bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging the Gap
Authors: Stappert Nora , Gammeltoft-Hansen Thomas
Published: April 2024

Recent years have seen a new, by now almost normalized, openness towards empirical, interdisciplinary approaches within international law scholarship, in part driven by research conducted within the Nordics. Scholarship that bridges International Law and International Relations has been a key example, promising new insights on how power dynamics shape international law, and how international law in turn constitutes global order. However, interdisciplinary work combining both disciplines has also been met with critique, including accusations of disciplinary hegemony, a priori theorising, and not accounting for international law’s normativity. This article argues that practice theory provides one possible way to address these challenges. Focusing on day-to-day legal practices, especially at the intersections of legal regimes, we identify three examples of particularly promising research avenues: state responses to international legal developments; international lawyers navigating overlapping communities of practice; and data-driven approaches for understanding how legal interpretations are negotiated across different groups of practitioners.
Elusive Interdisciplinarity in International Law in the Nordics
Authors: Korhonen Outi , Leppäkorpi Mervi
Published: April 2024

In this article we discuss the interdisciplinarity as a practical question and a theoretical challenge. We place international law on a disciplinary map and advocate for theoretical openings towards other social sciences using the critique on methodological nationalism in social sciences as an example of possibilities for broadening the theoretical approaches. We suggest that methodological dialogue should be taken as central in research practices. We also inquire into interdisciplinarity practices that include theoretical openness towards other disciplines and explain how they could benefit legal scholars particularly when analysing consequences of the law. A number of examples from the interdisciplinarity in Nordic countries are included and some of their approaches and terminological challenges discussed.
“Anarchy” against “Order”: French Elite Perception of the Conflict in Manchuria
Authors: Barthel Alexandre
Published: April 2024

The fall of the French empire in Asia is directly linked to the Second World War and France’s policy of appeasement that preceded it. The issue of France’s attitude to the invasion of Manchuria is important for understanding what French policy in East Asia was during the 1930s. For these reasons, this article intends to show the attitude of French political leaders and how, unable as they were to condemn the aggressor, Japan, it led to the policy of appeasement pursued by all French governments with regard to Japan during the rest of the decade. To do so, this article is based on the published diplomatic archives of the United States and the articles published by the newspaper Le Temps, the unofficial organ of the Third Republic.
A new sympagic nematode species Daptonema gelida sp. n. (Monhysterida, Xyalidae) from the White Sea landfast ice
Authors: TIMCHENKO ANNA I. , PORTNOVA DARIA A.
Published: April 2024

A new ice-associated species of Xyalidae family, Daptonema gelida sp. n., is described from the first-year fast sea ice of the Ermolinskaya Inlet, White Sea, Russia. The new species of Daptonema is a morphologically distinct species from other species of the genus. Daptonema gelida sp. n. is characterized by (1) elongated, slender body, (2) short, evenly distributed throughout the body somatic setae, (3) circular amphideal fovea, (4) thin and strongly curved, L-shaped spicules with round-shaped manubrium, (5) gubernaculum with short dorsal-caudal apophysis by triangular-shaped outline, (6) post-vulval uterine sac present, and (7) two short terminal setae. We barcoded partial 18S rRNA gene sequences from the new sympagic species. Phylogenetic reconstructions showed that the specimen of Daptonema gelida sp. n. formed a distinct lineage with high support among other Daptonema species and was genetically related to D. carnulentum, D. setosum, D. hirsutum, Metadesmolaimus sp. and Daptonema spp. We provided a list of valid Daptonema species, including key morphological characteristics of males, and additionally reviewed 30 species inquirenda.
Cooperative Economics in Racially Marginalized Communities: Reframing Economics Education Through Racial Capitalism and Democratic Practices
Authors: Dozono Tadashi
Published: April 2024

This article reimagines economics education through culturally sustaining pedagogy and Ethnic Studies, emphasizing economic practices rooted in racially marginalized urban communities as alternatives to the dominant economic system. The article presents an economics curriculum that asks, how can cooperative economics help to sustain urban communities that have been marginalized by the dominant capitalist white supremacist economic system? Through teacher practitioner inquiry at a small urban public school, this study is grounded in a twelfth-grade economics course on cooperative economics in marginalized communities.
Double-loop control in air–ground cooperation for a switched-trajectory quadrotor under gust winds
Authors: Cui Lei , Liang Shiqing , Yang Hongjiu , Zuo Zhiqiang
Published: April 2024

