bluuebunny/crossref_metadata_2025 huggingface dataset:
A Protocol for a Mixed Methods, Single-Arm, Hybrid Effectiveness-Implementation Trial Evaluating a 12-week Yoga Intervention Delivered by Videoconference for Young Adults Diagnosed With Cancer
Authors: Wurz Amanda , McLaughlin Emma , Janzen Anna , Cripps Hannah , Huang Longlong , Molina Heather , Cowley Lauren , Dreger Julianna , Culos-Reed S. Nicole , Quinn Kaitlyn , Currey in memory of Lisa , Pacelli Maria-Hélèna , Coombs Melissa , Shamshad Sundas
Published: December 2024

Background

Cancer among young adults (18-39 years) is relatively rare, but remains a leading cause of disability, morbidity, and mortality. Identifying strategies to support young adults’ health following a diagnosis of cancer is important. Yoga may enhance health and could be delivered by videoconference. However, little research exploring yoga, and no research exploring videoconference delivery of yoga has been conducted with this cohort. We worked with young adults affected by cancer and developed, piloted, and refined a yoga intervention delivered by videoconference.

Objective

To evaluate our yoga intervention in a full-scale, mixed methods, single-arm, hybrid effectiveness-implementation trial.

Methods

Young adults 18 years or older, diagnosed with cancer between the ages of 18-39 years of age, and at any stage along the cancer trajectory are eligible. Participants receive 2 yoga classes/week over 12-weeks by videoconference and complete assessments at baseline, post-intervention, and 6- and 12-month follow-ups. Assessments include self-reported questionnaires (ie, stress, yoga barriers, physical activity behaviour, fatigue, cognition, cancer-related symptoms, general health, health-related quality of life, self-compassion, mindfulness, group identification), physical assessments (ie, aerobic endurance, flexibility, range of motion, balance, functional mobility), and a semi-structured interview (post-intervention only; exploring perceptions of acceptability, feasibility, and experiences). Quality improvement cycles occur every 6 months. Repeated measures analysis of variance will be conducted to explore effectiveness, descriptive statistics and responder/non-responder analyses will be used to explore implementation, and qualitative interview data, analyzed using content analysis and reflexive thematic analysis, will bolster effectiveness and implementation findings.

Discussion

As the first full-scale trial to evaluate yoga delivered by videoconference for this cohort, findings will make substantial contributions to young adults' supportive cancer care.

Conclusion

This protocol, reporting on yoga delivered by videoconference for young adults diagnosed with cancer, will enhance transparency and reproducibility and provide a reference for forthcoming trial results.

Trial registration

NCT05314803 at clinicaltrials.gov .
Counter-practices: Understanding sensor datafication through subversive action
Authors: Borbach Christoph , Kanderske Max
Published: December 2024

Sensors have become embedded in all kinds of environments. Their ubiquity has prompted a boom in scholarly engagement centered around the effects of digitally interconnected sensor media and the data traces they ceaselessly produce. This research generally focuses either on theoretical or philosophical macro-perspectives—approaching the topic “from above,” so to speak—or it is ethnographic, “from below,” analyzing the practices of sensory (self-)surveillance, for example in the context of the quantified self-movement. In this article, we propose a situated, praxeological approach that combines both foci: expanding on the epistemically productive concepts of glitches and breakdowns, we follow three strands of what we call “counter-practices”—hiding in plain sight, dis/simulation, and the exploitation of sensor logics—through which we explore the inherent operations of technological sensing and sensemaking. We trace these counter-practices through historic and recent contexts, considering the interrelation of bodies, media and environments, and extrapolating epistemological conclusions that are meaningful for critiquing the codes, logics, and logistics of recent sensor-media societies. Asking how certain practices elude and subvert intended processes of sensor datafication provides a methodological blueprint for media studies and cultural theory that are faced with an algorithmic and technological situation that has rendered itself largely unobservable.
Impact of clinical factors on accuracy of ovarian cancer detection via platelet RNA profiling
Authors: Jopek Maksym A. , Sieczczyński Michał , Pastuszak Krzysztof , Łapińska-Szumczyk Sylwia , Jassem Jacek , Żaczek Anna J. , Rondina Matthew T. , Supernat Anna
Published: December 2024

Ovarian cancer (OC) presents a diagnostic challenge, often resulting in poor patient outcomes. Platelet RNA sequencing, which reflects host response to disease, shows promise for earlier OC detection. This study examines the impact of sex, age, platelet count, and the training on cancer types other than OC on classification accuracy achieved in the previous platelet-alone training data set. A total of 339 samples from healthy donors and 1396 samples from patients with cancer, spanning 18 cancer types (including 135 OC cases) were analyzed. Logistic regression was applied to verify our classifiers’ performance and interpretability. Models were tested at 100% specificity and 100% sensitivity levels. Incorporating patient age as an additional feature along with gene expression increased sensitivity from 68.6% to 72.6%. Models trained on data from both sexes and on female-only data achieved a sensitivity of 68.6% and 74.5%, respectively. Training solely on OC data reduced late-stage sensitivity from 69.1% to 44.1% but increased early-stage sensitivity from 66.7% to 69.7%. This study highlights the potential of platelet RNA profiling for OC detection and the importance of clinical variables in refining classification accuracy. Incorporating age with gene expression data may enhance OC diagnostic accuracy. The inclusion of male samples deteriorates classifier performance. Data from diverse cancer types improves advanced cancer detection but negatively affects early-stage diagnosis.
Genome-wide CRISPR/Cas9 screen identifies AraC-daunorubicin-etoposide response modulators associated with outcomes in pediatric AML
Authors: Nguyen Nam H. K. , Rafiee Roya , Parcha Phani K. , Tagmount Abderrahmane , Rubnitz Jeffrey , Ribeiro Raul , Cao Xueyuan , Pounds Stanley B. , Vulpe Christopher D. , Lamba Jatinder K.
Published: December 2024

