bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and causes of social media usage and addiction status of pregnant women
Authors: Bağrici Bozan Merve , Cangöl Eda
Published: December 2023

Background

This study was conducted to determine the prevalence and causes of social media usage and the addiction status of pregnant.

Materials and methods

This cross-sectional study, which was conducted in the Gynecology and Obstetrics Clinics of a university and state hospital between December 2019 and February 2020 in a city in the west of Turkey, aims to determine the prevalence and causes of social media usage and the addiction status of pregnant women. 500 people were included in the study. The data were collected with the face-to-face interview technique in the outpatient clinics.

Results

The prevalence of the pregnant women’s social media usage was found to be 100%. The average daily social media usage was 3.5 h, whereas the social media addiction index was X̅ = 65.58. There were 358 pregnant women (71.6%) with high social media addiction scores.

Conclusions

In the study, it was concluded that all the pregnant women used social media and that most of them had a high level of social media addiction. Healthcare professionals should promote the conscious and balanced use of social media by organizing educational programs related to the accessibility of accurate and reliable online content for pregnant women at every stage of healthcare, and the dangers and addiction of social media.
Physical exercise habits are related with reduced prevalence of falling among elderly women in China
Authors: Zhao Cuiqing , Wang Tongling , Yu Dawei , Li Wang
Published: December 2023

Background

Although some studies have examined the association between exercise and falls, most have focused on specific exercises, and the results have been inconsistent. In addition, there is a lack of evidence on elderly Chinese women who have different living and exercise habits compared to those in other countries. Therefore, this study aimed to investigate whether physical exercise is associated with falls in elderly Chinese women.

Methods

This cross-sectional study included 1429 elderly Chinese women with a mean age of 69.2 years. Information on physical exercise habits and fall experiences was collected using a self-report questionnaire. Logistic regression models were used to analyze the association between physical exercise habits and falls.

Results

The results showed that 15% participants had a fall in the past year. After adjusting for confounding factors, the odd ratios (ORs) and 95% Confidence Intervals (CIs) for fall experiences across categories of exercise frequency were as follow: 1 (reference) for no exercise behavior, 0.50 (0.29, 0.85) for exercise 1 to 5 times a week, and 0.37 (0.25, 0.55) for exercise more than 6 times a week. Furthermore, the ORs (95% CIs) across categories of exercise insistence were 1 (reference) for less than 1 year, 0.78 (0.37, 1.65) for 1 to 3 years, and 0.38 (0.20, 0.74) for more than 3 years. In terms of exercise duration, the ORs (95% CIs) for < 1 h/day, 1–2 h/day, and > 2 h/day were 1 (reference), 0.85 (0.53, 1.36), and 2.80 (1.30, 6.05). Unlike other variables, longer exercise duration was associated unfavorably with falls.

Conclusion

Physical exercise habits were associated with falls in elderly Chinese women. Keeping a proper exercise habit may contribute to lower risk of falling in elderly women.
Insights into diagnostic errors in endocrinology: a prospective, case-based, international study
Authors: Frey Jessica , Braun Leah T. , Handgriff Laura , Kendziora Benjamin , Fischer Martin R. , Reincke Martin , Zwaan Laura , Schmidmaier Ralf
Published: December 2023

Background

Diagnostic errors in internal medicine are common. While cognitive errors have previously been identified to be the most common contributor to errors, very little is known about errors in specific fields of internal medicine such as endocrinology. This prospective, multicenter study focused on better understanding the causes of diagnostic errors made by general practitioners and internal specialists in the area of endocrinology.

Methods

From August 2019 until January 2020, 24 physicians completed five endocrine cases on an online platform that simulated the diagnostic process. After each case, the participants had to state and explain why they chose their assumed diagnosis. The data gathering process as well as the participants’ explanations were quantitatively and qualitatively analyzed to determine the causes of the errors. The diagnostic processes in correctly and incorrectly solved cases were compared.

Results

Seven different causes of diagnostic error were identified, the most frequent being misidentification (mistaking one diagnosis with a related one or with more frequent and similar diseases) in 23% of the cases. Other causes were faulty context generation (21%) and premature closure (17%). The diagnostic confidence did not differ between correctly and incorrectly solved cases (median 8 out of 10, p = 0.24). However, in incorrectly solved cases, physicians spent less time on the technical findings (such as lab results, imaging) (median 250 s versus 199 s, p < 0.049).

Conclusions

The causes for errors in endocrine case scenarios are similar to the causes in other fields of internal medicine. Spending more time on technical findings might prevent misdiagnoses in everyday clinical practice.
A study on the types of disaster awareness in nursing students: Q methodology
Authors: Seong Mihyeon , Ryu Dajung , Sok Sohyune
Published: December 2023

Background

Research for the development of nursing education strategies to enhance the competency of the nursing students on disaster safety are needed. This study aimed to identify the types of perceptions on disaster safety in nursing students, and to analyze and describe the characteristics of each type of disaster safety perception of nursing students in South Korea.

Methods

An exploratory study design applying Q methodology, a research method designed to study subjectivity. Participants were 30 nursing students in their 20s who are living in C city. This P-set was selected to best reveal the disaster safety awareness of nursing students. Participants provided their subjective viewpoints by sorting 30 statements into a grid. Analyses involved correlation and factor analysis. The study was carried out from June to December, 2020.

