bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations between 11 parental discipline behaviours and child outcomes across 60 countries
Authors: Ward Kaitlin Paxton , Grogan-Kaylor Andrew , Ma Julie , Pace Garrett T , Lee Shawna
Published: October 2023

Objectives

To test associations between 11 caregiver aggressive and non-aggressive discipline behaviours and outcomes (aggression, distraction and prosocial peer relations) of children under 5 years in low-income and middle-income countries (LMICs).

Participants

Data came from the fourth (2009–2013) and fifth (2012–2017) rounds of the UNICEF Multiple Indicator Cluster Surveys. Analyses were restricted to households with children under 5 years, leaving a sample of 229 465 respondents across 60 LMICs. Data were analysed using Bayesian multilevel logistic regression.

Results

Verbal reasoning (80%) and shouting (66%) were the most common parental discipline behaviours towards young children. Psychological and physical aggression were associated with higher child aggression and distraction. Compared with not using verbal reasoning, verbal reasoning was associated with lower odds of aggression (OR)=0.92, 95% credible interval (CI)=0.86 to 0.99) and higher odds of prosocial peer relations (OR=1.30, 95% CI=1.20 to 1.42). Taking away privileges was associated with higher odds of distraction (OR=1.09, 95% CI=1.03 to 1.15) and lower odds of prosocial peer relations (OR=0.92, 95% CI=0.87 to 0.98). Giving the child something else to do was associated with higher odds of distraction (OR=1.06, 95% CI=1.01 to 1.12). The results indicated country-level variation in the associations between parenting behaviours and child socioemotional outcomes.

Conclusions

Psychological and physical aggression were disadvantageous for children’s socioemotional development across countries. Only verbal reasoning was associated with positive child socioemotional development. No form of psychological aggression or physical aggression benefited child socioemotional development in any country. Greater emphasis should be dedicated to reducing parental use of psychological and physical aggression across cultural contexts.
Dietary diversity and associated factors among school-aged children and adolescents in Lokossa district of southern Benin: a cross-sectional study
Authors: Sagbo Herbert , Kpodji Paulin
Published: October 2023

Objective

The main objective of this study was to assess the prevalence of dietary diversity and associated factors.

Design

Cross-sectional study.

Setting

Lokossa district, southern Benin.

Participants

A survey conducted in a probabilistic sample of 612 students (345 boys and 267 girls), aged 8–17 years old from 26 primary schools. Dietary Diversity Scores were calculated by summing the number of food groups consumed by the schoolchildren and adolescents over a 24-hour recall period. Adequate dietary diversity can be assigned to a consumption that is greater than or equal to five food groups, and inadequate dietary diversity can be assigned to a consumption that is lower than five food groups. Descriptive statistics such as frequency, mean and SD were computed. Statistical analysis was performed on the data to determine which variables were associated with dietary diversity as well as the results of the adjusted OR with a 95% CI. A p<0.05 was considered statistically significant.

Results

The proportion of schoolchildren and adolescents with inadequate dietary diversity was 25.8% (95% CI 15.1% to 40.5%). Schoolchildren and adolescents living in rural areas, having low household socioeconomic status, eating breakfast less than 5 days per week and no eating school meals were significantly associated with inadequate dietary diversity.

Conclusions

The results of this study revealed that the diet among schoolchildren and adolescents lacked diversity and is associated with socioeconomic status, rural living, eating breakfast and school meals. Public health interventions, such as school meal programmes in rural and isolated areas, in association with poverty-reducing programmes and nutrition education, are recommended to improve the quality of diet and limit the consequences of poor diet diversity.
Marital adjustment and depressive symptoms among Chinese perinatal women: a prospective, longitudinal cross-lagged study
Authors: Yang Yuqiong , Luo Biru , Ren Jianhua , Deng Xue , Guo Xiujing
Published: October 2023

Objectives

The objective was to assess the prevalence of perinatal depressive symptoms and determine the trajectories of marital adjustment and depressive symptoms and their reciprocal relationships among Chinese perinatal women.

Design

This was a prospective, longitudinal cross-lagged study.

Setting

The study was conducted at the outpatient department of the largest women’s and children’s hospital in China, which is located in Chengdu, Sichuan Province.

Participants

Four hundred and sixty-three mothers were conveniently sampled.

Main outcome measures

The Dyadic Adjustment Scale and the Chinese version of the Edinburgh Postnatal Depression Scale were used to evaluate marital adjustment and depressive symptoms, respectively, at three time points: the first trimester of pregnancy (T1), the third trimester of pregnancy (T2) and 6 weeks after childbirth (T3). Descriptive statistics were used to assess the prevalence of perinatal depressive symptoms, and repeated-measures analysis of variance (ANOVA) was used to determine the trajectories of marital adjustment and depressive symptoms among the participants. A cross-lagged model was used to explore the reciprocal relationship between marital adjustment and depressive symptoms.

