bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Diabetes Related-Complications in a Real-World Free-Text Electronic Medical Records in Hebrew Using Natural Language Processing Techniques
Authors: Saban Mor , Lutski Miri , Zucker Inbar , Uziel Moshe , Ben-Moshe Dror , Israel Ariel , Vinker Shlomo , Golan-Cohen Avivit , Laufer Izhar , Green Ilan , Eldor Roy , Merzon Eugene
Published: January 2024

Background:

Studies have demonstrated that 50% to 80% of patients do not receive an International Classification of Diseases (ICD) code assigned to their medical encounter or condition. For these patients, their clinical information is mostly recorded as unstructured free-text narrative data in the medical record without standardized coding or extraction of structured data elements. Leumit Health Services (LHS) in collaboration with the Israeli Ministry of Health (MoH) conducted this study using electronic medical records (EMRs) to systematically extract meaningful clinical information about people with diabetes from the unstructured free-text notes.

Objectives:

To develop and validate natural language processing (NLP) algorithms to identify diabetes-related complications in the free-text medical records of patients who have LHS membership.

Methods:

The study data included 2.3 million records of 41 469 patients with diabetes aged 35 or older between the years 2012 and 2017. The diabetes related complications included cardiovascular disease, diabetic neuropathy, nephropathy, retinopathy, diabetic foot, cognitive impairments, mood disorders and hypoglycemia. A vocabulary list of terms was determined and adjudicated by two physicians who are experienced in diabetes care board certified diabetes specialist in endocrinology or family medicine. Two independent registered nurses with PhDs reviewed the free-text medical records. Both rule-based and machine learning techniques were used for the NLP algorithm development. Precision, recall, and F-score were calculated to compare the performance of (1) the NLP algorithm with the reviewers’ comments and (2) the ICD codes with the reviewers’ comments for each complication.

Results:

The NLP algorithm versus the reviewers (gold standard) achieved an overall good performance with a mean F-score of 86%. This was better than the ICD codes which achieved a mean F-score of only 51%.

Conclusion:

NLP algorithms and machine learning processes may enable more accurate identification of diabetes complications in EMR data.
Trifecta rate and its predictor variables according to calibres in percutaneous nephrolithotomy
Authors: Szczesniewski Juliusz Jan , Boronat Catalá Juan , García-Cano Alba María , Rodríguez Castro Percy Miguel , Torres Pérez Diego , Llanes González Luis
Published: January 2024

Objective:

The aim of this study is to determine and compare the number of patients who met the trifecta criteria using standard, Mini-15Fr and Ultra-Mini percutaneous nephrolithotomy (PCNL).

Material and methods:

Retrospective study of PCNL in Galdakao-modified supine Valdivia position with standard, Mini-15Fr and Ultra-Mini PCNL.

Results:

A total of 164 consecutive patients were analysed. Forty-six patients underwent standard PCNL (29.6%), 58 patients Mini-15Fr (34.4%) and 61 patients Ultra-Mini (36%). The Ultra-Mini had the lowest rate of complications (15%) followed by standard PCNL (18.6%) and Mini-15Fr (20.7%). There was no difference in stone-free rate (SFR). The trifecta rate was slightly higher in the Ultra-Mini at 65%, followed by the Mini-15Fr group (55%) and PCNL standard with 50% ( p = 0.280). Univariate logistic regression found that lower surgical time (odds ratio (OR) = 1.01), tubeless technique (OR = 2.87) and shorter hospitalization (OR = 1.72) time were factors to favourable accomplishment of trifecta. In multivariate logistic regression, shorter hospitalization was established as independent predictor for achievement of trifecta (OR = 1.74).

Conclusions:

The miniaturized calibres in our study had a similar SFR and complications compared to the standard calibre in lithiasis smaller than 5 cm in diameter. The tubeless rate was higher and mean hospitalization was lower in the Mini-15Fr and Ultra-Mini. Tubeless technique and shorter hospitalization were predictors of trifecta.

Level of evidence:

2c
Mediatized politics in Palestine: Online platforms’ influence on framing of politicians’ messages
Authors: Abu-Ayyash Shadi
Published: January 2024

Based on a theoretical framework of mediatization and framing, this article examines the communication behaviors of leaders from the prominent Palestinian party, Fatah, on social media, with a specific focus on the general election decree of 2021. It involves interviews with journalists and an analysis of social media content to explain how politicians’ online behavior is influenced by the formats of social media content. It shows that Palestinian politicians often use identical content on both Facebook and X (previously Twitter), with a higher frequency of written material over visual content. Politicians use their social media accounts to express their positions on internal and international political affairs. Journalists consider these accounts a source of information, thus reaffirming that political social media is newsworthy for journalists. This article contributes to the study of mediatization that is largely conducted in Western contexts, challenging the notion that mediatization only occurs in highly digitized societies.
A multi-institutional assessment of low-dose protocols in chest computed tomography: Dose and image quality
Authors: Tonkopi Elena , Tetteh Mercy Afadzi , Gunn Catherine , Ashraf Haseem , Rusten Sigrid Lia , Safi Perkhah , Tinsoe Nora Suu , Colford Kylie , Ouellet Olivia , Naimi Salma , Johansen Safora
Published: January 2024

Background

Low-dose CT (LDCT) chest protocols have widespread clinical applications for many indications; as a result, there is a need for protocol assessment prior to standardization. Dalhousie University and Oslo Metropolitan University have a formally established cooperative relationship.

