bluuebunny/crossref_metadata_2025 huggingface dataset:
Building Information Modeling (BIM) integration in developing countries: An in-depth examination of adoption factors from public clients’ perspectives
Authors: Ozcan-Deniz Gulbin , Ozorhon Beliz , Kaya Osman Can
Published: August 2024

Over the past decade, the construction industry has undergone significant change due to technological advancements. Among these, Building Information Modeling (BIM) has been one of the pioneer technologies to impact this transformation. Projects using BIM reported increased productivity with expedited work of project stakeholders while maximizing their collaboration. While BIM has achieved remarkable success in developed countries, its adoption in developing countries remains limited. Studies showed that the acceptance of BIM technology is still very low in some countries. This study examines the status of BIM adoption including exploring the barriers as well as the factors that contribute to overcoming these barriers in adopting BIM in developing countries. BIM enablers in construction projects from the perspective of public clients were examined via a systematic review performed through the literature to identify these factors. Interviews were conducted with public clients to examine these factors. The average severity of each factor was ranked by clients. Notably, the study reveals that unfavorable economic conditions, high costs, and unclear project benefits as the significant barriers to BIM adoption. Clear advantages of BIM were reported as the ease of use, high analysis ability, positive attitude of the company, and demand/satisfaction of the clients.
Six-Year Outcomes of Total Arch Replacement vs Debranching With TEVAR for Aortic Arch Pathologies: Meta-Analysis of Kaplan-Meier–Derived Data From Propensity Score–Matched Studies
Authors: Sá Michel Pompeu , Iyanna Nidhi , Jacquemyn Xander , Brown James A. , Yousef Sarah , Ahmad Danial , Singh Michael J. , Serna-Gallegos Derek , Sultan Ibrahim
Published: August 2024

Background:

Total arch replacement (TAR) and debranching plus thoracic endovascular aortic repair (TEVAR) serve as significant therapeutic options for aortic arch pathologies. It remains unclear whether one of these approaches should be considered preferable. Our study aimed to compare the long-term outcomes of these 2 approaches.

Methods:

We carried out a pooled meta-analysis of time-to-event data extracted from studies published by December 2023. Eligibility criteria included populations with any aortic arch pathology who underwent debranching plus TEVAR or TAR, propensity score–matched (PSM) studies (prospective/retrospective; single-center/multicentric), and the outcomes included follow-up for overall survival/mortality and/or reinterventions.

Results:

Eleven PSM studies met our eligibility criteria, including a total of 1142 patients (571 matched pairs). We did not observe any statistically significant difference in the risk of all-cause death between the groups (hazard ratio [HR]=1.20, 95% confidence interval [CI]=0.91-1.56, p=0.202), but patients who underwent TAR had a significantly lower risk of late aortic reinterventions compared with patients who underwent debranching plus TEVAR (HR=0.38, 95% CI=0.23-0.64, p<0.001). Our meta-regression analyses for all-cause mortality identified statistically significant coefficients for age (coefficient=−0.047; p=0.012) and type A aortic dissections (coefficient=0.012; p=0.010).

Conclusions:

Debranching plus TEVAR and TAR demonstrate no statistically significant differences in terms of survival in patients with aortic arch pathologies, but TAR is associated with lower risk of late aortic reinterventions over time. Although older patients may benefit more from debranching plus TEVAR rather than from TAR, patients with dissections may benefit more from TAR.

Clinical Impact

Although the 2 strategies seem to be equally valuable in terms of survival, total aortic arch replacement (when compared with debranching plus TEVAR to treat patients with aortic arch pathologies) is associated with reduction of late aortic reinterventions over time in patients with and without aortic dissections. However, we should consider debranching plus TEVAR in older patients as it is associated with lower risk of death in this population. The novelty of our study lies in the fact that, instead of comparing study-level effect estimates, we analyzed the outcomes with reconstructed time-to-event data. This offered us the opportunity of performing our analyses with a mathematically appropriate model which consider events and time; however, these findings might be under the influence of treatment allocation bias.
Comparison of Subsequent Inframalleolar Bypass Surgery and Repeat Endovascular Therapy for Infrapopliteal Restenosis in Patients With Chronic Limb-Threatening Ischemia Undergoing Primary Endovascular Therapy
Authors: Suzuki Riho , Horiuchi Katsumi , Iida Osamu , Takahara Mitsuyoshi , Dannoura Yutaka , Asakawa Naoya , Makino Takao , Yokoshiki Hisashi
Published: August 2024

Purpose:

Although endovascular therapy (EVT) is considered a vital strategy for treating infrapopliteal lesions in chronic limb-threatening ischemia (CLTI), the recurrence rate after EVT exceeds that after bypass surgery (BSX). The optimal approach for managing infrapopliteal lesion recurrence in patients with CLTI and unhealed ulcers remains uncertain. This study aimed to evaluate the clinical outcomes of repeat EVT and subsequent inframalleolar BSX for CLTI with infrapopliteal lesion recurrence.

