bluuebunny/crossref_metadata_2025 huggingface dataset:
A arqueologia de um exilado: desconstruções e restaurações da mitologia portuguesa em Atlântico, de Manuel Alegre
Authors: Paniago Maria Eduarda Miranda
Published: June 2024

O presente artigo busca analisar, a partir do tópico do exílio, as revisitações e reformulações do imaginário mítico imperial português em alguns poemas do livro Atlântico(1981), de Manuel Alegre. Construindo um paralelo com as guerras de conquista dos séculos XV e XVI e com personagens fundamentais da cultura portuguesa, Alegre encontra no passado um modo de apreender tanto a experiência individual quanto a de sua nação nas últimas décadas do século XX, numa tentativa de elaboração das feridas recentes do Portugal pós-25 de Abril. Nesse escopo, a noção de “império como imaginação de centro” proposta por Margarida Calafate Ribeiro, bem como a “cultura de fronteira” que, segundo Boaventura de Sousa Santos, define a identidade portuguesa serão especialmente relevantes para compreender de que modo ocorrem as reconfigurações desse imaginário nos poemas em questão e quais são seus efeitos na construção de uma nova identidade pátria que se quer livre das amarras imperialistas reforçadas pela ditadura recém-terminada.
Nesting habits of Baya Weaver Ploceus philippinus (Linnaeus, 1766) on power and television cables in the agricultural landscape of Kallakurichi district, Tamil Nadu, India
Authors: M. Pandian
Published: June 2024

The nesting habits of Baya Weaver Ploceus philippinus with nesting site (e.g., power and television cables), source of nest materials, various developmental stages of nests, abnormal nests, number of individuals and their association with other bird species, and threats to their nests were studied between March and September 2021 in the agrarian landscapes of 42 villages in Kallakurichi District, Tamil Nadu. A total of 155 nest colonies containing 1,725 nests of various developmental stages and 1,993 adult birds were counted on power/television cables. The number of nests per colony found varied from one to 57. The average number of nests per colony was eleven. Baya Weaver had preferred power/television cables as nesting sites in the study area in spite of availability of potential nest-supporting trees, such as Cocos nucifera and Borassus flabellifer within 500 m radii from cables bearing nests. Birds used fibres of sugarcane leaves (Saccharum officinarum) for the construction of nests. Out of 778 helmet stage nests observed, 90% (n = 716) helmet stage nests had clay deposits on their inner walls and no clay deposits were found in the remaining 10% (n = 62) helmet stage nests. Eleven types of abnormal nests constituted 17% (n = 286) of the total nests. Sixteen other bird species (e.g., birds of order: Passeriformes, Coraciiformes, Piciformes, Cuculiformes and Columbiformes) were found associated with the individuals of Baya Weaver. These bird species strictly shared similar roosting and foraging grounds. The avian predators such as House Crow Corvus splendens, Large-billed Crow Corvus macrorhynchos, Black Drongo Dicrurus macrocercus, Rufous Treepie Dendrocitta vagabunda, Coucal Centropus senegalensis, and Shikra Accipiter badius had damaged the nests, eggs and chicks. The study revealed that about 1.1% nests (n = 197) were probably damaged by these avian predators. Power cables in the study sites had provided suitable nesting sites for Baya Weavers. The causes for utilization of power cables as nesting sites in larger geographical areas require further studies.
Adaptive Randomization Method to Prevent Extreme Instances of Group Size and Covariate Imbalance in Stroke Trials
Authors: Italiano Dominic , Campbell Bruce , Hill Michael D. , Johns Hannah T. , Churilov Leonid
Published: June 2024

BACKGROUND:

A recent review of randomization methods used in large multicenter clinical trials within the National Institutes of Health Stroke Trials Network identified preservation of treatment allocation randomness, achievement of the desired group size balance between treatment groups, achievement of baseline covariate balance, and ease of implementation in practice as critical properties required for optimal randomization designs. Common-scale minimal sufficient balance (CS-MSB) adaptive randomization effectively controls for covariate imbalance between treatment groups while preserving allocation randomness but does not balance group sizes. This study extends the CS-MSB adaptive randomization method to achieve both group size and covariate balance while preserving allocation randomness in hyperacute stroke trials.

METHODS:

A full factorial in silico simulation study evaluated the performance of the proposed new CSSize-MSB adaptive randomization method in achieving group size balance, covariate balance, and allocation randomness compared with the original CS-MSB method. Data from 4 existing hyperacute stroke trials were used to investigate the performance of CSSize-MSB for a range of sample sizes and covariate numbers and types. A discrete-event simulation model created with AnyLogic was used to dynamically visualize the decision logic of the CSSize-MSB randomization process for communication with clinicians.

RESULTS:

The proposed new CSSize-MSB algorithm uniformly outperformed the CS-MSB algorithm in controlling for group size imbalance while maintaining comparable levels of covariate balance and allocation randomness in hyperacute stroke trials. This improvement was consistent across a distribution of simulated trials with varying levels of imbalance but was increasingly pronounced for trials with extreme cases of imbalance. The results were consistent across a range of trial data sets of different sizes and covariate numbers and types.

