bluuebunny/crossref_metadata_2025 huggingface dataset:
Statistical Theory on Variation of Carbon Dioxide Concentration in Global Warming
Authors: Luo Liaofu , Lv Jun
Published: June 2024

To comprehend the relationship between global warming and CO2 emissions more comprehensively, we simulated historical data. This endeavor aimed to discern the underlying patterns governing the fluctuation of CO2 concentration and annual CO2 emissions. Our analysis revealed a consistent pattern: both variables followed time-dependent exponential functions characterized by positive feedback mechanisms. Expanding our investigation, we integrated these findings with the framework of five Shared Socio-economic Pathways (SSPs). Extending our simulations from 2015 to 2500, we uncovered a shift in CO2 concentration dynamics. While exponential growth persisted in earlier periods, a transition to negative feedback mechanisms became evident in later stages. We devised a modified exponential function to model CO2 concentration variation to capture this transition, facilitating the transition from positive to negative feedback. Subsequently, we explored the correlation between temperature anomalies and CO2 concentrations. Our analysis revealed a linear relationship between these variables and demonstrated that their physical correlation manifests only over the long term. Leveraging this relationship, we formulated predictions for global temperature anomalies up to 2500. Furthermore, we examined the impact of land-use changes as a strategy to mitigate CO2 emissions partially. By introducing an illustrative example, we elucidated the potential effectiveness of such measures. Finally, we delved into the short-term evolution of the climate system, focusing on peak series in CO2 concentration and temperature anomalies. This analysis provided valuable insights into the immediate trajectories of these critical variables.
Deep learning-based metabolomics data study of prostate cancer
Authors: Sun Liqiang , Fan Xiaojing , Zhao Yunwei , Zhang Qi , Jiang Mingyang
Published: June 2024

Background:
As a heterogeneous disease, prostate cancer (PCa) presents diverse clinical and biological features that pose challenges for early diagnosis and treatment. Metabolomics can provide new methods for the early diagnosis, treatment, and prognosis of prostate cancer. However, metabolomics data are characterized by high throughput, sparsity, high dimensionality, and small samples, which poses great challenges for classification. Despite the wide range of applications of deep learning methods, metabolomics research based on deep learning has not yet been widely conducted.
Results:
In this study, we propose a hybrid model, namely, TCNet, based on transformer and convolutional neural networks for prostate cancer metabolomics data classification. We introduce a 1D convolution for the inputs of the dot product attention, which enables the interaction of local-global information. A gating mechanism is used so that the model can dynamically adjust the attention weights. The features extracted by the multi-head attention are extracted at a more advanced level via 1D convolution. A residual network is introduced in the 1D convolution to alleviate the gradient vanishing problem. A five-fold cross-validation was used to complete the classification experiment, our experimental study shows that the TCNet model based on a transformer with a convolutional neural network can obtain better classification results than seven other machine learning comparison algorithms.
Conclusions:
We propose a novel hybrid model for classifying prostate cancer metabolomics data and demonstrate that our approach outperforms other methods based on deep learning. Our results provide new perspectives on prostate cancer early diagnosis.
Characterizing spatial patterns among freshwater fishes and shrimps of the Poso River (Sulawesi, Indonesia) using DNA barcoding
Authors: Wibowo Arif , Kurniawan Kurniawan , Prakoso Vitas Atmadi , Ginanjar Rendy , Rochman Fathur , Zamroni Mochammad , Atminarso Dwi , Sumarto Bayu Kreshna Adhitya , Chadijah Andi , Irawan Deni , Deniansen Tri , Suriani Irma , Syamsi Agus Noor , Achmadi Andi , Surbani Indah Lestari , Akbar Sabda Alam , Hubert Nicolas , Baumgartner Lee
Published: June 2024

Fish biodiversity assessments play a crucial role in identifying potential threats, and the overall health of aquatic ecosystems. Poso River in Sulawesi, Indonesia presents a complex scenario where changes in fish biodiversity can be influenced by habitat alteration, the introduction of non-native fish species and overfishing. In this study, we assessed fish biodiversity in Poso River to gain a better understanding of the challenges to its aquatic biodiversity. This knowledge is critical for enhancing fisheries management and conservation programs, and is essential for improving the fishway system integrated into hydropower dams. The biodiversity study utilized a comprehensive methodology that encompassed both traditional taxonomic approaches and DNA barcoding, specifically targeting the mitochondrial Cytochrome C Oxidase Subunit-1 (COI) gene for accurately identify species and validate their boundaries. It was conducted in upstream, environmental flows of hydropower dams, and downstream areas of the river. We found 27 species of fish in the Poso River, including both native and non-native species. Two endangered species were also observed. DNA barcoding was performed to examine species boundaries and identity. The fish population in the Poso River is dominated by non-native species, accounting for 85.70% of the total population. The upstream area had the highest fish abundance and diversity, while the downstream area had the lowest. There was no significant difference in species richness and diversity across different locations and seasons. The dominance of non-native species in the Poso River necessitates the improvement of existing fish passages equipped in hydropower dams through the development of selective fish passages that can block the distribution of these invasive species. This research highlights the critical issue of non-native species proliferation and its potential threat they pose to native fish populations, providing valuable insights for conservation and management efforts in Indonesia and similar ecosystems worldwide.
Translation Landscape of Stress Granules
Authors: Guo Qiang , Wu Yichun , Wang Xing , Meng Lingyu , Liao Zhizhao , Ji Wei , Zhang Peipei , Lin Jie
Published: June 2024

