bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term shear performance of concrete beam with carbon fiber-reinforced composite grid stirrups under sustained loadings and seawater immersion
Authors: Fu Huanchang , Lu Zhongyu , He Jun , Liu Zepu , Wu Yanhai
Published: December 2023

Using carbon fiber-reinforced composite (CFRP) grid stirrups to replace traditional steel stirrups in reinforced concrete (RC) beams can effectively improve the corrosion resistance of structures in marine environments. In this study, the durability of RC beams with CFRP grid stirrups under the coupled effects of sustained loads and immersion in seawater was studied. The sustained loads were set at 24% and 48% of the ultimate bearing capacity of the RC beam, and the specimens were immersed in artificial seawater at room temperature for 90 days, 180 days, and 360 days, respectively. The crack load and shear capacity of the beam were measured at the scheduled time. The initial stiffness of the beam decreased as the immersion time increased, and the higher the sustained load was, the lower the initial stiffness of the conditioned beam. The contribution of the CFRP grid stirrup to the shear load capacity after the cracking load was reached was more significant than that before. The effects of the 48% sustained load on the ultimate tensile strain of the CFRP stirrup were more significant than those for the 24% sustained load. Both immersion and sustained loading improved the cracking load and shear capacity of the beam, and the contribution of sustained loading to the shear capacity decreased as the immersion time and the sustained load level increased. Equations were proposed for predicting the shear strength of RC beams with CFRP grid stirrups under sustained loading and seawater immersion.
Entropy controlled reaction of piperidine with isatin derivatives in 80% aqueous methanol
Authors: El-Rahman Mohamed A , Ibrahim Mahmoud F , Fathalla Magda F , El-Sadany Samir K , Hamed Ezzat A , Omar Alaa Z
Published: December 2023

The reactions of 5- and 7-substituted isatin derivatives (H, Me, Cl, Br) with piperidine in 80% aqueous methanol gave the corresponding 1-(2’-amino-5’- or 3’- substituted phenyl)-2-(piperidin-1-yl) ethane-1,2-dione derivatives. The reaction is proceeded through nucleophilic attack on C-2 followed by ring opening process. The reaction showed a second order and the isokinetic temperature is 169 K indicating that the reaction is entropy controlled. The constant ∆G# value, the linear plot of ∆H# versus ∆S#, plot of log kN values at high temperature versus those at low temperatures indicated that a unified mechanism of the reactions for all substituents. The σo-Taft's constants are linearly correlated with log kN values and the ρ values are (2.01–1.86) pointing out that inductive effect of substituent is predominant and the rate-limiting is the breakdown of the tetrahedral intermediate T− and the ring opening is catalyzed by water.
The “Curious Case of Postictal Oxygen Dissipation”: Could ROS Be the Culprit?
Authors: Sri Hari Ashwini , Metcalf Cameron S.
Published: December 2023

[Box: see text]
Challenges facing Arab researchers in conducting and publishing scientific research: a qualitative interview study
Authors: Elgamri Alya , Mohammed Zeinab , El-Rhazi Karima , Shahrouri Manal , Ahram Mamoun , Al-Abbas Al-Mubarak , Silverman Henry
Published: December 2023

Arab researchers encounter formidable obstacles when conducting and publishing their scientific work. We conducted semi-structured interviews with 17 Arab researchers from various Arab Middle East countries to gain a comprehensive understanding of the difficulties they face in research and publication. We analyzed the transcripts using reflexive thematic analysis. Our findings revealed several key challenges. First, Arab researchers struggle to conduct high-quality research due to limited resources, inadequate funding, and a lack of a supportive research infrastructure. Furthermore, a shortage of teamwork and mentoring diminishes research productivity. Perverse promotion policies, heavy teaching loads, and low salaries force many researchers to seek external income sources, leaving them with insufficient time for research. Regarding publishing in high-impact journals, Arab researchers confront challenges existing of insufficient scientific writing skills, underrepresentation on editorial boards, and unconscious biases against researchers from economically challenged areas. Finally, achieving research integrity is closely tied to lack of access to essential resources. To address these issues, our participants proposed targeted interventions at the institutional and external levels. For example, universities can implement mentoring programs, offer workshops on scientific writing and publishing, and foster a supportive institutional culture for research. Addressing the underrepresentation of Arabic researchers on editorial boards is crucial for equity in global scientific publishing. In conclusion, acknowledging and addressing these challenges will empower Arab researchers, elevate research quality, and promote equitable global scientific collaboration. Our findings provide guidance for universities, governments, and international donors seeking to enhance research and publication practices in the Arab Middle East.
A systematic review of coach augmented verbal feedback during practice and competition in team sports
Authors: Corbett Ross , Partington Mark , Ryan Lisa , Cope Ed
Published: December 2023

