bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Cohort Analysis Comparing the Costs of Ankle Fracture Fixation in Orthopaedics and Podiatry in a U.S. Medicare Limited Data Set
Authors: Meyers James , Campbell Peter , Lieber Alexander , Luginbuhl Joshua , Zubizarreta Nicole , Gokcen Eric , Poeran Jashvant , Kelly Meghan
Published: September 2024

Background:

Increasing overlap exists between surgeries performed by podiatrists and orthopaedic surgeons. Large-scale cost comparisons between the two are lacking despite the current climate of cost containment in health care. Using national Medicare data, we aimed to compare per-case Medicare payments between podiatrists and orthopaedic surgeons for ankle fracture fixation.

Methods:

This retrospective cohort study included patients in an outpatient setting undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair from the national Medicare Limited Data Set (2013-2019). Type of surgeon (podiatrist or orthopaedic surgeon) was determined using publicly available information. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost. A subset analysis was also done to directly compare costs of orthopaedic surgeons to podiatric surgeons while excluding other fees (eg, hospital facility fees and surgery-related imaging payments). Additionally, patient demographics and hospital characteristics were compared to determine if any factors associated with costs may influence group differences. Univariable tests assessed significance of group differences.

Results:

Overall, 16 927 unimalleolar, 17 244 bimalleolar, and 11 717 trimalleolar fracture repairs were included; 86.7% and 13.3%, 92.4% and 7.6%, and 92.2% and 7.8% were performed by an orthopaedic surgeon or podiatrist, respectively. Median age (70-71 years) and median Charlson-Deyo Comorbidity Index (0) did not significantly differ between patients treated by either surgeon type. Median procedure-specific Medicare payments for all 3 categories of ankle fracture repairs (uni-, bi-, trimalleolar) were significantly lower for orthopaedic surgeons compared to podiatrists: $4156 vs $4300, $4205 vs $4379, and $4396 vs $4525, respectively (all P < .001).

Conclusion:

Our investigation using a national Medicare data set (2013-2019) found that the 3 types of ankle fractures (unimalleolar, bimalleolar, and trimalleolar) performed by orthopaedic surgeons in an outpatient setting were less expensive and that cost differences do not appear to be driven by patient characteristics. These results and further research into the causes of the cost differences may help improve the cost-effectiveness of ankle fracture surgery.
Two-Step Ballot Verification: Mitigating the Impact of the Hawthorne Effect on Vote-Flipping Studies
Authors: Gilbert Juan E. , McKenzie Jasmine , Smith Alaina , Jennings Darian , Hart Ashley
Published: September 2024

This paper investigates the effects of the Hawthorne effect on voter behavior in ballot verification studies, specifically in the context of using ballot marking devices (BMDs) to print paper ballots. Previous studies suggested an insufficient number of voters verify the printed ballot from the BMD. This study introduces a two-step verification process aimed at reducing the Hawthorne effect’s impact, which suggests that individuals alter their behavior due to the awareness of being observed. The methodology involves direct questioning about participants’ awareness of manipulated votes and a subsequent inquiry to identify the specific contest where a vote was flipped. The findings indicate that when directly asked, a higher percentage of participants acknowledged noticing vote discrepancies, illustrating the potential influence of the Hawthorne effect in previous research methodologies. The paper recommends a vote flipping study protocol to account for the effect and to ensure the accuracy of vote flipping studies.
The Effects of Ghana’s Free Maternal and Healthcare Policy on Maternal and Infant Healthcare: A Scoping Review
Authors: Adawudu Emefa Awo , Aidam Kizito , Oduro Elisha , Miezah Dennis , Vorderstrasse Allison
Published: September 2024

Ghana was the first sub-Saharan country to implement a National Health Insurance Scheme (NHIS). In furtherance of the nation’s Universal Health Coverage (UHC) goals, in 2008, Ghana actualized plans for a Free Maternal Healthcare Policy (FMHCP) under the NHIS. The FMHCP was aimed at removing financial barriers to accessing maternal and neonatal health services. This scoping review was conducted to map out the literature on the effects of the FMHCP under the NHIS on the utilization of maternal and infant health care in Ghana. Six databases including CINAHL, PubMed, Sage Journals, Academic Search Premier, Science Direct, and Medline were searched in conducting this review with key terms. A total of 175 studies were retrieved after the search and finally, 23 articles were included in the study after various stages of elimination. The review followed the reporting guidelines stated in the Preferred Reporting Items for Systematic and Meta-analyses Extensions for Scoping Reviews (PRISMA-ScR). The results showed an overall increase in the utilization of antenatal care, facility-based delivery, and postnatal care services. However, certain systemic issues persist regarding access to maternal and infant healthcare. Socio-demographic inequalities such as maternal level of education, place of residence, and economic status likewise barriers such as the existence of out-of-pocket payments, long distance to health facilities, and poor distribution of resources in rural areas hindered the utilization of maternal and infant healthcare. The country faces significant work to eliminate existing barriers and inequalities to ensure that it achieves its UHC goals.
Nonlinear dynamic characteristics induced by inter-shaft rub-impact in a counter-rotational dual-rotor system of aeroengine
Authors: Wu Zhidong , Hao Long , Zhao Wei , Wu Kun , Zhang Binglong , Zhao Qingjun
Published: September 2024