Cytarabine, daunorubicin, and etoposide (ADE) have been the standard backbone of induction chemotherapy regimen for patients with pediatric acute myeloid leukemia (pAML) for >5 decades. However, chemoresistance is still a major concern, and a significant proportion of pAML becomes resistant to ADE treatment and relapse, leading to poor survival. Therefore, there is a considerable need to identify mechanisms mediating drug resistance for overcoming chemoresistance. Herein, we performed synthetic lethal CRISPR/Cas9 screens using the ADE components to identify response markers. We further integrated significant markers in 3 independent pAML clinical cohorts treated with only an ADE regimen to identify drug response biomarkers with prognostic significance. We were able to identify several mediators that represent clinically and biologically significant marker genes for ADE treatment, such as BCL2, CLIP2, and VAV3, which are resistant markers to ADE, with high expression associated with poor outcomes in pAML treated with ADE, and GRPEL1, HCFC1, and TAF10, which are sensitive markers to ADE, with high expression showing beneficial outcomes. Notably, BCL2, CLIP2, and VAV3 knockdowns in their expression in AML cell lines sensitized the cells more to the ADE components, suggesting that these modulators should be further studied as potential therapeutic targets to overcome chemoresistance.
Microplastic contamination in Czech drinking water: insights from comprehensive monitoring
Authors: Halfar Jan , Heviánková Silvie , Brožová Kateřina , Čabanová Kristina , Valigůrová Alice , Motyka Oldřich
Published: December 2024

The growth of global plastic production and the associated increase in microplastic pollution in the environment has attracted increasing attention from both scientists and the general public. Drinking water from public water supply systems is essential for human life and therefore ensuring its high quality is a priority. The aim of this study was to detect and identify microplastics in drinking water from public water supply systems. Water samples were collected from various locations across the Czech Republic during two sampling campaigns in 2021 and 2023. A total of 58 samples and 580 particles were analyzed using μ-FTIR (micro-Fourier-transform infrared spectroscopy). These particles were categorized by material, shape, color, and quantity. Of the analyzed particles, 196 were identified as microplastics. Except for one sample, where no microplastics were detected, the concentration ranged from 20 to 180 microplastics per liter during the first campaign and from 20 to 120 microplastics per liter in the second campaign. In the first campaign, fibers and transparent microplastics were predominantly detected, while in the second collection, fragments and blue microplastics were more common. The most frequently observed materials were paper with polyethylene coating, polyethylene terephthalate (PET), and polyester (PES). This study also provides data on the average daily intake of microplastics via drinking water, calculated as 2 and 2.1 MP/kg/day, with all results undergoing statistical evaluation. Furthermore, the study addresses new European legislation and the proposed standardized methodology, which represents a significant step toward achieving consistent results across studies and, upon its adoption, will likely influence the direction of research on microplastics in drinking water. However, as discussed in the study, the methodology contains several problematic aspects, which are elaborated upon. With the planned inclusion of microplastics on the EU list of substances to be monitored, it is essential to continue research and collect more data. This study confirms the presence of microplastics and provides detailed information on their characteristics in drinking water supplied by public water systems in the Czech Republic.

Highlights

Two drinking water sampling campaigns were carried out.

Microplastics were found in 57 out of 58 analyzed drinking water samples.

The average MP concentrations in two campaigns amounted 68.3 and 65 MP/L.

Material, shape, and color of all detected microplastics were identified.

Average daily MP intake via drinking water was calculated as 2 and 2.1 MP/kg/day.

Graphical abstract
Characterising the metabolic functionality of the preterm neonatal gut microbiome prior to the onset of necrotising enterocolitis: a pilot study
Authors: Chapman Jonathan A. , Wroot Emily , Brown Toby , Beck Lauren C. , Embleton Nicholas D. , Berrington Janet E. , Stewart Christopher J.
Published: December 2024

Background

Necrotising enterocolitis (NEC) is a devastating bowel disease that primarily occurs in infants born prematurely and is associated with abnormal gut microbiome development. While gut microbiome compositions associated with NEC have been well studied, there is a lack of experimental work investigating microbiota functions and their associations with disease onset. The aim of this pilot study was to characterise the metabolic functionality of the preterm gut microbiome prior to the onset of NEC compared with healthy controls.

