bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access
Authors: Noh Dave Haeyun , Darwar Roopa , Uba Belinda V. , Gab-deedam Shiva , Yani Stella , Jimoh Akolade , Waziri Ndadilnasiya , David Joshua , Amoo Babatunde , Atobatele Sunday , Dimas Janada , Fadahunsi Rhoda , Sampson Sidney , Simple Edwin , Ugbenyo Gideon , Wisdom Margeret , Asekun Adeyelu , Pallas Sarah W. , Ikwe Hadley
Published: October 2024

Background

In 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.

Methods

This retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).

Results

The estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).

Conclusions

Findings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.
Differing effectiveness of transcranial random noise stimulation and transcranial direct current stimulation for enhancing working memory in healthy individuals: a randomized controlled trial
Authors: Tokikuni Yukina , Watanabe Akihiro , Nakazono Hisato , Miura Hiroshi , Saito Ryuji , Miaowen Duan , Fuyama Kanako , Takahashi Keita , Okada Kazufumi , Sugawara Kazuhiro , Tohyama Harukazu , Yoshida Susumu , Fong Kenneth N. K. , Sawamura Daisuke
Published: October 2024

Background

Transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (DLPFC) is a promising technique for enhancing working memory (WM) performance in healthy and psychiatric populations. However, limited information is available about the effectiveness of transcranial random noise stimulation (tRNS) applied to the left DLPFC on WM. This study investigated the effectiveness of tRNS on WM compared with that of tDCS, which has established functional evidence.

Methods

This randomized, double-blind, sham-controlled trial enrolled 120 healthy right-handed adults who were randomly allocated to four stimulation groups: tRNS + direct current (DC) offset, tRNS, tDCS, or sham. Each stimulus was placed over the left DLPFC and had a current intensity of 2 mA applied for 20 min during the dual n-back task. The dual n-back task was repeated thrice: pre-stimulation, during stimulation, and post-stimulation. The d-prime scores, and response times were calculated as the main outcome measures. A linear mixed model was created to identify the main effects and interactions between the groups and times, with the group and time as fixed effects, and baseline performance and the subject as a covariate and random effect, respectively. The relationships between the benefit of each stimulus and baseline WM performance were also examined.

Results

For the d-prime score during stimulation, the tRNS group significantly performed better than the sham group at online assessment (β = 0.310, p = 0.001). In the relationships between the benefit of each stimulus and baseline WM performance, the tRNS group had significantly larger negative line slopes than the sham group for the d-prime score (β = −0.233, p = 0.038).

Conclusions

tRNS applied to the left DLPFC significantly improved WM performance and generated greater benefits for healthy individuals with lower WM performance. These findings highlight the potential utility of tRNS for enhancing WM performance in individuals with lower WM performance and contribute evidence for clinical application to patients with cognitive decline.

Trial Registration

This study was registered in the University Hospital Medical Information Network Clinical Trial Registry in Japan (UMIN000047365) on April 1, 2022; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000054021.
Frequent callers contacting the Norwegian national emergency medical number 113: a retrospective study
Authors: Viken Sara Naess , Myrmel Lars , Brattebø Guttorm
Published: October 2024

Background

Calling for help is the first link in the chain of survival; however, few studies have investigated the challenges faced by frequent callers (FCs) to emergency medical communication centres (EMCCs). This study aimed to explore the characteristics of FCs and the nature of their calls to the Bergen EMCC, Norway.

Methods

This was a retrospective analysis of all emergency calls to the Bergen EMCC over three consecutive years (2019–2021). Bergen is the second-largest city in Norway, and the Bergen EMCC and ambulance services are part of the specialist medical service, covering a population of 460,000. The Bergen EMCC receives approximately 60,000 emergency calls per year. The study population comprised all adults identified during emergency medical calls. FCs were defined as individuals who registered five or more calls over 12 consecutive months during the three-year period.

Results

The analysis included approximately 50,000 individuals, who made > 90,000 calls during the study period. Of those, 1,594 (3.2%) were FCs, accounting for approximately one in four (21,339 of 90,085, 23.7%) calls. The FCs included more men (882 of 1,594 (55.3%) vs. 24,204 of 47,564 (50.9%)) and registered a lower proportion of calls with an acute degree of urgency (6,051 of 21,339 calls (28.4%) vs. 30,276 of 68,746 calls (44.0%)). Calls from FCs showed an even occurrence throughout the week, peaking between 19:00 h and 20:00 h. Compared with calls from non-FCs, calls from FCs had a higher proportion of ‘no response/verbal referral to local emergency medical department’ and involved a lower proportion of hospital transfers. The EMCC most frequently used the medical criterion ‘Mental health problems/suicide’ for calls from FCs.

