bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospitalization outcomes of patients with colorectal cancer (CRC) admitted with Clostridioides difficile colitis.
Authors: Sanjeevi Aditya , Bhandari Samikchhya Keshary , Kharel Himal , Kharel Zeni , Orakzai Abdullah Ahmad , Shah Purva , Eltaher Basant , Verma Rashmi , Rao Aniket , Niu Chengu , Idoate Domench Daniel
Published: June 2024

e15649

Background: Clostridioides difficile colitis poses a significant healthcare burden and is a leading cause of diarrheal disease. Emerging studies have suggested that certain C. difficile strains may potentially drive colonic tumorigenesis and C. difficile was more frequently isolated from colorectal cancerous lesions compared to healthy tissue. In addition, cancer patients are more likely to receive antibiotics. These factors place CRC patients at a high risk of acquiring C. difficile infection. This national inpatient sample (NIS) study aims to study the hospitalization outcomes of patients with CRC admitted with C. difficile colitis. Methods: A retrospective analysis of the NIS database from 2016 to 2020 was conducted using International Classification of Diseases (ICD-10) codes to identify hospitalizations with C. difficile colitis. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effect on mortality, length of stay, ileus and cost of hospitalization of colorectal cancer along with other variables as listed below. Results: There were 246685 hospitalizations with a primary diagnosis of C. difficile colitis. Among these, 2250 patients had a secondary diagnosis of colorectal cancer. Multivariate logistic regression showed that CRC was associated with increased mortality with odds ratio (OR) of 2.24 [95% confidence interval (CI) 1.13-4.44, p-value = 0.02], ileus (OR of 1.99, 95% CI 1.16-3.41, p-value = 0.01) and cost of hospitalization (10,585$ higher than patients without CRC, p-value = 0.001). CRC was not associated with increased length of stay (OR of 1.31, 95% CI 0.63-1.99). The effect of other pertinent variables is summarized in Table 1. Conclusions: Among the analyzed variables, we observed that colorectal cancer was associated with increased mortality, ileus and total cost of hospitalization in patients admitted with C. difficile colitis. Limitations of this study include failure of the multivariate model to account for other possible variables, coding errors and risk of bias due to the retrospective nature of data. [Table: see text]
Mortality outcomes in early versus late onset colorectal cancer: A US National Inpatient Sample (NIS) analysis (2020).
Authors: Khan Muhammad Atif , Khan Shahryar , Amin Muhammad Kashif , Khan Faiza Humayun , Khan Mashal Alam , Asif Samia
Published: June 2024

e15651

Background: Colorectal Cancer (CRC) is the third most common cancer diagnosed in the United States and contributes to significant cancer-related morbidity and mortality. An upward trend in the incidence is noticed in the population below 50 years of age. For similar reasons, U.S. Preventive Services Task Force recommended screening at the age of 45 in 2021.For the sake of this study, we categorized early onset (EO) for age 45 and below, and late onset (LO) for above 45 years per new screening criteria. We compared socioeconomic characteristics, mortality, length of stay and hospital cost between EO and LO CRC. Methods: It is a retrospective cohort study of adult patients hospitalized in 2020 with Colorectal cancer in acute care hospitals across the USA. Patients were selected from the Nationwide Inpatient Sample (NIS) database. IRB approval was not obtained as de-identified data was utilized. Our study population included all patients with a discharge diagnosis of colorectal cancer as their primary diagnosis using the International Classification of the Diseases (ICD-10). The primary outcome was in-hospital mortality, secondary outcomes were length of hospital stay and total hospitalization charges. Analysis was performed using STATA version 18.0. Univariable and Multivariable logistic regression analysis were used to adjust for potential confounders. Results: There were 32 million discharges included in the NIS database in 2020, our study included 153809 with colorectal cancer which includes 12043 in EO and 141750 in LO CRC. Both population groups are mostly similar in terms of baseline characteristics, however EO group were more likely to have Hispanic population (18.7% vs 9.5%), history of inflammatory bowel disease (2.9% vs 1.2%), family history of CRC (6.4% vs 3.8%) and smoker (15.8% vs 12.8%). Multivariable analysis revealed that Age, Sex, Charlson Comorbidity Index, Family history, Smoking, and Median household income for patients were predictors of mortality. There was no statistically significant difference found in the adjusted mortality between the two groups (odds ratio 1.08, 95% CI 0.84-1.39). Lower length of stay was noticed in the EO group (odds ratio 0.48, 95% CI 0.07-0.89). Total deaths are lower in EO than LO group (0.04% vs 0.06%). Conclusions: There is no difference in mortality in early and late onset CRC in our study. However, EO CRC is associated with shorter length of stay in hospital. EO CRC disproportionately affects non-White patients, particularly Hispanic patients. [Table: see text]
Angiogenesis inhibitors and cardiovascular outcomes in cancer: Real-world, population-based, matched cohort study.
Authors: Krishnan Arunkumar , Mukherjee Diptasree , Alqahtani Saleh A. , Walsh Declan
Published: June 2024