Materials and Methods:

We conducted a retrospective analysis of 140 patients with CLTI (mean age, 70±10 years; male, 71.4%; diabetes mellitus, 73.6%; dialysis, 74.3%; Rutherford 5, 79.3%; and Rutherford 6, 20.7%) who had an unhealed wound due to the recurrence of infrapopliteal lesions between January 2015 and May 2020. We compared the clinical outcomes of 40 patients who underwent the subsequent inframalleolar BSX with those of 100 patients who underwent repeat EVT. The outcome measures were amputation-free survival (AFS) and wound healing rate. Propensity score matching analysis was conducted to minimize differences in baseline characteristics.

Results:

Propensity score matching extracted 38 pairs (38 patients in the subsequent BSX group and 83 patients in the repeat EVT group). AFS was not significantly different between the repeat EVT and subsequent BSX groups (81.9% vs 82.6% at 1 year, p=0.97). Neither was cumulative wound healing (42.8% vs 43.3% at 1 year, p=0.55). No baseline characteristics had any significant interaction effect on the association between repeat EVT, subsequent BSX, and failure of AFS.

Conclusion:

This study using propensity score matching revealed that the clinical outcomes following repeat EVT were comparable with those following subsequent inframalleolar BSX, indicating that repeat EVT may be a viable treatment option for CLTI with infrapopliteal lesion recurrence.

Clinical Impact

Although endovascular therapy (EVT) has expanded the treatment options for chronic limb-threatening ischemia (CLTI), the recurrence rate after EVT is higher than that after bypass surgery (BSX). This retrospective study compared the clinical outcomes of repeat EVT with those of subsequent BSX for CLTI with infrapopliteal lesion recurrence. After propensity score matching, amputation-free survival (AFS) was not significantly different between the repeat EVT and subsequent BSX groups (81.9% vs 82.6% at 1 year, p=0.97). Neither was cumulative wound healing (42.8% vs 43.3% at 1 year, p=0.55). There was no difference between the 2 revascularization strategies when treating infrapopliteal restenosis lesions.
Joseph Pancoast (1805-1882) and His Innovations in Plastic Surgery
Authors: Agorgianitis Loukas , Karassava Heleni , Mavrommatis Evaggelos
Published: August 2024

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his career

Purpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy.

Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus.
Preparation and performance of phase change thermoregulating fabric with high heat storage density via spray coating
Authors: Lang Xiyan , Xiang Xuexue , Gao Jing
Published: August 2024

To achieve the efficient encapsulation of microencapsulated phase change materials (mPCMs) and the one-step preparation of a phase change fabric, we prepared self-adhesive phase change microcapsules. By adding sticky polymers during the preparation of the phase change microcapsules, the microcapsule preparation and thermoregulation finishing steps were integrated into a single process to realize the fast and efficient preparation of phase change thermoregulating fabrics with high energy storage density. A sticky polymer polyvinyl alcohol solution used instead of conventional water as the continuous phase medium for emulsion polymerization to synthesize sticky mPCMs in the emulsions, enabling their application in fabrics via rapid spraying. The micromorphology, chemical structure, thermal properties, dynamic heat storage and temperature regulation performance of the phase change fabrics with mPCMs were subsequently studied, revealing the successful preparation and effective adhesion of the mPCMs to the interior of the fabric. After about 10 min under simulated sunlight, the fabric treated with mPCMs exhibited a 14°C temperature buffering impact within the phase change temperature (~26°C) compared with the untreated fabric. The treated fabric also had a 4.5°C lower surface temperature upon reaching thermal equilibrium after 30 min, lead to the slower rise in the fabric temperature. Our approach simplified the preparation method into a one-step process to provide phase change thermoregulating fabrics with high heat storage density. These findings further demonstrated the potential of microencapsulated n-octadecane for thermal management applications, including automotive interiors, heat protection suits, sports clothing, thermoregulating covers for buildings and other commercial applications.
Effect of a 15-Week Whole Foods, Plant-Based Diet, Physical Activity, and Stress Management Intervention on Cardiometabolic Risk Factors in a Population of US Veterans: A Retrospective Analysis
Authors: Yiaslas Themis A. , Rogers-Soeder Tara S. , Ono Gregory , Kitazono Rachel E. , Sood Ajay
Published: August 2024