Results

In this study, four types of disaster safety awareness of nursing students were uncovered. The characteristics of each type were confirmed as follows: Type 1 was national responsibility, type 2 was individual responsibility, type 3 was preparedness-oriented, and type 4 was education-oriented.

Conclusion

This study shows that the types of perceptions on disaster safety in Korean nursing students were national responsibility, individual responsibility, preparedness-oriented, and education-oriented. The findings from this study can be implied as fundamental data in nursing education of disaster safety.
“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19
Authors: Odendaal Willem , Chetty Terusha , Tomlinson Mark , Goga Ameena , Singh Yages , Kauchali Shuaib , Marshall Carol , Hunt Xanthe
Published: December 2023

The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants’ experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders’ attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members’ mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.
Imputation strategies for genomic prediction using nanopore sequencing
Authors: Lamb H. J. , Nguyen L. T. , Copley J. P. , Engle B. N. , Hayes B. J. , Ross E. M.
Published: December 2023

Background

Genomic prediction describes the use of SNP genotypes to predict complex traits and has been widely applied in humans and agricultural species. Genotyping-by-sequencing, a method which uses low-coverage sequence data paired with genotype imputation, is becoming an increasingly popular SNP genotyping method for genomic prediction. The development of Oxford Nanopore Technologies’ (ONT) MinION sequencer has now made genotyping-by-sequencing portable and rapid. Here we evaluate the speed and accuracy of genomic predictions using low-coverage ONT sequence data in a population of cattle using four imputation approaches. We also investigate the effect of SNP reference panel size on imputation performance.

Results

SNP array genotypes and ONT sequence data for 62 beef heifers were used to calculate genomic estimated breeding values (GEBVs) from 641 k SNP for four traits. GEBV accuracy was much higher when genome-wide flanking SNP from sequence data were used to help impute the 641 k panel used for genomic predictions. Using the imputation package QUILT, correlations between ONT and low-density SNP array genomic breeding values were greater than 0.91 and up to 0.97 for sequencing coverages as low as 0.1 × using a reference panel of 48 million SNP. Imputation time was significantly reduced by decreasing the number of flanking sequence SNP used in imputation for all methods. When compared to high-density SNP arrays, genotyping accuracy and genomic breeding value correlations at 0.5 × coverage were also found to be higher than those imputed from low-density arrays.

Conclusions

Here we demonstrated accurate genomic prediction is possible with ONT sequence data from sequencing coverages as low as 0.1 × , and imputation time can be as short as 10 min per sample. We also demonstrate that in this population, genotyping-by-sequencing at 0.1 × coverage can be more accurate than imputation from low-density SNP arrays.
Association between menstrual cycle phase and metabolites in healthy, regularly menstruating women in UK Biobank, and effect modification by inflammatory markers and risk factors for metabolic disease
Authors: MacGregor Kirstin A. , Ho Frederick K. , Celis-Morales Carlos A. , Pell Jill P. , Gallagher Iain J. , Moran Colin N.
Published: December 2023

Background

Preliminary evidence demonstrates some parameters of metabolic control, including glycaemic control, lipid control and insulin resistance, vary across the menstrual cycle. However, the literature is inconsistent, and the underlying mechanisms remain uncertain. This study aimed to investigate the association between the menstrual cycle phase and metabolites and to explore potential mediators and moderators of these associations.

Methods

We undertook a cross-sectional cohort study using UK Biobank. The outcome variables were glucose; triglyceride; triglyceride to glucose index (TyG index); total, HDL and LDL cholesterol; and total to HDL cholesterol ratio. Generalised additive models (GAM) were used to investigate non-linear associations between the menstrual cycle phase and outcome variables. Anthropometric, lifestyle, fitness and inflammatory markers were explored as potential mediators and moderators of the associations between the menstrual cycle phase and outcome variables.

Results

Data from 8694 regularly menstruating women in UK Biobank were analysed. Non-linear associations were observed between the menstrual cycle phase and total (p < 0.001), HDL (p < 0.001), LDL (p = 0.012) and total to HDL cholesterol (p < 0.001), but not glucose (p = 0.072), triglyceride (p = 0.066) or TyG index (p = 0.100). Neither anthropometric, physical fitness, physical activity, nor inflammatory markers mediated the associations between the menstrual cycle phase and metabolites. Moderator analysis demonstrated a greater magnitude of variation for all metabolites across the menstrual cycle in the highest and lowest two quartiles of fat mass and physical activity, respectively.

Conclusions

Cholesterol profiles exhibit a non-linear relationship with the menstrual cycle phase. Physical activity, anthropometric and fitness variables moderate the associations between the menstrual cycle phase and metabolite concentration. These findings indicate the potential importance of physical activity and fat mass as modifiable risk factors of the intra-individual variation in metabolic control across the menstrual cycle in pre-menopausal women.
Avian pathogenic Escherichia coli infection causes infiltration of heterophilic granulocytes of chick tracheal by the complement and coagulation cascades pathway
Authors: Li Ziqi , Qi Zhao , Wang Xiaoru , Lu Liting , Wang Haiyang , He Zhenjie , Chen Zhe , Shao Ying , Tu Jian , Song Xiangjun
Published: December 2023

Background

Avian pathogenic Escherichia coli (APEC) causes tracheal damage and heterophilic granulocytic infiltration and inflammation in infected chicks. In this study, we infected chick tracheal tissue with strain AE17 and produced pathological sections with proteomic sequencing. We compared the results of pathological sections from the APEC-infected group with those from the PBS control group; the pathological sections from the experimental group showed hemorrhage, fibrinization, and infiltration of heterophilic granulocytes in the tracheal tissue. In order to explore the effect on proteomics on inflammation and to further search for the caus.

