bluuebunny/crossref_metadata_2025 huggingface dataset:
“I’d like more options!”: Interviews to explore young people and family decision-making needs for pain management in juvenile idiopathic arthritis
Authors: Toupin-April Karine , Gaboury Isabelle , Proulx Laurie , Huber Adam M. , Duffy Ciarán M. , Morgan Esi M. , Li Linda C. , Stringer Elizabeth , Connelly Mark , Weiss Jennifer E. , Gibbon Michele , Sachs Hannah , Sivakumar Aditi , Sirois Alexandra , Sirotich Emily , Trehan Natasha , Abrahams Naomi , Cohen Janice S. , Cavallo Sabrina , Hindi Tania El , Ragusa Marco , Légaré France , Brinkman William B. , Fortin Paul R. , Décary Simon , Lee Rebecca , Gmuca Sabrina , Paterson Gail , Tugwell Peter , Stinson Jennifer N.
Published: July 2023

Background

Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families’ decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs.

Methods

We conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8–18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis.

Results

A total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families’ values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied.

Conclusions

Findings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.
Silent suffering: unveiling factors associated with women’s inability to seek help for intimate partner violence in sub-Saharan Africa (SSA)
Authors: Dickson Kwamena S. , Boateng Ebenezer N. K. , Adzrago David , Addo Isaac Y. , Acquah Evelyn , Nyarko Samuel H.
Published: July 2023

Background

Evidence shows that intimate partner violence (IPV) occurs more frequently in sub-Saharan Africa (SSA) than in other regions of the world. However, limited empirical studies exist on the help-seeking behaviour of women who had experienced IPV in SSA. This study aimed to examine the help-seeking behaviour of women who had experienced IPV in SSA and the factors associated with their inability to seek help after experiencing IPV.

Methods

This is a quantitative study based on data from the latest demographic and health surveys (DHS) of 24 SSA countries. A sample of 53,446 women aged 15–49 years was included in the study. Associations between women’s background characteristics and their help-seeking behaviour after experiencing IPV were examined using proportions and multivariate logistic regression models.

Results

Overall, 60.7% of the sample did not seek help after experiencing IPV. Women's inability to seek help for IPV was highest in Mali (80.4%) and lowest in Tanzania (43.1%). Women’s level of education, wealth status, marital status, age, occupation, and country of residence had significant associations with ‘not seeking help’ for any type of IPV. Those who experienced generational violence (AOR = 1.26, CI = 1.19, 1.33) and those who justified wife-beating (AOR = 1.09, CI = 1.07, 1.15) had higher odds of not seeking help for any type of IPV compared to those who did not experience generational violence or did not justify wife beating. Women who experienced emotional violence (AOR = 0.53, CI = 0.51, 0.55) and physical violence (AOR = 0.74, CI = 0.70, 0.76) had lower odds of not seeking help for any type of IPV compared to their counterparts who did not experience these types of violence.

Conclusion

Women’s inability to seek help for IPV is common in many SSA countries. This study shows that several socio-demographic factors, such as women's age, educational levels, wealth status, and marital status are associated with their inability to seek help for IPV. Additionally, women's justification of wife beating and experience of generational abuse are strongly associated with their inability to seek help for IPV. These factors need to be considered critically in IPV interventions in SSA.
Management of atrial fibrillation in German military aircrew
Authors: Guettler Norbert , Sammito Stefan
Published: July 2023

Introduction

Arrhythmias are one of the most common causes of loss of flying privileges for both military and civilian pilots in the Western World, and atrial fibrillation (AF) is one of the most common arrhythmias worldwide. Aircrew, and particularly pilots, are subject to a unique and exacting working environment, especially in high-performance military aircraft. This manuscript analyzes AF cases in German military aircrew from both a clinical and occupational perspective to point out specific characteristics in this comparatively young, highly selected, and closely monitored group, and to discuss AF management with the aim of a return to flying duties.

Methods

The digital information systems of the German Air Force Centre of Aerospace Medicine (GAFCAM) were searched for aircrew (pilot and non-pilot aircrew from German Air Force, Army, and Navy) with the diagnosis of AF. Evaluation results for underlying disease, AF characteristics, important clinical findings, and occupational decisions were analyzed in the light of current clinical guidelines and aeromedical regulations.

Results

In a 34-year period, between March 1989 and January 2023, 42 aircrew with at least one episode of AF were registered, all of them were male. The median age at initial diagnosis was 47 years (min 22 years, max 62 years). The median follow-up period was 5.35 years. 19 of them (45%) were pilots. The breakdown of events and occurrence was found to be: single (23), paroxysmal (16), persistent (2), permanent (1). In 27 aircrew (64%) AF terminated spontaneously. Long-term recurrence prevention was variable with catheter ablations in 8 cases. 36/42 aircrew were returned to flight status with restrictions, while 6/42 were permanently disqualified from flying.