Stress granules, cytoplasmic assemblies of RNA-binding proteins and mRNAs formed during cellular stress, are implicated in translational control. However, their exact functions remain elusive. Here, we employed cryogenic correlative light and electron microscopy to visualize stress granules in their native environment and reconstructed them in 3D using tomography. This approach provided the first quantitative and spatial analysis of the translational machinery within stress granules. Our findings suggest that stress granules have a limited impact on global translation regulation but serve to protect small ribosomal subunits and pre-initiation complexes (PICs) from degradation. Numerical simulations based on a phase-field model accurately reproduced the spatial distribution of ribosomal components inside and outside the stress granules, shedding light on the thermodynamic principles governing this process.
Dynamics for Advective-cooperative System With Free Boundaries Ina Nondegenerate Epidemiological Model
Authors: Nguyen Hieu
Published: June 2024

The present paper is devoted to the investigation of the long time dynamics for advective-cooperativesystem with free boundaries, which models the infectious diseases transmitted via digestive system such as fecal-oraldiseases, cholera, hand-foot and mouth, etc... The couple advective yield significant obstacle that we cannot employthe approach of [1, 16]. To overcome this, we must prove the existence and the variational formula for the principaleigenvalue of a linear system with advective-cooperative, then use it to obtain the right limits as the dispersal ratesand domain tend to zero or infinity. Additionally, we conduct numerical simulations to validate our theoreticalresults, and explore the effects of various parameters.
Visuo-spatial compound stimuli discrimination with (Gryllus pennsylvanicus) in two-choices rewarding learning tasks
Authors: Cyr André , Morrow Isaiah , Morand-Ferron Julie
Published: June 2024

This paper proposes an experimental protocol allowing Gryllus pennsylvanicus to discriminate an A-A and A-B motif pairs of compound visual stimuli. Specifically, this study consists in an operant conditioning procedure including a dichotomic Y-maze, two different pairs of compound visual colored cues and a water reward. Results are conclusive for this visuo-spatial regularities study, Gryllus pennsylvanicus were able to significantly discriminate between the two compound visual patterns and learned the association with the reinforcer.
Transcriptome Analysis Reveals Age-Specific Growth Characteristics in the Rumen of Hanwoo (Korean Native Cattle) Steers
Authors: Park Yejee , Jang Sunsik , Chai Han-Ha , Son Ju-Whan , Lim Dajeong , Park Woncheoul
Published: June 2024

Background
Hanwoo cattle are a Korean breed renowned for their cultural significance and high-quality beef, characterized by low cholesterol and a high unsaturated fat ratio. Their growth is divided into a growing phase focused on development and a fattening phase for marbling. Proper feed management, considering genetic and environmental factors, is vital for maximizing growth potential. The rumen plays a crucial role in digestion and gene expression regulation, with rumen fermentation being central to nutrient absorption and cattle health. In this study, we conduct a transcriptome analysis of the rumen at eight timepoints. Our goal is to identify genetic factors that influence the growth of Hanwoo steers to enhance our understanding of the rumen’s functions during Hanwoo growth.
Results
In the RNA-sequencing analysis of Hanwoo steer rumen, differential gene expression was examined over eight timepoints, highlighting significant genetic changes, particularly between 12 and 26 months. The results of a weighted gene co-expression network analysis were identified and organized into three modules: turquoise, blue, and yellow. The turquoise module, linked to immune response, showed down-regulation in genes at 30 months. The blue module, associated with steroid metabolism, was notably up-regulated at 26 months. The yellow module’s genes showed a consistent increase in expression with growth. These modules and their functional annotations provide a deeper understanding of the biological processes during Hanwoo growth, highlighting the intricate relationship between gene expression and cattle development.
Conclusions
The growth stages of Hanwoo steers were explored in our investigation utilizing rumen transcriptome data. The rumen plays a critical role in their development, particularly during the growing and fattening phases. Proper feed management, considering the rumen’s function, is essential for optimal growth. Transcriptome analysis helps identify genes associated with growth and provides insights for cattle breeding and management practices. Understanding the complex connection between gene expression and Hanwoo development is essential for maximizing productivity and health.
Oxidation is a potentially significant methane sink in land-terminating glacial runoff
Authors: Strock Kristin E. , Krewson Rachel , Hayes Nicole M. , Deemer Bridget R.
Published: June 2024

