bluuebunny/crossref_metadata_2025 huggingface dataset:
The concept of a fresh start in the discharge of debt procedure in European Union insolvency law
Authors: Jokubauskas Remigijus
Published: December 2023

A fresh start is the essence of personal insolvency proceedings. In the last few decades, policymakers in the United States of America and European countries have focused on establishing effective and efficient insolvency proceedings which would address the particular needs of insolvent natural persons. Previously, personal insolvency proceedings aimed to address the social and economic problems of insolvent debtors (consumers) which were not able to meet their financial obligations in time. However, the latest developments in this area reveal that specific rules should be established in insolvency law to tackle the insolvency problems of individuals who incur most of their debts from economic activities (entrepreneurs’ insolvency). The adoption of the Directive on Restructuring and Insolvency is the first attempt in European Union law to counter the challenges of the insolvency of entrepreneurs. This article analyses the main elements of a fresh start in European Union insolvency law, how this phenomenon has evolved and whether the European Union insolvency law provides an effective fresh start for insolvent entrepreneurs.
Temporary agency employment: A supplement to regular jobs – under certain circumstances
Authors: Neumann Uwe
Published: December 2023

In countries with strict employment protection legislation, firms may seek to replace regular by atypical jobs in order to cut wages or to become more flexible. In Germany, the number of unprotected temporary jobs is comparatively low. During the past decades, temporary agency employment, however, has increased considerably and the share of agency workers is now above the EU average. Using German establishment data, the analysis draws on longitudinal (generalized method of moments) and cross-sectional (matching and difference in differences) methods to evaluate whether agency workers replaced or supplemented regular workers during and after the Great Recession of 2008/2009. The study finds that hiring (more) agency workers made it possible for user firms among Germany’s core manufacturing industries to employ a larger number of regular workers at the same time. In specific sectors and regions, temp agencies therefore provided an alternative to government-sponsored instruments such as short-time work schemes. Obviously, from the view of workers, many disadvantages remain, even more so as it is rare for temp spells to offer a stepping stone into regular employment.
The Funnel of Game Design – An Adaptive Game Design Approach for Complex Systems
Authors: Freese Maria , Lukosch Heide
Published: December 2023

Background

In a world of ever-increasing complexity, organizations and people have an ever-increasing need for support systems that help them understand and shape the world around them. While simulation game design derived from the very idea to propose an instrument able to address complexity, seminal approaches dealt with a different level of complexity. In a networked, digitalized world, complexity has increased, and traditional approaches towards designing games show certain shortcomings that have to be overcome.

Aim

This article proposes a new process of game design for complex problems and complex systems that can both be used by game designers as well as the scientific community in the field. This process is represented within a framework, based on two parts. The so-called ‘Funnel of Game Design’ based on the IDEAS approach represents the process of problem derivation, while the ‘House of Game Design’ also covers possible steps towards the final game product and process, including de-briefing and evaluation.

Method

Based on hands-on experiences and related work, we developed several steps of a game design process (IDEAS approach). In face-to-face interviews, we discussed the first version of the framework with experts in the field of simulation game studies.

Results

This process led to the framework presented in this article, which shows the steps of problem derivation as well as challenges that can occur, and proposes adaptive methods to overcome these challenges. The framework includes elements that support the definition of complex problems, and their translation into game designs.

Recommendation

We recommend practitioners and scientists to apply the new framework presented here in their efforts to define the underlying problem that should be addressed by an envisioned simulation game, and in translating this into a valid, engaging and meaningful game experience.
Sustainability in Tourism: Impact of Attractiveness Factors in the World’s Most Visited Destinations
Authors: Haller Alina
Published: December 2023

Iconic destinations are benchmarks for tourism development, but their effects on the environment are debatable. To highlight the tourism attractiveness factors of sustainability in the world’s most visited destinations, we applied clustering and multiple regression to specific indicators for the period 2000–2020. We observed a relatively high heterogeneity in terms of sustainability, with destinations split into four clusters: C1 (France, Spain, Italy, Germany and UK), C2 (Mexico and Thailand), C3 (USA, China) and C4 (Turkey). Unsustainable factors in all destinations include the industry and construction sector, social insecurity, inflation and transport services development. Renewable energy consumption is sustainable, while economic growth, education and tourism indicators have antagonistic effects. The effects of tourism attractiveness factors on the environment have decision-making implications at all levels. The novelty of this analysis lies in the tourism attractiveness factors examined, and the results can help shape tourism development policies in balance with structural policies such as energy and environment.
Hoof Work: The Feminisation of Donkeys in Ethiopia
Authors: Geiger Martha Rose
Published: December 2023