Coaches use of augmented verbal feedback (AVF), often measured through systematic observation, is acknowledged as having a vital role in athlete learning. The purpose of this review was to identify coaches’ use of AVF, through systematic observation, in developmental and performance contexts. A literature search was conducted using EBSCO HOST and SCOPUS databases. Studies were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted from 31 studies which met the inclusion criteria. Analysis revealed three themes: (a) variation in observation tool and feedback types observed; (b) evidence base surrounding feedback types observed; (c) quality of coach feedback. The multiple feedback types measured across the studies suggests there is limited agreement on the types of feedback most important to measure. For the impact of feedback to be better understood, feedback types captured via systematic observation need revising in line with research that has identified the important characteristics of feedback. A greater evidence-informed approach to the observation of feedback may help to develop a greater understanding of the feedback process in learning and performance. Where there were consistencies in feedback type, the quality of AVF delivered by coaches could be questioned.
Representation of women in the digital discourse of Spanish far-right female leaders
Authors: Camargo-Fernández Laura , Polo-Artal Alba
Published: December 2023

The Spanish far-right party – Vox – articulates several ideological components in public discourse, among which nativism and anti-feminism stand out. Anti-feminism is being central in the digital discourse of Vox female leaders, Carla Toscano and Rocío de Meer, and of the former Congress deputy, Macarena Olona. With the aim of deepening the analysis of the discursive representation of women in Vox, this research employs the approach and methodology of critical discourse analysis with the corpus, consisting of 6753 tweets from the accounts of these three leaders, taking into account three of the representation that they (re)produce. The results show the imaginary of the Spanish and Catholic-woman. The discourse of racial Spanishness is initiated through mystified historical events. This occurs with the representation of the Mother-woman, which reinforces the device of patriarchal femininity and the frame of the demographic change based on nativism. The representation of the Tormentor-woman is used to deny both the specificity of gender violence and the need for gender equality policies. These three frames are used to justify the anti-feminist discourse and to explain its modulations. The results show that we need to pay attention to gender in order to understand the discursive strategies of the far-right parties, with special care to the femonationalism strategy, as well as to observe its mobilizing and agglutinating capacity.
A Bibliometric and Visual Analysis of Populism Research (2000–2020)
Authors: Zhang Xinyu , Liao Yue
Published: December 2023

The 21st century has seen a revival of populism in politics worldwide. Although scholars in different fields have extensively investigated populism, the term remains controversial and fragmentary. This article uses the bibliometric method to analyze the scientific production, critical points, and main trends of studies on populism from 2000 to 2020 based on the literature retrieved from the Web of Science Core Collection, to better understand relevant themes and issues and conduct a comparative study. Populism research shows a general upward trend in three stages and covers a wide range of disciplines, with political science contributing the largest number of publications and sociology sharing the closest links with other subjects. Two relatively large cooperation groups of institutions were found in European countries, but cross-region links between institutions are weak. No relatively stable and large academic teams have been formed between political scholars, and low cooperation exists between prolific scholars in different disciplines. Literature with high co-citation counts are mainly conceptual and comparative studies, and research hotspots include the relationship between populism and democracy, the polarization of populism, and national populism. We believe that future research may shift focus to polarization, European populism, and political trust.
Evoking Nostalgia: Graffiti as Medium in Urban Space
Authors: Li Wen , Liu Peng
Published: December 2023

This study examines the role of graffiti as a medium in urban spaces, particularly in the context of Macau. Graffiti, seen as a form of artistic expression, has the potential to invigorate and enliven public spaces. Utilizing visual ethnography methods and analyzing cultural policies, the paper aims to examine the presence of graffiti in various neighborhoods within Macau. The concept of nostalgia also serves as a theoretical framework to understand how graffiti can evoke memories and create an emotional connection to the past. By investigating hotspots like Largo do Estaleiro, Rua de S. Tiago da Barra, and the vicinity surrounding Ruins of St. Paul’s through interviews with residents and an examination of distribution patterns, we aim to comprehend how these graffiti sites can establish a link to history and contribute to a shared memory and sense of locality. The findings of this research have important implications for urban planning and cultural policy in Macau, as they highlight the significance of incorporating graffiti as a legitimate form of public art that can contribute to the cultural identity and sense of nostalgia in urban spaces.
International Student Migration to the GCC States: A Comparative Study
Authors: Umar Sharique , Rahman Md Mizanur
Published: December 2023

This article examines the migration of international students to the Gulf Coop-eration Council (GCC) states from a comparative perspective. Over the past few decades, the GCC states have made significant investments in their education sec-tor, leading to notable improvements in educational infrastructure and quality, the establishment of new universities and knowledge parks, as well as the emergence of international university branches. Consequently, this transformation has attracted a growing number of international students to the Gulf region, including non-national resident students and foreign students arriving in the Gulf specifically for educational purposes. Student migration entails more than just entering a host country; it also involves university admissions policies, tuition fees, scholarship programs, immigration status and the pathways available for employment after graduation. Therefore, this article delves into the intricate aspects of student migration to the GCC states, shedding light on migration patterns, student compositions, admissions processes, financial considerations and integration into the Gulf labour market. The findings of this study indicate that the GCC states have made some headway in managing international student migration. However, there is still a need for the development of a comprehensive student migration policy that fully capitalises on the benefits of student migration to promote economic development in the Gulf states.
Systematic Review of Clinical Outcomes After Proximal Tibia Anterior Closing-Wedge Osteotomy With ACL Reconstruction
Authors: Itthipanichpong Thun , Uppstrom Tyler J. , V. Menta Samarth , Ranawat Anil S.
Published: December 2023

Background:

While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears.