In this paper, a double-loop tracking control strategy with finite-time convergence is investigated for a switched-trajectory quadrotor subjected to gust winds in air–ground cooperation. To handle the complexity of switched-trajectory tracking, an adaptive tracking differentiator is presented in an outer loop to arrange transition processes. Fast integral terminal sliding mode control is also used in the outer loop to improve convergence speed and tracking accuracy. The gust winds are estimated and compensated by a nonlinear extended state observer and a nonlinear controller with finite-time convergence in an inner loop, respectively. Convergency analyses are presented with the double-loop tracking control strategy for the switched-trajectory quadrotor. Comparison experiments with existing studies show superior performances of the proposed control method for the quadrotor in air–ground cooperation under gust winds.
Book review: Michael O. Slobodchikoff and Aakriti A. Tandon, India as a Kingmaker: Status Quo or Revisionist Power
Authors: Chandra Vikash
Published: April 2024

Michael O. Slobodchikoff and Aakriti A. Tandon, India as a Kingmaker: Status Quo or Revisionist Power (Ann Abor: University of Michigan Press, 2022), XIV+164 pp. $29.95, ISBN: 978-0-472-05566-1 (Paperback).
Efficacy and Safety of Long-Term Dual Antiplatelet Therapy: A Systematic Review and Meta-Analysis
Authors: Zhang Xiaoming , Zhou Da , Song Siying , Huang Xiangqian , Ding Yuchuan , Meng Ran
Published: April 2024

Background

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is a standard therapy in patients with ischemic vascular diseases (IVD) including coronary artery, cerebrovascular and peripheral arterial diseases, although the optimal duration of this treatment is still debated. Previous meta-analyses reported conflicting results about the effects of long-term and short-term as well as non-DAPT use in various clinical settings. Herein, we conducted a comprehensive meta-analysis to assess the efficacy and safety of different durations of DAPT.

Methods

We reviewed relevant articles and references from database, which were published prior to April 2023. Data from prospective studies were processed using RevMan5.0 software, provided by Cochrane Collaboration and transformed using relevant formulas. The inclusion criteria involved randomization to long-term versus short-term or no DAPT; the endpoints included at least one of total or cardiovascular (CV) mortalities, IVD recurrence, and bleeding.

Results

A total of 34 randomized studies involving 141 455 patients were finally included. In comparison with no or short-term DAPT, long-term DAPT reduced MI and stroke, but did not reduce the total and CV mortalities. Meanwhile, bleeding events were increased, even though intracranial and fatal bleedings were not affected. Besides, the reduction of MI and stroke recurrence showed no statistical significance between long-term and short-term DAPT groups.

Conclusion

Long-term DAPT may not reduce the mortality of IVD besides increasing bleeding events, although reduced the incidences of MI and stroke early recurrence to a certain extent and did not increase the risk of fatal intracranial bleeding.
Clinical Application and Fading of Synchronous Reinforcement for Increasing Self-Feeding for a Child with Autism Spectrum Disorder and History of Trauma
Authors: Demchuk Nicole C. , Bigham Megan H. , Hansen Bethany A.
Published: April 2024

In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization.
Lifestyle Medicine Approach to Wound Management
Authors: Lai Jengyu
Published: April 2024

Chronic wounds impact 4.5% of the US population, necessitating a comprehensive understanding of their types and underlying mechanisms. Diabetic foot ulcers (DFUs), prevalent in 25% of individuals with diabetes, contribute significantly to lower limb amputations. The pathophysiology involves neuropathy, peripheral arterial disease, impaired immunity, glycemic control, and mechanical stress. Lifestyle medicine emerges as a pivotal aspect of care, offering both prevention and treatment by integrating plant-predominant nutrition, physical activity, stress management, avoidance of harmful substances, restful sleep, and social connectedness. These interventions impact gene interactions, immune function, and tissue regeneration, playing a crucial role in chronic wound management. The standard of care involves a multidisciplinary approach, emphasizing infection and vascular management, pressure offloading, conducive wound healing environments, and lifestyle adjustments. As diabetes prevalence rises, a proactive integration of lifestyle interventions is crucial, offering a promising avenue to alleviate the growing healthcare burden associated with chronic wounds.
Vitamin D [Serum 25(OH) cholecalciferol] Insufficiency is Associated With Childhood Asthma: Recent Case-Control Findings From Bangladesh
Authors: Tabassum Nabila , Anwar Kazi Selim , Sarkar Probir Kumar , Kabir A. R. M. Luthful , Mollah Md. Abid Hossain , Saha Dipa , Alam Md. Jahangir , Chisti Mohammod Jobayer
Published: April 2024