Results

The prevalence of perinatal depressive symptoms among our participants ranged from 21.2% to 24.0%. Repeated-measures ANOVA showed that during the perinatal period there was a significant tendency towards worse marital adjustment (F=33.031, p=0.000) and a slight but not significant reduction in depressive symptoms (F=1.883, p=0.153) among the participants. The cross-lagged model showed that maternal marital adjustment at T1 significantly and negatively predicted depressive symptoms at T2 (β=−0.165, p<0.001), and that depressive symptoms at T2 significantly and negatively predicted marital adjustment at T3 (β=−0.135, p<0.001). However, the predictive effects of depressive symptoms at T1 on marital adjustment at T2 and that of marital adjustment at T2 on depressive symptoms at T3 were not significant.

Conclusion

The prevalence of perinatal depressive symptoms ranged from 21.2% to 24.0% among the participants. During the perinatal period, the marital adjustment of women tended to be worse; however, there was no significant change in depressive symptoms. This study showed that better marital adjustment at T1 was a protective factor against maternal depressive symptoms at T2, and a higher level of depressive symptoms at T2 was a risk factor for worse marital adjustment at T3.
Evaluating the implementation of a dynamic digital application to enable community-based decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study
Authors: Minja Neema W , Pulle Jafesi , Rwebembera Joselyn , de Loizaga Sarah R , Fall Ndate , Ollberding Nicholas , Abrams Jessica , Atala Jenifer , Kamarembo Jenipher , Oyella Linda , Odong Francis , Nalubwama Haddy , Nakagaayi Doreen , Sarnacki Rachel , Su Yanfang , Dexheimer Judith W , Sable Craig , Longenecker Chris T , Danforth Kristen , Okello Emmy , Beaton Andrea Zawacki , Watkins David A
Published: October 2023

Introduction

Rheumatic heart disease (RHD) affects over 39 million people worldwide, the majority in low-income and middle-income countries. Secondary antibiotic prophylaxis (SAP), given every 3–4 weeks can improve outcomes, provided more than 80% of doses are received. Poor adherence is strongly correlated with the distance travelled to receive prophylaxis. Decentralising RHD care has the potential to bridge these gaps and at least maintain or potentially increase RHD prophylaxis uptake. A package of implementation strategies was developed with the aim of reducing barriers to optimum SAP uptake.

Methods and analysis

A hybrid implementation-effectiveness study type III was designed to evaluate the effectiveness of a package of implementation strategies including a digital, cloud-based application to support decentralised RHD care, integrated into the public healthcare system in Uganda. Our overarching hypothesis is that secondary prophylaxis adherence can be maintained or improved via a decentralisation strategy, compared with the centralised delivery strategy, by increasing retention in care. To evaluate this, eligible patients with RHD irrespective of their age enrolled at Lira and Gulu hospital registry sites will be consented for decentralised care at their nearest participating health centre. We estimated a sample size of 150–200 registrants. The primary outcome will be adherence to secondary prophylaxis while detailed implementation measures will be collected to understand barriers and facilitators to decentralisation, digital application tool adoption and ultimately its use and scale-up in the public healthcare system.

Ethics and dissemination

This study was approved by the Institutional Review Board (IRB) at Cincinnati Children’s Hospital Medical Center (IRB 2021-0160) and Makerere University School of Medicine Research Ethics Committee (Mak-SOMREC-2021-61). Participation will be voluntary and informed consent or assent (>8 but <18) will be obtained prior to participation. At completion, study findings will be communicated to the public, key stakeholders and submitted for publication.
Incidence, demographics and outcomes of patients with penetrating injury: a Japanese nationwide 10-year retrospective study
Authors: Nagao Tsuyoshi , Toida Chiaki , Morimura Naoto
Published: October 2023

Background

Unintentional injury remains the leading cause of death among Japanese people younger than 35 years; however, data are limited on the evaluation of characteristics, long-term mortality trend and mortality risk of patients with penetrating injury in Japan. This prevents the development of effective strategies for trauma care in patients with penetrating injury.

Methods

This retrospective cohort study investigated 313 643 patients registered in the Japan Trauma Data Bank (JTDB) dataset between 1 January 2009 and 31 March 2018. The inclusion criteria comprised patients with penetrating injuries transferred from the injury site by emergency vehicles. Moreover, the patients registered in the JTDB dataset were included in this study regardless of age and sex. Outcomes measured were nationwide trends of characteristics, in-hospital mortality and in-hospital mortality risk among Japanese patients with penetrating injury. The mortality risk was analysed by hospital admission year, age, Injury Severity Score (ISS) and emergency procedures.

Results

Overall, 7132 patients were included. Median age significantly increased during the 10-year study periods (from 48 to 54 years, p=0.002). Trends for the mechanism of injury did not change; the leading cause of penetrating injury was stab wounds (SW: 76%–82%). Overall, the in-hospital mortality rate significantly decreased (4.0% to 1.7%, p=0.008). However, no significant improvement was observed in the in-hospital mortality trend in all ISS groups with SW and active bleeding. Patients with active bleeding who underwent urgent transcatheter arterial embolization had significantly lower mortality risk (p=0.043, OR=0.12, 95% CI=0.017 to 0.936). Conversely, the surgical procedure for haemostasis did not improve the mortality risk of patients with SW and active bleeding.

