bluuebunny/crossref_metadata_2025 huggingface dataset:
A Uses and Gratifications-Based Market Segmentation Approach to Football Fans’ Online Media Usage Motivation
Authors: Gächter Anina , Stegmann Pascal , Lang Grazia
Published: August 2024

With the rise of online media, the Uses and Gratifications approach has experienced a revival in general as well as in sports media research. However, most studies have not considered the variability in online media usage behavior, which indicates a heterogenity in fans’ gratification sought in online media consumption. To account for this heterogenity, this study conducts a cluster analysis based on the Uses and Gratifications approach to segment Swiss football fans according to their motivations for using online media. Further, it analyses how the emerging motivational profiles differ in online media usage and fan identification. The findings suggest that even though information, positive emotions, and entertainment remain the most sought gratifications across all participants, fans can be segmented into four motivational profiles: Football Afficionados, Casual Users, Joy-Seeking Spenders, and Online Media Enthusiasts. These profiles exhibit significant differences in their online media usage behaviour as well as in their fan identification. They, therefore, indicate a need for market segmentation when analysing online media usage motivation in football fans and demonstrate that clubs can achieve greater customer satisfaction by tailoring their online media content to the needs and online media consumption behaviour of their fans.
Explainable Machine Learning Approach to Prediction of Prolonged Intesive Care Unit Stay in Adult Spinal Deformity Patients: Machine Learning Outperforms Logistic Regression
Authors: Zaidat Bashar , Kurapatti Mark , Gal Jonathan S. , Cho Samuel K. , Kim Jun S.
Published: August 2024

Study Design

Retrospective cohort study.

Objectives

Prolonged ICU stay is a driver of higher costs and inferior outcomes in Adult Spinal Deformity (ASD) patients. Machine learning (ML) models have recently been seen as a viable method of predicting pre-operative risk but are often ‘black boxes’ that do not fully explain the decision-making process. This study aims to demonstrate ML can achieve similar or greater predictive power as traditional statistical methods and follows traditional clinical decision-making processes.

Methods

Five ML models (Decision Tree, Random Forest, Support Vector Classifier, GradBoost, and a CNN) were trained on data collected from a large urban academic center to predict whether prolonged ICU stay would be required post-operatively. 535 patients who underwent posterior fusion or combined fusion for treatment of ASD were included in each model with a 70-20-10 train-test-validation split. Further analysis was performed using Shapley Additive Explanation (SHAP) values to provide insight into each model’s decision-making process.

Results

The model’s Area Under the Receiver Operating Curve (AUROC) ranged from 0.67 to 0.83. The Random Forest model achieved the highest score. The model considered length of surgery, complications, and estimated blood loss to be the greatest predictors of prolonged ICU stay based on SHAP values.

Conclusions

We developed a ML model that was able to predict whether prolonged ICU stay was required in ASD patients. Further SHAP analysis demonstrated our model aligned with traditional clinical thinking. Thus, ML models have strong potential to assist with risk stratification and more effective and cost-efficient care.
Coincident Thyrotoxic Hypokalemic Periodic Paralysis and Cardiomyopathy
Authors: Swarath Steven , Maharaj Nicole , Katwaroo Arun , Seecheran Valmiki , Seecheran Rajeev , Ramcharan Priya , Peram Lakshmipathi , Seecheran Naveen
Published: August 2024

Thyrotoxic periodic paralysis (TPP) and thyrotoxic cardiomyopathy (TCMP) are potentially lethal complications of thyrotoxicosis that require emergent recognition and management to attenuate significant morbidity and mortality. We present the case of a 23-year-old Asian male with no prior medical history who developed TPP with coincident TCMP, which was successfully managed with antithyroid and heart failure therapies. The clinician should be aware of the diagnosis and treatment of these 2 life-threatening conditions in a hyperthyroid state.
Swedish Intensive Care Nurses’ Knowledge, Attitudes, and Views on Donation After Circulatory Death Before a National Implementation
Authors: Gripewall Emilie , Fagerström Lisbeth , Kumlien Christine , Mattsson Janet , Nyholm Linda , Björling Gunilla
Published: August 2024

Introduction

An increasing population and a shortage of identified potential organ donors are causing the waiting list for organ transplants to grow continuously. Donation after circulatory death (DCD) is a method aimed at meeting the demand for transplantable organs. However, it presents new challenges in nursing care, and there is a lack of studies investigating nurses’ attitudes and knowledge of DCD.

Objective

The objective of this study was to determine and describe intensive care nurses’ (ICNs’) knowledge, attitudes, and views on DCD before a national implementation in Sweden.

Method

This study utilized a cross-sectional mixed-method design. A convenience sampling method was employed, targeting ICNs working in four intensive care units in Sweden. A study-specific tool comprising fixed and free-text questions was developed. Fifty-one ICNs participated. Data were analyzed descriptively, and correlation analysis was performed using Spearman's correlation. Free-text answers were qualitatively assessed and analyzed. An integrated analysis was conducted to synthesize the quantitative and qualitative findings.