Objectives. To evaluate the interaction between childhood asthma and S. 25(OH) cholecalciferol among Bangladeshi children. Methods. This case control study was conducted in child asthma clinic, Bangladesh Shishu Hospital Institute during March-August 2021. Comparison was made between clinically-diagnosed (following GINA guideline) asthmatic children (2-12 years-old) (cases = 87) and age and sex-matched children having no respiratory illness (controls = 90) using SPSS’ (Statistical Package for Social Science, V.23.0 Windows) software. Results. Serum 25(OH) cholecalciferol was found to be significantly lower among the cases than the controls ( P < .01). The cases had 3.4 times higher likelihood of having low vitamin D (combined deficient + insufficient) than the controls ( P < .01). Conclusions. The results of the study demonstrate an association of Serum 25 (OH) cholecalciferol with asthma which underscores the importance of potential future trial to evaluate the efficacy of Vitamin-D supplementation for understanding the outcomes of asthmatic Bangladeshi children.
Writing History and Jain Literary Production in Early Modern South Asia
Authors: Jain Shalin
Published: April 2024

This article focuses on the social existence of the Jain community, as exhibited in literary production in early modern India. The existing historiography sometimes tends to make Jain epistemology subservient to contemporary political culture. One must be cautious in approaching the tension between identitarian stability and identitarian volatility and between social textures and cultural mobility beyond the binarities of literary cultures and mundane survival with reference to our existing knowledge of Jainology. The volatile world of religiosity in early modern India tended to shape circumstances that both enforced and drew upon polemical meanings arising out of hybrid identities and cultural intermediacy. Therein lie diverse and multiple possibilities of literary discourse on the multiple religious identities at the core of the histories of Jainism in early modern South Asia.
A pulmonary rehabilitation program is an effective strategy to improve forced vital capacity, muscle strength, and functional exercise capacity similarly in adults and older people with post-severe COVID-19 who required mechanical ventilation
Authors: Muñoz-Cofré Rodrigo , del Valle María Fernanda , Marzuca-Nassr Gabriel Nasri , Valenzuela Jorge , del Sol Mariano , Canales Constanza Díaz , Lizana Pablo A. , Valenzuela-Aedo Fernando , Lizama-Pérez Rodrigo , Escobar-Cabello Máximo
Published: April 2024

Background

It is internationally known that our population is aging. At the same time, some patients with COVID-19, due to their symptoms, required mechanical ventilation (MV) and subsequent pulmonary rehabilitation (PR). This study aimed to compare the effects of a multimodal PR program “ADULT” versus “OLDER” people with COVID-19 who were on MV.

Methods

The intervention consisted of an 8-week hybrid PR program (2x week). Forced vital capacity (FVC) was measured at the beginning and end of PR, upper and lower limb strength was obtained through hand grip strength (HGS) and the sit-to-stand test (STST), respectively, and functional exercise capacity was measured with the 6-minute walking test (6MWT).

Results

The main results were an increase in the FVC in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.27), an increase in HGS in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.52), in the same way, the number of repetitions on the STST increased in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.55). Finally, the distance covered on the 6MWT increased in the ADULT and OLDER groups (time effect, P = 0.000; η2 = 0.65).

Conclusions

The PR program is an effective strategy to improve FVC, muscle strength, and functional exercise capacity similarly in adults and older people with post severe COVID-19 who required MV.
Reconstitution of oral antibiotic suspensions for paediatric use in households: a cross-sectional study among caregivers of 3–5-year-old children from a selected district, Sri Lanka
Authors: Kumarasinghe Malith , Weerasinghe Manuj C.
Published: April 2024

Introduction

Reconstitution of oral pediatric antibiotic suspension by primary caregivers plays an essential role in determining the overall health outcome of the child. Incorrect reconstitution techniques could lead to underdosing, overdosing, or introduction of infection. Underdosing could lead to non-resolving infection and antimicrobial resistance.

Objectives

To assess the practice and associated factors on reconstitution of oral pediatric antibiotic suspensions (OPAS) among primary caregivers of 3–5-year-old children in a selected district in Sri Lanka.

Methods

A cross-sectional study was carried out among 835 primary caregivers selected using two-stage cluster sampling at field clinics to assess practices for the reconstitution of OPAS. A live demonstration of the reconstitution of the OPAS was assessed by a checklist. Associated factors with caregiver practices on reconstitution were assessed using Chi-square with the statistical significance level set at 0.05.