Globally, aquatic ecosystems are one of the largest but most uncertain sources of methane, a potent greenhouse gas. It is unclear how climate change will affect methane emissions, but recent work suggests that glacial systems, which are melting faster with climate change, may be an important source of methane to the atmosphere. Currently, studies quantifying glacial emissions are limited in number, and the role of methanotrophy, or microbial methane oxidizers, in reducing atmospheric emissions from source and receiving waters is not well known. Here we discuss three potential sites for methane oxidation that could mitigate emissions from glaciers into the atmosphere: under ice oxidation, oxidation within proglacial lakes, and oxidation within melt rivers. The research presented here increases the number of glacial sites with methane concentration data and is one of only a few studies to quantify the net microbial activity of methane production and oxidation in two types of land-terminating glacial runoff (lake and river). We find that oxidation in a glacial river may reduce atmospheric methane emissions from glacial melt by as much as 50%. Future efforts to constrain methane emissions from glacial systems should account for methane oxidation.
Comparison of Anthropometric Indices for Predicting the Risk of Metabolic Diseases: Result from Ravansar NonCommunicable Disease (RaNCD) Cohort Study
Authors: Darbandi Mitra , Mansouri Kamyar , Shahnazi Narges , Pasdar Yahya , Moludi Jalal , shadmani Fatemeh Khosravi , Shadmani Fatemeh Khosravi
Published: June 2024

Background
The effectiveness of anthropometric indices in predicting metabolic diseases is still of debate. This study aimed to compare anthropometric indices for predicting the risk of metabolic diseases.
Methods
We used the data of 10,047 Iranian adults aged 35 to 65 years participating in the first phase of Ravansar Non-Communicable Disease (RaNCD) cohort study. The investigated metabolic diseases included cardiovascular diseases (CVDs), hypertension, dyslipidemia, and diabetes. Anthropometric indices included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), visceral fat area (VFA), body fat mass (BFM), percent body fat (PBF), fat mass index (FMI), a body shape index (ABSI), and body roundness index (BRI). The predictive power of anthropometric indices was evaluated using Receiver Operating Characteristic (ROC) curve analysis.
Results
The BRI (AUC: 0.76; 95%CI: 0.74–0.78), WHtR (AUC: 0.63; 95%CI: 0.61–0.66), and PBF (AUC: 0.62; 95%CI: 0.59–0.64) indices showed the highest power for predicting CVDs, while WHtR (AUC: 0.65; 95%CI: 0.62–0.68) and BRI (AUC: 0.64; 95%CI: 0.61–0.67) indices were most effective for predicting diabetes. In men, BRI (AUC: 0.64, 95%CI: 0.61–0.66) and WHtR (AUC: 0.63, 95%CI: 0.61–0.65) indices had the highest power for predicting hypertension, while in women, BMI, WHtR, and VFA (AUC ≥ 0.60) indices were most effective for predicting hypertension. Additionally, BMI, BFM, FMI, VFA, and WHR indices had the highest power for predicting dyslipidemia (AUC ≥ 0.63).
Conclusion
Increasing anthropometric indices, especially BRI, WHtR, VFA, and BFM, can be used as independent predictors for metabolic diseases.
Impact of primary headache and health- seeking behaviour among advanced-level students: a cross-sectional study
Authors: Dinul Doluweera , Baarkavy Nanthakumar , Supun Adhikari , Ovini Vinoja , Dulangi Weerasinghe , Shyamini Adikaram , Surangi Jayakody
Published: June 2024

Background Primary headache is a common neurological disorder that causes significant disability. This study aimed to determine the proportion of primary headache, its impact on quality of life, and the patterns of health-seeking behaviour among advanced-level (A/L) students in the Western Province of Sri Lanka.Methods and material A cross-sectional study was conducted on students following the local A/L curriculum. A pretested self-administered questionnaire was distributed via online platforms to assess the presence of headache, type of headache and sociodemographic and educational factors associated with it. The Headache Impact Test-6 (HIT-6) questionnaire was used to assess the impact on quality of life. Data related to the methods of relief employed were also collected. Chi-square tests, Fisher’s exact tests and independent t tests were used to determine the factors associated with primary headache, and a p value of < 0.05 indicated statistical significance.Results A total of 441 students with a mean age of 19 ± 0.9 years consisting of predominantly females (66.4%) were included. The proportion of patients with primary headache among the participants was 57.1% (n = 252). It was significantly greater among females and students following the bioscience stream. According to the HIT-6 questionnaire, 42.1% (n = 106) of respondents reported that primary headache had a severe impact (score > 60) on their quality of life. Most students (71.4%, n = 180) used medication, with 51.7% (n = 130) self-medicating, while only 21% (n = 53) sought professional advice. Notably, over half (51.7%) of the respondents reported that self-medication was moderately effective, and 14.4% reported it to be ineffective.Conclusion A high proportion of A/L students suffer from primary headache, which significantly impacts their quality of life, with 42.1% having a HIT-6 score greater than 60. The majority were self-treated but with suboptimal relief. The rates of professional consultation were concerningly low. These findings highlighted the need for promoting proper diagnosis and management of headaches in this population, along with emphasis on the perils of unregulated analgesic use.
Epigenetic Fingerprints Link Early-Onset Colon and Rectal Cancer to Pesticide Exposure
Authors: Maas Silvana , Baraibar Iosune , Blanco-Irazuegui Odei , Tabernero Josep , Elez Elena , Seoane Jose
Published: June 2024