Results

The tandem mass tag-based (TMT) sequencing analysis showed 224 upregulated and 140 downregulated proteins after infection with the AE17 strain. Based on the results of KEGG in Complement and coagulation cascades, differential protein expression in the Protein export pathway was upregulated.

Conclusions

With these results, we found that chemokines produced by the Complement and coagulation cascades pathway may cause infiltration of heterophilic granulocytes involved in inflammation, as well as antimicrobial factors produced by the complement system to fight the infection together.These results suggest that APEC causes the infiltration of heterophilic granulocytes through the involvement of the complement system with serine protease inhibitors.
Effects of exenatide on coronary stent’s endothelialization in subjects with type 2 diabetes: a randomized controlled trial. The Rebuild study
Authors: Santos-Pardo Irene , Witt Nils , Angerås Oskar , Nyström Thomas
Published: December 2023

Background

Subjects with type 2 diabetes (T2D) have a higher risk of in-stent restenosis and stent thrombosis. The activation of the glucagon-like peptide-1 receptor (GLP-1R) has been suggested to induce several effects on the vasculature that may reduce the risk of stent failure following an angioplasty. The aim of this study is to evaluate the effect of the GLP-1R agonist exenatide on endothelialization of a modern drug-eluting stent (DES) in subjects with T2D.

Methods

38 subjects with T2D who were eligible for revascularization with implantation of DES were randomized to treatment with exenatide (once weekly) plus standard treatment, or to standard treatment alone. After 12 weeks, a new coronary angiography was performed to evaluate the percentage of strut coverage (primary endpoint) and the presence of neo-atherosclerosis by optical coherence tomography. This study was approved by the Stockholm’s Ethical Review Board.

Results

The two groups were well balanced regarding baseline clinical characteristics. Strut coverage was 95% (88.7–98.5%) in the exenatide group and 91.4% (88.8–98.5%) in the control group (p = 0.692). There were no significant differences between groups neither in the thickness of neo-intima (0.2 mm in both groups, p = 0.471), nor the maximal in-stent obstruction by neo-intima (15.5% in exenatide group vs 14.7% in control group, p = 0.801). No significant differences were detected in the rate of target lesion revascularization between groups (p = 0.224).

Conclusion

Twelve weeks treatment with exenatide did not lead to a significantly better stent coverage in people with T2D. No significant differences in the occurrence of neo-atherosclerosis were detected between groups.

Trial registration: The study was registered at www.clinicaltrials.gov (Rebuild Study, NCT02621489).
Effects of diabetes mellitus and glycemic traits on cardiovascular morpho-functional phenotypes
Authors: Li Zhaoyue , Xiong Jie , Guo Yutong , Tang Hao , Guo Bingchen , Wang Bo , Gao Dianyu , Dong Zengxiang , Tu Yingfeng
Published: December 2023

Background

The effects of diabetes on the cardiac and aortic structure and function remain unclear. Detecting and intervening these variations early is crucial for the prevention and management of complications. Cardiovascular magnetic resonance imaging-derived traits are established endophenotypes and serve as precise, early-detection, noninvasive clinical risk biomarkers. We conducted a Mendelian randomization (MR) study to examine the association between two types of diabetes, four glycemic traits, and preclinical endophenotypes of cardiac and aortic structure and function.

Methods

Independent genetic variants significantly associated with type 1 diabetes, type 2 diabetes, fasting insulin (FIns), fasting glucose (FGlu), 2 h-glucose post-challenge (2hGlu), and glycated hemoglobin (HbA1c) were selected as instrumental variables. The 96 cardiovascular magnetic resonance imaging traits came from six independent genome-wide association studies. These traits serve as preclinical endophenotypes and offer an early indication of the structure and function of the four cardiac chambers and two aortic sections. The primary analysis was performed using MR with the inverse-variance weighted method. Confirmation was achieved through Steiger filtering and testing to determine the causal direction. Sensitivity analyses were conducted using the weighted median, MR-Egger, and MR-PRESSO methods. Additionally, multivariable MR was used to adjust for potential effects associated with body mass index.

Results

Genetic susceptibility to type 1 diabetes was associated with increased ascending aortic distensibility. Conversely, type 2 diabetes showed a correlation with a reduced diameter and areas of the ascending aorta, as well as decreased distensibility of the descending aorta. Genetically predicted higher levels of FGlu and HbA1c were correlated with a decrease in diameter and areas of the ascending aorta. Furthermore, higher 2hGlu levels predominantly showed association with a reduced diameter of both the ascending and descending aorta. Higher FIns levels corresponded to increased regional myocardial-wall thicknesses at end-diastole, global myocardial-wall thickness at end-diastole, and regional peak circumferential strain of the left ventricle.