Results

A total of 820 respondents were recruited and completed the study (response rate = 98.2%). Overall, 56.0% displayed good performance in the demonstration of reconstitution of oral pediatric antibiotic suspension. Poorest performances were observed in shaking the bottle to loosen the powder (Correct: 53.7%), topping up the bottle with water up to the marked line (Correct: 58.0%), and filling the water below the marked line in the bottle (Correct: 59.0%). Caregivers in urban areas compared to rural and estate regions (45.6% vs. 22.7% and 26.5% respectively) and caregivers aged 35 years or above compared to less than 35 years age group (31.5% vs. 22.5%) performed the reconstitution of OPAS poorly. Parental factors, namely age, gender, level of education, and geographical region (urban/rural/estate) were significantly associated with the performance in reconstituting the oral paediatric antibiotic suspension (p = 0.002, p < 0.001, p < 0.001, and p < 0.001 respectively). Factors related to the child, specifically whether they attend preschool and whether they have an older sibling, were found to have a significant association with the correct execution of the reconstitution of OPAS (p = 0.017, and p = 0.030 respectively).

Conclusions and recommendations

A significant number of primary caregivers displayed poor practice in key steps during the reconstitution of OPAS, which could have a negative impact on the health of the child. Targeted place-based behavioural change health programs with the use of infographic leaflets/ posters may correct the practices of caregivers.
Clinical characteristics, HPV involvement, and demographic risk factors in women with cervical intraepithelial neoplasia complicated by vaginal intraepithelial neoplasia
Authors: Xu Mindan , Wang Yan
Published: April 2024

Purpose

This study aimed to explore the clinical characteristics and risk factors associated with cervical intraepithelial neoplasia (CIN) when coexisting with vaginal intraepithelial neoplasia (VAIN).

Methods

We analyzed the clinical data of 212 patients diagnosed with CIN, including 50 patients with concurrent VAIN. The groups were compared to identify distinct clinical features and independent risk factors for the co-occurrence of CIN and VAIN, using logistic regression analysis.

Results

Patients with both CIN and VAIN had a median age of 57, significantly older than the 41-year median age of patients with CIN only (P < 0.05). A higher prevalence of HPV infection (98.0%) was observed in the CIN and VAIN group, with a notable rate of multiple HPV infections (67.3%) compared to the CIN-only group (P < 0.05). Educational levels were significantly lower in the combined CIN and VAIN group (P < 0.05). HPV16, 33, and 52 were identified as significant types for single and multiple infections. Multivariate analysis confirmed age as an independent risk factor for CIN with VAIN (P < 0.05). VAIN3 patients were more likely to exhibit HSIL and ASC-H, whereas VAIN1 cases tended to correspond with ASCUS and LSIL diagnoses.

Conclusion

The co-occurrence of CIN and VAIN is significantly influenced by patient age and educational level. The findings advocate for more diligent vaginal examination during colposcopy in older patients, particularly those with multiple HPV infections and cytological abnormalities, to enhance the early detection of vaginal lesions and prevent missed diagnoses and treatments. Additionally, the high prevalence of HPV infection, especially with certain types, underscores the importance of HPV monitoring in this patient population.
Factors affecting the choice of medical specialties in Turkiye: an analysis based on cross-sectional survey of medical graduates
Authors: Yıldız Mustafa Said , Khan M. Mahmud
Published: April 2024

Background

Modern healthcare systems require the right mix of medical specialties for effective provision of high-quality services. Despite increased availability of general physicians and specialists, Türkiye lags behind high-income countries in terms of availability of specialists. The purpose of the study is to identify several specific factors that affect the choice of medical specialization.

Methods

All 350 medical school graduates in a specialty examination preparation bootcamp were requested to participate in the survey and 333 completed the self-administered questionnaire. The survey asked questions about factors affecting choice of medical specialty by medical graduates.

Results

The empirical results indicate that surgical specialties, compared to other broad medical specializations, are selected because of its higher income-earning potential and social prestige. The likelihood of selecting surgical specialties is negatively affected by rigorousness of the training program, high work-load, risk of malpractice lawsuits and risk of workplace violence. Male participants were 2.8 times more likely to select surgery specialty compared to basic medical science. Basic medical science areas were selected at a higher rate by female graduates and graduates with high level of academic performance in medical schools.

