bluuebunny/crossref_metadata_2025 huggingface dataset:
Adult children's responsiveness to parental needs during the pandemic
Authors: Lin I‐Fen , Wiemers Emily E. , Chin Janecca A. , Strauss Anna Wiersma , Seltzer Judith A. , Hotz V. Joseph
Published: November 2024

Objectives

Guided by the life‐course principles of linked lives embedded in historical time and place, we investigated whether nonresident adult children provided financial and time assistance to parents in response to their needs during the COVID‐19 pandemic.

Background

Adult children are an important source of support for older adults during crises, yet their ability to help parents may have been constrained during the pandemic.

Method

Data were extracted from the 2016, 2018, and 2020 waves of the Health and Retirement Study. We employed three analytic strategies. First, we examined how nonresident adult children responded to parental needs during the pandemic. Second, we compared the financial and time assistance received during the pandemic with earlier periods. Third, we assessed whether support patterns varied depending on the severity of the pandemic in places where parents lived. All analyses used linear probability models, adjusting for pre‐pandemic characteristics.

Results

Parents facing economic hardship more often received money help and those experiencing difficulty buying food for nonfinancial reasons more often received time help from adult children compared to those without such challenges. Moreover, both financial and time assistance from adult children increased during the pandemic compared to pre‐pandemic levels. Hardships increased the probability of receiving money and time help from adult children when parents lived in areas with a high level of pandemic severity.

Conclusion

Adult children became more responsive to parental needs during the COVID‐19 pandemic, underscoring the importance of linked lives across generations during times of crisis.
The fall and rise of parental financial investments during the COVID‐19 pandemic
Authors: Hastings Orestes P. , Amorim Mariana , Kornrich Sabino
Published: November 2024

Objective

This research note investigates changes in American parents' financial investments in children during the COVID‐19 pandemic, as well as whether and how changes in parents' spending varied based on parental education.

Background

Parents purchase goods, experiences, and services that shape children's human capital and life chances. Socioeconomic differences in parental expenditures on children represent an important pathway for perpetuating inequality across generations. The COVID‐19 pandemic disrupted children's lives in ways that may have changed these levels of investment.

Method

The 2015–2022 Consumer Expenditure Survey (CEX) is used to describe spending on five key categories of investments in children's human capital (educational spending, extracurricular activities and lessons, computers and tablets, formal childcare, informal childcare) overall and by parental education. Mediation analysis assesses the extent school closures explain these changes.

Results

Childcare and extracurricular expenditures initially decreased significantly and then gradually recovered to pre‐pandemic levels by the end of 2021. Cutbacks were primarily among more educated families. However, spending on schooling increased in 2021 and computer and tablet purchases spiked in 2020, particularly among more educated families. Mediation analysis suggests that when expenditures were most affected by the pandemic (in 2020), school closures explained 50%–70% of those changes.

Conclusion

This note provides evidence that during the pandemic socioeconomic inequalities in child‐related spending decreased in some categories of spending (e.g., childcare and extracurriculars) and increased in others (e.g., computers and tablets). Many changes appeared short‐term, but changes in education point to possible longer‐term shifts in parents' preferences about children's educational environments.
Dental Functional Status as a Possible Risk Factor of Sarcopenia: A Computed Tomography‐Based Study
Authors: Gürhan Ceyda , Dinç Funda
Published: November 2024

Background

Functional dentition may be associated with sarcopenia by affecting chewing activity.

Objectives

The objective of this study is to determine the sarcopenia status of participants using computed tomography (CT)‐based data and to investigate the association of sarcopenia with functional dentition, as well as denture condition.

Methods

The study included 309 patients. The number of teeth was recorded. Functional dentition was evaluated based on the following parameters: (1) ≥ 1 tooth in the maxilla and mandible; (2) ≥ 10 teeth in each arch; (3) the presence of 12 anterior teeth; (4) 3–4 premolar posterior occlusal pairs (POPs) and (5) ≥ 1 molar POP bilaterally. The denture condition was also evaluated. CT‐based assessment of sarcopenia was performed via measurement of the psoas muscle area at the level of the L3 vertebra and its hounsfield unit (HU) radiodensity on non‐contrast‐enhanced images. HU average calculation (HUAC), which is an imaging marker of sarcopenia, was performed. Gender‐specific quartiles were then generated, and the lowest quartile of HUAC scores within each gender group was set as the cut‐off point.