Conclusion

The severity-adjusted mortality trend in patients with penetrating injuries did not improve. Moreover, patients with active bleeding who underwent urgent surgical procedure for haemostasis had a higher mortality risk.
Effectiveness of an individually tailored complex intervention to improve activities and participation in nursing home residents with joint contractures (JointConEval): a multicentre pragmatic cluster-randomised controlled trial
Authors: Nguyen Natalie , Thalhammer Regina , Meyer Gabriele , Le Lien , Mansmann Ulrich , Vomhof Markus , Skudlik Stefanie , Beutner Katrin , Müller Martin
Published: October 2023

Objective

This study aims to examine the effects of the individually tailored complex intervention Participation Enabling Care in Nursing (PECAN) on activities and participation of residents with joint contractures.

Design

Multicentre pragmatic cluster-randomised controlled trial.

Setting

35 nursing homes in Germany (August 2018–February 2020).

Participants

562 nursing home residents aged ≥65 years with ≥1 major joint contracture (303 intervention group, 259 control group).

Interventions

Nursing homes were randomised to PECAN (18 clusters) or optimised standard care (17 clusters) with researcher-concealed cluster allocation by facsimile. The intervention targeted impairments in activities and participation. Implementation included training and support for selected staff. Control group clusters received brief information.

Primary and secondary outcome measures

The primary endpoint PaArticular Scales combined residents’ activities and participation at 12 months. The secondary outcome comprised quality of life. Safety measures were falls, fall-related consequences and physical restraints. Residents, staff and researchers were unblinded. Data collection, data entry and statistical analysis were blinded. Primary analyses were intention-to-treat at cluster level and individual level using a generalised mixed-effect regression model and imputation of missing data.

Results

Primary outcome analyses included 301 intervention group residents and 259 control group residents. The mean change on the Activities Scale was −1.47 points (SD 12.2) in the intervention group and 0.196 points (SD 12.5) in the control group and −3.87 points (SD 19.7) vs −3.18 points (SD 20.8) on the Participation Scale. The mean differences of changes between the groups were not statistically significant: Activities Scale: −1.72 (97.5% CI −6.05 to 2.61); Participation Scale: −1.24 (97.5% CI −7.02 to 4.45). We found no significant difference in the secondary outcome and no effects on safety measures.

Conclusion

The complex intervention did not improve the activities and participation of nursing home residents on the PaArticular Scales at 12 months. Current nursing conditions in Germany may hamper implementation.

Trial registration number

DRKS00015185.
Socio-demographic and clinical characteristics associated with retention in care among adults living with HIV and severe mental illness and reasons for loss to follow-up in Uganda: a mixed-methods study
Authors: Ojiambo Kevin Ouma , Nakku Juliet , Wangi Rachel Nante , Segawa Ivan , Ndagire Regina , Nangendo Joanita , Katahoire Anne , Semitala Fred
Published: October 2023

Objective

This study aimed to determine the socio-demographic and clinical characteristics associated with retention in care and reasons for loss to follow-up (LTFU) among people living with HIV (PLWH) with a known diagnosis of severe mental illness (SMI).

Design

We conducted a parallel convergent mixed-methods study. The quantitative study was used to determine the proportion and factors associated with retention in care among PLWH and SMI. The qualitative study explored reasons for LTFU.

Setting

This study was conducted at two the HIV clinics of two tertiary hospitals in Uganda.

Participants

We reviewed records of 608 PLWH who started antiretroviral therapy (ART) and included participants who had a documented diagnosis of SMI.

Outcomes

The primary outcome was retention in care. Age, gender, religion, tuberculosis (TB) status, WHO clinical stage, functional status, cluster of differentiation 4 (CD4) cell count, viral load and SMI diagnosis were among the predictor variables.

Results

We collected data from 328 participants. Retention at 6 months was 43.3% compared with 35.7% at 12 months. Having an unsuppressed viral load (≥1000 copies/mL) (adjusted incidence risk ratio (IRR)=1.54, 95% CI: 1.17 to 2.03), being 36 years and below (adjusted IRR=0.94, 95% CI: 0.94 to 0.95), initial presentation at outpatient department (adjusted IRR=0.74, 95% CI: 0.57 to 0.96), having TB signs and symptoms (adjusted IRR=0.98 95% CI: 0.97 to 0.99) and being in lower WHO stages (I and II) (adjusted IRR=1.08, 95% CI: 1.02 to 1.14) at ART initiation were significantly associated with retention in care at 6 and 12 months. Inadequate social support, long waiting hours at the clinic, perceived stigma and discrimination, competing life activities, low socioeconomic status and poor adherence to psychiatric medication were barriers to retention in care.

Conclusion

Twelve-month retention in care remains low at 35.7% far below the 90% WHO target. There is a need to design and implement targeted interventions to address barriers to retention in care among PLWH and SMI.
Host, parasite and drug determinants of clinical outcomes following treatment of visceral leishmaniasis: a protocol for individual participant data meta-analysis
Authors: Kumar Rishikesh , Dahal Prabin , Singh-Phulgenda Sauman , Siddiqui Niyamat Ali , Munir Abdalla , Naylor Caitlin , Wilson James , Buck Gemma , Rahi Manju , Malaviya Paritosh , Alves Fabiana , Sundar Shyam , Ritmeijer Koert , Stepniewska Kasia , Guérin Philippe J , Pandey Krishna
Published: October 2023

Introduction

Visceral leishmaniasis (VL) is a parasitic disease with an estimated 30 000 new cases occurring annually. There is an observed variation in the efficacy of the current first-line therapies across different regions. Such heterogeneity could be a function of host, parasite and drug factors. An individual participant data meta-analysis (IPD-MA) is planned to explore the determinants of treatment outcomes.