Conclusions

This study provides evidence that diabetes and glycemic traits have a causal relationship with cardiac and aortic structural and functional remodeling, highlighting the importance of intensive glucose-lowering for primary prevention of cardiovascular diseases.
Technical comparison of Abbott’s UroVysion® and Biocare’s CytoFISH urine fluorescence in situ hybridization (FISH) assays
Authors: Anderson Tammy , Hartman Sharon , Dunn William , Bellin Harvey , Ehlers Thomas W. , Groen Sarah , Ramos Jason A.
Published: December 2023

Background

This study aims to compare the technical performance of Abbott’s UroVysion and Biocare’s CytoFISH urine cytology probe panel and position the CytoFISH probe panel as an alternative to UroVysion. The CytoFISH probe panel was developed based on clinically sensitive chromosomes found to be amplified in bladder cancers, as well as a locus-specific probe also seen to be amplified in bladder tumors. After extensive testing comparing CytoFISH to UroVysion, we present here our findings for the two assays.

Materials and methods

A total of 216 cases representing a mix of male (ages 36–99) and female (ages 46–91) patients were assayed with both probe sets. The CytoFISH and UroVysion probe panels were tested in accordance with the UroVysion procedure, as outlined in the manufacturer’s supplied package insert with the following exception: the probe volume used was 3µL for UroVysion and 5µL for CytoFISH.

Results

The scoring used for the CytoFISH and UroVysion assays revealed a 95% concordance, suggesting that Biocare’s CytoFISH Test has at least the same clinical sensitivity and specificity as claimed by the Abbott UroVysion Kit. We found that the CytoFISH 5p15.2 locus-specific probe was easier to score than UroVysion’s 9p21 deletion.

Conclusion

The high rate of concordance between the two assays suggests that Biocare’s CytoFISH assay is a robust alternative to Abbott’s UroVysion in the diagnosis and monitoring of bladder carcinoma.
Different dietary carbohydrate component intakes and long-term outcomes in patients with NAFLD: results of longitudinal analysis from the UK Biobank
Authors: Liu Zhening , Huang Hangkai , Xie Jiarong , Hou Linxiao , Xu Chengfu
Published: December 2023

Background

This study aimed to investigate the association between the intake of different dietary carbohydrate components and the long-term outcomes of non-alcoholic fatty liver disease (NAFLD).

Methods

We used prospective data from 26,729 NAFLD participants from the UK Biobank cohort study. Dietary information was recorded by online 24-hour questionnaires (Oxford WebQ). Consumption of different carbohydrate components was calculated by the UK Nutrient Databank Food Composition Table. Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). A substitution model was used to estimate the associations of hypothetical substitution for free sugars.

Results

During a median of 10.5 (IQR: 10.2–11.2) years and a total of 280,135 person-years of follow-up, 310 incident end-stage liver disease (ESLD) and 1750 deaths were recorded. Compared with the lowest quartile, the multi-adjusted HRs (95% CI) of incident ESLD in the highest quartile were 1.65 (1.14–2.39) for free sugars, 0.51 (0.35–0.74) for non-free sugars, and 0.55 (0.36–0.83) for fiber. For overall mortality, the multi-adjusted HRs (95% CI) in the highest quartile were 1.21 (1.04–1.39) for free sugars, 0.79 (0.68–0.92) for non-free sugars, and 0.79 (0.67–0.94) for fiber. Substituting free sugars with equal amounts of non-free sugars, starch or fiber was associated with a lower risk of incident ESLD and overall mortality.

Conclusions

A lower intake of free sugars and a higher intake of fiber are associated with a lower incidence of ESLD and overall mortality in NAFLD patients. These findings support the important role of the quality of dietary carbohydrates in preventing ESLD and overall mortality in NAFLD patients.
Characterization of novel CD19-specific VHHs isolated from a camelid immune library by phage display
Authors: Ganji Mahmoud , Safarzadeh Kozani Pooria , Rahbarizadeh Fatemeh
Published: December 2023

Background

Monoclonal antibody (mAb)-based immunotherapies have achieved promising outcomes in the treatment of immunological and oncological indications. CD19 is considered one of the most qualified antigens in the treatment of B-cell neoplasms. VHHs (nanobodies) are known for their physicochemical advantages over conventional mAbs rendering them suitable therapeutics and diagnostic tools. Herein, we aimed to isolate CD19-specific VHHs from a novel immune library using phage display.

Methods

An immune VHH gene library was constructed. Using phage display and after five biopanning rounds, two monoclonal CD19-specific VHHs were isolated. The selected VHHs were expressed, purified, and characterized in terms of their affinity, specificity, sensitivity, and ability to target CD19-positive cell lines. Moreover, in silico analyses were employed for further characterization.

Results

A VHH library was developed, and because the outputs of the 4th biopanning round exhibited the most favorable characteristics, a panel of random VHHs was selected from them. Ultimately, two of the most favorable VHHs were selected and DNA sequenced (designated as GR37 and GR41). Precise experiments indicated that GR37 and GR41 exhibited considerable specificity, sensitivity, and affinity (1.15 × 107 M−1 and 2.08 × 107 M−1, respectively) to CD19. Flow cytometric analyses revealed that GR37 and GR41 could bind CD19 on the surface of cell lines expressing the antigen. Moreover, in silico experiments predicted that both VHHs target epitopes that are distinct from that targeted by the CD19-specific single-chain variable fragment (scFv) FMC63.