Conclusions

It is critically important to improve trust and inter-personal communications between the patients and physicians in all specialties to lower the likelihood of malpractice lawsuits and workplace violence. Policy-makers may adopt policies to affect income earning potential and social prestige of targeted specializations to improve their supply.
Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents
Authors: O’Brien Mary Ann , Lofters Aisha , Wall Becky , Elliott Regina , Makuwaza Tutsirai , Pietrusiak Mary-Anne , Grunfeld Eva , Riordan Bernadette , Snider Cathie , Pinto Andrew D. , Manca Donna , Sopcak Nicolette , Cornacchi Sylvie D. , Huizinga Joanne , Sivayoganathan Kawsika , Donnelly Peter D. , Selby Peter , Kyle Robert , Rabeneck Linda , Baxter Nancy N. , Tinmouth Jill , Paszat Lawrence
Published: April 2024

Background

The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews.

Methods

We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method.

Results

Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals.

Conclusions

Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention.

Trial registration

#NCT03052959, 10/02/2017.
Comparison of geographical and individual deprivation index to assess the risk of Sars-CoV-2 infection and disease severity: a retrospective cohort study
Authors: Mazzilli Sara , Paparatto Gianluca , Chieti Antonio , Nannavecchia Anna Maria , Bisceglia Lucia , Lopalco Pier Luigi , Martinelli Domenico , Tavoschi Lara
Published: April 2024

Background

It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020.

Methods

This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction.

Results

In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI.

Conclusions

Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems.
Concept analysis of health system resilience
Authors: Al Asfoor Deena , Tabche Celine , Al-Zadjali Manal , Mataria Awad , Saikat Sohel , Rawaf Salman
Published: April 2024

Background

There are several definitions of resilience in health systems, many of which share some characteristics, but no agreed-upon framework is universally accepted. Here, we review the concept of resilience, identifying its definitions, attributes, antecedents and consequences, and present the findings of a concept analysis of health system resilience.

Methods

We follow Schwarz-Barcott and Kim’s hybrid model, which consists of three phases: theoretical, fieldwork and final analysis. We identified the concept definitions, attributes, antecedents and consequences of health system resilience and constructed an evidence-informed framework on the basis of the findings of this review. We searched PubMed, PsycINFO, CINAHL Complete, EBSCOhost-Academic Search and Premier databases and downloaded identified titles and abstracts on Covidence. We screened 3357 titles and removed duplicate and ineligible records; two reviewers then screened each title, and disagreements were resolved by discussion with the third reviewer. From the 130 eligible manuscripts, we identified the definitions, attributes, antecedents and consequences using a pre-defined data extraction form.

Results

Resilience antecedents are decentralization, available funds, investments and resources, staff environment and motivation, integration and networking and finally, diversification of staff. The attributes are the availability of resources and funds, adaptive capacity, transformative capacity, learning and advocacy and progressive leadership. The consequences of health system resilience are improved health system performance, a balanced governance structure, improved expenditure and financial management of health and maintenance of health services that support universal health coverage (UHC) throughout crises.

Conclusion

A resilient health system maintains quality healthcare through times of crisis. During the coronavirus disease 2019 (COVID-19) epidemic, several seemingly robust health systems were strained under the increased demand, and services were disrupted. As such, elements of resilience should be integrated into the functions of a health system to ensure standardized and consistent service quality and delivery. We offer a systematic, evidence-informed method for identifying the attributes of health system resilience, intending to eventually be used to develop a measuring tool to evaluate a country’s health system resilience performance.
The economic burden of hemodialysis and associated factors among patients in private and public health facilities: a cross-sectional study in Addis Ababa, Ethiopia
Authors: Baye Tiruneh Amsalu , Gebeyehu Hamelmal , Bekele Mahteme , Abdelmenan Semira , Ashengo Tigistu Adamu , Mengistu Berhanu
Published: April 2024

Introduction

The treatment of kidney disease, including hemodialysis, poses challenges in healthcare and finances. Despite limited data on hemodialysis costs and determinants in Ethiopia, existing literature indicates a paucity of evidence regarding the economic burden of hemodialysis. This study aims to evaluate the direct and indirect costs of hemodialysis among end-stage renal disease (ESRD) patients, alongside associated factors, among selected governmental and private institutions in Addis Ababa, Ethiopia.