Results

A total of 76 (24.5%) of the patients had sarcopenia, and 233 (75.5%) did not have sarcopenia. The mean number of teeth in the sarcopenia group was 17.12 ± 8.39, compared to 22.24 ± 6.72 in those without sarcopenia (p < 0.001). The relationship between functional dentition and sarcopenia was also significant. There was a positive relationship between ill‐fitting dentures and sarcopenia (p < 0.001).

Conclusions

This unique perspective of the study contributes to the existing knowledge regarding the role of tooth loss in sarcopenia, highlighting the importance of functional occlusion.
Flight initiation distance differs among eumelanin‐based color morphs in feral pigeons
Authors: Frantz A. , Baneux M. , Pichon L. , Renier S. , Vilanova J.
Published: November 2024

Organisms facing anthropogenic activities usually exhibit phenotypic responses assumed to enhance coping with disturbance. These responses include a decreasing degree of reaction toward potentially risky situations (“behavioral tolerance”) with increasing disturbance. Though melanin is associated with many phenotypic traits, including pigmentation and behavior, the potential relationship between behavioral tolerance and melanin has never been explored. Such relationship may potentially result from either direct association between melanin and behavior (e.g., genetic correlation) or indirectly through a coloration‐dependent behavior‐modulating factor (e.g., differential predation or human preferences in cities toward color morphs). Feral pigeons (Columba livia) represent an ideal biological system to test for these hypotheses, due to their presence in cities worldwide, their considerable variation in eumelanin‐based coloration, ranging from white to black plumage, and their close proximity to humans. We measured Flight Initiation Distance (FID, classically used for behavioral tolerance assessment) of feral pigeons of 4 different eumelanin‐based color morphs in sites differing in their urbanization rate and pedestrian traffic within the restricted scale of a city center (Paris). Urbanization rate and pedestrian traffic had no effect on FID, maybe because of the small spatial scale considered. FID varied with eumelanin‐based coloration: white pigeons had lower FID (104.6 cm; i.e., higher behavioral tolerance) than darker morphs (232.3 cm for Blue bar, 184.4 cm for T‐pattern & Checker, and 181.8 cm for Spread color morphs). Though the exact underlying causes remain to be identified, we propose different possible mechanisms for this relationship that remain to be investigated in future work.
Osteoporosis Knowledge and Its Risk Factors in Older Adults With Upper Extremity Fragility Fractures: A National Cross‐Sectional Study
Authors: Shao Mengqi , Qiu Chen , Song Mi , Tang Nan , Song Jie , Su Qingqing , Li Jianan , Wang Youting , Chen Jingru , Gao Yuan
Published: November 2024

It is crucial to recognize upper extremity fragility fractures as sentinel events that allow healthcare professionals the opportunity to identify and address underlying factors contributing to poor bone health, thereby reducing the risk of future fragility fractures. This study seeks to evaluate the extent of understanding and factors influencing osteoporosis in older adults with upper extremity fragility fractures, aiming to establish a foundation for enhancing their comprehension. A total of 1443 participants in 31 provinces were included in this study as survey subjects from September to November 2023. A general information questionnaire and an osteoporosis knowledge assessment tool were used for a cross‐sectional survey. The univariate analysis and logistic regression were used to analyze the risk factors. The score of osteoporosis knowledge assessment tool of participants was 10.00 (7.00, 12.00), with only 24.95% scoring above 12 points. Being in an eastern hospital, suffering from chronic obstructive pulmonary disease, being diagnosed as severe osteoporosis, having bone mineral density testing, receiving osteoporosis health education, and receiving health education by phone were associated with higher knowledge of osteoporosis. The osteoporosis knowledge of older adults with upper extremity fragility fractures needs to be improved. To help the secondary prevention of osteoporosis, the standardized osteoporosis health education should be strengthened, and attention should be paid to key groups.
The censor's burden
Authors: Joshi Hrishikesh
Published: November 2024

Censorship involves, inter alia, adopting a certain type of epistemic policy. While much has been written on the harms and benefits of free expression and the associated rights thereof, the epistemic preconditions of justified censorship are relatively underexplored. In this paper, I argue that examining intrapersonal norms of how we ought to treat evidence that might come to us over time can shed light on interpersonal norms of evidence generation and sharing that are relevant in the context of censorship. The upshot is that justified censorship requires the censor to meet a very high epistemic burden regarding the target proposition(s)—importantly, one that exceeds knowledge.
Island colonization in flowering plants is determined by the interplay of breeding system, lifespan, floral symmetry, and arrival opportunity
Authors: Zell Annie N. , Miranda Charlotte H. , Grady Erin L. , Grossenbacher Dena L. , Igić Boris
Published: November 2024

Among flowering plants, self‐compatibility, longer lifespan, and generalized pollination syndrome are each thought to increase the lifetime odds of finding a mate, particularly in isolated locales. An accumulated body of evidence supports the role of breeding system in island colonization, but less is known about the impact of other traits and their interactions during establishment.