Purpose

The purpose is to assess radiation dose and image quality for LDCT chest protocols in seven different hospital locations in Norway and Canada.

Material and methods

Retrospective dosimetry data, volumetric CT dose index (CTDIvol), and dose length product (DLP) from 240 average-sized patients as well as CT protocol parameters were included in the survey. Effective dose (ED) and size-specific dose estimate (SSDE) were calculated for each examination. For a quantitative image quality analysis, noise, CT number, and signal-to-noise ratio (SNR) were determined for three regions in the chest. The contrast-to-noise ratio (CNR) was calculated for lung parenchyma in comparison to the subcutaneous fat. Differences in dose and image quality were evaluated by a single-factor ANOVA test. A two-sample t-test was performed to determine differences in means between individual scanners.

Results

The ANOVA test revealed significant differences ( p < .05) in dose values for all scanners, including identical scanner models. Statistically significant differences ( p < .05) were determined in mean values of the SNR distributions between the scanners in all three measured regions in the chest, as well as the CNR values.

Conclusion

The observed variations in dose and image quality measurements, even within the same hospitals and between identical scanner models, indicate a potential for protocol optimization in the involved hospitals in both countries.
The Effects of Growth Mindset and Resilience on Immigrant Students’ PISA Science Achievement: The Mediating Role of Attitudes Toward School
Authors: Kaya Sibel , Eryilmaz Nurullah , Yuksel Dogan
Published: January 2024

In recent years, self-theories such as growth mindset and resilience have gained interest as they have a sizable influence on achievement and school-related motivation. The aim of this study is to investigate the relationship between immigrant students’ growth mindset, resilience, and science achievement in PISA 2018 by considering the mediating effect of attitudes toward school. Using secondary data for Australia, the UK, and the USA obtained from PISA 2018, we conducted a series of Structural Equation Modeling analyses to unravel the relationship between self-theories and science achievement. The growth mindset had the strongest effect on science achievement for both immigrants and non-immigrants in all three countries; resilience was positively related to science achievement for immigrants in the US, and attitudes toward school were positively related to science achievement for immigrants in Australia. The mediating role of attitudes toward school between growth mindset, resilience and science achievement could not have been confirmed. We speculate that self-theories might be affecting immigrant groups differently in different countries. Implications regarding these findings are discussed.
More than neighbours: Assessing crisis narratives of Nordic-Baltic elites in the context of European Union’s eastern border
Authors: Braghiroli Stefano , Hagelin Sandra
Published: January 2024

Over the last decade, the European Union has faced multiple crises that have affected the direction and the nature of the integration process. This study focuses on the challenges posed by the Belarusian-EU border crisis (2021) and the proposed travel restrictions towards Russian citizens (2022) in the context of the Nordic-Baltic EU member states. The study addresses their impact through the double prisms of regionality and level of governance. The study looks at how national elite narratives on borders and the movement of people travel to the supranational context, in this case the European Parliament. While the Parliament is often overlooked in favour of the Council or the Commission, this study regards it as an effective analytical bridge between domestic and supranational decision-making levels. To achieve its empirical goals the study relies on governments’ official communiques, while the parliamentary analysis is based on pre-vote debates and Parliament’s roll-call votes. The article finds that, while the national narratives highlight a growing convergence of governmental narratives in adopting or justifying restrictive bordering measures, the EP debates and votes highlight the relevance of ideology and partisanship when it comes to the issue and the growing significance of the gap between mainstream and non-mainstream forces.
A constructive error management culture promotes innovation and corporate social responsibility: A multi-level analysis in 10 countries
Authors: Kruse Philipp , Wegge Jürgen
Published: January 2024