Military Veterans have a higher risk of incident atherosclerotic cardiovascular disease (ASCVD) than the general population and are often clinically complex. We studied the changes in cardiovascular risk factors with a lifestyle intervention in this population. We retrospectively analyzed data from 67 participants (mean age 69.2 (SD 7.9) years; 97% male) with atherosclerotic heart disease and/or type 2 diabetes in a 15-week, multiple health behavior change (MHBC) intervention implemented in a Veterans Affairs (VA) Behavioral Medicine Clinic. The intervention promoted a whole foods, plant-based (WFPB) diet, physical activity, and cognitive-behavioral stress management. We assessed cardiometabolic risk factors at baseline, 1 month into the intervention, and at 15 weeks (post-treatment). Among intervention completers (n = 67), we observed statistically significant improvements in waist circumference (−2.8 inches, P = .03), systolic blood pressure (−7.9 mmHg, P = .03), LDL cholesterol (−11.27 mg/dL, P = .04), fasting glucose (−15.10 mg/dL, P = .03), and hemoglobin A1c (−0.55%, P = .017) at post-treatment. Participants with type 2 diabetes (n = 34) achieved improvements in hemoglobin A1c (−0.80%, P = .007), systolic blood pressure (−10.98 mmHg, P = .01), and diastolic blood pressure (−6.65 mmHg, P = .03) at post-treatment. Medication usage did not significantly change. Veterans who completed the MHBC intervention achieved significant improvements in cardiometabolic risk in a routine VA clinical practice setting.
Dance sport movement therapy in the metaverse: A new frontier for alternative mental health therapies
Authors: Radanliev Petar
Published: August 2024

This paper investigates the integration of Dance Movement Therapy (DMT) within extended reality (XR) environments, exploring its potential as a non-pharmacological intervention for mental health conditions. The study employed a blend of qualitative evidence synthesis and analyses of primary quantitative data, focusing on the therapeutic implications of Dance in virtual, augmented and mixed realities. Data from wearables and sensors on movements, physiological responses and emotional feedback are analysed using AI/ML algorithms, including Random Forest, SVM, CNNs and RNNs. The research highlighted the importance of data privacy and ethical considerations, emphasising the need for securely storing metadata to ensure user trust and legal compliance. Findings underscored the potential of XR environments like the Metaverse in transforming mental health practices, offering efficient, engaging and effective therapeutic interventions. The study also introduced the novel concept of Physical Intensity Matching and the significance of personalised exercise selection. Despite its ground-breaking insights, the research acknowledged potential biases introduced by wearables and the challenges of ensuring data accuracy. This paper is a foundational exploration into the convergence of DMT, XR and AI, paving the way for future interdisciplinary research in mental health and technology.
Prediction of patient flow in the emergency department using explainable artificial intelligence
Authors: Moreno-Sánchez Pedro A , Aalto Matti , van Gils Mark
Published: August 2024

Introduction

Overcrowding in emergency departments (ED) is a significant problem affecting patient outcomes, hospital length of stay, and staff job satisfaction. This issue often stems from unpredictable patient flow and suboptimal resource allocation.

Objectives

This study aims to develop two machine learning (ML) models to assist in early and accurate resource allocation in EDs. The first model predicts patient admission at the time of triage, while the second predicts the specialty of care needed indicated by the initial ward transfer.

Methods

The study leverages the Medical Information Mart for Intensive Care (MIMIC-IV) database with 425,000 ED visits including basic vital signs, medications, presentation information, diagnoses, and demographic information about the patients. Ensemble tree classifiers are employed for model development, and model's explainability is assessed by investigating feature importance. The best model is selected based on the balance between performance and explainability. Features’ importances are calculated and presented using SHapley Additive exPlanations and models’ intrinsic feature importance.

Results

The best-balanced admission prediction model in terms of classification performance and explainability achieved an accuracy of 0.775 and an area under the receiver operating curve (AUROC) of 0.779 by using eXtreme Gradient Boosting (XGBoost). The resource allocation prediction model, using a one-vs-rest approach, attained an AUROC of 0.783 again by using XGBoost. The models shared acuity and age in the three most important features, whereas admission ratio and gender were the additional features for admission prediction and resource prediction, respectively.

Conclusion

The study successfully demonstrates the potential of ML models in predicting patient admission and required specialty care at the ED triage stage. While the admission prediction model shows moderate performance compared to existing studies, the resource prediction model exhibits superior performance compared to related works. The research highlights the importance of explainability in ML models, suggesting the need for further practical implementation to refine and validate these models in real-world settings.
Paraspinal Sarcopenia and Lower Hounsfield Units are Independent Predictors of Increased Risk for Proximal Junctional Complications Following Thoracolumbar Fusions Terminating in the Upper Thoracic Spine
Authors: Pinter Zachariah W. , Bernatz James , Mikula Anthony L. , Lakomkin Nikita , Pennington Zachary A. , Michalopoulos Giorgos D. , Nassr Ahmad , Freedman Brett A. , Bydon Mohamad , Fogelson Jeremy , Sebastian Arjun S. , Elder Benjamin D.
Published: August 2024

Study Design

Retrospective cohort study.

Objective

The impact of paraspinal sarcopenia following fusions that extend to the upper thoracic spine remain unknown. The purpose of the present study was to assess the impact of sarcopenia on the development of PJK and PJF following spine fusion surgery from the upper thoracic spine to the pelvis.