e24024

Background: Angiogenesis inhibitors (AI) have vascular side effects and are now recognized forcardiovascular adverse events (CVAEs). Clinical trial outcomes can underestimate treatment-related adverse events due to restrictive eligibility criteria, limited sample size, and failure to anticipate specific toxicities. In contrast, observational studies have small sample sizes and insufficient adjustment of confounding covariates. In addition, prospective high-quality evidence in real-world settings is scarce. We evaluated the incidence of CVAEs in real-world populations on AI therapy. Methods: This large retrospective cohort study was conducted using the TriNetX database and included adult patients ( > 18 years) with new cancer diagnoses. We performed 1:1 propensity score matching (PSM) for demographics, BMI, nicotine dependence, comorbidities, cancer type, and medications to similar controls as cancer patients never treated with AIs. The primary outcome was the new incidence of CVAEs-like heart failure (HF), major adverse cardiovascular events (MACE; coronary artery intervention myocardial infarction, or unstable angina), arrhythmia, ischemic heart disease (IHD), venous thromboembolism (VT), and cerebrovascular events (CVE cerebral infarction, carotid intervention, stroke, transient ischemic attack). Sensitivity analysis assessed statistical robustness. Hazard ratios (HR) were calculated to compare the AI therapy association with incident CVAEs. Results: We identified 1,170,667 patients with diagnoses of colorectal, cervical, kidney, liver, nonsmall cell lung, or ovarian cancer between 2010 and 2022. Among these, 59,890 had an AI treatment history, and 110,777 did not, with a median follow-up time of 3.1 years. After PSM, both cohorts (59545 each) were well-matched. In the adjusted analysis, AI therapy was associated with higher risks of MACE (HR, 1.23; 95% CI 1.16 -1.31), HF (HR, 1.16; 95% CI 1.08 - 1.25), and VT (HR 2.07; 95% CI 1.95 - 2.19), IHD (HR 1.23; 95% CI 1.16- 1.31), arrhythmias (HR 1.19; 95% CI 1.12-1.27), CVEs (HR, 1.30; 95% CI 1.21- 1.40) at 1 year of exposure. These outcomes were still significantly higher “increased,” suggesting causation; this is an association at follow-up by increasing the lag exposure. Sensitivity analysis results were consistent, and all statistically significant associations remained unchanged. Conclusions: Angiogenesis inhibitor treatment was associated with a significantly higher risk of CVAEs and various malignancies. The increased risk ranges from approximately 1.16 to 2.07 fold, indicating a substantial elevation in risk. These findings highlight the importance of risk stratification and cardiovascular monitoring during and after AI therapy. There is an unmet need to define strategies for CVAE prevention in this high-risk population.
Impact of multiple myeloma on outcomes of acute myocardial infarction: A propensity score matched analysis.
Authors: Bekoju Kanchhi , Kansakar Sajog , Shikhrakar Shreeja , Guragain Ashish , Chudy-Onwugaje Dilichukwu , Winn Soe , Neupane Niraj
Published: June 2024

e24027

Background: Patients with multiple myeloma (MM) are at increased risk of cardiovascular events secondary to its complications and adverse effects of pharmacotherapy. However, data on in-hospital outcomes of MM on acute myocardial infarction (AMI) is limited due to the clinical scenario being relatively uncommon. Thus, we conducted a retrospective study to investigate the in-hospital outcomes and resource utilization of AMI admissions in MM patients. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of AMI with and without co-morbid MM using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 3,191,049 hospitalizations for AMI were identified between 2016 and 2020, of which 6,565 (0.21%) had co-morbid MM. After propensity score matching, compared to those without MM, admissions for AMI with MM had higher odds ratio (OR) of mortality (OR 1.51, 95% CI 1.1-2.08, p = 0.01). Similar rates of complications such as respiratory failure, cardiogenic shock, stroke and vascular complications were seen between the two cohorts. However, acute kidney injury was more common in patients with MM (OR 1.81, 95% CI 1.52-2.14, p < 0.01). Compared to those without MM, admissions for AMI with MM were less likely to undergo coronary angiogram (OR 0.73, 95% 0.63-0.86, p < 0.01), percutaneous coronary intervention (PCI) (OR 0.71, 95% CI 0.60-0.84, p < 0.01) or coronary artery bypass grafting (CABG) (OR 0.52, 95% CI 0.37-0.71, p < 0.01). There was no difference in the length of stay but median hospitalization charges were higher in the cohort with MM ($ 54,125 vs $ 58,493, p < 0.01). Conclusions: Despite similar complication rates, patients with multiple myeloma (MM) who presented with acute myocardial infarction (AMI) experienced higher in-hospital mortality compared to those without MM. One plausible explanation is that patients with MM were less likely to undergo definitive management procedures such as coronary angiogram, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) during their admission, as observed in our study. Alternatively, MM might independently predict worse outcomes for AMI. Further research is needed to understand the interplay between AMI and MM, as well as to identify factors contributing to disparities in outcomes and intervention rates between patients with and without MM.
Establishing palliative care in tribal and rural Indian setting: A participatory action research approach.
Authors: Kahkasha Dr. , Varshney Saurabh , Bhatnagar Sushma
Published: June 2024