Conclusions

FCs were common, and more often men. The EMCC dispatched ambulances or admitted patients to hospitals less frequently following these calls. Many of these situations could be handled in other parts of the healthcare system, reducing the burden on EMCCs, and providing more suitable services for FCs. Thus, EMCCs should identify and adjust patient management to match their actual needs.
Telemedicine-based antibiotic stewardship program in pediatrics: study protocol of a stepped wedge cluster randomized trial—the TeleKasper study
Authors: Diexer Sophie , Ihling Angelika , Gomes Delphina , Moritz Stefan , Simon Arne , Dohna-Schwake Christian , Mikolajczyk Rafael , Huebner Johannes , von Both Ulrich ,   the TeleKasper Consortium
Published: October 2024

Background

Overuse and misuse of antibiotics is one of the driving factors of antimicrobial resistance, a growing global health threat. The use of antibiotics is particularly high in children. Even though the implementation of antibiotic stewardship programs (ASP) in pediatrics has been shown to reduce antibiotic use, this implementation has been limited to large university hospitals in Germany. Telemedicine applications might be an effective approach to implement ASP in non-university settings.

Methods

This protocol details the TeleKasper study (Telemedical Competence Network “Antibiotic Stewardship in Pediatrics”). Tele-Kasper is a stepped-wedge cluster-randomized trial that will be conducted across non-university children’s hospitals in Germany. The intervention consists of a telemedical consultation service in the form of a network in different German areas, using an app as a communication tool. The primary outcome will be a 20% reduction in overall antibiotic consumption measured using defined daily doses per 100 patient days.

Discussion

The TeleKasper study aims to implement and evaluate a prototype for a nationwide antibiotic stewardship program by telemedical means in pediatric departments in non-university hospitals in Germany to promote rational antibiotic use and improve medical care for infections.

Trial registration

German Clinical Trials Register (DRKS) DRKS00028534. Registered on 22nd of April 2022.
Effect of serum 25-hydroxyvitamin D level on quadriceps strength: a systematic review and meta-analysis
Authors: Ong Michael Tim-yun , Tsang Kitson Chun-Kit , Lu Victor Yan Zhe , Yam Stacy Lok Sze , Shen Wei , Man Gene Chi-Wai , Yung Patrick Shu-hang
Published: October 2024

Background

Vitamin D deficiency has been linked to poor muscle function, cartilage degeneration, and the development of knee osteoarthritis. However, the impact of serum 25-hydroxyvitamin D [25(OH)D] level on quadriceps muscle strength remains inconclusive, largely due to variations in study designs, differences in study populations, and the influence of confounding factors such as co-supplementation with other vitamins. The existing literature presents mixed findings, highlighting the need for a comprehensive evaluation of the available evidence.

Purpose

This systematic review and meta-analysis aim to summarise.

Study design

Systematic review; Level of evidence, 4.

Methods

Searches were conducted using Medline (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and SPORTDiscus (EBSCOhost), which aimed to summarise recent (published after 2000 and before March 1st, 2024) studies reporting the effects of serum 25(OH)D levels on quadriceps strength. Appraisal tool for Cross-Sectional Studies (AXIS) for cross-sectional studies and Quality in Prognosis Studies (QUIPS) for longitudinal studies. Results from the AXIS and QUIPS tools were used for GRADE quality assessment. The review was carried out using PRIMSA guidelines and registered in PROSPERO (ID: CRD42022313240).

Results

Four hundred studies were screened and 28 studies with 5752 participants were included. 28 published studies (24 cross-sectional and 4 longitudinal) were identified. Key results supported the significant positive correlation between serum 25(OH)D levels and isokinetic quadriceps strength at 180°/s in elderly and athletic populations with a correlation coefficient of 0.245 (95%CI: 0.078–0.398, p = 0.004). However, no significant correlation was found with isometric quadriceps strength or isokinetic strength at 60°/s (r = 0.190, p = 0.085). There was only a weak negative correlation with MVC.

Conclusion

This review found a statistically significant positive correlation between serum 25(OH)D levels and isokinetic quadriceps strength. This has important clinical implications, especially in the elderly cohort, with higher 25(OH)D levels being associated with a reduced incidence of falls and fragility fractures.
Chronic ankle instability: a cadaveric anatomical and 3D high-resolution MRI study for surgical reconstruction procedures
Authors: Dai Meng , Zhao Hu , Sun Peng , Wang Jiazheng , Kong Caixia , Liu Xiaoming , Duan Deyu , Liu Xi
Published: October 2024

Objectives

To quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI).

Methods

3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm3, 0.45 × 0.45 × 0.45 mm3, 0.6 × 0.6 × 0.6 mm3, 0.75 × 0.75 × 0.75 mm3, 0.9 × 0.9 × 0.9 mm3, 1.05 × 1.05 × 1.05 mm3). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle).

Results

In subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94–0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively.

Conclusion

We demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI.

Critical relevance statement

High-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients.

Key Points

Spatial resolutions of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 demonstrated highest consistency with autopsy measurements.

The spatial resolution of 0.45 × 0.45 × 0.45 mm3 was conformed more to clinical needs.

3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability.

Graphical Abstract
Body composition as a potential imaging biomarker for predicting the progression risk of chronic kidney disease
Authors: Liao Zhouyan , Yuan Guanjie , He Kangwen , Li Shichao , Gao Mengmeng , Liang Ping , Xu Chuou , Chu Qian , Han Min , Li Zhen
Published: October 2024

Purpose

To investigate whether the body composition parameters can be employed as potential biomarkers for predicting the progression risk of chronic kidney disease (CKD).