Methods and analysis

The Infectious Diseases Data Observatory (IDDO) VL living systematic review (IDDO VL LSR) library is an open-access resource of all published therapeutic studies in VL since 1980. For this current review, the search includes all clinical trials published between 1 January 1980 and 2 May 2021. Studies indexed in the IDDO VL LSR library were screened for eligibility for inclusion in this IPD-MA. Corresponding authors and principal investigators of the studies meeting the eligibility criteria for inclusion were invited to be part of the collaborative IPD-MA. Authors agreeing to participate in this collaborative research were requested to share the IPD using the IDDO VL data platform. The IDDO VL data platform currently holds data sets from clinical trials standardised to a common data format and provides a unique opportunity to identify host, parasite and drug determinants of treatment outcomes. Multivariable regression models will be constructed to identify determinants of therapeutic outcomes using generalised linear mixed-effects models accounting for within-study site clustering.

Ethics and dissemination

This IPD-MA meets the criteria for waiver of ethical review as defined by the Oxford Tropical Research Ethics Committee (OxTREC) granted to IDDO, as the research consists of secondary analysis of existing anonymised data (Exempt granted on 29 March 2023, OxTREC REF: IDDO) Ethics approval was granted by the ICMR-Rajendra Memorial Research Institute of Medical Sciences ethics committee (Letter no: RMRI/EC/30/2022) on 04-07-2022. The results of this IPD-MA will be disseminated at conferences, IDDO website and any peer-reviewed publications. All publications will be open source. Findings of this research will be critically important for the control programmes at regional/global levels, policy makers and groups developing new VL treatments.

PROSPERO registration

CRD42021284622.
Mediastinal lymph node dissection versus spared mediastinal lymph node dissection in stage IA non-small cell lung cancer presented as ground glass nodules: study protocol of a phase III, randomised, multicentre trial (MELDSIG) in China
Authors: Li Chenguang , Ni Yunfeng , Liu Changhao , Liu Renwang , Zhang Chenlei , Song Zuoqing , Liu Hongxu , Jiang Tao , Zhang Zhenfa
Published: October 2023

Introduction

Radical surgery including mediastinal lymph node dissection is the standard treatment for early-stage non-small cell lung cancer (NSCLC). About 50% lung nodules are pure ground glass or part-solid nodules, which are predominantly clinical stage IA NSCLC. Non-solid nodules rarely develop mediastinal lymph node metastasis.

Method and analysis

A phase III study was started in China to evaluate the non-inferiority in overall survival of spared mediastinal lymph node dissection compared with mediastinal lymph node dissection in stage IA NSCLC. A total of 1362 patients will be enrolled from 4 institutions in 2–3 years. The second endpoints are relapse-free survival and perioperative data, including duration of hospitalisation, duration of chest tube placement, operation time, blood loss.

Ethics and dissemination

This protocol has been reviewed and approved by the Clinical Research Review Board of Tianjin Medical University Cancer Institute and Hospital. The findings will be disseminated in peer-reviewed publications.

Trial registration number

NCT04631770.
Cohort profile update: the Norwegian STORK Groruddalen (STORK G) pregnancy and birth cohort—the role of ethnicity and causal pathways for obesity, type 2 diabetes, cardiovascular disease and other health issues
Authors: Waage Christin W , Toftemo Ingun , Brænd Anja Maria , Sletner Line , Sommer Christine , Birkeland Kåre Inge , Richardsen Kåre Rønn , Shakeel Nilam , Vøllestad Nina Køpke , Jenum Anne Karen
Published: October 2023

Purpose

The STORK Groruddalen cohort was set up in 2008 to explore ethnic differences in: (1)maternal health, primarily gestational diabetes (GDM) and related health issues during pregnancy and post partum, and effects of exposures on risk for type 2 diabetes, cardiovascular disease and other health issues, and (2)offspring’s growth and body composition, overweight/obesity and effects of early life exposures.

Participants

823 women (74% of invited) were followed from gestational week (GW) 15. Data were collected from 618 fathers. In total, 59% of women and 53% of fathers had origin from non-Western countries. Maternal mean age was 29.9 years (SD 4.9), and body mass index (BMI) 25.3 kg/m2(4.9). Data were obtained from 772 women (94%) at GW 28, and 662 women (80%) 14 weeks post partum. Eleven years post partum, 385 women (53% of eligible/47% of original cohort) attended, age was 42.0 years (4.8) and BMI 27.1 kg/m2(5.1). We have data for 783 children at birth, and for 586 at last time point, mean age 8.6 (0.5) years, weight 30.7 (6.8) kg and length 133.9 (6.3) cm.

Findings to date

We collected questionnaire data from parents, clinical measurements and blood samples from mothers, and data on children’s growth (mid-pregnancy to 8 years). Our biobank includes maternal blood and urine samples, biopsy material from placentas and umbilical venous cord blood. We found several clinically important differences inmaternal health, with higher risk in ethnic minority groups for GDM, insulin resistance, vitamin D and iron deficiency, depressive symptoms and physical inactivity. Contrasting patterns of fetal growth and risk of overweight/thinness at preschool age were observed across ethnic groups. Maternal GDM, obesity and high gestational weight gain were associated with children’s BMI trajectories.