Conclusion

Management of AF in military aircrew requires a comprehensive approach regarding the flight environment as well as clinical guidance. Aeromedical disposition should be case-by-case based on aeromedical regulations, individual clinical findings, and specific occupational requirements in this challenging field of work.
Management strategies and root causes of missed iatrogenic intraoperative ureteral injuries with delayed diagnosis: a retrospective cohort study of 40 cases
Authors: Zaghbib Selim , Saadi Ahmed , Boussaffa Hamza , Ayed Haroun , Slama Mohamed Riadh Ben
Published: July 2023

Background

Intraoperative iatrogenic ureteral injuries represent rare technical surgical complications with the potential for adverse patient outcomes, particularly when the diagnosis is delayed. Ideally, these technical complications are recognized and repaired intraoperatively. This study was designed to investigate the root causes and outcomes of missed intraoperative ureteral injuries at a tertiary urology referral centre in Tunisia.

Methods

This is a retrospective cohort study in a tertiary urology referral centre in Tunis from January 1st, 2015, to December 31st, 2020, including all patients with iatrogenic ureteral injury, not diagnosed intraoperatively. The factors associated with the success of endoscopic treatment and those associated with the unfavourable evolution were investigated.

Results

A total of 40 iatrogenic ureteral injuries were included. Gynaecological surgery was responsible for 85% of ureteral injuries, mainly during hysterectomies (55%). The symptoms were dominated by low back pain (37.5%) and pyelonephritis (25%). Endoscopic treatment was attempted in 22 cases, it was sufficient in 12 cases. Ureteral injury required surgical treatment in 24 cases, and ureteroneocystostomy was performed in 16 cases. Nephrectomy was performed in eight cases, representing 20% of injuries, including three cases as the first treatment for late-diagnosed cases with a destroyed kidney. In the analytical study, endoscopic treatment was sufficient in 50% in case of ureteral fistula versus 27% in case of ureteral stenosis (p = 0.04). Nephrectomy was performed in 10% of cases when ureteral injury was diagnosed within the first month postoperatively compared to 60% of cases when this delay exceeded one month (p = 0.004).

Conclusion

Iatrogenic ureteral injuries discovered postoperatively are mostly secondary to gynaecologic surgery. Although endoscopic treatment is usually performed as a first treatment, a more aggressive surgical is often necessary, with a nephrectomy rate of 20%.
Changes in the production materials of Burmese textiles in the nineteenth century—dyes, mordants and fibres of Karen garments from the British Museum’s collection
Authors: Tamburini Diego , Dyer Joanne , Cartwright Caroline , Green Alexandra
Published: July 2023

The materials of six Karen textiles from the British Museum’s collection were investigated with the main aim of studying the production changes over the course of the nineteenth century and how these changes related to local and colonial trade networks. The textiles span chronologically from the 1830s to the early 1900s according to their attribution dates, and include traditional garments such as tunics and skirts, in addition to representing a broad colour palette and different dyeing and weaving techniques. The investigation was conducted non-invasively by using digital microscopy, broadband multispectral imaging (MSI) and fibre optic reflectance spectroscopy (FORS). The results guided a sampling campaign during which samples were taken and investigated by optical microscopy (OM), scanning electron microscopy energy dispersive X-ray spectrometry (SEM–EDX) and high-performance liquid chromatography coupled to diode array detector and tandem mass spectrometry (HPLC–DAD-MS/MS). Local natural dyes, such as red and yellow from Morinda citrifolia, lac dye (Kerria lacca), gamboge (Garcinia sp.), turmeric (Curcuma longa), indigo and tannins were found in the older textiles, supporting a possible early production, whereas mixtures of natural and synthetic dyes, including synthetic alizarin (CI 58000), rhodamine B (CI 45170), orange I (CI 14600), diamond green B (CI 42000), diamond green G (CI 42040), auramine O (CI 41000), naphthol yellow S (CI 10316), chrysamine G (CI 22250), crystal violet (CI 42555) and Pigment Red 53:1 (CI 15585:1) were identified in the later textiles. Observations on mordants revealed the use of aluminium, tin and chrome, whereas fibre characterisation highlighted the use not only of cotton (Gossypium sp.) but also of felted wool imported from Europe and Chinese silk dyed with the Chinese cork tree (Phellodendron chinense) yellow dye. The results draw an interesting picture of the introduction of new dyeing materials and techniques in Myanmar over the nineteenth century, and how these impacted the production of traditional Karen textiles.
Exploration of a crucial mechanical property of gap-filling materials for restoration of deformed bronze and tentative application of carbon fiber reinforced composites
Authors: Shen Yijia
Published: July 2023