Methods

An institutional-based cross-sectional study using a simple random sampling technique was conducted from September 10 to November 1, 2021. One hundred twenty-eight patients participated in the study. Data was collected using an interviewer-administered questionnaire. The analysis used proportion and frequency measures of central tendency and linear regression measures. Both simple and multiple linear regression models were used to assess associated factors. The final model used a P value < 0.05 at 95% confidence interval (CI) was used to determine significance.

Result

The mean cost of hemodialysis in a representative sample of selected hospitals in Addis Ababa was 7,739.17 $ ±2,833.51 $, with direct medical cost contributing 72.9% of the total cost. Furthermore, the institution type (private or public) and duration on hemodialysis were associated with an increased cost of hemodialysis.

Conclusion

Our findings underline the necessity for policymakers, program administrators, and healthcare institution executives to prioritize this group, recognizing the substantial load they bear and extending these services in government facilities to a broader patient population.
Association of maternal exposure to endocrine disruptor chemicals with cardio-metabolic risk factors in children during childhood: a systematic review and meta-analysis of cohort studies
Authors: Rahimlou Mehran , Mousavi Mir Ali , Chiti Hossein , Peyda Mazyar , Mousavi Seyedeh Neda
Published: April 2024

Background

In the present systematic review and meta-analysis, the association of maternal exposure to the endocrine disrupting chemicals (EDCs) with cardio-metabolic risk factors in children during childhood for the first time.

Method

The PubMed, Scopus, EMBASE, and Web of Science databases were systematically searched, up to Feb 2023. In total 30 cohort studies had our inclusion criteria. A random-effects model was used for the variables that had considerable heterogeneity between studies. The Newcastle–Ottawa Scale (NOS) tool was used to classify the quality score of studies. All statistical analyses were conducted using Stata 14 and P-value < 0.05 considered as a significant level.

Results

In the meta-analysis, maternal exposure to the EDCs was weakly associated with higher SBP (Fisher_Z: 0.06, CI: 0.04, 0.08), BMI (Fisher_Z: 0.07, CI: 0.06, 0.08), and WC (Fisher_Z: 0.06, CI: 0.03, 0.08) z-scores in children. A significant linear association was found between maternal exposure to the bisphenol-A and pesticides with BMI and WC z-score in children (p < 0.001). Subgroup analysis showed significant linear association of BPA and pesticides, in the urine samples of mothers at the first trimester of pregnancy, with BMI and WC z-score in children from 2–8 years (p < 0.05).

Conclusion

Prenatal exposure to the EDCs in the uterine period could increase the risk of obesity in children. Maternal exposure to bisphenol-A and pesticides showed the strongest association with the obesity, especially visceral form, in the next generation.
Exploring the effectiveness of molecular subtypes, biomarkers, and genetic variations as first-line treatment predictors in Asian breast cancer patients: a systematic review and meta-analysis
Authors: Bahrin Nurul Wafiqah Saipol , Matusin Siti Nur Idayu , Mustapa Aklimah , Huat Lu Zen , Perera Sriyani , Hamid Mas Rina Wati Haji Abdul
Published: April 2024

Background

Breast cancer incidence has been on the rise significantly in the Asian population, occurring at an earlier age and a later stage. The potential predictive value of molecular subtypes, biomarkers, and genetic variations has not been deeply explored in the Asian population. This study evaluated the effect of molecular subtype classification and the presence or absence of biomarkers and genetic variations on pathological complete response (pCR) after neoadjuvant treatment in Asian breast cancer patients.

Methods

A systematic search was conducted in MEDLINE (PubMed), Science Direct, Scopus, and Cochrane Library databases. Studies were selected if they included Asian breast cancer patients treated with neoadjuvant chemotherapy and contained data for qualitative or quantitative analyses. The quality of the included studies was assessed using the Newcastle Ottawa Scale. Following the random effects model, pooled odds ratios or hazard ratios with 95% confidence intervals for pCR were analysed using Review Manager Software. Heterogeneity between studies was assessed using Cochran’s Q-test and I2 test statistics.

Results

In total, 19,708 Asian breast cancer patients were pooled from 101 studies. In the neoadjuvant setting, taxane-anthracycline (TA) chemotherapy showed better pCR outcomes in triple-negative breast cancer (TNBC) (p<0.0001) and human epidermal growth factor receptor 2 enriched (HER2E) (p<0.0001) than luminal breast cancer patients. Similarly, taxane-platinum (TP) chemotherapy also showed better pCR outcomes in TNBC (p<0.0001) and HER2E (p<0.0001). Oestrogen receptor (ER)-negative, progesterone receptor (PR)-negative, HER2-positive and high Ki-67 were significantly associated with better pCR outcomes when treated with either TA or TP. Asian breast cancer patients harbouring wildtype PIK3CA were significantly associated with better pCR outcomes when treated with TA in the neoadjuvant setting (p=0.001).