In the face of grand challenges like global warming or social inequality, firms are increasingly expected to make a positive contribution to society. As a result, they are looking for ways to fuse their own and common good interests, for example, by employing so-called Common Good HRM practices. These practices like the promotion of a constructive error management culture (EMC) aim to support an environment that facilitates positive societal and ecological change by enabling firm leaders and employees to contribute to global progress. Yet, to date empirical evidence for proposed positive effects is scarce and the embeddedness of employees in different teams and national cultures is largely neglected in prior research. The current study accounts for these shortcomings by investigating the effects of a constructive EMC as a Common Good HRM practice on employee innovativeness and internal corporate social responsibility (CSR) based on a sample of 82,927 employees working in 9253 teams in a large telecommunication company with subsidiaries in 10 different countries. Applying a comprehensive multi-level design, we find that (i) a constructive EMC has a positive impact on employee innovativeness and internal CSR and (ii) that team member diversity regarding gender, age, and tenure and cultural values affect EMC. Particularly, our analyses uncover that EMC effects differ depending on the kind of diversity and reveal a complex interplay of team composition and cultural values. Despite notable limitations like the examination of only one single organization, our work underpins the theoretically proposed benefits of applying Common Good HRM practices and highlights the need to take both team and cultural influences into account.
Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review
Authors: Nadgauda Ashni S. , Butts Samantha
Published: January 2024

Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: ‘transgender persons’ and ‘fertility preservation’ and ‘adolescents’ was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.
Operative Management of Lateral Ankle Instability: Examination Under Anesthesia, Ankle Arthroscopy and Stabilization Technique
Authors: Ashy Cody C. , Rodriguez Materon Solangel , Goodloe J. Brett , Scott Daniel J.
Published: January 2024

Background:

Ankle sprains are common injuries that can result in chronic ankle instability.

Indications:

Indications for surgical management include recurrent instability, failed conservative management for 3 to 6 months, and inability to return to play or activity.

Technique Description:

The patient’s ankle is initially examined under anesthesia with anterior drawer testing to confirm the diagnosis of ankle instability. Ankle arthroscopy is then preformed to identify and treat additional intra-articular pathology prior to modified Broström repair. During arthroscopy, care is taken to protect the superficial peroneal nerve. Routinely we perform a “drive-through sign” to assess syndesmotic stability and also debride pathologic intra-articular tissue such as hypertrophied synovium. Following the completion of arthroscopy, an incision is made directly over the fibula. The anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and distal fibular periosteum are dissected off the fibula. Two 3.0-mm suture anchors are placed at the origin of the CFL ligament and the ATFL ligament, and previously dissected tissue is incorporated for repair. We reinforce the CFL and ATFL tissues with incorporation of the distal fibular periosteum. Suture tape augmentation is considered for patients at high risk of recurrence, such as those with ligamentous laxity. After completion of our repair, the ankle is again examined under anesthesia with satisfactory confirmation of improved ankle stability.

Results:

Outcomes of our technique are promising, with improvement in patient-reported outcome measures, restoration of range of motion, return to sport as high as 94%, and low failure rates.

Discussion:

For patients with chronic instability, our described technique for sequential examination under anesthesia, ankle arthroscopy, and our modified Broström result in satisfactory improvement in ankle stability and patient symptoms.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
Revealing a Cleft in the Community: A Systematic Review of Sociodemographic Disparities Affecting the Care of Patients With Cleft Lip
Authors: Obinero Chioma G. , Boyd Alexandra , Barrera Jose , Valenti Alyssa , Munabi Naikhoba , Imahiyerobo Thomas , Greives Matthew R.
Published: January 2024

Introduction:

Comprehensive management of cleft lip with or without cleft palate (CL/P) often begins prenatally, continues into adulthood, and involves multidisciplinary collaboration. This study aims to review the current literature and summarize sociodemographic disparities that impact access to care, management, and postoperative outcomes in patients with CL/P.

Methods:

A systematic review was conducted using Pubmed, Embase, and Medline databases. Studies discussing sociodemographic disparities regarding access to care, management, and treatment outcomes for patients with CL/P were included. Studies performed outside the US and published before the year 2000 were excluded.

Results:

Of 3782 studies initially identified, 26 met the inclusion criteria. Disparities discussed included access to care (n = 11), missed appointments (n = 2), use of nasoalveolar molding [NAM] (n = 3), surgical timing (n = 8), and surgical outcomes (n = 8). Minority race or ethnicity, particularly black, Hispanic, Asian, and Native-American, as well as public insurance were associated with impaired access to care. Other factors causing impaired access to care were non-English primary language and high cost. Predictors for missed appointments were black race and Medicaid insurance. Decreased use of or success with NAM was associated with Asian race, public insurance, and long travel distance to a cleft care center. Factors associated with delayed CL surgery were Asian or black race, Hispanic ethnicity, public insurance, and non-English primary language. Surgical outcomes were assessed using various esthetic, speech, and quality of life measures; factors linked to worse outcomes included black or latin race and public insurance.