Results

Fifty-three percent reported limited knowledge about DCD. Nurses with previous education on DCD had significantly higher knowledge ( r = .380, p = .006), were more engaged with the public debate on organ donation ( r = .423, p = .002), and considered the ethical aspects of DCD more thoroughly ( r = .386, p = .022). The qualitative analysis identified four key categories: The importance of the team, the need for ethical discussions, increased knowledge of DCD, and unanswered questions and unmet needs. The integrated analysis underscored the need for targeted education, clear guidelines, and ongoing ethical discussions to prepare ICU nurses for DCD.

Conclusion

Nurses educated in organ donor care had better knowledge and a more positive attitude toward DCD implementation. The study also highlights the importance of interprofessional teamwork in DCD implementation. The findings suggest that education on DCD could improve the identification and implementation of DCD donors, addressing the global shortage of transplantable organs.
How Diabetic Foot Ulcer Patients Can Self-Treat Wound Care: An Integrative Literature Review
Authors: Manalu Novita Verayanti , Yunitasari Esti , Kotijah Siti , Yusuf Ah , Malinti Evelin
Published: August 2024

Introduction

To improve the capacity of diabetic foot ulcer (DFU) patients for self-management of wound care, there is a renewed need for self-care on their part, as well as an increase in their readiness to deal with issues and heal their wounds. Therefore, this review empirically assessed contemporary evidence on how patients with DFU can perform self-treat wound care.

Methods

This integrative literature review assessed how patients with DFU could perform self-treat wound care. Whittemore and Knafl integrative information literature review involved searching four databases (Scopus, PubMed, Web of Science, and Google Scholar), which resulted in 2,595 published articles, between 2010 and 2023. Nineteen articles satisfied the requirements for inclusion and quality assessment, and the PRISMA review checklist was followed.

Results

No research has addressed DFU patients’ self-treatment of wound care. The integration of evidence from quantitative and qualitative studies was achieved in three categories: (1) motivation, (2) self-wound care strategy, and (3) self-wound care performance by DFU patients.

Conclusion

To equip themselves to perform wound care independently, patients with DFU must receive training to clean wounds, apply wound medication, and perform dressings. There is a need for research that develops a self-treat wound care intervention model in patients with DFU.
Entrepreneurial Orientation and Firm Performance of Malaysian SMEs: A Systematic Review and the Uncharted Parts
Authors: Liew Mei Xuan , Jamaluddin Askiah , Zainalaludin Zumilah , Yusoff Irwan Syah Md.
Published: August 2024

Under NEP2030, aimed at transforming Malaysia into an entrepreneurial nation, this study identifies common themes in research on entrepreneurial orientation(EO)–firm performance (FP) linkages within Malaysian small and medium-sized enterprises (SMEs). It also explores how these themes interact with other variables, highlighting research gaps and suggesting future research avenues. A multi-step systematic review of the empirical literature on EO–FP linkages within Malaysian SMEs was conducted, adopting 19 papers published between 2001 and 2021 from an initial 27 identified through Scopus. The results show that research on EO–FP linkages in Malaysian SMEs is growing by leaps and bounds from 2016 onwards, and even gradually includes moderators and mediators. From here, studies have established that the unidimensional concept of EO dominates; however, whether services are more likely to form positive EO–FP linkages than manufacturing has not been explored; FP is measured primarily by financial indicators. Meanwhile, subjective measures were the only option in 19 studies. This study shows why, when, and how the EO–FP linkages work. These are context-specific (i.e., Malaysian SMEs), highlighting the integration of many pieces to generate new ideas. These ideas provide a possible agenda for future research on EO–FP linkages, particularly suitable for SMEs facing a sustainable economic framework.
Recurrent vascular events and mortality outcomes in patients with known atrial fibrillation, compared to atrial fibrillation detected early after stroke
Authors: Induruwa Isuru , Bhakta Shiv , Herlekar Rahul , Sur Roy Akangsha , Hajiev Saur , Warburton Elizabeth A , Khadjooi Kayvan , McCabe John J
Published: August 2024

Introduction:

Atrial fibrillation (AF) detected after stroke (AFDAS) may represent a distinct clinical entity to that of known AF (KAF). However, there is limited long-term outcome data available for patients with AFDAS. More information regarding prognosis in AFDAS is required to inform future trial design in these patients.

Patients and methods:

We used data (2015–2019) from a national prospective stroke registry of consecutive patients with acute ischaemic stroke and AF. AFDAS was defined as a new diagnosis of AF after stroke detected on electrocardiograph or cardiac monitoring. The co-primary endpoints were: (1) all-cause mortality; (2) recurrent major adverse cardiovascular events (MACE) at 3 years. Secondary endpoints were: (1) recurrent stroke; (2) functional outcome at discharge; (3) presence of co-existing stroke mechanisms.

Results:

583 patients were included. After a median follow-up of 2.65 years (cumulative 1064 person-years) 309 patients died and 23 had recurrent MACE. Compared with AFDAS, KAF was associated with a higher risk of all-cause mortality (adjusted Hazard Ratio (aHR) 1.56, 95% CI 1.12–2.18), a higher prevalence of co-existing stroke mechanisms (adjusted odds ratio (aOR) 2.28, 95% CI 1.14–4.59), but not poor functional outcome (aOR 1.61, 95% CI 0.98–2.64). A trend towards a higher risk of MACE was observed in patients with KAF, but this was limited by statistical power (aHR 2.90, 95% CI 0.67–12.51). All 14 recurrent strokes occurred in the KAF group (Log-rank p = 0.03).