Methods

We performed a retrospective review of patients who underwent spine fusion surgery that extended caudally to the pelvis and terminated cranially between T1-6. The cohort was divided into 2 groups: (1) patients without PJK or PJF and (2) patients with PJK and/or PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications.

Results

We identified 81 patients for inclusion in this study. Mean HU at the UIV was 186.1 ± 47.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK/PJF subgroup (142.4 ± 40.2) ( P < 0.001). Severe multifidus sarcopenia was identified at a higher rate in the subgroup of patients who developed proximal junction pathology (66.7%) than in the subgroup of patients who developed neither PJK nor PJF (7.4%; P < 0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF.

Conclusions

Severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF in following thoracolumbar fusions from the upper thoracic spine to the pelvis.
The Impact of Hearing Aids on Listening Effort and Listening-Related Fatigue - Investigations in a Virtual Realistic Listening Environment
Authors: Blümer M. , Heeren J. , Mirkovic B. , Latzel M. , Gordon C. , Crowhen D. , Meis M. , Wagener K. , Schulte M.
Published: August 2024

Participation in complex listening situations such as group conversations in noisy environments sets high demands on the auditory system and on cognitive processing. Reports of hearing-impaired people indicate that strenuous listening situations occurring throughout the day lead to feelings of fatigue at the end of the day. The aim of the present study was to develop a suitable test sequence to evoke and measure listening effort (LE) and listening-related fatigue (LRF), and, to evaluate the influence of hearing aid use on both dimensions in mild to moderately hearing-impaired participants. The chosen approach aims to reconstruct a representative acoustic day (Time Compressed Acoustic Day [TCAD]) by means of an eight-part hearing-test sequence with a total duration of approximately 2½ h. For this purpose, the hearing test sequence combined four different listening tasks with five different acoustic scenarios and was presented to the 20 test subjects using virtual acoustics in an open field measurement in aided and unaided conditions. Besides subjective ratings of LE and LRF, behavioral measures (response accuracy, reaction times), and an attention test (d2-R) were performed prior to and after the TCAD. Furthermore, stress hormones were evaluated by taking salivary samples. Subjective ratings of LRF increased throughout the test sequence. This effect was observed to be higher when testing unaided. In three of the eight listening tests, the aided condition led to significantly faster reaction times/response accuracies than in the unaided condition. In the d2-R test, an interaction in processing speed between time (pre- vs. post-TCAD) and provision (unaided vs. aided) was found suggesting an influence of hearing aid provision on LRF. A comparison of the averaged subjective ratings at the beginning and end of the TCAD shows a significant increase in LRF for both conditions. At the end of the TCAD, subjective fatigue was significantly lower when wearing hearing aids. The analysis of stress hormones did not reveal significant effects.
Completed U.S. Fertility by Sex, Cohort, and Education Level
Authors: Hudde Ansgar , Cohen Philip N.
Published: August 2024

This visualization shows the relationship between completed fertility and education across five decades of cohorts in the United States using data from the General Social Survey. Across these cohorts, the educational gradient of fewer children for those with more education is stronger for women than for men. The gradient has become less steep across cohorts as the gap between people with medium and high levels of education has narrowed. Those without high school degrees have the highest fertility rates at all times, but this group represents a decreasing share of the population as educational levels rise over time. Thus, the educational gradient in completed fertility persists but has become less important for overall fertility patterns.
Effects of berberine hydrochloride on antioxidant response and gut microflora in the Charybdis japonica infected with Aeromonas hydrophila
Authors: Han Mingming , Guo Yanxia , Tang ShengKai , Li Daming , Wan Jinjuan , Zhu Chenxi , Zuraini Zakaria , Liang Ji , Gao Tianheng , Zhou Zihan , Jiang Qichen
Published: August 2024

This study used berberine hydrochloride to treat the Asian paddle crab, Charybdis japonica infected with the Gram-negative bacterium Aeromonas hydrophila at concentrations of 0, 100, 200 and 300 mg/L. The effect of berberine hydrochloride on the survival rate and gut microbiota of C. japonica was investigated. Berberine hydrochloride improved the stability of the intestinal flora, with an increase in the abundance of probiotic species and a decrease in the abundance of both pathogenic bacteria after treatment with high concentrations of berberine hydrochloride. Berberine hydrochloride altered peroxidase activity (POD), malondialdehyde (MDA), and lipid peroxidation (LPO) in the intestinal tract compared to the control. Berberine hydrochloride could modulate the energy released from the enzyme activities of hexokinase (HK), phosphofructokinase (PFK), and pyruvate kinase (PK) in the intestinal tract of C. japonica infected with A. hydrophila. Zona occludens 1 (ZO-1), Zinc finger E-box binding homeobox 1 (ZEB1), occludin and signal transducer, and activator of transcription5b (STAT5b) expression were also increased, which improved intestinal barrier function. The results of this study provide new insights into the role of berberine hydrochloride in intestinal immune mechanisms and oxidative stress in crustaceans.
Multisource information fusion method for vegetable disease detection
Authors: Liu Jun , Wang Xuewei
Published: August 2024