Results

Eight NEC infants were selected of median gestation 26.5 weeks and median day of life (DOL) of NEC onset 20, with one sample used per infant, collected within one to eight days (median four) before NEC onset. Each NEC case was matched to a control infant based on gestation and sample DOL, the main driver of microbiome composition in this population, giving a total cohort of 16 infants for this study. Dietary exposures were well matched. The microbiota of NEC and control infants showed similar wide-ranging metabolic functionalities. All 94 carbon sources were utilised to varying extents but NEC and control samples clustered separately by supervised ordination based on carbon source utilisation profiles. For a subset of eight samples (four NEC, four control) for which pre-existing metagenome data was available, microbiome composition was found to correlate significantly with metabolic activity measured on Biolog plates (p = 0.035). Comparisons across all 16 samples showed the NEC microbiota to have greater utilisation of carbon sources that are the products of proteolytic fermentation, specifically amino acids. In pairwise comparisons, L-methionine was highly utilised in NEC samples, but poorly utilised in controls (p = 0.043). Carbon sources identified as discriminatory for NEC also showed a greater enrichment for established markers of inflammatory disease, such as inflammatory bowel disease, irritable bowel syndrome and diverticular disease.

Conclusions

Before NEC onset, the preterm gut microbiota showed greater metabolic utilisation of amino acids, potentially indicating a shift from predominantly saccharolytic to proteolytic fermentation. Products of amino acid breakdown could therefore act as biomarkers for NEC development. A larger study is warranted, ideally with infants from multiple sites.
Safflower CtFT genes orchestrating flowering time and flavonoid biosynthesis
Authors: Li Zhiling , Yu Lili , Umar Abdul Wakeel , Wang Jiaruo , Zhang Jian , Wang Nan , Zhang Min , Yao Na , Ahmad Naveed , Liu Xiuming
Published: December 2024

Background

Safflower thrives in dry environments but faces difficulties with flowering in wet and rainy summers. Flavonoids play a role in flower development and can potentially alleviate these challenges. Furthermore, the FLOWERING LOCUS T (FT) family of phosphatidylethanolamine-binding protein (PEBP) genes play a crucial role in the photoperiodic flowering pathway. However, their direct impact on flowering and flavonoid biosynthesis under different light duration is elusive.

Results

Utilizing the genome sequencing of Safflower (Jihong NO.1), the current study identifies three specific genes (CtFT1, CtFT2, and CtFT3) that exhibit upregulation in response to long-day conditions. The overexpression of CtFT2, displayed an early, whereas CtFT1 and CtFT3 late flowering phenotype in Arabidopsis thaliana. Interestingly, the transient overexpression of CtFT1 in safflower leaves caused early flowering, while overexpressing CtFT2 and CtFT3 led to late flowering. Additionally, overexpressing CtFT3 in Arabidopsis and CtFT1, CtFT2, and CtFT3 in safflower leaves, significantly increased flavonoid synthesis.

Conclusions

These findings showed that overexpression of CtFT genes could affect the flowering time and significantly increase the flavonoid content of safflower. The function of CtFT gene is different in safflower and Arabidopsis. This study provides valuable insights into the role of CtFT genes in flower formation and flavonoid synthesis in safflower, which may help in improving safflower breeding quality and its adaptability to diverse environmental conditions.
Genome-wide analysis of the cotton COBRA-like gene family and functional characterization of GhCOBL22 in relation to drought tolerance
Authors: Fu Wan-wan , Wang Zi-Yu , Liusui Yun-Hao , Zhang Xin , Han Ai-Xia , Zhong Xing-Yue , Zhang Jing-Bo , Guo Yan-Jun
Published: December 2024

Background

The COBRA-like (COBL) gene family is a crucial glycosylphosphatidylinositol (GPI)-anchored proteins that participate in various biological processes in plants by regulating the arrangement of cell wall microfibrils. While the functions of COBL genes have been analyzed in several plant species, their roles in cotton’s response to abiotic stress remain unexplored.

Results

This study identified and characterized the COBL gene family in Gossypium hirsutum, revealing a total of 39 COBL family members classified into five subgroups. Transcriptome analysis indicated that the transcription levels of several GhCOBL genes were upregulated following PEG treatment, with GhCOBL22 being significantly induced. Further silencing of the GhCOBL22 gene through virus-induced gene silencing (VIGS) technology demonstrated that this gene’s silencing reduced cotton’s drought stress tolerance. Under drought stress conditions, the activities of superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) enzymes, along with proline (PRO) content, were lower in GhCOBL22-silenced plants compared to control plants, while the accumulation of malondialdehyde (MDA) was significantly higher. Moreover, silencing the GhCOBL22 gene also led to reductions in the levels of cellulose, hemicellulose, and lignin content in cotton leaves.

Conclusion

A systematic survey of gene structure, motif composition, and evolutionary relationships of the COBL gene family was conducted in Gossypium hirsutum. Subsequent expression and functional studies indicated that GhCOBL22 plays a significant role in cotton’s drought tolerance. These findings enhance our understanding of the biological functions of the COBL family and highlight the critical role of the GhCOBL22 gene in cotton’s response to drought stress.
Trans-bronchial forceps biopsy for COVID-19 related diffuse parenchymal lung abnormalities
Authors: Kleymann Janina , Brückmann Sascha , Langner Simona , Koschel Dirk , Kolditz Martin
Published: December 2024

Purpose

The role of lung biopsy for evaluation of persistent chest radiographic abnormalities including secondary organizing pneumonia (OP) in COVID-19 remains uncertain. This study aimed to evaluate the diagnostic value of trans-bronchial forceps biopsy (TBFB) in patients with persistent lung abnormalities on thoracic computed tomography (CT) scan following SARS-CoV-2 infection with particular focus on cases with OP and immunocompromised (IC) patients.

