bluuebunny/crossref_metadata_2025 huggingface dataset:
Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE): the change in quality of life after resective epilepsy surgery–protocol for a multicentre, prospective cohort study
Authors: Kellenaers Julia T F , Rijkers Kim , van Mastrigt Ghislaine A P G , Schijns Olaf E M G , Hoogland Govert , Dings Jim , van Kuijk Sander , Vlooswijk Marielle C G , Wagner Louis G L , Idema Sander , van Straaten Ilse E C W , van der Salm Sandra M A , Majoie Marian H J M
Published: July 2023

Introduction

Resective epilepsy surgery is often seen as a last resort when treating drug-resistant epilepsy. Positive results on quality of life (QoL) and economic benefits after surgery argue for a less restrictive attitude towards epilepsy surgery for drug-resistant epilepsy. QoL and economic benefits are country-dependent. The objective of the Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE) trial is to evaluate the change in QoL before and after epilepsy surgery in Dutch people with drug-resistant epilepsy. The results will form part of an economic evaluation of epilepsy surgery in people with epilepsy (PWE) in The Netherlands.

Methods and analysis

A longitudinal prospective multicentre cohort study involving 100 PWE undergoing epilepsy surgery between 2019 and 2025 is being performed in three Dutch academic hospitals. Excluded are PWE who have a lower level of intelligence (TIQ<70) or who do not master the Dutch language. Before surgery and 3, 6, 12 and 24 months after surgery, PWE receive validated online questionnaires (QOLIE-31, EQ-5D, iMCQ and iPCQ) on QoL, cost of care, expectations and satisfaction. Primary outcome is the change in QoL. Secondary outcomes are change in generic QoL, seizure reduction (International League Against Epilepsy Outcome Classification), medical consumption, productivity, the correlation between QoL and seizure reduction and expectation of and satisfaction with the surgery.

Ethics and dissemination

The study design has been approved by the Medical Ethics Review Committee (METC) of Maastricht UMC+ (2019–1134) and the Amsterdam UMC (vu). At the time of writing, UMC Utrecht is in the process of considering approval. The study will be conducted according to the Dutch Medical Research Involving Human Subjects Act and the Declaration of Helsinki. The results will be publicly disclosed and submitted for publication in international peer-reviewed scientific journals. There is no veto on publication by the involved parties.

Trial registration

NL8278; Pre-results.
Characteristics of RCTs focusing on health promotion in community samples: a scoping review protocol based on the d-CoSPICO framework
Authors: López-González M. Angeles , Rodríguez-Cifuentes Francisco , Rubio-Garay Fernando , Amor-Hernández Paloma , Saúl Luis Angel
Published: July 2023

Introduction

Developing the capabilities of individuals, groups and communities to enhance their health has received a great deal of attention in the literature. One essential source of results is evidence-based intervention programmes, which often involve a number of different variables. This paper describes a methodology for carrying out a scoping review that maps available evidence on randomised controlled trials focusing on health promotion intervention programmes.

Methods and analysis

The scoping review protocol follows the general Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines. It also incorporates some modifications to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review flowchart and complements its methodological framework. This new format, called documents, Concept, Studies, Participants, Interventions, Comparator, and Outcomes (d-CoSPICO), guides the review sequence, which is represented in a flowchart. The search will focus on different sources of information using formal (searches in thematic –PubPsych, ERIC, MedLine, PsychINFO– and multidisciplinary databases –Academic Search Ultimate, Core Collection Web of Science, Scopus and ProQuest–, repositories and other websites), informal (contact with researchers), and retrospective (previous reviews on this topic) strategies to identify relevant publications until 2021, including grey literature. Coding, identification, selection, and data extraction will be carried out following the generation of a database in which each retrieved record’s content (abstract and/or full text) can be analysed. The review is expected to be completed in 2023.

Ethics and dissemination

Ethical approval is not required for this review. The d-CoSPICO framework and the results will be disseminated through (a) peer-reviewed publications; (b) presentations at scientific dissemination events and (c) training activities for applying this protocol.
Factors influencing the decision to use state-funded healthy lifestyle centres in a low-income setting: a qualitative study from Sri Lanka
Authors: Herath Thilini , Perera Manuja , Kasturiratne Anuradhani
Published: July 2023

Objective

Healthy lifestyle centres (HLCs) in Sri Lanka provide screening and lifestyle modification services targeting major non-communicable diseases (NCDs). Even though the service is highly accessible and affordable, HLCs are underused by its target population (adults >35 years). We aimed to explore the factors that influence the decision-making process of utilisation of HLCs in Sri Lanka.

Setting

Two districts (Gampaha and Kalutara) from the highest populous province (Western) located adjacent to the capital district of Sri Lanka.

Participants

Nine service providers, 37 HLC clients and 52 community participants were selected using judgemental, convenient and purposive sampling methods. Theoretical sampling method was used to decide the sample size for each category.

Method

A qualitative study design based on constructivist grounded theory was used. Data collected using in-depth interviews and focus group discussions during January to July 2019 and were analysed using the constant comparison method.