Automated detection and identification of vegetable diseases can enhance vegetable quality and increase profits. Images of greenhouse-grown vegetable diseases often feature complex backgrounds, a diverse array of diseases, and subtle symptomatic differences. Previous studies have grappled with accurately pinpointing lesion positions and quantifying infection degrees, resulting in overall low recognition rates. To tackle the challenges posed by insufficient validation datasets and low detection and recognition rates, this study capitalizes on the geographical advantage of Shouguang, renowned as the “Vegetable Town,” to establish a self-built vegetable base for data collection and validation experiments. Concentrating on a broad spectrum of fruit and vegetable crops afflicted with various diseases, we conducted on-site collection of greenhouse disease images, compiled a large-scale dataset, and introduced the Space-Time Fusion Attention Network (STFAN). STFAN integrates multi-source information on vegetable disease occurrences, bolstering the model’s resilience. Additionally, we proposed the Multilayer Encoder-Decoder Feature Fusion Network (MEDFFN) to counteract feature disappearance in deep convolutional blocks, complemented by the Boundary Structure Loss function to guide the model in acquiring more detailed and accurate boundary information. By devising a detection and recognition model that extracts high-resolution feature representations from multiple sources, precise disease detection and identification were achieved. This study offers technical backing for the holistic prevention and control of vegetable diseases, thereby advancing smart agriculture. Results indicate that, on our self-built VDGE dataset, compared to YOLOv7-tiny, YOLOv8n, and YOLOv9, the proposed model (Multisource Information Fusion Method for Vegetable Disease Detection, MIFV) has improved mAP by 3.43%, 3.02%, and 2.15%, respectively, showcasing significant performance advantages. The MIFV model parameters stand at 39.07 M, with a computational complexity of 108.92 GFLOPS, highlighting outstanding real-time performance and detection accuracy compared to mainstream algorithms. This research suggests that the proposed MIFV model can swiftly and accurately detect and identify vegetable diseases in greenhouse environments at a reduced cost.
Potentially inappropriate prescribing (PIP) in older people and its association with socioeconomic deprivation—a systematic review and narrative synthesis
Authors: Hire Adrian James , Franklin Bryony Dean
Published: August 2024

Background

Potentially inappropriate prescribing (PIP) refers to the prescription of medications that carry a higher risk of adverse outcomes, such as drug interactions, falls, and cognitive impairment. PIP is of particular concern in older adults, and is associated with increased morbidity, mortality, and healthcare costs. Socioeconomic deprivation has been identified as a potential risk factor for PIP. However, the extent of this relationship remains unclear. This review aimed to synthesize the current literature on the association between PIP and socioeconomic status (SES) in older adults.

Methods

A literature search was conducted using the databases Medline, Embase and CINAHL. A search strategy was developed to capture papers examining three key concepts: PIP, socioeconomic deprivation and older/elderly populations. Peer-reviewed quantitative research published between 1/1/2000 and 31/12/2022 was eligible for inclusion.

Results

Twenty articles from 3,966 hits met the inclusion criteria. The sample size of included studies ranged from 668 to 16.5million individuals, with the majority from Europe (n = 8) and North America (n = 8). Most defined older patients as being 65 or over (n = 12) and used income (n = 7) or subsidy eligibility (n = 5) to assess SES. In all, twelve studies reported a statistically significant association between socioeconomic deprivation and an increased likelihood of experiencing PIP. Several of these reported some association after adjusting for number of drugs taken, or the presence of polypharmacy. The underlying reasons for the association are unclear, although one study found that the association between deprivation and higher PIP prevalence could not be explained by poorer access to healthcare facilities or practitioners.

Conclusion

The findings suggest some association between an older person’s SES and their likelihood of being exposed to PIP. SES appears to be one of several factors that act independently and in concert to influence an older person’s likelihood of experiencing PIP. This review highlights that prioritising older people living in socioeconomically-deprived circumstances may be an efficient strategy when carrying out medication reviews.
Exercise, mental well-being and burnout in Thai medical students in 2020–2021: an online cross-sectional survey
Authors: Dhachpramuk Dhachdanai , Sonjaipanich Suprapath , Theppiban Supparat , In-iw Supinya
Published: August 2024

Introduction

Within the Thai medical curriculum, its rigorous education framework, demanding schedules and high academic standards can contribute to psychological distress. Regular physical activity has consistently shown positive effects on mental health. The aim of the study was to investigate the association between exercise and psychological well-being, including depression, anxiety, and burnout, in Thai medical students, and factors related to insufficient exercise and depression.

Methods

The cross-sectional study was conducted among medical students in the university hospital during 2020–2021. Participants completed self-administered questionnaires consisting of demographic data, Godin-Shephard Leisure-Time Physical Activity Questionnaire, depression screening (9Q), Thai General Health Question-28 (4 domains: somatic symptoms, anxiety and insomnia, social dysfunction, severe depression), and Maslach burnout inventory (Emotional exhaustion (EE), Depersonalization (DP), Reduced Personal Achievement (rPA).

