bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-Hop and Mesh for LoRa Networks: Recent Advancements, Issues, and Recommended Applications
Authors: Wong Andrew Wei-Loong , Goh Say Leng , Hasan Mohammad Kamrul , Fattah Salmah
Published: December 2023

A comprehensive review is presented on the latest approaches to solutions focusing on multi-hop and mesh LoRa networks through the evaluation of simulations and real-world experiments, based on papers published between 2015 and 2023. The approaches are systematically classified into four (4) aspects: energy awareness, concurrent access and duty cycle regulations, routing protocols, and security. The first aspect encompasses parameter selection, distance, and clustering. The second aspect focuses on network segregation and time synchronisation. The third aspect covers proactive, reactive, and hybrid routing protocols. The aspect of security includes privacy and Denial-of-Service (DoS). Findings show a consensus that multi-hop networks and adherence to radio duty cycle are able to lower average power consumption. Concurrent access method can improve network performance, but more research is needed due to different conclusions. Reactive protocols have a slight advantage over proactive protocols in terms of node deployment scalability and lower power consumption due to less frequent routing table updates. Hybrid protocols are only beneficial in specific topology deployments. Security is still a major concern for LoRa networks, particularly on attacks such as Man-In-The-Middle (MITM), spoofing, wormholes, flooding, packet replay, and information disclosure. The upcoming trend of implementing machine learning algorithms to multi-hop and mesh LoRa networks opens up a wide range of possibilities, ranging from airspace efficiency, efficient route selection, and improving data throughput. A detailed discussion of the aspects’ issues and recommended industry applications that will benefit from multi-hop and mesh LoRa networks are also provided.
Autism Spectrum Disorder Detection by Hybrid Convolutional Recurrent Neural Networks from Structural and Resting State Functional MRI Images
Authors: Koc Emel , Kalkan Habil , Bilgen Semih
Published: December 2023

This study aims to increase the accuracy of autism spectrum disorder (ASD) diagnosis based on cognitive and behavioral phenotypes through multiple neuroimaging modalities. We apply machine learning (ML) algorithms to classify ASD patients and healthy control (HC) participants using structural magnetic resonance imaging (s-MRI) together with resting state functional MRI (rs-f-MRI and f-MRI) data from the large multisite data repository ABIDE (autism brain imaging data exchange) and identify important brain connectivity features. The 2D f-MRI images were converted into 3D s-MRI images, and datasets were preprocessed using the Montreal Neurological Institute (MNI) atlas. The data were then denoised to remove any confounding factors. We show, by using three fusion strategies such as early fusion, late fusion, and cross fusion, that, in this implementation, hybrid convolutional recurrent neural networks achieve better performance in comparison to either convolutional neural networks (CNNs) or recurrent neural networks (RNNs). The proposed model classifies subjects as autistic or not according to how functional and anatomical connectivity metrics provide an overall diagnosis based on the autism diagnostic observation schedule (ADOS) standard. Our hybrid network achieved an accuracy of 96% by fusing s-MRI and f-MRI together, which outperforms the methods used in previous studies.
Inovativne metode poučavanja u obrazovanju medicinskih sestara
Authors: Težak Martina
Published: December 2023

Uvod: Područje sestrinstva razlikuje se od drugih područja obrazovanja jer kombinira klasičnu nastavu predavačkog tipa i vježbe. Izbor nastavne metode ovisi o cilju nastavnog procesa, složenosti sadržaja, predznanju učenika i osposobljenosti nastavnika, a odabir optimalne metode važan je zadak nastavnika jer on nije samo prenositelj znanja nego i mentor. Cilj je ovog rada prikaz važnosti implementacije inovativnih metoda učenja i poučavanja u obrazovni sustav medicinskih sestara i tehničara na srednjoškolskoj i visokoškolskoj razini.Metode: Temelj rada odnosi se na sažet prikaz inovativnih metoda učenja i poučavanja u sestrinstvu s naglaskom na razvoj kompetencija koje ističu Europski parlament i Državni standard kvalifikacije. Korištena je i analizirana stručna literatura iz područja odgoja i obrazovanja te biomedicine i zdravstva uključujući i dostupne strukovne kurikulume.Rezultati: Suvremeni se oblici inovativnih metoda nastave neprestano razvijaju u smjeru zajedničke suradnje učenika i nastavnika gdje nastavnik poprima ulogu mentora i omogućuje usmjeravanje učenika aktivnim sudjelovanjem u određenim aktivnostima da bi mogao ostvariti potrebne ishode učenja i steći kompetencije. Tradicionalni načini poučavanja neće u potpunosti nestati iz nastavnog kurikuluma u sestrinstvu, nego će doći do kombinacije suvremenih i tradicionalnih metoda nastave kao što je bio slučaj kod pandemije.Zaključak: Obrazovanjem budućih generacija učenika važno je osvijestiti da zanimanje medicinske sestre uključuje stjecanje različitih specifičnih vještina. Inovativne metode omogućuju jačanje kompetentnosti budućih medicinskih sestara i tehničara na tržištu rada te razvijanje i poboljšanje kvalitete pružanja sestrinske skrbi.
Važnost provođenja specifične sestrinske skrbi temeljene na dokazima u jedinicama za liječenje moždanog udara
Authors: Vučko Lea , Bis Sabina , Pokec Ivan
Published: December 2023