The incidence of colorectal cancer (CRC) is rapidly rising in individuals younger than 50, particularly in high-income countries. This rise parallels shifts in lifestyle and environmental factors, collectively termed the exposome; however, whether these are causally linked to the development of early-onset CRC (EOCRC) has not been investigated. Due to limited exposome data in most cancer cohorts, we constructed weighted methylation risk scores (MRS) as proxies for exposome exposure to pinpoint specific risk factors associated with EOCRC. Our analysis confirms previously identified risk factors, such as educational attainment, diet, and smoking habits. Moreover, we identified the exposure to the herbicide picloram as a novel risk factor (Padj. = 0.00049), a result we replicated in a meta-analysis comprising six CRC cohorts (P = 0.021), comparing EOCRC cases with patients diagnosed aged ≥70. Subsequently, we employed population-based data from 81 U.S. counties over 20 years and validated the association between picloram usage and EOCRC incidence (P = 2.87×10-3). These findings highlight the critical role of the exposome in EOCRC risk, underscoring the urgency for targeted personal and policy-level interventions.
The Green Trilemma: Energy Efficiency, Banking Stability and Climate Risk in the ESG Context at World Level
Authors: Arnone Massimo , Leogrande Angelo
Published: June 2024

In the following article, we analyse the relationships among banking stability, the efficiency of the energy system and climate risks at a global level. We present a detailed analysis of the literature relating to the relationship between the banking system and Environmental, Social and Governance-ESG models. In our research, we try to verify whether it is possible to achieve energy efficiency, stability of the banking system and reduction of climate risk together i.e. the “Green Trilemma”. The econometric analysis is conducted through the following models: Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squared and Weighted Least Squared-WLS. To estimate the variables we used World Bank data. The analysis shows that ESG growth is negatively associated with energy efficiency and positively associated with banking stability and climate risk. It therefore follows that the Green Trilemma hypothesis is rejected. Countries can only target banking stability and climate risk through ESG models.
JEL Code: G21, Q43, Q47, Q51, Q54.
Exploring individuals’ purchase willingness for cryptocurrency in an emerging context
Authors: M. Anwarul Islam K. , Omeish Fandi , Islam Serajul , Mohammed Yaslam Sarea Adel , Abdrabbo Tariq
Published: June 2024

This study aims to investigate the influencing factors of consumers’ willingness to buy cryptocurrency in Malaysia. The targeted population of this study was Malaysian citizens who had knowledge about digital currency such as cryptocurrency. In this study, the data collection process was completed using an online survey questionnaire from several social media groups in Malaysia. They were sent a survey invitation to take part in, and after their approval, their responses were gathered. Five-point Likert scale has been used, where ‘1’ stands for “strongly disagree” and ‘5’ stands for “strongly agree”, to find out the item-wise questionnaire. The final sample size was n = 620. Moreover, 5% significance level and SPSS software were used to analyze the data and evaluate the hypotheses. The outcome of this study exposes that the perception of the price value of the cryptocurrency, perceived trust, and perceived security measure positively and significantly affect consumers’ willingness to buy cryptocurrency. Overall, these variables can explain 49.50% (R2 = 0.495) of the variance in predicting consumers’ willingness to buy cryptocurrency. It is found that among the three determinants, perceived trust (β = 0.569) in cryptocurrency had the highest impact on the intention among Malaysian consumers compared to other variables. This study contributes to the limited existing literature concerning Bitcoin and digital currencies, offering insights that can aid scholars in comprehending the significance of cryptocurrency and delineating its predominant impacts within the Malaysian cryptocurrency space.
Military and school personnel psychological states amidst the Pandemic: A Kruskal-Wallis comparative analysis
Authors: Fernandez Aldwin Roy L. , Laud-Iligan Hanna Grace , Relleve Cesar Chester O.
Published: June 2024

