluids. However, the viability of these two models in ancient successions is continuously questioned by new studies which favour normal or slightly modified seawater as the dolomitizing fluid. This study presents an ancient example from the lower Cambrian Longwangmiao Formation (South China) which, although appearing to have formed in association with evaporite minerals and experienced meteoric subaerial exposure, was interpreted to be dolomitized by normal seawater. Three petrographic types of dolomites, formed in the penecontemporaneous to early burial diagenetic stages in the Longwangmiao Formation. These include finely, fine to medium and medium to coarse crystalline dolomites. The stable isotope compositions (δ13Ccarb, δ18Ocarb and Δ47) were determined on pure dolomite samples that had been chemically isolated, and the results interpreted using a coupled numerical model. This analysis strongly suggests that the dolomite was replaced by Cambrian seawater (ca −2‰) and subsequently experienced closed‐system recrystallization (water/rock ratio <0.4) in the deep burial stage. The vertical variation of the mol% Mg content of the dolomite shows multiple episodes of dolomitization with the increasing stoichiometry in each episode suggesting the control of sea‐level changes. This study has revealed that the normal‐seawater dolomitization could also proceed in an evaporative environment on a shallow‐water platform. As in many studies of ancient carbonates, the recognition of diagenetic fluids is often hindered by complex geochemical overprinting in bulk samples.
Evidence of Left Ventricular Cardiac Remodeling After 6 Weeks of Sprint Interval Training
Authors: Eriksson Lisa M. J. , Hedman Kristofer , Åström‐Aneq Meriam , Nylander Eva , Bouma Karin , Mandić Mirko , Gustafsson Thomas , Rullman Eric
Published: December 2024

Sprint interval training (SIT) leads to similar improvements in maximal oxygen uptake (V̇O2max) and maximal cardiac output as previously reported for traditional endurance training, but the exercise‐induced effects on cardiac remodeling are still largely unknown. The aim of the current study was therefore to explore the effects of SIT on cardiac structure and function assessed by echocardiography in relation to, and controlling for, changes in both blood volume (BV) and heart rate (HR). Healthy men and women (n = 28) performed 6 weeks of SIT. V̇O2max and total BV were measured, and echocardiography was performed before and after the intervention. There was a robust increase in BV (+7.1%; p < 0.001) and V̇O2max (+10.1%; p < 0.001) and a decrease in resting HR (−3.9%; p = 0.013) following the SIT intervention. Machine‐learning‐based feature selection and univariate analysis indicated that several measures of left ventricular dimension (+14.3% LVEDV, p = 0.013; +17.4% LVESV, p = 0.018; +12.3% LVSV, p = 0.031), left ventricular diastolic function (MVA, MVD‐slope, MVDT), and left ventricular stroke volume (LVOT VTI) were altered by 6 weeks of SIT. When controlling for the exercise‐induced changes in BV and HR, left ventricular dimensions remained significantly changed. Our data indicate that several measures of cardiac function are likely only indirectly affected by SIT, driven by increased BV. However, the disproportionate increase in left ventricular size exceeds what can be explained by changes in BV and HR alone, indicating volume‐independent structural cardiac remodeling.
Host preference of Anopheles stephensi mosquitoes for blood feeding in south of Iran: Insights from Multiplex‐PCR analysis
Authors: Oshaghi Mohammad Ali , Abbasi Madineh , Hanafi‐Bojd Ahmad Ali
Published: December 2024

Background

The study aims to determine the host preference for blood feeding among potential hosts of Anopheles stephensi in Iran, using the Multiplex‐PCR method. An. stephensi is the primary malaria vector in urban areas of South Asia and the Middle East, including southern Iran, where approximately 30.21% of malaria cases are urban. This trend has become more evident during the recent outbreaks in Iran, driven by infections of Plasmodium falciparum, Plasmodium vivax, and as well as mixed infections. Hormozgan province, one of the most endemic areas in Iran, was selected for its critical public health significance. This study builds on the validated efficiency of Multiplex‐PCR for blood meal analysis by applying it to mosquitoes in southern Iran.