This article explores how gendered divisions of labour manifest across species lines. It applies a feminist, more-than-human intersectional approach, building on previous work on animal labour. The vital labour donkeys do with and for humans and their contributions to multispecies societies have been under-recognised and under-theorised. Drawing on empirical research conducted in central Ethiopia on the human-donkey relationship, findings reveal the multiple ways human gender and class coalesce to shape the kinds of labour performed and social relations among women, men, and donkeys across urban and rural environments. At the nexus of these intersecting forces, equivalence is drawn, by research participants themselves, between women and donkeys. Women and donkeys are aligned and othered, differentiated from men, a dynamic that results in the feminisation of donkeys and mutual marginalisation of women and donkeys and exposes male violence perpetrated on both groups. The article contributes empirical insights into human-donkey relations and interspecies labour and offers theoretical considerations of more-than-human intersectionality.
Mapping lesbians’ everyday community-making in a small city: (In)visibility, belonging and safety
Authors: Reed Elizabeth , Paddon Laura , Wilkinson Eleanor , MacLeod Cathryn
Published: December 2023

This paper presents findings from a project exploring how lesbians make community in the ‘ordinary city’ of Southampton on the South coast of England. In the context of trans-exclusionary debates and the supposed demise of lesbian spaces, we sought to discover how self-identified lesbian people in Southampton conceptualised the location and boundaries of their community. The study used collaborative participatory mapping techniques, which resulted in a diffuse and multi-layered understanding of lesbian community in the city. The paper focuses on three key themes: (1) crafting ‘safe’ spaces; (2) terminology: naming ‘lesbians’ and (3) finding and creating places of community. The paper concludes that finding a space to articulate an explicitly lesbian identity can be fraught, but is deeply valued, continually becoming, and carefully negotiated both between peers and within urban space. Collaborative mapping is shown as a valuable tool in delivering more inclusive participatory research that can help foster transformative and emancipatory research into LGBTQ communities and spaces.
The obsolescence of detention: Versatility, expendability and plasticity in the field of immigration confinement
Authors: Ballesteros-Pena Ana , Fernández-Bessa Cristina , Brandariz José A
Published: December 2023

Studies on immigration enforcement and bordered penality frequently depict immigration detention as a system of confinement enforced in closed, relatively opaque facilities geared towards the expeditious deportation of non-citizens. This notion is actually a synecdoche of the diverse forms of containment and the varying, more or less dispensable roles played by detention practices within immigration enforcement systems. This paper challenges this perspective by considering prominent changes taking place in the detention field across Europe, which can be seen as signals of a gradual detention crisis. In this respect, it explores the versatility of detention practices, which have made the detention system particularly resilient. Despite this resilience, though, the paper unveils and maps the obsolescence of detention centric models of immigration enforcement, which manifests itself in the jurisdictions in which detention systems either are largely irrelevant or have been shrinking in the recent past. Additionally, the paper examines the consolidation of the hotspot archipelago in Mediterranean Europe, which has expanded the containment capacity of the border control apparatus and made it increasingly plastic. Yet the hotspot system is in itself an additional manifestation of the obsolescence of detention-centric models of enforcement. After having scrutinised these different dimensions, the paper concludes by exploring the promises and pitfalls of a changing detention landscape and suggesting directions for future research.
Multiple functions of immigration detention: Police measures in the governance of mobile populations
Authors: Könönen Jukka
Published: December 2023

Notwithstanding punitive implications, immigration detention as an administrative deprivation of liberty represents a characteristic police measure, targeting deportable noncitizens with limited rights and protections. Drawing on an analysis of the detention system in Finland, I discuss different functions of immigration detention, focusing on police powers in the governance of mobile populations. In Finland, immigration detention is separated from the criminal justice system and delegated to the police, who possess broad powers to impose coercive measures for the enforcement of immigration decisions and social control in the absence of effective judicial supervision. Despite being affiliated with the removal of rejected asylum seekers, immigration detention also is intertwined with crime prevention and control of irregular migration. In addition to deprivation of liberty in the first place, police measures support removal procedures that continue during detention, as well as other administrative strategies to control deportable people and deter unauthorized residency, involving varying degrees of coercion. Though connected with criminal justice and manifestations of penal power in border criminology discussions, immigration detention can arguably be better understood as a coercive police measure, which can be employed alongside other administrative means for immigration enforcement outside of the criminal justice system.
‘A lot of people think it’s just a Mickey Mouse role’: Role ambiguity among dementia support workers within secondary care and community hospital settings
Authors: Prendergast Louise Margaret , Davies Ceryl Teleri , Williamson Tracey
Published: December 2023

Purpose: Dementia support workers (DSWs) are employed to improve the hospital care for patients living with dementia. An evaluation sought to understand the perspectives and experiences of DSWs and related healthcare practitioners within one health board, to identify any role ambiguity and inform future role development.

Design/methodology/approach: Framework analysis was used to synthesise data from semi-structured interviews and focus groups with dementia support workers, and a wider group of related healthcare practitioners.

Findings: Thirteen semi-structured interviews were conducted with DSWs. Two focus groups were held with DSWs ( n = 2 and 4) and two with associated healthcare practitioners ( n = 3 and 5). Participants described inconsistencies in the understanding and delivery of the DSW role. Role ambiguity was identified as a key theme.