Results

Of the 404 participants, 50.5% were women, the mean age (SD) was 21.06 (1.8) years, and 52% were in clinical years. The prevalence of insufficient exercise was 59.6%, depression (30.2%), somatic symptoms (27.7%), anxiety (30.7%), insomnia (89.4%), social dysfunction (89.4%), high level of EE (32.4%), DP (21%), and rPA (56.7%). Insufficient exercise was associated with moderate to severe depression (OR 2.89, 95% CI 1.16–7.25), anxiety and insomnia (OR 1.56, 95% CI 1.01–2.43), social dysfunction (OR 2.51, 95% CI 1.31–4.78), burnout in part due to high rPA (OR 2.4, 95% CI 1.4–4.13), and study in clinical years (OR 1.91, 95% CI 1.28–2.87). After adjusted significant factors, only studying in the clinical year, social dysfunction, and burnout in part of rPA were related to insufficient exercise.

Conclusions

High rates of insufficient exercise, psychological challenges, and burnout were prevalent among medical students. To effectively address these issues, medical school should advise students to participate in regular exercise, promoting mental well-being and healthier lifestyles.
Towards an integrative approach of healthcare: implementing positive health in three cases in the Netherlands
Authors: de Bekker Ankie , Beijer Maarten , Lemmens Lidwien
Published: August 2024

Background

The healthcare system is under tremendous pressure. One possible solution towards relieving some of this pressure is to use Positive Health, which takes ‘health’ as a starting point, rather than ‘illness’. Positive Health provides opportunities for stimulating integrated care.

Methods

Three cases in the Netherlands are studied in this paper. Their way of working with Positive Health is investigated through semi-structured and narrative interviews, using realist-evaluation and thematic analyses.

Results

Seven ‘working elements’ are identified that enhance the chances of successfully implementing Positive Health in practice (part 1). The interviews show that healthcare professionals have noticed that people adopt a healthier lifestyle and gain a greater degree of control over their own health. This boosts job satisfaction for healthcare professionals too. The organisations and professionals involved are enthusiastic about working with Positive Health, but still experience barriers (part 2).

Conclusions

The results of this study imply that implementing Positive Health in practice can facilitate collaboration between organisations and professionals from different disciplines, such as healthcare, welfare, and municipal health services. Operating from the perspective of a shared goal, professionals from different disciplines will find it easier to jointly organise activities to foster citizens’ health. Additionally, more attention is paid to non-medical problems affecting people’s well-being, such as loneliness or financial problems.
India Hypertension Control Initiative: decentralization of hypertension care to health wellness centres in Punjab and Maharashtra, India, 2018–2022
Authors: Chavan Tejpalsinh A. , Kaviprawin Mogan , Sakthivel Manikandanesan , Kishore Navneet , Jogewar Padmaja , Gill Sandeep Singh , Kunwar Abhishek , Durgad Kiran , Wankhede Amol B. , Bharadwaj Vishwajit , Khedkar Suhas N. , Sarode Lalit , Das Bidisha , Bangar Sampada D. , Venkatasamy Vettrichelvan , Gupta Ashu , Kriina Mosoniro , Krishna Ashish , Pathni Anupam Khungar , Sahoo Swagata K. , Parasuraman Ganeshkumar , Shivashankar Roopa , Pragya Pragati , Sharma Meenakshi , Kaur Prabhdeep
Published: August 2024

Introduction

The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018–2022.

Methods

We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care.

Results

The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018–2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types.

Conclusion

We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.
Validity and reliability of self-reported methods for assessment of 24-h movement behaviours: a systematic review
Authors: Šuc Anja , Einfalt Lea , Šarabon Nejc , Kastelic Kaja
Published: August 2024

Background

Time spent in sleep, sedentary behaviour (SB), and physical activity are exhaustive and mutually exclusive parts of a 24-h day that need to be considered in a combination. The aim of this study was to identify validated self-reported tools for assessment of movement behaviours across the whole 24-h day, and to review their attributes and measurement properties.

Methods

The databases PubMed, Scopus, and SPORTDiscus were searched until September 2023. Inclusion criteria were: (i) published in English language, (ii) per-reviewed paper, (iii) assessment of self-reported time spent in sleep, SB, and physical activity, (iv) evaluation of measurement properties of all estimates across the full 24-h day, and (v) inclusion of adolescents, adults, or older adults. The methodological quality of included studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments checklist.

Results

Our search returned 2064 records. After studies selection, we included 16 articles that reported construct validity and/or test-retest reliability of 12 unique self-reported tools – eight questionnaires, three time-use recalls, and one time-use diary. Most tools enable assessment of time spent in sleep, and domain-specific SB and physical activity, and account that sum of behaviours should be 24 h. Validity (and reliability) correlation coefficients for sleep ranged between 0.22 and 0.69 (0.41 and 0.92), for SB between 0.06 and 0.57 (0.33 and 0.91), for light-intensity physical activity between 0.18 and 0.46 (0.55 and 0.94), and for moderate- to vigorous-intensity physical activity between 0.38 and 0.56 (0.59 and 0.94). The quality of included studies being mostly fair-to-good.