Purpose:

To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we performed a systematic review of the existing literature on ACWO and ACL reconstruction using PubMed (MEDLINE), Cochrane Library, Scopus, and Embase. The search phrases included “anterior closing wedge osteotomy,”“anterior closing wedge tibial osteotomy,”“anterior closing wedge proximal tibial osteotomy,”“anterior cruciate ligament,” and “revision anterior cruciate ligament.” Non-English publications and single-patient case reports were excluded. Extracted data included study details, patient demographics, patient-reported outcomes (PROs), clinical outcomes, radiographic outcomes, complications, and return-to-sport (RTS) rates.

Results:

A total of 6 studies with 110 patients (110 knees) were included. Two-stage ACWO and ACL reconstruction was reported in 2 studies of 78 patients (71%), while a single-stage technique was reported in 4 studies of 32 patients (29%). ACWO was performed in the setting of primary ACL tear in 23 patients (21%) and in recurrent ACL tear in 87 patients (79%). Patients demonstrated postoperative improvements in Lysholm, pivot-shift test, and side-to-side difference in anterior tibial translation. After ACWO, all studies reported mean postoperative PTS of <10° (range, 4.4°-9.2°). Of patients with available RTS data (n = 43), the same-level RTS rate ranged from 65% to 100%. A two-stage procedure reported in 1 study had a lower RTS rate (n = 13 of 20 [65%]) than that of 2 studies with single-stage procedure (n = 4 of 5 [80%] and n = 18 of 18 [100%]). The overall complication rate was 0.9% to 1.3%, and there were no reported ACL retears.

Conclusion:

The current evidence, which is constrained by the quantity and quality of studies, showed that ACWO with single- or two-stage ACL reconstruction in patients with ACL insufficiency and increased PTS was associated with significant improvements in PROs and high RTS rates.
Place of origin, education, and the career development plights of the suburban migrant workers in Zhejiang manufacturing industry
Authors: Zhang Xiaoqing , Zhou Jia
Published: December 2023

China’s rapid urbanization over the past three decades has created a multifaceted social-spatial dynamic on the urban fringe – urbanized suburbs, wherein an influx of migrants juxtaposed with an outflow of the local population. Against this background, the extant migrant studies in China mainly focus on rural and urban migration, yet suburban migrants are relatively underrepresented. Suburban migrants have roots in the built-up urban, and they designate rural residents who have been resettled during the urbanization process and subsequently moved into other cities to live and work. As the complexities of governmental schemes, their household registrations ( hukou) may or may not be changed from rural to urban during neighborhood redevelopment. In migrant studies that use rural-urban hukou as a dichotomous statistical classification, their socio-demographic characteristics as a sample group are hard to capture.

This paper examines the career development of suburban migrants in the manufacturing industry in Zhejiang China, where migrant workers are concentrated. It compares the career development of migrant workers from rural, suburban, and urban areas on four dimensions – unemployment risk, occupational skill level, income level, and occupational position. The study of 553 intra-provincial migrant workers finds that suburban migrants encountered comparable challenges in their career development as rural migrants did. Furthermore, the level of education attained by individuals has a noteworthy mediating effect, contributing to the disparities observed across urban, suburban, and rural groups. The gap in career development between suburban migrants and their urban counterparts – even in Zhejiang, a province with the smallest economic gap between urban and rural development in China and was relatively less impacted by the epidemic outbreak – is still significant.

This research aims to enrich scholarly dialogues surrounding the field of migrant studies and the intricate socio-spatial dynamics prevalent within Chinese suburban areas.
Complexity in the Au–Ag–Hg system: New information from a PGE (‘osmiridium’) concentrate at Waratah Bay, Victoria, Australia
Authors: Birch William D. , Ma Chi
Published: December 2023

Au–Hg–Ag phases have been described from a variety of metallogenic orebodies and the placer deposits derived from them. In many documented placer deposits, the phases typically occur intergrown as ‘secondary’ rims to primary Au–Ag grains. The origin of these rims has been ascribed to supergene redistribution reactions during deposition or to the effects of amalgamation (i.e. use of mercury) during mining for gold. Difficulties in determining compositions and crystal structures on such a small scale have made full characterisation of these phases problematic. This paper describes a new occurrence of these phases, found by accident during investigation of a historical concentrate of ‘osmiridium’ containing a number of gold grains from beach sands at Waratah Bay, in southern Victoria, Australia. The phases occur as rims to gold grains and are intergrown on a scale of tens of micrometres or less. Application of electron microprobe analysis (EPMA) and limited electron back-scattered diffraction (EBSD) was required to characterise them. These techniques revealed the presence of the approved mineral weishanite (Au–Hg–Ag) and a phase with compositional range Au2Hg–Au3Hg surrounding primary Au–Ag (electrum) containing trace amounts of Hg. EBSD analysis showed weishanite is hexagonal P63/mmc and Au2Hg to be hexagonal P63/mcm. Comparison with published data from other localities (Philippines, British Columbia and New Zealand) suggests weishanite has a wide compositional field. Textures shown by these phases are difficult to interpret, as they might form by either supergene processes or by reaction with anthropogenic mercury used during mining. However, in the absence of any historical evidence for the use of mercury for gold mining at Waratah Bay, we consider the formation of the Au–Hg phases is most probably due to supergene alteration of primary Au–Ag alloy containing small amounts of Hg. In addition to revealing some of the reaction sequences in the development of these secondary Au–Hg–Ag rims, this paper illustrates methods by which these phases can be more fully characterised and thereby better correlated with the Au–Hg synthetic system.
Genome-wide identification and expression analysis of the JMJ-C gene family in melon (Cucumis melo L.) reveals their potential role in fruit development
Authors: Jin Wuyun , Yan Wei , Ma Ming , Hasi Agula , Che Gen
Published: December 2023