The influence and mechanism of inter-shaft rub-impact have not been given a wide attention in exciting literature. This paper aims to insight into the coupled bending-torsional analysis of a counter-rotational dual-rotor system nonlinear vibration characteristics under inter-shaft rubbing fault. Firstly, a dual-rotor finite element model is established, which is based on Timoshenko beam element considering torsional deformations. In particular, the impact force is described by the nonlinear cylindrical collision model. Secondly, the modal characteristics are clarified in detail by the Campbell diagram and modal shapes diagram. Finally, the Newmark-β method is applied to solve the dual-rotor system governing equations with inter-shaft rub-impact numerically. Bifurcation diagram, three-dimensional spectrum, whirl orbit, spectrum plot, and Poincare map are used to preliminarily demonstrate the rotor system dynamic behaviors with inter-shaft rub-impact and the influences of friction coefficient and elastic modulus of the coating. Results reveal the vibration coupling effect and complicated vibration characteristics caused by inter-shaft rub-impact.
Exploring facade structural information: Harnessing the power of parametric analysis case study: 16th street (Shahid Farshi Moghaddam), Tehran
Authors: Ghozatlou Fatemeh , Sharghi Ali
Published: September 2024

This study proposes a comprehensive methodology to extract and analyze structural information from urban facades. The approach integrates visual analysis, reasoning techniques, and a parametric measurement tool to gain insights into facade complexity and underlying design logic. Through the parameterization of structural data and algorithm development, the framework identifies and examines key facade features. A case study in Tehran applies this method by conducting visual analysis to understand facade elements and retrieving parametric data through computational reasoning. Algorithms adaptively measure urban fabric criteria, demonstrating practical applicability in context. The results validate the effectiveness of this facade analysis technique, while the parametric tool enables the exploration of optimal design configurations. In conclusion, this integrated process of qualitative visual assessment and quantitative parametric modeling provides a novel solution to decipher urban facade complexity. The algorithms transform conceptual parameters into actionable data, guiding impactful design decisions. Quantifying facade features facilitates organized urban development and context-appropriate architecture. This research highlights the value of computable urban analysis, setting a foundation for future computational methods in urban design.
Margaret Mead: Early childhood and local expertise in Indonesia
Authors: Newberry Jan
Published: September 2024

Margaret Mead shaped the field of childhood studies in anthropology in the early 20th century. One of her concerns was the challenge posed to the continuity of childcare from rapid social change in the 1940s and 1960s in the United States. Her interest in the contrast between slowly changing homogenous cultures and those undergoing rapid change developed into a one between independent and interdependent training of children. Yet, Mead was much more concerned with the social institutions that support continuity in enculturation than a binary contrast. Mead’s own expertise and her attention to the local expertise of women and mothers is juxtaposed with recent scholarly work on the production of expertise as a form of knowledge. Interest in local forms of women’s knowledge associated with ethnomethodology and feminist standpoint theory seems to have gone missing. Dramatic social change in Indonesia since the late 1990s has corresponded with a realignment of expertise in the era of democratic reform, highlighting the tension between local and globalized forms of knowledge around early childhood education and care (ECEC). Based on long-term ethnographic research in central Java, I argue that existing forms of governmentality offer the possibility for recognizing and redistributing the local expertise of neighborhood women and mothers as a balance to globalized programs for ECEC.
Green synthesis of antipathogenic particles by utilizing the citrus plant waste and their application in medicated fabrics
Authors: Ali Shaukat , Rasul Akhtar , Shah Pervaiz Akhtar , Al-Rawi Mahmood BA , Naseem Misbah
Published: September 2024