Conclusion

The selected VHHs can be used as potential targeting tools for the development of CD19-based immunotherapeutics.
Audiovisual biofeedback amplifies plantarflexor adaptation during walking among children with cerebral palsy
Authors: Spomer Alyssa M. , Conner Benjamin C. , Schwartz Michael H. , Lerner Zachary F. , Steele Katherine M.
Published: December 2023

Background

Biofeedback is a promising noninvasive strategy to enhance gait training among individuals with cerebral palsy (CP). Commonly, biofeedback systems are designed to guide movement correction using audio, visual, or sensorimotor (i.e., tactile or proprioceptive) cues, each of which has demonstrated measurable success in CP. However, it is currently unclear how the modality of biofeedback may influence user response which has significant implications if systems are to be consistently adopted into clinical care.

Methods

In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 [12.5,15.5] years) adapted their gait patterns during treadmill walking (6 min/modality) with audiovisual (AV), sensorimotor (SM), and combined AV + SM biofeedback before and after four acclimation sessions (20 min/session) and at a two-week follow-up. Both biofeedback systems were designed to target plantarflexor activity on the more-affected limb, as these muscles are commonly impaired in CP and impact walking function. SM biofeedback was administered using a resistive ankle exoskeleton and AV biofeedback displayed soleus activity from electromyography recordings during gait. At every visit, we measured the time-course response to each biofeedback modality to understand how the rate and magnitude of gait adaptation differed between modalities and following acclimation.

Results

Participants significantly increased soleus activity from baseline using AV + SM (42.8% [15.1, 59.6]), AV (28.5% [19.2, 58.5]), and SM (10.3% [3.2, 15.2]) biofeedback, but the rate of soleus adaptation was faster using AV + SM biofeedback than either modality alone. Further, SM-only biofeedback produced small initial increases in plantarflexor activity, but these responses were transient within and across sessions (p > 0.11). Following multi-session acclimation and at the two-week follow-up, responses to AV and AV + SM biofeedback were maintained.

Conclusions

This study demonstrated that AV biofeedback was critical to increase plantarflexor engagement during walking, but that combining AV and SM modalities further amplified the rate of gait adaptation. Beyond improving our understanding of how individuals may differentially prioritize distinct forms of afferent information, outcomes from this study may inform the design and selection of biofeedback systems for use in clinical care.
Reducing sick leave, improving work ability, and quality of life in patients with mild to moderate Long COVID through psychosocial, physiotherapeutic, and nutritive supportive digital intervention (MiLoCoDaS): study protocol for a randomized controlled trial
Authors: Krotz Adrian , Sosnowsky-Waschek Nadia , Bechtel Stephanie , Neumann Christine , Lohkamp Monika , Kovacs Gabor , Genser Bernd , Fischer Joachim E.
Published: December 2023

Background

Following ﻿SARS-CoV-2 infection, a relevant proportion of patients suffer from persistent or recurring sequela, even after initially mild primary illness. Many patients experience exhaustion and fatigue, rendering them incapable of working. Long COVID exerts a substantial burden on society and the healthcare system: at least 65 million people are currently affected worldwide. The underlying pathobiology is a complex derangement in several organ systems. To date, causal pharmaceutical therapies remain elusive. Waiting lists for specialist care are long. Rapidly scalable digital interventions offering support for the frequent subgroup of patients with mild to moderate impairment from Long COVID are urgently needed. The MiLoCoDaS study compares three intensities of a potentially rapidly scalable digital intervention aiming to accelerate recovery. The overall objective is to figure out if there is a difference in the effect sizes between these modalities.

Methods

The online intervention uses a learning platform (LMS, TYPO3 framework) comprising 12 sessions of medical, psychological, physiotherapeutic, and nutritional content. The three modalities differ as follows: patient information only (sham intervention, control), information plus interactive digital workbook including practical exercises (digital intervention), and the digital workbook augmented by once-weekly online seminars and discussion groups (person and peer-contact). Eligible patients are 18–67 years old satisfying Long COVID diagnostic criteria. Patients are recruited through primary care physicians and randomly allocated. The primary endpoint is the number of sick leave days during the 6-month observation period; secondary endpoints are patient-reported symptoms, quality of life, and work ability. The study size provides a power of 80% at a type I error of < 0.05 to show an effect size of Cohen = 0.3 between the augmented and the sham intervention (N = 152 per arm, total accounting for attrition N = 600).

Discussion

If one of the two interventions is superior to providing information alone, MiLoCoDaS would provide the starting point for a rapidly scalable digital intervention for the frequent and currently underserved patient group with mild to moderate impairment from Long COVID. Several caveats pertain to the heterogeneity of Long COVID manifestation and duration prior to inclusion. It is conceivable that the possible effect of the intervention may differ across subgroups. Therefore, a priori defined secondary analysis will be conducted.