Background

Proteins with the jumonji (JMJ)-C domain belong to the histone demethylase family and contribute to reverse histone methylation. Although JMJ-C family genes have an essential role in regulating plant growth and development, the characterization of the JMJ-C family genes in melon has not been uncovered.

Results

In this study, a total of 17 JMJ-C proteins were identified in melon (Cucumis melo L.). CmJMJs were categorized into five subfamilies based on the specific conserved domain: KDM4/JHDM3, KDM5/JARID1, JMJD6, KDM3/JHDM2, and JMJ-C domain-only. The chromosome localization analyses showed that 17 CmJMJs were distributed on nine chromosomes. Cis-acting element analyses of the 17 CmJMJ genes showed numerous hormone, light, and stress response elements distributed in the promoter region. Covariance analysis revealed one pair of replicated fragments (CmJMJ3a and CmJMJ3b) in 17 CmJMJ genes. We investigated the expression profile of 17 CmJMJ genes in different lateral organs and four developmental stages of fruit by RNA-seq transcriptome analysis and RT-qPCR. The results revealed that most CmJMJ genes were prominently expressed in female flowers, ovaries, and developing fruits, suggesting their active role in melon fruit development. Subcellular localization showed that the fruit-related CmJMJ5a protein is specifically localized in the cell nucleus.

Conclusions

This study provides a comprehensive understanding of the gene structure, classification, and evolution of JMJ-C in melon and supports the clarification of the JMJ-C functions in further research.
Assessing the impact of aprepitant and ondansetron on postoperative nausea and vomiting in orthognathic surgeries: a randomized controlled trial
Authors: Alam Mostafa , Shakeri Alireza , Khorsand Ardeshir , Nasseri Karim , Nasseri Sadaf
Published: December 2023

Background

Postoperative nausea and vomiting (PONV) is a common side effect associated with general anesthesia. Both ondansetron and aprepitant been effectively used to prevent PONV. However, there is a disagreement of opinions regarding the superiority of these two drugs. This study aims to compare the efficacy of aprepitant with ondansetron in preventing PONV following orthognathic surgeries.

Methods

In this double-blinded clinical trial, 80 patients scheduled for orthognathic surgery at Imam Hossein Hospital, Tehran, Iran, were randomly assigned to two groups. A standardized anesthesia protocol was used for all patients. The first group received a placebo capsule administered one hour before the surgical procedure along with 4 mg (2 ml) of ondansetron intravenously after anesthesia induction. The second group was given 80 mg aprepitant capsules one hour before the surgery, followed by an injection of 2 ml intravenous distilled water after anesthesia induction.

The occurrence and severity of PONV, the amount of rescue medication required, and the complete response of patients assessed within 24 h after the surgery.

Results

There were no significant differences in demographic data between the two groups. Patients in the aprepitant group had a significantly lower incidence and severity of nausea (2.5% versus 27.5%), vomiting (5% versus 25%), and required fewer rescue medications (7.5% versus 62.5%) compared to the ondansetron group. Additionally, the aprepitant group showed a higher complete response rate (90% versus 67.5%) in the 0-2 and 12-24 postoperative hours.

Conclusion

According to the findings of this study, aprepitant has demonstrated a greater efficacy in preventing PONV following orthognathic surgery, when compared to ondansetron.

Trial registration

Iranian Registry of Clinical Trials (IRCT code: IRCT20211205053279N3), date of registration: 16/12/2022.
Favorable factors for the survival of ST-segment elevation myocardial infarction patients with medium- and high-risk thrombolysis in myocardial infarction scores
Authors: Luo Zhengli , Feng Yuan , Luo Dan , Li Shiyang , Xiao Kaiyi , Shen Hongmei , Hu Qiang
Published: December 2023

Objective

ST-segment myocardial infarction (STEMI) is a time-sensitive emergency. This study screened the favorable factors for the survival of STEMI patients with medium- and high-risk thrombolysis in myocardial infarction (TIMI) scores.