Methods

In 2021, mosquitoes were collected monthly from three coastal villages in Bandar Abbas county, Hormozgan province, using WHO‐recommended collection methods. Blood‐fed An. stephensi mosquitoes were dissected, and their stomach contents analysed via Multiplex‐PCR to identify human and animal blood sources.

Results

Of 77 An. stephensi samples analysed, humans were the most common host was humans (29.9%), followed by mammals (19%), dogs (2.6%), and birds (1.3%). Mixed blood meals were detected in 34% of samples, including 23% with human and other hosts. Informal observations suggest that domestic animals such as goats, sheep, and chickens are commonly present near homes in these areas.

Conclusion

Approximately 50% of An. stephensi blood meals were sourced from humans, with 29% exclusively from humans and 23% from mixed hosts. Domestic animals such as goats, sheep, and chickens appear to attract mosquitoes, highlighting their potential role in malaria dynamics. Zooprophylaxis, alongside existing measures like insecticide residual spraying, insecticide‐treated bed nets, and personal protection strategies, may strengthen urban malaria control. Further research on the ecological and behavioural drivers of mosquito host selection in urban settings is warranted.
On the order of the classical Erdős–Rogers functions
Authors: Mubayi Dhruv , Verstraete Jacques
Published: December 2024

For an integer , the Erdős–Rogers function is the maximum integer such that every ‐vertex ‐free graph has a ‐free induced subgraph with vertices. It is known that for all , as . In this paper, we show that for all , there exists a constant such that
This improves previous bounds of order by Dudek, Retter and Rödl and answers a question of Warnke.
Characterization of Knocking Pressure Data From Two Closely Spaced Transducers: Effect of Transducer Mounting
Authors: Caselli Andrea , Frigo Stefano , Ghandhi Jaal B.
Published: December 2024

In this study, pressure data acquired simultaneously from two different, closely spaced pressure transducers were compared to understand the quantification of knock intensity. The comparison between four different transducer models located in the same position showed very small changes in the power spectral density, suggesting that the transducer has a limited effect on the results. Simultaneous data acquired from the different locations were found to be significantly different, independent of transducer. This was shown to be the result of a small passage, which was only 0.25 mm longer than the manufacturer’s recommended length, that existed for one of the transducers; the other transducer had a passage shorter than the manufacturer’s specification. The nearly flush transducer showed clearly defined peaks in the power spectral density all the way to 40 kHz, but the passage produced a broadband disturbance in the frequency domain from 20 to 50 kHz. This disturbance significantly affected the knock measurement but largely did not affect the heat release analysis. A moving-window cross correlation between the two pressure signals, which eliminates any phase differences, showed that there was high correlation between the signals on a cycle-by-cycle basis after a period of time after knock onset (KO). The knock intensity (KI), characterized by the maximum amplitude of pressure oscillations, showed poor correlation between the two locations. The difference in the knock intensity was also evaluated using a ring-down magnitude (RDM) method, which showed better comparison. Recommendations for, and assessment of, the absolute quantification of knock intensity are provided.
A Model on Bubble Dynamics in Liquid Film Boiling
Authors: Zou Qifan , Li Pengkun , Liu Xiuliang , Yang Ronggui
Published: December 2024