Discussion and conclusion:

These data provide further evidence that AFDAS differs to KAF with respect to risk of recurrent stroke, MACE, and all-cause mortality.
Systemic light-chain amyloidosis, peritoneal dialysis, and transplantation: Lessons from a demanding yet successful journey
Authors: Pantanowitz Joshua , Bender Filitsa , Bursic Alexandra , Piraino Beth , Amarapurkar Pooja
Published: August 2024

Kidney involvement in systemic light-chain amyloidosis (AL-SA) is associated with rapidly declining kidney function and increased mortality. The optimal kidney replacement therapy for AL-SA patients has not been ascertained. There is some suggestion that peritoneal dialysis (PD) may be safer than intermittent hemodialysis (iHD) for these patients. However, the clinical course of these patients can be rather complex and daunting, both for the patient and for the treating physicians. There is also a lack of data describing the associated challenges and outcomes, especially with respect to the use of chemotherapy, hematopoietic stem cell transplantation (HSCT), and kidney transplantation (KT) in patients with AL-SA who are on PD for end stage kidney disease (ESKD). We present the interesting case of a 41-year-old patient on PD for ESKD due to AL-SA, for which she underwent chemotherapy and HSCT. She ultimately was able to receive a successful KT. Through this case, we aim to highlight the complexities involved in the treatment journey of patients with AL-SA and kidney disease. We present evidence for greater hemodynamic stability with PD as compared to iHD and thus gentler ultrafiltration, information on anticancer agent dosing for PD, and finally offer hope for the feasibility of PD and KT to support a better quality of life for AL-SA patients with kidney disease.
Rare glomerulopathy associated with renal extramedullary hematopoiesis in a patient with primary myelofibrosis: A case report
Authors: Mesgun Sami , Grosser Daniel , Oduro Kwadwo , Wang Jing , Elmi Adily , Chang Richard , Rashidi Arash
Published: August 2024

Renal involvement in primary myelofibrosis (PMF) is rare. Clinically, glomerular disease associated with PMF and other forms of myeloproliferative neoplasm (MPN) is characterized by renal insufficiency and high proteinuria. Few studies have observed extramedullary hematopoiesis (EMH) and glomerulopathy associated with PMF. In this article, we report a rare case of PMF-related glomerulopathy with renal EMH in a patient who presented with renal dysfunction and heavy proteinuria.
Technology-enabled Justice in Indian Courts: New Dilemmas and Way Forward
Authors: Mathew Dona
Published: August 2024

The adoption of technology in Indian courts has improved and increased the rate of data collection, particularly from court proceedings. Data is now available in accessible formats, making them valuable for developing artificial intelligence-based tools. While the potential for risks and harms from incomplete or biased datasets is known and documented, there are also system-level issues that emerge from this datafication and adoption of advanced technologies in justice delivery systems. They can lead to an over-reliance on quantifiable aspects of the system, hinder the development of legal theory and lead to the commercialisation of case data. With advances in data processing and analytics, earlier open-by-default models for case data need a careful rethink, considering the potential for misuse of personal and sensitive information and commercialisation of publicly available data. Adequate safeguards rooted in a legal basis and built through wide stakeholder deliberation are needed to meet the ends of technology-enabled justice.
Extended Intraocular Drug-Delivery Platforms for the Treatment of Retinal and Choroidal Diseases
Authors: Wykoff Charles C. , Kuppermann Baruch D. , Regillo Carl D. , Chang Margaret , Hariprasad Seenu M. , Duker Jay S. , Altaf Syed , Saïm Saïd
Published: August 2024

Purpose: To review sustained-release intraocular platforms used to treat diseases of the retina and choroid. Methods: A literature review of the current applications of biomaterials for sustained-release therapy in retinal and choroidal diseases was performed. Results: Retinal and choroidal diseases, such as neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), and uveitis, are commonly treated using intravitreal (IVT) therapies that require frequent IVT injections. Multiple sustained-release options for IVT therapy have been approved by the US Food and Drug Administration for the treatment of inflammatory eye diseases, including noninfectious uveitis, infectious diseases, and exudative retinal diseases (eg, retinal venous occlusive disease and DME) using drugs such as fluocinolone acetonide, ganciclovir, and dexamethasone. The platforms for these drugs are biodegradable or nonbiodegradable. They use biomaterials such as polymers and hydrogels and are typically implanted surgically or injected into the vitreous, where they release the drug gradually over months or years. Building on these technologies, novel platforms are being studied that are intended to treat conditions including nAMD, DR, DME, and uveitis. These platforms are being tested for their safety, efficacy, and ability to reduce the injection and visit burden. Conclusions: Multiple sustained-release ocular drug-delivery platforms are currently commercially available, and many new sustained-release IVT platforms are being investigated. The hope is that meaningfully reducing the injection burden by extending intervals between treatments while maintaining optimal efficacy will improve long-term outcomes.
Brief Overview of the Late-Breaking Trials Presented at ACC’24: PART 2
Authors: Nagula Praveen , Parvathareddy Krishna Mala Konda Reddy
Published: August 2024