Results

The decision-making process of utilisation of HLCs was found to be a chain of outcomes with three main steps, such as: intention, readiness and utilisation. Awareness of HLCs, positive attitudes on health, intrinsic or extrinsic motivators, positive attitudes on NCDs and screening were internal factors with a positive influence on intention. Readiness was positively influenced by positive characteristics of the HLCs. It was negatively influenced by negative attitudes on staff and services of HLCs and negative past experiences related to services in state healthcare institutions and HLCs, service provider-related barriers and employment-related barriers. Family-related factors, social support and norms influenced both intention and readiness, either positively or negatively.

Conclusion

The decision-making process of utilisation of HLCs links with factors originating from internal, family, service provider and societal levels. Thus, a multifactorial approach that addresses all these levels is needed to improve the utilisation of HLCs in Sri Lanka.
Role of intraoperative processes of care during major upper gastrointestinal oncological resection in postoperative outcomes: a scoping review protocol
Authors: Rajendran Luckshi , Hopkins Alexander , Hallet Julie , Sinha Rishie , Tanwani Jaya , Kao Mian-Mian , Eskander Antoine , Barabash Victoria , Idestrup Christopher , Perez Pablo , Jerath Angela
Published: July 2023

Introduction

Optimal delivery and organisation of care is critical for surgical outcomes and healthcare systems efficiency. Anaesthesia volumes have been recently associated with improved postoperative recovery outcomes; however, the mechanism is unclear. Understanding the individual processes of care (interventions received by the patient) is important to design effective systems that leverage the volume-outcome association to improve patient care. The primary objective of this scoping review is to systematically map the evidence regarding intraoperative processes of care for upper gastrointestinal cancer surgery. We aim to synthesise the quantity, type, and scope of studies on intraoperative processes of care in adults who undergo major upper gastrointestinal cancer surgeries (oesophagectomy, hepatectomy, pancreaticoduodenectomy, and gastrectomy) to better understand the volume-outcome relationship for anaesthesiology care.

Methods and analysis

This scoping review will follow the Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension framework for scoping reviews. We will systematically search MEDLINE, Embase and Cochrane databases for original research articles published after 2010 examining postoperative outcomes in adult patients undergoing either: oesophagectomy, hepatectomy, pancreaticoduodenectomy, or gastrectomy, which report at least one intraoperative processes of care (intervention or framework) applied by anaesthesia or surgery. The data from included studies will be extracted, charted, and summarised both quantitatively and qualitatively through descriptive statistics and narrative synthesis.

Ethics and dissemination

No ethics approval is required for this scoping review. Results will be disseminated through publication targeted at relevant stakeholders in anaesthesiology and cancer surgery.

Trial registration number

10.17605/OSF.IO/392UG;https://archive.org/details/osf-registrations-392ug-v1.
Examining the responsiveness of the National Health Insurance Fund to people living with hypertension and diabetes in Kenya: a qualitative study
Authors: Oyando Robinson , Were Vincent , Willis Ruth , Koros Hillary , Kamano Jemima H , Naanyu Violet , Etyang Anthony , Mugo Richard , Murphy Adrianna , Nolte Ellen , Perel Pablo , Barasa Edwine
Published: July 2023

Objectives

To assess the responsiveness of the National Health Insurance Fund (NHIF) Supa Cover benefit package to the needs of individuals with diabetes and hypertension in Kenya.

Design, setting and participants

We carried out a qualitative study and collected data using key informant interviews (n=39) and focus group discussions (n=4) in two purposively selected counties in Western Kenya. Study participants were drawn from NHIF officials, county government officials, health facility managers, healthcare workers and individuals with hypertension and diabetes who were enrolled in NHIF. We analysed data using a thematic approach.

Results

Study participants reported that the NHIF Supa Cover benefit package expanded access to services for people living with hypertension and diabetes. However, the NHIF members and healthcare workers had inadequate awareness of the NHIF service entitlements. The NHIF benefit package inadequately covered the range of services needed by people living with hypertension and diabetes and the benefits package did not prioritise preventive and promotive services. Sometimes patients were discriminated against by healthcare providers who preferred cash-paying patients, and some NHIF-empanelled health facilities had inadequate structural inputs essential for quality of care. Study participants felt that the NHIF premium for the general scheme was unaffordable, and NHIF members faced additional out-of-pocket costs because of additional payments for services not available or covered.

Conclusion

Whereas NHIF has reduced financial barriers for hypertension and diabetes patients, to enhance its responsiveness to patient needs, NHIF should implement mechanisms to increase benefit package awareness among members and providers. In addition, preventive and promotive services should be included in NHIF’s benefits package and mechanisms to monitor and hold contracted providers accountable should be strengthened.
Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach – a Randomised controlled Trial in the Older adult Population considering Surgery
Authors: Ajitsaria Pragya , Lott Natalie , Baker Angela , Lacey Jeanette , Magnusson Monique , Douglas Jeanene Lizbeth , Healey Paul , Tan-Gore Eileen , Szwec Stuart V , Barker Daniel , Deeming Simon , Tavener Meredith , Smith Steve , Gani Jon , Attia John
Published: July 2023

Introduction

The Australian population presenting with surgical pathology is becoming older, frailer and more comorbid. Shared decision-making is rapidly becoming the gold standard of care for patients considering high-risk surgery to ensure that appropriate, value-based healthcare decisions are made. Positive benefits around patient perception of decision-making in the immediacy of the decision are described in the literature. However, short-term and long-term holistic patient-centred outcomes and cost implications for the health service require further examination to better understand the full impact of shared decision-making in this population.