Materials and methods

Four hundred sixteen patients diagnosed with CKD were included in this retrospective study. Patients with a greater than 50% decline in estimated glomerular filtration rate or progression to end-stage kidney disease were in the high-risk group, otherwise, they were in a low-risk group. Body composition area, the index, and radiodensities in the Hounsfield unit (HU), which reflect the degree of X-ray absorption, were measured on abdominal CT images. Risk factors in body composition and clinical parameters of CKD were identified by Cox regression and utilized to construct the nomogram. The performance of the nomogram was assessed using time receiver operating characteristics curves, calibration curves, and decision curve analysis.

Results

There were 254 patients in low-risk group and 162 in high-risk group (268 males, 148 females, mean age: 55.89 years). Urea, diabetes, 24 h-urinary protein, mean arterial pressure, and subcutaneous adipose tissue radiodensity (SATd) were valuable indicators for predicting the high-risk group. The area under curve values for the nomogram of training/validation set at 1 year, 2 years, and 3 years were 0.805/0.753, 0.784/0.783, and 0.846/0.754, respectively. For diabetic CKD patients, extra attention needs to be paid to visceral to subcutaneous fat ratio and renal sinus fat radiodensity.

Conclusion

SATd was the most valuable noninvasive indicator of all body composition parameters for predicting high-risk populations with CKD. The nomogram we constructed has generalization with easily obtainable indicators, good performance, differentiation, and clinical practicability.

Critical relevance statement

Radiodensity rather than an area of adipose tissue can be used as a new biomarker of prognosis for CKD patients, providing new insights into risk assessment, stratified management, and treatment for CKD patients.

Key Points

Obesity is an independent risk factor for the development and prognosis of CKD.

Adipose tissue radiodensity is more valuable than fat area in prognosticating for kidney disease.

Parameters that prognosticate in diabetic CKD patients are different from those in other CKD patients.

Graphical Abstract
Protocol for a systematic review and meta-analysis of interventions aimed at delabeling low-risk penicillin allergies with consideration for sex and gender
Authors: Maximos Mira , Elsayed Sameer , Maxwell Colleen , Houle Sherilyn K. D. , Pelletier Ryan , McConnell Brie , Pylypiak Andrew , Gamble John-Michael
Published: October 2024

Background

Approximately, 10% of people report a penicillin allergy; however, more than 90% can safely undergo delabeling after a detailed history, oral challenge, or other investigations such as penicillin skin testing (PST). Although PST is the gold standard, the results can be heterogeneous, and awaiting specialist assessment may take an inordinate amount of time. Therefore, oral provocation challenge has become acceptable for individuals with low-risk penicillin allergy histories. There also appears to be an association with increased prevalence of adverse drug reaction reporting in female individuals, which may translate to penicillin allergy prevalence; however, the evidence has not been assessed through a sex and gender lens. This systematic review will identify and synthesize the findings from studies that report measures of effectiveness and safety of interventions aimed at delabeling penicillin allergies in low-risk individuals. Information related to sex and gender will be extracted, where available, to understand potential differences in allergy reporting and patient outcomes.

Methods

The Cochrane Handbook for Systematic Reviews of Interventions and the Centre for Review and Dissemination’s Guidance for Undertaking Reviews in Health Care will be used as frameworks for conducting this systematic review. The literature search will be conducted by a medical librarian (B. M. M.) and will consist of a search strategy to identify and retrieve published studies that meet our inclusion criteria. Studies that require penicillin skin testing (PST) as a step prior to other interventions will be excluded. Integrated knowledge translation involving co-design was carried out for this systematic review protocol creation. Data extraction will be conducted at four levels: (1) study level, (2) patient level, (3) intervention level, and (4) outcome level. A narrative descriptive synthesis of results and risk of bias of all included studies will be provided, and, if relevant, a meta-analysis will be performed.

Discussion

The dissemination of findings from this knowledge synthesis to various stakeholders is intended to inform on options for evidence-based interventions to aid in delabeling penicillin allergies in individuals with a low risk of experiencing a hypersensitivity reaction. Detailed reporting on the characteristics of delabeling interventions as well as the effectiveness of similar interventions will benefit policy makers considering the implementation of a penicillin allergy delabeling protocol. Additionally, findings from this systematic review will report on the current evidence regarding the role of sex and gender in both the prevalence and outcomes associated with the presence of penicillin allergies.