In this second part of the Journal scan of this issue, we provide a brief overview of the late-breaking trials presented at the American College of Cardiology (ACC) Conference held in Atlanta, Georgia, from April 6 to 8, 2024, and their relevance to our daily clinical practice. The trials are categorized under the following headings:

F. Lipidology (VICTORION INITIATE, SHASTA2, Liberate HR, Bridge-TIMI 73A, AEGIS II,)

G. Artificial Intelligence (TACTic, Be Active, Tele ACS)

H. Others (Deposition, Crescent, TACT2)
The Significance of von Willebrand Factor Antigen Levels in Predicting the Severity of Coronary Artery Disease in Patients with ST-Segment Elevation Myocardial Infarction
Authors: Parvathareddy Krishna Malakonda Reddy , Bandaru Susruth Kumar , Birajdar Avinash V. , Syed Imamuddin , Ravi Srinivas , Karumuri Suneetha , Nagula Praveen
Published: August 2024

Background

When the endothelium of the coronary artery is damaged, it exposes the underlying structure to a series of events that can cause complete blockage and a myocardial infarction with ST-segment elevation (STEMI). One of the key factors in this process is a protein called von Willebrand factor (vWF) that helps platelets adhere to the damaged area. Our objective was to investigate the importance of measuring vWF levels in patients with STEMI to determine the severity of their coronary artery disease (CAD) on angiography.

Methods

The study included 30 patients who experienced their first STEMI. Patients with a history of CAD, cardiomyopathies, valvular heart disease, atrial fibrillation, anticoagulants, coagulation disorders, and pregnancy were not included in the study. After informed consent, all patients were subjected to routine blood investigations, electrocardiography, echocardiography, and coronary angiography. Blood samples were collected for vWF Ag within 24 hours of the patients’ arrival at the hospital. After the angiography, the coronary arteries were evaluated for stenosis and quantified using the modified Gensini score (mGS). The score was then correlated with vWF Ag levels using the Spearman rank correlation. Additionally, the receiver operating characteristic (ROC) curve was plotted for the value of vWF Ag levels to detect significant CAD.

Results

The average age of the group was (49.77 ± 10.79) years. The average levels of vWF Ag were (204.17% ± 51.99%). Patients with an mGS score of over 150 had higher levels of vWF Ag than those with a score of under 100 ( P < .001). There was a positive correlation ( r2: 0.67) between the parameters. On the ROC curve, vWF Ag levels higher than 186% predicted the presence of CAD, with an area under curve indicating sensitivity and specificity.

Conclusion:

In patients with STEMI, higher levels of vWF Ag were found to be associated with a greater severity of CAD.
Atrial Fibrillation in Heart Failure: Strategies for Restoring Sinus Rhythm
Authors: Atreya Auras R. , Arora Sonali , Subramanian Muthiah , Yalagudri Sachin D. , Narasimhan Calambur , Saggu Daljeet K.
Published: August 2024

Atrial fibrillation (AF) and heart failure (HF) are epidemics that deserve greater attention in the current era. With improved medical therapies and robust revascularization strategies for acute coronary syndromes, there has been a substantial increase in the population of people living with stable coronary artery disease, which in turn contributes to the AF and HF burden. AF and HF are unique disease processes, in that each can precipitate the other, and in those with co-existing AF and HF, the burden of morbidity and mortality is amplified. While there has been remarkable progress in the sphere of pharmacological therapy for HF (particularly HF with reduced ejection fraction), medical therapy options for rate and rhythm control for AF have been largely unchanged for several decades. Instead, advances in catheter ablation (CA) technology and strategies for AF ablation have culminated in a robust evidence base, showing improved survival, quality of life, and restoration of ventricular function. The purpose of this clinical review article is to summarize the pathophysiological link between AF and HF and to emphasize the role of CA in the management of such patients.
Continuous Improvement Revisited: Organization Design as the Last Step in Gaining the Full Competitive Advantage of Kaizen
Authors: Iwao Shumpei
Published: August 2024

By strategically choosing to adopt organizational design, firms will gain a greater competitive advantage than ever from kaizen. Shumpei Iwao argues that, contrary to common practice, the top-down approach to continuous improvement is sometimes much more powerful than the bottom-up approach.
The Adaptive Hybrid: Innovation with Virtual Work
Authors: Arena Michael J. , Carroll Glenn R. , O’Reilly Charles , Golden John , Hines Scott
Published: August 2024

Michael Arena, Glenn Carroll, Charles O’Reilly, John Golden, and Scott Hines discuss how remote work can undermine organizational innovation. They propose an approach which overcomes these limitations.
Can Artificial Intelligence Overshadow Human Intelligence in Marketing?
Authors: Kumar V , Rajshekhar “Raj” G. Javalgi  , Dixit Ashutosh , Turken Nazli Z.
Published: August 2024

V Kumar, Ashutosh Dixit, Rajshekhar “Raj” G. Javalgi, and Nazli Turken explain how AI uses real-time data, enhances connections, and sustains interest to make the process described as the purchase funnel both smart and precise. They discuss how AI affects a company’s bottom line, examine its downside, and offer thoughts on a better future for marketing.
Make Your Business Quantum-Ready Today
Authors: Sodhi ManMohan S. , Tayur Sridhar R.
Published: August 2024