Purpose – This study aims to determine the Compassion Satisfaction, Burnout, and Secondary Traumatic Stress among Military and School Personnel.Method - Quantitative descriptive-comparative research design was used.  There are 147 respondents participated in this study.Result - Compassion Satisfaction levels of Military-Enlisted and Teaching Personnel were Average, while for the Military-Officer and Non-Teaching School Personnel were High; Burnout for the Military-Enlisted and Teaching Personnel were both Average, while the Military-Officer and Non-Teaching School Personnel were both low; and the Secondary Traumatic Stress was Low for the Military-Officer and Average to other three groups of respondents. Significant differences manifested after employing the parametric test MANOVA and non-parametric Kruskal-Wallis.  Post Hoc test was employed in order to identify the specific significant differences.Implication – The researchers have identified significant pattern and trends that contribute to the understanding of comparison, personnel who are less often directly exposed to the clients have better Psychological States descriptively.Originality - This research contributes to the existing body of knowledge in the areas of Compassion, Burnout and Stress   experienced by militaries and educators in the conduct of their respective public services.***Tujuan - Penelitian ini bertujuan untuk mengetahui Kepuasan Belas Kasih, Burnout, dan Stres Trauma Sekunder di antara Personel Militer dan Sekolah, serta untuk membandingkan kondisi-kondisi psikologis tersebut.Metode - Desain penelitian deskriptif-komparatif kuantitatif digunakan.   Ada 147 responden yang berpartisipasi dalam penelitian ini.Hasil - Tingkat Kepuasan Belas Kasih pada Tamtama Militer dan Tenaga Pengajar tergolong sedang, sedangkan pada Perwira Militer dan Tenaga Kependidikan tergolong tinggi; Burnout pada Tamtama Militer dan Tenaga Pengajar tergolong sedang, sedangkan pada Perwira Militer dan Tenaga Kependidikan tergolong rendah; dan Stres Traumatis Sekunder tergolong rendah pada Tamtama Militer dan tergolong sedang pada tiga kelompok responden lainnya.  Perbedaan yang signifikan terlihat setelah menggunakan uji parametrik MANOVA dan non parametrik Kruskal-Wallis.  Uji Post Hoc digunakan untuk mengidentifikasi perbedaan signifikan yang spesifik,Implikasi - Para peneliti telah mengidentifikasi pola dan tren signifikan yang berkontribusi pada pemahaman perbandingan, personel yang lebih jarang terpapar langsung dengan klien memiliki kondisi psikologis yang lebih baik secara deskriptif.Orisinalitas - Penelitian ini berkontribusi pada pengetahuan yang sudah ada di bidang Welas Asih, Kelelahan dan Stres yang dialami oleh militer dan pendidik dalam melaksanakan layanan publik masing-masing.
Assessing and auditing water transport systems by applying the energy equations
Authors: Cabrera Enrique , Abreu José Manuel , Gómez Elena , del Teso Roberto , Estruch-Juan Elvira
Published: June 2024

In improving the energy efficiency of water transport systems, two critical stages are involved: assessment (to understand the system's operation and identify potential energy savings) and auditing (to locate and break down the energy losses). Both stages are based on energy balances, which can be conducted using either the extended Bernoulli equation or the energy integral equation. Both equations can be applied, but depending on the system, data availability, and the kind of study to be performed, one is preferable over the other. This paper analyses, applies and compares both equations, with a particular focus on the less commonly used energy integral equation in the hydraulic field. This more general equation includes thermal and transient effects and it is more suitable for analyzing complex systems. In contrast, the extended Bernoulli equation, while simpler to apply, can lead to the loss of relevant information, such as the evaluation of the topographic energy. The main objective of this work is to bridge the gap between these two fundamental energy equations and recommend the most appropriate one for hydraulic problems. Real examples are presented to show their differences and validate our recommendations.
Degradation of acetochlor via the UV/persulfate process: Mechanisms, kinetics, and pathways
Authors: Hu Chen-Yan , Ji Sheng-Jie , Dong Zheng-Yu , Wu Yi-Hui , Dong Zi-Yi , Hu Li-Li , Yang Xin-Yu , Liu Hao
Published: June 2024