Moždani udar ostaje jedna od vodećih determinanti smrti i teške invalidnosti u cijelom svijetu. Rad prikazuje ključnu ulogu medicinskih sestara u brizi za bolesnika s poremećajem moždane cirkulacije nakon moždanog udara. Ističe se važnost stalnih procjena i praćenja vitalnih znakova kao što su temperatura, krvni tlak, zasićenost kisikom, te važnost pravodobnog otkrivanja komplikacija. Prikazane su potencijalne medicinske komplikacije povezane s moždanim udarom, motorički problemi, spastičnost, gubitak osjeta, urinarne i gastrointestinalne komplikacije, a čije rano otkrivanje i tretiranje smanjuje trajanje hospitalizacije te posljedično utječe na smanjenje smrtnosti i bolju kvalitetu života bolesnika. Procjena mentalnog zdravlja bolesnika prikazana je kroz psihosocijalne aspekte oporavka kao što su depresija, umor i socijalna izolacija.Multidisciplinarnim pristupom medicinska sestra ima ključnu ulogu u sprečavanju komplikacija, pravodobnom prepoznavanju problema te pružanju podrške bolesnicima tijekom oporavka nakon poremećaja moždane cirkulacije. Istaknuta je potreba za specijaliziranom njegom i protokolima, kako u jedinicama za moždani udar, tako i u ostalim prijemnim jedinicama da bi bolesnici primili sestrinsku njegu u skladu s najboljom praksom bez obzira na bolničku jedinicu u koju su primljeni.
Jesmo li umorni od suosjećanja?
Authors: Šimunić Nevena , Bušac Vesna , Šimunić Roko , Višnjić Junaković Nikolina
Published: December 2023

Medicinske sestre neizostavni su članovi zdravstvene skrbi koji pružaju kontinuiranu i holističku skrb pacijentima tijekom liječenja. Međutim, zbog učestalih traumatičnih situacija i stresnih iskustava s kojima se susreću u svakodnevnom radu, medicinske su sestre izložene riziku od razvoja umora od suosjećanja, smanjenog zadovoljstva poslom i izgaranja, što negativno utječe na njihovu sposobnost pružanja kvalitetne skrbi.Umor od suosjećanja predstavlja kompleksan i multidimenzionalan fenomen koji uključuje emocionalnu iscrpljenost, osjećaj depersonalizacije i smanjenje osobnog postignuća. Medicinske sestre izložene su većem riziku od razvoja umora od suosjećanja u usporedbi s drugim zdravstvenim radnicima zbog svoje bliske interakcije s pacijentima, dugotrajnih razdoblja rada i visokog stupnja odgovornosti koji nosi njihov posao.Umor od suosjećanja ima ozbiljne posljedice na kvalitetu zdravstvene skrbi, stoga zdravstvene organizacije trebaju prepoznati ovaj fenomen i poduzeti preventivne mjere kako bi smanjili rizik od razvoja umora od suosjećanja među svojim osobljem. To uključuje razvoj programa edukacije i podrške za zdravstvene radnike, pružanje emocionalne podrške i mentorstva, prilagođavanje radnog okruženja i uspostavljanje politika koje promiču samopomoć i brigu o zdravlju zaposlenika.Razumijevanje i prepoznavanje umora od suosjećanja posebno je važno za zdravlje i dobrobit medicinskih sestara, pacijenata i zdravstvenih organizacija. Kao neizostavni članovi tima zdravstvene skrbi, medicinske sestre zaslužuju podršku i brigu kako bi se osiguralo da mogu nastaviti pružati najbolju moguću skrb pacijentima.
Common Carotid Artery Stenosis Degree as a Predictor of Cardiovascular Disease in a General Population: The Suita Study
Authors: Teramoto Masayuki , Kokubo Yoshihiro , Arafa Ahmed , Kashima Rena , Nakao Yoko M. , Sheerah Haytham A. , Kataoka Hiroharu
Published: December 2023

Background

The utility of screening for the degree of common carotid artery (CCA) stenosis as a predictor of cardiovascular disease (CVD) in a general population remains unclear.

Methods and Results

We studied 4775 Japanese men and women whose CCA was measured using bilateral carotid ultrasonography at baseline (April 1994–August 2001). We calculated the degree of stenosis as a percentage of the stenotic area of the lumen in the cross‐section perpendicular to the long axis. The Cox proportional hazards model was used to calculate multivariable‐adjusted hazard ratios (HRs) with 95% CIs for incident CVD and its subtypes according to the degree of CCA stenosis. During the median 14.2 years of follow‐up, 385 incident CVD events (159 coronary heart disease and 226 stroke) were documented. The degree of CCA stenosis was associated with increased risks of incident CVD, coronary heart disease, and stroke, with multivariable‐adjusted HRs (95% CIs) for <25%, 25%–49%, and ≥50% stenosis with plaque compared with no CCA plaque of 1.37 (1.07–1.76), 1.72 (1.23–2.40), and 2.49 (1.69–3.67), respectively. Adding the CCA stenosis degree to traditional CVD risk factors increased Harrell's C statistics (0.772 [95% CI, 0.751–0.794] to 0.778 [95% CI, 0.758–0.799];
P
=0.04) and improved the 10‐year risk prediction ability (integrated discrimination improvement, 0.0129 [95% CI, 0.0078–0.0179];
P
<0.001; continuous net reclassification improvement, 0.1598 [95% CI, 0.0297–0.2881];
P
=0.01).