How can executives capitalize on the promise of quantum computing for their businesses? ManMohan Sodhi and Sridhar Tayur suggest a low-risk approach using quantum-inspired computing.
The Reality Distortion Field in Care Delivery: Overcoming Obstacles to Improve Healthcare Delivery
Authors: Richardville Kyle , Staats Bradley R. , Miller Brian J.
Published: August 2024

Kyle Richardville, Bradley R. Staats, and Brian J. Miller explore how the healthcare industry is impeded by negative reality distortion fields. Examining the factors that contribute to inhibiting progress, they offer guidance to help healthcare organizations shift their reality distortion from negative to positive.
The Rebirth of Marketing and the Role of Chief Marketing Officers
Authors: Yoram “Jerry” Wind , Primola Nick
Published: August 2024

Yoram “Jerry” Wind and Nick Primola describe the role of the new CMO in today’s firms and propose a framework that makes the CMO directly responsible for the organization’s customer engagement and growth.
Book Review: Artificial Intelligence for Sustainable Value Creation, Margherita Pagani and Renaud Champion, eds.
Authors: Hofacker Charles
Published: August 2024

Artificial Intelligence for Sustainable Value Creation is an edited volume whose authors offer a detailed and insightful exploration of both the possibilities and the challenges of widespread use of artificial intelligence (AI). It analyzes the effects of AI on business and society with an eye to assessing what we know about managing other information systems, strategy, and marketing, reexamining this knowledge in the context of AI. The book’s contributors explore how human-centric AI systems create value for organizations, discussing three main categories: ethical value, societal value, and business value.
White Glove Service: AI in Wealth Management Raises Client Engagement at Scale
Authors: Lincoln Brian , Grant Robert , Iyengar Suresh
Published: August 2024

Brian Lincoln, Robert Grant, and Suresh Iyengar explain why firms seeking to win in the growing wealth management market must apply AI for intelligent document processing and how doing so will drive clients’ engagement, meeting their experience expectations and scaling operations for efficiency.
“I Was Treated Differently”: Reproductive Health Care Experiences Among Women With Recent Experiences of Incarceration, Homelessness, And/Or Substance Use in a Medically Underserved Area in the Southwestern US
Authors: Hackett Colleen
Published: August 2024

Background: Women with upstream social determinants of health, particularly those with recent experiences of incarceration, homelessness, and/or substance use, encounter a series of barriers in accessing health care services and consequently face poor sexual and reproductive health outcomes. Driven by a community concern for increasing rates of syphilis and congenital syphilis among women who are structurally disadvantaged, this study focuses on their experiences with reproductive healthcare access across healthcare settings.

Research Design and Study Sample: This community-based  pláticas (conversational) research project gathered 12 in-depth interviews and  testimonios (testimonies) with women who reported a criminalized upstream barrier (incarceration, homelessness, and/or substance use) in a small city in the southwestern U.S. – most of whom identified as Latina/Hispanic.

Analysis and Results: Using a grounded analysis and drawing upon Chicana feminist methodologies, this study identifies four major themes: (1) homelessness and economic vulnerabilities, (2) incarceration and health care, (3) drug use, provider stigma, and motherhood, and (4) desired changes to the healthcare experience.

Conclusion: Results highlight the need for economic and transportation supports, community-based preventive services as alternatives to incarcerated healthcare, along with more compassionate and structurally competent provider-patient dialogue.
Introduction to a review series on globin disorders
Authors: Coates Thomas D. , Roberts Irene
Published: August 2024

Introduced by Associate Editors Thomas Coates and Irene Roberts, this review series focuses on globin disorders, covering advances in our understanding of globin gene biology that have already been translated into meaningful benefit for patients as well as those with the potential for future therapeutic impact. Written by leaders in the field of α- and β-globin study, these articles collectively highlight the rewards for patients that can arise from decades of dedicated research.
Reassessing Halm's clinical stability criteria in community-acquired pneumonia management
Authors: Bastrup Israelsen Simone , Fally Markus , Brok Nielsen Pernille , Kolte Lilian , Karmark Iversen Kasper , Ravn Pernille , Benfield Thomas
Published: August 2024

Background

Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary real-world setting.

Methods

This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017 and 2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan–Meier survival curves were used to analyse these outcomes, considering competing risks.

Results

The study population primarily comprised elderly individuals (median age 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders and 17.3% (276/1595) among the rest.

Conclusion

Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this ageing population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.
Treatment of latent tuberculosis infection in migrants in primary careversussecondary care
Authors: Burman Matthew , Zenner Dominik , Copas Andrew J. , Goscé Lara , Haghparast-Bidgoli Hassan , White Peter J. , Hickson Vicky , Greyson Opal , Trathen Duncan , Ashcroft Richard , Martineau Adrian R. , Abubakar Ibrahim , Griffiths Christopher J. , Kunst Heinke
Published: August 2024

Background

Control of latent tuberculosis infection (LTBI) is a priority in the World Health Organization strategy to eliminate TB. Many high-income, low TB incidence countries have prioritised LTBI screening and treatment in recent migrants. We tested whether a novel model of care, based entirely within primary care, was effective and safe compared to secondary care.