Conclusion:

Patients with CL/P from minority racial or ethnic groups, particularly black, Asian, and Hispanic, as well as those with public insurance are disproportionately impacted by health disparities. Disparities related to age, geographic location, and primary language have also been reported, among others. Statewide or institutional social programs may help address these disparities.
The centrality of the Other: Self-development, values, and democracy
Authors: Branco Angela Uchoa
Published: January 2024

This paper aims at analyzing the centrality of the Other in human ontogeny, by highlighting its ontological role in the development of self, values, and democracy. Inspired by Streib’s thoughtful contributions I argue for the intrinsic relations between wisdom, ethics, and values, as well as how those relations can become an important venue in the cultural construction of democratic societies. By assuming a dialogical cultural approach, I stress the role of affective-semiotic processes in promoting individuals’ ethical sensibility toward others, and values’ openness to different perspectives and wisdom, stressing the role of education in this process.
On the way to thinking otherwise
Authors: Freeman Mark
Published: January 2024

Heinz Streib’s article “Wisdom and the Other” marks a significant step in moving toward a more “ex-centric” psychology—that is, one more oriented toward “thinking Otherwise” about the human condition. Streib’s article is also a valiant attempt to marry responsive phenomenology to the psychology of wisdom. Nevertheless, there is reason to question this marriage in terms of both the philosophical fit between the two and the methodological framework deemed necessary to empirically investigate it. Although Streib is to be commended for undertaking this important work, therefore, there is more to be done in the service of truly recognizing and affirming the priority of the Other in psychology and psychological life.
A Systematic Review of State Office-Based Buprenorphine Treatment Laws Effective During 2022: Counseling, Dosage, and Visit Frequency Requirements
Authors: Andraka-Christou Barbara , Golan Olivia K. , Williams Michelle , Buksbaum Scott , Gordon Adam J. , Stein Bradley D.
Published: January 2024

Background:

Buprenorphine is among the most effective treatments for opioid use disorder. Even though the federal government recently eliminated the waiver requirement and patient limits applicable to office-based buprenorphine treatment (OBBT), among other settings, some states may still have policies imposing requirements on OBBT providers not required by federal law.

Methods:

We collected statutes and regulations from 50 US states and the District of Columbia (ie, 51 jurisdictions) between August 11 and November 30, 2022 using the Nexis Uni legal database and search terms related to OBBT counseling, dosage, and/or frequency of visits. We then used template analysis, a mixed deductive-inductive qualitative method, to analyze legal content.

Results:

Ten jurisdictions (20%) in 2022 had an OBBT counseling, dosage, and/or visit frequency requirement. Four jurisdictions had at least one law in each OBBT policy category examined. One-fifth of jurisdictions have OBBT policies not required under federal law. Five of these jurisdictions are among those with the highest overdose death rates per capita, according to publicly available data from 2021. Some OBBT requirements could potentially limit clinician interest in offering buprenorphine treatment or result in inadequate care (eg, if dosage limitations are too low.)

Conclusions:

Even though a federal waiver is no longer required for OBBT, our results suggests that at least some jurisdictions have other OBBT requirements, such as counseling, dosage, and/or frequency requirements. Given the severity of the ongoing opioid overdose crisis, policymakers should carefully consider the extent to which OBBT requirements are evidence based.
Congenital fibrinogen disorders: a retrospective clinical and genetic analysis of the Prospective Rare Bleeding Disorders Database
Authors: Mohsenian Samin , Palla Roberta , Menegatti Marzia , Cairo Andrea , Lecchi Anna , Casini Alessandro , Neerman-Arbez Marguerite , Asselta Rosanna , Scardo Sara , Siboni Simona Maria , Blatny Jan , Zapletal Ondrej , Schved Jean-Francois , Giansily-Blaizot Muriel , Halimeh Susan , Daoud Mohamad Ayman , Platokouki Helen , Pergantou Helen , Schutgens Roger E. G. , Van Haaften-Spoor Monique , Brons Paul , Laros-van Gorkom Britta , Van Pinxten Elise , Borhany Munira , Fatima Naveena , Mikovic Danijela , Saracevic Marko , Özdemir Gül Nihal , Ay Yılmaz , Makris Michael , Lockley Caryl , Mumford Andrew , Harvey Andrew , Austin Steve , Shapiro Amy , Williamson Adrianna , McGuinn Catherine , Goldberg Ilene , De Moerloose Philippe , Peyvandi Flora
Published: January 2024