e24085

Background: We established a palliative care center in the tribal area of Santhal Pargana, India, under a tertiary care facility, as a crucial step in addressing the palliative needs of oncology patients. This study assesses the center's inaugural year, focusing on referral patterns, morphine consumption, and pain management. Methods: Data from all patients visiting the palliative care outpatient department (OPD) in 2023 were prospectively collected and analyzed. The study focused on key palliative care indicators, including morphine consumption, patient referrals, and the mean Numeric Rating Scale (NRS) pain score after initial consultation. The PAR approach was utilized to tailor services to the community's needs. Results: The center observed an increase in patient referrals, from 8 new patients in January to 19 by December. The patient demographic primarily comprised individuals with head and neck cancer (43%), followed by breast cancer (28%) and gall bladder cancer (12%), alongside other types such as cervix, sarcomas, lung, and adult hematolymphoid malignancies. Bone metastasis was present in 46 (55.4%) patients at initial presentation. Morphine consumption demonstrated a notable rise, from 840 mg in May to 2860 mg in December, totaling 9800 mg for the year. The mean NRS pain score improved significantly from 6.5 in January to 4.3 post-initial consultation. The center maintained an overall median of 3 consultations per patient, and bereavement support was provided to 13 (15.7%) patients. Conclusions: The integration of the Participatory Action Research approach, specifically the CTC-5, was instrumental in the successful initiation and expansion of palliative care services within the center. The structured training, mentorship, and organizational restructuring, facilitated by the program, were crucial in establishing a modest palliative care infrastructure. This comprehensive approach not only enhanced care delivery but also ensured the sustainability and adaptability of palliative services, effectively addressing the gap in palliative care in rural, tribal settings.
Orthorexia nervosa in breast cancer survivors: The role of disease characteristics and psychological aspects (GOIRC 02-2019).
Authors: Barbieri Elena , Moscetti Luca , Toss Angela , Cortesi Laura , Cuoghi Costantini Riccardo , Molinaro Alessia , Ferrari Silvia , Dominici Massimo
Published: June 2024

e24092

Background: Orthorexia Nervosa (ON), although not yet considered as a full-blown psychopathological disorder, is defined as altered thoughts and behaviours related to healthy eating and its prevalence is increasing in general population. Surviving cancer is a condition that may affect patients behaviour and mental status leading to beliefs that may affect everyday life to avoid cancer recurrence. Among these, eating behaviour is mostly represented in cancer survivors. The aim of the present study is to evaluate the prevalence and characteristics of ON among breast cancer (BC) survivors. Methods: This observational study enrols adult patients attending the outpatient clinic at the Oncology Division of Modena University Hospital. Patients with a BC diagnosis that have concluded the surgical, radiotherapy and chemo and/or targeted therapy treatment phase were considered eligible. Ongoing hormonal adjuvant therapy was permitted. Socio-demographic, clinical variables (stage, year of diagnosis, hormone receptor status, HER2 status, proliferation index, treatment) were collected on an anonymized database. Moreover, three psychometric measurements were administered to patients: the Hospital Anxiety-Depression Scale (HADS), the Personality Inventory for DSM-5 Brief Form (PID-5-BIF) and the ORTO-R, a 6-item self-administered tool that is the most used scale to measure ON. Results: Data were collected from 137 patients. Mean age was 62.4 years and (± 10.3) and the mean BMI was 26.3 (± 5.2). Sixty-six percent of patients were diagnosed with stage I disease, 28% with stage II and 6% with stage III disease. Thirty percent of patients received adjuvant chemotherapy, 89% hormonal therapy and 15.5% anti-HER2 targeted therapy. The ORTO-R mean score was 12.2 ± 3.8. The prevalence of psychiatric symptoms at the HADS was 36.5%. The ORTO-R score was found to correlate negatively to age of patients (the older, the less the score at ORTO-R, p = 0.001) and positively to 3 of the constructs of personality at the PID-5-BF, disinhibition, psychoticism and negative affect. Interestingly, ORTO-R was poorly associated to cancer variables, such as stage, hormone receptors, treatments, phenotype (luminal, HER2 positive, triple negative), lifestyle and psychiatric symptomatology. Conclusions: Eating behaviours among cancer patients may be influenced by psychological aspects and need to be addressed during follow-up. Further investigations are needed to evaluate correlation with BC specific characteristics.[Table: see text]
Fulvestrant with or without the cyclin-dependent kinase 7 (CDK7) inhibitor samuraciclib in advanced hormone receptor positive (HR+) breast cancer after CDK4/6 inhibition: Phase II SUMIT-BC study.
Authors: Pernas Sonia , Hinojo Carmen , Pascual Javier , Aksoy Sercan , Clack Glen , McIntosh Stuart
Published: June 2024

