bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid innovation logics: Exploratory product development with users in a corporate makerspace
Authors: Browder Russell E. , Crider Cole J. , Garrett Robert P.
Published: December 2022

Advances in digital manufacturing technologies have not only altered R&D processes for new product development (NPD), but they have also opened new possibilities for user innovators to engage in traditionally closed innovation processes. However, incorporating external sources of user innovation—through design challenges or crowdsourcing, for example—can introduce competing logics into exploratory innovation processes. Using the lens of complexity, we conduct an ethnographic study of the competing logics at work in the NPD processes of a corporate makerspace launched by a large firm in the consumer appliances industry. The makerspace was founded with a hybrid logic, intended to combine the community logic of makers with the corporate logic of the parent organization. We analyze the conflicts that arose between logics and how the hybrid logic evolved through four iterations of the NPD process. We identify how managing multiple logics led to structural and identity changes, and we explain how two mechanisms—structural bridging and stakeholder identity linking—enabled the makerspace to innovate with a hybrid logic and overcome the constraints of a dominant logic on the NPD process. The results offer insights into dynamic organizational responses to complexity, how new business initiatives can be structured to act as exploratory units for corporate parents, and how corporate makerspaces can help incorporate external sources of innovation.
Cyclophilin effector Al106 of mirid bug Apolygus lucorum inhibits plant immunity and promotes insect feeding by targeting PUB33
Authors: Dong Yumei , Zhou Jiangxuan , Yang Yuxia , Lu Wangshan , Jin Yan , Huang Xingge , Zhang Wendan , Li Jifen , Ai Gan , Yin Zhiyuan , Shen Danyu , Jing Maofeng , Dou Daolong , Xia Ai
Published: December 2022

Apolygus lucorum (Meyer‐Dur; Heteroptera: Miridae) is a major agricultural pest infesting crops, vegetables, and fruit trees. During feeding, A. lucorum secretes a plethora of effectors into its hosts to promote infestation. However, the molecular mechanisms of these effectors manipulating plant immunity are largely unknown.

Here, we investigated the molecular mechanism underlying the effector Al106 manipulation of plant–insect interaction by RNA interference, electrical penetration graph, insect and pathogen bioassays, protein–protein interaction studies, and protein ubiquitination experiment.

Expression of Al106 in Nicotiana benthamiana inhibits pathogen‐associated molecular pattern‐induced cell death and reactive oxygen species burst, and promotes insect feeding and plant pathogen infection. In addition, peptidyl‐prolyl cis‐trans isomerase (PPIase) activity of Al106 is required for its function to inhibit PTI.Al106 interacts with a plant U‐box (PUB) protein, PUB33, from N. benthamiana and Arabidopsis thaliana. We also demonstrated that PUB33 is a positive regulator of plant immunity. Furthermore, an in vivo assay revealed that Al106 inhibits ubiquitination of NbPUB33 depending on PPIase activity.

Our findings revealed that a novel cyclophilin effector may interact with plant PUB33 to suppress plant immunity and facilitate insect feeding in a PPIase activity‐dependent manner.
Association of fast‐food restaurants with overweight and obesity in school‐aged children and adolescents: A systematic review and meta‐analysis
Authors: Jiang Jun , Lau Patrick W. C. , Li Yanhui , Gao Di , Chen Li , Chen Manman , Ma Ying , Ma Tao , Ma Qi , Zhang Yi , Liu Jieyu , Wang Xingxing , Dong Yanhui , Song Yi , Ma Jun
Published: December 2022

We aimed to explore associations between the accessibility of fast‐food restaurants (FFRs) and weight‐related outcomes in children and adolescents through a systematic review and meta‐analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Meta‐analysis was performed, and the leave‐one‐out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low‐and middle‐income countries (only six studies) are much higher than those in high‐income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.
Effects of social support on oral health behavior: Serial multiple‐mediator model
Authors: Jiang Nan , Shi Hongyan , Zhao Jie , Zhang Yuxin , Wang Ting , Cao He , Wang Quqing , Wang Jiwei , Xu Xiaoming
Published: December 2022

Objective

This study investigates the serial multiple mediation of job stress and perceived behavioral control (PBC) in the relationship between social support and oral health behavior (OHB).

Materials and Methods

This cross‐sectional study was conducted in Minhang District, Shanghai, China, between July and November 2021. 559 Employees from 10 community health centers were recruited. A five‐part survey was used to collect data on demographic characteristics, social support, job stress, PBC and OHB. Descriptive statistics, independent‐sample t‐test, Pearson's correlation analysis, ordinary least‐squares regression and the bootstrap method were used to analyze data.