CONCLUSIONS:

The proposed adaptive CSSize-MSB algorithm successfully controls for group size imbalance in hyperacute stroke trials under various settings, and its logic can be readily explained to clinicians using dynamic visualization.
Diagnostic Accuracy of Posterior/Anterior Periventricular WMH Ratio to Differentiate CAA From Hypertensive Arteriopathy
Authors: Deasy Louise , Laurent-Chabalier Sabine , Wacongne Anne , Parvu Teodora , Mura Thibault , Thouvenot Eric , Renard Dimitri
Published: June 2024

BACKGROUND:

Periventricular white matter hyperintensities (PVWMHs) in cerebral amyloid angiopathy (CAA) have been reported posterior predominant using semiautomated segmentation method and logarithmic transformation. We aimed to compare PVWMH extent and posterior/anterior distribution between patients with CAA and patients with hypertensive arteriopathy with radiological tools available in daily practice.

METHODS:

We retrospectively analyzed confluent PVWMH directly adjacent to lateral ventricles on axial FLAIR (fluid-attenuated inversion recovery) from 108 patients with CAA and 99 patients with hypertensive arteriopathy presenting with hemorrhage-related symptoms consecutively recruited in our stroke database (Nîmes University Hospital, France) between January 2015 and March 2022. For each of the left (L), right (R), anterior (A), and posterior (P) horns of lateral ventricles, the maximal distance between the outer PVWMH border and ventricle border was measured. The sum of anterior left PVWMH and anterior right PVWMH, and posterior left PVWMH and posterior right PVWMH resulted in anterior and posterior extent, respectively.

RESULTS:

Compared with hypertensive arteriopathy, patients with CAA were older (median, 77 versus 71;
P
=0.0010) and less frequently male (46% versus 64%;
P
=0.012) and had less frequent hypertension (45% versus 63%;
P
=0.013) and more chronic hemorrhages (
P
<0.0001). CAA showed slightly more extensive anterior right PVWMH (median, 6.50 versus 5.90 mm;
P
=0.034), far more extensive (all
P
<0.0001) posterior left PVWMH (median, 13.95 versus 6.95 mm), posterior right PVWMH (median, 14.15 versus 5.45 mm), posterior (median, 27.95 versus 13.00 mm), and total (median, 39.60 versus 24.65 mm) PVWMH, and higher posterior/anterior ratios (median, 1.82 versus 1.01). Age-/sex-adjusted model predicting CAA incorporating total PVWMH extent and posterior/anterior ratios for the given score (−4.3683+0.0268×PVWMH-T+0.3749×posterior/anterior PVWMH ratio+0.0394×age+0.3046 when female) showed highest area under the curve (0.76 [0.70–0.83]), with a 72% [62.50–80.99] sensitivity and 76% [67.18–84.12] specificity. Values above the optimal threshold of 0.22 for the score showed a crude relative risk of 2.75 (2.26–2.37;
P
<0.0001).

CONCLUSIONS:

Severe posterior PVWMH and high posterior/anterior PVWMH ratio assessed by radiological tools used in daily practice are associated with probable CAA versus hypertensive arteriopathy.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT05486897.
Conservation of Coluber lanceolatus as the valid name of the Martinique fer-de-lance (no matter who its author is)
Authors: BAUER AARON M. , POWELL ROBERT
Published: June 2024

The fer-de-lance of Martinique is a pitviper of medical importance and conservation concern. It was described by La Cepède in 1789 as Coluber lanceolatus but as a result of a ruling of the Commission (Opinion 1463) this nomen is unavailable. Although a proposed new use of the Plenary Power by the Commission could restore the availability of Coluber lanceolatus La Cepède, 1789, this possibility remains hypothetical and under the Code-compliant interpretation, C. lanceolatus was made available by Bonnaterre in 1790 who proposed a homonymous poieonym. Coluber lanceolatus, which, as Bothrops lanceolatus, is currently universally accepted as the valid nomen of the fer-de-lance, is at risk because of the existence of two older nomina that apply to this taxon, Vipera cærulescens Laurenti, 1768 and its replacement name Coluber glaucus Gmelin, 1789. Consequently, we here provide the evidence necessary to demonstrate that Vipera cærulescens and Coluber glaucus are nomina oblita and to designate Coluber lanceolatus, under both the current proposed interpretations of its authorship, as a nomen protectum. Coluber lanceolatus Bonnaterre, 1790 has precedence over Coluber brasiliensis and C. tigrinus, two nomina with which it is considered synonymous and which were made available in the same work. However, precedence was established as a result of determination by the First Reviser only as recently as 2021. The case of Bothrops lanceolatus highlights that even well-established and widely accepted nomina may be potentially vulnerable to destabilisation by long-forgotten synonyms and illustrates the particular nomenclatural complications that can arise from valid Bonnaterre nomina that are homonymous with long-used but now unavailable La Cepède names.
Small island but great diversity: thirty six species of Parmotrema (Parmeliaceae, lichenized Ascomycota), including sixteen new species, on Réunion (Mascarenes), with additional data from the Western Indian Ocean
Authors: MASSON DIDIER , MAGAIN NICOLAS , SÉRUSIAUX EMMANUËL
Published: June 2024