Conclusions

In the neoadjuvant setting, molecular subtypes (HER2E and TNBC), biomarkers (ER, PR, HER2, HR, Ki-67, nm23-H1, CK5/6, and Tau), and gene (PIK3CA) are associated with increased pCR rates in Asian breast cancer patients. Hence, they could be further explored for their possible role in first-line treatment response, which can be utilised to treat breast cancer more efficiently in the Asian population. However, it needs to be further validated with additional powered studies.

Systematic review registration

PROSPERO CRD42021246295.
Longtime dynamics of solutions for higher-order $(m_{1},m_{2})$-coupled Kirchhoff models with higher-order rotational inertia and nonlocal damping
Authors: Lv Penghui , Yuan Yuan , Lin Guoguang
Published: April 2024

The Kirchhoff model is derived from the vibration problem of stretchable strings. This paper focuses on the longtime dynamics of a higher-order $(m_{1},m_{2})$
(

m
1

,

m
2

)
-coupled Kirchhoff system with higher-order rotational inertia and nonlocal damping. We first obtain the state of the model’s solutions in different spaces through prior estimation. After that, we immediately prove the existence and uniqueness of their solutions in different spaces through the Faedo-Galerkin method. Subsequently, we prove their family of global attractors using the compactness theorem. Finally, we reflect on the subsequent research of the model and point out relevant directions for further research on the model. In this way, we systematically study the longtime dynamics of the higher-order $(m_{1},m_{2})$
(

m
1

,

m
2

)
-coupled Kirchhoff model with higher-order rotational inertia, thus enriching the relevant findings of higher-order coupled Kirchhoff models and laying a theoretical foundation for future practical applications.
Prediction of malignant esophageal fistula in esophageal cancer using a radiomics-clinical nomogram
Authors: Zhu Chao , Sun Wenju , Chen Cunhai , Qiu Qingtao , Wang Shuai , Song Yang , Ma Xuezhen
Published: April 2024

Background

Malignant esophageal fistula (MEF), which occurs in 5% to 15% of esophageal cancer (EC) patients, has a poor prognosis. Accurate identification of esophageal cancer patients at high risk of MEF is challenging. The goal of this study was to build and validate a model to predict the occurrence of esophageal fistula in EC patients.

Methods

This study retrospectively enrolled 122 esophageal cancer patients treated by chemotherapy or chemoradiotherapy (53 with fistula, 69 without), and all patients were randomly assigned to a training (n = 86) and a validation (n = 36) cohort. Radiomic features were extracted from pre-treatment CTs, clinically predictors were identified by logistic regression analysis. Lasso regression model was used for feature selection, and radiomics signature building. Multivariable logistic regression analysis was used to develop the clinical nomogram, radiomics-clinical nomogram and radiomics prediction model. The models were validated and compared by discrimination, calibration, reclassification, and clinical benefit.

Results

The radiomic signature consisting of ten selected features, was significantly associated with esophageal fistula (P = 0.001). Radiomics-clinical nomogram was created by two predictors including radiomics signature and stenosis, which was identified by logistic regression analysis. The model showed good discrimination with an AUC = 0.782 (95% CI 0.684–0.8796) in the training set and 0.867 (95% CI 0.7461–0.987) in the validation set, with an AIC = 101.1, and good calibration. When compared to the clinical prediction model, the radiomics-clinical nomogram improved NRI by 0.236 (95% CI 0.153, 0.614) and IDI by 0.125 (95% CI 0.040, 0.210), P = 0.004.

Conclusion

We developed and validated the first radiomics-clinical nomogram for malignant esophageal fistula, which could assist clinicians in identifying patients at high risk of MEF.
Nutritional status of people who inject drugs in Coastal Kenya: a cross-sectional study
Authors: Budambula Valentine , Ngari Moses , Budambula Nancy L.M. , Ahmed Aabid A. , Were Tom
Published: April 2024

Introduction

Despite documentation on injection drug use (IDU) in Kenya, the nutritional status of people who inject drugs (PWIDs) is under-explored. Elsewhere studies report under-nutrition among PWIDs which is attributed to food insecurity; competing priorities between drugs and food supply; chaotic lifestyle; reduced food intake; substance use induced malnutrition due to inflammation and comorbidities.