Originality/value: This paper offers insight into challenges experienced by DSWs and addresses factors that could help improve and support the DSW role, and potentially the experience of other staff, and patients/people living with dementia. Overall, this evaluation highlights both the value of the DSW role in supporting the needs of patients/people living with dementia and the potential for person-centred activities to be used as therapeutic interventions.
Physical activity, lifestyle, sociocultural factors and prevalence of excess weight gain among postmenopausal women: A cross-sectional study
Authors: Mensah Bonsu Isaac , Brandt Corlia , Ajidahun Adedayo Tunde , Omoniyi Moses , Myezwa Hellen
Published: December 2023

Background:

Most women experienced postmenopausal symptoms during the menopause transition, and they are a common reason for seeking medical attention and lifestyle modification during this phase of life.

Objective:

This study assessed the physical activity, lifestyle, and sociocultural levels-associated prevalence of excess weight (overweight and obesity) among postmenopausal women (PW) in Bono-East (Techiman) region, Ghana.

Design:

This is cross-sectional study.

Method:

This was a cross-sectional study conducted at Bono-East regional capital, Techiman in Ghana over 5 months. Self-administered questionnaires were used to obtain sociodemographic data, physical activity, lifestyle, and sociocultural associated prevalence of excess weight. Anthropometric indices including ((body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR)) were assessed.

Results:

A total of 393 postmenopausal women with a mean age of 60.09 ± 6.24 years participated in the study. When reporting prevalence, obesity, and overweight were distinguished. Using the anthropometric parameters (BMI, WHtR, and WHR) as measured for being overweight, the prevalent rates were 35.7%, 21.7%, and 9.0% respectively. Also, when using obesity, the prevalent rate was 37.8%, 70.1%, and 82.0% using BMI, WHtR, and WHR, respectively. Over 55 (55.2%) of the study participants engaged in moderate physical activities, 23.1% were low and 21.7% with high physical activities. Housewives and unemployed participants are shown to have a higher risk of gaining weight (obese) especially when assessed with WHR and WHtR. Most participants responded that cultural beliefs prevent them from losing weight. Most participants had a poor attitude toward their eating habits.

Conclusion:

According to the findings, postmenopausal Ghanaian women showed a high level of obesity and a moderate level of being overweight. The cultural perception of beauty influences Ghanaian postmenopausal women’s physical activity level and dietary habits.
The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis
Authors: Kwok Chun Shing , Moody William E.
Published: December 2023

Cardiac amyloidosis (CA) is a condition caused by extracellular deposition of amyloid fibrils in the heart. It is an underdiagnosed disease entity which can present with a variety of cardiac and non-cardiac manifestations. Diagnosis usually follows an initial suspicion based on clinical evaluation or imaging findings before confirmation with subsequent imaging (echocardiography, cardiac magnetic resonance imaging, 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy) in combination with biochemical screening for monoclonal dyscrasia (serum free light chains and serum and urine electrophoresis) and/or histology (bone marrow trephine, fat or endomyocardial biopsy). More than 95% of CA can be classified as either amyloid light-chain (AL) CA or amyloid transthyretin (ATTR) CA; these two conditions have very different management strategies. AL-CA, which may be associated with multiple myeloma, can be managed with chemotherapy agents, autologous stem cell transplantation, cardiac transplant and supportive therapies. For ATTR-CA, there is increasing importance in making an early diagnosis because of novel treatments in development, which have transformed this once incurable disease to a potentially treatable disease. Timely diagnosis is crucial as there may only be a small window of opportunity where patients can benefit from treatment beyond which therapies may be less effective. Reviewing the existing patient pathway provides a basis to better understand the complexities of real-world activities which may be important to help reduce missed opportunities related to diagnosis and treatment for patients with CA. With healthcare provider interest in improving the care of patients with CA, the development of an optimal care pathway for the condition may help reduce delays in diagnosis and treatment and thus enhance patient outcomes.
Does patella lowering as part of multilevel surgery improve knee kinematics in children with cerebral palsy and crouch gait? A meta-analysis of comparative studies
Authors: Galán-Olleros María , Lerma-Lara Sergio , Torres-Izquierdo Beltran , Ramírez-Barragán Ana , Egea-Gámez Rosa M , Hosseinzadeh Pooya , Martínez-Caballero Ignacio
Published: December 2023

Purpose:

To evaluate differences in knee kinematic outcomes of patellar-lowering surgery, specifically patellar tendon advancement or patellar tendon shortening, compared with no-patellar-lowering surgery in multilevel surgery for children with cerebral palsy and crouch gait.

Methods:

Four databases were searched to retrieve studies published from inception until 2023. Three reviewers independently screened for studies with observational or randomized control designs, comparing two groups of patients with cerebral palsy and crouch gait who underwent multilevel surgery (with patellar-lowering surgery versus no-patellar-lowering surgery), where various gait analysis outcomes were reported (CRD42023450692). The risk of bias was assessed with the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool.