Methods

Descriptive retrospective single center analysis of all TBFB performed for diffuse lung parenchymal changes after COVID-19 03–2020 to 06–2023.

Results

Twenty seven consecutive TBFB including 23 in IC patients resulted in 100% samples with alveolar tissue showing a high frequency of 12/27 (44%) histological pattern of OP. Steroids were used in 21/27 patients (78%) including 11/12 (92%) with OP. Clinical outcome at discharge was favorable in 89% (92% with OP).

Conclusion

TBFB contributes to the diagnosis of diffuse parenchymal lung abnormalities in the context of COVID-19 including a frequent OP pattern particularly in IC patients. Larger studies are necessary to confirm our data and elucidate on the optimal steroid treatment modality.

Trial registration

Clinical trial number: not applicable. The study was approved by the Ethics Committee of the University Medicine Carl Gustav Carus, TU Dresden (BO-EK-309072023). Waiver of informed consent was granted because of the retrospective nature of the study.
Functional characterization of the second feedback loop in the circadian clock of the Antarctic krill Euphausia superba
Authors: Stefanelli Chiara , Colaianni Davide , Mazzotta Gabriella M. , Sales Gabriele , Bertolucci Cristiano , Meyer Bettina , Biscontin Alberto , De Pittà Cristiano
Published: December 2024

Background

The Antarctic krill Euphausia superba is a keystone species in the Southern Ocean ecosystem. This crustacean has an ancestral clock whose main components have been identified and characterized in the past few years. However, the second feedback loop, modulating clock gene expression through two transcription factors, VRI and PDP1, has yet to be described. The presence of this second regulatory mechanism is suggested by the identification of its negative component, vrille, at the transcriptional level.

Results

Here, we describe the second feedback loop of krill by identifying the positive component, pdp1, and functionally characterizing both pdp1 and vrille. Starting from the online transcriptome database KrillDB2, we identified and cloned three putative pdp1 sequences which were subsequently analyzed for tissue expression and functional activity using luciferase assays, individually and in combination with two vrille isoforms. Among the pdp1 isoforms, Espdp1_3 displayed higher expression levels in relevant circadian districts than the other two. Furthermore, EsPDP1_3 and EsVRI_2 exhibited the expected positive and negative regulation of the V/P-box in our in vitro system. Finally, Espdp1_3 and Esvrille also showed rhythmic expression in light–dark cycles, supporting their involvement in the regulation of the main circadian clock of the Antarctic krill.

Conclusions

This study expands our knowledge about the molecular architecture of the Antarctic krill circadian clock by defining the components that take part in the modulation of clock expression, establishing a second feedback loop.
Partially substituting roughage with traditional Chinese herbal medicine residues in the diet of goats improved feed quality, growth performance, hematology, and rumen microbial profiles
Authors: Long Yong , Zhang Naifeng , Bi Yanliang , Ma Tao , Paengkoum Pramote , Xin Jiamin , Xiao Wen , Zhao Yanpin , Yuan Chao , Wang Defeng , Yang Yang , Su Chaozhi , Han Yong
Published: December 2024

This study aimed to reveal the effect of traditional Chinese herbal medicine residues (TCHMR) on growth performance, hematology, ruminal microbiota, and economic benefits of Guizhou black male goats through the fermented total mixed ration (FTMR) diet technique. A total of 22 Guizhou black male goats with an initial weight of 21.77 ± 0.85 kg were randomly divided into 2 groups (n = 11), with 11 goats in each group. The control group (CON) was fed a traditional total mixed ration (TMR) diet without the TCHMR. The TCHMR group was fed an FTMR diet containing 40%TCHMR. Compared with the CON group, the results showed that the incorporation of TCHMR into goat diets reduced feeding costs and Feed conversion ratio (FCR). On the contrary, it improved (P < 0.01) feed quality, apparent digestibility of Dry matter (DM), Crude Protein (CP), Neutral detergent fiber (NDF), average daily gain (ADG), and dry matter intake. Interestingly, TCHMR also reduced (P < 0.01) acetate levels in the rumen of goats. Supplementally, TCHMR significantly increased (P < 0.01) the levels of GH, IgM, IgA (p < 0.05), and IFN-γ (P < 0.05), while significantly reducing (P < 0.01) the levels of IL-6, ALT, and AST in serum. Notably, at the phylum level, TCHMR significantly reduced (P < 0.01) the abundance of Bacteroidota and increased (P < 0.01) the abundance of Firmicutes. Moreover. at the genus level, TCHMR significantly reduced (P < 0.01) the abundance of Prevotella, F082, and Bacteroidales_RF16_group, while Muribaculaceae, Proteus, Lachnospiraceae_ND3007_group, and Ruminococcus were increased (P < 0.01). In conclusion, our current findings indicated that 40% TCHMR improved feed quality and the apparent digestibility of nutrients. Additionally, 40% TCHMR improved the growth performance and immunity of Guizhou black male goats, while also reorganizing the composition of ruminal microbiota. So far, under the conditions of this experiment, we have not found any negative effects of 40% TCHMR on goats. This study will be a new idea for developing feed resources, which will reduce environmental pollution and the cost of animal husbandry.
Microbial enzymes as powerful natural anti-biofilm candidates
Authors: Al-Madboly Lamiaa A. , Aboulmagd Asmaa , El-Salam Mohamed Abd , Kushkevych Ivan , El-Morsi Rasha M.
Published: December 2024