Liquid film boiling, where bubbles are generated together with evaporation in several hundred micrometers thick liquid film, has attracted great interest recently due to its potential in dissipating high heat flux with low superheat. However, the existing models on bubble dynamics based on pool boiling are not suitable for predicting the bubble behaviors in liquid film boiling. Here, we develop a theoretical model to study bubble dynamics (including nucleation, growth, and departure) in liquid film boiling on the horizontal surface. By considering the evaporation atop the liquid film surface, we solve the transient heat conduction in the liquid film, and then derive the waiting period for bubble nucleation. The bubble growth rate is computed by taking into account evaporation from both superheated liquid layer and microlayer. Bubble departure diameter is obtained by considering the surface tension force atop the liquid film and reconstructing the pendant bubble shape based on the Young-Laplace equation. It is shown that when liquid film thickness reduces, the bubble waiting period increases, while the bubble growth period and growth rate decrease. By predicting the heat transfer based on bubble dynamics, we find that the enhanced heat transfer in liquid film boiling, compared to pool boiling, mainly benefits from the significantly increased bubble departure frequency due to reduced departure diameter.
Parametrized Maximal Admissible Sets With Application to Constraint Management of Systems With Slowly Varying Parameters
Authors: Pedari Yasaman , Freiheit Collin , Anand Dhananjay M. , Ossareh Hamid R.
Published: December 2024

Real-time constraint management schemes for time-varying or parameter-varying systems often result in conservative (slow) responses or carry a heavy computational burden. This makes some of the existing solutions less suitable for practical applications within these systems. To address this issue, this paper proposes a numerically efficient reference governor (RG) scheme for constraint management of systems with slowly time-varying parameters and constraints. The solution, which we call the adaptive-contractive reference governor (RG-AC), utilizes a contractive, parameterized characterization of the so-called maximal admissible set (MAS). To ensure low computational overhead, this parameter-dependent MAS (PD-MAS) is approximated using a sensitivity-based method that describes the changes in the facets of PD-MAS as a function of the system parameters around a nominal operating point. The computational and theoretical properties of the PD-MAS and RG-AC are presented. The effectiveness and limitations of the proposed method are demonstrated by studying a basic mass–spring–damper system.
No Effect of Individualized Sodium Bicarbonate Supplementation on 200-m or 400-m Freestyle-Swimming Time-Trial Performance in Well-Trained Athletes
Authors: Gurton William H. , Dabin Lilly , Marshall Steven
Published: December 2024

Purpose: This study investigated the effect of an individualized sodium bicarbonate (SB) supplementation-timing strategy on 200-m and 400-m freestyle swimming time-trial (TT) performance. Methods: Thirteen well-trained swimmers (8 men and 5 women; mean [SD] 22 [3] y, 1.76 [0.79] m, 73.4 [9.6] kg) had their time-to-peak bicarbonate (HCO3−) determined after ingestion of 0.3 g·kg−1 body mass SB in size 0 vegetarian capsules alongside a carbohydrate-high meal (1.5 g·kg−1 body mass). Following familiarization, participants performed 200-m and 400-m freestyle TTs after individualized timing (160 [36] min) of either SB or a placebo (PL; cornflour) on 4 separate occasions in a randomized, double-blind, crossover design. Completion times, blood lactate, and rating of perceived exertion (6–20 Borg) were measured. Results: SB did not improve completion times compared with PL during the 200-m (124.5 [7.3] vs 125.1 [6.2] s, P = .219, g = 0.09) or 400-m (263.4 [12.8] vs 264.7 [13.6] s; P = .192, g = 0.10) TTs. Blood lactate was elevated for SB compared with PL following the 200-m (12.99 [1.45] vs 10.98 [2.25] mmol·L−1; P = .042) and 400-m (13.05 [2.29] vs 10.44 [2.40] mmol·L−1; P = .017) TTs. SB reduced rating of perceived exertion after the TTs compared with PL (200 m: −0.9 [1.4] au, P = .033; 400 m: −1.2 [1.4] au, P = .012). Conclusions: SB consumed in capsules at individualized time-to-peak [HCO3−] did not improve 200-m or 400-m freestyle-swimming TT performance and might not be a worthwhile SB ingestion strategy for well-trained swimmers.
Are Mobile Apps Effective at Targeting Physical Activity or Malnutrition in Community-Dwelling Older Adults? A Systematic Review and Meta-Analysis
Authors: French Chloe , McKenzie Yvonne , Stanmore Emma , Burden Sorrel
Published: December 2024