Systematic review registration

PROSPERO CRD42022336457.
Historical Geographical Information System (HGIS): social trajectories of two Chinese historical figures Su Shi and Zuo Zongtang in spatial context
Authors: Fu Jing , Chen Kangsheng , Qin Jianxin , Yang Liguo , Liu Peilin , Zheng Wenwu
Published: October 2024

Historical figures have important significance worldwide. This paper introduces the concept of historical Geographical Information System (HGIS) using the lives of two personalities from Chinese history as case studies: Su Shi, a literary figure of the Northern Song Dynasty, and Zuo Zongtang, a military strategist from the late Qing era. By studying the geographical points marking their life activities, their migratory patterns were explored, along with the dynamics of their social networks within time and space, examining the distinctive phases and characteristics of their individual journeys. Kernel density estimation, standard deviation ellipse, location-based distance analysis, and social network graphs were employed in this work. Our findings reveal that Su Shi’s migrations were largely dictated by official appointments, ultimately rooted in imperial successions and factional strife, with his intellectual pursuits significantly influenced by the humanistic milieu. Conversely, Zuo Zongtang’s migrations were predominantly shaped by war, reflecting the challenges of the late Qing era in relation to governance, sovereignty, and diplomacy. The military encampments selected by Zuo Zongtang tended to be situated near water sources, illustrating how his migratory trajectory was influenced by natural geographic conditions. The social circles of these figures are tied to their social and political stature. Through the socio-historic context, the characteristics of these historical figures’ behavioral trajectories relate to the unfolding process of societal and historical development. These insights offer a glimpse into the life journey behind historical figures, implicitly highlighting their perseverance and resilience in adversity, thereby describing innovative approaches to inheriting and disseminating the cultural legacy.
Dynamic correction of forest fire spread prediction using observation error covariance matrix estimation technique based on FLC-GRU
Authors: Wu Tianyu , Zhang Qixing , Zhu Jiping , Wu Jinhong , Dai Jinyang , Zhang Yongming
Published: October 2024

Background

Data assimilation (DA) techniques have played a significant role in improving the prediction accuracy of forest fire spread. The dynamic correction technique weights the predicted and observed values to obtain an analytical value that better reflects the position of the fire perimeter. The weighted importance of each contribution is determined by the magnitude of its associated error. However, as a crucial parameter affecting prediction accuracy, the covariance matrix of observation errors is often inaccurate and neglects its own temporal correlation. This is unfriendly to spread prediction results. To address this issue, we proposed a targeted technique for estimating the observation error covariance matrix (R matrix) based on the Fire Line Convolutional Gated Recurrent Unit (FLC-GRU).

Results

We integrated this method into the DA framework and validated its applicability and accuracy using Observing System Simulation Experiment (OSSE). Through comparisons with traditional methods, the results indicate that using the FLC-GRU estimated R matrix for correction calculations leads to wildfire prediction locations that are closer to the true values.

Conclusions

The proposed approach learns the covariance matrix directly from time-series observed fire line data, without requiring any prior knowledge or assumptions about the error distribution, in contrast to classical posterior tuning methods. The proposed method significantly improves the rationality and accuracy of R matrix estimation, enhances the utility of observational data, and thereby improves the correction accuracy of forest fire spread predictions. Moreover, the study also demonstrates the applicability of the proposed method within the DA framework.
Measuring clinical outcomes in adult ADHD clinics: psychometrics of a new scale, the adult ADHD Clinical Outcome Scale
Authors: Adamis Dimitrios , Singh Jasmin , Coada Iulian , Wrigley Margo , Gavin Blánaid , McNicholas Fiona
Published: October 2024

Background

Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate.

Aims

To present the psychometrics of a short outcome measure of key clinical areas including symptoms.

Method

The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered.

Results

The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = −0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships.

Conclusions

The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.
Cancer-related Fear and Worry in Patients With Low-risk Thyroid Cancer: A Longitudinal Cohort Study
Authors: Lee Stephanie S , Antunez Alexis G , Sinco Brandy , Saucke Megan C , Bushaw Kyle J , Dream Sophie , Fingeret Abbey , Livhits Masha J , Mathur Aarti , McDow Alexandria D , Roman Sanziana , Voils Corrine I , Pitt Susan C
Published: October 2024

Context

Little is known about how patients’ emotions impact the choice between hemi- and total thyroidectomy (TT) for low-risk thyroid cancer (LR-TC) and how these emotions change after treatment.

Objective

To investigate thyroid cancer-specific fear and worry both before and after treatment of LR-TC with hemi- or TT.

Methods

This prospective cohort study enrolled adults with confirmed or likely LR-TC at 15 institutions. Participants completed measures of thyroid cancer-related fear and worry at the time of their treatment decision and 9 months later. Participants were categorized as having low, medium, or high levels of fear and worry in accordance with the literature. Those choosing hemithyroidectomy were compared to those choosing TT.

Results

Of 177 eligible patients, 125 (70.6%) enrolled and 114 completed both surveys (91.2% retention). Overall, 41 (36.0%) participants chose hemithyroidectomy and 73 (64.0%) chose TT. Across all participants, thyroid cancer-related fear and worry both decreased significantly after surgery (fear, 25.8 ± 6.4 to 23.1 ± 7.4; worry, 8.2 ± 2.4 to 5.4 ± 2.1, P < .001). The proportion of participants with high fear decreased from 64.9% to 50.9%, whereas the proportion with high worry decreased from 75.4% to 41.2% (P < .001 for both). At both time points, no differences existed between those choosing hemi- and TT in levels of worry or fear.