Methods

According to the TIMI scores at admission, 433 STEMI patients were retrospectively and consecutively selected and allocated into low-/medium-/high-risk groups, with their general information/blood routine/biochemical indicators/coagulation indicators documented. The factors influencing the in-hospital survival of STEMI patients were analyzed using univariate and multivariate logistic regression analyses. Moreover, the predictive value of favorable factors was analyzed by receiver operating characteristics (ROC) curve, and patients were assigned into high/low level groups based on the cut-off value of these factors, with their in-hospital survival rates compared.

Results

The in-hospital survival rate of the medium-/high-risk groups was lower than that of the low-risk group. Emergency percutaneous coronary intervention (PCI), lymphocyte (LYM), total protein (TP), albumin (ALB), and sodium (Na) were independent favorable factors for in-hospital survival in the medium-/high-risk groups. Besides, LYM > 1.275 × 109/L, TP > 60.25 g/L, ALB > 34.55 g/L, and Na > 137.9 mmo1/L had auxiliary predictive value for the survival of STEMI patients with medium-/high-risk TIMI scores. Patients with high levels of LYM, TP, ALB, and Na exhibited higher in-hospital survival rates than patients with low levels.

Conclusion

For STEMI patients with medium- and high-risk TIMI scores, accepting emergency PCI and normal levels of LYM, TP, ALB, and Na were more conducive to in-hospital survival.
Cannabis use and atherosclerotic cardiovascular disease: a Mendelian randomization study
Authors: de La Harpe Roxane , Schoeler Tabea , Thorball Christian W. , Thomas Aurélien , Kutalik Zoltán , Vaucher Julien
Published: December 2023

Background

Association between cannabis use and development of atherosclerotic cardiovascular disease (ASCVD) is inconsistent and challenging to interpret, given existing study limitations.

Methods

Sixty five independent single-nucleotide polymorphisms (SNPs), obtained from a genome-wide association study on lifetime cannabis use, were employed as genetic instruments to estimate the effects of genetically indexed cannabis use on risk of coronary artery disease (CAD) and acute ischemic stroke (IS) using a two-sample Mendelian randomization (MR) approach. Summary statistics on CAD (CARDIoGRAMplusC4D; 60,801 cases and 123,504 controls) and IS (MEGASTROKE; 34,217 cases and 406,111 controls) were obtained separately. A comprehensive review of the observational literature on cannabis use and CAD or IS was also performed and contrasted with MR results.

Results

There was no causal effect of cannabis use on the risk of CAD (odds ratio (OR) per ever-users vs. never-users 0.93; 95% confidence interval (CI), 0.83 to 1.03) or IS (OR 1.05; 95%CI, 0.93 to 1.19). Sensitivity analyses yielded similar results, and no heterogeneity and directional pleiotropy was observed. Our meta-analysis of observational studies showed no significant association between ever use of cannabis with risk of CAD (k = 6 studies; ORpooled = 1.23, 95%CI 0.78 to 1.69), nor with IS (k = 6 studies; ORpooled = 1.22, 95%CI 0.95 to 1.50).

Conclusion

Using a genetic approach approximating a clinical trial does not provide evidence consistent with a causal effect of genetic predisposition to cannabis use on CAD or IS development. Further studies are needed to replicate our findinds, an to investigate more precisely the risk of ASCVD in relation to the quantity, type, route of administration, or the age at exposure to cannabis.
Prognostic value of CT-derived fractional flow reserve and fat attenuation index in patients with suspected coronary artery disease: a sex-disaggregated analyses
Authors: Yu Yang , Kou Jieli , Guo Fuqian , Zhang Dan , Pan Tong , Chen Yicheng , Bao Wenjun , Sun Yuhan , Zhang Haowen , Li Caiying
Published: December 2023

Background

There are sex differences in many risk factors associated with coronary artery disease (CAD). CT-derived fractional flow reserve (CT-FFR) and fat attenuation index (FAI) have been shown to independently predict cardiovascular events. We aimed to examine the impact of sex on the prognostic value of CT-FFR and FAI in suspected CAD patients, and to examine the incremental prognostic value of FAI over CT-FFR in both sex.

Methods

A total of 1334 consecutive suspected CAD subjects who underwent coronary computed tomographic angiography (CCTA) were retrospectively collected. We divided the patients into males and females and calculated CT-FFR and FAI data from CCTA images. Kaplan-Meier analysis was used to assess the risk of major adverse cardiovascular events (MACE) stratified by CT-FFR and FAI in both sex. Cox regression models were used to assess the incremental prognostic value of FAI by adding the variable to a model that included CT-FFR and clinical variables.

Results

During a median follow-up of 2.08 years, 212 patients had MACE. CT-FFR ≤ 0.80 was significantly associated with MACE in both sex. FAI value of left anterior descending artery (FAI[LAD]) and FAI value of left circumflex (FAI[LCX]) ≥ 70.1 were significantly associated with MACE in females. FAI[LCX] added incremental prognostic value over clinical and CT-FFR variables in females, with hazard ratio (HR) 3.230 (1.982–5.265, P = 0.000), Harrel’s C 0.669 (P < 0.001), net reclassification improvement (NRI) 0.161 (0.073–0.260, P < 0.001), and integrated discrimination index (IDI) 0.036 (0.008–0.090, P = 0.010). FAI[LAD] did not enhance risk prediction in females (Harrel’s C 0.643, P = 0.054; NRI 0.041, P = 0.189; IDI 0.005, P = 0.259). The decision curve analysis demonstrated that the model including FAI[LCX] resulted in the highest net benefit.