Results

Social support was found to impact OHB through three significant mediation pathways: the pathway through job stress (point estimate = 0.033; 95%BC CI [0.004, 0.089]), the pathway through PBC (point estimate = 0.283; 95%BC CI [0.174, 0.416]), and the serial multiple mediating pathway through first job stress and then PBC (point estimate = 0.006; 95%BC CI [0.001, 0.019]).

Conclusion

This study indicates that job stress and PBC play a serial multiple‐mediator role in the relationship between social support and OHB. To ensure the effectiveness of social support intervention on OHB, workplace managers and employees should strengthen the motivators that could promote the reduction of job stress and the improvement of PBC.
What are Risk Factors of Postoperative Pneumonia in Geriatric Individuals after Hip Fracture Surgery: A Systematic Review and Meta‐Analysis
Authors: Gao Yu‐Cheng , Zhang Yuan‐Wei , Shi Liu , Gao Wang , Li Ying‐Juan , Chen Hui , Rui Yun‐Feng
Published: December 2022

Postoperative pneumonia (POP) is a common postoperative complication. Negative consequences associated with POP included prolonged hospital length of stay, more frequent intensive care unit (ICU) stays, and a higher rate of sepsis, readmission, and mortality. This meta‐analysis aimed to assess the incidence and risk factors associated with POP after hip fracture surgery in elderly patients. PubMed, Web of Science, and Cochrane Library were searched (up to March 31, 2022). All studies on the risk factors for POP after hip fracture surgery in elderly patients, published in English, were reviewed. The qualities of the included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled, and a meta‐analysis was performed. Ten studies, including 12,084 geriatric patients undergoing hip fracture surgery, were included. Of these 12,084 patients, POP occurred in 809 patients. The results indicated that age (mean difference [MD] = 4.95, 95% confidence interval [CI]: 3.22–6.69), male (odds ratio [OR] = 1.41, 95% CI: 1.02–1.93), the American Society of Anaesthesiologists classification ≥3 (OR = 3.48, 95% CI: 1.87–6.47), dependent functional status (OR = 5.23, 95% CI: 2.18–12.54, P = 0.0002), smoking (OR = 1.33, 95% CI: 1.07–1.65), chronic obstructive pulmonary disease (OR = 3.76, 95% CI: 2.07–6.81), diabetes mellitus (OR = 1.19, 95% CI: 1.01–1.40), coronary heart disease (OR = 1.74, 95% CI: 1.23–2.46), arrhythmia (OR = 1.47, 95% CI: 1.01–2.14), cerebrovascular disease (OR = 1.88, 95% CI: 1.56–2.27), dementia (OR = 2.36, 95% CI: 1.04–5.36), chronic renal failure (OR = 1.85, 95% CI: 1.29–2.67), hip arthroplasty (OR = 1.30, 95% CI: 1.08–1.56), delayed surgery (OR = 6.40, 95% CI: 3.00–13.68), preoperative creatinine (MD = 5.32, 95% CI: 0.55–10.08), and preoperative serum albumin (MD = −3.01, 95% CI: −4.21 – −1.80) were risk factors for POP. Related prophylactic measures should be provided in geriatric patients with the above‐mentioned risk factors to prevent POP after hip fracture surgery.
Education as a tool of social equality?
Authors: Gingrich Jane , Giudici Anja
Published: December 2022

Do political parties approach education with different social policy aims? We argue that while parties have adopted a common language of equality as an aim of education, they draw on different conceptions of it linked to diverging social projects. To make this argument, we first normatively distinguish education as a tool for creating equal opportunity, equal outcomes, and representational diversity. We then draw on an original dataset coding the educational content in the political manifestos of the largest center‐left and center‐right party across 19 Western democracies from 1950 to present. The analysis shows that left parties emphasise more equality of outcome than rightwing parties and pay less attention to equality of opportunity, and that they associate equality‐related aims more extensively with promises of resources. These findings suggest that there remain critical differences in parties' understanding of education as a tool of social policy.
Sources of variability in auditory brainstem response thresholds in a mouse model of noise-induced hearing loss
Authors: Schrode Katrina M. , Dent Micheal L. , Lauer Amanda M.
Published: December 2022