Methods

This was a cross-sectional study that sought to assess the nutritional status of PWIDs in Coastal Kenya. We recruited 752 participants of whom 371(49%) were on IDUs and 75 non-IDUs and 306 non-drug users using respondent driven sampling, traditional snowball, makeshift outreach and purposive sampling methods.

Results

More than one half of the participants (56%) had BMI classified as normal while 35% had BMI < 18.5. The proportion with BMI < 18.5 was higher among IDUs (46%) compared to the non-IDUs (33%) and non-drug users (23%) at P < 0.001. Using the mid upper arm circumference (MUAC), 17% were classified as underweight and the proportion was lowest (11%) among non- drugs users compared to 22% among IDUs (P < 0.001). However, the IDUs had lower proportion of overweight (8.1%) compared to 55% among the non- drug users. The proportion with low waist-for-hip ratio was highest among the IDUs (74%) while high waist-for-hip ratio was lowest in the same group of IDUs (11%) at P < 0.001. One half (50%), of the participants had no signs of anaemia, (47%) had mild/moderate anaemia while 21 (2.8%) had severe anaemia. However, IDUs were more likely to be overweight based on waist circumference as a parameter. The IDUs had the highest proportion (54%) of mild to moderate anaemia compared to non-IDUs (37%) and 40% non- drug users (P < 0.001). In the multivariable models, IDUs (aRRR 2.83 (95%CI 1.84‒4.35)) and non-IDUs (aRRR 1.42 (95%CI 1.07‒1.88)) compared to non- drug users were positively associated with BMI < 18.5. Being an IDU was positively associated with mild or moderate anaemia (aRRR 1.65 (95%CI 1.13‒2.41)) while non-IDUs were positively associated with severe anaemia (aRRR 1.69 (95%CI 1.16‒2.48)).

Conclusion

A significant proportion of the participants were under-nourished with those injecting drugs bearing the heaviest brunt. Being an IDU was positively associated with the low BMI, MUAC, waist for hip ratio and mild or moderate anaemia but high waist circumference. People who inject drugs have high risk for under-nutrition and should be targeted with appropriate interventions.
Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0–8) across UK early years and children’s services
Authors: Randell Elizabeth , Nollett Claire , Henley Josie , Smallman Kim , Johnson Sean , Meister Lena , McNamara Rachel , Wilkins David , Segrott Jeremy , Casbard Angela , Wakelyn Jenifer , McKay Kathy , Bordea Ekaterina , Totsika Vaso , Kennedy Eilis
Published: April 2024

Background

Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective.

Methods

A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children’s services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child’s play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years.

Discussion

This study will address feasibility questions associated with progression to a future randomised trial of WMP.

Trial registration

ISRCTN13644899. Registered on 14th April 2023.
Civil society organisations and the healthcare of irregular migrants: the humanitarianism-equity dilemma
Authors: Piccoli Lorenzo , Perna Roberta
Published: April 2024

Individuals who reside in a country without regular authorisation generally find it difficult to access public medical services beyond emergency treatment. Even in countries with universal healthcare, there is often a gap between rights on paper and their implementation. Civil society organisations (CSOs) fill this gap by providing medical services to vulnerable populations, including irregular migrants. What, if any, are the ethical dilemmas that arise for CSO staff when delivering such services in countries with universal healthcare? Under what conditions do these dilemmas arise? And what strategies do CSO staff use to mitigate them? We answer these questions using 40 semi-structured interviews with CSO staff working in two European countries with high levels of irregularity, universal healthcare provisions on paper, and significant differences in approaches and availability of public services for irregular migrants: Italy and Spain. We show that CSO staff providing medical services to irregular migrants in places with universal healthcare coverage face a fundamental dilemma between humanitarianism and equity. CSO staff respond to the humanitarian belief in the value of taking all possible steps to prevent or alleviate human suffering, thus promoting a decent quality of life that includes access to both emergency and non-emergency care. In doing so, however, they run the risk of substituting rather than complementing public provisions, thereby preventing governments from assuming responsibility for these services in the long term. Individuals who acknowledge the existence of this dilemma generally oppose the creation of parallel structures; that is, services specifically developed for irregular migrants outside the public system; while those who ignore it essentially subscribe to a tiered system, giving up on considerations of equity. We argue that CSOs involved in the provision of healthcare to irregular migrants do not simply provide services; they also play an inherently political role.