Methods

This was a pragmatic cluster-randomised, parallel group, superiority trial (ClinicalTrials.gov:NCT03069807) conducted in 34 general practices in London, UK, comparing LTBI treatment in recent migrants in primary care to secondary care. The primary outcome was treatment completion, defined as taking ≥90% of antibiotic doses. Secondary outcomes included treatment acceptance, adherence, adverse effects, patient satisfaction, TB incidence and a cost-effectiveness analysis. Analyses were performed on an intention-to-treat basis.

Results

Between September 2016 and May 2019, 362 recent migrants with LTBI were offered treatment and 276 accepted. Treatment completion was similar in primary and secondary care (82.6%versus86.0%; adjusted OR (aOR) 0.64, 95% CI 0.31–1.29). There was no difference in drug-induced liver injury between primary and secondary care (0.7%versus2.3%; aOR 0.29, 95% CI 0.03–2.84). Treatment acceptance was lower in primary care (65.2% (146/224)versus94.2% (130/138); aOR 0.10, 95% CI 0.03–0.30). The estimated cost per patient completing treatment was lower in primary care, with an incremental saving of GBP 315.27 (95% CI 313.47–317.07).

Conclusions

The treatment of LTBI in recent migrants within primary care does not result in higher rates of treatment completion but is safe and costs less when compared to secondary care.
Definition of sinonasal and otological exacerbation in patients with primary ciliary dyskinesia: an expert consensus
Authors: Goutaki Myrofora , Lam Yin Ting , Anagiotos Andreas , Armengot Miguel , Burgess Andrea , Campbell Raewyn , Carlier Mathilde , Caversaccio Nathalie , Chadha Neil K. , Demir Berat , Dheyauldeen Sinan Ahmed D. , Gunaydin Onder , Harris Amanda , Hayn Isolde , Inal-Ince Deniz , Levi Eric , Fernandez Trini Lopez , Lucas Jane S. , Maitre Bernard , Poirrier Anne-Lise M.L. , Schofield Lynne , Takeuchi Kazuhiko , van Gogh Christine , Wolter Nikolaus E. , Papon Jean-François
Published: August 2024

Background

Recurrent infections of the nose, sinuses and ears are common problems for people with primary ciliary dyskinesia. While pulmonary exacerbations in primary ciliary dyskinesia are defined, there is no definition for ear-nose-throat exacerbations, a potential outcome for research and clinical trials.

Methods

We set up an expert panel of 24 ear-nose-throat specialists, respiratory physicians, other healthcare professionals and patients to develop consensus definitions of sinonasal and otological exacerbations in children and adults with primary ciliary dyskinesia for research settings. We reviewed the literature and used a modified Delphi approach with four electronic surveys.

Results

Definitions for both sinonasal and otological exacerbations are based on a combination of major and minor criteria, requiring three major or two major and at least two minor criteria each. Major criteria for a sinonasal exacerbation are 1) reported acute increase in nasal discharge or change in colour, 2) reported acute pain or sensitivity in the sinus regions and 3) mucopurulent discharge on examination. Minor criteria include reported symptoms, examination signs, doctor's decision to treat and improvement after at least 14 days. Major criteria for the otological exacerbation are 1) reported acute ear pain or sensitivity, 2) reported acute ear discharge, 3) ear discharge on examination and 4) signs of otitis media in otoscopy. Minor criteria are reported acute hearing problems, signs of acute complication, and doctor's decision to treat.

Conclusion

These definitions might offer a useful outcome measure for primary ciliary dyskinesia research in different settings. They should be validated in future studies and trials together with other potential outcomes, to assess their usability.
Automated method of bronchus and artery dimension measurement in an adult bronchiectasis population
Authors: Pieters Angelina L.P. , Lv Qianting , Meerburg Jennifer J. , van der Veer Tjeerd , Andrinopoulou Eleni-Rosalina , Ciet Pierluigi , Chalmers James D. , Loebinger Michael R. , Haworth Charles S. , Elborn J. Stuart , Tiddens Harm A.W.M.
Published: August 2024

Aim

Bronchiectasis (BE) is a disease defined by irreversible dilatation of the airway. Computed tomography (CT) plays an important role in the detection and quantification of BE. The aim of this study was three-fold: 1) to assess bronchus–artery (BA) dimensions using fully automated software in a cohort of BE disease patients; 2) to compare BA dimensions with semi-quantitative BEST-CT (Bronchiectasis Scoring Technique for CT) scores for BE and bronchial wall thickening; and 3) to explore the structure–function relationship between BA-method lumen dimensions and spirometry outcomes.

Methods

Baseline CTs of BE patients who participated in a clinical trial were collected retrospectively. CTs were analysed manually with the BEST-CT scoring system and automatically using LungQ (v.2.1.0.1, Thirona, The Netherlands), which measures the following BA dimensions: diameters of bronchial outer wall (Bout), bronchial inner wall (Bin) and artery (A), and bronchial wall thickness (Bwt) and computes BA ratios (Bout/A and Bin/A) to assess bronchial widening. To assess bronchial wall thickness, we used the Bwt/A ratio and the ratio between the bronchus wall area (Bwa) and the area defined by the outer airway (Boa) (Bwa/Boa).