The environmental health risks of acetochlor (ACE) have received widespread attention. The removal of ACE via the ultraviolet/persulfate (UV/PS) process was investigated in this study. The degradation of ACE in the UV/PS process fitted pseudo-first-order kinetics. ACE can be effectively removed in the pH range of 5.0–9.0. In addition, the removal efficiency of ACE increases with the increase in PS concentration. The experimental and calculation results prove that the contributions of UV irradiation, sulfate radicals (SO4•-) and hydroxyl radicals (HO·) were 40, 52.1, and 6.43%, respectively, and the second-order rate constants between SO4•- and with ACE are 3.5 × 109 and 5.6 × 109M−1s−1, respectively. The influences of different water matrices were explored. Both chloride ions and bicarbonate can inhibit the degradation of ACE, while the effects of sulfate ions and nitrate can be negligible. Humic acid (HA) has an inhibitory effect of ACE degradation. The intermediates were detected and the possible degradation pathway of ACE was proposed. The results of this study can provide technical support for the control of ACE in the environment.
Real-World Survival Comparisons Between Radiotherapy and Surgery for Metachronous Second Primary Lung Cancer and Predictions of Lung Cancer–Specific Outcomes Using Machine Learning: Population-Based Study
Authors: Zheng Yue , Zhao Ailin , Yang Yuqi , Wang Laduona , Hu Yifei , Luo Ren , Wu Yijun
Published: June 2024

Background

Metachronous second primary lung cancer (MSPLC) is not that rare but is seldom studied.

Objective

We aim to compare real-world survival outcomes between different surgery strategies and radiotherapy for MSPLC.

Methods

This retrospective study analyzed data collected from patients with MSPLC between 1988 and 2012 in the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) analyses and machine learning were performed to compare variables between patients with MSPLC. Survival curves were plotted using the Kaplan-Meier method and were compared using log-rank tests.

Results

A total of 2451 MSPLC patients were categorized into the following treatment groups: 864 (35.3%) received radiotherapy, 759 (31%) underwent surgery, 89 (3.6%) had surgery plus radiotherapy, and 739 (30.2%) had neither treatment. After PSM, 470 pairs each for radiotherapy and surgery were generated. The surgery group had significantly better survival than the radiotherapy group (P<.001) and the untreated group (563 pairs; P<.001). Further analysis revealed that both wedge resection (85 pairs; P=.004) and lobectomy (71 pairs; P=.002) outperformed radiotherapy in overall survival for MSPLC patients. Machine learning models (extreme gradient boosting, random forest classifier, adaptive boosting) demonstrated high predictive performance based on area under the curve (AUC) values. Least absolute shrinkage and selection operator (LASSO) regression analysis identified 9 significant variables impacting cancer-specific survival, emphasizing surgery’s consistent influence across 1 year to 10 years. These variables encompassed age at diagnosis, sex, year of diagnosis, radiotherapy of initial primary lung cancer (IPLC), primary site, histology, surgery, chemotherapy, and radiotherapy of MPSLC. Competing risk analysis highlighted lower mortality for female MPSLC patients (hazard ratio [HR]=0.79, 95% CI 0.71-0.87) and recent IPLC diagnoses (HR=0.79, 95% CI 0.73-0.85), while radiotherapy for IPLC increased mortality (HR=1.31, 95% CI 1.16-1.50). Surgery alone had the lowest cancer-specific mortality (HR=0.83, 95% CI 0.81-0.85), with sublevel resection having the lowest mortality rate among the surgical approaches (HR=0.26, 95% CI 0.21-0.31). The findings provide valuable insights into the factors that influence cumulative cancer-specific mortality.

Conclusions

Surgical resections such as wedge resection and lobectomy confer better survival than radiation therapy for MSPLC, but radiation can be a valid alternative for the treatment of MSPLC.
Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis
Authors: Turkington Robin , Potts Courtney , Mulvenna Maurice , Bond Raymond , O'Neill Siobhán , Ennis Edel , Hardcastle Katie , Scowcroft Elizabeth , Moore Ciaran , Hamra Louise
Published: June 2024

Background

National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom’s 4 countries or regions.

Objectives

The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK.

Methods

Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller’s current region (intraregional calls) or routed to a branch that is in a different region from that of the caller’s current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene’s test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration.

Results

ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin.

Conclusions

Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service.
Behavioral Weight Loss Programs for Cancer Survivors Throughout Maryland: Protocol for a Pragmatic Trial and Participant Characteristics (Preprint)
Authors: Jerome Gerald J , Appel Lawrence J , Bunyard Linda , Dalcin Arlene T , Durkin Nowella , Charleston Jeanne B , Kanarek Norma F , Carducci Michael A , Wang Nae-Yuh , Yeh Hsin-Chieh
Published: June 2024

BACKGROUND

Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland.

OBJECTIVE

The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants.

METHODS

Participants were aged ≥18 years, residing in Maryland, with a BMI ≥25 kg/m2, who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program.

RESULTS

Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7% (254/340) were female, 55.9% (190/340) identified as non-Hispanic Black, 58.5% (199/340) had a bachelor’s degree, and the average BMI was 34.1 kg/m2 (SD 5.9 kg/m2). The most common types of cancers were breast (168/340, 49.4%), prostate (72/340, 21.2%), and thyroid (39/340, 8.5%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024.

CONCLUSIONS

Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs.