Conclusion

Patients with LR-TC report lower levels of fear and worry 9 months after surgery regardless of the extent of surgery, suggesting that both surgeries provide an emotional benefit to some patients. Thyroid cancer-related fear and worry do not appear to influence patients’ decisions to undergo hemi- or TT.
Approach to the Patient With Thyroid Nodules: Considering GLP-1 Receptor Agonists
Authors: Kelly Clare A , Sipos Jennifer A
Published: October 2024

Glucagon-like peptide 1 receptor agonists (GLP1RAs) have rapidly changed the landscape of diabetes and obesity treatment. Enthusiasm for their use is tempered with concerns regarding their risk for inducing C-cell tumors based on preclinical studies in rodents. A black-box warning from the US Food and Drug Administration recommends against using GLP1RA in patients with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2A or 2B (MEN2), providing clear guidance regarding this cohort of patients. However, emerging data also suggest an increased incidence of differentiated thyroid cancer (DTC) in patients treated with these agents. Other studies, though, have not confirmed an association between GLP1RAs and DTC. With conflicting results concerning thyroid cancer risk, there is no clear consensus regarding the optimal approach to screening patients prior to initiating the medications and/or evaluating for thyroid cancer during GLP1RA treatment. Within the context of patient cases, this review will summarize the existing data, describe ongoing controversies, and outline future areas for research regarding thyroid cancer risk with GLP1RA use.
Prepregnancy and Gestational Interventions to Prevent Childhood Obesity
Authors: Kampmann Ulla , Suder Louise Birk , Nygaard Malene , Geiker Nina Rica Wium , Nielsen Henriette Svarre , Almstrup Kristian , Bruun Jens Meldgaard , Magkos Faidon , Ovesen Per , Catalano Patrick
Published: October 2024

Childhood obesity is a significant global health issue with complex and multifactorial origins, often beginning before conception and influenced by both maternal and paternal health. The increased prevalence of prepregnancy obesity and gestational diabetes mellitus in women of reproductive age contributes to a heightened risk of metabolic dysfunction in offspring. Current clinical practices often implement lifestyle interventions after the first trimester and have limited success, implying that they miss a critical window for effective metabolic adjustments. This review examines the limitations of lifestyle interventions during pregnancy in improving perinatal outcomes and highlights the importance of initiating such interventions before conception to positively impact parental health and fetal development. A re-evaluation of strategies is needed to enhance the metabolic health of prospective parents as a preventive measure against childhood obesity.
Landbridge
Authors: Troeung Y-Dang
Published: October 2024

In 1980, Y-Dang Troeung and her family were among the last of the 60,000 refugees from Cambodia that then-prime minister Pierre Trudeau pledged to relocate to Canada. As the final arrivals, their landing was widely documented in newspapers, with photographs of the PM shaking Troeung's father’s hand, reaching out to pat baby Y-Dang’s head. Forty years later, Troeung returns to this moment, and to many others before and after, to explore the tension between the public narrative of happy “arrival,“ and the multiple, often hidden truths of what happened to the people in her family. Troeung weaves back and forth in time to tell stories about her parents and two brothers who lived through the Cambodian genocide, about the lives of her grandparents and extended family, about her own childhood in the refugee camps and in rural Ontario, and eventually about her young son’s illness and her own diagnosis with a terminal disease. Through it all, Troeung looks with bracing clarity at refugee existence, refusal of gratitude, becoming a scholar, and love.
Shared and unique consequences of Joubert Syndrome gene dysfunction on the zebrafish central nervous system
Authors: Noble Alexandra R. , Masek Markus , Hofmann Claudia , Cuoco Arianna , Rusterholz Tamara D. S. , Özkoc Hayriye , Greter Nadja R. , Phelps Ian G. , Vladimirov Nikita , Kollmorgen Sepp , Stoeckli Esther , Bachmann-Gagescu Ruxandra
Published: October 2024

Joubert Syndrome (JBTS) is a neurodevelopmental ciliopathy defined by a highly specific midbrain–hindbrain malformation, variably associated with additional neurological features. JBTS displays prominent genetic heterogeneity with >40 causative genes that encode proteins localising to the primary cilium, a sensory organelle that is essential for transduction of signalling pathways during neurodevelopment, among other vital functions. JBTS proteins localise to distinct ciliary subcompartments, suggesting diverse functions in cilium biology. Currently, there is no unifying pathomechanism to explain how dysfunction of such diverse primary cilia-related proteins results in such a highly specific brain abnormality. To identify the shared consequence of JBTS gene dysfunction, we carried out transcriptomic analysis using zebrafish mutants for the JBTS-causative genes cc2d2aw38, cep290fh297, inpp5ezh506, talpid3i264 and togaram1zh510 and the Bardet-Biedl syndrome-causative gene bbs1k742. We identified no commonly dysregulated signalling pathways in these mutants and yet all mutants displayed an enrichment of altered gene sets related to central nervous system function. We found that JBTS mutants have altered primary cilia throughout the brain but do not display abnormal brain morphology. Nonetheless, behavioural analyses revealed reduced locomotion and loss of postural control which, together with the transcriptomic results, hint at underlying abnormalities in neuronal activity and/or neuronal circuit function. These zebrafish models therefore offer the unique opportunity to study the role of primary cilia in neuronal function beyond early patterning, proliferation and differentiation.
Οι ελληνοαμερικανικές σχέσεις από το 1991 μέχρι σήμερα
Authors: Δρίβας Αλέξανδρος
Published: October 2024