Numerous and non-acoustic experimental factors can potentially influence experimental outcomes in animal models when measuring the effects of noise exposures. Subject-related factors, including species, strain, age, sex, body weight, and post-exposure measurement timepoints, influence the observed hearing deficits. Experimenter effects, such as experience with experimental techniques and animal handling, may also factor into reported thresholds. In this study, the influence of subject sex, body mass, age at noise exposure, and timepoint of post-exposure recording are reported from a large sample of CBA/CaJ mice. Auditory brainstem response (ABR) thresholds differed between noise-exposed and unexposed mice, although the differences varied across tone frequencies. Thresholds across age at noise exposures and measurement delays after exposure also differed for some timepoints. Higher body mass correlated with higher ABR thresholds for unexposed male and female mice, but not for noise-exposed mice. Together, these factors may contribute to differences in phenotypic outcomes observed across studies or even within a single laboratory.
Restriction Endonuclease-Based Modification-Dependent Enrichment (REMoDE) of DNA for Metagenomic Sequencing
Authors: Enam Syed Usman , Cherry Joshua L. , Leonard Susan R. , Zheludev Ivan N. , Lipman David J. , Fire Andrew Z.
Published: December 2022

Pathogens that contaminate the food supply or spread through other means can cause outbreaks that bring devastating repercussions to the health of a populace. Investigations to trace the source of these outbreaks are initiated rapidly but can be drawn out due to the labored methods of pathogen isolation.
Polymyxin Resistance and Heteroresistance Are Common in Clinical Isolates of
Achromobacter
Species and Correlate with Modifications of the Lipid A Moiety of Lipopolysaccharide
Authors: MacDonald Lewis , Keenan Sean , Di Lorenzo Flaviana , Adade Nana E. , Kenna Dervla T. D. , Millar Beverley C. , Moore John E. , Ramos Vivas José , Molinaro Antonio , Valvano Miguel A.
Published: December 2022

Achromobacter
species can cause chronic and potentially severe infections in immunocompromised patients, especially in those with cystic fibrosis. Bacteria cannot be eradicated due to
Achromobacter
's intrinsic multidrug resistance.
Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand
Authors: Yu Dahai , Wang Zheng , Cai Yamei , Osuagwu Uchechukwu Levi , Pickering Karen , Baker John , Cutfield Richard , Orr-Walker Brandon J , Sundborn Gerhard , Jayanatha Kalpa , Zhao Zhanzheng , Simmons David
Published: December 2022

Introduction

Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II–V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared.

Research design and methods

As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II–V were ruled out. To balance potential confounders, we applied a tapered matching method . ‘Quasi-trial’-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994–2018 were examined by weighted Cox regression model.

Results

The HRs for developing any CKD, CKD stages II–V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II–V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively.

Conclusions

Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT
Authors: Robberegt Suzanne J , Kooiman Bas E A M , Albers Casper J , Nauta Maaike H , Bockting Claudi , Stikkelbroek Yvonne
Published: December 2022

Introduction

Youth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience.

Method and analysis

In this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13–21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes.

Ethics, funding and dissemination

The study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences.

Trial registration number

NCT05551468; NL8237.
Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data
Authors: Vedsted Peter , Weller David , Zalounina Falborg Alina , Jensen Henry , Kalsi Jatinderpal , Brewster David , Lin Yulan , Gavin Anna , Barisic Andriana , Grunfeld Eva , Lambe Mats , Malmberg Martin , Turner Donna , Harland Elizabeth , Hawryluk Breann , Law Rebecca-Jane , Neal Richard D , White Victoria , Bergin Rebecca , Harrison Samantha , Menon Usha ,   The ICBP Module 4 Working Group
Published: December 2022

Objectives

A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.

Setting

Primary care in 10 jurisdictions.

Participant

Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.

Primary and secondary outcome measures

Patient, primary care, diagnostic and treatment intervals.

Results

Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3–29 (Denmark and Sweden), 0–20 (seven jurisdictions and Ontario) and 8–29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15–39 (Norway, Victoria and Manitoba) and 4–78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).

Conclusions

Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.
COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants
Authors: Omale Ugwu I , Iyare Osarhiemen , Ewah Richard L , Amuzie Chidinma I , Oka Onyinyechukwu U , Uduma Victor U , Adeke Azuka S , Ikegwuonu Cordis O , Nnachi Olaedo O , Ukpabi Okechukwu O , Okeke Ifeyinwa M , Nkwo Glory E , Nwali Ugochi IA
Published: December 2022

Introduction

The COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria.