Congenital fibrinogen deficiency (CFD) is a rare bleeding disorder caused by mutations in FGA, FGB, and FGG. We sought to comprehensively characterize patients with CFD using PRO-RBDD (Prospective Rare Bleeding Disorders Database). Clinical phenotypes, laboratory, and genetic features were investigated using retrospective data from the PRO-RBDD. Patients were classified from asymptomatic to grade 3 based on their bleeding severity. In addition, FGA, FGB, and FGG were sequenced to find causative variants. A total of 166 CFD cases from 16 countries were included, of whom 123 (30 afibrinogenemia, 33 hypofibrinogenemia, 55 dysfibrinogenemia, and 5 hypodysfibrinogenemia) were well characterized. Considering the previously established factor activity and antigen level thresholds, bleeding severity was correctly identified in 58% of the cases. The rates of thrombotic events among afibrinogenemic and hypofibrinogenemic patients were relatively similar (11% and 10%, respectively) and surprisingly higher than in dysfibrinogenemic cases. The rate of spontaneous abortions among 68 pregnancies was 31%, including 86% in dysfibrinogenemic women and 14% with hypofibrinogenemia. Eighty-six patients received treatment (69 on-demand and/or 17 on prophylaxis), with fibrinogen concentrates being the most frequently used product. Genetic analysis was available for 91 cases and 41 distinct variants were identified. Hotspot variants (FGG, p.Arg301Cys/His and FGA, p.Arg35Cys/His) were present in 51% of dysfibrinogenemia. Obstetric complications were commonly observed in dysfibrinogenemia. This large multicenter study provided a comprehensive insight into the clinical, laboratory, and genetic history of patients with CFDs. We conclude that bleeding severity grades were in agreement with the established factor activity threshold in nearly half of the cases with quantitative defects.
Frozen tissue coring and layered histological analysis improves cell type-specific proteogenomic characterization of pancreatic adenocarcinoma
Authors: Savage Sara R. , Wang Yuefan , Chen Lijun , Jewell Scott , Newton Chelsea , Dou Yongchao , Li Qing Kay , Bathe Oliver F. , Robles Ana I. , Omenn Gilbert S. , Thiagarajan Mathangi , Zhang Hui , Hostetter Galen , Zhang Bing
Published: January 2024

Background

Omics characterization of pancreatic adenocarcinoma tissue is complicated by the highly heterogeneous and mixed populations of cells. We evaluate the feasibility and potential benefit of using a coring method to enrich specific regions from bulk tissue and then perform proteogenomic analyses.

Methods

We used the Biopsy Trifecta Extraction (BioTExt) technique to isolate cores of epithelial-enriched and stroma-enriched tissue from pancreatic tumor and adjacent tissue blocks. Histology was assessed at multiple depths throughout each core. DNA sequencing, RNA sequencing, and proteomics were performed on the cored and bulk tissue samples. Supervised and unsupervised analyses were performed based on integrated molecular and histology data.

Results

Tissue cores had mixed cell composition at varying depths throughout. Average cell type percentages assessed by histology throughout the core were better associated with KRAS variant allele frequencies than standard histology assessment of the cut surface. Clustering based on serial histology data separated the cores into three groups with enrichment of neoplastic epithelium, stroma, and acinar cells, respectively. Using this classification, tumor overexpressed proteins identified in bulk tissue analysis were assigned into epithelial- or stroma-specific categories, which revealed novel epithelial-specific tumor overexpressed proteins.

Conclusions

Our study demonstrates the feasibility of multi-omics data generation from tissue cores, the necessity of interval H&E stains in serial histology sections, and the utility of coring to improve analysis over bulk tissue data.
PoMeLo: a systematic computational approach to predicting metabolic loss in pathogen genomes
Authors: Glascock Abigail , Waltari Eric , Dudas Gytis , Wong Joan , Ahyong Vida
Published: January 2024

Background

Genome streamlining, the process by which genomes become smaller and encode fewer genes over time, is a common phenomenon among pathogenic bacteria. This reduction is driven by selection for minimized energy expenditure in a nutrient-rich environment. As pathogens evolve to become more reliant on the host, metabolic genes and resulting capabilities are lost in favor of siphoning metabolites from the host. Characterizing genome streamlining, gene loss, and metabolic pathway degradation can be useful in assessing pathogen dependency on host metabolism and identifying potential targets for host-directed therapeutics.

Results

PoMeLo (Predictor of Metabolic Loss) is a novel evolutionary genomics-guided computational approach for identifying metabolic gaps in the genomes of pathogenic bacteria. PoMeLo leverages a centralized public database of high-quality genomes and annotations and allows the user to compare an unlimited number of genomes across individual genes and pathways. PoMeLo runs locally using user-friendly prompts in a matter of minutes and generates tabular and visual outputs for users to compare predicted metabolic capacity between groups of bacteria and individual species. Each pathway is assigned a Predicted Metabolic Loss (PML) score to assess the magnitude of genome streamlining. Optionally, PoMeLo places the results in an evolutionary context by including phylogenetic relationships in visual outputs. It can also initially compute phylogenetically-weighted mean genome sizes to identify genome streamlining events. Here, we describe PoMeLo and demonstrate its use in identifying metabolic gaps in genomes of pathogenic Treponema species.