Conclusions

This review found that only a limited number of validated self-reported tools for assessment of 24-h movement behaviours are currently available. Validity and reliability of most tools are generally adequate to be used in epidemiological studies and population surveillance, while little is known about adequacy for individual level assessments and responsiveness to behavioural change. To further support research, policy, and practice, there is a need to develop new tools that resonate with the emerging 24-h movement paradigm and to evaluate measurement properties by using compositional data analysis.

Systematic review registration

PROSPERO CRD42022330868.
Primary pulmonary meningioma presenting as a pulmonary ground glass nodule: a case report and review of the literature
Authors: Zhao Shengliang , Liu Xiaoqing , Xiang Mingzhang , Dai Jigang
Published: August 2024

Background

A primary pulmonary meningioma is an extremely rare entity. Primary pulmonary meningiomas manifested with a ground glass nodule are a very rare occurrence in clinical practice.

Case presentation

In this study, we report a case of a primary pulmonary meningioma with atypical computed tomography features. A 59-year-old Han Chinese female came to our hospital for treatment and reported that her physical examination revealed a ground glass nodule in the right lung for over 3 months. The histologic result revealed a primary pulmonary meningioma. The patient underwent a thoracoscopic lung wedge resection of the right upper lobe for a ground glass nodule. After 1 year of follow-up, the patient is still alive without evidence of metastasis or recurrence.

Conclusions

Primary pulmonary meningiomas could have a variety of radiological findings. As there are no specific radiologic features for the diagnosis of primary pulmonary meningiomas, complete resection of the lesion is required for both diagnosis and treatment. It is necessary to note the imaging features of primary pulmonary meningiomas, presenting as a ground glass nodule; this rare tumor should be considered in differential diagnoses.
Fast computation of function composition derivatives for flatness-based control of diffusion problems
Authors: Scholz Stephan , Berger Lothar
Published: August 2024

The chain rule is a standard tool in differential calculus to find derivatives of composite functions. Faà di Bruno’s formula is a generalization of the chain rule and states a method to find high-order derivatives. In this contribution, we propose an algorithm based on Faà di Bruno’s formula and Bell polynomials (Bell in Ann Math 29:38–46, 1927; Parks and Krantz in A primer of real analytic functions, 2012) to compute the structure of derivatives of function compositions. The application of our method is showcased using trajectory planning for the heat equation (Laroche et al. in Int J Robust Nonlinear Control 10(8):629–643, 2000).
Food security and large-scale land acquisitions by sovereign wealth funds: a systematic review of the literature from 2012 to 2023
Authors: Blekking Jordan , Aassouli Dalal , Jureidini Ray
Published: August 2024

Many countries that have large surplus financial resources but contend with limited land and water resources use large-scale land acquisitions (LSLAs) in foreign countries to ensure national food security and earn long-term returns on their investments. LSLAs can provide positive direct and indirect benefits in countries where investment occurs by increasing access to financial and technical resources. On the other hand, LSLA critics state inequitable and unsustainable resource use practices are common, and that negative impacts tend to disproportionately impact local communities. Using the PRISMA systematic literature review approach, we conducted a literature review of 49 articles published between 2012 and early 2023 to understand if LSLAs contribute to food security, if national sovereign wealth funds invest in LSLAs, and to what extent the environmental, social, and governance impacts of LSLAs are evaluated. We find that most articles in our review state LSLAs do not improve food security in the country where the investment occurs or in the country where the investment originates. We also find that sovereign wealth funds were not prevalent LSLA investors during the study period, despite becoming a top contributor to agri-food sector investments during the same time. Finally, we find that the environmental, social, and governance impacts of LSLAs are not equally considered. Specifically, governance impacts are poorly understood. Improving the governance mechanisms associated with LSLAs could increase the equitability and sustainability of LSLAs, thus ensuring the public’s best interest in the immediate and long-term and reassuring investors about the long-term financial viability of their investment.
Five-Year Follow-Up of Standard-of-Care Axicabtagene Ciloleucel for Large B-Cell Lymphoma: Results From the US Lymphoma CAR T Consortium
Authors: Jain Michael D. , Spiegel Jay Y. , Nastoupil Loretta J. , Tamaresis John , Ghobadi Armin , Lin Yi , Lekakis Lazaros , Reagan Patrick , Oluwole Olalekan , McGuirk Joseph , Deol Abhinav , Dorritie Kathleen A. , Sehgal Alison R. , Goy Andre , Hill Brian T. , Andreadis Charalambos , Munoz Javier , Ulrickson Matthew , Westin Jason , Chavez Julio C. , Patel Dilan , Jacobs Miriam T. , Bansal Radhika , Bennani N. Nora , Patel Vivek G. , Rapoport Aaron P. , Vose Julie M. , Miklos David B. , Neelapu Sattva S. , Locke Frederick L. , Lunning Matthew , Dahiya Saurabh
Published: August 2024

PURPOSE

Axicabtagene ciloleucel (axi-cel) is an autologous CD19 chimeric antigen receptor (CAR) T-cell therapy that is approved for the treatment of relapsed or refractory large B-cell lymphoma. Little is known about the long-term survivorship after CAR T-cell therapy.