Methods

We propose a novel multidisciplinary shared decision-making model of care in the perioperative period for patients considering high-risk surgery in the fields of general, vascular and head and neck surgery. We assess it in a two arm prospective randomised controlled trial. Patients are randomised to either ‘standard’ perioperative care, or to a multidisciplinary (surgeon, anaesthetist and end-of-life care nurse practitioner or social worker) shared decision-making consultation. The primary outcome is decisional conflict prior to any surgical procedure occurring. Secondary outcomes include the patient’s treatment choice, how decisional conflict changes longitudinally over the subsequent year, patient-centred outcomes including life impact and quality of life metrics, as well as morbidity and mortality. Additionally, we will report on healthcare resource use including subsequent admissions or representations to a healthcare facility up to 1 year.

Ethics and dissemination

This study has been approved by the Hunter New England Human Research Ethics Committee (2019/ETH13349). Study findings will be presented at local and national conferences and within scientific research journals.

Trial registration number

ACTRN12619001543178.
Health and well-being after being deployed in a major incident; how do Swedish ambulance nurses perceive their health recover process? A qualitative study
Authors: Blomberg Karin , Hugelius Karin
Published: July 2023

Objectives

To explore health problems and the recovery process after being deployed in a major incident.

Design

Qualitative, explorative design.

Setting

Ambulance services in Sweden.

Participants and methods

Semistructured, individual two-session interviews with 15 ambulance nurses with the experience of being deployed to major incidents were conducted. Data were analysed with thematic analysis.

Results

Being deployed in major incidents was perceived to be straining and led to both physical health problems and distress. To recover, the ambulance nurses strived to use strategies to distance themselves from the situation and created supportive conditions for their recovery, and if successful, the experiences led to both professional and personal growth and self-awareness. However, being deployed in major incidents without significant preparedness or experience could harm individuals and, in the worst case, end their career.

Conclusions

A successful recovery from the physical and mental exhaustion experienced after being deployed in a major incident required both individual abilities and self-care strategies as well as a supportive working environment. Supporting individual recovery strategies and following up on physical and mental well-being over time should be part of all ambulance services procedures after major incidents.
Protocol for a multicentre, double-blind, randomised, placebo-controlled trial of riociguat on peak cardiac index during exercise in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty (THERAPY-HYBRID-BPA trial)
Authors: Shimokawahara Hiroto , Inami Takumi , Kubota Kayoko , Taniguchi Yu , Hashimoto Hiroya , Saito Akiko M , Sekimizu Masahiro , Matsubara Hiromi
Published: July 2023

Objectives

Balloon pulmonary angioplasty (BPA) and medical therapy, such as soluble guanylate cyclase stimulators, are recommended treatments for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy (PEA). However, monotherapy with BPA or medical therapy cannot always eliminate symptoms such as exertional dyspnoea. Thus, this study aims to clarify the efficacy of continuous treatment with riociguat in inoperable CTEPH patients with normalised haemodynamics after BPA.

Methods and analysis

This is a double-blind, multicentre, randomised, placebo-controlled trial. Participants with CTEPH who are ineligible for PEA will receive riociguat followed by BPA. Subsequently, participants will be randomised (1:1) into either riociguat continuing or discontinuing groups and will be observed for 16 weeks after randomisation. The primary endpoint will be the change in peak cardiac index (CI) during the cardiopulmonary exercise test. In the primary analysis, the least square mean differences and 95% CIs for the change in peak CI at 16 weeks between the groups will be estimated by a linear mixed-effects model with baseline value as a covariate, treatment group as a fixed effect and study institution as a random effect.

Ethics and dissemination

National Hospital Organisation Review Board for Clinical Trials (Nagoya) and each participating institution approved this study and its protocols. Written informed consent will be obtained from all participants. The results will be disseminated at medical conferences and in journal publications.

Registration details

Japan Registry of Clinical Trials: jRCT no. 041200052. ClinicalTrials.gov by National Library of Medicine Registry ID:NCT04600492.

Trial registration number

NCT04600492.
Extended reality as a health education strategy of adolescents at school: protocol for systematic review and meta-analysis
Authors: dos Santos Thais Teixeira , Piuvezam Grasiela , Medeiros Gidyenne Christine Bandeira Silva , Mata Ádala Nayana de Sousa , Silva Júnior Danyllo do Nascimento , Martínez Daniel Guillén , Pardo Ríos Manuel
Published: July 2023

Introduction

Extended reality (XR) is the ensemble of interactive experiences based on a computer-simulated environment that encompasses virtual reality and augmented reality and has been proven to be potentially innovative in the field of health education with adolescents. The objective of this study is to present a systematic review and meta-analysis protocol that seeks to evaluate the main effects of interventions that use XR on health parameters (food intake, sound quality and physical activity) of adolescent students.