The fracture of a bronze object is usually accompanied by localized deformation. The deformed part often tends to spring back at an unpredictable moment after its shape is corrected. The reconstruction of the area adjacent to the damage should be sufficiently resistant to the stress derived from springback so that the whole structure can remain stable. However, the choice of gap-filling materials for bronze objects is typically based on personal experience, and there are few available studies on their pertinent properties. The present study focused on a typical situation of deformation, took the flexural modulus as a crucial parameter and explored the development of a protocol for selecting a gap-filling material for bronze restoration in terms of its mechanical property. The flexural modulus was measured for the main classes of materials in use, and the factors related to preparation that influenced performance were studied. Among the various materials tested, carbon fiber reinforced (CFR) materials exhibited an advantageous value of the modulus and notable operational convenience. Further tests were conducted to assess their chemical safety for application in a museum context, as well as their surface workability. After obtaining overall encouraging results, composites reinforced with CF cloth and chopped CF were applied to the reconstruction of different parts of an archaeological bronze vessel. Indications for future improvement in the experimental setup and some practical notes regarding the use of CFR materials were also provided in this paper.
FDG-PET/CT for lymph node staging prior to radical cystectomy
Authors: Pihl Vilhelm , Markus Maria , Abrahamsson Johan , Bläckberg Mats , Hagberg Oskar , Kollberg Petter , Simoulis Athanasios , Trägårdh Elin , Liedberg Fredrik
Published: July 2023

Background

18F-Fluorodeoxyglucose positron emission combined with computed tomography (FDG-PET/CT) has been proposed to improve preoperative staging in patients with bladder cancer subjected to radical cystectomy (RC).

Objective

Our aim was to assess the accuracy of FDG-PET/CT for lymph node staging ascertained at the multidisciplinary tumour board compared to lymph node status in the surgical lymphadenectomy specimen obtained at RC, and to explore potential factors associated with false-positive FDG-PET/CT results.

Design, setting and participants

Consecutive patients with bladder cancer undergoing RC with extended lymph node dissection between 2011 and 2019 without preoperative chemotherapy in a tertial referral cystectomy unit were included in the study.

Outcome measurements and statistical analyses

Sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated. Potential factors investigated for association with false-positive FDG-PET/CT were; bacteriuria within four weeks prior to FDG-PET/CT, Bacillus Calmette–Guerin (BCG) treatment within 12 months prior to FDG-PET/CT and transurethral resection of bladder tumour (TURB) within four weeks prior to FDG-PET/CT.

Results

Among 157 patients included for analysis, 44 (28%) were clinically node positive according to FDG-PET/CT. The sensitivity and specificity for detection of lymph node metastasis were 50% and 84%, respectively, and the corresponding positive predictive and negative predictive values were 61% and 76%. Positive and negative likelihood ratios were 3.0 and 0.6, respectively. No association was found between bacteriuria, previous BCG treatment or TURB within 28 days and false-positive FDG-PET/CT results.

Conclusions

Preoperative FDG-PET/CT prior to RC had a clinically meaningful high specificity (84%) but lower sensitivity (50%) for detection of lymph node metastases compared to lymph node status in an extended pelvic lymphadenectomy template. We could not identify any factors associated with false-positive FDG-PET/CT outcomes.
Severity of waterborne diseases in developing countries and the effectiveness of ceramic filters for improving water quality
Authors: Shayo Godfrey Michael , Elimbinzi Elianaso , Shao Godlisten N. , Fabian Christina
Published: July 2023

Background

It is anticipated that three (3) billion people will experience water stress by 2025 due to limited access to clean water. Water-related diseases and fatalities affect both industrialized and developing countries. Waterborne diseases are challenging worldwide, especially in developing countries. This article evaluates strategies used by various countries, particularly developing countries, to combat waterborne diseases. These strategies have been largely successful in reducing the prevalence of water-related diseases in developing countries.

Main body of the abstract

The effectiveness of these strategies is evaluated in terms of their ability to remove water contaminants such as bacteria, viruses, and chemicals. Different strategies can be used, including traditional water treatment techniques such as boiling, chlorination, flocculation, solar disinfection and ceramic-based water filtration systems. These methods can help improve water quality and safety. The choice of strategy depends on the specific contaminants in the water and the desired outcome. Proper implementation of these strategies is key to ensuring safe drinking water.

Short conclusion

It was revealed that in developing countries, multiple water treatment techniques are used. This has led to the reduction in waterborne diseases from 50 to 90%. Ceramic-based water purification systems are reportedly the modern and least expensive technique, since they are highly efficient and can be made locally. Thus, ceramic water filtration systems are widely used due to their affordability and easy maintenance.
Mortality in a Moroccan psychiatric hospital
Authors: Khlil Chouaib , Attouche Nadia , Choujaa Hafsa , Alami Khadija Mchichi
Published: July 2023

Background and objectives

Even though the statistics have shown that patients with severe mental disorders such as schizophrenia and bipolar disorder are most likely to die 10 to 20 years earlier than the general population, the information on mortality in the Moroccan psychiatric setting is significantly limited. In the course of this study, we aim to describe the clinical characteristics and death-related data of the 18 patients who died over 10 years.