We employ a global dataset of 3222 flowering plant species from 169 families to estimate the effects of traits on the probability of island occurrence. Our analyses additionally account for taxonomic group membership and assess the role of island arrival opportunity.

Self‐compatibility is strongly associated with island colonization. A longer lifespan and generalized pollination syndrome are also associated with increased island colonization, although this is influenced by their interaction with breeding system. The probability of island colonization is highly dependent on taxonomically conserved unmeasured traits and arrival opportunity. As expected, mate limitation appears to increase with dispersal distance, although many other factors are at play.

We find that arrival opportunity and breeding system are the primary drivers of island colonization relative to other life‐history traits we account for here, lending additional support for the positive role of uniparental reproduction in establishment following long‐distance dispersal.
The BBX7/8‐CCA1/LHY transcription factor cascade promotes shade avoidance by activating PIF4
Authors: Bian Yeting , Song Zhuolong , Liu Changseng , Song Zhaoqing , Dong Jie , Xu Dongqing
Published: November 2024

Sun‐loving plants undergo shade avoidance syndrome (SAS) to compete with their neighbors for sunlight in shade conditions. Phytochrome B (phyB) plays a dominant role in sensing the shading signals (low red to far‐red ratios) and triggering SAS. Shade drives phyB conversion to inactive form, consequently leading to the accumulation of PHYTOCHROMEINTERACTING FACTOR 4 (PIF4) that promotes plant growth.

Here, we show B‐box PROTEIN 7 (BBX7)/BBX8 and CIRCADIAN CLOCK ASSOCIATED 1 (CCA1)/LATE ELONGATED HYPOCOTYL (LHY) positively regulate the low R : FR‐induced PIF4 expression and promote the low R : FR‐triggered hypocotyl growth in Arabidopsis.

Shade interferes the interactions of phyB with BBX7 or BBX8 and triggers the accumulation of BBX7 and BBX8 independent of phyB. BBX7 and BBX8 associate with CCA1 and LHY to activate their transcription, the gene produces of which subsequently upregulate the expression of PIF4 in shade. Genetically, BBX7 and BBX8 act upstream of CCA1, LHY, and PIF4 with respect to hypocotyl growth in shade conditions.

Our study reveals the BBX7/8‐CCA1/LHY transcription factor cascade upregulates PIF4 expression and increases its abundance to promote plant growth and development in response to shade.
The Effects of a Newborn Care Education Program on Mothers’ Self‐Confidence, Care Knowledge, and Breastfeeding Behavior: A Systematic Review and Meta‐Analysis
Authors: Guo Kangle , Shang Xue , Deng Xinxin
Published: November 2024

Objective

To assess the effect of newborn care education programs on mothers’ self‐confidence, care knowledge, and exclusive breastfeeding behavior and anxiety.

Methods

We searched for intervention studies comparing newborn care education programs versus standard care for mothers in five comprehensive databases (July 2024). The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool. The R software version 4.2.2 software was used to perform the meta‐analysis on mothers’ self‐confidence, care knowledge, exclusive breastfeeding behavior, and anxiety, and the GRADE approach was used to evaluate the certainty of evidence.

Results

Twenty trials involving 6136 mothers were included. The results of meta‐analysis revealed that newborn care education program improved mothers’ confidence scores (SMD = 1.25, 95% CI: [0.22, 2.28], p < 0.05), care knowledge level scores (SMD = 1.05, 95% CI: [–0.00, 2.09], p < 0.05), the frequency of exclusive breastfeeding (RR = 1.15, 95% CI: [1.10, 1.20], p < 0.05), and significantly decreased anxiety scores (SMD = –0.40, 95% CI: [–0.73, –0.07], p < 0.05) than standard care programs.