This systematic review aims to identify the effectiveness of digital health applications (apps) to increase physical activity (PA) or prevent malnutrition in community-dwelling older adults. Searches were conducted in June 2023 across seven electronic databases (MEDLINE, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials), and grey literature were searched via google scholar. Data from studies that met the inclusion criteria were extracted. Risk of bias was assessed, and the quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were undertaken where appropriate using DerSimonian and Laird random-effects model (Stata version 16.1), or data were described narratively. Twenty-seven studies met the eligibility criteria, although 23 of these had low or unclear risk of bias. Twelve studies considered PA outcomes only, two studies considered nutritional outcomes only, and three studies considered both PA and nutritional components. A meta-analysis comprising six studies (818 participants) showed that those using a digital health app had a higher step count compared with participants in the control group (mean difference = 799, 95% CI [48.76, 1550.08]). Studies looking at nutritional outcomes aimed to increase protein intake or adherence to dietary patterns with mixed findings. Digital health apps have the potential to increase PA in community-dwelling older adults. Digital health app interventions that aim to reduce the risk of malnutrition in older adults is a relatively unexplored area with mixed findings, so more high-quality studies should be prioritized.
Healthcare professionals’ perspectives on commercial milk formula marketing in the UK: a qualitative study
Authors: McNaughton Eilidh , Chen Lydia , Smith Andrea D , Conway Rana
Published: December 2024

Objectives

To understand (1) healthcare professionals’ (HCPs) perceptions and experiences of commercial milk formula (CMF) marketing to consumers and HCPs and (2) HCPs’ perspectives on regulation of CMF marketing.

Setting

UK.

Design

In-person and online interviews with 41 HCPs with regular contact with pregnant women and mothers. Individual semistructured interviews were conducted from October 2019 to March 2021, focusing on experiences of CMF marketing and perceptions of legislation. Data were analysed using reflexive thematic analysis.

Results

Three themes were developed: (1) ‘Industry relationships have changed and not disappeared’—some HCPs reported contact with industry ceasing due to the Baby Friendly Initiative (BFI) but contact with HCPs in other roles was believed to have increased; (2) ‘Direct-to-consumer marketing presents challenges for HCPs’—to support women to make informed choices about infant feeding, HCPs felt they had to challenge misinformation families receive from the CMF industry; (3) ‘System changes are needed to support informed infant feeding decisions’—HCPs wanted policy changes, including effective legislation to restrict CMF marketing to both HCPs and families. They also felt initiatives to normalise breastfeeding were important.

Conclusions

Reduced contact with CMF representatives was reported by HCPs covered by the BFI but continued or increased contact was seen with other HCPs. HCPs believed CMF marketing impacted women’s beliefs about infant feeding and they had to work hard to provide a balanced perspective. HCPs wanted stricter regulation of CMF marketing.
How patients and informal caregivers can be trained to effectively contribute to improved quality of healthcare services: action research on the development of the Dutch Patient As a Person Academy
Authors: Romme Sjim , Hermans Max , Bosveld Matthijs Hugo , Plak Angela , Sehlbach Carolin , van Bokhoven Marloes Amantia
Published: December 2024

Objectives

Patient and public involvement is regarded as vital in fostering high-quality care. While involvement has clear societal advantages, it is still widely viewed as tokenistic and surrounded by issues of representation. This study aims to understand how patients and informal caregivers can be trained to effectively contribute to improved quality of healthcare services.

Design

Using an action research approach, a 15-week training programme for patients and informal caregivers called the Patient As a Person Academy was developed, tested and evaluated in three development cycles. Evaluation methods varied per development cycle and included open-ended questionnaires (N=27) and semistructured interviews (N=35) as well as agile evaluation sessions of all 15 training sessions.