Methods

It is a retrospective and descriptive study of deceased inpatients within the Department of Psychiatry of the University Hospital Center, Ibn Rochd. The study extended over a period of 10 years, from January 1, 2011, to January 1, 2021.

Results

The study identified the death cases of 18 patients over 10 years, with a mortality rate of 1.99/1000, in which the average age of death is around 46,4 years. Men represented 55.6% of the deceased patients. 44.4% were diagnosed with schizophrenia, and 39% had medical comorbidity. The most common causes of death were cardiac causes (22.2%), followed by neuroleptic malignant syndrome (16.7%). Suicide, sudden death, and digestive diseases accounted for 11.1% of all causes.

Conclusion

People with mental disorders experience a high mortality rate. In this study, cardiovascular diseases and the neuroleptic malignant syndrome were the main causes of death, which requires close monitoring of high-risk psychiatric patients with comorbid cardiac problems.
Emergence of a New Glucoregulatory Mechanism for Glycemic Control With Dapagliflozin/Exenatide Therapy in Type 2 Diabetes
Authors: Cersosimo Eugenio , Alatrach Mariam , Solis-Herrera Carolina , Baskoy Gozde , Adams John , Hansis-Diarte Andrea , Gastaldelli Amalia , Chavez Alberto , Triplitt Curtis , DeFronzo Ralph A
Published: July 2023

Context

This study addresses the development of a new glucoregulatory mechanism in type 2 diabetes (T2D) patients treated with SGLT-2 inhibitors, which is independent of glucose, insulin and glucagon. The data suggest the presence of a potential trigger factor (s) arising in the kidney that stimulates endogenous glucose production (EGP) during sustained glycosuria.

Objective

To investigate effects of SGLT-2 inhibitor therapy together with GLP-1 receptor agonist on EGP and glucose kinetics in patients with T2D. Our hypothesis was that increased EGP in response to SGLT2i-induced glycosuria persists for a long period and is not abolished by GLP-1 RA stimulation of insulin secretion and glucagon suppression.

Methods

Seventy-five patients received a 5-hour dual-tracer oral glucose tolerance test (OGTT) (intravenous 3-(3H)-glucose oral (1-14C)-glucose): (1) before/after 1 of dapagliflozin (DAPA); exenatide (EXE), or both, DAPA/EXE (acute study), and (2) after 1 and 4 months of therapy with each drug.

Results

In the acute study, during the OGTT plasma glucose (PG) elevation was lower in EXE (Δ = 42 ± 1 mg/dL) than DAPA (Δ = 72 ± 3), and lower in DAPA/EXE (Δ = 11 ± 3) than EXE and DAPA. EGP decrease was lower in DAPA (Δ = −0.65 ± 0.03 mg/kg/min) than EXE (Δ = −0.96 ± 0.07); in DAPA/EXE (Δ = −0.84 ± 0.05) it was lower than EXE, higher than DAPA. At 1 month, similar PG elevations (EXE, Δ = 26 ± 1 mg/dL; DAPA, Δ = 62 ± 2, DAPA/EXE, Δ = 27 ± 1) and EGP decreases (DAPA, Δ = −0.60 ± 0.05 mg/kg/min; EXE, Δ = −0.77 ± 0.04; DAPA/EXE, Δ = −0.72 ± 0.03) were observed. At 4 months, PG elevations (EXE, Δ = 55 ± 2 mg/dL; DAPA, Δ = 65 ± 6; DAPA/EXE, Δ = 46 ± 2) and lower EGP decrease in DAPA (Δ = −0.66 ± 0.04 mg/kg/min) vs EXE (Δ = −0.84 ± 0.05) were also comparable; in DAPA/EXE (Δ = −0.65 ± 0.03) it was equal to DAPA and lower than EXE. Changes in plasma insulin/glucagon could not explain higher EGP in DAPA/EXE vs EXE mg/kg/min.

Conclusion

Our findings provide strong evidence for the emergence of a new long-lasting, glucose-independent, insulin/glucagon-independent, glucoregulatory mechanism via which SGLT2i-induced glycosuria stimulates EGP in patients with T2D. SGLT2i plus GLP-1 receptor agonist combination therapy is accompanied by superior glycemic control vs monotherapy.
Endovascular Thrombectomy for the Treatment of Large Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Control Trials
Authors: Atchley Travis J. , Estevez-Ordonez Dagoberto , Laskay Nicholas M. B. , Tabibian Borna E. , Harrigan Mark R.
Published: July 2023

BACKGROUND AND OBJECTIVES:

Endovascular thrombectomy has previously been reserved for patients with small to medium acute ischemic strokes. Three recent randomized control trials have demonstrated functional benefit and risk profiles for thrombectomy in large-volume ischemic strokes. The primary objective of the meta-analysis was to determine the combined benefit of endovascular thrombectomy in patients with large-volume ischemic strokes and to determine the risk of adverse events after treatment.