TPS1126

Background: CDK7 enhances oncogene transcription and upregulates anti-apoptotic genes, accelerates the cell cycle via CDK phosphorylation, and activates estrogen receptors (ERs) that can drive resistance to hormonal therapy in cancer. CDK7 inhibition therefore represents a potential anticancer strategy in cancer. Samuraciclib (CT7001) is a small molecule, ATP competitive, selective oral inhibitor of CDK7 that inhibits these key effects of CDK7. Samuraciclib had a favorable safety profile and showed clinical activity when combined with fulvestrant in a phase I study in patients with HR+/HER2− advanced breast cancer (BC) who had previously been treated with a CDK4/6 inhibitor. Patients with no detectable TP53 mutation in ctDNA at baseline and those without baseline liver metastases appeared to have better outcomes. The instant release capsule formulation of samuraciclib used in this study released large amounts of samuraciclib high in the gastrointestinal (GI) tract, which may have contributed to the observed low grade GI adverse events, which were managed with prophylaxis and counselling (1). Methods: A phase 2 open-label randomized study has been designed to evaluate the efficacy, safety, pharmacokinetics (PK), and quality of Life (QoL) of samuraciclib combined with fulvestrant compared to fulvestrant monotherapy (SUMIT-BC; NCT05963984). Eligible patients (n=60) are ≥18 years, have histologically or cytologically confirmed ER+/HER2− advanced or metastatic BC not amenable to resection or radiotherapy of curative intent, have received an aromatase inhibitor combined with a CDK4/6 inhibitor in the adjuvant or advanced setting, are receiving a luteinizing hormone-releasing hormone agonist if pre/perimenopausal, and have RECIST v1.1 evaluable disease. Prior SERD, mTOR inhibition, or chemotherapy for advanced BC are not permitted. All patients undergo baseline Guardant360 ctDNA analysis to establish TP53 and other mutation status. Patients are randomized 1:1:1 to fulvestrant alone (500 mg IM administered on days 1, 15 and 29 and then monthly), fulvestrant and samuraciclib 240 mg QD, or fulvestrant and samuraciclib 360 mg QD. In preparation for phase 3 development, a novel single tablet formulation of samuraciclib is used, which may enhance GI tolerability. Patients undergo RECIST v1.1 evaluation at baseline, every 8 weeks until week 48, and every 12 weeks thereafter. The primary endpoint is clinical benefit response at 24 weeks. Secondary endpoints are tolerability, progression free survival, overall response rate, duration of response, and PK of fulvestrant and samuraciclib. QoL (Functional Assessment of Cancer Therapy - Breast questionnaire [FACT-B]) and correlations between TP53 mutation and efficacy/safety will be assessed. 1. Coombes et al. Nature Comms 2023. Clinical trial information: NCT05963984 .
Genetic Background Strongly Influences the Impact of Carrying the Thr92Ala-DIO2 Polymorphism in the Male Mouse
Authors: Gabriel de Almeida Guilherme , Bolin Anaysa P , Batistuzzo Alice , Fonseca Tatiana L , Ribeiro Miriam O , Bianco Antonio C
Published: June 2024

About half of the world population carries at least one allele of the Ala92-DIO2, which slows down the activity of the type 2 deiodinase (D2), the enzyme that activates T4 to T3. Carrying the Ala92-DIO2 allele has been associated with increased body mass index and insulin resistance, but this has not been reproduced in all populations. To test if the genetic background affects the impact of this polymorphism, here we studied the genetically distant C57Bl/6J (B6) and FVB/N (FVB) mice carrying the Ala92-Dio2 allele as compared to control mice carrying the Thr92-Dio2 allele. Whereas B6-Ala92-Dio2 and B6-Thr92-Dio2 mice—fed chow or high-fat diet—behaved metabolically similar in studies using indirect calorimetry, glucose- and insulin tolerance tests, and measuring white adipose tissue (WAT) weight and liver steatosis, major differences were observed between FVB-Ala92-Dio2 and FVB-Thr92-Dio2 mice: carrying the Ala92-Dio2 allele (on a chow diet) resulted in hypercholesterolemia, smaller WAT pads, hepatomegaly, steatosis, and transcriptome changes in the interscapular brown adipose tissue (iBAT) typical of ER stress and apoptosis. Acclimatization at thermoneutrality (30 °C) eliminated most of the metabolic phenotype, indicating that impaired adaptive (BAT) thermogenesis can be involved. In conclusion, the metabolic impact of carrying the Ala92-Dio2 allele depends greatly on the genetic background of the mouse, varying from no phenotype in B6 mice to a major phenotype in FVB mice. These results will help the planning of future clinical trials studying the Thr92Ala-DIO2 polymorphism and may explain why some clinical studies performed in different populations across the globe have obtained inconsistent results.
Patient-Reported and Clinical Outcomes of Surgically Treated Patients With Symptomatic Spinal Metastases: Results From Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a Prospective, Multi-Institutional and International Study
Authors: Barzilai Ori , Sahgal Arjun , Rhines Laurence D. , Versteeg Anne L. , Sciubba Daniel M. , Lazary Aron , Weber Michael H. , Schuster James M. , Boriani Stefano , Bettegowda Chetan , Arnold Paul M. , Clarke Michelle J. , Laufer Ilya , Fehlings Michael G. , Gokaslan Ziya L. , Fisher Charles G.
Published: June 2024

BACKGROUND AND OBJECTIVES:

The palliative impact of spine surgery for metastatic disease is evolving with improvements in surgical technique and multidisciplinary cancer care. The goal of this study was to prospectively evaluate long-term clinical outcomes including health-related quality-of-life (HRQOL) measures, using spine cancer–specific patient-reported-outcome (PRO) measures, in patients with symptomatic spinal metastases who underwent surgical management.