This work is part of our taxonomical and phylogenetic studies on the lichen flora of Réunion (Mascarene Archipelago, Indian Ocean). Thirty-six species belonging to the conspicuous genus Parmotrema are recognized on the island, sixteen being new to science: P. aurantioreagens, P. brachyblepharum, P. crossotum, P. eleonomum, P. intonsum (also found in Madagascar), P. mezierii, P. mascarenense (also found in Mauritius), P. mirum, P. nemorum, P. nephophilum, P. occultum, P. orarium, P. paramascarenense (also found in Madagascar), P. reunionicum, P. subdeflectens (also found in Madagascar) and P. udisilvestre (also found in Madagascar). Parmotrema mwaliense is a further new species found on the island of Mohéli (Comoros). Three new combinations are introduced: Parmotrema inexspectatum, P. meiospermum and P. odontatum. We propose synonymization of P. acrotrychum with P. subcorallinum. The following species are confirmed or reported as new to Réunion: P. austrosinense, P. cetratum, P. cf. clavuliferum, P. cooperi, P. crinitum, P. cristiferum, P. cf. deflectens, P. dilatatum, P. mellissii, P. cf. negrosorientale, P. praesorediosum, P. reticulatum, P. robustum, P. subcorallinum, P. subisidiosum, and P. tinctorum. Parmotrema appendiculatum and P. thomsonii are only known to Réunion from single reports, poorly documented, dating back to the 19th century; detailed descriptions with photographs, distribution maps and ecological data are provided for the other species. An identification key for the 36 species is provided. Parmotrema austrosinense and P. cf. negrosorientale are newly reported, and P. meiospermum confirmed, for Mauritius; the Papuan P. menyamyaense is newly reported for Mohéli (Comoros). One hundred and seventy-four new sequences for the barcode ITS loci have been produced, an increase of ca. one third for Parmotrema on GenBank. LSU, mtSSU and EF1-α loci have been added for subgroups. The molecular data highlight the existence of two pairs of ‘nearly’ cryptic species (P. crinitum/P. occultum, P. brachyblepharum/P. eleonomum), high variability in the production of vegetative propagules in two of the new species described (P. nephophilum, P. orarium), and two strongly supported clades including potential endemics to Réunion or the MIOI (Madagascar and the Indian Ocean Islands) biodiversity hotspot. One clade comprises 10 species (P. brachyblepharum, P. crossotum, P. eleonomum, P. intonsum, P. mezierii, P. cf. negrosorientale, P. nemorum, P. subcorallinum, P. subdeflectens and P. udisilvestre), eight described as new for science, the other five species (P. aurantioreagens, P. mascarenense, P. meiospermum, P. odontatum and P. orarium), three of them new for science.
Five new species of the genus Phlugiolopsis (Orthoptera: Tettigoniidae: Meconematinae) from Yunnan, China
Authors: PAN YANGYANG , RAN YIQI , BIAN XUN
Published: June 2024

In this paper we described five new species in the genus Phlugiolopsis from Yunnan Province. P. heterotrullis, P. cryphiconica sp. nov., P. puerensis sp. nov., P. platicercis sp. nov., P. minoriproceris sp. nov. One new synonym is proposed, Phlugiolopsis clavata syn. nov. with Phlugiolopsis tridigitis Pan & Bian, 2024. Other species in the genus are commented on and illustrated: Phlugiolopsis trullis Bian, Shi & Chang, 2012, P. huangi Bian, Shi & Chang, 2012.
Characterization and genetic analysis of extensively drug-resistant hospital acquired Pseudomonas aeruginosa isolates
Authors: Abdelaziz Mai A. , El-Aziz Abeer M. Abd , El-Sokkary Mohamed M. A. , Barwa Rasha
Published: June 2024

Background

The incidence of hospital-acquired infections in extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide and is frequently associated with an increase in mortality and morbidity rates. The aim of this study was to characterize clinical XDR-PA isolates recovered during six months at three different hospitals in Egypt.

Results

Seventy hospital-acquired clinical isolates of P. aeruginosa were classified into multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR), according to their antimicrobial resistance profile. In addition, the possession of genes associated with mobile genetic elements and genes encoding antimicrobial resistance determinants among isolates were detected using polymerase chain reaction. As a result, a significant percentage of the isolates (75.7%) were XDR, while 18.5% were MDR, however only 5.7% of the isolates were non-MDR. The phenotypic detection of carbapenemases, extended-spectrum β-lactamases (ESBLs) and metallo β-lactamase (MBL) enzymes showed that 73.6% of XDR-PA isolates were carbapenemases producers, whereas 75.5% and 88.7% of XDR-PA isolates produced ESBLs and MBL respectively. In addition, PCR screening showed that oxa gene was the most frequently detected gene of carbapenemases (91.4%), while aac(6ʹ)-lb gene was mostly detected (84.3%) among the screened aminoglycosides-resistance genes. Furthermore, the molecular detection of the colistin resistance gene showed that 12.9% of isolates harbored mcr-1 gene. Concerning mobile genetic element markers (intI, traA, tnp513, and merA), intI was the highest detected gene as it was amplified in 67 isolates (95.7%). Finally, phylogenetic and molecular typing of the isolates via ERIC-PCR analysis revealed 10 different ERIC fingerprints.