Conclusions

The degree of CCA stenosis may be used as a predictive marker for the development of CVD in the general population.
Nematode population dynamics and plant steaming effects on strawberry cultivars under organic field conditions in Florida
Authors: Oliveira Clemen J. , Peres Natalia A. , Desaeger Johan
Published: December 2023

Demand for Florida organic strawberries has significantly increased in recent years, yet this industry is threatened by pests and pathogens that often come with transplants from out-of-state nurseries. Plant steaming has been explored as an alternative to reduce those threats in transplants. This study evaluated the yield performance of seven strawberry cultivars and their impact on nematode densities and plant vigour after steaming was applied to transplants imported from California during two growing seasons (2020-2021 and 2021-2022). The cultivars used were ‘Sensation® Florida127’, ‘Florida Brilliance’, ‘Florida Radiance’, ‘Winterstar™ FL 05-107’, ‘Florida Elyana’, ‘Strawberry Festival’ and ‘Florida Beauty’. Plant steaming reduced plant vigour only 4 weeks after transplanting. Nevertheless, no negative effect was observed in total fruit yield. Differences among cultivars were observed for plant vigour, total fruit yield and abundance of root-knot nematodes. The plant vigour of each cultivar depended on the time of the year, which varied significantly throughout the season. Cultivars ‘Sensation® Florida127’ and ‘Florida Radiance’ attained the highest total yield in both seasons. There was an effect of the cropping system in the nematode community, which increased the bacterivores but drastically reduced omnivores and ring nematodes over time. No effect of cultivar was observed in plant-parasitic nematode populations. The cultivar ‘Winterstar™ FL 05-107’ was an exception since Meloidogyne javanica population densities were significantly higher in ‘Winterstar™ FL 05-107’s experimental plots. Overall, transplant steaming shows the potential to be a component of an integrated pest and disease management programme for the success of sustainable and profitable yields
Prolonged Military Occupation: Rethinking the Israeli Occupation on the Occupied Palestinian Territories
Authors: Salmoodi Rezeq Ahmad
Published: December 2023

This research focuses on an increasingly important question associated with the state of military occupation as part of International Humanitarian Law, namely, to what extent the rights and duties of an occupying power are to be broadened or otherwise minimized when an occupation of a foreign territory lasts for a long period of time? This question is necessitated by the practices of some occupying powers that claim their ‘original’ authority over occupied areas should exceed the original rights embodied in the legal corpus on military occupation due to the prolonged nature of their military presence. This research focuses on the state of the Israeli military occupation over the Occupied Palestinian Territories (OPTs.) and found that the Israeli practices are calculated in this direction, i.e., the expansionist policy, which ultimately conflict with the corpus of rules of international law on military occupation.
Revisiting the Relationship between Polar Lows and Weather Regimes
Authors: Boyd Kevin , Wang Zhuo
Published: December 2023

The link between weather regimes (WRs) and polar low (PL) activity is examined over the North Atlantic and North Pacific basins. Compared to earlier studies based on limited, regional PL datasets, our study conducts a more complete evaluation of regional WR–PL relationships using an expanded PL climatology. Our findings show that PL activity is increased over the Norwegian and Barents Seas during the Atlantic ridge regime and decreased over the former region during the Scandinavian blocking regime, with negative impacts also stretching to the Irminger Sea. Over the Labrador and Irminger Seas, PL activity is modulated strongest by the North Atlantic Oscillation (NAO), with positive impacts during the positive phase and vice versa. Over the North Pacific, the Arctic low contributes to increased PL activity over most regions, while the opposite is true for the Pacific wave train regime. The variability of PL activity associated with WRs is strongly related to changes in key environmental conditions. In general, regions of enhanced (reduced) PL activity are coincident with anomalous low-level northerly (southerly) flow and reduced (increased) static stability. Further analysis shows that certain persistent WRs can strongly modulate PL activity over some regions, either due to the amplification or propagation of favorable or unfavorable conditions, which cautions the limitation of regarding WRs as stationary patterns. A previously developed PL genesis potential index is shown to represent the observed impacts well, which serves to confirm the robustness of our findings and suggests the potential applicability of WRs to the subseasonal prediction of PLs.

Significance Statement

Polar lows are intense small-scale (∼300 km) cyclones that form over high-latitude oceanic regions. The hazardous impacts they pose to coastal communities and maritime and air operations in the Arctic motivate their skillful prediction, which remains a major challenge at lead times beyond a few days. In this study, we relate PLs and the key environmental conditions that favor their development to weather regimes, which are recurrent large-scale circulation patterns that can persist for weeks at a time. We find that weather regimes have strong impacts on polar low activity through the modulation of key environmental conditions. These relationships can potentially be utilized in the extended-range prediction of polar lows.
The Respective Roles of Ocean Heat Transport and Surface Heat Fluxes in Driving Arctic Ocean Warming and Sea Ice Decline
Authors: Oldenburg Dylan , Kwon Young-Oh , Frankignoul Claude , Danabasoglu Gokhan , Yeager Stephen , Kim Who M.
Published: December 2023