Results

In total, 65 patients and 16 900 BA pairs were analysed by the automated BA method. The median (range) percentage of BA pairs defined as widened was 69 (55–84)% per CT using a cut-off value of 1.5 for Bout/A, and 53 (42–65)% of bronchial wall were thickened using a cut-off value of 0.14 for Bwt/A. BA dimensions were correlated with comparable outcomes for the BEST-CT scoring method with a correlation coefficient varying between 0.21 to 0.51. The major CT BA determinants of airflow obstruction were bronchial wall thickness (p=0.001) and a narrower bronchial inner diameter (p=0.003).

Conclusion

The automated BA method, which is an accurate and sensitive tool, demonstrates a stronger correlation between visual and automated assessment and lung function when using a higher cut-off value to define bronchiectasis.
Childhood lung function is associated with adolescent-onset and persistent asthma
Authors: Koefoed Hans Jacob L. , Ullah Anhar , Hallberg Jenny , Merid Simon Kebede , Kere Maura M. , Lowe Lesley , Simpson Angela , Murray Clare S. , Gehring Ulrike , Vermeulen Roel , Kull Inger , Bergström Anna , Vonk Judith M. , Custovic Adnan , Melén Erik , Koppelman Gerard H.
Published: August 2024

Background

Asthma is associated with impaired lung function; however, it is uncertain if a lower childhood lung function is associated with asthma onset and persistence during adolescence. The aims of the present study were to investigate the association between childhood lung function and onset and persistence of asthma during adolescence.

Methods

In the population-based BAMSE (Sweden), PIAMA (Netherlands) and MAAS (UK) birth cohorts, we analysed the association of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory volume at 75% of FVC at age 8 years with asthma onset and persistence in adolescence (age 12–16 years) using cohort-specific logistic regression analysis followed by meta-analysis.

Results

In the BAMSE, PIAMA and MAAS cohorts, asthma incidence in adolescence was 6.1% (112/1824), 3.4% (36/1050) and 5.0% (39/779), respectively. Persistent asthma from childhood to adolescence was observed in 8.2%, 6.4% and 7.7% of all subjects within the respective cohorts. A higher FEV1% predicted and FEV1/FVC at age 8 years was associated with a lower odds for adolescent-onset asthma: OR 0.98 (95% CI 0.97–1.00) and 0.97 (0.94–0.99). These associations remained significant also when restricting the analyses to subjects with no wheezing or asthma treatment in childhood. A higher FEV1/FVC at age 8 years was associated with a lower odds for asthma persistence in adolescence (0.96 (0.93–0.99)). Sex by lung function interaction analysis was not significant.

Conclusions

A higher lung function at school age was associated with a lower risk of adolescent-onset asthma, predominantly in males. This indicates that a lower lung function in childhood may precede and or potentially contribute to asthma incidence and persistence.
Physiological effects of high-flow nasal cannula during sustained high-intensity exercise in healthy volunteers: a randomised crossover trial
Authors: Moya-Gallardo Eduardo , Garcia-Valdés Patricio , Marambio-Coloma Consuelo , Gutierrez-Escobar Constanza , Hernández-Vargas Betsabeth , Muñoz-Castro Carolina , Riquelme-Sánchez Santiago , Moo-Millan Joel , Basoalto Roque , Bruhn Alejandro , Diaz Orlando , Damiani L. Felipe
Published: August 2024

Introduction

High-flow nasal cannula (HFNC) has increased exercise capacity in patients with chronic respiratory diseases. However, it remains unknown whether HFNC impacts respiratory physiological variables during exercise. This study aimed to evaluate the effect of HFNC on respiratory physiological variables during sustained high-intensity exercise in healthy volunteers.

Methods

We performed a single-centre, open-label, randomised crossover trial to compare HFNC (60 L·min−1) and Sham-HFNC (2 L·min−1) interventions during a constant work rate exercise (CWRET) through randomised order. The primary outcome was change in oesophageal pressure (ΔPoes), and the secondary outcomes were other variables of inspiratory effort, ventilation distribution, ventilatory variables and clinical assessment. We evaluated volunteers at seven time points (baseline=T0; CWRET=T1-T2-T3 (1, 4 and 6 min); cooldown period=T4-T5-T6 (1, 6 and 10 min)) in both interventions.

Results

14 healthy volunteers (50% women; age: 22 (21–27) years) were enrolled. Mean differences in ΔPoesdecreased to favour the HFNC intervention compared to Sham-HFNC at T2 (−2.8 cmH2O; 95% CI −5.3 to −0.3), as well as the simplified oesophageal pressure–time product (sPTP) per minute at T2 (−86.1 cmH2O·s·min−1; 95% CI −146.2 to −26.1) and T3 (−79.9 cmH2O·s·min−1; 95% CI −142.3 to −17.6). The standard deviation of the Regional Ventilation Delay index was also lower with HFNC compared to Sham-HFNC (T1: −1.38; 95% CI −1.93 to −0.83; T2: −0.71; 95% CI −1.27 to −0.16). There was decreased dyspnoea to favour the HFNC, but sPTP per breath, spatial distribution ventilation indexes, ventilatory variables and clinical assessments were nonsignificant between interventions.