Conclusion

The present study revealed a high prevalence of XDR-PA in hospital settings which were resistant to a variety of antibiotics due to several mechanisms. In addition, 98% of the XDR-PA clinical isolates contained at least one gene associated with movable genetic elements, which could have aided the evolution of these XDR-PA strains. To reduce spread of drug resistance, judicious use of antimicrobial agents and strict infection control measures are therefore essential.
Green synthesis of a dual-functional sulfur nanofertilizer to promote growth and enhance salt stress resilience in faba bean
Authors: Khalifa Asmaa M. , Safhi Fatmah A. , Elsherif Doaa E.
Published: June 2024

Background

Salinity is a major abiotic stress, and the use of saline water in the agricultural sector will incur greater demand under the current and future climate changing scenarios. The objective of this study was to develop a dual-functional nanofertilizer capable of releasing a micronutrient that nourishes plant growth while enhancing salt stress resilience in faba bean (Vicia faba L.).

Results

Moringa oleifera leaf extract was used to synthesize sulfur nanoparticles (SNPs), which were applied as a foliar spray at different concentrations (0, 25, 50, and 100 mg/l) to mitigate the negative effects of salt stress (150 mM NaCl) on faba bean plants. The SNPs were characterized and found to be spherical in shape with an average size of 10.98 ± 2.91 nm. The results showed that salt stress had detrimental effects on the growth and photosynthetic performance (Fv/Fm) of faba bean compared with control, while foliar spraying with SNPs improved these parameters under salinity stress. SNPs application also increased the levels of osmolytes (soluble sugars, amino acids, proline, and glycine betaine) and nonenzymatic antioxidants, while reducing the levels of oxidative stress biomarkers (MDA and H2O2). Moreover, SNPs treatment under salinity stress stimulated the activity of antioxidant enzymes (ascorbate peroxidase (APX), and peroxidase (POD), polyphenol oxidase (PPO)) and upregulated the expression of stress-responsive genes: chlorophyll a-b binding protein of LHCII type 1-like (Lhcb1), ribulose bisphosphate carboxylase large chain-like (RbcL), cell wall invertase I (CWINV1), ornithine aminotransferase (OAT), and ethylene-responsive transcription factor 1 (ERF1), with the greatest upregulation observed at 50 mg/l SNPs.

Conclusion

Overall, foliar application of sulfur nanofertilizers in agriculture could improve productivity while minimizing the deleterious effects of salt stress on plants. Therefore, this study provides a strong foundation for future research focused on evaluating the replacement of conventional sulfur-containing fertilizers with their nanoforms to reduce the harmful effects of salinity stress and enhance the productivity of faba beans.
Exogenous regulation of macronutrients promotes the accumulation of alkaloid yield in anisodus tanguticus (Maxim.) pascher
Authors: Liu Na , Chen Chen , Wang Bo , Wang Xiaoyun , Zhang Dengshan , Zhou Guoying
Published: June 2024

Background

Anisodus tanguticus (Maxim.) Pascher (A. tanguticus) is a valuable botanical for extracting tropane alkaloids, which are widely used in the pharmaceutical industry. Implementing appropriate cultivation methods can improve both the quality and yield of A. tanguticus. A two-year field experiment was conducted from 2021 to 2023 using a single-factor randomized complete block design replicated three times. The study examined the effects of different nutrient levels (nitrogen: 0, 75, 150, 225, 300, 375 kg/ha; phosphorus: 0, 600, 750, 900, 1050, 1200 kg/ha; potassium: 0, 75, 112.5, 150, 187.5, 225 kg/ha) on the growth, primary alkaloid contents, and alkaloid yield of A. tanguticus at different growth stages (S-Greening, S-Growing, S-Wilting; T-Greening, T-Growing, and T-Wilting) in both the roots and aboveground portions.

Results

Our results demonstrate that nutrient levels significantly affect the growth and alkaloid accumulation in A. tanguticus. High nitrogen levels (375 kg/ha) notably increased both root and aboveground biomass, while phosphorus had a minimal effect, especially on aboveground biomass. For alkaloid content (scopolamine, anisodamine, anisodine, atropine), a moderate nitrogen level (225 kg/ha) was most effective, followed by low potassium (75 kg/ha), with phosphorus showing a limited impact. Increased phosphorus levels led to a decrease in scopolamine content. During the T-Growing period, moderate nitrogen addition (225 kg/ha) yielded the highest alkaloid levels per unit area (205.79 kg/ha). In the T-Wilting period, low potassium (75 kg/ha) and low phosphorus (750 kg/ha) resulted in alkaloid levels of 146.91 kg/ha and 142.18 kg/ha, respectively. This indicates nitrogen has the most substantial effect on alkaloid accumulation, followed by potassium and phosphorus. The Douglas production function analysis suggests focusing on root biomass and the accumulation of scopolamine and atropine in roots to maximize alkaloid yield in A. tanguticus cultivation.

Conclusions

Our findings show that the optimum harvesting period for A. tanguticus is the T-Wilting period, and that the optimal nitrogen addition is 225 kg/ha, the optimal potassium addition is 75 kg/ha, and the optimal phosphorus addition is 600 kg/ha or less.
Dexmedetomidine ameliorates x-ray-induced myocardial injury via alleviating cardiomyocyte apoptosis and autophagy
Authors: Zhang Runze , Xie Kangjie , Lian Yanhong , Hong Shufang , Zhu Yuntian
Published: June 2024

Background

Radiotherapy is a primary local treatment for tumors, yet it may lead to complications such as radiation-induced heart disease (RIHD). Currently, there is no standardized approach for preventing RIHD. Dexmedetomidine (Dex) is reported to have cardio-protection effects, while its role in radiation-induced myocardial injury is unknown. In the current study, we aimed to evaluate the radioprotective effect of dexmedetomidine in X-ray radiation-treated mice.