CLINICALTRIAL

ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/54126
Efficacy and Safety of Remimazolam Versus Etomidate for Induction of General Anesthesia: Protocol for a Systematic Review and Meta-Analysis (Preprint)
Authors: Zhao Li , Guo Yiping , Zhou Xuelei , Mao Wei , Chen Linlin , Xie Ying , Li Linji
Published: June 2024

BACKGROUND

Postinduction hypotension (PIHO) is a hemodynamic abnormality commonly observed during the induction of general anesthesia. Etomidate is considered a safer drug for the induction of anesthesia because it has only minor adverse effects on the cardiovascular and pulmonary systems. Recent evidence indicates that the novel benzodiazepine remimazolam has minimal inhibitory effects on the circulation and respiration. However, the efficacy and safety of remimazolam versus etomidate in the induction of anesthesia are unclear.

OBJECTIVE

To further understand the potential of remimazolam in anesthesia induction, it is necessary to design a meta-analysis to compare its effects versus the classic safe anesthetic etomidate. The aim of this study is to determine which drug has more stable hemodynamics and a lower incidence of PIHO. Our study will also yield data on sedation efficiency, time to loss of consciousness, time to awakening, incidence of injection pain, and postoperative nausea and vomiting with the two drugs.

METHODS

We plan to search the Web of Science, Cochrane Library, Embase, PubMed, China National Knowledge Infrastructure, and Wanfang databases from the date of their creation until March 31, 2025. The language is limited to English and Chinese. The search terms are “randomized controlled trials,” “etomidate,” and “remimazolam.” The incidence of PIHO is the primary outcome measure. Secondary outcomes include depth of anesthesia after induction, sedation success rate, time to loss of consciousness, hemodynamic profiles, recovery time, incidence of injection pain, and postoperative nausea and vomiting. Reviews, meta-analyses, case studies, abstracts from conferences, and commentaries will not be included. The heterogeneity of the results will be evaluated by sensitivity and subgroup analyses. RevMan software and Stata software will be used for data analysis. We will evaluate the quality of included studies using version 2 of the Cochrane risk-of-bias tool. The confidence of the evidence will be assessed through the Grading of Recommendations, Assessments, Developments, and Evaluations system.

RESULTS

The protocol was registered in the international PROSPERO (Prospective Register of Systematic Reviews) registry in November 2023. As of June 2024, we have performed a preliminary article search and retrieval for further review. The review and analyses are expected to be completed in March 2025. We expect to submit manuscripts for peer review by the end of June 2025.

CONCLUSIONS

By synthesizing the available evidence and comparing remimazolam and etomidate, we hope to provide valuable insights into the selection of anesthesia-inducing drugs to reduce the incidence of PIHO and improve patient prognosis.

CLINICALTRIAL

PROSPERO CRD42023463120; https://tinyurl.com/333jb8bm

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/55948
Systematic Review of Challenges in Implementing Artificial Intelligence in Breast Cancer Screening Programs: Towards a Framework for Safe Adoption (Preprint)
Authors: Goh Serene , Goh Rachel Sze Jen , Chong Bryan , Ng Qin Xiang , Koh Gerald Choon Huat , Ngiam Kee Yuan , Hartman Mikael
Published: June 2024

BACKGROUND

Artificial intelligence (AI) studies show promise in improving accuracy and efficiency in mammographic screening programs worldwide. However, its adoption in the clinical workflow faces challenges, such as unintended errors, professional training needs, and ethical concerns. Of note, specific frameworks for AI in breast cancer screening are lacking.

OBJECTIVE

This paper reports a systematic review aiming to assess existing literature and develop a tailored AI governance framework for adoption in breast cancer screening

METHODS

Three electronic databases (PubMed, EMBASE, and Medline) were searched using combinations of the key words, “artificial intelligence”, “regulation”, “governance”, “breast cancer” and “screening”. Original studies evaluating AI in breast cancer detection or discussing challenges related to AI implementation in this setting were eligible for review. Findings were narratively synthesized before being mapped directly against the constructs within the Consolidated Framework for Implementation Research (CFIR).

RESULTS

A total of 1240 results were retrieved, and 20 original studies were eventually included in this systematic review. Studies identified challenges in adopting AI in breast screening included reproducibility, evidentiary standards, technology concerns, trust issues, ethical, legal, societal concerns, and post-adoption uncertainty. Mapping these findings against the constructs within the CFIR, we recognize the complex interactions in the development and implementation of a governance framework, across the AI adoption life-cycle in the context of breast cancer screening. Action plans corresponding to the main challenges were included within the framework, aiding in a structured approach to address these issues.

CONCLUSIONS

This systematic review identified key themes as well as the barriers and facilitators for AI governance in breast cancer screening. Post-market surveillance is emphasized for continuous monitoring and auditing to ensure the effectiveness and ethical implementation of AI in breast cancer screening.