Arctic Ocean warming and sea ice loss are closely linked to increased ocean heat transport (OHT) into the Arctic and changes in surface heat fluxes. To quantitatively assess their respective roles, we use the 100-member Community Earth System Model, version 2 (CESM2), Large Ensemble over the 1920–2100 period. We first examine the Arctic Ocean warming in a heat budget framework by calculating the contributions from heat exchanges with atmosphere and sea ice and OHT across the Arctic Ocean gateways. Then we quantify how much anomalous heat from the ocean directly translates to sea ice loss and how much is lost to the atmosphere. We find that Arctic Ocean warming is driven primarily by increased OHT through the Barents Sea Opening, with additional contributions from the Fram Strait and Bering Strait OHTs. These OHT changes are driven mainly by warmer inflowing water rather than changes in volume transports across the gateways. The Arctic Ocean warming driven by OHT is partially damped by increased heat loss through the sea surface. Although absorbed shortwave radiation increases due to reduced surface albedo, this increase is compensated by increasing upwelling longwave radiation and latent heat loss. We also explicitly calculate the contributions of ocean–ice and atmosphere–ice heat fluxes to sea ice heat budget changes. Throughout the entire twentieth century as well as the early twenty-first century, the atmosphere is the main contributor to ice heat gain in summer, though the ocean’s role is not negligible. Over time, the ocean progressively becomes the main heat source for the ice as the ocean warms.

Significance Statement

Arctic Ocean warming and sea ice loss are closely linked to increased ocean heat transport (OHT) into the Arctic and changes in surface heat fluxes. Here we use 100 simulations from the same climate model to analyze future warming and sea ice loss. We find that Arctic Ocean warming is primarily driven by increased OHT through the Barents Sea Opening, though the Fram and Bering Straits are also important. This increased OHT is primarily due to warmer inflowing water rather than changing ocean currents. This ocean heat gain is partially compensated by heat loss through the sea surface. During the twentieth century and early twenty-first century, sea ice loss is mainly linked to heat transferred from the atmosphere; however, over time, the ocean progressively becomes the most important contributor.
Comprehensive genome‑wide analysis of the chicken heat shock protein family: identification, genomic organization, and expression profiles in indigenous chicken with highly pathogenic avian influenza infection
Authors: Truong Anh Duc , Tran Ha Thi Thanh , Chu Nhu Thi , Nguyen Huyen Thi , Phan Lanh , Phan Hoai Thi , Vu Thi Hao , Song Ki-Duk , Lillehoj Hyun S. , Hong Yeong Ho , Dang Hoang Vu
Published: December 2023

Background

Heat shock proteins (HSPs) function as molecular chaperones with critical roles in chicken embryogenesis, immune response to infectious diseases, and response to various environmental stresses. However, little is known on HSP genes in chicken. In this study, to understand the roles of chicken HSPs, we performed genome-wide identification, expression, and functional analyses of the HSP family genes in chicken.

Results

A total of 76 HSP genes were identified in the chicken genome, which were further classified into eight distinct groups (I-VIII) based on phylogenetic tree analysis. The gene-structure analysis revealed that the members of each clade had the same or similar exon-intron structures. Chromosome mapping suggested that HSP genes were widely dispersed across the chicken genome, except in chromosomes 16, 18, 22, 25, 26, and 28–32, which lacked chicken HSP genes. On the other hand, the interactions among chicken HSPs were limited, indicating that the remaining functions of HSPs could be investigated in chicken. Moreover, KEGG pathway analysis showed that the HSP gene family was involved in the regulation of heat stress, apoptotic, intracellular signaling, and immune response pathways. Finally, RNA sequencing data revealed that, of the 76 chicken HSP genes, 46 were differentially expressed at 21 different growth stages in chicken embryos, and 72 were differentially expressed on post-infection day 3 in two indigenous Ri chicken lines infected with highly pathogenic avian influenza.

Conclusions

This study provides significant insights into the potential functions of HSPs in chicken, including the regulation of apoptosis, heat stress, chaperone activity, intracellular signaling, and immune response to infectious diseases.
Integrative transcriptomics reveals association of abscisic acid and lignin pathways with cassava whitefly resistance
Authors: Nye Danielle G. , Irigoyen Maria L. , Perez-Fons Laura , Bohorquez-Chaux Adriana , Hur Manhoi , Medina-Yerena Diana , Lopez-Lavalle Luis Augusto Becerra , Fraser Paul D. , Walling Linda L.
Published: December 2023

Background

Whiteflies are a global threat to crop yields, including the African subsistence crop cassava (Manihot esculenta). Outbreaks of superabundant whitefly populations throughout Eastern and Central Africa in recent years have dramatically increased the pressures of whitefly feeding and virus transmission on cassava. Whitefly-transmitted viral diseases threaten the food security of hundreds of millions of African farmers, highlighting the need for developing and deploying whitefly-resistant cassava. However, plant resistance to whiteflies remains largely poorly characterized at the genetic and molecular levels. Knowledge of cassava-defense programs also remains incomplete, limiting characterization of whitefly-resistance mechanisms. To better understand the genetic basis of whitefly resistance in cassava, we define the defense hormone- and Aleurotrachelus socialis (whitefly)-responsive transcriptome of whitefly-susceptible (COL2246) and whitefly-resistant (ECU72) cassava using RNA-seq. For broader comparison, hormone-responsive transcriptomes of Arabidopsis thaliana were also generated.