METHODS:

We systematically searched Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Scopus, the Cochrane Central Register, and Google Scholar for randomized trials published between January 1, 2010, and February 19, 2023. We included trials specifically comparing endovascular thrombectomy with medical therapy in adults with acute ischemic stroke with large-volume infarctions (defined by Alberta Stroke Program Early Computed Tomography Score 3-5 or a calculated infarct volume of >50 mL). Data were extracted based on prespecified variables on study methods and design, participant characteristics, analysis approach, and efficacy/safety outcomes. Results were combined using a restricted maximum-likelihood estimation random-effects model. Studies were assessed for potential bias and quality of evidence. The primary outcome was an overall ordinal shift across modified Rankin scale scores toward a better outcome at 90 days after either treatment arm.

RESULTS:

Three thousand forty-four studies were screened, and 29 underwent full-text review. Three randomized trials (N = 1011) were included in the analysis. The pooled random-effects model for the primary outcome favored endovascular thrombectomy over medical management, with a generalized odds ratio of 1.55 (95% CI 1.25-1.91, I2= 42.84%). There was a trend toward increased risk of symptomatic intracranial hemorrhage in the thrombectomy group, with a relative risk of 1.85 (95% CI 0.94-3.63, I2= 0.00%).

CONCLUSION:

In patients with large-volume ischemic strokes, endovascular thrombectomy has a clear functional benefit and does not confer increased risk of significant complications compared with medical management alone.
Fast Synthesis of CHA-type Zeolite Using Dealuminated Amorphous Aluminosilicates with High Reactivity
Authors: Sada Yuki , Miyagi Shoko , Yoshioka Masato , Ishikawa Tomoya , Naraki Yusuke , Sano Tsuneji , Okubo Tatsuya , Wakihara Toru
Published: July 2023

Use of dealuminated amorphous aluminosilicates (deAl-Amor) achieved faster synthesis of CHA-type zeolites compared with using conventional amorphous aluminosilicates (Amor). The deAl-Amor also expanded the synthesis window of reactant compositions. Moreover, there was a large difference in morphologies of solid products obtained during the crystallization process between deAl-Amor and Amor, suggesting the time gap in supplying aluminosilicate species contributing to the CHA crystal growth. These results indicate the high potential of deAl-Amor as starting materials for zeolite synthesis.
Disclosure in Markets for Ratings
Authors: Weksler Ran , Zik Boaz
Published: July 2023

We study the implications of the disclosure regime of ratings on the level of information released to the public. Specifically, we compare mandatory and voluntary disclosure. We analyze a model where the potential issuers are initially endowed with homogeneous soft information about their values before paying to acquire ratings. We find that for every accuracy level of the issuers’ initial information, voluntary disclosure results in a more informative equilibrium than mandatory disclosure. This finding identifies a dimension in which the existing European Union regulations that impose the mandatory disclosure of ratings may lead to a loss of information to the public. (JEL D21, D42, D43, D82, D83, G24)
Clinical benefit of range uncertainty reduction in proton treatment planning based on dual-energy CT for neuro-oncological patients
Authors: Taasti Vicki Trier , Decabooter Esther , Eekers Daniëlle , Compter Inge , Rinaldi Ilaria , Bogowicz Marta , van der Maas Tim , Kneepkens Esther , Schiffelers Jacqueline , Stultiens Cissy , Hendrix Nicole , Pijls Mirthe , Emmah Rik , Fonseca Gabriel Paiva , Unipan Mirko , van Elmpt Wouter
Published: July 2023

Objective:

Several studies have shown that dual-energy CT (DECT) can lead to improved accuracy for proton range estimation. This study investigated the clinical benefit of reduced range uncertainty, enabled by DECT, in robust optimisation for neuro-oncological patients.

Methods:

DECT scans for 27 neuro-oncological patients were included. Commercial software was applied to create stopping-power ratio (SPR) maps based on the DECT scan. Two plans were robustly optimised on the SPR map, keeping the beam and plan settings identical to the clinical plan. One plan was robustly optimised and evaluated with a range uncertainty of 3% (as used clinically; denoted 3%-plan); the second plan applied a range uncertainty of 2% (2%-plan). Both plans were clinical acceptable and optimal. The dose–volume histogram parameters were compared between the two plans. Two experienced neuro-radiation oncologists determined the relevant dose difference for each organ-at-risk (OAR). Moreover, the OAR toxicity levels were assessed.