Bacterial biofilms pose significant challenges, from healthcare-associated infections to biofouling in industrial systems, resulting in significant health impacts and financial losses globally. Classic antimicrobial methods often fail to eradicate sessile microbial communities within biofilms, requiring innovative approaches. This review explores the structure, formation, and role of biofilms, highlighting the critical importance of exopolysaccharides in biofilm stability and resistance mechanisms. We emphasize the potential of microbial enzymatic approaches, particularly focusing on glycosidases, proteases, and deoxyribonucleases, which can disrupt biofilm matrices effectively. We also delve into the importance of enzymes such as cellobiose dehydrogenase, which disrupts biofilms by degrading polysaccharides. This enzyme is mainly sourced from Aspergillus niger and Sclerotium rolfsii, with optimized production strategies enhancing its efficacy. Additionally, we explore levan hydrolase, alginate lyase, α-amylase, protease, and lysostaphin as potent antibiofilm agents, discussing their microbial origins and production optimization strategies. These enzymes offer promising avenues for combating biofilm-related challenges in healthcare, environmental, and industrial settings. Ultimately, enzymatic strategies present environmentally friendly solutions with high potential for biofilm management and infection control.
Automated total nucleic acid extraction with magnetic beads for the detection of Plasmodium falciparum in large study cohorts
Authors: Inoue Juliana , Huber Nina , Fendel Rolf , Held Jana
Published: December 2024

Background

Molecular methods play an important role in clinical trials assessing anti-malarial drugs and vaccines, as well as in epidemiological studies aimed at detecting Plasmodium species, especially when dealing with large sample sizes. Molecular techniques are more sensitive and generally have a higher throughput compared to the gold standard microscopy. Further optimization can be achieved with automation of nucleic acid isolation, allowing for rapid and precise extraction. This study evaluated the isolation of total nucleic acids from Plasmodium falciparum mocked samples using an automated extraction method with a magnetic bead-based kit compared to a manual silica column-based kit. Additionally, two different RNA preservation solutions were compared.

Methods

Plasmodium falciparum Dd2 parasites were serially diluted and spiked into whole blood. The dilutions were stored in two different RNA preservation solutions and total nucleic acids extracted with an automated magnetic bead-based kit and a manual silica column-based kit. Subsequently, a reverse transcription (RT) qPCR for Plasmodium detection targeting Plasmodium 18S rRNA and DNA in a single reaction was performed and the quantification cycle (Cq) values across the different sample groups were compared.

Results

Comparable Cq values across the various sample preparations were obtained, suggesting minimal influence from RNA preservation solutions (p = 0.686) or extraction methods (p = 0.119) on RT-qPCR outcomes. Automated nucleic acids extraction allowed processing numerous samples in a shorter timeframe and showed similar efficiency in detecting Plasmodium in blood samples by RT-qPCR as manual extraction.

Conclusions

The automated method for nucleic acid isolation is a valuable tool for the detection of Plasmodium infections in large-scale studies. It is efficient, reliable, and cost-effective. Its potential applications extend to other molecular surveillance studies to support malaria control measures.
The role of guideline organizations in nationwide guideline implementation: a qualitative study
Authors: Thoonsen Andrea C. , Merten Hanneke , Broeders Toby T. , Gans Anika , van Beusekom Ilse , Delnoij Diana M. J. , de Bruijne Martine C.
Published: December 2024

Background

Research indicates suboptimal uptake and impact of clinical practice guidelines in Dutch healthcare. Dutch guideline organizations, i.e. guideline developers, governmental agencies, health insurers and other national organizations, develop, authorize and/or support the use of guidelines in Dutch clinical practice. These organizations influence the end users’ awareness, accessibility, understanding, acceptability and applicability of guidelines and, therefore, play a crucial role in guideline implementation. This study explores how they plan, execute, monitor and evaluate guideline dissemination and implementation.

Methods

Utilizing a qualitative design, we conducted semi-structured interviews with 35 participants from 24 guideline organizations. We conducted framework analysis, using theories on guideline implementation planning, the ‘taxonomy of strategies for achieving guideline implementation and compliance’ and the principles of logic models to analyse the data.

Results

Most guideline organizations made limited use of implementation planning approaches that are known to enhance guideline uptake and impact. These approaches include pre-identifying implementation barriers, engaging stakeholders and applying implementation theories, models and frameworks to select and tailor implementation strategies. Instead, they primarily relied on a standard set of predominantly dissemination and occasional implementation strategies known to be practical in terms of ease, cost and time. Commonly used implementation strategies included distributing, advertising and presenting guideline materials, along with providing additional implementation supporting materials. Regarding monitoring and evaluation methods, few organizations assessed the process, outcome or impact of guideline implementation. Those that did primarily relied on clinical peer review and benchmark information for their assessments.