Results

Whitefly infestation, salicylic acid (SA), jasmonic acid (JA), ethylene (ET), and abscisic acid (ABA) transcriptome responses of ECU72 and COL2246 were defined and analyzed. Strikingly, SA responses were largely reciprocal between the two cassava genotypes and we suggest candidate regulators. While susceptibility was associated with SA in COL2246, resistance to whitefly in ECU72 was associated with ABA, with SA-ABA antagonism observed. This was evidenced by expression of genes within the SA and ABA pathways and hormone levels during A. socialis infestation. Gene-enrichment analyses of whitefly- and hormone-responsive genes suggest the importance of fast-acting cell wall defenses (e.g., elicitor recognition, lignin biosynthesis) during early infestation stages in whitefly-resistant ECU72. A surge of ineffective immune and SA responses characterized the whitefly-susceptible COL2246’s response to late-stage nymphs. Lastly, in comparison with the model plant Arabidopsis, cassava’s hormone-responsive genes showed striking divergence in expression.

Conclusions

This study provides the first characterization of cassava’s global transcriptome responses to whitefly infestation and defense hormone treatment. Our analyses of ECU72 and COL2246 uncovered possible whitefly resistance/susceptibility mechanisms in cassava. Comparative analysis of cassava and Arabidopsis demonstrated that defense programs in Arabidopsis may not always mirror those in crop species. More broadly, our hormone-responsive transcriptomes will also provide a baseline for the cassava community to better understand global responses to other yield-limiting pests/pathogens.
Distinctive plastome evolution in carnivorous angiosperms
Authors: Fu Chao-Nan , Wicke Susann , Zhu An-Dan , Li De-Zhu , Gao Lian-Ming
Published: December 2023

Background

Independent origins of carnivory in multiple angiosperm families are fabulous examples of convergent evolution using a diverse array of life forms and habitats. Previous studies have indicated that carnivorous plants have distinct evolutionary trajectories of plastid genome (plastome) compared to their non-carnivorous relatives, yet the extent and general characteristics remain elusive.

Results

We compared plastomes from 9 out of 13 carnivorous families and their non-carnivorous relatives to assess carnivory-associated evolutionary patterns. We identified inversions in all sampled Droseraceae species and four species ofUtricularia,Pinguicula,DarlingtoniaandTriphyophyllum. A few carnivores showed distinct shifts in inverted repeat boundaries and the overall repeat contents. Manyndhgenes, along with some other genes, were independently lost in several carnivorous lineages. We detected significant substitution rate variations in most sampled carnivorous lineages. A significant overall substitution rate acceleration characterizes the two largest carnivorous lineages of Droseraceae and Lentibulariaceae. We also observe moderate substitution rates acceleration in many genes ofCephalotus follicularis,Roridula gorgonias, andDrosophyllum lusitanicum. However, only a few genes exhibit significant relaxed selection.

Conclusion

Our results indicate that the carnivory of plants have different effects on plastome evolution across carnivorous lineages. The complex mechanism under carnivorous habitats may have resulted in distinctive plastome evolution with conserved plastome in theBrocchinia hechtioidesto strongly reconfigured plastomes structures in Droseraceae. Organic carbon obtained from prey and the efficiency of utilizing prey-derived nutrients might constitute possible explanation.
Medical behaviours and medication adherence of older hypertensive patients in different medical insurance programs in Beijing, China: a cross-sectional study
Authors: Lan Lan , Hai Pengcheng , Luo Jiawei , Li Rui , Wang Yilong
Published: December 2023

Background

Grassroots medical institutions are the primary “battlefield” of hypertension management based on hierarchical diagnosis and treatment policies in China. There is a considerable difference in the insured population and reimbursement ratio between different medical insurance programs. The management of hypertension directly affects the development trend of cardiovascular and cerebrovascular diseases.

Methods

To understand the difference between different medical insurance programs regarding the management of older hypertensive patients, all outpatients aged 60 and above with hypertension in the basic medical insurance database of Beijing, China, from April 1, 2019, to January 31, 2020, were included. Medical behaviours included patients’ choice of hospital level, type of hospital, number of hospitals visited, grassroots medical institutions and cross-district visits. Medication adherence was evaluated by calculating the medication possession ratio of antihypertensive medications. First, we adopted a statistical description for medical behaviours and medication adherence. Then, multivariate logistic regression was used to analyse the influencing factors of medication adherence.

Results

This study included 1.29 million patients with Urban Employee Basic Medical Insurance (UEBMI) and 0.31 million patients with Urban‒Rural Resident Basic Medical Insurance (URRBMI). The proportions of patients with UEBMI who chose tertiary hospitals, comprehensive hospitals, grassroots medical institutions and cross-district visits were 25.84%, 56.09%, 57.34% and 39.32%, respectively, while those of patients with URRBMI were 11.14%, 60.59%, 81.28% and 6.07%, respectively. The medication adherence rates of men and women taking one medication were 61.04% and 55.86%, respectively. UEBMI patients who took their medication accounted for 62.36%, while only 40.27% of URRBMI patients adhered to their medication. The percentages of young-old, old-old and oldest-old patients who took their antihypertensive medications were 58.05%, 59.09% and 56.78%, respectively. The adherence to taking ≥ 2 medications (35.47%) was lower than that to taking one medication (58.33%). The medication adherence rates of patients with UEBMI and URRBMI for taking ≥ 2 medications were 37.21% and 27.45%, respectively.