Methods

18 male mice were randomized into 3 groups: control, 16 Gy, and 16 Gy + Dex. The 16 Gy group received a single dose of 16 Gy X-ray radiation. The 16 Gy + Dex group was pretreated with dexmedetomidine (30 µg/kg, intraperitoneal injection) 30 min before X-ray radiation. The control group was treated with saline and did not receive X-ray radiation. Myocardial tissues were collected 16 weeks after X-ray radiation. Hematoxylin-eosin staining was performed for histopathological examination. Terminal deoxynucleotidyl transferase dUTP nick-end labeling staining was performed to assess the state of apoptotic cells. Immunohistochemistry staining was performed to examine the expression of CD34 molecule and von Willebrand factor. Besides, western blot assay was employed for the detection of apoptosis-related proteins (BCL2 apoptosis regulator and BCL2-associated X) as well as autophagy-related proteins (microtubule-associated protein 1 light chain 3, beclin 1, and sequestosome 1).

Results

The findings demonstrated that 16 Gy X-ray radiation resulted in significant changes in myocardial tissues, increased myocardial apoptosis, and activated autophagy. Pretreatment with dexmedetomidine significantly protects mice against 16 Gy X-ray radiation-induced myocardial injury by inhibiting apoptosis and autophagy.

Conclusion

In summary, our study confirmed the radioprotective effect of dexmedetomidine in mitigating cardiomyocyte apoptosis and autophagy induced by 16 Gy X-ray radiation.
Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis
Authors: Khazaei Afshin , Afshari Ali , Salimi Rasoul , Fattahi Abbas , Imani Behzad , Torabi Mohammad
Published: June 2024

Background

Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers.

Methods

This study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45–60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman’s conventional content analysis approach.

Results

The analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses.

Conclusions

The results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.
Multi-level factors linked to young adult primary care transitions: evidence from a state all-payer claims analysis
Authors: Nowak Sarah A. , Reblin Maija , Fung Mark , Turley Chelsea , Threlkeld Kirsten
Published: June 2024

Objective

Delayed transitions from pediatric to adult primary care leads to gaps in medical care. State all-payer claims data was used to assess multilevel factors associated with timely transition from pediatric to adult primary care.

Materials and methods

We created a cohort of 4,320 patients aged 17–20 in 2014–2017 continuously enrolled in health insurance 36 months between 2014 and 2019 and attributed to a pediatric provider in months 1–12. We also constructed primary care provider networks identifying links between providers who saw members of the same family. Logistic regression was used to predict adult primary care in months 25–36 on family, provider, and county-level factors. Finally, we modeled the effect of county and network cluster membership on care transitions.

Results

Male sex, having another family member seeing a pediatrician, and residing in a county with high pediatric care capacity or low adult primary care capacity were associated with lower odds of adult primary care transition.

Discussion

We investigated factors associated with successful transitions from pediatric to adult primary care. Family ties to a pediatrician and robust county capacity to provide primary care to children were associated with non-transition to adult primary care.

Conclusion

Multiple level factors contribute to non-transition to adult primary care. Understanding the factors associated with appropriate transition can help inform state and national policy.
Vaccination intentions of hypertensive Chinese individuals during the COVID-19 epidemic: a structural equation modeling study
Authors: Lei Zhi , Liu Dongyang , Li Minghui , Xian Deqiang , Fan Song
Published: June 2024

Objective

Given the high prevalence of hypertension among Chinese adults, this population is at a significantly increased risk of severe COVID-19 complications. The purpose of this study is to assess the willingness of Chinese hypertensive adults to receive the COVID-19 vaccine and to identify the diverse factors that shape their vaccination decisions.

Methods

Sampling was conducted utilizing multistage stratified random sampling, and ultimately, a total of 886 adult hypertensive patients from Luzhou City in Southwest China were included in this study. The questionnaire design was based on the Theory of Planned Behaviour and was used to investigate their willingness to be vaccinated with COVID-19. Structural equation modeling was employed for data analysis.

Results

The results showed that 75.6% of hypertensive individuals were willing to receive COVID-19 vaccination. The structural equation modeling revealed that Subjective Norms (path coefficient = 0.361, CR = 8.049, P < 0.001) and Attitudes (path coefficient = 0.253, CR = 4.447, P < 0.001) had positive effects on vaccination willingness, while Perceived Behavioral Control (path coefficient=-0.004, CR=-0.127, P = 0.899) had no significant impact on Behavioral Attitudes. Mediation analysis indicated that Knowledge (indirect path coefficient = 0.032, LLCI = 0.014, ULCI = 0.058), Risk Perception (indirect path coefficient = 0.077, LLCI = 0.038, ULCI = 0.124), and Subjective Norms (indirect path coefficient = 0.044, LLCI = 0.019, ULCI = 0.087) significantly influenced vaccination willingness through Attitudes as a mediating factor.