Results:

Seven studies (249 patients and 368 limbs) met the eligibility criteria. Patients undergoing patellar-lowering surgery demonstrated statistically significant improvements in knee flexion at initial contact (mean difference = −6.39; 95% confidence interval = [−10.4, −2.75]; p = 0.0006; I2 = 84%), minimum knee flexion in stance (mean difference = −14.27; 95% confidence interval = [−18.31, −10.23]; p < 0.00001; I2 = 89%), and clinical knee flexion contracture (mean difference = −5.6; 95% confidence interval = [−9.59, −1.6]; p = 0.006; I2 = 95%), with a significant increase in anterior pelvic tilt (mean difference = 2.97; 95% confidence interval = [0.58, 5.36]; p = 0.01; I2 = 15%). However, improvements in gait deviation index and decrease in peak knee flexion in swing did not reach statistical significance. Subgroup analysis reduced heterogeneity and revealed (1) greater improvement using patellar tendon shortening versus patellar tendon advancement techniques; (2) lack of knee flexion contracture improvement in high-quality or longer-term studies; (3) longer-term improvement only in minimum knee flexion in stance, with a decrease in peak knee flexion in swing; and (4) an inability to assess the potential benefit of rectus femoris procedure and hamstring preservation.

Conclusions:

Overall, the combination of patellar-lowering surgery with multilevel surgery demonstrated superior improvements in stance-phase knee kinematics compared with multilevel surgery alone, despite an increase in anterior pelvic tilt and a longer-term knee flexion reduction during the swing phase.

Level of evidence:

Level III, Systematic review of level III studies.
Research on the Construction of Digital Economy Index System Based on K-means-SA Algorithm
Authors: Su Jinqi , Dong Changhong , Su Ke , He Lin
Published: December 2023

The digital economy is developing rapidly worldwide, which is of great strategic significance in leading and driving the process of high-quality and high-efficiency development of the economy. It has gradually become a new engine to promote China’s economic growth. Therefore, it is vital to establish a digital economy indicator system. In this context, according to the connotation of digital economy, comprehensively consider the four dimensions of digital foundation, digital application, digital innovation and digital benefit, and build a full-scale digital economy indicator system. However, some previous literature proposed operating the K-means clustering algorithm in optimizing the index system. The algorithm, susceptible to the initial selection of cluster center, generates completely different clustering results with other random seed points and is thus unsuitable for optimizing the index system. Based on this, the advantages of GRA, SA, and K-means algorithms are combined to propose a K-means-SA algorithm that can obtain the global optimal solution. Then, by combining the K-means SA algorithm and the rough set algorithm, the constructed index system is further optimized. Ultimately, it establishes a set of all-round, multi-system and multi-dimensional digital economy index systems, which is of great reference significance for formulating relevant policies, provides scientific index support for the subsequent extension of digital economy theory, and promotes the benign growth of the worldwide economy.
Combined Anterior Thoracic Vertebral Body Tethering and Posterior Lumbar Tethering Results in Quicker Return to Sport and Activity Compared to Posterior Spinal Instrumented Fusion in Patients with Adolescent Idiopathic Scoliosis
Authors: Oeding Jacob F. , Siu Jeremy , O’Donnell Jennifer , Wu Hao-Hua , Allahabadi Sachin , Saggi Satvir , Flores Michael , Brown Kelsey , Baldwin Avionna , Diab Mohammad
Published: December 2023

Study Design

Retrospective comparative study.

Objective

To compare patient-reported physical activity between anterior thoracic vertebral body tethering and posterior lumbar spine tethering (ATVBT/PLST) and posterior spinal instrumentation and fusion (PSIF) with minimum 2 year follow-up.

Methods

Consecutive skeletally immature patients with idiopathic scoliosis and a thoracic and lumbar curve magnitude ≥40° who underwent either ATVBT/PLST or PSIF from 2015-2019 were included. The primary outcome was rate of returning to sport. Secondary outcomes included ability to bend and satisfaction with sport performance as well as weeks until return to sport, school, physical education (PE) classes, and running.

Results

Ten patients underwent ATVBT/PLST and 12 underwent PSIF. ATVBT/PLST patients reported significantly faster return to sport (13.5 weeks vs 27.9 weeks, P = .04), running (13.3 weeks vs 28.8 weeks, P = .02), and PE class (12.6 weeks vs 26.2 weeks, P = .04) compared to PSIF patients. ATVBT/PLST patients reported that they had to give up activities due to their ability to bend at lower rates than PSIF patients while reporting “no changes” in their ability to bend after surgery at higher rates than PSIF patients (0% vs 4% giving up activities and 70% vs 0% reporting no changes in bending ability for ATVBT/PLST and PSIF, respectively, P = .01). Compared to PSIF patients, ATVBT/PLST patients experienced less main thoracic and thoracolumbar/lumbar curve correction at most recent follow-up (thoracic: 41 ± 19% vs 69 ± 18%, P = .001; thoracolumbar/lumbar: 59 ± 25% vs 78 ± 15%, P = .02). No significant differences in the number of revision surgeries were observed between ATVBT/PLST and PSIF patients (4 (40%) and 1 (8%) for ATVBT/PLST and PSIF, respectively, P = .221).