Conclusion

HFNC intervention reduces respiratory effort and dyspnoea and improves temporal ventilation distribution in healthy volunteers during CWRET.
The effect of triple CFTR modulator therapy and azithromycin on ion channels and inflammation in cystic fibrosis
Authors: Bani Melhim Suhad , Douglas Lisa E.J. , Reihill James A. , Downey Damian G. , Martin S. Lorraine
Published: August 2024

Background

Inflammation in cystic fibrosis (CF) airways is difficult to treat with well-established regimens often including azithromycin (AZ) as an immunomodulatory drug. As AZ has been reported to require CF transmembrane conductance regulator (CFTR) to be able to reduce interleukin (IL)-8 and given the emergence of highly effective CFTR “triple” modulator therapy (elexacaftor/tezacaftor/ivacaftor; ETI), the aim of this study was to investigate the effect of AZ and ETI, singly and in combination, on ion channel activity and to assess the potential anti-inflammatory effects.

Methods

Electrophysiological assessment of ETI and AZ was performed on three-dimensional cultures of primary CF human bronchial epithelial (HBE) cells using a Multi Trans-Epithelial Current Clamp. IL-8 from NuLi-1 (non-CF) and CuFi-1 (CF) cells treated with AZ was measured by ELISA. Inflammatory mediators from primary CF HBE cells exposed to tumour necrosis factor-α in the presence of AZ, ETI and their combination, were screened using the Proteome Profiler™ Human Cytokine Array Kit, with selected targets validated by ELISA.

Results

AZ did not alter CFTR chloride efflux, nor did it have any synergistic/antagonistic effect in combination with ETI. AZ reduced IL-8 in NuLi-1 but not CuFi-1 cells. The Proteome Profiler™ screen identified several disease-relevant cytokines that were modulated by treatment. Subsequent analysis by ELISA showed IL-8, IL-6, CXCL1 and granulocyte–macrophage colony-stimulating factor to be significantly reduced by treatment with ETI, but not by AZ.

Conclusions

Incorporating ETI into the standard of CF care provides an opportunity to re-evaluate therapeutic regimens to reduce treatment burden and safely discontinue chronic treatments such as AZ, without loss of clinical benefit. Identification of redundant treatments in the era of CFTR modulation may improve medication adherence and overcome potential adverse effects associated with the chronic use AZ and other drugs.
Inhaled alpha-1 antitrypsin (AAT) restores lower respiratory tract protease–antiprotease homoeostasis and reduces inflammation in AAT-deficient individuals: a randomised phase 2 study
Authors: Brantly Mark , Stocks James , Lascano Jorge , Flagg Tammy , Jeffers Ann M. , Owens Shuzi Z. , Tucker Torry A. , Devine Megan , Alagem Noga , Tov Naveh
Published: August 2024

Background

Alpha-1 antitrypsin (AAT)-deficient individuals have a greater risk for developing COPD than individuals with normal AAT levels.

Methods

This was a double-blind, randomised, parallel group, placebo-controlled trial to examine the safety and tolerability of “Kamada-AAT for Inhalation” (inhaled AAT) in subjects with AAT deficiency, and to explore its effect on AAT and biomarkers in the lung epithelial lining fluid (ELF). 36 patients with severe AAT deficiency were randomised 2:1 to receive 80 mg or 160 mg inhaled AAT or placebo once daily for 12 weeks. The primary outcomes were AAT and antineutrophil elastase capacity (ANEC) in bronchoalveolar lavage and plasma after treatment. Secondary outcomes included safety, levels of normal M-type AAT in the plasma and concentrations of AAT, neutrophil elastase (NE), AAT–NE complexes and neutrophil count in the ELF.

Results

12 weeks of active treatment significantly increased AAT, ANEC and AAT–NE complexes in the ELF. Mean antigenic AAT levels in the ELF were restored to 5.2±2.3 μM in the 80 mg arm and to 17.7±2 μM in the 160 mg arm. Both doses significantly restored AAT antiprotease activity within the lung and reduced NE levels. M-specific AAT levels in plasma increased in a dose-dependent manner. A clinically meaningful reduction in ELF neutrophil % was observed in the 80 mg arm. AAT for inhalation was well tolerated.

Conclusions

Inhaled AAT restores protease–antiprotease homoeostasis and may represent a safe and effective therapy.
Exploring social activity patterns among community-dwelling older adults in South Korea: a latent class analysis
Authors: Shin Jiyoung , Kang Hun , Choi Seongmi , Choi JiYeon
Published: August 2024

Background

With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns.

Methods

Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression.

Results

We identified four distinct social activity patterns: “minimal in both digital and in-person” (22.0%), “moderate in both digital and in-person” (46.7%), “moderate in digital & very high in in-person” (14.5%), and “high in both digital and in-person” (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the “moderate in both digital and in-person” than the “minimal in both digital and in-person” group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the “moderate in digital & very high in in-person” than the “minimal in both digital and in-person” group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the “high in both digital and in-person” than the “minimal in both digital and in-person” group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups.

Conclusions

This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being.