Future plans

We will examine the impact of maternal and fetal health and development during pregnancy on long-term outcomes for mothers and offspring.

Trial registration number

Project title STORK G-2: Women and Risk of Type 2 DiabetesNCT03870724(ClinicalTrials.gov).
Combined surveillance and treatment register for children with cerebral palsy: the protocol of the Netherlands CP register
Authors: Andringa Aukje , Veerkamp Kirsten , Roebroeck Marij , Ketelaar Marjolijn , Klem Martijn , Dekkers Hurnet , Voorman Jeanine , van Driel Marieke , Buizer Annemieke
Published: October 2023

Introduction

Cerebral palsy (CP) is a childhood onset, lifelong, condition. Early detection and timely treatment of potential problems during the child’s development are important to prevent secondary impairments and improve function. Clinical management of children with CP requires a spectrum of multidisciplinary interventions, which have an impact on short-term and long-term outcomes. However, there is a lack of knowledge about a personalised approach in this heterogeneous population. Various CP registers with different aims have been developed worldwide, which has made an important contribution to our understanding of CP. The purpose of this protocol is to describe the unique design of a combined multidisciplinary surveillance and treatment register for children with CP in the Netherlands, which aims to improve quality of care and to enhance an individual treatment approach.

Methods and analysis

The Netherlands CP Register combines a multidisciplinary surveillance programme with a standardised protocol for treatment registry. The register systematically collects real-life surveillance and treatment data of children with CP. The register contributes to daily care at the individual level by screening for potential secondary impairments using a decision-support tool, by visualising individual development using a dashboard, and by supporting goal setting and shared decision-making for interventions. The register provides a platform at the national level for quality of care improvement and a comprehensive database of real-life data allowing multicentre studies with a long-term follow-up. People with lived experience of CP, healthcare professionals from different disciplines and researchers collaborated in the development of the register.

Ethics and dissemination

The Netherlands CP register was submitted to the Medical Ethics Review Committee of VU University Medical Center (Amsterdam, the Netherlands), who judged the register not to be subject to the Medical Research Involving Human Subjects Act. A scientific board reviews requests for dissemination of data from the register for specific research questions.
Improving hepatitis B screening and vaccination rates in a veterans affairs resident-based primary care clinic
Authors: Yu Zhuo Lin , Fisher Lisa
Published: October 2023

Introduction

In 2022, the Advisory Committee on Immunization Practices (ACIP) updated its recommendation regarding hepatitis B vaccination and advised vaccination for all adults aged 19–59 regardless of risk factors and those 60 years and older with risk factors. Adults 60 years and older without known risk factors may also be vaccinated. Our project aimed to spread awareness of the updated hepatitis B virus (HBV) vaccination guideline and improve HBV vaccination rates among veterans in a resident-based primary care clinic.

Methods

Preintervention data were collected from October to December 2021 and post intervention data were collected from March to May 2022; patients seen in the clinic during these months were included. Patients were considered immune against HBV if they had positive anti-hepatitis B surface antigen and susceptible to infection if the hepatitis B panel was negative. Interventions included educating each resident group regarding current guidelines via multifaceted modalities. In addition, a reminder for checking hepatitis B status was embedded in the veterans affairs (VA) electronic medical record.

Results

In the preintervention period from October to December 2021, a total of 1242 veterans were seen. 532 veterans had previous screening for hepatitis B immunity in the chart with 378 veterans negative for hepatitis B surface antibody. Of those 378 veterans, only 35 were vaccinated against hepatitis B during the time period studied. In the postintervention period, 1174 veterans were seen and 559 had prior hepatitis B immunity screening with 430 veterans negative for hepatitis B surface antibody. Of the 430 veterans with no immunity against HBV, 123 received hepatitis B vaccination during the time period studied, which is an increase of greater than 20% in the number of veterans vaccinated.

Discussion

Our data suggest that HBV vaccination rate was suboptimal among the veteran population. A low-cost intervention could be beneficial in integrating new vaccination guidelines in the VA standard of care. Increased awareness of the updated HBV vaccination guideline would likely help to achieve the goal of full vaccination among the veteran population.
Reducing scope 3 carbon emissions in gastrointestinal endoscopy: results of the prospective study of the ‘Green Endoscopy Project Würzburg’
Authors: Henniger Dorothea , Lux Thomas , Windsheimer Max , Brand Markus , Weich Alexander , Kudlich Theodor , Schöttker Katrin , Hann Alexander , Meining Alexander
Published: October 2023

Objective

Carbon emissions generated by gastrointestinal endoscopy have been recognised as a critical issue. Scope 3 emissions are mainly caused by the manufacturing, packaging and transportation of purchased goods. However, to our knowledge, there are no prospective data on the efficacy of measurements aimed to reduce scope 3 emissions.