Antipathogenic fabrics coated with different types of metallic nanoparticles were developed for the use in healthcare sector. The citrus plant waste was collected and processed to extract the bioactive molecules for the green synthesis of metal particles. Here, the citrus extract was used for a dual purpose, as a bio reductant and also as a bio dispersant (D-limonene). Subsequently, the green synthesis of a highly concentrated and stable colloidal dispersion of Silver nanoparticles (Ag-NPs), Copper nanoparticles (Cu-NPs) and Zinc Oxide (ZnO-NPs) was carried out using the self-assembled respective salts and green extracted reducing agents without using any other hazardous chemicals. Furthermore, the effect of the loaded D-limonene as a dispersant was justified by PDI, Zeta potential, particle size analysis and Dynamic Light Scattering (DLS). The synthesized particles were assessed for their morphology and geometric characteristics by Scanning Electron Microscopy (SEM), revealing the formation of particles with spherical and oval shapes. The justification for the formation of particles was also analyzed by using Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) techniques. In the next step, the synthesized Ag-NPs, Cu-NPs and ZnO-NPs were applied to cotton fabric and their antipathogenic properties (antibacterial, antiviral, and antifungal) before and after severe washing were characterized. It was observed that the nanoparticles applied fabric at higher concentration (5g) exhibit even covering of fiber surface, average particles sizes between 350 and 470 nm, with excellent antimicrobial activity against Escherichia coli (3.4 ± 0.35 mm) and Staphylococcus aureus (5.5 ± 0.19 mm). The untreated fabric had a log CFU/ml value of 5.43, indicating no antibacterial effectiveness of the control sample. However, the log values of all the treated samples were significantly lower. Moreover, the intensity of concentration of zinc silver and copper particles explains the 88.48 %, 85.01 % and 94.23% antifungal activity respectively. While antiviral activity (84% reduction) was also highest against copper nanoparticles coated fabric. The level of significance against antipathogenic activities among all particles coated samples was analysed by applying the statistical analysis of simple linear regression with paired t test. In addition the comfort parameters (air and water vapor permeability) for developed medicated textiles were also analyzed.
Preconception and antenatal care for women with a history of haematopoietic stem cell transplantation: Results of a UK clinician survey
Authors: Birchenall Katherine A , David Anna L , Davies Melanie , Grandage Victoria , Griffin Melanie
Published: September 2024

Background

Female childhood cancer survivors with history of bone marrow transplant with or without total body irradiation have increased pregnancy risks. Preconception counselling and early referral to appropriate clinical pathways may improve pregnancy outcomes.

Methods

UK-wide survey of clinicians, promoted via social media and conferences, jointly funded by Action Medical Research/Borne.

Results

Forty responses received between 22 October 2020 and 21 October 2021: 43% reviewed this group monthly, 15% annually, 15% less than annually, and 27% never (for O & G only: 13%, 13%, 26%, and 48%, respectively). Pre-pregnancy, most discussed potential fertility/pregnancy implications. Early pregnancy discussions included late miscarriage (34%), preterm birth (44%), fetal growth restriction (31%), and health risks other than cancer (30%). During pregnancy: 80% refer to specialist clinics; 87% offer extra investigations; 33% prescribed aspirin; 20% offered cervical cerclage; and 13% prescribed progesterone.

Conclusions

Evidence of variation in care. As previous observations suggest pregnancy outcomes improve when managed in specialist clinics, clearer guidance is required.
An Analysis of Tobacco and Marijuana Use by Middle School and High School Bisexual and Homosexual Students Surveyed by the National Youth Tobacco Survey From 2020 to 2022
Authors: Derrick William , Yang Shengping , Nugent Kenneth
Published: September 2024

Objectives:

This study aimed to analyze tobacco and marijuana use by middle and high school students identifying as bisexual, gay, lesbian, or heterosexual using data from the National Youth Tobacco Survey (NYTS) spanning from 2020 to 2022. By comparing substance use patterns among different sexual orientation groups, the study sought to identify disparities and potential socioeconomic factors influencing these behaviors.

Methods:

Data from the 2020 to 2022 NYTS were analyzed, focusing on responses regarding ever use of cigarettes, e-cigarettes, and marijuana by students of varying sexual orientations. Descriptive statistics and chi-square tests were employed to analyze differences in substance use and socioeconomic indicators between sexual orientation groups.

Results:

Of the 37 541 students included in the analysis, significant differences in substance use were observed among bisexual, gay, lesbian, and heterosexual students. Bisexual and gay/lesbian students exhibited higher rates of ever use of cigarettes, e-cigarettes, and marijuana compared to heterosexual students. In addition, socioeconomic differences, such as lower rates of family vehicle ownership and reduced access to vacations, were noted among bisexual and gay/lesbian students.

Conclusions:

The findings underscore significant differences in tobacco and marijuana use by adolescents based on sexual orientation, mirroring differences observed in LGBTQ adults. These results highlight the importance of targeted interventions, educational initiatives, and support systems tailored to the unique needs of LGBTQ youth. Addressing socioeconomic disparities and fostering inclusive environments are crucial steps in promoting the health and well-being of LGBTQ adolescents. Continued research and collaborative efforts are essential in mitigating health disparities and creating equitable environments for all adolescents.
Effect of electroacupuncture on total motile sperm count and sperm motility
Authors: Budihastuti Uki Retno , Murti Bhisma , Prakosa Teguh , Nurwati Ida , Laqif Abdurahman , Melinawati Eriana , Hadi Cahyono , Susanto Lunardhi , Sukmawati Metanolia , Prasetya Hanung , Wijayanti Agung Sari , Ahmad Miftahul Falah
Published: September 2024

Background:

Approximately 50% of infertility cases are attributed to male factors. Acupuncture has long been employed as a complementary therapy to enhance male infertility treatment outcomes. This study aimed to assess the impact of electroacupuncture (EA) therapy on sperm motility and TMSC in male infertility patients.