Methods and analyses

The study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach.

Ethics and dissemination

Ethical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022–02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021–17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate.

Trial registration number

ISRCTN16735844.
Incremental medical cost of delirium in elderly patients with cognitive impairment: analysis of a nationwide administrative database in Japan
Authors: Igarashi Masakazu , Okuyama Kotoba , Ueda Naoya , Sano Hideki , Takahashi Kanae , P Qureshi Zaina , Tokita Shigeru , Ogawa Asao , Okumura Yasuyuki , Okuda Shoki
Published: December 2022

Objectives

Delirium is a neuropsychiatric disorder that commonly occurs in elderly patients with cognitive impairment. The economic burden of delirium in Japan has not been well characterised. In this study, we assessed incremental medical costs of delirium in hospitalised elderly Japanese patients with cognitive impairment.

Design

Retrospective, cross-sectional, observational study.

Setting

Administrative data collected from acute care hospitals in Japan between April 2012 and September 2020.

Participants

Hospitalised patients ≥65 years old with cognitive impairment were categorised into groups—with and without delirium. Delirium was identified using a delirium identification algorithm based on the International Classification of Diseases 10thRevision codes or antipsychotic prescriptions.

Outcome measures

Total medical costs during hospitalisation were compared between the groups using a generalised linear model.

Results

The study identified 297 600 hospitalised patients ≥65 years of age with cognitive impairment: 39 836 had delirium and 257 764 did not. Patient characteristics such as age, sex, inpatient department and comorbidities were similar between groups. Mean (SD) unadjusted total medical cost during hospitalisation was 979 907.7 (871 366.4) yen for patients with delirium and 816 137.0 (794 745.9) yen for patients without delirium. Adjusted total medical cost was significantly greater for patients with delirium compared with those without delirium (cost ratio=1.09, 95% CI: 1.09 to 1.10; p<0.001). Subgroup analyses revealed significantly higher total medical costs for patients with delirium compared with those without delirium in most subgroups except patients with hemiplegia or paraplegia.

Conclusions

Medical costs during hospitalisation were significantly higher for patients with delirium compared with those without delirium in elderly Japanese patients with cognitive impairment, regardless of patient subgroups such as age, sex, intensive care unit admission and most comorbidities. These findings suggest that delirium prevention strategies are critical to reducing the economic burden as well as psychological/physiological burden in cognitively impaired elderly patients in Japan.
Association of oral health knowledge, self-efficacy and behaviours with oral health-related quality of life in Chinese primary school children: a cross-sectional study
Authors: Zhao Jie , Shi Hongyan , Wang Jingya , Huang Rui , Liu Yongyi , Zhang Yuxin , Jiang Nan , Wang Ting , Wang Jiwei , Xu Xiaoming
Published: December 2022

Objective

Achieving good oral health-related quality of life (OHRQOL) is of particular concern in children. The inter-relations among oral health knowledge, self-efficacy, behaviours and OHRQOL in children groups remain unclear. This study aimed to explore the inter-relations between these oral health behaviour-related factors and OHRQOL in primary school children.

Methods

In this cross-sectional study, 651 children in grades 2 and 3 were recruited in October 2020 from two primary schools in Minhang District, Shanghai, China. Data were collected through self-reported questionnaires, consisting of demographic characteristics, oral health knowledge, self-efficacy, oral health behaviours and OHRQOL. Pearson’s correlation analyses were used to analyse the relationship between study variables. Structural equation models were used to test the inter-relations between OHRQOL and oral health behaviour-related factors.

Results

Four hypothetical structural equation models were tested and one of them was selected as the most appropriate model, which explained 15.0% of the variance in OHRQOL. This selected model showed that oral health behaviours were directly related to OHRQOL. Oral health knowledge was indirectly associated with OHRQOL through both self-efficacy and oral health behaviours. Self-efficacy was directly associated with OHRQOL or was indirectly associated with OHRQOL through oral health behaviours.

Conclusion

This study revealed a pathway of association between children’s oral health knowledge and their OHRQOL, in which children’s oral health self-efficacy and behaviours had indirect effects. This provides a basis for understanding the mechanism of oral health promotion interventions to improve children’s OHRQOL and helps to identify direct or indirect intervention targets.
When and why do medical students drop out of extracurricular longitudinal general practice tracks? A cross-sectional study from two German medical faculties
Authors: Nafziger Melanie , Geier Anne-Kathrin , Bauch Felix Johannes , Deutsch Tobias , Frese Thomas
Published: December 2022

Objectives

To explore when and why undergraduate medical students drop out of longitudinal extracurricular general practice (GP) tracks and to describe their future career plans.