Design

The study was performed in a medium-sized academic endoscopy unit. Manufacturers of endoscopic consumables were requested to answer a questionnaire on fabrication, origin, packaging and transport. Based on these data, alternative products were purchased whenever possible. In addition, staff was instructed on how to avoid waste. Thereafter, the carbon footprint of each item purchased was calculated from February to May 2023 (intervention period), and scope 3 emissions were compared with the same period of the previous year (control period).

Results

26 of 40 companies answered the questionnaire. 229 of 322 products were classified as unfavourable. A switch to alternative items was possible for 47/229 items (20.5%). 1666 endoscopies were performed during the intervention period compared with 1751 examinations during the control period (−4.1%). The number of instruments used decreased by 10.0% (3111 vs 3457). Using fewer and alternative products resulted in 11.5% less carbon emissions (7.09 vs 8.01 tons of carbon equivalent=tCO2 e). Separation of waste led to a reduction of 20.1% (26.55 vs 33.24 tCO2e). In total, carbon emissions could be reduced by 18.4%.

Conclusion

Use of fewer instruments per procedure, recycling packaging material and switching to alternative products can reduce carbon emissions without impairing the endoscopic workflow.
Multiplex imaging in immuno-oncology
Authors: Zhao Chen , Germain Ronald N
Published: October 2023

Multiplex imaging has emerged as an invaluable tool for immune-oncologists and translational researchers, enabling them to examine intricate interactions among immune cells, stroma, matrix, and malignant cells within the tumor microenvironment (TME). It holds significant promise in the quest to discover improved biomarkers for treatment stratification and identify novel therapeutic targets. Nonetheless, several challenges exist in the realms of study design, experiment optimization, and data analysis. In this review, our aim is to present an overview of the utilization of multiplex imaging in immuno-oncology studies and inform novice researchers about the fundamental principles at each stage of the imaging and analysis process.
Current perspectives on mass spectrometry-based immunopeptidomics: the computational angle to tumor antigen discovery
Authors: Zhang Bing , Bassani-Sternberg Michal
Published: October 2023

Identification of tumor antigens presented by the human leucocyte antigen (HLA) molecules is essential for the design of effective and safe cancer immunotherapies that rely on T cell recognition and killing of tumor cells. Mass spectrometry (MS)-based immunopeptidomics enables high-throughput, direct identification of HLA-bound peptides from a variety of cell lines, tumor tissues, and healthy tissues. It involves immunoaffinity purification of HLA complexes followed by MS profiling of the extracted peptides using data-dependent acquisition, data-independent acquisition, or targeted approaches. By incorporating DNA, RNA, and ribosome sequencing data into immunopeptidomics data analysis, the proteogenomic approach provides a powerful means for identifying tumor antigens encoded within the canonical open reading frames of annotated coding genes and non-canonical tumor antigens derived from presumably non-coding regions of our genome. We discuss emerging computational challenges in immunopeptidomics data analysis and tumor antigen identification, highlighting key considerations in the proteogenomics-based approach, including accurate DNA, RNA and ribosomal sequencing data analysis, careful incorporation of predicted novel protein sequences into reference protein database, special quality control in MS data analysis due to the expanded and heterogeneous search space, cancer-specificity determination, and immunogenicity prediction. The advancements in technology and computation is continually enabling us to identify tumor antigens with higher sensitivity and accuracy, paving the way toward the development of more effective cancer immunotherapies.
Consent-GPT: is it ethical to delegate procedural consent to conversational AI?
Authors: Allen Jemima Winifred , Earp Brian D , Koplin Julian , Wilkinson Dominic
Published: October 2023

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making.

In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices.
Microvascular reperfusion during endovascular therapy: the balance of supply and demand
Authors: Favilla Christopher G , Forti Rodrigo M , Carter Sarah , Kofke W Andrew , Kasner Scott E , Baker Wesley B , Yodh Arjun G , Messé Steven R , Cummings Stephanie , Kung David K , Burkhardt Jan Karl , Choudhri Omar A , Pukenas Bryan , Srinivasan Visish M , Hurst Robert W , Detre John A
Published: October 2023

Background

Endovascular therapy (EVT) has revolutionized the treatment of acute stroke, but large vessel recanalization does not always result in tissue-level reperfusion. Cerebral blood flow (CBF) is not routinely monitored during EVT. We aimed to leverage diffuse correlation spectroscopy (DCS), a novel transcranial optical imaging technique, to assess the relationship between microvascular CBF and post-EVT outcomes.

Methods

Frontal lobe CBF was monitored by DCS in 40 patients undergoing EVT. Baseline CBF deficit was calculated as the percentage of CBF impairment on pre-EVT CT perfusion. Microvascular reperfusion was calculated as the percentage increase in DCS-derived CBF that occurred with recanalization. The adequacy of reperfusion was defined by persistent CBF deficit, calculated as: baseline CBF deficit − microvascular reperfusion. A good functional outcome was defined as 90-day modified Rankin Scale score ≤2.

Results

Thirty-six of 40 patients achieved successful recanalization, in whom microvascular reperfusion in itself was not associated with infarct volume or functional outcome. However, patients with good functional outcomes had a smaller persistent CBF deficit (median 1% (IQR −11%–16%)) than patients with poor outcomes (median 28% (IQR 2–50%)) (p=0.02). Smaller persistent CBF deficit was also associated with smaller infarct volume (p=0.004). Multivariate models confirmed that persistent CBF deficit was independently associated with infarct volume and functional outcome.