Setting and participants

We purposively sampled patients and informal caregivers who had prior experience in patient and public involvement. Patients and informal caregivers who participated as patient and partner educators in health professions education in the Netherlands could participate.

Intervention

Participants followed the Patient As a Person Academy, a 15-week training programme that aims to prepare patients and informal caregivers to become patient partners.

Results

Participants reported that the Patient As a Person Academy’s focus on self-management skills, understanding healthcare professionals’ perspectives and communication skills helped them to engage in meaningful dialogue with healthcare professionals as patient partners and made them more confident in their roles. However, tailoring towards individual participants’ levels of acceptance of illness and reflexivity was needed. Participants reported that, next to the training programme, peer-to-peer coaching and guidance towards roles in quality improvement initiatives would be necessary to optimise their contributions.

Conclusions

Initiatives like the Patient As a Person Academy may alleviate the problems of tokenism in patient and public involvement. However, extensively preparing patients and informal caregivers raises issues around representation.
Effects of traditional Chinese medicine massage therapy on pain, functional activity, muscle activation patterns and proprioception in knee osteoarthritis: a randomised controlled trial protocol
Authors: Zhu Bowen , Tang Cheng , Zhou Xin , Janice Hiew Yuen Yee , Fang Sitong , Fu Yangyang , Zhu Qingguang , Fang Min
Published: December 2024

Introduction

Health education, weight control and exercise therapy are recognised treatment options for the non-surgical management of knee osteoarthritis (KOA); however, the pain and muscle fatigue associated with exercise make it difficult for patients to initially adhere. Traditional Chinese medicine (TCM) massage is an important complementary and alternative therapy that can effectively address these deficiencies. According to TCM theory and preliminary clinical practice, loosening of the muscles while pointing to acupoints can promote the recovery of KOA. Therefore, we hypothesised that exercise therapy in conjunction with TCM massage may lead to more satisfactory results in terms of pain management, active functional muscle activation patterns and proprioception in patients with KOA.

Methods and analysis

A parallel, single-centre, randomised controlled trial involving 106 patients will be conducted at Shuguang Hospital, Shanghai University of Traditional Chinese Medicine. Eligible patients with KOA who agree to participate will be randomised via a 1:1 randomisation system into the experimental group (receiving TCM massage and exercise treatment) and the control group (receiving exercise treatment). The primary endpoint is the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain from baseline to 24 weeks. Secondary outcomes include knee function (measured using the WOMAC stiffness and WOMAC functional subscale questionnaire and the timed ‘Up and Go’ test), muscle activation states (evaluated with electromyography techniques), knee proprioception and treatment satisfaction, adherence, safety evaluation and other relevant factors. Outcome assessors and data analysts will be blinded to the allocations, and the participants will not disclose their specific allocations. Outcome analyses will be conducted on both intention-to-treat and per-protocol populations. A preliminary analysis will test whether TCM massage, in addition to exercise, has statistically better outcomes.

Ethics and dissemination

The study protocol has received approval from the Ethics Committee of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine (2023-1357-124-01).

All study participants will be required to give written informed consent. The findings of the study will be submitted to a peer-reviewed journal for publication and presented at scientific conferences. Additionally, the participants will receive copies of the results.

Trial registration number

ChiCTR2300077308.
Knowledge and attitudes towards cervical cancer and screening among migrant women: a qualitative study in Portugal
Authors: Silva Joana , Gama Ana , Fronteira Inês , Marques Patrícia , Dias Sónia
Published: December 2024

Objective

To explore the perceptions of migrant women, healthcare professionals and community workers regarding migrant women’s knowledge and attitudes about cervical cancer (CC) and screening and how these influence cervical cancer screening (CCS) uptake.

Design

Qualitative study with seven focus groups, using a semistructured guide.

Setting

Five focus groups were conducted online and two in community associations in Lisbon, Portugal.