METHODS:

The Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO, ClinicalTrials.gov identifier: NCT01825161) trial is a prospective-observational cohort study that included 10 specialist centers in North America and Europe. Patients aged 18 to 75 years who underwent surgery for spinal metastases were included. Prospective assessments included both spine tumor–specific and generic PRO tools which were collected for a minimum of 2 years post-treatment or until death.

RESULTS:

Two hundred and eighty patients (51.8% female, mean age 57.9 years) were included. At presentation, the mean Charlson Comorbidity Index was 6.0, 35.7% had neurological deficits as defined by the American Spinal Cord Injury Association scores, 47.2% had high-grade epidural spinal cord compression (2-3), and 89.6% had impending or frank instability as measured by a Spinal Instability Neoplastic Score of ≥7. The most common primary tumor sites were breast (20.2%), lung (18.8%), kidney (16.2%), and prostate (6.5%). The median overall survival postsurgery was 501 days, and the 2-year progression-free-survival rate was 38.4%. Compared with baseline, significant and durable improvements in HRQOL were observed at the 6-week, 12-week, 26-week, 1-year, and 2-year follow-up assessments from a battery of PRO questionnaires including the spine cancer–specific, validated, Spine Oncology Study Group Outcomes Questionnaire v2.0, the Short Form 36 version 2, EuroQol-5 Dimension (3L), and pain numerical rating scale score.

CONCLUSION:

Multi-institutional, prospective-outcomes data confirm that surgical decompression and/or stabilization provides meaningful and durable improvements in multiple HRQOL domains, including spine-specific outcomes based on the Spine Oncology Study Group Outcomes Questionnaire v2.0, for patients with metastatic spine disease.
Modelling human genetic disorders in Xenopus tropicalis
Authors: Willsey Helen Rankin , Seaby Eleanor G. , Godwin Annie , Ennis Sarah , Guille Matthew , Grainger Robert M.
Published: June 2024

Recent progress in human disease genetics is leading to rapid advances in understanding pathobiological mechanisms. However, the sheer number of risk-conveying genetic variants being identified demands in vivo model systems that are amenable to functional analyses at scale. Here we provide a practical guide for using the diploid frog species Xenopus tropicalis to study many genes and variants to uncover conserved mechanisms of pathobiology relevant to human disease. We discuss key considerations in modelling human genetic disorders: genetic architecture, conservation, phenotyping strategy and rigour, as well as more complex topics, such as penetrance, expressivity, sex differences and current challenges in the field. As the patient-driven gene discovery field expands significantly, the cost-effective, rapid and higher throughput nature of Xenopus make it an essential member of the model organism armamentarium for understanding gene function in development and in relation to disease.
Optimal Income Taxation
Authors: Kaplow Louis
Published: June 2024

This article explores subjects in optimal income taxation characterized by recent research interest, practical importance in light of concerns about inequality, potential for misunderstanding, and prospects for advancement. Throughout the analysis, paths for further investigation are highlighted. Areas of focus include multidimensional abilities and endogenous wages; asymmetric information and the income of founders; production and consumption externalities from labor effort; market power and rents; behavioral phenomena relating to perceptions of the income tax schedule, myopic labor supply, and the interactions of savings, savings policies, and labor supply; optimal income transfers; the relationship between optimal income taxation and the use of other instruments; and issues relating to the social welfare function and utility functions, including non-welfarist objectives, welfare weights, heterogeneous preferences, and taxation of the family. (JEL D63, D82, D91, H21, H24, H53, J22)
Meta-analysis of Empirical Estimates of Loss Aversion
Authors: Brown Alexander L. , Imai Taisuke , Vieider Ferdinand M. , Camerer Colin F.
Published: June 2024

Loss aversion is one of the most widely used concepts in behavioral economics. We conduct a large-scale, interdisciplinary meta-analysis to systematically accumulate knowledge from numerous empirical estimates of the loss aversion coefficient reported from 1992 to 2017. We examine 607 empirical estimates of loss aversion from 150 articles in economics, psychology, neuroscience, and several other disciplines. Our analysis indicates that the mean loss aversion coefficient is 1.955 with a 95 percent probability that the true value falls in the interval [1.820, 2.102]. We record several observable characteristics of the study designs. Few characteristics are substantially correlated with differences in the mean estimates. (JEL D81, D91)
Περιβαλλοντικοί πρόσφυγες: Η υπόθεση του Ioane Teitiota κατά Νέας Ζηλανδίας
Authors: Λαδάς Ιωάννης
Published: June 2024