Conclusions

CBF augmentation alone does not predict post-EVT outcomes, but when microvascular reperfusion closely matches the baseline CBF deficit, patients experience favorable clinical and radiographic outcomes. By recognizing inadequate reperfusion, bedside CBF monitoring may provide opportunities to personalize post-EVT care aimed at CBF optimization.
Sex-specific diagnostic efficacy of MRI in axial spondyloarthritis: challenging the ‘One Size Fits All’ notion
Authors: Ulas Sevtap Tugce , Proft Fabian , Diekhoff Torsten , Rios Valeria , Rademacher Judith , Protopopov Mikhail , Greese Juliane , Eshed Iris , Adams Lisa C , Hermann Kay Geert A , Ohrndorf Sarah , Poddubnyy Denis , Ziegeler Katharina
Published: October 2023

Objectives

Sex-specific differences in the presentation of axial spondyloarthritis (axSpA) may contribute to a diagnostic delay in women. The aim of this study was to investigate the diagnostic performance of MRI findings comparing men and women.

Methods

Patients with back pain from six different prospective cohorts (n=1194) were screened for inclusion in this post hoc analysis. Two blinded readers scored the MRI data sets independently for the presence of ankylosis, erosion, sclerosis, fat metaplasia and bone marrow oedema. Χ2tests were performed to compare lesion frequencies. Contingency tables were used to calculate markers for diagnostic performance, with clinical diagnosis as the standard of reference. The positive and negative likelihood ratios (LR+/LR–) were used to calculate the diagnostic OR (DOR) to assess the diagnostic performance.

Results

After application of exclusion criteria, 526 patients (379 axSpA (136 women and 243 men) and 147 controls with chronic low back pain) were included. No major sex-specific differences in the diagnostic performance were shown for bone marrow oedema (DOR m: 3.0; f: 3.9). Fat metaplasia showed a better diagnostic performance in men (DOR 37.9) than in women (DOR 5.0). Lower specificity was seen in women for erosions (77% vs 87%), sclerosis (44% vs 66%), fat metaplasia (87% vs 96%).

Conclusion

The diagnostic performance of structural MRI markers is substantially lower in female patients with axSpA; active inflammatory lesions show comparable performance in both sexes, while still overall inferior to structural markers. This leads to a comparably higher risk of false positive findings in women.
Out-of-distribution Detection in Time-series Domain: A Novel Seasonal Ratio Scoring Approach
Authors: Belkhouja Taha , Yan Yan , Doppa Janardhan Rao
Published: October 2023

Safe deployment of time-series classifiers for real-world applications relies on the ability to detect the data that is not generated from the same distribution as training data. This task is referred to as out-of-distribution (OOD) detection. We consider the novel problem of OOD detection for the time-series domain. We discuss the unique challenges posed by time-series data and explain why prior methods from the image domain will perform poorly. Motivated by these challenges, this article proposes a novel
Seasonal Ratio Scoring (SRS)
approach. SRS consists of three key algorithmic steps. First, each input is decomposed into class-wise semantic component and remainder. Second, this decomposition is employed to estimate the class-wise conditional likelihoods of the input and remainder using deep generative models. The seasonal ratio score is computed from these estimates. Third, a threshold interval is identified from the in-distribution data to detect OOD examples. Experiments on diverse real-world benchmarks demonstrate that the SRS method is well-suited for time-series OOD detection when compared to baseline methods.
Watermarking in Secure Federated Learning: A Verification Framework Based on Client-Side Backdooring
Authors: Yang Wenyuan , Shao Shuo , Yang Yue , Liu Xiyao , Liu Ximeng , Xia Zhihua , Schaefer Gerald , Fang Hui
Published: October 2023

Federated learning (FL) allows multiple participants to collaboratively build deep learning (DL) models without directly sharing data. Consequently, the issue of copyright protection in FL becomes important since unreliable participants may gain access to the jointly trained model. Application of homomorphic encryption (HE) in a secure FL framework prevents the central server from accessing plaintext models. Thus, it is no longer feasible to embed the watermark at the central server using existing watermarking schemes. In this article, we propose a novel client-side FL watermarking scheme to tackle the copyright protection issue in secure FL with HE. To the best of our knowledge, it is the first scheme to embed the watermark to models under a secure FL environment. We design a black-box watermarking scheme based on client-side backdooring to embed a pre-designed trigger set into an FL model by a gradient-enhanced embedding method. Additionally, we propose a trigger set construction mechanism to ensure that the watermark cannot be forged. Experimental results demonstrate that our proposed scheme delivers outstanding protection performance and robustness against various watermark removal attacks and ambiguity attack.
Community Preserving Social Recommendation with Cyclic Transfer Learning
Authors: Ni Xuelian , Xiong Fei , Pan Shirui , Wu Jia , Wang Liang , Chen Hongshu
Published: October 2023