Trial registration

German Clinical Trials Register (DRKS) DRKS00028964. Registered on 24 August 2022.
Development and evaluation of a decision-making aid for couples hesitant about transitioning from infertility treatment to advanced assisted reproductive technology: a usability and feasibility study
Authors: Asazawa Kyoko , Takahata Kaori , Kojima Natsuko , Onizawa Hiromi , Kawanami Masami , Yoshida Atsumi , Hasegawa Kumiko , Chihara Makoto , Arimori Naoko
Published: December 2023

Objectives

The aims of this study were (1) to develop a decision-making aid for couples hesitant about transitioning from infertility treatment to advanced assisted reproductive technology, (2) to examine the adequacy of this aid, and (3) to evaluate its usability. After the first version of the decision-making aid was created, the first version was supervised and finally a prototype of the decision-making aid was completed. We conducted a feasibility study from February to March 2022. We used a quantitative cross-sectional descriptive design involving 22 medical professionals and infertility survivors recruited.

Results

Twenty-two participants (3 reproductive medical specialists, 11 nurses who specialize in reproductive medicine, and 8 infertility survivors) were included in the final analysis (91.7% valid response rate). Of these participants, 81.8% answered Agree regarding “Easy-to-read degree of charts”, 17 (77.3%) answered It is just the right amount regarding “Appropriateness of information volume”, 81.8% answered Agree regarding “Ease of understanding content”, and 90.9% answered Good regarding “Overall performance”. From the opinions received, we extracted 4 categories: “Useful for decision making,” “Suitable for providing information,” “Useful in clinical practice,” and “Needs improvement.” Certain degrees of surface validity and content validity were confirmed for the trial version of the decision-making aid.
Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit
Authors: Xia Jiangling , Hu Chunhuan , Wang Leilei , Zhang Yuzhu
Published: December 2023

Background

Delirium occurs frequently in patients with chronic obstructive pulmonary disease in the intensive care unit. Effective prevention and treatment strategies for delirium remain limited. We aimed to assess delirium and 30-day mortality in patients with chronic obstructive pulmonary disease who were statin and non-statin users.

Methods

In this retrospective study, patients with chronic obstructive pulmonary disease were identified from the Medical Information Mart for Intensive Care database (MIMIC-IV). The primary exposure variable was the use of statins 3 days after entering the intensive care unit and the primary outcome measure was the presence of delirium. The secondary outcome measure was 30-day mortality. Since the cohort study was retrospective, we used an inverse probability weighting derived from the propensity score matching to balance different variables.

Results

Among a cohort of 2725 patients, 1484 (54.5%) were statin users. Before propensity score matching, the prevalence of delirium was 16% and the 30-day mortality was 18% in patients with chronic obstructive pulmonary disease. Statin use was significantly negatively correlated with delirium, with an odds ratio of 0.69 (95% CI 0.56–0.85, p < 0.001) in the inverse probability weighted cohort and 30-day mortality of 0.7 (95% CI 0.57–0.85, p < 0.001).

Conclusions

Statin use is associated with a lower incidence of delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit.
Robotic‐assisted total knee arthroplasty improves the rotational mismatch between femoral and tibial components, but not the forgotten joint score 12: a single‐center retrospective cohort study
Authors: Yamamoto Ayakane , Kaneko Takao , Takada Kazutaka , Yoshizawa Shu
Published: December 2023

Purpose

The primary aim of this study was to compare postoperative short‐term patient reported outcome measurements (PROMs) and rotational mismatch between femoral and tibial following conventional jig‐based total knee arthroplasty (Conv‐TKA) versus robotic‐assisted TKA (RA‐TKA) using three‐dimensional computed tomography (3DCT) measurements.

Methods

This retrospective, consecutive case–control trial included 83 patients with varus osteoarthritis of the knee undergoing Conv‐TKA versus RA‐TKA using bi‐cruciate stabilized TKA. The rotational mismatch of the femoral and tibial components between the two groups were compared using 3DCT measurements. PROMs (2011 Knee Society Score (KSS), forgotten joint score‐12 (FJS‐12), patella score were compared in patients between 1 and 2 years postoperatively.

Results

The two groups did not exhibit significant differences in any of the following preoperative factors: age at surgery, body mass index (BMI), preoperative range of motion (ROM), hip‐knee‐ankle (HKA) angle. There were no significant differences in postoperative HKA angle and tibial rotation angle, the absolute values of the femoral rotational angle and rotational mismatch were significantly smaller in the RA‐TKA group than in the Conv‐TKA group (both p < 0.01). Neither Postoperative PROMs (2011 KSS: pain, patient satisfaction, patient expectation, advanced activities score) nor patella score differed significantly between the groups, but FJS‐12 was significantly better in the Conv‐TKA group than in the RA‐TKA group (p < 0.01).

Conclusions

RA‐TKA did not improve FJS‐12 compared to Conv‐TKA, but did result in more accurate rotational alignment of femoral component and rotational mismatch between the femoral and tibial components.

Level of evidence

IV.
Comparison of pregnancy and neonatal outcomes in a retrospective full pregnancy history survey versus population-based prospective records: a validation study in rural Sarlahi District, Nepal
Authors: Erchick Daniel J. , Lama Tsering P. , Subedi Seema , Verhulst Andrea , Guillot Michel , Khatry Subarna K. , LeClerq Steven C. , Tielsch James M. , Mullany Luke C. , Katz Joanne
Published: December 2023

Introduction

Countries without complete civil registration and vital statistics systems rely on retrospective full pregnancy history surveys (FPH) to estimate incidence of pregnancy and mortality outcomes, including stillbirth and neonatal death. Yet surveys are subject to biases that impact demographic estimates, and few studies have quantified these effects. We compare data from an FPH vs. prospective records from a population-based cohort to estimate validity for maternal recall of live births, stillbirths, and neonatal deaths in a rural population in Sarlahi District, Nepal.