Ο Ioane Teitiota, με καταγωγή από τη Δημοκρατία του Κιριμπάτι, ζήτησε άσυλο στη Νέα Ζηλανδία, υποστηρίζοντας ότι τόσο ο ίδιος όσο και η οικογένειά του αναγκάστηκαν να εγκαταλείψουν την Ταράουα, εξαιτίας της σημειούμενης περιβαλλοντικής διατάραξης, η οποία έθετε σε κίνδυνο τη ζωή τους. Το γεγονός αυτό και οι πραγματοποιηθείσες ενέργειες για την αναγνώρισή του ως περιβαλλοντικού πρόσφυγα είχαν ως αποτέλεσμα να δοκιμαστούν τα όρια του διεθνούς δικαίου και να αποκαλυφθούν τα κενά, αναφορικά με την προστασία των ανθρώπων που πλήττονται από τις επιπτώσεις της κλιματικής αλλαγής. Αν και η υπόθεση δεν έληξε θετικά για τον Teitiota, χαρακτηρίστηκε ορόσημο, καθώς αποτελεί ένα σημαντικό βήμα και συνεισφέρει στη νομολογία για τα δικαιώματα των περιβαλλοντικών προσφύγων. Υπό το πνεύμα αυτό, στο ανά χείρας άρθρο αφενός εξετάζεται η περίπτωση του Ioane Teitiota και αφετέρου επιχειρείται η ηθική της αξιολόγηση.
Unpacking WHO and CDC Bottle Bioassay Methods: A Comprehensive Literature Review and Protocol Analysis Revealing Key Outcome Predictors
Authors: Praulins Giorgio , Murphy-Fegan Annabel , Gillespie Jack , Mechan Frank , Gleave Katherine , Lees Rosemary
Published: June 2024

Background Resistance monitoring is a key element in controlling vector-borne diseases. The World Health Organization (WHO) and Centres for Disease Control and Prevention (CDC) have each developed bottle bioassay methods for determining insecticide susceptibility in mosquito vectors which are used globally. Methods This study aimed to identify variations in bottle bioassay methodologies and assess the potential impact on the data that is generated. Our approach involved a systematic examination of existing literature and protocols from WHO and CDC, with a focus on the specifics of reported methodologies, variation between versions, and reported outcomes. Building on this, we experimentally evaluated the impact of several variables on bioassay results. Results Our literature review exposed a significant inconsistency in the how bioassay methods are reported, hindering reliable interpretation of data and the ability to compare results between studies. The experimental research provided further insight by specifically identifying two key factors that influence the outcomes of bioassays: mosquito dry weight and relative humidity (RH). This finding not only advances our comprehension of these assays but also underscores the importance of establishing precisely defined methodologies for resistance monitoring. The study also demonstrates the importance of controlling bioassay variables, noting the significant influence of wing length, as an indicator of mosquito size, on mortality rates in standardized bioassays. Conclusions Generating data with improved protocol consistency and precision will not only deepen our understanding of resistance patterns but also better inform vector control measures. We call for continued research and collaboration to refine and build consensus on bioassay techniques, to help bolster the global effort against vector-borne diseases like malaria.
Diagnostic test accuracy of screening tools for the detection of neurocognitive disorders in older adults post-trauma: A protocol for a systematic review
Authors: Merriman Niamh A. , Walsh Mary E. , O'Regan Niamh , Carrigan Marie , Hickey Pamela , Brent Louise , Blake Catherine
Published: June 2024

Background Neurocognitive disorders (NCDs), including delirium, cognitive impairment, or dementia are prevalent in up to 39% of older adults in acute care, particularly older trauma patients. Undiagnosed NCDs result in poor outcomes, such as increased incidence of depressive symptoms, longer length of stay, and mortality. Objective This study aims to identify the diagnostic test accuracy of screening tools for the detection of NCDs in older trauma patients in acute settings. Design Systematic review protocol. Literature search Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library) will be searched for journal articles. Search terms related to NCDs, delirium and cognitive screening tools, and diagnostic accuracy will be included. Study selection criteria Cross-sectional, prospective, or retrospective cohort studies of adults aged ≥60 post-trauma, in an acute setting, will be included where the study aimed to validate a screening tool for detection of 1) delirium or 2) cognitive impairment, or dementia against a reference standard of a clinical decision, based on standardised diagnostic criteria or a validated tool. Data synthesis Two review authors will conduct study selection, data extraction, and appraisal. Data will be extracted based on the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) checklist. Studies will be assessed for methodological quality by two independent review authors using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Narrative summaries will be generated describing risk of bias and concerns regarding applicability. Quantitative synthesis of study findings will be conducted. Conclusion This systematic review will aim to identify screening tools with the best diagnostic accuracy for detection of 1) delirium and 2) cognitive impairment or dementia in adults aged ≥60 post-trauma in acute care settings. Results will inform clinical practice to enhance the probability of patients with NCDs receiving appropriate care and management. Registration PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024518730 (11/03/2024).
Testing ethical impact assessment for nano risk governance
Authors: MALSCH Ineke , Isigonis Panagiotis , Bouman Evert , Afantitis Antreas , Melagraki Georgia , Dusinska Maria
Published: June 2024