Transfer learning-based recommendation mitigates the sparsity of user-item interactions by introducing auxiliary domains. Social influence extracted from direct connections between users typically serves as an auxiliary domain to improve prediction performance. However, direct social connections also face severe data sparsity problems that limit model performance. In contrast, users’ dependency on communities is another valuable social information that has not yet received sufficient attention. Although studies have incorporated community information into recommendation by aggregating users’ preferences within the same community, they seldom capture the structural discrepancies among communities and the influence of structural discrepancies on users’ preferences. To address these challenges, we propose a community-preserving recommendation framework with cyclic transfer learning, incorporating heterogeneous community influence into the rating domain. We analyze the characteristics of the community domain and its inter-influence on the rating domain, and construct link constraints and preference constraints in the community domain. The shared vectors that bridge the rating domain and the community domain are allowed to be more consistent with the characteristics of both domains. Extensive experiments are conducted on four real-world datasets. The results manifest the excellent performance of our approach in capturing real users’ preferences compared with other state-of-the-art methods.
Understanding the Electrooxidation of Dimethyl Ether on Pt3Pd3Sn2 Supported on a Mixture of Carbon Materials
Authors: Gebremedhin Medhanie , Teller Hannan , Schechter Alex
Published: October 2023

Recently, we reported a rigorous study on the effect of carbon supports and their cold plasma treatment on a state-of-the-art catalyst, Pt3Pd3Sn2, for dimethyl ether (DME) electrooxidation. The catalyst supported on a mixture of 75% activated multi-walled carbon nanotube (MWCNT) (75 M) and 25% pristine black pearl 2000 (BP2000) (25B) (Pt3Pd3Sn2/75M25B) offered improved DME kinetics with respect to the single or other combinations of the same supports. In this work, the results of the electrochemical impedance spectroscopy (EIS) were coupled with physicochemical characterizations (X-ray Diffraction (XRD), Small Angle X-ray Scattering (SAXS), and Scanning Tunneling Electron Microscopy (STEM)) for a detailed understanding of the origins of the improved kinetics. With an appropriate composition of the two supports in the mixture (75M25B), a catalyst with optimized particle size, dispersion, and conductivity was obtained. A Pt3Pd3Sn2/75M25B-coated electrode exhibited a reduced charge transfer resistance of 0.63 ohms at the catalyst layer compared to BP2000 and MWCNT, which showed 1.53 and 1.31 ohms, respectively. These results provide vital insights into catalyst support design considering the use of support mixtures of optimized conductivity and surface area for enhanced power output.
Augmented Catalytic Performance of PVA- Assisted Fe2O3 Nano Catalyst for Water Treatment Synthesized via Green Route
Authors: Memon Muddassir Ali , Wasim Akhtar M. , Khan Muhammad Yasir , Khuhawar Muhammad Yar , Abdullah  , Kim Yang Soo
Published: October 2023

Metal oxides (MO) are widely preferred for removing various effluents from water and air, however due to poor utilization of visible light, the application of MO nanoparticles for water treatments is hindered. This work reports the synthesis of ring structured PVA-assisted Fe2O3 (P-Fe2O3) nanocomposite through green route synthesis, for the elimination of methylene blue via Sunlight triggered photocatalyst. FTIR spectroscopy confirmed the presence of desired functional groups in novel ring structured Fe2O3 and PVA-assisted Fe2O3 (P-Fe2O3) nanocomposite. The crystallinity of Fe2O3 was also studied through XRD. Surface topography of Fe2O3 was examined through FE-SEM, that reveals a central hole with extended surface area of Fe2O3. UV–vis-spectroscopy is used to evaluate photocatalytic efficiency which shows, pristine Fe2O3 exhibited 27% degradation in stipulated time intervals of 30∼120 mins. The photocatalytic efficiency of augmented P-Fe2O3 nanocomposite expelled 82% of the methylene blue in span of just 02 hrs. The stability of the developed nanocomposite in the effluent medium was investigated through FTIR by observing the change in carboxyl adsorption band produced during degradation of PVA, that manifests the fact that no degradation was witnessed for PVA even after 120 min, that makes P-Fe2O3 a promising material for the degradation of azo dyes.
Versatile lactate signaling via HCAR1: a multifaceted GPCR involved in many biological processes
Authors: Mohammad Nezhady Mohammad Ali , Modaresinejad Monir , Zia Aliabbas , Chemtob Sylvain
Published: October 2023

G-coupled protein receptors (GPCRs) are the ultimate refuge of pharmacology and medicine as more than 40% of all marketed drugs are directly targeting these receptors. Through cell surface expression, they are at the forefront of cellular communication with the outside world. Metabolites among the conveyors of this communication are becoming more prominent with the recognition of them as ligands for GPCRs. HCAR1 is a GPCR conveyor of lactate. It is a class A GPCR coupled to Gαi which reduces cellular cAMP along with the downstream Gβγ signaling. It was first found to inhibit lipolysis, and lately has been implicated in diverse cellular processes, including neural activities, angiogenesis, inflammation, vision, cardiovascular function, stem cell proliferation, and involved in promoting pathogenesis for different conditions, such as cancer. Other than signaling from the plasma membrane, HCAR1 shows nuclear localization with different location-biased activities therein. Although different functions for HCAR1 are being discovered, its cell and molecular mechanisms are yet ill understood. Here, we provide a comprehensive review on HCAR1, which covers the literature on the subject, and discusses its importance and relevance in various biological phenomena.