Conclusion

The willingness of hypertensive individuals to receive the COVID-19 vaccination is not satisfactory. The Theory of Planned Behavior provides valuable insights into understanding their vaccination intentions. Efforts should be concentrated on enhancing the subjective norms, attitudes, and knowledge about vaccination of hypertensive patients.
The Concept of Stroma AReactive Invasion Front Areas (SARIFA) as a new prognostic biomarker for lipid-driven cancers holds true in pancreatic ductal adenocarcinoma
Authors: Grochowski Przemyslaw , Grosser Bianca , Sommer Florian , Probst Andreas , Waidhauser Johanna , Schenkirsch Gerhard , Reitsam Nic G. , Märkl Bruno
Published: June 2024

Background

Pancreatic ductal adenocarcinoma (PDAC) is a ‘difficult-to-treat’ entity. To forecast its prognosis, we introduced a new biomarker, SARIFA (stroma areactive invasion front areas), which are areas at the tumour invasion front lacking desmoplastic stroma reaction upon malignant invasion in the surrounding tissue, leading to direct contact between tumour cells and adipocytes. SARIFA showed its significance in gastric and colorectal carcinoma, revealing lipid metabolism alternations that promote tumour progression.

Methods

We reviewed the SARIFA status of 166 PDAC cases on all available H&E-stained tumour slides from archival Whipple-resection specimens. SARIFA positivity was defined as SARIFA detection in at least 66% of the available slides. To investigate alterations in tumour metabolism and microenvironment, we performed immunohistochemical staining for FABP4, CD36 and CD68. To verify and quantify a supposed delipidation of adipocytes, adipose tissue was digitally morphometrised.

Results

In total, 53 cases (32%) were classified as SARIFA positive and 113 (68%) as SARIFA negative. Patients with SARIFA-positive PDAC showed a significantly worse overall survival compared with SARIFA-negative cases (median overall survival: 11.0 months vs. 22.0 months, HR: 1.570 (1.082–2.278), 95% CI, p = 0.018), which was independent from other prognostic markers (p = 0.014). At the invasion front of SARIFA-positive PDAC, we observed significantly higher expression of FABP4 (p < 0.0001) and higher concentrations of CD68+ macrophages (p = 0.031) related to a higher risk of tumour progression. CD36 staining showed no significant expression differences. The adipocyte areas at the invasion front were significantly smaller, with mean values of 4021 ± 1058 µm2 and 1812 ± 1008 µm2 for the SARIFA-negative and -positive cases, respectively (p < 0.001).

Conclusions

SARIFA is a promising prognostic biomarker for PDAC. Its assessment is characterised by simplicity and low effort. The mechanisms behind SARIFA suggest a tumour-promoting increased lipid metabolism and altered immune background, both showing new therapeutic avenues.
Comparison of the diagnostic value of various microRNAs in blood for colorectal cancer: a systematic review and network meta-analysis
Authors: Xu Jianhao , Pan Lanfen , Wu Dan , Yao Liqian , Jiang Wenqian , Min Jiarui , Xu Song , Deng Zhiyong
Published: June 2024

Background

Despite the existence of numerous studies investigating the diagnostic potential of blood microRNAs for colorectal cancer, the microRNAs under consideration vary widely, and comparative analysis of their diagnostic value is lacking. Consequently, this systematic review aims to identify the most effective microRNA blood tumor markers to enhance clinical decision-making in colorectal cancer screening.

Method

A comprehensive search of databases, including PubMed, Embase, Web of Science, Scopus, and Cochrane, was conducted to identify case‒control or cohort studies that examined the diagnostic value of peripheral blood microRNAs in colorectal cancer. Studies were included if they provided sensitivity and specificity data, were published in English and were available between January 1, 2000, and February 10, 2023. The Critical Appraisal Skills Programme (CASP) checklist was employed for quality assessment. A Bayesian network meta-analysis was performed to estimate combined risk ratios (RRs) and 95% confidence intervals (CIs), with results presented via rankograms. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202,380,092.

Results

From an initial pool of 2254 records, 79 met the inclusion criteria, encompassing a total of 90 microRNAs. The seven most frequently studied microRNAs (43 records) were selected for inclusion, all of which demonstrated moderate to high quality. miR-23, miR-92, and miR-21 exhibited the highest sensitivity and accuracy, outperforming traditional tumor markers CA19-9 and CEA in terms of RR values and 95% CI for both sensitivity and accuracy. With the exception of miR-17, no significant difference was observed between each microRNA and CA19-9 and CEA in terms of specificity.

Conclusions

Among the most extensively researched blood microRNAs, miR-23, miR-92, and miR-21 demonstrated superior diagnostic value for colorectal cancer due to their exceptional sensitivity and accuracy. This systematic review and network meta-analysis may serve as a valuable reference for the clinical selection of microRNAs as tumor biomarkers.
Satisfaction of lecturers and undergraduate students of medical faculties in Indonesia towards online anatomy learning during COVID-19 pandemic
Authors: Liem Isabella Kurnia , Fatril Ayu Eka , Husna Firda Asma’ul
Published: June 2024