Conclusions

PoMeLo represents an advance over existing methods for identifying metabolic gaps in genomic data, allowing comparison across large numbers of genomes and placing the resulting data in a phylogenetic context. PoMeLo is freely available for academic and non-academic use at https://github.com/czbiohub-sf/pomelo.
Evaluation of soluble suppression of tumorigenicity 2 (sST2) as serum marker for liver fibrosis
Authors: Hildenbrand Florian F. , Illi Barbara , von Felten Stefanie , Bachofner Jacqueline , Gawinecka Joanna , von Eckardstein Arnold , Müllhaupt Beat , Mertens Joachim C. , Blümel Sena
Published: January 2024

Background & aims

With the increase in patients at risk of advanced liver disease due to the obesity epidemic, there will be a need for simple screening tools for advanced liver fibrosis. Soluble suppression of tumorigenicity 2 (sST2) is a serum biomarker for fibrotic processes. The aim of this study was to evaluate sST2 as marker for liver fibrosis in patients successfully treated for chronic hepatitis C.

Methods

424 patients from the Swiss Hepatitis C Cohort Study were screened for inclusion in this post-hoc cohort study. Inclusion criteria were sustained virological response (SVR), available elastography (VCTE) and serum samples for biomarker analysis before and after treatment. For the validation of sST2, values were compared to VCTE, FIB-4 and APRI using Spearman’s correlation and AUROC analyses.

Results

Data of 164 subjects were finally analyzed. Median sST2 values slightly increased with VCTE-derived fibrosis stages and remained stable after reaching SVR within the respective fibrosis stage, suggesting that sST2 is not influenced by liver inflammation. However, correlation of sST2 pre- and post-treatment with VCTE was fair (Spearman’s rho = 0.39 and rho = 0.36). The area under the curve (AUROC) for sST2 in detecting VCTE-defined F4 fibrosis (vs. F0-F3) before therapy was 0.74 (95%CI 0.65–0.83), and 0.67(95%CI 0.56–0.78) for the discrimination of F3/F4 fibrosis vs. F0-F2. Adding sST2 to either APRI or FIB-4, respectively, increased diagnostic performance of both tests.

Conclusions

sST2 can potentially identify patients with advanced fibrosis as a single serum marker and in combination with APRI and FIB-4.
Tuakana-teina peer education programme to help Māori elders enhance wellbeing and social connectedness
Authors: Oetzel John G. , Simpson Mary , Meha Pare , Cameron Michael P. , Zhang Yingsha , Nock Sophie , Reddy Rangimahora , Adams Hariata , Akapita Ngapera , Akariri Ngareo , Anderson Justina , Clark Marama , Ngaia Kawarau , Hokowhitu Brendan
Published: January 2024

Background

There are significant inequities between Māori (Indigenous people) and non-Māori in ageing outcomes. This study used a strengths-based approach based on the key cultural concept of mana motuhake (autonomy and self-actualisation) to develop a tuakana-teina (literally older sibling-younger sibling) peer education programme to assist kaumātua (elders) in addressing health and social needs. The purpose of this study was to test the impact on those receiving the programme. Three aims identify the impact on outcomes, resources received and the cost effectiveness of the programme.

Methods

Five Kaupapa Māori (research and services guided by Māori worldviews) iwi (tribe) and community providers implemented the project using a partnership approach. Tuakana (peer educators) had up to six conversations each with up to six teina (peer learners) and shared information related to social and health services. A pre- and post-test, clustered staggered design was the research design. Participants completed a baseline and post-programme assessment of health and mana motuhake measures consistent with Māori worldviews. Open-ended questions on the assessments, five focus groups, and four individual interviews were used for qualitative evaluation.

Findings

A total of 113 kaumātua were recruited, and 86 completed the programme. The analysis revealed improvements in health-related quality of life, needing more help with daily tasks, life satisfaction, paying bills and housing problems. Qualitative results supported impacts of the programme on mana motuhake and hauora (holistic health) through providing intangible and tangible resources. Cost-effectiveness analysis showed that the intervention is cost effective, with a cost per QALY of less than the conventional threshold of three times GDP per capita.

Conclusions

A culturally-resonant, strengths-based programme developed through a participatory approach can significantly improve health and social outcomes in a cost-effective way.

Trial Registry

Clinical trial registry: Trial registration: (ACTRN12620000316909). Prospectively registered 06/03/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379302&isClinicalTrial=False.
Factors associated with an unsuppressed viral load among HIV-positive individuals attending STI services in South Africa, 2019
Authors: Mapiye Marceline , Ravhuhali Khuliso , de Voux Alex , Kufa Tendesayi
Published: January 2024

Background

Sexually transmitted infections (STIs), particularly in the absence of viral suppression, increase the risk of HIV transmission to uninfected partners. We determined factors associated with having an unsuppressed VL among HIV-positive individuals attending STI services in South Africa (SA).