Conclusion

Our evidence supports the benefits of newborn care education programs in improving mothers’ self‐confidence, care knowledge, exclusive breastfeeding behavior (optimal duration of more than 6 months), and reducing anxiety. Newborn care education program is beneficial to mothers both in behaviors and psychology state of taking care of newborn. It is recommended conducting more well‐designed intervention with large samples to verify current findings.
Characterization of a plant‐pathogenic T3SS‐lacking Xanthomonas strain isolated from common ragweed
Authors: Biessy Adrien , Cadieux Mélanie , Ciotola Marie , McDuff Florence , Soufiane Brahim , Laforest Martin , Filion Martin
Published: November 2024

Common ragweed (Ambrosia artemisiifolia) is one of the leading causes of allergenic rhinitis, as well as a major weed of many crops. Biological control with plant pathogens, such as fungi and bacteria, represents an attractive alternative to the application of synthetic herbicides to control this noxious weed. In this study, we isolated a Xanthomonas strain (designated as 10‐10) from a diseased common ragweed plant collected in southern Quebec, Canada. We characterized the bioherbicidal potential of this strain against common ragweed, and determined whether it can infect other plant species. Its genome was sequenced using PacBio's SMRT technology, enabling us to gain insight into the phylogenetic placement of this strain within the genus Xanthomonas, and to study the repertoire of virulence‐associated genes and clusters. Xanthomonas sp. 10‐10 belongs to a clearly defined subclade within clade C (group 2), which includes X. vesicatoria, X. dyei and X. pisi. While this strain is closely related to X. pisi, it represents a new species within the genus Xanthomonas. Surprisingly, this strain lacks a type III secretion system, which is the main virulence determinant in pathogenic Xanthomonas spp., but harbours an arsenal of cell wall‐degrading enzymes. The addition of the organosilicone surfactant Silwet L‐77 drastically increased the disease symptoms caused by Xanthomonas sp. 10‐10 on common ragweed plants grown under controlled conditions, but the plants remained alive. This strain also caused disease symptoms on tomato, pepper and lettuce. More research is needed to develop Xanthomonas‐based bioherbicide specifically targeting common ragweed.
Blood donation practices, motivators and barriers in the Caribbean: A narrative review
Authors: Reid Latoya N. , Miller Maureen J. , West‐Mitchell Kamille A.
Published: November 2024

Adequacy and safety are the twin prerogatives of the blood transfusion service which in turn is an indispensable component of public health delivery; however, many Caribbean countries have inadequate blood supply for the current and projected demands of their health care systems. Understanding blood donor motivators and barriers is crucial to improving the rate of voluntary non‐remunerated blood donation (VNRD) to meet World Health Organisation (WHO) targets. The objective of this study was to review current research on the landscape of blood donation practices and attitudes in the Caribbean. We undertook a systematic search of electronic databases through September 2023 to identify studies of blood donation practices, knowledge and attitudes, including motivators and barriers to donation in the English‐speaking Caribbean. We identified eight (8) relevant studies of observational study design. VNRD remain relatively uncommon; family replacement or remunerated donations were most common. Barriers to blood donation included lack of a known recipient such as a family member who needed blood, never having been asked to donate, presumed ineligibility to donate, and fear of needles or adverse reactions. Study participants indicated willingness to donate blood if provided more information about the importance of blood donation. There is a paucity of published research regarding blood donor knowledge, motivators and barriers in the Caribbean context. Such research could indicate the necessary interventions for achieving the goals of an adequate and safe blood supply.
Electro-Osmotic Mechanism of Ellis Fluid With Joule Heating, Viscous Dissipation, and Magnetic Field Effects in a Pumping Microtube
Authors: Noreen Saima , Aslam Farida
Published: November 2024

The dynamics of electro-osmotically generated flow of biological viscoelastic fluid in a cylindrical geometry are investigated in this paper. This flux is the result of walls contracting and relaxing sinusoidally in a magnetic environment. The blood's viscoelasticity and shear-thinning viscosity are the primary causes of its non-Newtonian characteristics. Hence, the rheology of the fluid (blood) is accurately captured with the Ellis fluid model. Both Joule heating and viscous dissipation are accounted for during thermal analysis. The electric potential induced in the electric double layer (EDL) is obtained by applying the Debye-Huckel linearization to the nonlinear Poisson-Boltzmann equation. Mathematical modelling is incorporated in cylindrical coordinates in wave frame of reference. Assuming a long wavelength and creeping flow characterized by a low Reynolds number, the Ellis fluid model's governing equations are simplified. The resulting differential equations are evaluated numerically via the built-in tool NDSolve of the Mathematica. Graphical representations are utilized to visually and comprehensively assess the thermal characteristics, flow features, heat transfer coefficient, and skin friction coefficient. Various factors are taken into consideration, including the impact of Ellis fluid parameters, electric double layer, magnetic field, Brinkman number, and Ohmic dissipation. Ellis fluid's axial velocity boosts with a rise of the electro-osmotic parameter and power-law index while decreasing with an increase in the Hartmann number and material fluid parameter. The fluid temperature is directly proportional to EDL parameter and parameters of Ohmic and viscous dissipation. The presence of both electric and magnetic fields may aid in the management and control of Ellis fluid (blood) mobility at different temperatures, which is helpful in controlling bleeding during surgeries. The current model may be used in clinical scenarios involving the gastrointestinal system and capillaries, electrohydrodynamic therapy, delivery of drugs in pharmacological, and biomedical devices. This research creates a theoretical model that can predict the effects of different parameters on the characteristics of fluid flows that are like blood.
Estimation of Joint Kinetics During Manual Material Handling Using Inertial Motion Capture: A Follow-Up Study
Authors: Skals Sebastian , de Zee Mark , Skipper Andersen Michael
Published: November 2024