Risk governance of nanomaterials and nanotechnologies has been traditionally mainly limited to risk assessment, risk management and life cycle assessment. Recent approaches have experimented with widening the scope and including economic, social, and ethical aspects. This paper reports on tests and stakeholder feedback on fine-tuning the use of ethical impact assessment guidelines (RiskGONE D3.6) and online tools adapting the CEN Workshop Agreement part 2 CWA 17145-2:2017 (E)) to support risk governance of nanomaterials, in the RiskGONE project. The EIA guidelines and tools are intended to be used as one module in a multicriteria decision support framework for risk governance of nanomaterials, but may also be used for a stand-alone ethical impact assessment.
The Beating Heart of Untapped Business Opportunities for Additive Manufacturing
Authors: Froes Isabel , Struthers David , Malacarne Ciro , Perini Matteo , Rossi Maurizio , Gregori Paolo
Published: June 2024

This article presents two cases that join user-driven innovation and additive manufacturing (AM) to examine latent business opportunities for AM in the medical sector. The first case arose as a response to shortages during the early stages of the covid 19 pandemic. The second case, explored in more depth, came from maker-medical collaboration during preparation for a life-threatening operation. Surgeons, confronted with a patient with a delicate heart condition, collaborated with a prototyping facility to print a realistic 3D model of the patient’s aortic aneurysm. The model allowed the surgeons to first study and then experiment to determine the most effective operation procedure before the actual operation, which shortened the surgery time by approximately 70%. Reducing surgery time creates two forms of value: improving patient outcomes and reducing costs. Shorter times under anesthetic and on cardiopulmonary bypass correlate with better surgical results. Reducing healthcare costs brings broad societal benefits in both publicly and privately funded healthcare systems. We outline a case for makerspaces to capture value by joining their expertise and manufacturing equipment with the needs of nearby healthcare systems for novel business development.
Therapeutic relationship elements and therapy session outcomes: Protocol for a longitudinal study of the patient’s perspective.
Authors: Stefana Alberto , Fusar-Poli Paolo , Vieta Eduard , Youngstrom Eric A.
Published: June 2024

Background There is a growing recognition of the key role of the therapeutic relationship in the outcomes of psychotherapy. However, current understanding of its specific components, their interplay and related patient-therapist dynamics is limited. Objective (a) To validate two self-report measures to assess subjective affective reactions of patients toward their psychotherapists during specific therapy sessions, and (b) to explore the relationships and dynamics among four elements of the therapeutic relationship: patient reactions toward the therapist, working alliance, alliance ruptures and repairs, and the real relationship. Methods This study uses a nonrandomized, two-time point longitudinal design. The target population is adult patients currently engaged in individual psychotherapy for heterogeneous mental conditions. Participants are recruited through two online recruitment platforms: Research for Me and ResearchMatch. Data collection involves administering two surveys through the Qualtrics online survey platform. The baseline survey assesses information about the most recent therapy session and the preceding week, while the follow-up survey collects data on the subsequent therapy session and the days leading up to it. Discussion This research offers three main contributions: (a) it furthers evidence-based assessment in psychotherapy by creating and validating two novel, succinct self-report tools; (b) it enhances theoretical understanding within therapeutic relationship research by exploring the significant impact of patients' perceptions of relationship elements on session outcomes variability; and (c) it will identify therapeutic relationship elements that can either enhance or hinder the overall relationship quality and session outcomes. Ethics and dissemination The study protocol was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill. The results will be published in indexed peer-reviewed journals and presented at relevant psychology and psychiatry conferences.
Clinical Applications of Phototherapy in Treating Skin Disorders
Authors: Dębiec Patrycja , Roman Jakub , Gondko Daniel , Pietrzak Nikodem
Published: June 2024

Introduction and Purpose: Phototherapy, involving the therapeutic use of ultraviolet and visible light, has been a cornerstone in dermatology for treating various skin disorders. This review aims to consolidate current knowledge on the mechanisms of action and clinical applications of phototherapy, with a focus on enhancing understanding among clinicians and researchers.State of Knowledge: Phototherapy is particularly effective for chronic conditions such as psoriasis, vitiligo, and atopic dermatitis, where traditional therapies might not suffice. The mechanism involves modulation of immune response and inhibition of cellular proliferation, achieved through various wavelengths, including UVA and UVB. Recent advancements have introduced narrow-band UVB, which offers targeted therapy with fewer side effects compared to broad-band UVB. Moreover, the review explores innovations such as LED-based therapies and photodynamic therapy, expanding the spectrum of phototherapeutic options.Summary: Phototherapy remains a vital and evolving treatment modality in dermatology, offering safe and effective management for multiple skin disorders. Its success hinges on precise application and adherence to treatment protocols. Future research should aim to optimize treatment regimens, reduce side effects, and enhance patient compliance to improve outcomes. By advancing our understanding and application of phototherapy, we can better tailor treatments to meet individual patient needs, thereby improving the quality of life for those afflicted with chronic skin conditions.
Why is surgery not popular among medical students and young doctors? - Review of literature
Authors: Daniel Piotr , Składanek Justyna , Leśkiewicz Michał , Otręba Karina , Cieszkowska Joanna , Czupryńska Karolina
Published: June 2024