Methods

We used prospective data, collected through frequent visits of women from early pregnancy through the neonatal period, from a population-based randomized trial spanning 2010–2017. We randomly selected 76 trial participants from three pregnancy outcome groups: live birth (n = 26), stillbirth (n = 25), or neonatal death (n = 25). Data collectors administered the Nepal 2016 Demographic and Health Surveys (DHS)-VII pregnancy history survey between October 22, 2021, and November 18, 2021. We compared total pregnancy outcomes and numbers of pregnancy and neonatal outcomes between the two data sources. We matched pregnancy outcomes dates in the two sources within ± 30 days and calculated measures of validity for adverse outcomes.

Results

Among 76 participants, we recorded 122 pregnancy outcomes in the prospective data and 104 outcomes in the FPH within ± 30 days of each woman’s total observation period in the trial. Among 226 outcomes, we observed 65 live births that survived to 28 days, 25 stillbirths, and 32 live births followed by neonatal death in the prospective data and participants reported 63 live births that survived to 28 days, 15 stillbirths, and 26 live births followed by neonatal death in the pregnancy history survey. Sixty-two FPH outcomes were matched by date within ± 30 days to an outcome in prospective data. Stillbirth, neonatal death, higher parity, and delivery at a health facility were associated with likelihood of a non-matched pregnancy outcome.

Conclusions

Stillbirth and neonatal deaths were underestimated overall by the FPH, potentially underestimating the burden of mortality in this population. There is a need to develop tools to reduce or adjust for biases and errors in retrospective surveys to improve reporting of pregnancy and mortality outcomes.
Chinese pre-service chemistry teachers’ perception of augmented reality-assisted secondary chemistry learning
Authors: Zhang Sifang , Zhou Chenshuang , Zhao Jiaoyan
Published: December 2023

This research aims to explore the functional characteristics of Augmented Reality (AR) supported teaching in secondary chemistry learning, based on the theoretical framework of AR research in science education proposed by (JSET 22:449-462, 2013). Grounded theory and interview were used to construct AR related functional models. In the study, pre-service teachers were first asked to experience organic chemistry AR teaching app—“Meet Organic”, and then semi-structured interview was conducted. Secondly, Nvivo12 was used to encode the interview results and finally relevant functional models were obtained. According to the results, AR education functions in science education are mainly divided into three parts: “Visual Presentation”, “Concept Understanding” and “Thinking Construction”, and each function is divided into 2–3 sub-functions based on the interview depth coding. Exploring the functional differences of AR between male and female meanwhile. The results of this research are of great importance to promote the in-depth understanding of the essence of augmented reality supported teaching, and the deep integration of AR teaching with science education. It also provides suggestions for future teachers to design teaching methods based on AR.
Diffusion tensor imaging and voxel-based morphometry in differentiating multiple sclerosis and its mimics
Authors: Elkossi Samaa Mostafa , Sayed Samy Abd El-Aziz , Shehata Ghaydaa A. , Seif Eldein Gehan S. , Ahmed Sayed Hassan , Ali Abeer Houssein
Published: December 2023

Background

The discrimination between multiple sclerosis (MS) and other white matter lesions in adults is still problematic as multiple diseases have similar clinical and radiological findings, especially at the disease onset. This case–control study aimed to evaluate the efficacy of diffusion tensor imaging (DTI) and brain morphometry in the differentiation between adult MS and its magnetic resonance imaging (MRI) mimics.

Methods

Fifty-eight patients (49 women and 9 men; mean age 35.74 ± 11.86 years, range 18–50 years) with clinically suspected MS and age- and sex-matched fifteen healthy subjects were included. All study subjects underwent MRI using 3D FLAIR, 3D T1 MPRAGE, axial T2WI fast spin echo, and DTI sequences. The included patients were classified into MS and mimics groups according to MC Donald’s criteria 2017. Image post-processing using the region of interest (ROI) analysis for DTI parameters and automated voxel brain morphometry and segmentation was done for all study groups. Statistical comparison between the two patient groups and between them and the control group was performed regarding DTI indices (fractional anisotropy [FA], mean diffusivity [MD], and relative anisotropy [RA]) and brain morphometry parameters (including white matter volume (WMV), grey matter volume (GMV), cerebrospinal fluid volume (CSFV), T2 lesion load and deep grey matter volume).

Results

A statistically significant difference was observed between the MD, FA, and RA values of the patients and control groups. The MD values were significantly higher in the MS than in its mimics with a cut-off value of > 1.058 × 10−3 mm2/s (p < 0.001). Compared to the mimics group, the MS patients showed significantly lower WMV (33.31 ± 4.40 versus 35.71 ± 4.58; p = 0.047) and higher CSFV (16.38 ± 5.93 versus 13.06 ± 3.09; p = 0.012) with no significant difference regarding the GMV.