Methods and analysis

The literature search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA and ADOLEC. Intervention studies (clinical trials—randomised or non-randomised) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomised controlled trials (RCTs), non-RCTs and quasi-experimental trials. Two independent researchers will conduct all the assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be performed using RevMan V.5.4.1 software. The study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline.

Ethics and dissemination

Ethical approval and human consent were not required, as this is a protocol for a systematic review and only secondary data will be used. The findings will be published in a journal and presented at conferences. In case of any changes to this protocol, it will be updated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses website, and the modifications will be explained in the final report of this review.

PROSPERO registration number

CRD42022373876.
Unveiling the spatial divide in open defecation practices across India: an application of spatial regression and Fairlie decomposition model
Authors: Roy Avijit , Rahaman Margubur , Adhikary Mihir , Kapasia Nanigopal , Chouhan Pradip , Das Kailash Chandra
Published: July 2023

Objective

The study contextualises the spatial heterogeneity and associated drivers of open defecation (OD) in India.

Design

The present study involved a secondary cross-sectional survey data from the fifth round of the National Family Health Survey conducted during 2019–2021 in India. We mapped the spatial heterogeneity of OD practices using LISA clustering techniques and assessed the critical drivers of OD using multivariate regression models. Fairlie decomposition model was used to identify the factors responsible for developing OD hot spots and cold spots.

Setting and participants

The study was conducted in India and included 636 699 sampled households within 36 states and union territories covering 707 districts of India.

Primary and secondary outcome measures

The outcome measure was the prevalence of OD.

Results

The prevalence of OD was almost 20%, with hot spots primarily located in the north-central belts of the country. The rural–urban (26% vs 6%), illiterate-higher educated (32% vs 4%) and poor-rich (52% vs 2%) gaps in OD were very high. The odds of OD were 2.7 and 1.9 times higher in rural areas and households without water supply service on premises compared with their counterparts. The spatial error model identified households with an illiterate head (coefficient=0.50, p=0.001) as the leading spatially linked predictor of OD, followed by the poorest (coefficient=0.31, p=0.001) and the Hindu (coefficient=0.10, p=0.001). The high-high and low-low cluster inequality in OD was 38%, with household wealth quintile (67%) found to be the most significant contributing factor, followed by religion (22.8%) and level of education (6%).

Conclusion

The practice of OD is concentrated in the north-central belt of India and is particularly among the poor, illiterate and socially backward groups. Policy measures should be taken to improve sanitation practices, particularly in high-focus districts and among vulnerable groups, by adopting multispectral and multisectoral approaches.
Care-seeking behaviours of mothers and associated factors for possible serious bacterial infection in young infants during COVID-19 pandemic in Ethiopia: mixed-methods formative research
Authors: Tiruneh Gizachew Tadele , Hirschhorn Lisa R , Fesseha Nebreed , Emaway Dessalew , Eifler Kristin , Betemariam Wuleta
Published: July 2023

Objectives

Implementation research was employed to examine rates and contextual factors associated with mothers’ care-seeking for their sick neonates and identify challenges for community-based possible serious bacterial infection (PSBI) services access and implementation during the COVID-19 pandemic.

Design

We conducted formative research involving household survey and programmatic qualitative study.

Setting

This formative study was conducted in Dembecha and Lume woredas of Amhara and Oromia regions.

Participants

Data were captured from 4262 mothers aged 15–49 years who gave live birth 2–14 months before data collection, and interviews with 18 programme managers and 16 service providers in April to May 2021.

Analysis

A multilevel regression model was employed to identify predictors of maternal care-seeking for PSBI and thematic qualitative analysis to inform strategy development to strengthen PSBI implementation.

Results

Overall, 12% (95% CI 11.0% to 12.9%) and 8% (95% CI 7.9% to 9.6%) of mothers reported any newborn illness and severe neonatal infection (PSBI), respectively. More than half of mothers sought formal medical care, 56% (95% CI 50.7% to 60.8%) for PSBI. Women who received postnatal care within 6 weeks (adjusted OR (AOR) 2.08; 95% CI 1.12 to 3.87) and complete antenatal care (ie, weight measured, blood pressure taken, urine and blood tested) (AOR 2.04; 95% CI 1.12 to 3.75) had higher odds of care-seeking for PSBI. Conversely, fear of COVID-19 (AOR 0.27; 95% CI 0.15 to 0.47) and residing more than 2 hours of walking distance from the health centre (AOR 0.39; 95% CI 0.16 to 0.93) were negatively associated with care-seeking for severe newborn infection. Multiple pre-existing health system bottlenecks were identified from interviews as barriers to PSBI service delivery and exacerbated by the COVID-19 pandemic.