Conclusions

While Dutch guideline organizations recognized and endorsed the importance of implementation, this did not consistently translate into tailored implementation actions. Most guideline organizations did not have an integrated, structural and well-thought-out plan for implementation. The lack of regular, structured monitoring and evaluation raised uncertainties about the effectiveness of implementation in supporting end users and improving patient outcomes. Suggested follow-up research and practice enhancements could strengthen central-level implementation efforts, fostering more effective local implementation and, ultimately, improving health outcomes.
The efficacy of using continuous glucose monitoring as a behaviour change tool in populations with and without diabetes: a systematic review and meta-analysis of randomised controlled trials
Authors: Richardson Kelli M. , Jospe Michelle R. , Bohlen Lauren C. , Crawshaw Jacob , Saleh Ahlam A. , Schembre Susan M.
Published: December 2024

Background

Continuous glucose monitoring (CGM) holds potential as a precision public health intervention, offering personalised insights into how diet and physical activity affect glucose levels. Nevertheless, the efficacy of using CGM in populations with and without diabetes to support behaviour change and behaviour-driven outcomes remains unclear. This systematic review and meta-analysis examines whether using CGM-based feedback to support behaviour change affects glycaemic, anthropometric, and behavioural outcomes in adults with and without diabetes.

Methods

Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Elsevier Embase, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global were searched through January 2024. Eligible studies were randomised controlled trials in adults that implemented CGM-based feedback in at least one study arm compared to a control without CGM feedback. Dual screening, data extraction, and bias assessment were conducted independently. Mean differences in outcomes between intervention and comparison groups were analysed using generic inverse variance models and random effects. Robustness of pooled estimates from random-effects models was considered with sensitivity and subgroup analyses.

Results

Twenty-five clinical trials with 2996 participants were included. Most studies were conducted in adults with type 2 diabetes (n = 17/25; 68%), followed by type 1 diabetes (n = 3/25, 12%), gestational diabetes (n = 3/25, 12%), and obesity (n = 3/25, 12%). Eleven (44%) studies reported CGM-affiliated conflicts of interest. Interventions incorporating CGM-based feedback reduced HbA1c by 0.28% (95% CI 0.15, 0.42, p < 0.001; I2 = 88%), and increased time in range by 7.4% (95% CI 2.0, 12.8, p < 0.008; I2 = 80.5%) compared to arms without CGM, with non-significant effects on time above range, BMI, and weight. Sensitivity analyses showed consistent mean differences in HbA1c across different conditions, and differences between subgroups were non-significant. Only 4/25 studies evaluated the effect of CGM on dietary changes; 5/25 evaluated physical activity.

Conclusions

This evidence synthesis found favourable, though modest, effects of CGM-based feedback on glycaemic control in adults with and without diabetes. Further research is needed to establish the behaviours and behavioural mechanisms driving the observed effects across diverse populations.

Trial registration

CRD42024514135.
Machine-learning based prediction of appendicitis for patients presenting with acute abdominal pain at the emergency department
Authors: Schipper Anoeska , Belgers Peter , O’Connor Rory , Jie Kim Ellis , Dooijes Robin , Bosma Joeran Sander , Kurstjens Steef , Kusters Ron , van Ginneken Bram , Rutten Matthieu
Published: December 2024

Background

Acute abdominal pain (AAP) constitutes 5–10% of all emergency department (ED) visits, with appendicitis being a prevalent AAP etiology often necessitating surgical intervention. The variability in AAP symptoms and causes, combined with the challenge of identifying appendicitis, complicate timely intervention. To estimate the risk of appendicitis, scoring systems such as the Alvarado score have been developed. However, diagnostic errors and delays remain common. Although various machine learning (ML) models have been proposed to enhance appendicitis detection, none have been seamlessly integrated into the ED workflows for AAP or are specifically designed to diagnose appendicitis as early as possible within the clinical decision-making process. To mimic daily clinical practice, this proof-of-concept study aims to develop ML models that support decision-making using comprehensive clinical data up to key decision points in the ED workflow to detect appendicitis in patients presenting with AAP.

Methods

Data from the Dutch triage system at the ED, vital signs, complete medical history and physical examination findings and routine laboratory test results were retrospectively extracted from 350 AAP patients presenting to the ED of a Dutch teaching hospital from 2016 to 2023. Two eXtreme Gradient Boosting ML models were developed to differentiate cases with appendicitis from other AAP causes: one model used all data up to and including physical examination, and the other was extended with routine laboratory test results. The performance of both models was evaluated on a validation set (n = 68) and compared to the Alvarado scoring system as well as three ED physicians in a reader study.

Results

The ML models achieved AUROCs of 0.919 without laboratory test results and 0.923 with the addition of laboratory test results. The Alvarado scoring system attained an AUROC of 0.824. ED physicians achieved AUROCs of 0.894, 0.826, and 0.791 without laboratory test results, increasing to AUROCs of 0.923, 0.892, and 0.859 with laboratory test results.

Conclusions

Both ML models demonstrated comparable high accuracy in predicting appendicitis in patients with AAP, outperforming the Alvarado scoring system. The ML models matched or surpassed ED physician performance in detecting appendicitis, with the largest potential performance gain observed in absence of laboratory test results. Integration could assist ED physicians in early and accurate diagnosis of appendicitis.