Conclusions

In suspected CAD patients, the prognostic value of CT-FFR is not significantly biased by sex. The prognostic value of FAI[LAD] and FAI[LCX] were significantly associated with MACE in females, but not males. FAI[LCX], not FAI[LAD], added incremental prognostic value over CT-FFR and might enhance CT-FFR risk stratification in females.
Identifying inflammatory bowel disease patients at risk of metabolic dysfunction-associated fatty liver disease: usefulness of non-invasive steatosis predictive scores
Authors: Capela Tiago Lima , Silva Vítor Macedo , Freitas Marta , Arieira Cátia , Gonçalves Tiago Cúrdia , de Castro Francisca Dias , Magalhães Joana , Cotter José
Published: December 2023

Background

Inflammatory bowel disease (IBD) patients have a higher risk of metabolic dysfunction-associated fatty liver disease (MAFLD) compared with the general population. However, it is not known whether available non-invasive hepatic steatosis scores are useful in predicting MAFLD in IBD patients. We aimed to analyze the performances of MAFLD screening score (MAFLD-S), Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI) and Clinical Prediction Tool for NAFLD in Crohn’s Disease (CPN-CD), in identifying MAFLD in IBD patients.

Methods

A cross-sectional study was carried out including consecutive adult IBD outpatients submitted to transient elastography (TE). MAFLD criteria were assessed, and hepatic steatosis (HS) was defined by a controlled attenuation parameter (CAP) >248 dB/m using TE. MAFLD-S, FLI, HSI, and CPN-CD were calculated and their accuracy for the prediction of MAFLD was evaluated through their areas under the receiver-operating characteristic (AUROC) curves.

Results

Of 168 patients, body mass index ≥25, type 2 diabetes mellitus, dyslipidemia and arterial hypertension were present in 76 (45.2%), 10 (6.0%), 53 (31.5%), 20 (11.9%), respectively. HS was identified in 77 (45.8%) patients, of which 65 (84.4%) fulfilled MAFLD criteria. MAFLD-S (AUROC, 0.929 [95% CI, 0.888-0.971]) had outstanding and FLI (AUROC, 0.882 [95% CI, 0.830–0.934]), HSI (AUROC, 0.803 [95% CI, 0.736–0.871]), and CPN-CD (AUROC, 0.822 [95% CI, 0.753–0.890) had excellent discrimination in predicting MAFLD.

Conclusions

MAFLD-S, FLI, HSI and CPN-CD scores can accurately identify MAFLD in IBD patients, allowing the selection of those in whom hepatic steatosis and metabolic risk factors assessment may be particularly beneficial.
Association between health-related quality of life and heart rate variability in elderly individuals with cognitive impairment in Korea: cross-sectional study
Authors: Kim Donghoon , Lee Jaeho , Choi Ju-Young , Lee Hyo-Jung , Min Jin-Young , Min Kyoung-Bok
Published: December 2023

Background

Cognitive impairment, a characteristic and prior stage of dementia, is a serious public health concern in Korea a country with rapidly aging population. In a neurovisceral integration model, cognitive ability is connected to emotional and autonomic regulation via an interconnection in the brain, which may be associated with health-related quality of life (HRQoL).

Methods

This study investigated the association between the HRQoL and the autonomic nervous system (ANS) via EuroQoL-5 Dimension (EQ-5D) and heart rate variability (HRV) among 417 patients who visited the Neurology Department in Veterans Health Service Medical Center, Seoul, South Korea.

Results

The mean age of 275 patients in the cognitive impairment group (CIG) was higher than that of 142 patients in the normal cognition group (NCG) (74.85 years vs. 72.96 years, p < 0.001). In a generalized linear model with a beta coefficient (β), an increase in HRQoL was associated with higher HRV levels was observed only in CIG (CIG: the standard deviation of all NN intervals (SDNN) (ln, ms): β = 0.02, p = 0.007; Total power spectral density (TP) (ln, ms2): β = 0.01, p = 0.007; High frequency (HF) (ln, ms2): β = 0.01, p = 0.015; Low frequency (LF) (ln, ms2): β = 0.01, p = 0.003) (NCG: SDNN (ln, ms): β = 0.01, p = 0.214; TP (ln, ms2): β = 0.01, p = 0.144; HF (ln, ms2): β = 0.00, p = 0.249; LF (ln, ms2): β = 0.01, p = 0.294).