Design and methods:

This randomized clinical trial involved 30 male infertility patients divided into 2 groups. Consecutive sampling was utilized among men diagnosed with infertility at the Fertility Clinic Sekar, Dr. Moewardi General Hospital, Surakarta. Both groups underwent assessments of sperm motility and TMSC before and after the intervention. The first group received Coenzyme Q, while the second group received Coenzyme Q + EA.

Results:

The Qoenzyme Q + EA group exhibited no significant difference in motility levels before treatment, with an average motility of 41.40% ± 13.33 and a TMSC level of 33.59 × 106 ± 27.91. Post-treatment, motility remarkably increased by 56.40% ± 11.78, and the TMSC level rose by 78.63 × 106 ± 58.38 in the Qoenzyme Q + EA group. Conversely, the Qoenzyme Q pre-treatment group had an average motility of 48.07% ± 15.77 and a TMSC level of 30.20 × 106 ± 34.82. After Coenzyme Q treatment, a significant decrease in motility by 42.80% ± 18.03 and TMSC level by 28.22 × 106 ± 15.16 was observed.

Conclusion:

Combining Coenzyme Q + EA had a more significant impact on sperm motility and TMSC levels than Coenzyme Q alone. These findings underscore the differential effects of Coenzyme Q + EA and Coenzyme Q on sperm motility and TMSC levels, suggesting potential therapeutic implications for male reproductive health. Future studies with larger sample sizes are warranted to validate and expand upon these results.
Digital Twin Implementation in the Pharmaceutical Industry
Authors: Kirby Matthew , Asan Onur
Published: September 2024

Digital twins have reached the pharmaceutical industry through the recent development of Pharma 4.0, and they have the potential to greatly improve the drug development process through their modelling capabilities. The objective of this paper is to determine where digital twins have been implemented thus far and determine any future benefits that have been identified through this research. A scoping review was conducted on PubMed.com using a Boolean string of Mesh terms. Once the papers were identified, 6 mapping questions were answered to extract details from the selected publications and determine the trends and areas where digital twin implementation has occurred. A total of 9 publications were selected after multiple screening rounds. Most of the papers focused on the creation of models that enhance the manufacturing process. In the future, the ability to enhance clinical trials and the drug target discovery process was identified. Overall, digital twins can enhance a range of processes and phases in the drug development process.
The Impact of Wearable Devices on Health Management: Insights from Consumers Data
Authors: Wang Bijun , Zhang Linghan , Asan Onur
Published: September 2024

This study explores the impact of wearable health technologies on individuals’ confidence in managing their health, examining the mediating roles of social isolation, understanding of medical statistics, and confidence in finding online health resources via a national cross-sectional survey. Our findings indicate a significant direct effect of wearable device use on self-care confidence, with social isolation identified as a key mediator. However, understanding medical statistics and finding online health resources did not significantly mediate this relationship. The results highlight the potential of wearable technologies to enhance health management confidence, suggesting future enhancements should focus on fostering social connectivity and improving access to health information.
Investigating the Impact of Healthcare Restructuring on Patient Experience through Data Mining
Authors: Esmaeili Negin , Booth Amy , Kasasbeh Anemone , Jesso Stephanie Tulk
Published: September 2024

This paper examines the consequences of healthcare mergers and acquisitions on patient experiences through a comprehensive data mining approach, combining both traditional and innovative methodologies. Utilizing web scraping techniques and machine learning algorithms, we compiled a national dataset, analyzing reviews and ratings from Google and Yelp to gauge patient perspectives pre and post healthcare restructuring. Our analysis included 10 healthcare centers, with a focus on a six-month period before and after mergers or acquisitions took effect. The study identified 35 merger events and 60 acquisition events within the dataset after refining data set, highlighting significant variations in patient experiences post-restructuring. Our two-way ANOVA revealed significant main effects for restructure type (F(1, 661) = 211.77, p < 2e-16) and time period (F(1, 661) = 29.74, p < 6.99e-08), along with a significant interaction between these factors (F(1, 661) = 201.85, p < 2e-16). This significant interaction suggests a differential impact of mergers and acquisitions on patient experience review ratings, dependent on the timing relative to the restructuring event. This decline underscores the nuanced impact of healthcare consolidation on patient care quality and access, particularly among vulnerable populations. Our findings contribute to the ongoing discourse on healthcare restructuring, demonstrating the potential of data mining in uncovering the intricate dynamics of healthcare service delivery and patient satisfaction in the context of organizational changes.
Viability of Proxy Users for Usability Testing of Neonatal Devices for Use in Sub-Saharan Africa: A Qualitative Analysis of use Errors
Authors: Allen Elizabeth , Matin Shababa , Asma Elizabeth , Mangwiro Lucky , Mjumira Rowland , Valle Maureen , Acemyan Claudia , Oden Maria , Kawaza Kondwani , Richards-Kortum Rebecca , Kortum Philip
Published: September 2024