Introduction: Contemporary medicine is witnessing significant advancements in conservative treatment modalities. However, surgery remains paramount for radical cancer treatment and emergent conditions such as trauma, peritonitis, gastrointestinal obstruction, and cholecystitis. Despite the essential role of surgeons, there is a global trend indicating waning interest among medical students in pursuing surgical specialties. Concurrently, practicing surgeons report heightened levels of professional burnout, and many regions face a looming shortage of surgical professionals, posing a threat to healthcare quality.
Brief Overview of Current Knowledge: Research conducted across Poland, Germany, Argentina, the United Kingdom, and Japan highlights the declining inclination towards surgery among medical students. Students cite unattractive working conditions, poor work-life balance, elevated stress levels, and limited avenues for scholarly growth as deterrents. Gender plays a role, with females expressing heightened concerns regarding work-life balance and family aspirations. Furthermore, the surgical work environment, inadequate preparatory training in medical schools, and prolonged working hours are identified as factors exacerbating burnout risk among surgeons.
Summary: Professional burnout represents a significant concern among surgeons, impacting both their work satisfaction and patient safety. Despite the strides made in conservative medical therapies, surgery remains indispensable, yet its allure as a specialty is diminishing among medical students. Understanding and addressing the discouraging factors, along with promoting healthy work practices, may mitigate burnout and encourage young physicians to consider surgical careers.
Does Volunteering Crowd Out Donations? Evidence from Online Experiments
Authors: Wu Chao , Eftekhar Mahyar
Published: June 2024

Problem definition: Conventional wisdom often cautions charities against providing volunteer opportunities to potential donors based on the assumption that volunteering crowds out monetary donations. We challenge this assumption and investigate the causal relationship between an individual’s volunteering activities and their subsequent decisions to donate. Methodology/results: We conducted three consequential experiments where participants engaged in virtual assignments and were subsequently prompted to donate to an existing charity. In the first two experiments, participants were tasked with creating affectionate cards for the homeless, enjoying full autonomy in the design of these cards. In the third experiment, participants colored patterns of varying complexity. Our results indicated that volunteering increased both the propensity and the amount of participants’ donations, pointing to a potential explanation rooted in moral consistency. However, as individuals’ volunteering efforts intensified, their subsequent donations decreased, reflecting a mental budgeting mechanism in these settings. Managerial implications: Our results suggest that (i) volunteer programs not only build up a charity’s labor source but may also increase their donation income; (ii) charities should consider developing virtual volunteering programs that increase their resources by connecting them with more volunteers; and (iii) to maximize donations, charities should carefully design light volunteer tasks.
Experiências subjetivas de estudante universitária ingressante pelo sistema de cotas
Authors: Nunes Mallu Stephanie de Almeida , Ramos Wilsa Maria
Published: June 2024

A Lei Federal Brasileira 12711/2012 ampliou o acesso ao ensino superior federal público assegurando vagas para os estudantes concluintes do ensino médio em escolas públicas. A pesquisa teve por objetivo compreender como a condição de estudante universitário está configurada subjetivamente para uma estudante cotista da Universidade de Brasília. O estudo baseia-se na Teoria da Subjetividade e na Epistemologia Qualitativa, na perspectiva histórico-cultural. Em termos metodológicos, realizou-se o estudo de caso baseado nos princípios da Metodologia Construtivo-Interpretativa, organizado por meio de dinâmicas conversacionais e instrumentos indutores da produção subjetiva. A análise das informações evidenciou que no curso das experiências da estudante no espaço sociorrelacional universitário e em outros contextos foram gerados recursos subjetivos favorecedores de novos processos de subjetivação rompendo com o sistema normativo hegemônico do não pertencimento à universidade e se posicionando na condição de sujeito. Recomenda-se a promoção de ações que busquem a integração social e acadêmica dos estudantes.
Tracing Montessori
Authors: Willis Richard
Published: June 2024

Richard Willis, visiting professor at the University of South Wales, reviews a book which charts Montessori education from its historical roots to exploring current scholarship and contemporary issues
Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice
Authors: Xing Ying , Liu Zheng-Rong , Li You-Guo , Zhang Hong-Yi
Published: June 2024

BACKGROUND

Percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice, yet the safety and effect of endobiliary radiofrequency ablation (EB-RFA) combined PTCD is rarely reported, in this article, we report our experience of EB-RFA combined PTCD in such patients.

AIM

To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.

METHODS

Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected, the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases. The general conditions of all patients, preoperative tumour markers, total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), alkaline phosphatase (ALP), and glutamyl transferase (GGT) before and on the 7th day after the procedure, as well as perioperative complications, stent patency time and patient survival were recorded.

RESULTS

All patients successfully completed the operation, TBIL and DBIL decreased significantly in all patients at the 7th postoperative day (P = 0.009 and 0.006, respectively); the values of ALB, ALP and GGT also decreased compared with the preoperative period, but the difference was not statistically significant. Perioperative biliary bleeding occurred in 2 patients, which was improved after transfusion of blood and other conservative treatments, pancreatitis appeared in 1 patient after the operation, no serious complication and death happened after operation. Except for 3 patients with loss of visits, the stent patency rate of the remaining 14 patients was 100% 71% and 29% at the 1st, 3rd, and 6th postoperative months respectively, with a median survival of 4 months.

CONCLUSION

EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety, which is worthy of further clinical practice.