Design

Cross-sectional online survey and descriptive analysis of routine data.

Setting

GP tracks at two German medical faculties, data collection took place between September 2020 and April 2021.

Participants

Of 111 students who had taken part in one of the two GP tracks and dropped out prematurely, 101 were contactable via email. Overall, the response rate was 72.3% with 73 completed questionnaires and 75.3% of the participants were female.

Primary and secondary outcome measures

Reasons for leaving the GP track (closed and free-text answers), attitudes towards a career in GP and future career plans.

Results

Students left the tracks predominantly during the first 2 years of study. Students most frequently stated that structural reasons such as the distance to the GP teaching practice (74.2%), interest in another medical discipline (66.1%), private reasons (58.1%) and the GP mentor (53.1%) influenced their decision to drop out. However, 87.1% of the students indicated that their exit could not have been prevented by the project administration.

Conclusions

Reasons for dropping out differ between GP tracks and not all reasons are within reach of programme design and staff. Addressable issues include student selection with regard to career plans, support and strengthening of student–mentor relationships, the location of GP practices, and/or travel and accommodation support.
Efficacy and safety of radiotherapy combined with atezolizumab plus bevacizumab in treating hepatocellular carcinoma with portal vein tumour thrombus: a study protocol
Authors: Wang Kang , Yu Hong-Ming , Xiang Yan-Jun , Cheng Yu-Qiang , Ni Qian-Zhi , Guo Wei-Xing , Shi Jie , Feng Shuang , Zhai Jian , Cheng Shu-Qun
Published: December 2022

Introduction

Vascular invasion and metastasis are poor prognostic factors in patients with hepatocellular carcinoma (HCC). The efficacy of available therapeutic regimens for unresectable HCC is not satisfactory in HCC with portal vein tumour thrombosis (PVTT). Therefore, this open-label, single-arm phase II clinical trial aims to investigate the efficacy and safety of radiotherapy combined with atezolizumab plus bevacizumab in treating HCC patients with PVTT.

Methods and analysis

We plan to enrol patients diagnosed with unresectable HCC complicated by PVTT. Intensity-modulated radiotherapy (IMRT) combined with atezolizumab plus bevacizumab will be administered for treatment. Patients will initially receive radiotherapy, with each IMRT cycle lasting for 28 days and the total dose of tumour (DT) of 40 Gy/20 f/26 d. CT scan will be performed again, and the treatment plan will be reformulated after field constriction. The treatment will continue until the total DT is up to 54–56 Gy/27–28 f. The treatment with atezolizumab plus bevacizumab will be started at 3±1 days after the initiation of radiotherapy and will continue until unacceptable toxicity or disease progression. The primary endpoint is objective response rate (ORR), while the secondary endpoints include overall survival, disease control rate, progression-free survival, time to progression, duration of response and the rate of surgical conversions. Assuming an ORR of 47%, with a one-sided alpha error of 0.1, 90% power, and a 10% drop-out rate, the required number of evaluable patients is 42.

Ethics and dissemination

This study will be conducted according to the standards of Good Clinical Practice and in compliance with the principles of the Declaration of Helsinki. The Ethics Committee of our Hospital has approved the protocol (EHBHKY2021-K-017). All participants are required to provide written informed consent. The results of the trial will be published in peer-reviewed journals and presented at international conferences.

Trial registration number

ChiCTR2100049831.
Impact of the COVID-19 pandemic on staff turnover at long-term care facilities: a qualitative study
Authors: Yaraghi Niam , Henfridsson Ola , Gopal Ram
Published: December 2022

Objective

The objective of this research was to explore the lived experiences of long-term care facilities’ staff during the COVID-19 pandemic and examine if and how the pandemic played a role in their decision to leave their jobs.

Design

Qualitative study using thematic analysis of semistructured interviews. Interview transcripts were analysed using coding techniques based in grounded theory.

Participants

A total of 29 staff with various roles across 21 long-term care facilities in 12 states were interviewed.

Results

The pandemic influenced the staff’s decision to leave their jobs in five different ways, namely: (1) It significantly increased the workload; (2) Created more physical and emotional hazards for staff; (3) Constrained the facilities and their staff financially; (4) Deteriorated morale and job satisfaction among the staff and (5) Increased concerns with upper management’s commitment to both general and COVID-19-specific procedures.