Conclusions

We found a significant association between HRQoL and HRV in Korean elders with cognitive impairment. However, this study is cross-sectional, so we cannot define direct causation. Further studies are needed to support our findings and to elucidate the biological mechanisms underlying these associations, especially in people cognitively impaired.
Quantitative evaluation of diffusion-weighted MRI for differentiating benign and malignant thyroid nodules larger than 4 cm
Authors: Zheng Tingting , Xie Xiaoli , Ni Zhaoxian , Tang Lang , Wu Pu-Yeh , Song Bin
Published: December 2023

Purpose

Our study aimed to diagnose benign or malignant thyroid nodules larger than 4 cm using quantitative diffusion-weighted imaging (DWI) analysis.

Methods

Eighty-two thyroid nodules were investigated retrospectively and divided them into benign (n = 62) and malignant groups (n = 20). We calculated quantitative features DWI and apparent diffusion coefficient (ADC) signal intensity standard deviation (DWISD and ADCSD), DWI and ADC signal intensity ratio (DWISIR and ADCSIR), mean ADC and minimum ADC value (ADCmean and ADCmin) and ADC value standard deviation (ADCVSD). Univariate and multivariate logistic regression were conducted to identify independent predictors, and develop a prediction model. We performed receiver operating characteristic (ROC) analysis to determine the optimal threshold of risk factors, and constructed combined threshold models. Our study calculated diagnostic performance including area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and unnecessary biopsy rate of all models were calculated and compared them with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) result.

Results

Two independent predictors of malignant nodules were identified by multivariate analysis: DWISIR (P = 0.007) and ADCmin (P < 0.001). The AUCs for multivariate prediction model, combined DWISIR and ADCmin thresholds model, combined DWISIR and ADCSIR thresholds model and ACR-TIRADS were 0.946 (0.896–0.996), 0.875 (0.759–0.991), 0.777 (0.648–0.907) and 0.722 (0.588–0.857). The combined DWISIR and ADCmin threshold model had the lowest unnecessary biopsy rate of 0%, compared with 56.3% for ACR-TIRADS.

Conclusion

Quantitative DWI demonstrated favorable malignant thyroid nodule diagnostic efficacy. The combined DWISIR and ADCmin thresholds model significantly reduced the unnecessary biopsy rate.
Scarce resources, public health and professional care: the COVID-19 pandemic exacerbating bioethical conflicts — findings from global qualitative expert interviews
Authors: Vonderschmitt Jane , Wöhlke Sabine , Schicktanz Silke
Published: December 2023

Background

Since spring 2020, the SARS-CoV-2 virus has spread worldwide, causing dramatic global consequences in terms of medical, care, economic, cultural and bioethical dimensions. Although the resulting conflicts initially appeared to be quite similar in most countries, a closer look reveals a country-specific intensification and differentiation of issues. Our study focused on understanding and highlighting bioethical conflicts that were triggered, exposed or intensified by the COVID-19 pandemic in low and middle-income countries (LMICs) and high-income countries (HICs).

Methods

We conducted qualitative interviews with 39 ethics experts from 34 countries (Argentina, Australia, Austria, Brazil, Canada, Colombia, Denmark, Ecuador, Ethiopia, France, Germany, India, Italy, Israel, Japan, Kyrgyzstan, Mexico, Nigeria, Oman, Pakistan, Paraguay, Poland, Romania, Russia, Singapore, South Korea, Spain, Sweden, South Africa, Tunisia, Türkiye, United-Kingdom, United States of America, Zambia) from November 2020 to March 2021. We analysed the interviews using qualitative content analysis.

Results

The scale of the bioethical challenges between countries differed, as did coping strategies for meeting these challenges. Data analysis focused on:

Resource scarcity in clinical contexts: Scarcity of medical resources led to the need to prioritize the care of some COVID-19 patients in clinical settings globally. Because this entails the postponement of treatment for other patients, the possibility of serious present or future harm to deprioritized patients was identified as a relevant issue.

Health literacy: The pandemic demonstrated the significance of health literacy and its influence on the effective implementation of health measures.

Inequality and vulnerable groups: The pandemic highlighted the context-sensitivity and intersectionality of the vulnerabilities of women and children in LMICs and the aged in HICs.

Conflicts surrounding healthcare professionals: The COVID-19 outbreak underscored the tough working conditions for nurses and other health professionals, raising awareness of the need for reform.

Conclusion

The pandemic exposed pre-existing structural problems in LMICs and HICs. Without neglecting individual contextual factors in the observed countries, we created a mosaic of different voices of experts in bioethics across the globe, drawing attention to the need for international solidarity in the context of a global crisis.
Labour market attachment dynamics in patients with concussion: a Danish nationwide register-based cohort study
Authors: Graff Heidi Jeannet , Siersma Volkert , Møller Anne , Waldorff Frans Boch , Modin Frederikke Agerbo , Rytter Hana Malá
Published: December 2023

Background

Concussion may lead to persisting post-concussive symptoms affecting work ability and employment. This study examined the transitions between labour market states an individual can experience after the acute phase of concussion. The aim was to describe the incidence of favourable and adverse transitions between different labour market states (e.g., employment, sick leave) in relation to socioeconomic and health characteristics in individuals with concussion relative to matched controls.