METHODS

We previously reported the results of 298 patients who were leukapheresed with the intent to receive standard-of-care axi-cel (n = 275 infused) after two or more previous lines of therapy at a median follow-up of 12.9 months. Here, we report extended follow-up of this cohort to a median of 58 months, with a focus on late survivorship events.

RESULTS

Among axi-cel–infused patients, progression-free survival at 5 years was 29% and overall survival (OS) at 5 years was 40%. The 5-year lymphoma-specific survival was 53% with infrequent late relapses. However, the 5-year nonrelapse mortality (NRM) was 16.2%, with over half of NRM events occurring beyond 2 years. Patients who were 60 years and older had a lower risk of relapse (
P
= .02), but a higher risk of NRM compared with patients younger than 60 years (NRM odds ratio, 4.5 [95% CI, 2.1 to 10.8];
P
< .001). Late NRM was mainly due to infections and subsequent malignant neoplasms (SMNs). In total, SMNs occurred in 24 patients (9%), including therapy-related myeloid neoplasms (n = 15), solid tumors (n = 7), and unrelated lymphoid malignancies (n = 2).

CONCLUSION

In the standard-of-care setting, axi-cel exhibits outcomes consistent with those reported in clinical trials, with sustained, durable responses observed at the 5-year time point. However, late infections and the development of SMN are key survivorship issues that reduce long-term survival after CAR T-cell therapy, particularly in the elderly.
Stick With Intravenous or Give Subcutaneous a Shot? Time and Other Considerations When Evaluating Cancer Drug Formulations
Authors: Gupta Arjun , Tregear Michelle , Pace Makala B. , Vogel Rachel I.
Published: August 2024

Time and other considerations when evaluating a switch to newer drug formulations (eg, subQ vs IV).
Lessons for Expanding the Share of Disadvantaged Students in Economics from the AEA Summer Program at Michigan State University
Authors: Cook Lisa D. , Moser Christine
Published: August 2024

Since 1974, the American Economic Association Summer Training Program has provided training and mentoring to students from disadvantaged backgrounds in economics. The aim of the program is to encourage and prepare these students to apply to PhD programs in economics and ultimately to increase diversity in the profession. The program has been hosted by different universities over the years. This paper provides insights and lessons learned from the program’s tenure at Michigan State University from 2016 to 2020. In addition to discussing the structure and outcomes of the program, we provide advice to students, faculty, and potential hosts who may be interested in the AEA Summer Program or similar programs.
Mixture and Non-Mixture Cure Models for the survival analysis of SARS-CoV-2 patients in Khyber Pakhtunkhwa, Pakistan
Authors: Asghar Naseem , Khalil Umair , Iftikhar Uddin
Published: August 2024

Objective: To examine the potential difference in survival and risk of death between asymptomatic and symptomatic SARS-CoV-2 patients, controlled by age and gender for all the attendance in hospitals of Khyber Pakhtunkhwa (KP), Pakistan.
Methods: In this retrospective study, the medical records of 6273 SARS-CoV-2 patients admitted to almost all hospitals in Khyber Pakhtunkhwa during the first wave of the coronavirus outbreak from March to June 2020 were analysed. The effects of gender, age, and being symptomatic on the survival of SARS-CoV-2 patients were assessed using cure-survival models as opposed to the conventional Cox proportional hazards model.
Results: The prevalence of initially symptomatic patients was 55.8%, and the overall mortality rate was 11.8%. The fitted cure-survival models suggest that age affects the probability of death (incidence) but not the short-term survival time of patients (latency); symptomatic patients have a higher risk of death than their asymptomatic counterparts, but the survival time of symptomatic patients is longer on average; gender has no significant effect on the probability of death and survival time.
Conclusion: The available data and statistical results suggest that asymptomatic and young patients are generally less susceptible to initial infection with SARS-CoV-2 and therefore have a lower risk of death. Our regression models show that uncured asymptomatic patients generally have poorer short-term survival than their uncured symptomatic counterparts. The association between gender and survival outcome was not significant.
doi: https://doi.org/10.12669/pjms.40.8.8931
How to cite this: Asghar N, Khalil U, Iftikhar Uddin. Mixture and Non-Mixture Cure Models for the survival analysis of SARS-CoV-2 patients in Khyber Pakhtunkhwa, Pakistan. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.8931
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.