Conclusions

ATVBT/PLST patients reported significantly faster rates of returning to sport, running, and PE. In addition, ATVBT/PLST patients were less likely to have to give up activities due to bending ability after surgery and reported no changes in their ability to bend after surgery more frequently than PSIF patients. However, the overall rate of return to the same or higher level of sport participation was high amongst both groups, with no significant difference observed between ATVBT/PLST and PSIF patients.
Calciphylaxis in a Patient With Lupus Nephritis and Acute Kidney Injury: A Rare Case Report and Literature Review
Authors: Gholizadeh Ghozloujeh Zohreh , Rajasekaran Arun , Abdipour Amir , Norouzi Sayna
Published: December 2023

Calciphylaxis is a rare and severe disease characterized by calcification, fibrosis, and thrombosis of small blood vessels. Although it primarily affects patients with end-stage renal disease (ESRD) on dialysis, limited cases have been reported of calciphylaxis in patients with acute kidney injury (AKI) and lupus. This case report describes the occurrence of calciphylaxis in a 35-year-old female recently diagnosed with lupus nephritis class IV and AKI requiring dialysis.
A five-step approach to safer skin surgery
Authors: Smith Hayley , Bhutani Raman , Mitra Angana , Goulden Victoria , Hussain Walayat , Rahim Rajib , Machin Claire , Stables Graeme I
Published: December 2023

Background: Wrong site skin surgery is a never event with implications for patient well-being, in addition to potential medicolegal ramifications. There is no standardised approach to wrong site surgery (WSS) prevention in the United Kingdom. However, the World Health Organisation surgical checklist and NHS England's safety standards for invasive procedures (NatSSIP) have been useful in guiding the direction of change.

Our experience: We describe our experience over the past decade, detailing five cases of WSS including three wrong site biopsies and two re-excisions of the wrong scar. Each provided a learning opportunity, identifying vulnerabilities in the skin surgery pathway.

Our five-step approach to safer skin surgery: By reflecting on our experience, we created a simple five-step approach to safer skin surgery which could easily be adopted by other dermatology departments. This includes, developing a Standard operating procedure, requesting a surgical procedure, medical photography, in theatre, and education/governance. Our approach provides a step in the right direction for national standardisation of the skin surgery pathway.
The role of TLR4/MyD88/NF-κB in the protective effect of ulinastatin on the intestinal mucosal barrier in mice with sepsis
Authors: Wenying Song , Jing Huang , Ying Li , Hui Ding
Published: December 2023

Objective

To investigate the effect of the TLR4/MyD88/NF-κB (Toll-like receptor 4/myeloid differentiation factor/nuclear factor kappa B) signalling pathway on the protective effect of ulinastatin on the intestinal mucosal barrier in mice with sepsis.

Methods

A mouse model of sepsis was established by classical caecal ligation and perforation. Forty-four SPF C57BL/6 mice were randomly divided into the following four groups with 11 mice in each group: the control group (Con group), ulinastatin group (Uti group), Uti + LPS (lipopolysaccharide, LPS) group (Uti + LPS group) and LPS group. Mice in the Con group and Uti group received saline or ulinastatin injected 2 h after modelling; Mice in the Uti + LPS group received LPS injected 0 h after modelling, other procedures were the same as in the Uti group; Mice in the LPS group received LPS only. At 48 h after surgery, the levels of TNF-α (tumour necrosis factor-α, TNF-α), IL-6 (interleukin-6, IL-6) and IL-1β (interleukin-1β, IL-1β) in vein, and the expression of TLR4, MyD88 and NF-κB mRNA in small intestinal mucosa tissues using ELISA and RT‒PCR.

Results

The pathological specimens showed increased inflammatory injury in the Con and LPS groups, while these injuries and changes improved in the Uti group. The scores of intestinal mucosal injury at 48 h of Uti injection were significantly lower than those of the Con group (P < 0.001), while the scores of intestinal mucosal injury of Uti + LPS were significantly higher than those of the Uti group (P = 0.044). The expression of TNF-α, IL-6 and IL-1β in the Uti decreased significantly at 48 h after surgery than that in the Con group (P = 0.001, P = 0.014, P = 0.004), while the expression of TNF-α, IL-6 and IL-1β in the Uti + LPS group increased significantly after surgery than that in the Uti group (P = 0.026, P = 0.040, P = 0.039). The expression of TLR4, MyD88 and NF-κB mRNA in the Uti group decreased significantly compared with that in the Con group (P = 0.001, P = 0.021, P = 0.007), while the expression of TLR4, MyD88 and NF-κB mRNA in the Uti + LPS group was higher than that in the Uti group (P = 0.023, P = 0.040, P = 0.045).