Conclusions

Staff at long-term care facilities discussed a wide variety of reasons for their decision to quit their jobs during the pandemic. Our findings may inform efforts to reduce the rate of turnover in these facilities.
Understanding discrimination towards persons experiencing homelessness: A scoping review protocol
Authors: Canham Sarah L , Rose Jeffrey N , Weldrick Rachel , Siantz Elizabeth , Casucci Tallie , McFarland Mary M
Published: December 2022

Introduction

Given the increasing rates of homelessness in recent years, there is an urgent need to address the ongoing discrimination and societal disinterest in preventing, reducing and ending homelessness. There is no systematic review of experiences of stigma and discrimination among persons experiencing homelessness or interventions to combat this discrimination. The objective for the proposed study is to identify ways in which persons experiencing homelessness have been stigmatised and discriminated against, the results of these experiences, and interventions to reduce stigma and discrimination towards persons experiencing homelessness.

Methods and analysis

We are conducting a scoping review with guidance from the JBI Manual for Evidence Synthesis and Arksey and O’Malley’s framework. From 15 to 19 July 2022, we searched the following databases from our institutional licensed years of coverage: Medline, Embase, CINAHL Complete, Academic Search Ultimate, APA PsycINFO, Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, Emerging Sources Citation Index, Left, PAIS International, PILOTS, Psychology & Behavioral Sciences Collection, Sociological Abstracts, and Dissertations and Theses Global. Two independent reviewers are screening study titles/abstracts and will independently screen the full texts. Study inclusion criteria include any study type reporting primary findings of English-language research on non-refugee persons experiencing homelessness in any type of setting or service worldwide. Three reviewers will then chart data of our included studies. Data will be extracted and organised into categories and subthemes in tabular form. To understand the validity of the scoping review findings in the local context and to gather additional perspectives on the topic, we will conduct an ‘expert consultation’ workshop.

Ethics and dissemination

This study has ethics approval from the University of Utah Institutional Review Board. Review findings will be disseminated through a peer-reviewed journal and at conferences. We plan to preregister this protocol with Open Science Framework.
Chronic conditions patient’s perception of post-COVID-19 pandemic teleconsulting continuation in primary care clinics: a qualitative descriptive study
Authors: Poitras Marie-Eve , Poirier Marie-Dominique , Couturier Yves , T Vaillancourt Vanessa , Cormier Caroline , Gauthier Gilles , Massé Sylvie , Gendron Audrey , Oswick Megan L , Morin Anaelle , Blanchette Patricia , Bernier Andréanne
Published: December 2022

Objectives

The COVID-19 pandemic has led to the prioritisation of teleconsultation instead of face-to-face encounters. However, teleconsultation revealed some shortcomings and undesirable effects that may counterbalance benefits. This study aims to explore the perspective of patients with chronic diseases on teleconsultation in primary care. This article also proposes recommendations to provide patient-oriented and appropriate teleconsultations.

Design

We conducted a qualitative descriptive study that explored the patients’ perception regarding teleconsultation services and the following themes: access, perceived benefits and disadvantages, interprofessional collaboration, patient-centred approach, specific competencies of professionals, and patient’s global needs and preferences.

Setting

Six primary care clinics in three regions of Quebec.

Participants

39 patients were interviewed by telephone through semistructured qualitative interviews.

Results

Patients want to maintain teleconsultation for the postpandemic period as long as their recommendations are followed: be able to choose to come to the clinic if they wish to, feel that their individual and environmental characteristics are considered, feel involved in the choice of the modality of each consultation, feel that interprofessional collaboration and patient-centred approach are promoted, and to maintain the professionalism, which must not be lessened despite the remote context.

Conclusion

Patients mainly expressed high satisfaction with teleconsultation. However, several issues must be addressed. Patients do and should contribute to the implementation of teleconsultation in primary care. They wish to be frequently consulted about their preferred consultation modality, which may change over time. The patient perspective must, therefore, be part of the balanced implementation of optimal teleconsultation that is currently taking place.
Biomarkers and outcomes in hospitalised patients with COVID-19: a prospective registry
Authors: Khedar Raghubir Singh , Gupta Rajeev , Sharma Krishnakumar , Mittal Kartik , Ambaliya Harshad C , Gupta Jugal B , Singh Surendra , Sharma Swati , Singh Yogendra , Mathur Alok
Published: December 2022

Objectives

To determine association of biomarkers—high-sensitivity C reactive protein (hsCRP), D-dimer, interleukin-6 (IL-6), lactic dehydrogenase (LDH), ferritin and neutrophil–lymphocyte ratio (NLR)—at hospitalisation with outcomes in COVID-19.