Η παρούσα διδακτορική διατριβή εκπονήθηκε με σκοπό να αναδειχθούν οι παράμετροι που επηρέασαν τις ελληνοαμερικανικές σχέσεις μετά το τέλος του Ψυχρού Πολέμου, και πιο συγκεκριμένα, κατά την περίοδο της δεύτερης δεκαετίας του 21ου αιώνα. Κατά την περίοδο αυτή, υπάρχει θεμελιώδη αλλαγή της δομής του διεθνούς συστήματος η οποία ξεκίνησε με την περίοδο της μονοπολικής στιγμής αμέσως μετά της κατάρρευση της ΕΣΣΔ και συνεχίστηκε με τη σταδιακή μετάβαση προς ένα πολυπολικό διεθνές σύστημα. Οι σχέσεις μικρομεσαίων δυνάμεων (Ελλάδα) και υπεδρυνάμεων (ΗΠΑ) επηρεάζονται από τη συστημική αλλαγή. Οι σχέσεις της Ελλάδας με άλλες μεγάλες δυνάμεις της διεθνούς πολιτικής, η αλλαγή της αμερικανικής εξωτερικής πολιτικής στην Ανατολική Μεσόγειο, ο ρόλος της Τουρκίας στις ελληνοαμερικανικές σχέσεις, και η απόπειρα εξορθολογισμού της ελληνικής εξωτερικής πολιτικής μετά την είσοδο της Ελλάδας σε προγράμματα δημοσιονομικής σταθερότητας, συνιστούν σημαντικά ζητήματα που χρήζουν περαιτέρω έρευνας. Η μετάβαση προς τον πολυπολικό κόσμο, συνοδεύτηκε από την ανάγκη επαναπροσδιορισμού της εξωτερικής πολιτικής και των ζητημάτων ασφάλειας, τόσο από την πλευρά της Ελλάδας, όσο και από την πλευρά των ΗΠΑ. Ο γεωγραφικός χώρος ο οποίος πλαισιώνει τα συμφέροντα της Ελλάδας και των ΗΠΑ, περιλαμβάνει τα Βαλκάνια, την περιοχή της Μαύρης Θάλασσας και την Ανατολική Μεσόγειο. Οι πόλεμοι στα Βαλκάνια δοκίμασαν τις ελληνοαμερικανικές σχέσεις, όπως και το Μακεδονικό Ζήτημα το οποίο ήλθε να προστεθεί στην ομολογουμένως δύσκολη ατζέντα των δύο χωρών. Από τις αρχές του 21 ου αιώνα, η επάνοδος της Ρωσίας και η εμφάνιση της Κίνας, συμπληρώνουν την εποχή της παγκοσμιοποίησης και του πολέμου εναντίον της τρομοκρατίας, καθιστώντας αναγκαίο τον επαναπροσδιορισμό των διμερών σχέσεων τόσο για την Ελλάδα, όσο και για τις ΗΠΑ. Αυτός ο επαναπροσδιορισμός, δεν κατέστη αμοιβαία επωφελής πριν από το 2009. Οι λόγοι για τους οποίους η Ελλάδα και οι ΗΠΑ βελτίωσαν δραματικά τις σχέσεις τους κατά τη διάρκεια της δεύτερης δεκαετίας του 21 ου αιώνα, είναι αρκετοί και αφορούν όλα τα επίπεδα ανάλυσης (εσωτερικό, περιφερειακό, διεθνές). Η ενδυνάμωση της Κίνας, η ολοένα και πιο έντονη παρουσία της Ρωσίας στη Νοτιοανατολική Ευρώπη και στη Μέση Ανατολή, η Αραβική Άνοιξη, η κρίση στην Ουκρανία, η τουρκική απομάκρυνση από το πάλαι ποτέ στρατηγικό τρίγωνο Ουάσιγκτον-Τελ Αβίβ-Άγκυρας, η είσοδος της Ελλάδας σε προγράμματα δημοσιονομικής σταθερότητας, κ.α., οδήγησαν Ελλάδα και ΗΠΑ να εξετάσουν τις σχέσεις τους πιο ρεαλιστικά. Από το τέλος του 2018, Ελλάδα και ΗΠΑ πλαισιώνουν τη συνεργασία τους μέσα από τον Στρατηγικό Διάλογο Ελλάδας-ΗΠΑ. Η ανάδυση του πολυπολικού διεθνούς συστήματος, οδήγησε τις δύο χώρες στην εξερεύνηση νέων δυνατοτήτων συνεργασίας.
Study of the effect of dendritic morphology and ion channels on neuronal modeling
Authors: Μποζέλος Παναγιώτης
Published: October 2024