Methods

This Danish nationwide register-based cohort study extracted 18–60-year-old individuals between 2003–2007 with concussion from the Danish National Patient Register (ICD-10 S06.0). Controls were matched on age, sex, and municipality. Patients and controls were followed for 5 years starting three months after injury.

Exclusion criteria were neurological injuries and unavailability to the labour market in the inclusion period (2003–2007) and 5-years before injury (1998–2002). Labour market states were defined from transfer income data in the Danish Register for Evaluation of Marginalization. Incidence rates of transitions between these labour market states were analysed in multistate models. Transitions were bundled in favourable and adverse transitions between labour market states and the difference in incidence rates between individuals with concussion relative to matched controls were assessed with hazard ratios from Cox regression models.

Results

Persons with concussion (n = 15.580) had a lower incidence of favourable transitions (HR 0.88, CI 0.86–0.90) and a higher incidence of adverse transitions (HR 1.30, CI 1.27–1.35), relative to matched controls (n = 16.377).

The effect of concussion differed depending on health and socioeconomic characteristics. Notably, individuals between 30–39 years (HR 0.83, CI 0.79–0.87), individuals with high-income (200.000–300.000 DKK) (HR 0.83, CI 0.80–0.87), and wage earners with management experience (HR 0.60, CI 0.44–0.81) had a markedly lower incidence of favourable transitions compared to controls. Additionally, individuals with high income also had a higher incidence of adverse transitions (HR 1.46, CI 1.34–1.58) compared to controls.

Conclusions

Concussion was associated with enhanced risk of adverse transitions between labour market states and lower occurrence of favourable transitions, indicating work disability, potentially due to persistent post-concussive symptoms. Some age groups, individuals with high income, and employees with management experience may be more affected.
Multifaceted precarity: pandemic experiences of recent immigrant women in the accommodation and food services sector
Authors: Mũrage Alice , Smith Julia
Published: December 2023

The COVID-19 pandemic disproportionately affected those who face historical and ongoing marginalization. In centering pandemic experience of recent immigrant women in the accommodation and food services sector in Canada, we examine how their precarious work translated to experiences of work precarity and wellbeing. This paper illuminates how pre-existing and ongoing marginalization are reproduced during a health crisis for those at the intersection of gender, race, migration, and labour inequities. Using semi-structured interviews and systematic analysis using the Work Precarity Framework, we found that the pandemic exacerbated pre-existing socio-economic marginalization and resulted in unique experiences of work precarity. The latter was experienced as precarity of work (unpredictable work hours and job or employment insecurity), precarity from work (inadequate incomes), and precarity at work (physical, psychological, and relational unsafety). Work precarity stood out as a social determinant of health in relation to its outcome of degraded mental health and wellbeing. Recognizing the role of policies in producing, reproducing, and distributing precarity, we recommend policy directions to reduce social inequities in pandemic recovery.
Investigating oral health among US adults with sleep disorder: a cross-sectional study
Authors: Movahed Emad , Moradi Shayan , Mortezagholi Bardia , Shafiee Arman , Moltazemi Hassan , Hajishah Hamed , Siahvoshi Sepehr , Monfared Ayad Bahadori , Amini Mohammad Javad , Safari Farima , Bakhtiyari Mahmood
Published: December 2023

Background

This study aims to investigate the relationship between sleep disorders and oral health outcomes among a representative sample of the United States population.

Methods

The study sample comprised 6,161 participants who participated in the NHANES 2017–2018, representing a population of 255,939,599. Oral health outcomes were assessed using the Oral Health Questionnaire (OHQ), covering dental pain, periodontal disease, bone loss, emotional perceptions of oral health, and impact on daily life. Sleep disorders were evaluated using questions related to sleep trouble and daytime sleepiness.

Results

Analysis of the NHANES 2017–2018 dataset, revealed notable associations between sleep disorders and oral health outcomes. Individuals with sleep disorders were more likely to report dental pain (19.79% vs. 11.8%), periodontal issues (19.5% vs. 12.25%), and feeling bad or embarrassed about their oral health (21% vs. 12%), compared to those without sleep disorders. Difficulty due to oral health issues was also more prevalent among participants with sleep disorders (32.6% vs. 12.9%). Adjusted models demonstrated that individuals with sleep disorders had a significantly higher likelihood of experiencing oral aches [adjusted odds ratio (aOR) = 1.58 (1.22–2.22)], reporting negative emotions about oral health [aOR = 1.59 (1.06–2.37)], and encountering challenges in school or job performance [aOR = 2.27 (1.47–3.51)], compared to individuals without sleep disorders (refer to Table 3). Other significant covariates affecting oral health outcomes included smoking, income, and education level.

Conclusions

This study reveals a compelling association between sleep disorders and adverse oral health outcomes in the U.S. population.
Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014
Authors: Kimura Kazuki , Inoue Kazuo , Ando Takahito , Ito Masanori
Published: December 2023

Background

Japan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors.

Methods

We analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians’ gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience.

Results

The number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315–0.298–0.298 (male physicians: 0.311–0.289–0.283, female physicians: 0.394–0.385–0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas.

Conclusion

Female physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.