Conclusion

We found gaps in and factors associated with care-seeking behaviour of mothers for their sick young infants including fear of COVID-19 and pre-existing health system-level barriers. The findings of the study were used to design and implement strategies to mitigate COVID-19 impacts on management of PSBI.
Data sharing implementation in top 10 ophthalmology journals in 2021
Authors: Ruamviboonsuk Varis , Thinkhamrop Bandit , Kulvichit Kittisak , Tulvatana Wasee
Published: July 2023

Background/Aims

Deidentified individual participant data (IPD) sharing has been implemented in the International Committee of Medical Journal Editors journals since 2017. However, there were some published clinical trials that did not follow the new implemented policy. This study examines the number of clinical trials that endorsed IPD sharing policy among top ophthalmology journals.

Method

All published original articles in 2021 in 10 highest-ranking ophthalmology journals according to the 2020 journal impact factor were included. Clinical trials were determined by the WHO definition of clinical trials. Each article was then thoroughly searched for the IPD sharing statement either in the manuscript or in the clinical trial registry. We collected the number of published clinical trials that implemented IPD sharing policy as our primary outcome.

Results

1852 published articles in top 10 ophthalmology journals were identified, and 9.45% were clinical trials. Of these clinical trials, 44% had clinical trial registrations and 49.14% declared IPD sharing statements. Only 42 (48.83%) clinical trials were willing to share IPD, and 5 (10.21%) of these share IPD via an online repository platform. In terms of sharing period, 37 clinical trials were willing to share right after the publication and only 2 showed the ending of sharing period.

Conclusion

This report shows that the number of clinical trials in top ophthalmology journals that endorsed the IPD sharing policy and the number of registrations is lower than half even though the policy has been implemented for several years. Future updates are necessary as policy evolves.
Burden of ocular abnormalities in patients with beta thalassaemia: a cross-sectional study
Authors: Baig Rashid , Zahid Nida , Kausar Faiza , Qazi Hina Israr Ahmed , Moiz Bushra , Hussain Shabneez , Khan Aysha Habib , Arain Fazal , Ahmad Khabir
Published: July 2023

Introduction

In Pakistan, the reported carrier rate of thalassaemia is estimated to be 5%–8% with 5000 new patients diagnosed every year. Several known systemic complications of beta thalassaemia major have been studied, but no studies are conducted to assess ocular complications among these patients from our population.

Methods

It was a cross-sectional study design conducted at three private and public sector centres in Pakistan. We recruited 203, 11–17 years old children with beta thalassaemia major in our study. Frequency of overall ocular complications such as retinal pigment epithelium degeneration, visual field defects, increased retinal vascular tortuosity, lenticular opacities, anterior segment abnormality, etc among beta thalassaemia patients were verified by an ophthalmologist.

Results

On univariate analysis male gender (prevalence ratio (PR): 1.023 (0.903 to 1.160), OGTT levels (PR: 0.99 (0.978 to 1.003) and serum calcium levels (PR: 0.716 (0.616 to 0.936)) were significantly associated with ocular complications. However, on multivariable analysis after adjusting for covariates we observed that the prevalence of ocular complications was 88% higher in males as compared with females. Moreover, with every one unit increase in serum calcium levels the prevalence of ocular complications were decreased by 24%.

Conclusion

Our study results showed that the frequency of ocular complications in beta thalassaemia children was 22.7%. Male gender was a risk factor for ocular complications among children with beta thalassaemia. However, high calcium levels among these patients were found to be protective for ocular complications.
Family caregivers’ experience of care with a child with cerebral palsy: the lived experiences and challenges of caregivers in a resource-limited setting in northern Ghana
Authors: Mwinbam Mavis Mallory , Suglo Joseph Ngmenesegre , Agyeman Yaa Nyarko , Kukeba Margaret Wekem
Published: July 2023

Introduction

Caring for a child with cerebral palsy may be more emotionally and physically exhausting than caring for a typical growing child. The family caregivers’ perspective of this phenomenon needs exploring to facilitate the development of services. Our study explored the challenges family caregivers face with children with cerebral palsy in a resource-limited context in northern Ghana.

Methods

We conducted a qualitative study underpinned by phenomenological principles where it is believed that the reality of a phenomenon is tied to caregivers’ perspectives of their own experiences. In this study, we unearthed caregivers’ experiences/challenges from their own perspectives. The method of data analysis used was to allow the issues to emerge from the data (inductive process) using the content analysis approach. We recruited 13 caregivers of children with cerebral palsy from the physiotherapy unit at Tamale Teaching Hospital, and conducted individual in-depth interviews supported by an open-ended topic guide. Interviews were audio recorded, transcribed, and translated and coded inductively before conducting a content analysis of the data when grouped into themes.

Results

We have identified barriers to managing a child with cerebral palsy, including sociocultural barriers (values, attitudes and belief systems within society), economic challenges and immediate physical care burdens. Specific barriers included discrimination and isolation, lack of family and societal support, with poor access to health information and formal education. Others were lack of information on the cause and course of cerebral palsy, caregivers’ loss of jobs, increased healthcare expenditure and struggles in lifting and moving children, which resonate with evidence-based multidimensional model of caregiving process and caregiver burden.