Medical devices designed for use in low-resource settings require unique and thoughtful design considerations to facilitate successful implementation and adoption. Usability testing is critical for good design but conducting research in international locations with intended target users is challenging and costly. Proxy user groups have been proposed as a reasonable solution when travel is impractical or wholly restricted, as it was during the Covid-19 pandemic. This study explored the viability of utilizing a proxy user group in Houston, TX, USA, to represent nurses in Blantyre, Malawi, to assess the usability of neonatal medical devices designed for use in sub-Saharan Africa. Seven devices were tested with 13 clinicians in Houston, Texas, and 17 clinicians in Blantyre, Malawi. Participants in Houston were carefully selected to mirror Malawi's expected demographics, particularly educational background and years of experience. This analysis compared the rates and types of use errors that occurred within each group. Results indicated that the Houston nurses recruited were an insufficient proxy to represent Malawian nurses in usability studies, with only 53.7% of errors observed in both groups. Furthermore, common errors identified tended to be more severe in Blantyre than in Houston, indicating that caution should be exercised when relying on proxy users. Future work should explore these observed differences further, and larger sample sizes should be utilized to assess the viability of a proxy group. Although proxy usability testing can be advantageous, testing with target users remains the gold standard.
Rupture, loneliness and education: Experiences of refugee and asylum-seeking people
Authors: Sagan Olivia , Palombo Gianluca
Published: September 2024

This paper explores the intrinsic links between rupture, loneliness, resilience and agency within the experiences of refugee and asylum-seeking people, drawing on a wider study conducted in Scotland during the COVID-19 lockdowns in 2020 and 2021. The paper then posits education, in its diverse forms, as a potential anchor, providing a sense of structure, belonging and purpose, thus serving as a bulwark against the negative impacts of rupture and loneliness. The findings presented here are based on 51 semi-structured interviews with people at different stages of the asylum process or with refugee status, offering insights into how educational experiences, both formal and informal, can act as a crucial support system during times of uncertainty and crisis. This exploration contributes to a deeper understanding of the challenges faced by refugee and asylum-seeking people, and the potential of education to foster resilience and integration within host communities.
Exploring autistic employment and retention realities: A qualitative study among 12 Dutch organizations
Authors: Schuurmans Jantje A , Wright Elaine P , Bunders-Aelen Joske GF , Regeer Barbara J
Published: September 2024

This study explored positive features and challenges in the employment and retention of autistic individuals within 12 Dutch organizations, focusing primarily on the perspectives of employers. Sixteen participants from 12 Dutch organizations were interviewed. Four researchers were involved in a thematic analysis, which revealed five themes and 13 sub-themes. The study identified five main themes around which positive features and challenges revolved: (1) employers’ primary motivations for hiring autistic individuals, (2) consideration of the needs of all employees, including those who are autistic, (3) employers’ perceptions of autistic employees, (4) the adoption of a learning-oriented mindset by employers, and (5) the alignment of human resource development practices with diversity and inclusion policies. Our findings suggest that beneficial organizational characteristics for the employment and retention of autistic individuals include valuing the skills of autistic employees, fostering an understanding of autism devoid of stereotypes and stigmatization, and taking the needs of all employees into account based on personal experiences employers have with employees. Conversely, organizations that primarily hire to fulfil diversity quotas or meet objectives set in diversity and inclusion policies without promoting destigmatizing conditions risk adversely affecting the employment and retention of autistic individuals.
Transcriptome analysis and genome-wide identification of the dehydration-responsive element binding gene family in jackfruit under cold stress
Authors: Ma Xiangwei , Zhu Pengjin , Du Yingjun , Song Qiqi , Ye Weiyan , Tang Xiuguan , He Jiang , Zhong Yunjie , Ou Jingli , Pang Xinhua
Published: September 2024

Background

Jackfruit (Artocarpus heterophyllus Lam.) is the world’s largest and heaviest fruit and adapts to hot, humid tropical climates. Low-temperature injury in winter is a primary abiotic stress, which affects jackfruit growth and development. Therefore, breeding cold-resistant varieties and identifying the vital genes in the process of cold resistance are essential. The dehydration-responsive element binding (DREB) gene family is among the subfamily of the APETALA2/ethylene response factor transcription factor family and is significant in plant abiotic stress responses.

Methods

In this study, a comparative analysis of the cold resistance property of ‘GuangXi’ (‘GX’) and ‘Thailand’ (‘THA’) jackfruit strains with different cold resistance characteristics was performed through chlorophyll fluorescence and transcriptome sequencing.

Results

We found that differentially expressed genes (DEGs) are significantly enriched in the metabolic processes. Here, 93 DREB genes were identified in the jackfruit genome, and phylogenetic analysis was used to classify them into seven groups. Gene structure, conserved motifs, chromosomal location, and homologous relationships were used to analyze the structural characteristics of the DREB family. Transcriptomics indicated that most of the AhDREB genes exhibited down-regulated expression in ‘THA.’ The DEGs AhDREB12, AhDREB21, AhDREB29, and AhDREB34 were selected for quantitative real-time PCR, and the results showed that these genes also had down-regulated expression in ‘THA.’