Results:

For 24 patients, a dose reduction >0.5/1 Gy (relevant dose difference depending on the OAR) was seen in one or more OARs for the 2%-plan; e.g. for brainstem D0.03cc in 10 patients, and hippocampus D40% in 6 patients. Furthermore, 12 patients had a reduction in toxicity level for one or two OARs, showing a clear benefit for the patient.

Conclusion:

Robust optimisation with reduced range uncertainty allows for reduction of OAR toxicity, providing a rationale for clinical implementation. Based on these results, we have clinically introduced DECT-based proton treatment planning for neuro-oncological patients, accompanied with a reduced range uncertainty of 2%.

Advances in knowledge:

This study shows the clinical benefit of range uncertainty reduction from 3% to 2% in robustly optimised proton plans. A dose reduction to one or more OARs was seen for 89% of the patients, and 44% of the patients had an expected toxicity level decrease.
Racial disparities in major cardiovascular and cerebrovascular adverse events in breast cancer survivors: A nationwide analysis
Authors: Jain Akhil , Desai Rupak , Ahmed Ibrahim , Amakye Kingsley , Raval Maharshi , Patel Sagar , Uttam Chandani Kanishka , Majmundar Vidit , Agrawal Siddharth Pravin , Sanghvi Labdhi , Garg Monika , Patel Darsh , Hamza Mohammad , Bonita Raphael , Dhar Sunil
Published: July 2023

Background:  Improved survival outcomes in breast cancer has brought attention to major cardiovascular and cerebrovascular adverse events (MACCE). Racial disparities in these events among breast cancer survivors are understudied.

Methods:  Using National Inpatient Sample datasets (October 2015-December 2017, ICD-10-CM), we investigated racial disparities in the hospitalized breast cancer survivors for MACCE. They were further sub-categorized on the basis of prior chemotherapy or radiation therapy (CT/RT).

Results:  Of 1,301,320 breast cancer survivor women, 75.8% were White, 11.3% were Black, and 16.1% had prior CT/RT. All-cause in-hospital mortality was highest in Asian or Pacific Islanders (3.2%) in the whole breast cancer survivor population; and in Native Americans (4.7%) in CT/RT subgroup. Native Americans (4.1%) had the highest incidence of acute myocardial infarction (AMI) in the overall population, whereas White patients (2.9%) predominated in CT/RT subgroup. White patients (29.6%) had the highest prevalence of arrhythmia, regardless of the prior CT/RT. For strokes, Asian or Pacific Islanders (3.9%) and Black patients (3.8%) had a higher prevalence. All-cause mortality, AMI, arrhythmia, and stroke had the highest adjusted odds in Asian or Pacific Islanders (1.19), Native Americans (1.31), White patients (1), and Black patients (1.12) respectively. Black patients had the lowest quartile income and a longer median stay. White patients had the highest transfer to nursing facilities, whereas Asian or Pacific Islanders had the highest mean hospital expenditures.

Conclusions: Racial disparities exist in MACCE among breast cancer survivors. Further research, especially pooling and analyzing real-world data is needed on the prevalence of MACCE in breast cancer survivors, particularly in subgroups with different cancer-related treatments.
Evaluation of premetastatic changes in lymph nodes(pN0) of oral tongue tumour: A prospective observational Study
Authors: Geetha Rajalakshmi , Iyer Subramania , Keechilat Pavithran , N Gopalakrishna Iyer , Thankappan Krishna Kumar , N V Smitha
Published: July 2023

Background:Tongue tumors show intra and inter-tumoral heterogenicity with high incidence, relapse and mortality rates necessitating further research.  Recurrence/metastasis that occurs  after surgical resection of primary cancer is often the reason for poor survival in these patients.  Lymph nodes are the most common site of metastasis in tongue tumors. Therefore, premetastatic molecular changes can be best evaluated in lymph nodes which may epitomize the earliest events in the metastasis cascades. The presence of circulating tumor cells(CTCs) in the absence of nodal disease (N0) may represent tumor aggressiveness, suggesting an immune escape which may have high metastatic potential. This trial  was developed  to investigate the earliest pre-metastatic changes which may regulate tumor dormancy and predict metastasis. A better understanding of organotropism or pre-metastatic changes can help in theragnostic, thereby  preventing the outbreak of overt metastasis. 

Methods:A single-institutional prospective observational cohort study. This trial will be conducted at a tertiary care Centre (Amrita Institute of Medical Sciences Kochi).  Eligible patients will be enrolled after obtaining informed consent. The dissected lymph nodes will  be subjected to histopathological and immunohistochemical analyses for premetastatic niche (PMN) formation. In addition, circulating tumor cells will be evaluated before treatment and 6 months after treatment. The patients will be followed  up for a period of two years to correlate the findings with the recurrence-free survival.

Expected results: The pre-metastatic changes, if detected will  be  a predictive biomarker. It may help to define future drug targets for metastasis chemoprevention   . CTCs may  define the tumor aggressiveness ,there by  prognostication  and helps in better disease management.