CLINICALTRIAL

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Adolescent Self-reflection Process through Self-recording on Multiple Health Metrics: Qualitative Study (Preprint)
Authors: Cho Minseo , Park Doeun , Choo Myounglee , Han Doug Hyun , Kim Jinwoo
Published: June 2024

BACKGROUND

Self-recording is an effective behavior change technology which has long been used in diverse health contexts. Recent technological advancements have broadened its applications. While previous studies have explored its role and benefits in enhancing self-awareness and informed decision-making, relatively little attention has been given to its potential in addressing the multidimensional nature of health with various health metrics.

OBJECTIVE

Our study investigates the process of self-recording in adolescent health, recognizing the connections between lifestyle behaviors and mental health. Specifically, we aim to incorporate both behavioral and emotional health metrics into the self-recording process. Grounded in self-regulation theory, we explore how adolescents record lifestyle behaviors and emotions, and how they inform and implement health management strategies.

METHODS

We conducted a qualitative study using grounded theory methodology. Data were collected through individual semi-structured interviews with 17 adolescents, who recorded their emotions and behaviors over four weeks using a prototype application. Analysis followed iterative phases of coding, constant comparison, and theme saturation. This process revealed how adolescents engage in self-recording for behaviors and emotions, as well as their failures and potential system support strategies. We further examined the relevance of the identified themes to theoretical constructs in self-regulation theory.

RESULTS

Under self-regulation theory, we gained insights into how adolescents manage their health through self-recording. Findings suggested variability in the self-recording process, in relation to specific health metrics of lifestyle behaviors and emotions. Adolescents focused on evaluating behaviors for management purposes, while exploring the causes underlying emotional experiences. Throughout the health management, which involved modifying behavior or distancing from triggering factors, they monitored progress and outcomes, demonstrating a self-experimental approach. Uncertainty emerged as a barrier throughout the self-regulation process, suggesting that self-recording systems for adolescents should prioritize strategies to address these uncertainties. Additionally, the self-recording system demonstrated interventional effects in aiding future planning and fostering a sense of relatedness among users.

CONCLUSIONS

This study offers a theoretical framework for adolescents' self-recording process on diverse health metrics. By integrating self-regulation theory, we suggest the stepwise process from recording lifestyle behaviors and emotions to health management behaviors. Through exploring potential features and health-supportive effects, our findings contribute to the development of digital self-recording systems that address various health metrics in adolescent health.
Asynchronous Distance Learning Performance and Knowledge Retention of the NIH Stroke Scale among Health Care Professionals using Video or E-learning: A Web-based Randomized Controlled Trial (Preprint)
Authors: Koka Avinash , Stuby Loric , Carrera Emmanuel , Gabr Ahmed , O'Connor Margaret , Missilier Peruzzo Nathalie , Waeterloot Olivier , Medlin Friedrich , Rigolet Fabien , Schmutz Thomas , Michel Patrik , Desmettre Thibaut , Suppan Mélanie , Suppan Laurent
Published: June 2024

BACKGROUND

Stroke treatment has significantly improved over the last decades, but the complexity of stroke cases requires specialized care especially in the first days after onset. To reliably assess neurological deficits, health care professionals (HCPs) must be highly trained, particularly in the usage of the widely used National Institutes of Health Stroke Scale (NIHSS). Traditional didactic methods may not adequately address certain intricacies of NIHSS nor engage HCPs in continuous learning, leading to suboptimal proficiency. In the context of time-constrained clinical settings, e-learning could be a promising alternative for knowledge dissemination and skill acquisition.

OBJECTIVE

This study aimed to assess the efficacy of a highly interactive e-learning module compared to a traditional didactic video in improving NIHSS knowledge among previously trained HCPs.

METHODS

A prospective, multi-centric, triple-blind, web-based randomized controlled trial was conducted involving previously trained HCPs working in three Swiss hospitals. Invitation to participate was sent via email, and participants were randomized to either the e-learning or traditional didactic video group through a fully automated process upon self-registration. Pre- and post-training quizzes were administered to assess knowledge acquisition, with a follow-up quiz after one month to evaluate retention. Subjective assessments of learning methods were also collected.

RESULTS

Of 174 enrolled participants, 97 completed the study course. Both learning methods significantly improved NIHSS knowledge, with the e-learning group demonstrating higher scores in knowledge acquisition (median score: 39 vs 37, P=.031) and retention (mean score: 38.2 vs. 35.8). Participants in the e-learning group were significantly more likely to recommend the learning method (P=.024).

CONCLUSIONS

A highly interactive e-learning module was found to be an effective asynchronous method for NIHSS knowledge acquisition and retention, in previously NIHSS-trained HCPs, and should therefore be integrated into NIHSS training programs.

INTERNATIONAL REGISTERED REPORT

RR2-10.3390/healthcare9111460