Conclusions

The above results suggest the significance of the DREB family in improving the cold resistance property of ‘GX.’
A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy
Authors: Peprah Prince , Lloyd Jane , Ajang David Ajak , Harris Mark F
Published: September 2024

Background

Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia.

Methods

This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation.

Results

Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness.

Conclusion

African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.
Information behaviours of people with type 2 diabetes in Kuwait: a grounded theory study
Authors: Meer Zainab , Al-Ozairi Ebaa , Fernandes Genevie , Ranganathan Sruthi , Patel Jay
Published: September 2024

Background

Relative to country-specific epidemiological trends, Kuwait experiences a far greater burden of type 2 diabetes among its population. Information behaviours form a significant component of self-care management for patients diagnosed with type 2 diabetes, however this remains an understudied aspect of disease management. This study aims to investigate the information behaviours of patients with type 2 diabetes in Kuwait, and characterise the methods employed to manage their disease.

Methods

This qualitative study employed a grounded theory method. Semi-structured interviews were conducted with twenty-seven participants over three phases of data collection in primary, secondary and tertiary healthcare settings across Kuwait. These were complemented by in-depth interviews to detail the information behaviours of these participants. The interviews were translated where appropriate, transcripts, and analysed through qualitative coding to synthesise the information behaviour patterns.

Results

The findings demonstrated that living with type 2 diabetes involved a range of developmental and transformative stages, including changes to the patients’ emotional state, reconstruction of their lifestyle and identity, and changes in the ways they find and use information. Living with the chronic condition was viewed as a dynamic and transitional process, where patients’ information behaviours continually changed throughout the process across various identifiable stages. This dynamic pattern was reflected most prominently across the participants’ behavioural needs, sources and information-seeking patterns.

Conclusion

Patients with type 2 diabetes continuously adapted their information behaviours to optimise the self-management of their condition across a relatively predictable pattern. Greater understanding of these behaviours across a wider population would improve the provision of clinical care for patients with diabetes.
Risk factors associated with the intensity of COVID-19 outbreaks in Canadian community settings: a retrospective analysis of outbreak-level surveillance data
Authors: Dam Demy , Chen Michelle , Rees Erin E. , Cheng Bethany , Sukkarieh Lynn , McGill Erin , Tehami Yasmina , Bellos Anna , Edwin Jonathan , Patterson Kaitlin
Published: September 2024

Background

The severity of COVID-19 outbreaks is disproportionate across settings (e.g., long-term care facilities (LTCF), schools) across Canada. Few studies have examined factors associated with outbreak severity to inform prevention and response. Our study objective was to assess how outbreak severity, as measured using outbreak intensity and defined as number of outbreak-associated cases divided by outbreak duration, differed by setting and factors known to influence SARS-CoV-2 transmission.

Methods

We described outbreak intensity trends in 2021 using data from the Canadian COVID-19 Outbreak Surveillance System from seven provinces/territories, representing 93% of the Canadian population. A negative binomial fixed-effects model was used to assess for associations between the outcome, outbreak intensity, and characteristics of outbreaks: setting type, median age of cases, number at risk, and vaccination coverage of at least 1 dose. Also included were variables previously reported to influence SARS-CoV-2 transmission: stringency of non-pharmaceutical interventions (NPI) and the predominant SARS-CoV-2 variant detected by surveillance.

Results

The longest outbreaks occurred in LTCF (mean = 25.4 days) and correctional facilities (mean = 20.6 days) which also reported the largest outbreaks (mean = 29.6 cases per outbreak). Model results indicated that outbreak intensity was highest in correctional facilities. Relative to correctional facilities (referent), the second highest adjusted intensity ratio was in childcare centres (intensity ratio = 0.58 [95% CI: 0.51–0.66]), followed by LTCF (0.56 [95% CI: 0.51–0.66]). Schools had the lowest adjusted intensity ratio (0.46 [95% CI: 0.40–0.53]) despite having the highest proportion of outbreaks (37.5%). An increase in outbreak intensity was associated with increases in median age, the number at risk, and stringency of NPI. Greater vaccination coverage with at least 1 dose was associated with reduced outbreak intensity.

Conclusion

Descriptive and multivariable model results indicated that in Canada during 2021, outbreak intensity was greatest in closed congregate living facilities: correctional facilities and LTCF. Findings from this study support the importance of vaccination in reducing outbreak intensity when vaccines are effective against infection with circulating variants, which is especially important for closed congregate living facilities where NPIs are more challenging to implement.
Trustworthy and ethical AI-enabled cardiovascular care: a rapid review
Authors: Mooghali Maryam , Stroud Austin M. , Yoo Dong Whi , Barry Barbara A. , Grimshaw Alyssa A. , Ross Joseph S. , Zhu Xuan , Miller Jennifer E.
Published: September 2024

Background

Artificial intelligence (AI) is increasingly used for prevention, diagnosis, monitoring, and treatment of cardiovascular diseases. Despite the potential for AI to improve care, ethical concerns and mistrust in AI-enabled healthcare exist among the public and medical community. Given the rapid and transformative recent growth of AI in cardiovascular care, to inform practice guidelines and regulatory policies that facilitate ethical and trustworthy use of AI in medicine, we conducted a literature review to identify key ethical and trust barriers and facilitators from patients’ and healthcare providers’ perspectives when using AI in cardiovascular care.