Conclusion

Caregivers have the arduous task of caring for a child with cerebral palsy. Social support interventions and policy initiatives that seek to ameliorate caregivers’ finances and make formal education accessible to this marginalised child population may be beneficial in this context.
Individual cartoon video for alleviating perioperative anxiety and reducing emergence delirium in children: a prospective randomised trial
Authors: Tang Xinyu , Zhang Muchun , Yang Lizhuang , Tao Xinchen , Li Yamei , Wang Yi , Wang Xin , Hu Xianwen
Published: July 2023

Background

Perioperative anxiety and emergence delirium (ED) in young children may cause a series of adverse events, which are worth investigating. Pharmacological treatments of anxiety and delirium remain uncertain, while non-pharmacological treatments lack personalization and pertinence.

Aims

The aim of study was to determine whether an individual cartoon video can alleviate perioperative anxiety and reduce ED in young children undergoing adenoidectomy and tonsillectomy.

Methods

Children between 3 and 7 years old undergoing adenoidectomy and tonsillectomy were randomly assigned to an individual cartoon video group (group V) or a control group (group C). In group V, an individual cartoon video of the child’ s own choice was played throughout the whole waiting, anaesthesia induction and recovery periods. The children in group C were contacted through verbal conversation. The primary outcomes were anxiety measured by the Modified Yale Preoperative Anxiety Scale and ED assessed by the Paediatric Anaesthesia Emergence Delirium (PAED) scale. The secondary outcomes included cooperation during induction, postoperative pain and adverse events.

Results

The incidence of anxiety were comparable in group V and group C at the holding area (T0) (26% vs 22%, p=0.323), but the incidence of anxiety of group V were significantly lower than those of group C at the time of entering the operating room (T1), during the induction of anaesthesia (T2) and leaving the post anaesthesia care unit (T6) (p<0.001, p<0.001, p<0.001) after intervention. The peak PAED score in group V was significantly lower than that in group C (12.00 (9.00–13.00) vs 13.50 (10.00–15.00), p=0.016). We found no significant differences in cooperation during induction, postoperative pain or the incidence of adverse events between the groups (2.00 (0.00–4.00) vs 3.00 (1.25–4.00), p=0.110; F=0.059, Pgroup=0.808; 3 (7.5%) vs 4 (10), p=0.692).

Conclusions

The individual cartoon video is an effective method of reducing perioperative anxiety and alleviating ED in children.

Trial registration number

ChiCTR2200062300 (https://www.chictr.org.cn/index.aspx).
Risk factors for postreperfusion syndrome during living donor liver transplantation in paediatric patients with biliary atresia: a retrospective analysis
Authors: Li Tianying , Wu Yuli , Gong Xinyuan , Che Lu , Sheng Mingwei , Jia Lili , Li Hongxia , Yu Wenli , Weng Yiqi
Published: July 2023

Background

Living donor liver transplantation (LT) is the main treatment for paediatric biliary atresia (BA) in Asia. During LT, a series of haemodynamic changes often occur during LT reperfusion, which is called postreperfusion syndrome (PRS), and PRS is related to a prolonged postoperative hospital stay, delayed recovery of graft function and increased mortality. To reduce adverse reactions after paediatric living donor LT (LDLT), our study’s objectives were to ascertain the incidence of PRS and analyse possible risk factors for PRS.

Methods

With the approval of the Ethics Committee of our hospital, the clinical data of 304 paediatric patients who underwent LDLT from January 2020 to December 2021 were analysed retrospectively. According to the presence or absence of PRS, the paediatric patients were divided into the non-PRS group and the PRS group. Independent risk factors of PRS were analysed using logistic regression analysis.

Results

PRS occurred in 132 recipients (43.4%). The peak values of AST (816 (507–1625) vs 678 (449–1107), p=0.016) and ALT (675 (415–1402) vs 545 (389–885), p=0.015) during the first 5 days after LDLT in paediatric patients with PRS were significantly higher than those in the non-PRS group. Meanwhile, the paediatric patients in the PRS group had longer intensive care unit stays and hospital stays, as well as lower 1-year survival rates. Graft cold ischaemic time (CIT) ≥90 min (OR (95% CI)=5.205 (3.094 to 8.754)) and a temperature <36°C immediately before reperfusion (OR (95% CI)=2.973 (1.669 to 5.295)) are independent risk factors for PRS.

Conclusions

The occurrence of hypothermia (<36.0℃) in children immediately before reperfusion and graft CIT≥90 min are independent risk factors for PRS. PRS was closely related to the postoperative adverse outcomes of paediatric patients.
NeuroCNVscore: a tissue-specific framework to prioritise the pathogenicity of CNVs in neurodevelopmental disorders
Authors: Liu Xuanshi , Xu Wenjian , Leng Fei , Zhang Peng , Guo Ruolan , Zhang Yue , Hao Chanjuan , Ni Xin , Li Wei
Published: July 2023

Background

Neurodevelopmental disorders (NDDs) are associated with altered development of the brain especially in childhood. Copy number variants (CNVs) play a crucial role in the genetic aetiology of NDDs by disturbing gene expression directly at linear sequence or remotely at three-dimensional genome level in a tissue-specific manner. Despite the substantial increase in NDD studies employing whole-genome sequencing, there is no specific tool for prioritising the pathogenicity of CNVs in the context of NDDs.