Methods

We analysed secondary cross-sectional data collected on HIV-positive individuals presenting with STI symptoms s at sentinel sites in Western Cape and Gauteng provinces between January–December 2019 in SA. We compared demographic characteristics of individuals on ART or not on ART, and a Poisson regression model to identify factors associated with having an unsuppressed VL (≥ 50 copies/ml) was used.

Results

Among 93 HIV-positive individuals attending STI services with VL data, the median age was 32 years (IQR 27–37). Thirty-two (34.41%) individuals were on ART compared to 61 (65.59%) not on ART. Most of those on ART (56.25%) had an unsuppressed VL, while 86.89% of those not on ART had an unsuppressed VL. ART use was associated with a 33% lower prevalence of having unsuppressed VL. In a model adjusting for age, age at first sex and oral sex, none of the factors were significant. Among those on ART, individuals < 25 years were more likely to have an unsuppressed VL (aPRR = 1.94: 95% CI = 1.27–2.97) compared to those ≥ 25 years.

Conclusion

ART use among HIV-positive individuals was low and VL suppression among those on ART was sub-optimal. Intensified ART initiation and adherence support to HIV-positive individuals seeking STI services could improve VL suppression.
Radiographic characteristics of rifampicin-resistant tuberculosis in the STREAM stage 1 trial and their influence on time to culture conversion in the short regimen
Authors: Chiang Chen-Yuan , Bern Henry , Goodall Ruth , Chien Shun-Tien , Rusen I. D. , Nunn Andrew ,   on behalf of the STREAM Sub-study Collaborators, Ali Oumer , Teferi Mekonnen , Ndlovu Muziwandile , Ngubane Nosipho , Bennet Rachel , Fabiane Stella , Meredith Sarah , Nyamda Naranbat , Tsogt Bazarragchaa , Dat Phan-Thuong , Howell Pauline , Hailu Meseret , Meressa Daniel , Aucock Samantha , Moodliar Ronelle
Published: January 2024

Background

Stage 1 of the STREAM trial demonstrated that the 9 month (Short) regimen developed in Bangladesh was non-inferior to the 20 month (Long) 2011 World Health Organization recommended regimen. We assess the association between HIV infection and radiographic manifestations of tuberculosis and factors associated with time to culture conversion in Stage 1 of the STREAM trial.

Methods

Reading of chest radiographs was undertaken independently by two clinicians, and films with discordant reading were read by a third reader. Recording of abnormal opacity of the lung parenchyma included location (right upper, right lower, left upper, and left lower) and extent of disease (minimal, moderately-advanced, and far advanced). Time to culture conversion was defined as the number of days from initiation of treatment to the first of two consecutive negative culture results, and compared using the log-rank test, stratified by country. Cox proportional hazards models, stratified by country and adjusted for HIV status, were used to identify factors associated with culture conversion.

Results

Of the 364 participants, all but one had an abnormal chest X-ray: 347 (95%) had opacities over upper lung fields, 318 (87%) had opacities over lower lung fields, 124 (34%) had far advanced pulmonary involvement, and 281 (77%) had cavitation. There was no significant association between HIV and locations of lung parenchymal opacities, extent of opacities, the presence of cavitation, and location of cavitation. Participants infected with HIV were significantly less likely to have the highest positivity grade (3+) of sputum culture (p = 0.035) as compared to participants not infected with HIV. Cavitation was significantly associated with high smear positivity grades (p < 0.001) and high culture positivity grades (p = 0.004) among all participants. Co-infection with HIV was associated with a shorter time to culture conversion (hazard ratio 1.59, 95% CI 1.05–2.40).

Conclusions

Radiographic manifestations of tuberculosis among the HIV-infected in the era of anti-retroviral therapy may not differ from that among those who were not infected with HIV. Radiographic manifestations were not consistently associated with time to culture conversion, perhaps indicating that the Short regimen is sufficiently powerful in achieving sputum conversion across the spectrum of radiographic pulmonary involvements.

Trial registration

ISRCTN ISRCTN78372190. Registered 14/10/2010. The date of first registration 10/02/2016.
The mediating effects of motivation on the relations between occupational stress and physical activity among underresourced afterschool program staff
Authors: Deng Anqi , Zarrett Nicole , Sweeney Allison M.
Published: January 2024

Objective

Guided by Self-Determination Theory, this study aimed to examine the potential mediating effects of autonomous and controlled motivations on physical activity (PA) experiences of afterschool program (ASP) staff with occupational stress.

Method

A total of 58 ASP staff provided full data. Staff occupational stress and self-determination motivations for PA were assessed. Participants’ daily moderate-to-vigorous physical activity (MVPA) was measured using accelerometer wear. A path analysis was used to address the research purpose.