Design and Setting

Tertiary-care hospital based prospective registry.

Participants

Successive virologically confirmed patients with COVID-19 hospitalised from April 2020 to July 2021 were prospectively recruited. Details of clinical presentation, investigations, management and outcomes were obtained.

Primary and secondary outcome measures

All biomarkers were divided into tertiles to determine associations with clinical features and outcomes. Primary outcome was all-cause deaths and secondary outcome was oxygen requirement, non-invasive and invasive ventilation, dialysis, duration of stay in ICU and hospital. Numerical data are presented in median and interquartile range (IQR 25–75). Univariate and multivariate (age, sex, risk factors, comorbidities, treatments) ORs and 95% CIs were calculated.

Results

3036 virologically confirmed patients with COVID-19 were detected and 1251 hospitalised. Men were 70.0%, aged >60 years 44.8%, hypertension 44.1%, diabetes 39.6% and cardiovascular disease 18.9%. Median symptom duration was 5 days (IQR 4–7) and oxygen saturation 95% (90%–97%). Total white cell count was 6.9×109/L (5.0–9.8), neutrophils 79.2% (68.1%–88.2%), lymphocytes 15.8% (8.7%–25.5%) and creatinine 0.93 mg/dL (0.78–1.22). Median (IQR) for biomarkers were hsCRP 6.9 mg/dL (2.2–18.9), D-dimer 464 ng/dL (201–982), IL-6 20.1 ng/dL (6.5–60.4), LDH 284 mg/dL (220–396) and ferritin 351 mg/dL (159–676). Oxygen support at admission was in 38.6%, subsequent non-invasive or invasive ventilatory support in 11.0% and 11.6%, and haemodialysis in 38 (3.1%). 173 (13.9%) patients died and 15 (1.2%) transferred to hospice care. For each biomarker, compared with the first, those in the second and third tertiles had more clinical and laboratory abnormalities, and oxygen, ventilatory and dialysis support. Multivariate-adjusted ORs (95% CI) for deaths in second and third versus first tertiles, respectively, were hsCRP 2.24 (1.11 to 4.50) and 12.56 (6.76 to 23.35); D-dimer 3.44 (1.59 to 7.44) and 14.42 (7.09 to 29.30); IL-6 2.56 (1.13 to 5.10) and 10.85 (5.82 to 20.22); ferritin 2.88 (1.49 to 5.58) and 8.19 (4.41 to 15.20); LDH 1.75 (0.81 to 3.75) and 9.29 (4.75 to 18.14); and NLR 3.47 (1.68 to 7.14) and 17.71 (9.12 to 34.39) (p<0.001).

Conclusion

High levels of biomarkers—hsCRP, D-dimer, IL-6, LDH, ferritin and NLR—in COVID-19 are associated with more severe illness and higher in-hospital mortality. NLR, a widely available investigation, provides information similar to more expensive biomarkers.
Knowledge and beliefs about autism spectrum disorders among physicians: a cross-sectional survey from China
Authors: Mao Shujiong , Fan Xiaoli , Ma Ye , Chen Yi , Lv Jiamin , Yang Rongwang
Published: December 2022

Background

The incidence of autism spectrum disorders (ASDs) is increasing greatly, with high demands for earlier diagnosis and intervention. However, little is known about ASD knowledge and beliefs among physicians in China.

Methods

A questionnaire survey was used to assess the knowledge and beliefs about the diagnosis and management of ASD and 24 beliefs regarding the treatment and prognostic aspects of ASD among physicians of any medical specialty in China.

Results

A total of 1160 physicians were recruited and surveyed, with an average score of 8.48±2.66 (total of 18 points) for the questionnaire on the main symptoms of ASD and 14.35±3.69 (total of 24 points) for beliefs about ASD. Physicians’ age, sex, specialty and practice years were related to their knowledge of identifying patients with ASD. Physicians specialising in paediatrics/psychology/psychiatry scored higher than those specialising in other specialties both in response to diagnostic questions (8.98±2.63 vs 8.30±2.65, p<0.001) and beliefs about ASD (15.57±3.44 vs 13.97±3.97, p<0.001).