Methods

In this rapid literature review, we searched six bibliographic databases to identify publications discussing transparency, trust, or ethical concerns (outcomes of interest) associated with AI-based medical devices (interventions of interest) in the context of cardiovascular care from patients’, caregivers’, or healthcare providers’ perspectives. The search was completed on May 24, 2022 and was not limited by date or study design.

Results

After reviewing 7,925 papers from six databases and 3,603 papers identified through citation chasing, 145 articles were included. Key ethical concerns included privacy, security, or confidentiality issues (n = 59, 40.7%); risk of healthcare inequity or disparity (n = 36, 24.8%); risk of patient harm (n = 24, 16.6%); accountability and responsibility concerns (n = 19, 13.1%); problematic informed consent and potential loss of patient autonomy (n = 17, 11.7%); and issues related to data ownership (n = 11, 7.6%). Major trust barriers included data privacy and security concerns, potential risk of patient harm, perceived lack of transparency about AI-enabled medical devices, concerns about AI replacing human aspects of care, concerns about prioritizing profits over patients’ interests, and lack of robust evidence related to the accuracy and limitations of AI-based medical devices. Ethical and trust facilitators included ensuring data privacy and data validation, conducting clinical trials in diverse cohorts, providing appropriate training and resources to patients and healthcare providers and improving their engagement in different phases of AI implementation, and establishing further regulatory oversights.

Conclusion

This review revealed key ethical concerns and barriers and facilitators of trust in AI-enabled medical devices from patients’ and healthcare providers’ perspectives. Successful integration of AI into cardiovascular care necessitates implementation of mitigation strategies. These strategies should focus on enhanced regulatory oversight on the use of patient data and promoting transparency around the use of AI in patient care.
Human–exoskeleton interaction portrait
Authors: Shushtari Mohammad , Foellmer Julia , Arami Arash
Published: September 2024

Human–robot physical interaction contains crucial information for optimizing user experience, enhancing robot performance, and objectively assessing user adaptation. This study introduces a new method to evaluate human–robot interaction and co-adaptation in lower limb exoskeletons by analyzing muscle activity and interaction torque as a two-dimensional random variable. We introduce the interaction portrait (IP), which visualizes this variable’s distribution in polar coordinates. We applied IP to compare a recently developed hybrid torque controller (HTC) based on kinematic state feedback and a novel adaptive model-based torque controller (AMTC) with online learning, proposed herein, against a time-based controller (TBC) during treadmill walking at varying speeds. Compared to TBC, both HTC and AMTC significantly lower users’ normalized oxygen uptake, suggesting enhanced user-exoskeleton coordination. IP analysis reveals that this improvement stems from two distinct co-adaptation strategies, unidentifiable by traditional muscle activity or interaction torque analyses alone. HTC encourages users to yield control to the exoskeleton, decreasing overall muscular effort but increasing interaction torque, as the exoskeleton compensates for user dynamics. Conversely, AMTC promotes user engagement through increased muscular effort and reduces interaction torques, aligning it more closely with rehabilitation and gait training applications. IP phase evolution provides insight into each user’s interaction strategy formation, showcasing IP analysis’s potential in comparing and designing novel controllers to optimize human–robot interaction in wearable robots.
Shaping corticospinal pathways in virtual reality: effects of task complexity and sensory feedback during mirror therapy in neurologically intact individuals
Authors: Norris Trevor A. , Augenstein Thomas E. , Rodriguez Kazandra M. , Claflin Edward S. , Krishnan Chandramouli
Published: September 2024

Background

Restoration of limb function for individuals with unilateral weakness typically requires volitional muscle control, which is often not present for individuals with severe impairment. Mirror therapy—interventions using a mirror box to reflect the less-impaired limb onto the more-impaired limb—can facilitate corticospinal excitability, leading to enhanced recovery in severely impaired clinical populations. However, the mirror box applies limitations on mirror therapy, namely that all movements appear bilateral and are confined to a small area, impeding integration of complex activities and multisensory feedback (e.g., visuo-tactile stimulation). These limitations can be addressed with virtual reality, but the resulting effect on corticospinal excitability is unclear.

Objective

Examine how virtual reality-based unilateral mirroring, complex activities during mirroring, and visuo-tactile stimulation prior to mirroring affect corticospinal excitability.