Participants

This study included 23 migrant women, 12 healthcare professionals and 10 community workers.

Results

A lack of knowledge and negative attitudes towards screening among migrants were discussed as important factors leading to a lower CCS uptake. For participants, many migrant women are unaware of the disease and CCS. Feelings of uneasiness related to screening and reservation from their husbands towards consultations underlie negative attitudes towards CCS. Disparities among migrant women regarding uptake of CCS rooted on sociocultural factors were highlighted, with women from African origin and older tending to engage less. Healthcare professionals were identified as the preferred source of information; nevertheless, difficulties in delivering information on sensitive topics were reported by professionals. Additionally, participants agreed that peers and social networks may play a role in promoting screening among communities.

Conclusions

Healthcare professionals and community actors are paramount to promote CCS among migrant women, especially through culturally adapted awareness interventions and health-promoting activities engaging local communities and social networks of women. Training on cross-cultural communication skills of healthcare professionals may contribute to improving migrant women’s knowledge and uptake of CCS.
Uncovering the boundary conditions of the association between concerns about falling and physical activity in adult populations: a scoping review protocol
Authors: Amireault Steve , Reed Jason Brian , Kerschner Reese Colby , Chadwell Emilie Ann , Roh Heesoo , Jakob Emily Ryan , Muller Kelsie Jo
Published: December 2024

Introduction

Despite evidence of variation in how concerns about falling influence physical activity, many of the currently available knowledge syntheses merely assume that this relation is uniform across populations and contexts. Therefore, we propose a scoping review protocol to guide a summary of the bodywork that has examined the association between concerns about falling and physical activity in adult populations, with an eye on the availability of empirical evidence of moderation.

Methods and analyses

Studies reporting on both the concepts of concerns about falling and physical activity among samples with a mean age≥18 years will be included. Five electronic databases will be searched. We will conduct a hand search of the reference lists for all included studies and relevant knowledge syntheses and perform a citing reference search for all included studies using the Web of Science. A team of six reviewers will single-screen titles and abstracts. Two reviewers will independently assess the eligibility of each study based on a full-text examination. Results will be presented using a tree graph to display the moderating factor(s) investigated, and a ratio showing the number of time evidence for moderation was examined by the total number of investigations.

Ethics and dissemination

The university Human Research Protection Program determined that the proposed scoping review does not qualify as human subject research under federal human subject research regulations (IRB-2023–1656). Results will be published in a peer-reviewed journal and in the form of a one-page summary for extension programme leaders, part of a nationwide Cooperative Extension network.
Stakeholder perspectives to inform the implementation of a community health worker-delivered home management of hypertension intervention in Zimbabwe
Authors: Mundagowa Paddington Tinashe , Musariri Malvin , Magande Pamela , Hlabangana Tendai , Mukwambo Linda Jane , Zambezi Pemberai , Muchemwa-Munasirei Priscillah , Mukora-Mutseyekwa Fadzai
Published: December 2024

Objective

Implementing evidence-based innovations often fails to translate into meaningful outcomes in practice due to dynamic real-world contextual factors. Identifying these influencing factors is pivotal to implementation success. This study aimed to determine the barriers and facilitators of implementing a community health worker (CHW)-delivered home management of hypertension (HoMHyper) intervention from a stakeholder’s perspective using the Consolidated Framework for Implementation Research (CFIR).

Design

Exploratory qualitative study.

Setting

Five primary healthcare facilities in Mutare City, Zimbabwe.

Participants

25 CHWs, 10 health facility nurses and 3 Mutare City health administrators.

Results

Perceived barriers to implementation of the HoMHyper intervention were staff shortage, patient privacy and confidentiality, limited access to antihypertensive medication, CHW incentivisation and equipment shortage, as well as patient knowledge and beliefs about hypertension. The proposed intervention was superior to the current practice, easy to implement and adaptable in the local context. Perceived facilitating factors were commitment from health system leadership, CHW training and support, regular engagement between CHWs and health providers, community partnerships, and CHW self-efficacy and knowledge and skills.