Results

Occupational stress negatively and indirectly predicted daily MVPA which was mediated by controlled motivation (β = − 4.15, p <.05). Autonomous motivation directly and positively predicted daily MVPA across all types and levels of ASP staff occupational stress (β = 9.93, p =.01).

Conclusions

Autonomous motivation is a powerful predictor of staff PA levels despite the degree to which they experience stress. In contrast, controlled motivations are more vulnerable to occupational stress, and can lead to lower MVPA.

Trial registration

Connect Through PLAY: A Staff-based Physical Activity Intervention for Middle School Youth (Connect). https://clinicaltrials.gov/ct2/show/NCT03732144. Registered 11/06/2018. Registration number: NCT03732144.
Improving end-of-life care for people with dementia: a mixed-methods study
Authors: Triandafilidis Zoi , Carr Sally , Davis Daneill , Jeong Sarah Yeun-Sim , Hensby Jacinta , Wong Daniel , Attia John , Goodwin Nicholas
Published: January 2024

Background

Improving palliative and end-of-life care for people with dementia is a growing priority globally. This study aimed to integrate multiple perspectives on end-of-life care for people with dementia and carers, to identify clinically relevant areas for improvement.

Methods

The mixed-methods study involved surveys, interviews, and workshops with two participant groups: healthcare professionals and carers (individuals who provided care and support to a family member or friend). Healthcare professionals were invited to complete an online adapted version of the Australian Commission on Safety and Quality in Health Care, End-of-Life Care Toolkit: Clinician Survey Questions. Carers completed a hard copy or online adapted version of the Views of Informal Carers—Evaluation of Services (Short form) (VOICES-SF) questionnaire. Interview schedules were semi-structured, and workshops followed a co-design format. Findings were integrated narratively using a weaving approach.

Results

Five areas in which we can improve care for people with dementia at the end of life, were identified: 1) Timely recognition of end of life; 2) Conversations about palliative care and end of life; 3) Information and support for people with dementia and carers; 4) Person-and-carer-centred care; 5) Accessing quality, coordinated care.

Conclusions

There are multiple areas where we can improve the quality of end-of-life care people with dementia receive. The findings demonstrate that the heterogeneous and challenging experiences of living with and caring for people with dementia necessitate a multidisciplinary, multifaceted approach to end-of-life care. The identified solutions, including care coordination, can guide local development of co-designed models of end-of-life care for people with dementia.
Characteristics and clinical challenges in patients with substance use disorder in palliative care—experience from a tertiary center in a high-income country
Authors: Marti Laura , Hünerwadel Ellen , Hut Bigna , Christ Sebastian M. , Däster Fabienne , Schettle Markus , Seiler Annina , Blum David , Hertler Caroline
Published: January 2024

Background

Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care.

Methods

We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons.

Results

The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role.

Conclusion

Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care.
Comparative assessment of synthetic time series generation approaches in healthcare: leveraging patient metadata for accurate data synthesis
Authors: Isasa Imanol , Hernandez Mikel , Epelde Gorka , Londoño Francisco , Beristain Andoni , Larrea Xabat , Alberdi Ane , Bamidis Panagiotis , Konstantinidis Evdokimos
Published: January 2024

Background

Synthetic data is an emerging approach for addressing legal and regulatory concerns in biomedical research that deals with personal and clinical data, whether as a single tool or through its combination with other privacy enhancing technologies. Generating uncompromised synthetic data could significantly benefit external researchers performing secondary analyses by providing unlimited access to information while fulfilling pertinent regulations. However, the original data to be synthesized (e.g., data acquired in Living Labs) may consist of subjects’ metadata (static) and a longitudinal component (set of time-dependent measurements), making it challenging to produce coherent synthetic counterparts.

Methods

Three synthetic time series generation approaches were defined and compared in this work: only generating the metadata and coupling it with the real time series from the original data (A1), generating both metadata and time series separately to join them afterwards (A2), and jointly generating both metadata and time series (A3). The comparative assessment of the three approaches was carried out using two different synthetic data generation models: the Wasserstein GAN with Gradient Penalty (WGAN-GP) and the DöppelGANger (DGAN). The experiments were performed with three different healthcare-related longitudinal datasets: Treadmill Maximal Effort Test (TMET) measurements from the University of Malaga (1), a hypotension subset derived from the MIMIC-III v1.4 database (2), and a lifelogging dataset named PMData (3).

Results

Three pivotal dimensions were assessed on the generated synthetic data: resemblance to the original data (1), utility (2), and privacy level (3). The optimal approach fluctuates based on the assessed dimension and metric.

Conclusion

The initial characteristics of the datasets to be synthesized play a crucial role in determining the best approach. Coupling synthetic metadata with real time series (A1), as well as jointly generating synthetic time series and metadata (A3), are both competitive methods, while separately generating time series and metadata (A2) appears to perform more poorly overall.