Ethics and dissemination:The study has received the following approval:

Ethics Committee of Amrita School of Medicine (ECASM-AIMS-2022-048).Trial Registered Prospectively( CTRI/2022/03/041256 ) on 22/03/2022 under Clinical Trial Registry of India
Co-Design of a website for women with pelvic organ prolapse: A study protocol
Authors: Carroll Maria-Louise , Doody Catherine , O' Sullivan Cliona , Perrotta Carla , Fullen Brona M
Published: July 2023

Background: Despite high reported prevalence of pelvic organ prolapse (POP), women report difficulties accessing evidence-based and reliable information about the condition. Many rely on social media and other popular and highly visible internet platforms which have been found to contain poor quality information that is difficult for the average patient to understand. The aim of the study is to co-design an information website for women with POP. The website design will be based on the Website Developmental Model for the Healthcare Consumer (WDMHC) framework.

Methods: A four phase process will be utilised as per the WDMHC framework: 1) User, task and environmental analysis; 2) Functional and representational analysis; 3) Cognitive walkthrough, keystroke level model, heuristic testing; 4) Content based testing, expert testing and user-based testing.  

Ethics approval has been obtained (LS-23-19-Carroll-Ful). Two groups of stakeholders will be recruited (i) patient group (ii) healthcare professional (HCP) group. Patient participants will be recruited from an online pelvic floor dysfunction (PFD) support group (n=950 members). A website designer and HCP stakeholders involved in the multidisciplinary team caring for women with POP will be invited to participate. 

Both groups will participate in separate co-design online workshops. Focus group workshops will be video-recorded, transcribed and imported into NVivo. Themes and subthemes will be developed.  

The website will be designed and disseminated to all participants for feedback. Cognitive walkthrough and heuristic testing will be undertaken. Following this, necessary modifications will be made to the website. Participants will then complete a modified System Usability Scale (SUS) and the eHealth Impact Questionnaire, while five HCPs will complete the DISCERN instrument.  

Conclusion: This study will inform the design and testing of an information website for women with POP. The website design and content will be informed by patient and HCP stakeholder voices and the health literacy literature.
A living mapping review for COVID-19 funded research projects: final (27 month) update
Authors: Bucher Adrian , Antonio Emilia , Jabin Nusrat , Jones Chantel , Padilla Andrea , Khader Susan , Boily-Larouche Genevieve , Lay Morgan , Norton Alice
Published: July 2023

Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There has however been an ongoing need for greater coordination, with limited resources for research and the shifting global pandemic.

Methods: The UK Collaborative on Development Research (UKCDR) and Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), two funder coordination groups have collaborated to develop a live database of funded research projects across the world relating to COVID-19. Drawing data continually from their members and further global funding bodies, as of 15th October 2022 the database contains 20,006 projects, funded by 351 funders, taking place across 157 countries representing an investment of at least $7.4 billion. To our knowledge it is one of the most comprehensive databases. The database is aligned to the World Health Organisation and GloPID-R Global Research Roadmap: 2019 Novel Coronavirus and the UN Research Roadmap for the COVID-19 Recovery. It is being used by the WHO, governments and further policy makers, research funders and researchers.

This living mapping review aims to supplement the database by providing an open, accessible, and frequently updated resource summarising the characteristics of the COVID-19 funded research portfolio. Both descriptive and thematic analyses are presented and updated frequently to aid interpretation of the global COVID-19 funded research portfolio.

Results: In this final version ten analysis, we provide an updated detailed descriptive analysis of the database (on data from three months after version nine) and focus our thematic analysis on research gaps, research areas in need of coordination, study populations, and research locations (with a focus on resource-limited countries).

Conclusions: As the global research response to COVID-19 plateaus, this living mapping review has helped both funders and researchers to prioritise resources and review investments.
The genome sequence of the Oak Hook-tip, Watsonalla binaria (Hufnagel, 1767)
Authors: Boyes Douglas , Chua Physilia ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: July 2023

We present a genome assembly from an individual female Watsonalla binaria (the Oak Hook-tip; Arthropoda; Insecta; Lepidoptera; Drepanidae). The genome sequence is 333.0 megabases in span. Most of the assembly is scaffolded into 33 chromosomal pseudomolecules, including the W and Z sex chromosomes. The mitochondrial genome has also been assembled and is 15.24 kilobases in length. Gene annotation of this assembly on Ensembl identified 16,002 protein coding genes.
The genome sequence of a riffle beetle, Elmis aenea (Müller, 1806)
Authors: Findlay John D.S. , Foster Garth ,   Natural History Museum Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: July 2023

We present a genome assembly from an individual female Elmis aenea (a riffle beetle; Arthropoda; Insecta; Coleoptera; Elmidae). The genome sequence is 516.5 megabases in span. Most of the assembly is scaffolded into 9 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 18.06 kilobases in length.
Does Decision Making for Others Close the Gender Gap in Competition?
Authors: Ifcher John , Zarghamee Homa
Published: July 2023