Conclusion

Integrating CHWs into chronic disease management can potentially improve health service access in low-resource settings. Well-coordinated planning guided by implementation evidence frameworks such as the CFIR significantly enhances the identification of important barriers and facilitators to inform implementation.
Incidence of cancer-related lymphoedema: a protocol for a living systematic review with meta-analysis
Authors: Plinsinga Melanie , Singh Ben , Bloomquist Kira , Bernas Michael , Geyer Debbie , Devoogdt Nele , Koelmeyer Louise , Piller Neil , Reul-Hirche Hildegard , Rockson Stanley , Hayes Sandi
Published: December 2024

Introduction

Given the projected rise in the incidence of cancer treatment-related conditions, such as lymphoedema, and the limited research on lymphoedema in cancers with poor prognoses, there is a need for a better understanding of cancer-related lymphoedema incidence and associated risk factors across all types of cancers. The objectives of this review are (1) to produce a resource on an open-access platform that facilitates continuous update of incidence estimates and risk factors as evidence emerges, (2) to provide the most up-to-date estimate of the incidence of cancer-related lymphoedema and (3) to evaluate the strength and consistency of the association between lymphoedema and cancer treatment and non-treatment-related risk factors.

Methods and analysis

A living systematic and grey literature search will be conducted to identify studies reporting the incidence, prevalence of lymphoedema or associated risk factors in individuals who have undergone treatment for any type of cancer. Two investigators will independently extract data and assess the risk of bias using the Cochrane Risk of Bias Tool Version 2.0, the Risk of Bias in Non-randomised Studies – of Interventions or the National Institutes of Health Heart, Lung and Blood Institute Study Quality Assessment Tools, depending on study design. The overall strength of evidence will be appraised with the Grading of Recommendations, Assessment, Development and Evaluations tool. Random effect models will be used to produce pooled overall lymphoedema incidence estimates. Subgroup analyses that explore relationships between lymphoedema incidence and lymphoedema measurement method, time since cancer diagnosis and treatment and diagnosis, treatment and behavioural characteristics will be conducted dependent on available data.

Ethics and dissemination

This living systematic review enables clinicians and researchers to consult a contemporary, comprehensive overview of the incidence of cancer-related lymphoedema and the association between lymphoedema and treatment and non-treatment-related risk factors.

PROSPERO registration number

CRD42022333291.
What strategies are used to select patients for direct admission under acute medicine services? A protocol paper for a systematic review of the literature
Authors: Evans Samuel , Atkin Catherine , Hunt Austin , Ball Georgina , Cassidy Charlotte , Costley-White Alexander , Toy Louise , Wilding Rebecca , Sapey Elizabeth
Published: December 2024

Introduction

Despite unprecedented pressures on urgent and emergency care services, there is no clear consensus on how to provide acute medical care delivery in the UK. These pressures can lead to significant delays in care for patients presenting with emergencies when admitted via traditional routes through the emergency department. Historically, a separate pathway has existed where patients are directly admitted to acute medicine services without attending the emergency department. It is suspected that there is a significant variation in how these patients are selected, triaged and managed in the UK. This systematic review will assess the methods and evidence base used for direct patient admissions to acute medicine services compared with traditional admission pathways through the emergency department.

Methods and analysis

A systematic review of the literature will be conducted and a total of six databases will be searched: MEDLINE (Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in process, Web of Science, CINAHL and Embase. This will include studies from the period 01 January 1975 to 24 January 2024. Covidence software will be the platform for the extraction of data and paper screening with the selection process reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Both title and abstract screening and full-text screening will be done by two reviewers independently. The risk of bias of included studies will be assessed using the methods introduced in the Cochrane Handbook for Systematic Reviews of Interventions and the tool used will be dependent on the type of study. Where possible, outcomes will be dealt with as continuous variables. Change percentage will be assessed between any pathway characteristic or outcome. Theχ² test andI² test will be used to evaluate the heterogeneity of included studies. Where appropriate, relevant meta-analysis techniques will be used to compare studies and forest plot produced.