The changing of education activities (offline into online) to reduce coronavirus transmission during COVID-19 pandemi has influence on the learning strategies, which ultimately might impact the achievement of learning objectives. Therefore, we conducted a cross-sectional study using a valid (p < 0.01; two-tailed Pearson correlation) and reliable (r = 0.878 and r = 0.849; Cronbach Alpha) online questionnaire to evaluate the perspectives of human anatomy lecturers and undergraduate medical students in Indonesia in implementing the online anatomy learning. We also explored their expectations and preferred learning methods after COVID-19 pandemic. Using purposive sampling, 467 respondents, which consisted of 66 lecturers from 41 universities in six islands (Java, Sumatera, Kalimantan, Sulawesi, Nusa Tenggara and Papua) and 401 students from 19 universities in four islands (Java, Sumatera, Kalimantan, Papua) were recruited. A Chi-square test was used to analyze the differences in categorical variables. The lecturers (74.2%) and students (63.1%) agreed that online learning effectively delivered the course material (p = 0.095). They (69.7% lecturers and 57.9% students) also agreed that learning time allocation was sufficient (p = 0.079); moreover, lecturers (53%) and students (56.1%) had good interaction (p = 0.689). Nevertheless, 56.1% lecturers and 63.3% students had problem during online practical sessions. They had different perspectives about issues during online classes (69.7% vs 36.4%; p < 0.01), motivation improvement (72.7% vs 37.4%; p < 0.01), and time management (87.9% vs 58.4%; p < 0.01). According to the location of the university, especially in the student's side, students in Java had higher proportion in the two aspects, i.e. learning material (p < 0.01) and lecturer-student interaction (p < 0.01), and had lower proportion in the problems during online class (p = 0.003) and practical sessions (p = 0.008). Majority of the respondents (62,2% lecturers in Java, 71.4% lecturers outside Java, 79.6% Students in Java, and 76.6% students outside Java) preferred the use of blended learning after the pandemic (new normal era) and expected to continue the cadaveric practical sessions (82.2% lecturers in Java, 81.0% lecturers outside Java, 91.1% students in Java, and 78.3% students outside Java). In conclusion, the study showed that the satisfaction toward online anatomy learning related to the subject’s role (lecturer or student) and the university region in some aspects.
Comparative accuracy of ChatGPT-4, Microsoft Copilot and Google Gemini in the Italian entrance test for healthcare sciences degrees: a cross-sectional study
Authors: Rossettini Giacomo , Rodeghiero Lia , Corradi Federica , Cook Chad , Pillastrini Paolo , Turolla Andrea , Castellini Greta , Chiappinotto Stefania , Gianola Silvia , Palese Alvisa
Published: June 2024

Background

Artificial intelligence (AI) chatbots are emerging educational tools for students in healthcare science. However, assessing their accuracy is essential prior to adoption in educational settings. This study aimed to assess the accuracy of predicting the correct answers from three AI chatbots (ChatGPT-4, Microsoft Copilot and Google Gemini) in the Italian entrance standardized examination test of healthcare science degrees (CINECA test). Secondarily, we assessed the narrative coherence of the AI chatbots’ responses (i.e., text output) based on three qualitative metrics: the logical rationale behind the chosen answer, the presence of information internal to the question, and presence of information external to the question.

Methods

An observational cross-sectional design was performed in September of 2023. Accuracy of the three chatbots was evaluated for the CINECA test, where questions were formatted using a multiple-choice structure with a single best answer. The outcome is binary (correct or incorrect). Chi-squared test and a post hoc analysis with Bonferroni correction assessed differences among chatbots performance in accuracy. A p-value of < 0.05 was considered statistically significant. A sensitivity analysis was performed, excluding answers that were not applicable (e.g., images). Narrative coherence was analyzed by absolute and relative frequencies of correct answers and errors.

Results

Overall, of the 820 CINECA multiple-choice questions inputted into all chatbots, 20 questions were not imported in ChatGPT-4 (n = 808) and Google Gemini (n = 808) due to technical limitations. We found statistically significant differences in the ChatGPT-4 vs Google Gemini and Microsoft Copilot vs Google Gemini comparisons (p-value < 0.001). The narrative coherence of AI chatbots revealed “Logical reasoning” as the prevalent correct answer (n = 622, 81.5%) and “Logical error” as the prevalent incorrect answer (n = 40, 88.9%).

Conclusions

Our main findings reveal that: (A) AI chatbots performed well; (B) ChatGPT-4 and Microsoft Copilot performed better than Google Gemini; and (C) their narrative coherence is primarily logical. Although AI chatbots showed promising accuracy in predicting the correct answer in the Italian entrance university standardized examination test, we encourage candidates to cautiously incorporate this new technology to supplement their learning rather than a primary resource.

Trial registration

Not required.
Virtual platform to tackle challenges associated with lifelong medical education during the COVID-19 pandemic
Authors: Ko Sang-Hun , Park Ki-Bong , Cha Jae-Ryong , Jeon Young-Dae , Kim Sang-Gon
Published: June 2024

Background

During the COVID-19 pandemic, large in-person conferences were mostly cancelled to avoid further disease contagion. Physicians continued to demand changes in form to enable participation in lifelong medical education programs, and the traditional model of in-person conferences needed to be rethought. As such, a regional branch of the national orthopedic association tried to move in-person conferences onto a virtual platform. This study aimed to investigate the effect of transitioning large in-person conferences to a virtual model during the COVID-19 pandemic, especially examining any differences in the attendance of each type of conference.

Methods

In this retrospective observational study, 776 participants in virtual conferences and 575 participants in in-person conferences were analyzed. Institutions were classified based on their location in a central city and two neighboring cities. Affiliated institutions were divided into resident training hospitals, general hospitals, and private clinics. The change in the number and proportion of participants between the virtual conference year and in-person conference year was calculated.