Graphical abstract
Risk of infection and conversion time from external to definitive fixation in open tibial fracture
Authors: Aljuhani Wazzan S. , Alshabi Yasir A. , Alanazi Abdullah M. , Alothri Meshal A. , Almutairi Saleh A. , Aljaafri Ziad A. , Alzahrani Abdullah M.
Published: December 2024

Background

An open fracture of the tibia is one of the most common and dangerous type of open fractures. In the management of these injuries, the primary focus is on reducing the infection rate, as this is crucial for achieving the best clinical outcomes. This study aims to explore how provisional external fixation duration influences the rates of infection and union in open tibial shaft fractures.

Methods

A retrospective study with a total of 55 patients who received temporary external fixation. Groups A (less than 12 days), B (12–24), C (25–36), and D (more than 36) were the four groups into which they were split according to the conversion time.

Results

12.8%, 18.2%, 50%, and 100% of the infections were found in Groups A, B, C, and D, respectively. Significant (P < 0.05) differences were found throughout the four groups. The conversion time from external to definitive fixation was found to have a relationship with the occurrence of an infection (P = 0.004). A higher prevalence of infection was observed over time. However, no association was observed between infection and antibiotic duration or initial debridement time (P = 0.689 and P = 0.963, respectively).

Conclusions

Results of this study demonstrate that the likelihood of infection increases when the change from external fixation to definitive internal fixation is delayed. Therefore, it is important to convert to definitive internal fixation immediately when the local and general conditions are favorable for doing so.
Application of four pricing models for orphan medicines: a case study for lumasiran
Authors: Rosenberg Noa , Manders Evert , van den Berg Sibren , Deesker Lisa J. , Garrelfs Sander F. , de Visser Saco J. , Groothoff Jaap W. , Hollak Carla E. M.
Published: December 2024

Background

The combination of high prices and uncertain effectiveness is a growing challenge in the field of orphan medicines, hampering health technology assessments. Hence, new methods for establishing price benchmarks might be necessary to support reimbursement negotiations. In this study, we applied several pricing models containing cost-based elements to the case of lumasiran for treating primary hyperoxaluria type 1.

Methods

Price ranges were calculated by estimating minimum and maximum scenarios for four pricing models: Novel Cancer Pricing Model (NCP-model), AIM Model for Innovative Medicines (AIM-model), Discounted Cash Flow model (DCF-model), and the Real-Option Rate Of Return model (ROROR-model). Data was gathered from disease registries, scientific literature, Security and Exchange Committee filings, and expert opinion. A sensitivity analysis was performed to assess the parameters with the largest influence.

Results

Outcomes resulting from the NCP-model ranged between €87,000 and €224,000 per patient per year, between €33,000 and €340,000 for the AIM-model, between €182,000 and €748,000 for the DCF-model, and between €81,000 and €273,000 for the ROROR-model.

Conclusion

Outcomes of the four pricing models show wide and heterogeneous price ranges. The DCF-model might be most compatible with the case of lumasiran, due to inclusion of parameters for prevalence, incidence, prescription restrictions and cost of capital. The minimum DCF price could serve as a starting point for pricing and reimbursement negotiations. Uncertainties can be solved by more transparency on input variables.
Association of preconception premenstrual disorders with perinatal depression: an analysis of the perinatal clinical database of a single Japanese institution
Authors: Ohsuga Takuma , Egawa Miho , Tsuyuki Kaori , Ueda Akihiko , Komatsu Maya , Chigusa Yoshitsugu , Mogami Haruta , Mandai Masaki
Published: December 2024

Background

Recent studies have identified premenstrual disorders (PMDs) as a risk factor for postpartum depression. However, routine screening for preconception PMDs is not yet common in Japan. This study investigated the association between preconception PMDs and perinatal depression in a single tertiary care setting.

Methods

We analyzed data from pregnant women who gave birth at Kyoto University Hospital between April 2020 and October 2023. The Premenstrual Symptoms Screening Tool was administered at the first postconception visit to retrospectively assess PMD status before the current pregnancy. The Edinburgh Postnatal Depression Scale (EPDS) was administered during pregnancy and one month postpartum as a prospective measure of perinatal depression. EPDS cutoff values were set at 12/13 during pregnancy and 8/9 at one month postpartum.

Results

Of the 781 women analyzed, 53 had preconception PMD. Univariate and multivariate logistic regression analyses revealed that preconception PMD was associated with an EPDS score of ≥ 13 during pregnancy, with a crude odds ratio (OR) of 5.78 (95% confidence interval [CI]: 2.70–11.75) and an adjusted OR of 3.71 (95% CI: 1.54–8.35). For an EPDS score of ≥ 9 at 1 month postpartum, the crude OR was 3.36 (95% CI: 1.79–6.12) and the adjusted OR was 2.16 (95% CI: 1.04–4.35).

Conclusions

Our findings indicate that preconception PMDs are a significant risk factor for both depression during pregnancy and postpartum depression. These results support the implementation of preconception PMD screening during antenatal checkups as a preventive measure and to identify women in need of early mental health care.
Decision-making for childhood vaccination in crisis settings: a survey of practice & barriers
Authors: Light Page M. , Singh Neha S. , Alhaffar Mervat , Allison Lauren E. , Mounier-Jack Sandra , Ratnayake Ruwan , Checchi Francesco , Abdelmagid Nada
Published: December 2024

Background

Children, particularly those who have received no routine vaccinations (zero-dose children), are at high risk of vaccine-preventable diseases in humanitarian crisis settings. However, the decision-making processes underlying vaccine intervention design and delivery in such settings are poorly understood. The present study investigated the decision-making practices of organisations involved in childhood vaccination in humanitarian crisis settings globally via an online survey.