Conclusions

Knowledge and beliefs about ASD symptoms, diagnosis and treatment are insufficient among physicians in China. Education and training programmes on this topic should be enhanced in physicians of all specialties, especially for male physicians who have short years in practice.
Efficacy of rectus femoris stretching on pain, range of motion and spatiotemporal gait parameters in patients with knee osteoarthritis: a randomised controlled trial
Authors: ElGendy Mohamed Hussein , Zalabia Mostafa Mahmoud , Moharram Ashraf Nehad , Abdelhay Mohamed Ibrahim
Published: December 2022

Objective

This study aimed to investigate the efficacy of rectus femoris stretching on pain intensity, knee range of motion (ROM), spatiotemporal gait parameters and function in patients with knee osteoarthritis (KOA).

Methods

This parallel group, single-blinded randomised controlled trial was conducted in two outpatient physical therapy clinics. Study participants (n=60, with age>45 years) with mild-to-moderate bilateral KOA were randomised into the study group (SG) and control group (CG). SG received rectus femoris stretching exercises together with stretching exercises of the calf, hamstring and iliotibial band, strength exercises for the quadriceps, gluteus medius, gluteus maximus and calf muscles, whereas, the CG received all exercises mentioned for SG except rectus femoris stretching. Pain intensity, ROM, spatiotemporal gait parameters and function were measured before and after 4 weeks of treatment.

Results

The SG showed a significant improvement in the visual analogue scale, Western Ontario and McMaster Universities measure and ROM (p<0.001). The SG also had a significantly greater step length and speed than CG (p<0.001). Extension ROM did not significant difference between the groups (p>0.05).

Conclusion

Simple rectus femoris stretching exercises are easy to perform even at home and are beneficial for pain, flexion ROM, function and spatiotemporal gait parameters, such as step length and speed, in KOA patients if the compliance with the exercise regimen is good.

Trial registration number

Pan African Clinical Trials Registry PACTR202003828737019.
Palliative care inpatients favour research participation irrespective of prognosis, performance or socioeconomic status: multicentre cohort study
Authors: Dewhurst Felicity , Wakefield Donna , Elverson Joanna , McConnell Robert , Bryan Charlotte , Spriggs Helena , Atkinson Kate , Frew Katherine
Published: December 2022

Objectives

Palliative care needs to embrace research to guide service development and effective symptom management. Healthcare professionals often feel research is too burdensome for patients who have poor performance status or are near the end of life. Many studies exclude these groups from participating.

We aimed to identify whether specialist palliative care inpatients would wish to take part in research and whether preference varies according to study design, demographics, diagnosis, performance status and prognosis.

Methods

100 inpatients in two National Health Service specialist palliative care units and one independent hospice in the Northeast of England completed a short questionnaire about preferences for involvement in research.

Results

92% of participants stated they were interested in being involved in research. This was mostly unaffected by age, diagnosis, prognosis, performance and socioeconomic status. Three-quarters were within the last 3 months of life. Simple questions or interviews were the preferred methodology, whereas only half of patients would want further investigations or additional medications and fewer still wanted to participate in online activities, lifestyle change or group activities.

Conclusions

Palliative care inpatients welcome the opportunity to be involved in research and should not be excluded on the grounds of advanced disease, poor prognosis and low performance status.
Palliative care development in India: new WHO conceptual model
Authors: Nair Devi Nair , Paul Aneka Suresh , Raveendran Krishnan Unni
Published: December 2022

Background

Palliative care is gaining global attention and is endorsed in high level policy commitments,but progress towards universal palliative care coverage is constrained in many countries. The WHO released a new conceptual model for the assessment of palliative care development in 2021, comprising 18 indicators to measure a country’s palliative care situation. Of these 10 core indicators to be used to monitor the progressof palliative care in countries at more mature stage of development. The coreindicators would then facilitate both in country and global comparativeanalysis and will also inform decision makers about the gaps and challenges in palliative care provision.

Aim

This article tries to analyse the position of the development of palliative care in India on the 10 coreindicators and uses information from various relevant secondary resources.

Results

National programme forpalliative care (2017) has been included in the National Health Mission and policies on palliative care have been framed by four states: Kerala, Maharashtra, Karnataka and Tamilnadu. While significant improvement in the availability of palliative care services across India have been observed, regional and state- wise disparities remain high.

Conclusion

Our analysis indicates that the prosed set of indicators by WHO can be a valuable means to monitor the progress of palliative care development in the country on a year- on -year basis.