Conclusion

These findings indicate that the protective effect of ulinastatin on the intestinal mucosal barrier against sepsis may be mediated through the TLR4/MyD88/NF-κB pathway.
A population study on factors associated with unintentional falls among Iranian older adults
Authors: Sotoudeh Gholam Reza , Mohammadi Reza , Mosallanezhad Zahra , Viitasara Eija , Soares Joaquim J.F.
Published: December 2023

Introduction

Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran.

Methods

The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors.

Results

The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months.

Conclusions

Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.
A hybrid model for hand-foot-mouth disease prediction based on ARIMA-EEMD-LSTM
Authors: Wan Yiran , Song Ping , Liu Jiangchen , Xu Ximing , Lei Xun
Published: December 2023

Background

Hand, foot, and mouth disease (HFMD) is a common infectious disease that poses a serious threat to children all over the world. However, the current prediction models for HFMD still require improvement in accuracy. In this study, we proposed a hybrid model based on autoregressive integrated moving average (ARIMA), ensemble empirical mode decomposition (EEMD) and long short-term memory (LSTM) to predict the trend of HFMD.

Methods

The data used in this study was sourced from the National Clinical Research Center for Child Health and Disorders, Chongqing, China. The daily reported incidence of HFMD from 1 January 2015 to 27 July 2023 was collected to develop an ARIMA-EEMD-LSTM hybrid model. ARIMA, LSTM, ARIMA-LSTM and EEMD-LSTM models were developed to compare with the proposed hybrid model. Root mean square error (RMSE), mean absolute error (MAE) and coefficient of determination (R2) were adopted to evaluate the performances of the prediction models.

Results

Overall, ARIMA-EEMD-LSTM model achieved the most accurate prediction for HFMD, with RMSE, MAPE and R2 of 4.37, 2.94 and 0.996, respectively. Performing EEMD on the residual sequence yields 11 intrinsic mode functions. EEMD-LSTM model is the second best, with RMSE, MAPE and R2 of 6.20, 3.98 and 0.996.

Conclusion

Results showed the advantage of ARIMA-EEMD-LSTM model over the ARIMA model, the LSTM model, the ARIMA-LSTM model and the EEMD-LSTM model. For the prevention and control of epidemics, the proposed hybrid model may provide a more powerful help. Compared with other three models, the two integrated with EEMD method showed significant improvement in predictive capability, offering novel insights for modeling of disease time series.
Early antithrombotic therapy in patients with postinterventional cerebral hyperdensity reduces early neurological deterioration after mechanical thrombectomy
Authors: Luo Yunhe , Chu Min , Wang Daosheng , Gu Xin , Wang Delong , Zheng Jin , Zhao Jing
Published: December 2023

Background

Initiation of early antithrombotic therapy after acute ischemic stroke (AIS) is crucial. We aimed to investigate whether early antithrombotic therapy influences early neurological deterioration (END) in AIS patients with postinterventional cerebral hyperdensity (PCHD) immediately after mechanical thrombectomy (MT).

Methods

We retrospectively analyzed 108 consecutive anterior circulation AIS patients with PCHD immediately after MT. All patients were divided into END group and non-END group and END was defined as an increase of four points or more on the postinterventional National Institutes of Health Stroke Scale (NIHSS) score within the first 72 h after MT. Early antithrombotic therapy was defined as patients with PCHD who received antithrombotic therapy within 24 h after MT. Statistical analyses were performed to evaluate the association between early antithrombotic therapy and the risk of END.

Results

Among 108 patients, 27 (25%) patients developed END. Multivariate regression analysis revealed that early use of antithrombotic therapy (OR = 0.229, 95%CI = 0.083–0.626, P = 0.004) was an independent protector of END and postinterventional low density shadow exceeding 1/3 of the vascular territory (OR = 4.000, 95%CI = 1.157–13.834, P = 0.029) was an independent risk factor for END.

Conclusion

Antithrombotic therapy within 24 h after MT maybe associated with the reduced risk of END in anterior circulation AIS patients with PCHD.
A content analysis of women’s experiences of different models of maternity care: the Birth Experience Study (BESt)
Authors: Pelak Helen , Dahlen Hannah G. , Keedle Hazel
Published: December 2023

Background

Pregnancy, birth, and early parenthood are significant life experiences impacting women and their families. Growing evidence suggests models of maternity care impact clinical outcomes and birth experiences. The aim of this study was to explore the strengths and limitations of different maternity models of care accessed by women in Australia who had given birth in the past 5 years.

Methods

The data analysed and presented in this paper is from the Australian Birth Experience Study (BESt), an online national survey of 133 questions that received 8,804 completed responses. There were 2,909 open-ended comments in response to the question on health care provider/s. The data was analysed using content analysis and descriptive statistics.