Methods

Individuals involved in the design or delivery of childhood vaccination programmes in humanitarian crisis settings were invited to fill out a self-administered online survey. Respondents were asked about factors influencing intervention design and vaccine delivery; use of technical guidance, specifically the WHO decision-making framework for vaccination in acute humanitarian emergencies (WHO Framework); and practices for reaching zero-dose children.

Results

Fourteen responses were received. Large international organisations and UN agencies were overrepresented in the sample. Technical guidance was considered of high importance when designing vaccine interventions. However, the WHO Framework is not available in relevant languages and has not been well-distributed to local and national actors. Awareness of initiatives to reach zero-dose children was high within our sample, though this may not accurately reflect global awareness. Security and resource availability were key barriers to vaccine delivery and reaching zero-dose children. Problems with vaccine access in our sample pertained primarily to issues with the procurement system rather than vaccine cost.

Conclusions

The WHO Framework should be provided in more languages, and vaccination actors at local and national level should be engaged to improve its practicality and increase awareness of its aims. In order to reach zero-dose children, vaccines must be made available for use in expanded age groups, which is sometimes not currently feasible within the Gavi/UNICEF procurement system. Clarifying this policy would allow relevant organisations to reach more zero-dose children. Additionally, security is a key barrier impeding vaccine delivery, including for zero-dose children. Safe operational space for humanitarian actors in conflict must be maintained and global conflict resolution mechanisms improved.
The extent of physical and psychological workplace violence experienced by prehospital personnel in Denmark: a survey
Authors: Schøsler Brit , Bang Frederik Stuhr , Mikkelsen Søren
Published: December 2024

Background

Workplace violence against healthcare workers has been a well-known problem for more than 40 years. This problem is also relevant for prehospital personnel who are at risk of physical and/or psychological violence during work. Violence and threats of violence can have physical and psychological consequences, including personal challenges in their everyday life, use of sick days, reports, and the need for professional help. Therefore, this study aimed to describe the extent of and subsequent reporting of physical and psychological workplace violence toward the prehospital healthcare workers in Denmark in a two-year period. Moreover, we wanted to elucidate any possible effect of workplace violence on the private and professional lives of the prehospital healthcare personnel.

Methods

A nation-wide survey where a validated anonymised questionnaire was directed to all of the approximately 4500 Danish prehospital healthcare workers.

Results

Out of 584 complete responses we found that 47.4% had experienced psychological violence on the job whereas 25.7% had experienced physical violence on the job within the past two years. The perpetrators were mainly patients or relatives of the patients. Physical violence was mostly reported as punching, pushing, and kicking, while psychological violence included threats of violence and other intimidation. After experiencing violence the respondents reported both physical and psychological harm, which for some prehospital healthcare workers had consequences for their professional and/or personal life. Furthermore, some prehospital healthcare workers reported that the violence had resulted in some patients receiving worse treatment afterwards. We found that violence was rarely reported to either employers or the police, because respondents believed the events were not important enough to merit reporting, or because a report was not considered to make any difference to the healthcare worker. The survey demonstrates that, as a minimum, at least one healthcare worker in 30 and one healthcare worker in 16 has been exposed to episodes of violence and threats of violence within the last two years.

Conclusion

We suggest that the prehospital organisations emphasise reporting future episodes of physical and/or psychological violence. Knowing the extent of the problem is a prerequisite for addressing, debriefing, and/or other psychological follow-up.

Trial registration

N/A.
Efficacy of azithromycin combined with compounded atovaquone in treating babesiosis in giant pandas
Authors: Ma Rui , Yue Chanjuan , Gu Jiang , Wu Wei , Hou Rong , Huang Wenjun , Li Bi , Xue Fei , Huang Chong , Bi Wenlei , Liu Jiabin , Yu Xiang , Li Zusheng , Yang Wanjing , Fu Mingxia , Yang Hong , Qi Dunwu
Published: December 2024

Background

Babesia is a tick-borne protozoan blood parasite that can cause hemolytic anemia, thrombocytopenia, lethargy and splenomegaly in giant pandas.

Methods

We evaluated the efficacy and safety profile of a therapeutic regimen combining atovaquone and zithromycin in the context of babesiosis in giant pandas that have been naturally infected. The examined pandas underwent clinical and laboratory analyses, including hematology, biochemistry and thyroid hormone profiles. Upon diagnosis, the giant pandas were administered a compounded treatment consisting of atovaquone oral suspension (15 mg/kg, PO, q8 h), azithromycin tablets (10 mg/kg, PO, q24 h) and Enteral Nutritional Suspension (TPF) as a fat-rich supplement (0.5 ml/kg, PO, q8 h) for a 10-day period.

Results

The combination treatment increased the red blood cell count, hemoglobin levels and hematocrit in the pandas within a short period, while also reducing parasite levels below the PCR detection threshold.

Conclusions

Our study suggested that atovaquone and azithromycin combination therapy is highly effective for emergency treatment of Babesia sp. infection in giant pandas.

Graphical Abstract