Materials and methods

Participants with no known neurological conditions (n = 17) donned a virtual reality system (NeuRRoVR) that displayed a first-person perspective of a virtual avatar that matched their motions. Transcranial magnetic stimulation-induced motor evoked potentials in the nondominant hand muscles were used to evaluate corticospinal excitability in four conditions: resting, mirroring, mirroring with prior visuo-tactile stimulation (mirroring + TACT), and control. During mirroring, the movements of each participant’s dominant limb were reflected onto the nondominant limb of the virtual avatar, and the avatar’s dominant limb was kept immobile (i.e., unilateral mirroring). The mirroring + TACT condition was the same as the mirroring condition, except that mirroring was preceded by visuo-tactile stimulation of the nondominant limb. During the control condition, unilateral mirroring was disabled. During all conditions, participants performed simple (flex/extend fingers) and complex (stack virtual blocks) activities.

Results

We found that unilateral mirroring increased corticospinal excitability compared to no mirroring (p < 0.001), complex activities increased excitability compared to simple activities during mirroring (p < 0.001), and visuo-tactile stimulation prior to mirroring decreased excitability (p = 0.032). We also found that these features did not interact with each other.

Discussions

The findings of this study shed light onto the neurological mechanisms of mirror therapy and demonstrate the unique ways in which virtual reality can augment mirror therapy. The findings have important implications for rehabilitation for design of virtual reality systems for clinical populations.
Two +ssRNA mycoviruses cohabiting the fungal cultivar of leafcutter ants
Authors: Rødsgaard-Jørgensen Asta , Leal-Dutra Caio Ambrosio , de Santana Sabrina Ferreira , Jensen Asger Roland , Marques Rafael Elias , Aguiar Eric Roberto Guimarães Rocha , Shik Jonathan Zvi
Published: September 2024

Leafcutter ants are dominant herbivores in the Neotropics and rely on a fungus (Leucoagaricus gongylophorus) to transform freshly gathered leaves into a source of nourishment rather than consuming the vegetation directly. Here we report two virus-like particles that were isolated from L. gongylophorus and observed using transmission electron microscopy. RNA sequencing identified two +ssRNA mycovirus strains, Leucoagaricus gongylophorus tymo-like virus 1 (LgTlV1) and Leucoagaricus gongylophorus magoulivirus 1 (LgMV1). Genome annotation of LgTlV1 (7401 nt) showed conserved domains for methyltransferase, endopeptidase, viral RNA helicase, and RNA-dependent RNA polymerase (RdRp). The smaller genome of LgMV1 (2636 nt) contains one open reading frame encoding an RdRp. While we hypothesize these mycoviruses function as symbionts in leafcutter farming systems, further study will be needed to test whether they are mutualists, commensals, or parasites.
High serological and molecular prevalence of Ehrlichia canis and other vector-borne pathogens in dogs from Boa Vista Island, Cape Verde
Authors: Checa Rocio , Peteiro Laura , Pérez-Hernando Belén , de la Morena María , Cano Lourdes , López-Suárez Pedro , Barrera Juan Pedro , Estévez-Sánchez Efrén , Sarquis Juliana , Fernández-Cebrián Blanca , Montoya Ana , Miró Guadalupe
Published: September 2024

Despite the high global impacts of canine vector-borne diseases (CVBD) due to their wide distribution and zoonotic potential, the current epidemiological situation of CVBD in many tropical and subtropical regions remains unknown. This study examines the seroprevalence and molecular prevalence of Ehrlichia canis and other pathogens causing CVBDs (Leishmania infantum, Dirofilaria immitis, Babesia spp., Anaplasma spp. and Hepatozoon canis) in dogs living on the island of Boa Vista (Cape Verde Republic). Blood samples and infesting ticks were taken from 150 dogs across the island (stray, shelter, and pet dogs). Serum samples were tested using a rapid immunochromatographic test (Uranotest® Quattro) that detects antibodies against E. canis, L. infantum, Anaplasma spp. and D. immitis antigen. Levels of serum antibodies against E. canis were measured using the immunofluorescence antibody test (IFAT). In addition, tick-borne pathogens in blood samples (Anaplasma spp., Babesia spp., Hepatozoon spp., and Ehrlichia canis) were detected by microscopy observation and/or PCR plus sequencing. The seroprevalence of E. canis was extremely high at 82% (123/150), as revealed by both immunochromatography and IFAT. Most dogs returning a seropositive test result (82.92%; 102/123) had antibody titres > 1:1280 but showed no clinical signs or notable laboratory abnormalities. Of the 123 animals testing seropositive for E. canis, 67 (54.47%) also presented antibodies against Anaplasma spp., and 13 (10.56%) showed the presence of Hepatozoon spp. gamonts in the blood smear. Ehrlichia canis infection was detected in 17.1% (25/146) of dogs tested by direct sequencing of polymerase chain reaction (PCR) products. Co-infections were detected in seven of these dogs: four dogs tested PCR-positive for both E. canis and A. platys, two dogs tested positive for E. canis and Hepatozoon spp., and one dog tested positive for E. canis, A. platys and Hepatozoon spp. Rhipicephalus sanguineus sensu lato was the only tick species found infesting the canine study population. The high prevalence of tick-borne pathogens detected in dogs from Boa Vista Island highlights a need for improved control measures designed to prevent the transmission of these pathogens.

Graphical Abstract