Ethics and dissemination

This systematic review does not require ethical approval. Findings will be disseminated widely in peer-reviewed publication and media, including conferences.

PROSPERO registration number

CRD42023495786.
Physical activity pattern and its influencing factors among patients with inflammatory bowel disease in East China
Authors: Zhou Ying , Liu Huiwei , Xu Liyan , Zhang Xie , Xu Feng
Published: December 2024

Objective

To investigate the current level of physical activity (PA) and its influencing factors among patients with inflammatory bowel disease (IBD) in East China.

Design

Cross-sectional study.

Setting

Questionnaire survey recruiting from six tertiary referral hospitals in East China between October and December 2023.

Participants

Patients with Crohn’s disease (CD) or ulcerative colitis (UC) aged 18–65 years without conditions limiting PA engagement.

Primary and secondary outcome measures

Primary outcomes comprised total PA, PA levels and sedentary time over 1 week. Demographic and clinical characteristics, disease-related and non-disease-related barriers to PA, and PA outcome expectation score were also assessed.

Results

Of 391 eligible respondents, including 271 CD (69.3%) and 237 males (60.6%), the median total PA in IBD patients was 594 (0–1695) metabolic equivalent of task (MET)-min/week, with 53 patients (13.6%) of high, 140 (35.8%) of moderate and 198 (50.6%) of low level. The median sedentary time was 2325 (1500~3120) min/week in IBD patients, with CD significantly more than UC (p<0.01). A total of 180 IBD patients (46.0%) had reduced total PA after diagnosis, 134 (49.4%) in CD and 46 (38.3%) in UC (CD vs UC, p<0.05). Multifactorial logistic regression analysis showed that gender (OR=1.704, 95% CI 1.132 to 2.565, p=0.011) and PA outcome expectation score (OR=1.176, 95% CI 1.090 to 1.270, p<0.01) were independent influencing factors of PA levels in patients with IBD.

Conclusion

In East China, total PA and proportion of moderate- to high-level PA in IBD patients was considerably low. Compared with UC, CD patients had longer sedentary time and more postdiagnostic PA reduction. Gender and PA outcome expectation scores were independent influencing factors on PA levels in IBD patients. These results pointed to potential patient populations for future-focused interventions.
Preserving REST-ful Visibility Of Rich Web Applications With Generalized Hypermedia Controls
Authors: Gross Carson , Revelle Matthew
Published: December 2024

This research investigates how the visibility benefits of the REST architectural style can be pre- served through the use of generalized hypermedia controls without sacrificing user experience in web applications. JavaScript, an implementation of the code-on-demand constraint of REST, has been used to enable rich user experiences on the World Wide Web (WWW) but its use has increasingly become detrimental to visibility in modern web applications. We review the benefits provided by visibility to the WWW and the tension between visibility and code-on-demand. The concept of generalized hypermedia controls is presented and we demonstrate how generalized hypermedia controls preserve visibility while enabling a rich user experience in real-world web applications.
Surfacing Text Changes in Archived US Federal Environmental Websites
Authors: Frew Lesley
Published: December 2024

Lesley Frew is a PhD student in the Web Science and Digital Libraries Research Group at Old Dominion University in Norfolk, Virginia, USA, under the supervision of Dr. Michele C. Weigle, Professor of Computer Science and Dr. Michael L. Nelson, Eminent Scholar of Computer Science. She received her Master of Science degree in Computer Science at Old Dominion University. Her main research interests are in the area of information-seeking behavior in web archives. Her work on searching for changes in archived webpages won the best student paper award at ACM/IEEE JCDL (2023).