Conclusions

Patients with UEBMI were more inclined to choose tertiary hospitals and cross-district visits than patients with URRBMI. The adherence of patients with UEBMI was better than that of patients with URRBMI in China.
The value of serum neutralizing antibody in evaluating predictability of COVID-19 after recovery and the validation of vaccine
Authors: Guo Bianqin , Li Zheng , Fu Gang , Li Hong , Yang Jing , Zhang Zhenbin , Wu Lixiang , Wang Jing
Published: December 2023

Background

This work aimed to study natural humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods

Chemiluminescent immunoassay (CLIA) was used to detect the neutralizing antibody (Nabs) and IgG.

Results

Nabs peaked on days 57–96 after symptom onset and remained detected on days 97–132. The Nabs in the 32 patients who were dynamically monitored showed four changing patterns. The titers of Nabs and IgG were correlated, and three modes of relationship were found between them.

Conclusions

Nabs showed a regular change in the course of coronavirus disease 2019 (COVID-19). The detection of Nabs is very important for monitoring the course of COVID-19 and predicting the strength of antibody protection.
Investigating cognitive reserve, symptom resolution and brain connectivity in mild traumatic brain injury
Authors: Ekdahl Natascha , Möller Marika C. , Deboussard Catharina Nygren , Stålnacke Britt-Marie , Lannsjö Marianne , Nordin Love Engström
Published: December 2023

Background

A proportion of patients with mild traumatic brain injury (mTBI) suffer long-term consequences, and the reasons behind this are still poorly understood. One factor that may affect outcomes is cognitive reserve, which is the brain's ability to maintain cognitive function despite injury. It is often assessed through educational level or premorbid IQ tests. This study aimed to explore whether there were differences in post-concussion symptoms and symptom resolution between patients with mTBI and minor orthopedic injuries one week and three months after injury. Additional aims were to explore the relationship between cognitive reserve and outcome, as well as functional connectivity according to resting state functional magnetic resonance imaging (rs-fMRI).

Method

Fifteen patients with mTBI and 15 controls with minor orthopedic injuries were recruited from the emergency department. Assessments, including Rivermead Post-Concussion Questionnaire (RPQ), neuropsychological testing, and rs-fMRI scans, were conducted on average 7 days (SD = 2) and 122 days (SD = 51) after injury.

Results

At the first time point, significantly higher rates of post-concussion symptoms (U = 40.0, p = 0.003), state fatigue (U = 56.5, p = 0.014), and fatigability (U = 58.5, p = 0.025) were observed among the mTBI group than among the controls. However, after three months, only the difference in post-concussion symptoms remained significant (U = 27.0, p = 0.003). Improvement in post-concussion symptoms was found to be significantly correlated with cognitive reserve, but only in the mTBI group (Spearman’s rho = -0.579, p = .038). Differences in the trajectory of recovery were also observed for fatigability between the two groups (U = 36.5, p = 0.015). Moreover, functional connectivity differences in the frontoparietal network were observed between the groups, and for mTBI patients, functional connectivity differences in an executive control network were observed over time.

Conclusion

The findings of this pilot study suggest that mTBI, compared to minor orthopedic trauma, is associated to both functional connectivity changes in the brain and concussion-related symptoms. While there is improvement in these symptoms over time, a small subgroup with lower cognitive reserve appears to experience more persistent and possibly worsening symptoms over time. This, however, needs to be validated in larger studies.

Trial registration

NCT05593172. Retrospectively registered.
How should the healthcare system support cancer survivors? Survivors’ and health professionals’ expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study
Authors: Lee Su Jung , Jin Dal-Lae , Kim Young Ae , Seo Hyun-Ju , Yoon Seok-Jun
Published: December 2023

Background

Qualitative research on cancer survivors’ need for comprehensive cancer survivorship care within the health care system is limited. Our study aimed to understand cancer survivors' and health professionals' expectations and perceptions for developing a comprehensive cancer survivorship care system in South Korea.

Methods

An exploratory qualitative study was conducted. A total of 16 subjects (11 cancer survivors and 5 health professionals) were purposively sampled from Regional Cancer Survivorship Centers or Cancer Survivor Clinics in Korea. In-depth semi-structured online or face-to-face interviews were conducted. Six steps of thematic analysis were used to analyze data.

Results

The following four primary themes emerged from the interviews: 1) introducing a customized follow-up care system to improve continuity of survivorship care, 2) implementing educational strategies for both survivors and health professionals to manage changed health, and 3) accepting cancer survivors as companions. These three themes included a total of nine subthemes. As a result, the comprehensive survivorship model identified needs in terms of 1) changes in the medical healthcare system and core services that can accommodate the cancer survivors’ condition and 2) necessary care services and social support for cancer survivors.

Conclusions

This study identified the existing gaps in Korea’s current healthcare system regarding comprehensive cancer survivorship care for cancer survivors. Further research on eHealth-based counseling and educational support, the payment models of cancer survivorship care within universal health coverage, and changing social perceptions to strengthen the biopsychosocial needs of cancer survivors is needed.
Role of polygenic risk scores in the association between chronotype and health risk behaviors
Authors: Zhang Yi , Li Shuqin , Xie Yang , Xiao Wan , Xu Huiqiong , Jin Zhengge , Li Ruoyu , Wan Yuhui , Tao Fangbiao
Published: December 2023

Background

This study explores the association between chronotypes and adolescent health risk behaviors (HRBs) by testing how genetic background moderates these associations and clarifies the influence of chronotypes and polygenic risk score (PRS) on adolescent HRBs.