Η παρούσα διδακτορική διατριβή επικεντρώνεται σε δύο κύριες εργασίες που σχετίζονται με: i) την αναδόμηση νευρωνικής μορφολογίας και ii) την ανάλυση μοντέλων ιοντικών διαύλων. Στο Κεφάλαιο ΙΙ, παρουσιάζεται το REMOD, ένα καινοτόμο λογισμικό ανοιχτού κώδικα που αναπτύχθηκε για τη μορφομετρική ανάλυση και την αναδόμηση τρισδιάστατων (3D) νευρωνικών μορφολογιών. Το REMOD προσφέρει μια σειρά από εργαλεία για στοχευμένη τροποποίηση και ανάλυση τρισδιάστατων ανακατασκευών, επιτρέποντας σε ερευνητές να μελετήσουν τις επιδράσεις μορφολογικών αλλαγών στη λειτουργία των νευρώνων με ακριβή και ευέλικτο τρόπο. Στο Κεφάλαιο ΙΙΙ, αναλύεται η πρόκληση που προκύπτει από τον πολλαπλασιασμό παρόμοιων και σχεδόν πανομοιότυπων μοντέλων ιοντικών διαύλων σε βάσεις δεδομένων υπολογιστικής νευροεπιστήμης, όπως το ModelDB. Για την αντιμετώπιση αυτής της πρόκλησης, παρουσιάζεται μια νέα μέθοδος που αξιοποιεί ομοιότητες στον πηγαίο κώδικα και ανάλυση δικτύων/γραφημάτων των μοντέλων ιοντικών διαύλων. Αυτή η προσέγγιση επιτρέπει τον εντοπισμό, την ομαδοποίηση και τη σύγκριση πρωτότυπων μοντέλων και των παραγώγων τους, διευκολύνοντας μια πιο αποτελεσματική χρήση του υπάρχοντος συνόλου των μοντέλων ιοντικών διαύλων. Συνολικά, η διατριβή συμβάλλει στην ανάπτυξη νέων εργαλείων και μεθοδολογιών με σκοπό την κατανόηση της αλληλεπίδρασης μεταξύ της δενδριτικής μορφολογίας και της λειτουργίας των νευρώνων, και τη βελτίωση της αξιοποίησης μοντέλων ιοντικών διαύλων.
Η φιλοσοφική προσευχή ως μέσο μέθεξης της ψυχής στο θείο φως των ὑπερουσίων ἑνάδων
Authors: ΜΑΡΚΟΠΟΥΛΟΥ ΑΝΝΑ
Published: October 2024

Αντικείμενο του παρόντος άρθρου είναι η ανάλυση των πέντε σταδίων της φιλοσοφικής προσευχής, μέσω των οποίων η ψυχή καθίσταται ικανή να μετέχει στο νοητό κόσμο αλλά και να ενώνεται με τις θείες ενάδες. Στο πλαίσιο αυτό, στόχος του παρόντος άρθρου είναι να αναδείξει τον τρόπο με τον οποίο τα πέντε στάδια της φιλοσοφικής προσευχής συνιστούν πέντε, πολύ διακριτούς, τρόπους συμμετοχής της ψυχής στο νοητό κόσμο, ανάλογους με τους πέντε τρόπους ύπαρξης της ψυχής στο νοητό κόσμο. Υπό αυτό το πρίσμα, προηγείται η γνώση όλων των τάξεων των θεών (γνῶσις), στις οποίες μετάσχει αυτός που προσεύχεται. Ακολουθεί η προσαρμογή της ψυχής (οἰκείωσις) στους θεούς, τρίτον επαφή (συναφή), σύμφωνα με την οποία, μέσω της κορυφής της ψυχής, αρχίζει κανείς να φτάνει στη θεία ουσία. Έπειτα έρχεται η άμεση γειτνίαση (ἐμπέλασις), που φέρνει την ψυχή σε μεγαλύτερη επικοινωνία με το θείο και προκαλεί τη μέθεξη της ψυχής με μεγαλύτερη καθαρότητα στο θείο φως. Τέλος, το πέμπτο στάδιο της φιλοσοφικής προσευχής είναι η ένωση (ἕνωσις), που είναι ο υπέρτατος στόχος της αληθινής προσευχής, αφού εγκαθιδρύει την ψυχή στο ίδιο το ἓν των θεών και την περιβάλλει με θείο φως.
An assessment of the factors contributing to the unavailability of drugs at outpatient pharmacy of tertiary care hospital: an observational study
Authors: Bakare Abhishek , Bhargav Aditya
Published: October 2024

Introduction Throughout history and up until the present, there has been a medicine shortage. In the early 1920s, there was a shortage of insulin, which is when drug scarcity first appeared in the records. Drug shortages are now more prevalent globally than they were back then. The goal of this essay is to pinpoint the key components that make up a definition for medication shortages and to pinpoint the circumstances that should be considered when reporting drug shortages in databases. Understanding the factors that led certain organizations to create their own definition of a medicine shortage was crucial for achieving these goals. The pharmaceutical regulatory environment can be connected to several reasons why there are medication shortages, including parallel trading, quality standards, and business choices to halt or reduce manufacturing. The many rules governing medicine shortages have not yet been the subject of a thorough investigation. This protocol’s objective is to analyze the pertinent legislative and regulatory frameworks in the European pharmaceutical system that affect medication shortages. The objectives of the study will be the non–availability of drugs at an outpatient pharmacy and to analyze the reason of non–availability of drugs. Methods An observational study will be adopted in this study. It includes a collection of data from the patient coming to the outpatient pharmacy of AVBRH Sawangi (Meghe) Wardha. Expected result It can lead to delayed treatment for patients seeking alternative medication. It can also lead to increased healthcare costs if patients seek alternative treatments that are more expensive or require additional medical care. The unavailability of drugs can also lead to frustration and anxiety for patients who need medication to manage their health condition. It can also negatively impact the reputation of the hospital.
Crossing Genres and Fields
Authors: Hart Jonathan Locke
Published: October 2024