Methods

Using an XGBoost classifier, we integrated 189 features that represent genomic sequences, gene information and functional/genomic segments for evaluating genome-wide CNVs in a neuro/brain-specific manner, to develop a new tool, neuroCNVscore. We used Human Phenotype Ontology to construct an independent NDD-related set.

Results

Our neuroCNVscore framework (https://github.com/lxsbch/neuroCNVscore) achieved high predictive performance (precision recall=0.82; area under curve=0.85) and outperformed an existing reference method SVScore. Notably, the predicted pathogenic CNVs showed enrichment in known genes associated with autism.

Conclusions

NeuroCNVscore prioritises functional, deleterious and pathogenic CNVs in NDDs at whole genome-wide level, which is important for genetic studies and clinical genomic screening of NDDs as well as for providing novel biological insights into NDDs.
Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation
Authors: Hohmann Christopher , Pfister Roman , Frerker Christian , Beckmann Andreas , Walther Thomas , Bleiziffer Sabine , Ensminger Stephan , Bekeredjian Raffi , Seiffert Moritz , Sinning Jan-Malte , Möllmann Helge , Beyersdorf Friedhelm , Baldus Stephan , Böning Andreas , Herrmann Eva , Balaban Ümniye , Kuhn Elmar
Published: July 2023

Objective

After transcatheter aortic valve implantation (TAVI), the optimal regimen of anticoagulant therapy in patients with an additional indication for oral anticoagulation remains a matter of debate. This study investigates the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients after TAVI in a real-world population.

Methods

The German Aortic Valve RegistrY (GARY) is a prospective, multicentre registry enrolling patients undergoing invasive treatment for aortic valve disease. From January 2011 to December 2019, 1 41 790 patients from 92 hospitals in Germany were enrolled. Anticoagulatory treatment regimens were assessed at hospital discharge for patients after TAVI procedures. All-cause mortality and the combined endpoint ‘cardiac and cerebrovascular events’ containing myocardial infarction, stroke, transient ischaemic attack, aortic prosthesis reintervention and all-cause mortality in the first year after TAVI were examined by treatment regimen.

Results

Of 45 598 patients (mean age 80.7±5.7 years, 49.3% males) undergoing TAVI, 16 974 patients (37.2%) received an anticoagulant regimen that included VKA or DOAC. Hereof, the majority of patients were prescribed VKA (n=11 333, 66.8%) compared with DOAC (n=5641, 33.2%) with an increase of DOAC use from 9.4% in 2011 to 69.9% in 2019. During the 1-year follow-up, the absolute event rates per 100 person-years for all-cause mortality and the combined endpoint cardiac and cerebrovascular events were 1.9 and 1.3 for VKA-treated and 1.7 and 1.2 for DOAC-treated patients, respectively. After adjustment for baseline confounders, all-cause mortality (HR 0.95, 95% CI 0.88 to 1.01, p=0.114) and cardiac and cerebrovascular event-free survival (HR 0.93, 95% CI 0.86 to 1.01, p=0.071) did not differ significantly between VKA and DOAC groups.

Conclusions

This study supports evidence of the efficacy of DOAC use after TAVI in patients with an indication for oral anticoagulation.
Thematic analysis of tools for health innovators and organisation leaders to develop digital health solutions fit for climate change
Authors: Rivard Lysanne , Lehoux Pascale , Rocha de Oliveira Robson , Alami Hassane
Published: July 2023

Objectives

While ethicists have largely underscored the risks raised by digital health solutions that operate with or without artificial intelligence (AI), limited research has addressed the need to also mitigate their environmental footprint and equip health innovators as well as organisation leaders to meet responsibility requirements that go beyond clinical safety, efficacy and ethics. Drawing on the Responsible Innovation in Health framework, this qualitative study asks: (1) what are the practice-oriented tools available for innovators to develop environmentally sustainable digital solutions and (2) how are organisation leaders supposed to support them in this endeavour?

Methods

Focusing on a subset of 34 tools identified through a comprehensive scoping review (health sciences, computer sciences, engineering and social sciences), our qualitative thematic analysis identifies and illustrates how two responsibility principles—environmental sustainability and organisational responsibility—are meant to be put in practice.

Results

Guidance to make environmentally sustainable digital solutions is found in 11 tools whereas organisational responsibility is described in 33 tools. The former tools focus on reducing energy and materials consumption as well as pollution and waste production. The latter tools highlight executive roles for data risk management, data ethics and AI ethics. Only four tools translate environmental sustainability issues into tangible organisational responsibilities.