Results

In models of fragmented care, including standard public hospital care (SC), high-risk care (HRC), and GP Shared care (GPS), women reported feelings of frustration in being unknown and unheard by their health care providers (HCP) that included themes of exhaustion in having to repeat personal history and the difficulty in navigating conflicting medical advice. Women in continuity of care (CoC) models, including Midwifery Group Practice (MGP), Private Obstetric (POB), and Privately Practising Midwifery (PPM), reported positive experiences of healing past birth trauma and care extending for multiple births. Compared across models of care in private and public settings, comments in HRC contained the lowest percentage of strengths (11.94%) and the highest percentage of limitations (88.06%) while comments in PPM revealed the highest percentage of strengths (95.93%) and the lowest percentage of limitations (4.07%).

Conclusions

Women across models of care in public and private settings desire relational maternity care founded on their unique needs, wishes, and values. The strengths of continuity of care, specifically private midwifery, should be recognised and the limitations for women in high risk maternity care investigated and prioritised by policy makers and managers in health services.

Trial registration

The study is part of a larger project that has been retrospectively registered with OSF Registries Registration DOI https://doi.org/10.17605/OSF.IO/4KQXP.
Untargeted serum metabolomics reveals potential biomarkers and metabolic pathways associated with the progression of gastroesophageal cancer
Authors: Che Jiajing , Zhao Yongbin , Gu Bingbing , Li Shuting , Li Yunfei , Pan Keyu , Sun Tiantian , Han Xinyue , Lv Jiali , Zhang Shuai , Fan Bingbing , Li Chunxia , Wang Cheng , Wang Jialin , Zhang Tao
Published: December 2023

Background

Previous metabolic studies in upper digestive cancer have mostly been limited to cross-sectional study designs, which hinders the ability to effectively predict outcomes in the early stage of cancer. This study aims to identify key metabolites and metabolic pathways associated with the multistage progression of epithelial cancer and to explore their predictive value for gastroesophageal cancer (GEC) formation and for the early screening of esophageal squamous cell carcinoma (ESCC).

Methods

A case-cohort study within the 7-year prospective Esophageal Cancer Screening Cohort of Shandong Province included 77 GEC cases and 77 sub-cohort individuals. Untargeted metabolic analysis was performed in serum samples. Metabolites, with FDR q value < 0.05 and variable importance in projection (VIP) > 1, were selected as differential metabolites to predict GEC formation using Random Forest (RF) models. Subsequently, we evaluated the predictive performance of these differential metabolites for the early screening of ESCC.

Results

We found a distinct metabolic profile alteration in GEC cases compared to the sub-cohort, and identified eight differential metabolites. Pathway analyses showed dysregulation in D-glutamine and D-glutamate metabolism, nitrogen metabolism, primary bile acid biosynthesis, and steroid hormone biosynthesis in GEC patients. A panel of eight differential metabolites showed good predictive performance for GEC formation, with an area under the receiver operating characteristic curve (AUC) of 0.893 (95% CI = 0.816–0.951). Furthermore, four of the GEC pathological progression-related metabolites were validated in the early screening of ESCC, with an AUC of 0.761 (95% CI = 0.716–0.805).

Conclusions

These findings indicated a panel of metabolites might be an alternative approach to predict GEC formation, and therefore have the potential to mitigate the risk of cancer progression at the early stage of GEC.
Perioperative tislelizumab plus chemotherapy for locally advanced resectable thoracic esophageal squamous cell carcinoma trial: a prospective single-arm, phase II study (PILOT trial)
Authors: Ding Chengzhi , Guo Yijun , zhou Yaning , He Yi , Chen Chunji , Zhang Ming , Guo Xufeng
Published: December 2023

Background

The promising therapeutic outcomes of neoadjuvant immunotherapy combined with chemotherapy in the treatment of locally advanced esophageal squamous cell carcinoma (ESCC) have been confirmed by several phase II clinical trials and have been widely demonstrated in clinical work. Theoretically, postoperative adjuvant immunotherapy may further improve the therapeutic effect, but there is still lack of evidence. The aim of this study was to analyse the safety and efficacy of perioperative immunotherapy (tislelizumab) in locally advanced resectable thoracic ESCC (PILOT trial).

Methods

Seventy-three eligible patients with pathologically confirmed thoracic ESCC of clinical T1b-3N1-3M0 or T3N0M0 stage were allocated to receive neoadjuvant immunotherapy (tislelizumab 200 mg d1, q3w × 2 cycles) plus chemotherapy (nad-paclitaxel 260 mg/m2 d1 + carboplatin AUC = 5 d1, q3w × 2 cycles) treatment. Patients with pathologic complete response (pCR) after esophagectomy received adjuvant tislelizumab (200 mg every 3 weeks for up to one year), and patients with non-pCR were assigned adjuvant tislelizumab plus chemotherapy for two cycles and then maintenance tislelizumab (200 mg every 3 weeks for up to 15 cycles). The primary endpoint of this study is 2-year disease-free survival (DFS) in non-pCR patients. The secondary endpoints include pCR rate, major pathological response rate, 2-year DFS in pCR patients, R0 resection rate, adverse events, and overall survival.