Crossing Genres and Fields
Affect in Literary Translations: What is at Stake for the Author and the Translator
Authors: Kaldjärv Klaarika
Published: October 2024

This article explores the relationships between authors, translators, and readers within the context of literature and translation. Emphasising the reciprocal influence between texts, it delves into the desire of writers to control the interpretation of their works during translation. The examination extends to the hierarchy within literature and translation, questioning whether a translated text can be considered an autonomous entity and if translators can be acknowledged as authors considering the transformative nature of translation and the subjective, creative processes involved. The article also sheds light on the emotional and affective aspects involved in the translation process, highlighting the recurring theme of trust and the fear of translatorial non-compliance. Through examples, it demonstrates how authors can actively engage in the translation process to safeguard their narrative nuances. Case studies, including instances involving Umberto Eco, Guillermo Cabrera Infante, Carlos Fuentes, and Günter Grass, illustrate various levels of authorial control and collaboration. The discussion expands to the global literary landscape, emphasising the dominance of certain languages and the dynamics between the literary centre and periphery. Ultimately, it raises fundamental questions about authorship, control, and the transformative power of translation in shaping the “world republic of letters”. The article investigates the multifaceted dynamics between authors and translators, examining collaboration along a continuum from carte blanche to conflictual relationships. The extent of an author’s involvement in the translation process is explored, questioning the reasons behind some authors’ keen interest in ensuring accurate translations. The power imbalances within collaborations are scrutinised, raising questions about the translator’s agency. The article concludes with reflections on the challenges and potential pitfalls of authors participating in the translation of their own works, emphasising the inherent plurality of interpretations in the act of translation.
Othering Nature in Arundhati Roy’s 'The God of Small Things': A Postcolonial Ecocritical Study
Authors: Yasin Ghulam
Published: October 2024

By mainly referring to Huggan and Tiffin (2010) on postcolonial ecocriticism, the study aims to explore how Arundhati Roy’s novel The God of Small Things (1997) contributes new perspectives on the intertwining between postcolonial studies and ecocriticism. In addition, it explores how the anthropocentric attitude of human beings ruins their natural environment. The selected text is analyzed by utilizing the techniques of content analysis. Human beings are involved to ‘other’ natural environments for their economic gains in the name of development. It is the way of justifying their colonizing attitudes and manipulation of nature. The research finds out that the humans’ desires for economic development are materialized through putting aside the traditional ways of agriculture, building dams, clearing forests, and adopting modern ways of living which destroy the balance of their ecosystem. These factors eventually lead towards the ‘othering’ of nature and the natives in the hands of the colonizers, having some hidden economic and political agendas. Though, Roy’s selected text (1997) has been explored through different postcolonial perspectives but, the colonizers’ attitude towards nature and lands of the colonized is ignored. So, the study is an effort to fill this research gap.
About Authors
Authors: Authors About
Published: October 2024

About Authors
Les genres littéraires participent de domaines: en relisant Croce, Frye et McLuhan
Authors: Bessière Jean
Published: October 2024

Literary Genres Are Parts of Fields: Reading Croce, Frye and McLuhan. Literary critics widely apply the notion of genre to literary works; the use of the notion of field is far less frequent. This application of the notion of genre is defined as a tool to code literary works and to subsume the many variants of coding under specific names – the names of genres. The notion of literary genre and its realities are relativistic; they do not succeed in accounting for literary works’ singularities and similarities. Any systematic use of literary genres in criticism ends with inconsistent views of what is supposed to be the whole of literary genres. Genette’s notion of ‘architext’ illustrates this impasse. The notion of field – here translated in French by ‘domain’ and specified by the expression ‘domaine de sens’ (field of sense) – enables critics and readers to align views on singularities and similarities, to reject any systematic perspective and to outline literary works’ differences, proximities and conti nuities. The notion of ‘domaine de sens’ deprives references to constant kinds of forms/ genres of theoretical and practical usefulness. Literary works are constant because they are texts. As texts, they require no coding to be identified as literary. They just ‘appear’ to be works when they are linked to fields of sense, i.e. linked to the discourses and semantics of the place and time of their writing or reading. These discourses and semantics may include literary genres. Fields of sense are innumerous and change according to the place and time of works’ writing and reception, and each field of sense eventually comprises many works. Fields of sense explain literary works’ proximities and chains across time. Croce’s, Frye’s and McLuhan’s theses about literary genres support the aforementioned argument.