Conclusions

Recognising that key design and development decisions in the digital health industry are largely shaped by market considerations, this study indicates that significant work lies ahead for medical and organisation leaders to support the development of solutions fit for climate change.
Calibrating geologic strata, dinosaurs, and other fossils at Dinosaur Provincial Park (Alberta, Canada) using a new CA-ID-TIMS U–Pb geochronology
Authors: Eberth David A. , Evans David C. , Ramezani Jahandar , Kamo Sandra L. , Brown Caleb M. , Currie Philip J. , Braman Dennis R.
Published: July 2023

The 100 m thick stratigraphic section exposed at Dinosaur Provincial Park (DPP; southern Alberta) contains bentonites that have been used for more than 30 years to date DPP’s rocks and fossils using the K–Ar decay scheme. Limited reproducibility among different vintages of K–Ar and 40Ar/39Ar ages inhibited the development of a high-resolution chronostratigraphy. Here, we employ and further test a recently completed U–Pb geochronology and associated age-stratigraphy model to update temporal constraints on the Park’s bentonites, formational contacts, and other markers. In turn, we document rock accumulation rates and calibrate ages and durations of informal megaherbivore dinosaur assemblage zones and other biozones. Weighted mean 206 Pb/238 U ages from five bentonites range from 76.718 ± 0.020 to 74.289 ± 0.014 Ma (2σ internal uncertainties) through an interval of 88.75 m, indicating a duration of ∼2.43 Myr and an overall rock accumulation rate of 3.65 ± 0.04 cm/ka. An increase in rate above the Oldman–Dinosaur Park formational contact conforms to a regionally expressed pattern of increased accommodation at ∼76.3 Ma across Alberta and Montana. Palynological biozone data suggest a condensed section/hiatus in the uppermost portion of the Oldman Formation. Dinosaur assemblage zones exhibit durations of ∼700–600 kyr and are significantly shorter than those in the overlying Horseshoe Canyon Formation. A decreased rate in dinosaur assemblage turnovers in the last eight million years of the Mesozoic in western Canada may be explained by withdrawal of the Western Interior Seaway and the expansion of ecologically homogenous lowlands in its wake.
Quantum hair in electrodynamics and gravity
Authors: Calmet Xavier , Hsu Stephen D. H.
Published: July 2023

We demonstrate the existence of quantum hair in electrodynamics and gravity using effective action techniques. In the case of electrodynamics we use the Euler–Heisenberg effective action, while in the case of quantum gravity we use the unique effective action. We give a general formulation of these effects which applies to both theories and discuss analogies and differences between them. Furthermore, we present a QED analog to black hole evaporation. Spontaneous pair production in the external field of a ball of charge is analogous to Hawking radiation from black holes. Assuming spherical symmetry, the Gauss law prevents the external field from depending on the density profile of the ball. Quantum corrections violate these expectations, showing that quantum radiation can encode classically forbidden information about the source.
Policy Note: Mental Accounts and Water Prices
Authors: Leong Ching
Published: July 2023

Raising the price of municipal water services is highly fraught in many countries due to the political pressures to keep water bills affordable. As a result, most countries fail to recover the full costs of water provision, a problem made worse by an underestimation of the real cost of providing water. The case of Singapore illustrates that this problem is in part due to “mental accounting,” which is consistent with Lasswell’s concept of an “intelligence function.” Situating an understanding of this intelligence function within the Singapore water case gives a better understanding of the reluctance to raise water prices.
On a new species of
Rhizodopsis
from the Carboniferous of Scotland
Authors: Elliott Francis M.
Published: July 2023

A new species of
Rhizodopsis
is described from material recovered from several Carboniferous locations within the Midland Valley of Scotland. Individual dermal skull bones were obtained from derelict coal waste tips at Wester Bracco, North Lanarkshire from shales originally overlying the Drumgray Coal. Individual dermal skull bones are well preserved, allowing for detailed description and reconstructions of the skull roof and cheek.
Rhizodopsis rankini
sp. nov. is distinguished by the presence of a lobed opercular, a deeply embayed postparietal shield between the supratemporal and tabular bones, and enlarged lateral extrascapulars.
Rhizodopsis
is here included in the Megalichthyidae, and an emended diagnosis of the family is given. The composition of the genus
Rhizodopsis
is reviewed. Except for
Rhizodopsis hanbuchi
,
Rhizodopsis rankini
and
Rhizodopsis sauroides
, all other species are based solely on scales. The validity of these scale-based species is reassessed and all but
Rhizodopsis granulatus
and
Rhizodopsis mazonius
are considered to be valid species.

Thematic collection:
This article is part of the Palaeontology of Scotland collection available at:
https://www.lyellcollection.org/topic/collections/palaeontology-of-scotland
NSFuzz: Towards Efficient and State-Aware Network Service Fuzzing - RCR Report
Authors: Hu Fan , Qin Shisong , Ma Zheyu , Zhao Bodong , Yin Tingting , Zhang Chao
Published: July 2023

We provide artifacts to reproduce the evaluation results of our article: “NSFuzz: Towards Efficient and State-Aware Network Service Fuzzing”. The provided artifacts can be downloaded from
https://zenodo.org/record/7134490
. It includes 14 docker containers, several scripts for execution and analysis, one additional proof for the crash results, and six related documents for the running of experiments. We claim for all three badges, i.e., Available, Functional, and Reusable. This report gives instructions on how to reproduce the answers which mainly involve basic operations on the Ubuntu operating system.