Conclusions

MD analysis of DTI, WMV, and CSFV are useful quantitative measurements in confirming the diagnosis of MS and differentiating it from its imaging mimics.
Discriminative Dissolution Method Development Through an aQbD Approach
Authors: Chen Hongbo , Wang Rui , McElderry John-David
Published: December 2023

Using a one-factor-at-a-time approach for dissolution method and discrimination analysis can be time-consuming and may not yield the optimal and discriminative method. To address this, we have developed a two-stage workflow for the dissolution method development followed by demonstration of discrimination power through an analytical Quality by Design (aQbD) approach. In the first stage, an optimal dissolution method was achieved by determining the method operable design region (MODR) through a design of experiment study of the high-risk method-related parameters. In the second stage, we established a Formulation-Discrimination Correlation Diagram strategy to examine the method discrimination capability, through which one can determine the method discriminative design region (MDDR) and visualize the impact of each formulation parameter and their interactions on dissolution. The application of aQbD principles into a workflow provides a scientific-driven guidance for robust method development and demonstrating discrimination power for dissolution methods.

Graphical Abstract
Methods for alien species impact assessment
Authors: Τσιριντάνης Κωνσταντίνος-Παναγιώτης
Published: December 2023

Οι βιολογικές εισβολές αποτελούν έναν παγκόσμιο παράγοντα περιβαλλοντικής αλλαγής των οικοσυστημάτων καθώς επηρεάζουν τη δομή και τον τρόπο λειτουργίας τους. Μετά την εγκατάσταση τους σε νέα οικοσυστήματα, τα ξενικά είδη μπορεί να εξελιχθούν σε εισβολικά και να προκαλέσουν σημαντικές επιπτώσεις στην βιοποικιλότητα, την παροχή οικοσυστημικών υπηρεσιών, την τοπική οικονομία και την ανθρώπινη υγεία. Ο ρυθμός εισαγωγής νέων ξενικών ειδών στα οικοσυστήματα αυξάνεται διαρκώς λόγω της αυξανόμενης κινητικότητας των ανθρώπων. Επιπλέον, οι επιπτώσεις των βιολογικών εισβολών μπορούν να ενταθούν λόγω της παράλληλης δράσης άλλων περιβαλλοντικών πιέσεων όπως η κλιματική αλλαγή. Οι επιπτώσεις των ξενικών ειδών μπορεί να είναι και θετικές για την βιοποικιλότητα όπως σε περιπτώσεις που καταλαμβάνουν κενό οικολογικό θώκο και παρέχουν χαμένες οικολογικές λειτουργίες ή για τις οικοσυστημικές υπηρεσίες σε περιπτώσεις όπως η παροχή νέων αλιευτικών στόχων. H αξιολόγηση επιπτώσεων είναι απαραίτητη προκειμένου να κατανοήσουμε τις συνέπειες των βιολογικών εισβολών και να επιλεχθούν οι κατάλληλες δράσεις διαχείρισης. Τα θαλάσσια οικοσυστήματα της Μεσογείου έχουν επηρεαστεί σε πολύ σημαντικό βαθμό από τις βιολογικές εισβολές. Η παρούσα διδακτορική διατριβή αξιολόγησε τις επιπτώσεις ξενικών ειδών στη βιοποικιλότητα, τις οικοσυστημικές υπηρεσίες και την ανθρώπινη υγεία στη Μεσόγειο Θάλασσα. Η αξιολόγηση των επιπτώσεων πραγματοποιήθηκε χρησιμοποιώντας ένα εύρος διαφορετικών μεθόδων που περιλάμβαναν βιβλιογραφική έρευνα, συστηματικά πλαίσια αξιολόγησης επιπτώσεων, έρευνες πεδίου, πειράματα και χαρτογράφηση επιπτώσεων με στόχο της ενίσχυση της σχετικής γνώσης των βιολογικών εισβολών στα θαλάσσια οικοσυστήματα της Μεσογείου. Οι τεχνικές που εφαρμόστηκαν για την αξιολόγηση των επιπτώσεων των ξενικών ειδών, στόχευσαν επίσης να παρέχουν την κατάλληλή γνώση και τα κατάλληλα εργαλεία για την ενίσχυση της διαχείρισης των βιολογικών εισβολών στη Μεσόγειο Θάλασσα.
‘Heaven guide him to thy husband’s cudgel’
Authors: Vogel Kubik Sharon
Published: December 2023

This essay argues that in Shakespeare’s The Merry Wives of Windsor, when the merry wives dress Falstaff as the old woman of Brentford, they reveal his true character by visually associating him with a witch and thus force the men of Windsor to punish him for his crimes. Falstaff’s behaviour matches the social disruption of the male witch; furthermore, his position as a new and unestablished member of a community, his gender, and the fact that the authorities of Windsor are inept make it difficult for the merry wives to successfully accuse him without appealing to popular witchcraft belief.
The Devil at the Edge of this Book: Intertextual Ecologies of Early Modern Crime Narratives
Authors: George Emily
Published: December 2023

This essay uses The Wonderfull Discouerie of Elizabeth Sawyer and The Witch of Edmonton to examine how the multiple, conflicting agendas and intertextual relationships of crime narratives in popular print and professional drama manifest on both the space of the page and of the stage. Considering paratexts as part of the intertextual ecology of early modern crime narratives as they move between print and stage reveals materialized ambivalence about the relationships among the narratives themselves; the audiences consuming, circulating, and reproducing those narratives; and the criminals whose voices are both marginalized and authoritative in the story.