Methods

Using VOS-viewer software to select the corresponding data, this study used knowledge domain mapping to identify and develop the research direction with respect to adolescent risk factor type. Next, DNA samples from 264 students were collected for low-depth whole-genome sequencing. The sequencing detected HRB risk loci, 49 single nucleotide polymorphisms based to significant SNP. Subsequently, PRSs were assessed and divided into low, moderate, and high genetic risk according to the tertiles and chronotypes and interaction models were constructed to evaluate the association of interaction effect and clustering of adolescent HRBs. The chronotypes and the association between CLOCK-PRS and HRBs were examined to explore the association between chronotypes and mental health and circadian CLOCK-PRS and HRBs.

Results

Four prominent areas were displayed by clustering information fields in network and density visualization modes in VOS-viewer. The total score of evening chronotypes correlated with high-level clustering of HRBs in adolescents, co-occurrence, and mental health, and the difference was statistically significant. After controlling covariates, the results remained consistent. Three-way interactions between chronotype, age, and mental health were observed, and the differences were statistically significant. CLOCK-PRS was constructed to identify genetic susceptibility to the clustering of HRBs. The interaction of evening chronotypes and high genetic risk CLOCK-PRS was positively correlated with high-level clustering of HRBs and HRB co-occurrence in adolescents, and the difference was statistically significant. The interaction between the sub-dimensions of evening chronotypes and the high genetic CLOCK-PRS risk correlated with the outcome of the clustering of HRBs and HRB co-occurrence.

Conclusions

The interaction of PRS and chronotype and the HRBs in adolescents appear to have an association, and the three-way interaction between the CLOCK-PRS, chronotype, and mental health plays important roles for HRBs in adolescents.
Use of nicotine replacement therapy to reduce children’s exposure to second-hand smoke in the home: a qualitative pilot study involving local community pharmacies
Authors: Howell Rebecca , McBurney Stephen , Di Tano Giovanna , Boags Aileen , Rowa-Dewar Neneh , Dobson Ruaraidh , O’Donnell Rachel
Published: December 2023

Background

In Scotland, and in several other countries, most second-hand smoke exposure now occurs in low-income households, where housing constraints and sole parenting often make it harder to create a smoke-free home. This pilot study provided people who smoke with a free 12-week supply of nicotine replacement therapy through local community pharmacies to reduce smoking indoors.

Methods

Twenty-five parents/caregivers who smoked in the home and cared for children at least weekly were recruited via Facebook during the COVID-19 pandemic. Air quality (PM2.5) was monitored in participant homes for seven days before their first pharmacy visit and 12 weeks later. Qualitative interviews (N = 14) were conducted with 13 participants who completed the study and one who withdrew part-way through. The interviews explored views/experiences of using nicotine replacement therapy to help create a smoke-free home. Another participant took part in a shorter telephone discussion at their request, with detailed notes taken by the interviewer, because of their speech disorder.

Results

Three participants reported smoking outdoors only, one of whom subsequently quit smoking. Six participants reported reduced cigarette consumption by 50% in the home, four reported no (sustained) reduction and one reported increased smoking indoors. Self-reported outcomes were not always consistent with PM2.5 readings. Participants’ experiences of accessing nicotine replacement therapy through community pharmacies varied. Some suggested ongoing support to use nicotine replacement products could better assist behavioural change, and that access could be streamlined by posting products to the home. Several suggested that focusing on changing home smoking behaviours using nicotine replacement therapy might facilitate a future quit attempt.

Conclusion

Access to free nicotine replacement therapy for temporary use indoors may support some people who smoke to reduce children’s exposure to second-hand smoke. Our findings confirm the need to modify the intervention before undertaking a definitive trial to assess the effectiveness of this approach. This work is now underway.
Increasing access to palliative care for patients with advanced cancer of African and Latin American descent: a patient-oriented community-based study protocol
Authors: Santos Salas Anna , Watanabe Sharon M. , Sinnarajah Aynharan , Bassah Nahyeni , Huang Fleur , Turner Jill , Alcalde Castro Jacqueline , O’Rourke Hannah M. , Camargo-Plazas Pilar , Salami Bukola , Santana María , Campbell Katy , Abdel-Rahman Omar , Wildeman Tracy , Vaughn Lisa , Judge Harkeert , Ahmed Sadia , Adewale Bisi , Iyiola Iqmat ,   the Patient Advisory Council, Russon Nazret , Godlu Atobrhan , Pardo María Castrellon , Mendez Mendez German , Ramirez Edna , Weldehanna Tibebe , Asfaha Foto , Seyoum Meron , Cameron Brenda , Oladele Bayo , Oladele Yinka
Published: December 2023

Background

Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent.