We examine whether the gender gap in competitiveness in stereotypically male tasks persists when the decision to compete is made by someone else. In a within-subject laboratory experiment, decision makers make competition entry decisions for both themselves and a randomly selected other. Although we replicate the standard gender gap in decisions for oneself, we do not find a gender gap when the decision to compete is made by someone else. This is driven by men being significantly more willing to enter themselves than others into competitions. Men’s and women’s willingness to enter others into competitions is statistically indistinguishable from women’s willingness to enter themselves into competitions. Subgroup analyses reveal that competitive preferences are significantly greater for Asian than non-Asian subjects. Our results have implications for the effectiveness of nominations and mentorship to close gender gaps in labor market outcomes that are affected by competitive preferences.

This paper was accepted by Yan Chen, behavioral economics and decision analysis.

Funding: This work was supported by the Russell Sage Foundation [Grant G-5602].

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4861 .
Technical Note—A Stationary Infinite-Horizon Supply Contract Under Asymmetric Inventory Information
Authors: Bensoussan Alain , Sethi Suresh , Wang Shouqiang
Published: July 2023

A New Approach to Contract Design with Private Inventory Information

In a typical decentralized supply chain, a downstream retailer privately observes its inventory level and has an informational advantage over the upstream supplier. In “A Stationary Infinite-Horizon Supply Contract Under Asymmetric Inventory Information” by Bensoussan, Sethi, and Wang, the authors study how to optimally design a stationary, truth-telling, long-term contract in such a setting. In contrast to the classic first order approach in literature, they formulate the contract design as an optimization over a functional space and develop a solution approach based on the calculus of variations. They further apply their necessary optimality condition to the class of batch-order contracts, which replenish a prespecified inventory quantity for a fixed payment in each period only when the retailer has zero inventory on hand.
DE FREIRE A RIPPER: diálogos sobre uma educação humanista
Authors: Castro Maria Cecilia Rocha de , Alcântara Alzira Batalha
Published: July 2023

Este artigo apresenta semelhanças entre pontos centrais do pensamento e práticas educativas do educador Paulo Freire e do fotodocumentarista João Roberto Ripper, tendo como base a experiência da Escola de Fotógrafos Populares (EFP) e a Agência de Fotógrafos vinculada à escola, localizadas no complexo de favelas da Maré, no município do Rio de Janeiro. A EFP, uma iniciativa do Observatório de Favelas, destinou-se à formação profissionalizante em fotografia humanista a jovens de distintas periferias, com turmas no período de 2004 a 2014. A premissa fundamental era formar comunicadores populares a fim de combater o discurso hegemônico da grande mídia em retratar a favela enquanto território desprovido de valores, buscando, assim, promover a ressignificação individual e coletiva dos moradores de favelas. Por meio de entrevistas qualitativas semiestruturadas com alguns egressos e profissionais que participaram da idealização e das atividades da Escola, percebeu-se que a herança deixada pela EFP ultrapassou a fronteira da excelência técnica, visto que promoveu profundas transformações nos egressos e, por extensão, nas respectivas comunidades. Ainda que não mencionado diretamente, verificou-se, também, que as práticas educativas na EFP foram essencialmente freirianas.
A reflective account on delivering psychological first-aid by phone to critical care nurses during the COVID-19 pandemic
Authors: Broadway-Horner Matt , Credland Nicola
Published: July 2023

Background:

COVID-19 presented critical care nurses with significant challenges. Due to the volume of patients requiring intensive care, bed capacity was quadrupled virtually overnight, with non-critical care trained staff re-deployed into intensive care units (ICUs) to support existing teams. This increased workload, acuity of patients, increased death, lack of visiting due to infection prevention measures, and the need to support re-deployed staff, had a significant impact on staff wellbeing and psychological health.

Aim:

The aim of this paper is to reflect upon the author's experiences as a nurse consultant in supporting critical care nurses delivering care in ICUs to critically ill patients with COVID-19.

Sources:

The experiences of critical care nurses working during the COVID-19 pandemic, which were gathered from conversations via the semi-structured psychological first aid (PFA) process.

Discussion:

Advanced practitioner ‘four pillar thinking’ is a critical in-service development that can be used to bring about a responsive, robust and vigorous service in and outside of any future pandemics.

Summary and implications:

Critical care nurses' psychological health and wellbeing was, and still has been, significantly impacted by providing treatment during COVID-19. To ensure the wellbeing of the staff group, healthcare professionals need to identify support mechanisms that will continue to ensure their mental health and wellbeing remain intact. Such measures will enable them to deliver expert care at times of increased demand, as well as support recruitment and retention strategies. This experience highlighted the importance of providing psychological first aid within support services to critical care staff.