Discussion

This protocol was reviewed and approved by the Ethics Committee of Shanghai Chest Hospital (IS23059). This is the first prospective clinical trial to investigate the safety and efficacy of perioperative immunotherapy for locally advanced resectable thoracic ESCC. We hypothesize that perioperative immunotherapy could be a promising therapeutic strategy that can provide better 2-year DFS in non-pCR patients.

Trial registration

ClinicalTrial.gov: NCT0605633.
Predictors of mortality among under-five children in rural Ethiopia: a cross sectional study
Authors: Gebrerufael Gebru Gebremeskel , Hagos Bsrat Tesfay
Published: December 2023

Background

Under-five child mortality (UFCM) is one of the major significant and sensitive indicators of the health status of the public. Although the world has seen a remarkable and substantial decrease in UFCM since 1990, its progression rate still remains alarmingly high in Sub-Saharan African (SSA) countries, particularly in Ethiopia. Therefore, this study aimed to assess associations between mortality and under-five children in rural Ethiopia.

Methods

This study used a secondary data analysis of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) report. A total of 4,425 under-five children were included in the final analysis. The Kaplan-Meier (K-M) and Cox proportional hazard (PH) model analyses were utilized to estimate survival time and investigate the major predictors of mortality in under-five children, respectively. An adjusted hazard ratio (AHR) along with a 95% confidence interval (CI) was employed to measure the association size and direction of the association (STATA 12).

Results

The study showed that 6.2% (95% CI: 5.43, 6.86) of children died beforehand celebrating their fifth birthday in rural Ethiopia. The multivariable Cox PH regression model analysis revealed associations of large spacing preceding birth interval (16–26 months) (AHR = 0.61; 95% CI: (0.402–0.920)), 27–38 months (AHR = 0.72; 95% CI: (0.496–1.03)), and ≥ 39 months, multiple births (AHR = 3.9; 95% CI: (2.77–5.62)), being breastfeeding (AHR = 0.13; 95% CI: (0.099–0.162)), and unvaccinated child (AHR = 11.6; 95% CI: (1.62–83.1)) were significant associations of under-five children mortality.

Conclusions

In this study, the UFCM rate was present, with 6.2% in the rural areas of Ethiopia. The birth type, preceding birth interval, vaccination of the child, and breastfeeding are identified as significant associations with under-five child mortality in rural Ethiopia. Therefore, public health interventions should be given attention to multiple births, unvaccinated, and non-breastfeeding children, as well as mothers’ better encouragement to have a large spacing preceding the birth interval. Moreover, investigators should conduct continuous research on UFCM, which is imperative to provide current information and inform interventions in a timely manner.
Additive interactions between obesity and insulin resistance on hypertension in a Chinese rural population
Authors: Li Xiaoxia , Chang Xiaoyu , Dang Yuanyuan , Xue Yixuan , Wang Qingan , Liu Wanlu , Yin Ting , Zhao Yi , Zhang Yuhong
Published: December 2023

Background

Adiposity and insulin resistance (IR) are closely associated with hypertension; however, the role of interactions between obesity phenotypes and IR in hypertension is unclear. This study aimed to evaluate the interactions of body mass index (BMI), waist circumference (WC), and body fat percentage (BF%) with IR on hypertension risk.

Methods

We analyzed data from 4888 participants (mean age 57 years, 41.2% men) in the China Northwest Natural Population Cohort, Ningxia Project. BMI, WC, and BF% were determined using bioelectrical impedance analysis devices. IR was estimated using a homeostasis model assessment index (HOMA-IR). Multivariable-adjusted logistic regression was used to evaluate the association between HOMA-IR and hypertension risk. We calculated the relative excess risk and attributable proportion with their 95% confidence intervals (CIs) to assess whether adiposity phenotypes modified the effect of HOMA-IR on hypertension risk.

Results

The crude prevalence of hypertension was 52.2%. The multivariable-adjusted odds ratio of HOMA-IR was 1.80 (95% CI: 1.23–2.65) for the risk of hypertension in the highest versus the lowest quartiles, but this association became marginal in models further adjusting for BMI, WC, and BF% (P for trend = 0.056). Relative excess risk and attributable proportion for interaction between high HOMA-IR and high BF% were 0.32 (0.04–0.59) and 0.33 (0.06–0.60), respectively. Additionally, high truncal and leg BF% and high HOMA-IR accounted for the hypertension risk in women, but not in men. We did not observe any significant interactions between BMI or WC and HOMA-IR on hypertension.

Conclusion

BF% modified the association between IR and increased risk of hypertension in women with high truncal and leg BF%, but not in men.