Results

The number of virtual conference participants was significantly greater than that of in-person conference participants (P = 0.01). Although the highest number of participants was from central city for both years, the proportion of participants from the two neighboring cities increased. Although the proportion of participants from resident training hospitals and private clinics decreased, the proportion of participants from general hospitals increased.

Conclusions

We implemented a virtual platform to tackle challenges associated with lifelong medical education during the COVID-19 pandemic. The virtual platforms can be helpful for organizations that must hold regular lifelong medical education programs for members spread across a wide geographic region.
Identifying obesogenic environment through spatial clustering of body mass index among adults
Authors: Wong Kimberly Yuin Y’ng , Moy Foong Ming , Shafie Aziz , Rampal Sanjay
Published: June 2024

Background

The escalating trend of obesity in Malaysia is surmounting, and the lack of evidence on the environmental influence on obesity is untenable. Obesogenic environmental factors often emerge as a result of shared environmental, demographic, or cultural effects among neighbouring regions that impact lifestyle. Employing spatial clustering can effectively elucidate the geographical distribution of obesity and pinpoint regions with potential obesogenic environments, thereby informing public health interventions and further exploration on the local environments. This study aimed to determine the spatial clustering of body mass index (BMI) among adults in Malaysia.

Method

This study utilized information of respondents aged 18 to 59 years old from the National Health and Morbidity Survey (NHMS) 2014 and 2015 at Peninsular Malaysia and East Malaysia. Fast food restaurant proximity, district population density, and district median household income were determined from other sources. The analysis was conducted for total respondents and stratified by sex. Multilevel regression was used to produce the BMI estimates on a set of variables, adjusted for data clustering at enumeration blocks. Global Moran’s I and Local Indicator of Spatial Association statistics were applied to assess the general clustering and location of spatial clusters of BMI, respectively using point locations of respondents and spatial weights of 8 km Euclidean radius or 5 nearest neighbours.

Results

Spatial clustering of BMI independent of individual sociodemographic was significant (p < 0.001) in Peninsular and East Malaysia with Global Moran’s index of 0.12 and 0.15, respectively. High-BMI clusters (hotspots) were in suburban districts, whilst the urban districts were low-BMI clusters (cold spots). Spatial clustering was greater among males with hotspots located closer to urban areas, whereas hotspots for females were in less urbanized areas.

Conclusion

Obesogenic environment was identified in suburban districts, where spatial clusters differ between males and females in certain districts. Future studies and interventions on creating a healthier environment should be geographically targeted and consider gender differences.
Access to and acceptability of sexual and reproductive health, harm reduction and other essential health services among people who inject drugs in Durban, South Africa
Authors: Milford Cecilia , Cavanagh Tammany , Bosman Shannon , Wilson Michael , Smit Jennifer , Zanoni Brian
Published: June 2024

Background

People who inject drugs (PWID) are at risk of HIV acquisition. The number of PWID in South African cities is increasing, and in spite of an advanced HIV prevention and treatment programme, there are PWID who experience challenges accessing sexual and reproductive health (SRH) and HIV related services. Access to and acceptability of SRH and harm reduction services by PWID needs to be further understood and explored.

Methods

In-depth interviews (IDIs) were conducted with 10 key stakeholders and 11 PWID, in Durban, South Africa. Interviews were transcribed and translated. Data were thematically analysed using Dedoose software.

Results

Participants described stigma/discrimination from healthcare workers and other clients accessing services as barriers to accessing healthcare services. They were concerned about long waiting times at healthcare facilities because of possibilities of withdrawal, as well as lost opportunities to “hustle”. Targeted, non-discriminatory services, as well as mobile clinics existed in the city. Non-governmental organisations reportedly worked together with the public sector, facilitating access to HIV and TB prevention and treatment services. There were also needle exchange programmes and a harm reduction clinic in the city. However, there was limited access to contraceptive and STI services. Although there was reportedly good access to HIV and TB and harm reduction services in the city of Durban, uptake was low.

Conclusions

The integration of services to enable PWID to access different services under one roof is critical. There is also a need to strengthen linkages between public and private healthcare, and ensure services are provided in a non-discriminatory environment. This will facilitate uptake and access to more comprehensive SRH and harm reduction services for PWID in Durban, South Africa.
Empowerment of Italian general practitioners in depression and suicide prevention: the iFightDepression tool, a game changer of the EAAD-Best project
Authors: Vargiu Nuhara , Belfanti Aurora , Roberti Michela , Trentin Serena , Ferrara Camilla , Tosti Manuela , Lazzeri Marco , Giupponi Giancarlo , Conca Andreas
Published: June 2024

General Practitioners (GPs) play a key role in the early detection and management of depression and in preventing suicide risk. They are often the first healthcare professionals that people in crisis contact. However, their effectiveness can be limited by several barriers, including the lack of specific training and appropriate tools.

The EAAD-Best project aims to fill these gaps through its iFightDepression tool, an online tool designed to support patients, psychologists, psychiatrists, and GPs in managing depression and preventing suicide. This article examines the implementation of the iFightDepression platform in Italy, assessing its impact on the empowerment of GPs in the fight against depression. Through a qualitative and quantitative analysis of the data collected by the project, the ‘unmet need’ of GPs’ in Italy regarding their specific training in mental health is highlighted.

The response of 2,068 Italian GPs in just 7 months after the start of the iFD project is an expression of GPs’ engagement to work against depression and for suicide risk prevention.