Methods

This is a community-based participatory research study that will take place in two Canadian provinces. Patients and community members representatives have been engaged as partners in the planning and design of the study. We have formed a patient advisory council (PAC) with patient partners to guide the development of the Access to Palliative Care Strategy for people of African and Latin American descent. We will engage100 participants consisting of advanced cancer patients, families, and community members of African and Latin American descent, and health care providers. We will conduct in-depth interviews to delineate participants’ experiences of access to palliative care. We will explore the intersections of race, gender, socioeconomic status, language barriers, and other social categorizations to elucidate their role in diverse access experiences. These findings will inform the development of an action plan to increase access to palliative care that is tailored to our study population. We will then organize conversation series to examine together with community partners and healthcare providers the appropriateness, effectiveness, risks, requirements, and convenience of the strategy. At the end of the study, we will hold knowledge exchange gatherings to share findings with the community.

Discussion

This study will improve our understanding of how patients with advanced cancer from racialized communities in Canada access palliative care. Elements to address gaps in access to palliative care and reduce inequities in these communities will be identified. Based on the study findings a strategy to increase access to palliative care for this population will be developed. This study will inform ways to improve access to palliative care for racialized communities in other parts of Canada and globally.
Post-COVID-19 condition risk in patients with intellectual and developmental disabilities: a retrospective cohort study involving 36,308 patients
Authors: Liu Ting-Hui , Huang Po-Yu , Wu Jheng-Yan , Chuang Min-Hsiang , Hsu Wan-Hsuan , Tsai Ya-Wen , Kao Pei-Hsin , Lai Chih-Cheng
Published: December 2023

Background

To date, no studies have investigated the prevalence of post-COVID-19 conditions in patients with Intellectual and Developmental Disabilities (IDD). Addressing this research gap is crucial, as understanding post-COVID-19 conditions in IDD patients can improve care planning, and it is essential not to overlook this vulnerable population in COVID-19 studies. This study was aimed at investigating the prevalence of post-COVID-19 conditions in patients with IDD and compare their risk with that of the general population.

Methods

Using the TriNetX network, we identified patients with and without an IDD who had COVID-19. Subsequently, we compared the risk of developing any post-COVID-19 condition between these two groups, during the 90–180-day follow-up after SARS-CoV-2 infection.

Results

During the follow-up, patients with an IDD exhibited a significantly higher prevalence of post-COVID-19 conditions compared to the general population (hazard ratio [HR], 1.120; 95% confidence interval [CI]: 1.053–1.191). Specifically, COVID-19 survivors with IDD had a significantly increased risk of experiencing abnormal breathing (HR, 1.216; 95% CI: 1.077–1.373), abdominal symptoms (HR, 1.259; 95% CI: 1.128–1.406), fatigue (HR, 1.397; 95% CI: 1.216–1.606), anxiety/depression (HR, 1.157; 95% CI: 1.050–1.274), cognitive symptoms (HR, 1.828; 95% CI: 1.529–2.186), myalgia (HR, 1.325; 95% CI: 1.077–1.631), sleep disturbances (HR, 1.481; 95% CI: 1.148–1.910), and cough (HR, 1.315; 95% CI: 1.146–1.508) compared to the non-IDD group.

Conclusions

Patients with IDD might be associated with a higher risk of post-COVID-19 conditions following SARS-CoV-2 infection compared to the general population.
Socioeconomic representativeness of Australian, Canadian and British cohorts from the paediatric diabetes AdDIT study: comparisons to regional and national data
Authors: Mahmud Farid H. , Clarke Antoine B. M. , Elia Yesmino , Curtis Jacqueline , Benitez-Aguirre Paul , Cameron Fergus J. , Chiesa Scott T. , Clarson Cheril , Couper Jennifer J. , Craig Maria E. , Dalton R. Neil , Daneman Denis , Davis Elizabeth A. , Deanfield John E. , Donaghue Kim C. , Jones Timothy W. , Marshall Sally M. , Neil Andrew , Marcovecchio M. Loredana
Published: December 2023

Background

Given limited data regarding the involvement of disadvantaged groups in paediatric diabetes clinical trials, this study aimed to evaluate the socioeconomic representativeness of participants recruited into a multinational clinical trial in relation to regional and national type 1 diabetes reference populations.

Methods

Retrospective, cross-sectional evaluation of a subset of adolescent type 1 diabetes cardiorenal intervention trial (AdDIT) participants from Australia (n = 144), Canada (n = 312) and the UK (n = 173). Validated national measures of deprivation were used: the Index of Relative Socioeconomic Disadvantage (IRSD) 2016 (Australia), the Material Resources (MR) dimension of the Canadian Marginalisation index 2016 (Canada) and the Index of Multiple Deprivation (IMD) 2015 (UK). Representativeness was assessed by comparing the AdDIT cohort’s distribution of deprivation quintiles with that of the local paediatric type 1 diabetes population (regional), and the broader type 1 diabetes population for which the trial’s intervention was targeted (national).

Results

Recruited study cohorts from each country had higher proportions of participants with higher SES, and significant underrepresentation of lower SES, in relation to their national references. The socioeconomic make-up in Australia mirrored that of the regional population (p = 0.99). For Canada, the 2nd least deprived (p = 0.001) and the most deprived quintiles (p < 0.001) were over- and under-represented relative to the regional reference, while the UK featured higher regional and national SES bias with over-representation and under-representation from the least-deprived and most-deprived quintiles (p < 0.0001).

Conclusions

Significant national differences in trial participation of low SES participants were observed, highlighting limitations in access to clinical research and the importance of reporting sociodemographic representation in diabetes clinical trials.

Trial registration

NCT01581476. Registered on 20 April 2012.