Musculoskeletal models based on inertial motion capture (IMC) and ground reaction force (GRF) prediction hold great potential for field-based risk assessment of manual material handling (MMH). However, previous evaluations have identified inaccuracies in the methodology's estimation of spinal forces, while the accuracy of other key outcome variables is currently unclear. This study evaluated knee, shoulder, and L5–S1 joint reaction forces (JRFs) derived from a musculoskeletal model based on inertial motion capture and GRF prediction against a model based on simultaneously collected optical motion capture (OMC) and force plate measurements. Data from 19 healthy subjects performing lifts with various horizontal locations (HLs), deposit heights (DHs), and asymmetry angles (AAs) were analyzed, and the consistency and absolute agreement of the model estimates statistically compared. Despite varying levels of agreement across tasks and variables, considerable absolute differences were identified for the L5–S1 axial compression (AC) (root-mean-square error (RMSE) = 63.0–94.2%BW) and anteroposterior (AP) shear forces (RMSE = 40.9–80.6%BW) as well as the bilateral knee JRFs (RMSE = 78.9–117%BW). Glenohumeral JRFs and vertical GRFs exhibited the highest overall consistency (r = 0.33–0.91, median 0.78) and absolute agreement (RMSE = 7.63–34.9%BW), while the L5–S1 axial compression forces also showed decent consistency (r = 0.04–0.89, median 0.80). The findings generally align with prior evaluations, indicating persistent challenges with the accuracy of key outcome variables. While the modeling framework shows promise, further development of the methodology is encouraged to enhance its applicability in ergonomic evaluations.
Acute phlegmonous esophagitis
Authors: Gopal Prashant , Dahale Amol , Payagude Aniket , Banerjee Debabrata
Published: November 2024

Acute phlegmonous esophagitis (APE) is a rare disease caused by bacterial infection of the oesophagus, typically involving the submucosal and muscularis layers. Patients may present with chest pain, dysphagia, odynophagia, dyspnoea, fever, nausea and vomiting, making diagnosis difficult. We present two cases of APE, both young females who presented with dysphagia and odynophagia. The first patient had a history of surgery (left mastoidectomy) which might have functioned as a nidus for infection, whereas the second patient had uncontrolled diabetes. CT findings in both patients revealed diffuse oesophageal thickening, and oesophagogastroduodenoscopy showed erythema and ulcerations. Both patients were managed conservatively using intravenous antibiotics and supportive therapy. APE is associated with a high mortality rate and warrants early diagnosis and treatment. CT is the preferred non-invasive diagnostic modality. Treatment includes systemic antibiotics, nutritional support and timely endoscopic or surgical intervention. Invasive intervention is indicated in patients not responding to medical therapy or in those with complications.
A comparative analysis of supply chain factors impacting COVID-19 vaccine security in high-income countries (HICs) and low-income and middle-income countries (LMICs)
Authors: Puri Manveen , Veillard Jeremy H , Brown Adalsteinn , Klein David
Published: November 2024

Introduction

The COVID-19 pandemic focused attention on the importance of vaccine security to national security. Demand for vaccines far exceeded supply when the first COVID-19 vaccines were released. Growing data suggest a non-perfect correlation among vaccine development, production, purchases, deliveries and vaccination rates. As such, the best approach to strengthening vaccine security remains unclear. In this study, we use an operations research/operations management framework to characterise the relationship between vaccine security and key supply chain predictor variables in high-income countries (HICs) and low-income and middle-income countries (LMICs).

Methods

We performed a comparative analysis of vaccine security against eight supply chain variables in a purposive sample of five HICs and five LMICs during the early phase of the pandemic (31 March 2021 and 30 April 2021). All data were obtained from publicly available databases. We used descriptive statistics to characterise our data, basic statistics to compare data and scatter plots to visualise relationships.

Results

Our data show greater vaccine security in HICs compared with LMICs (32.2% difference in April 2021; 95% CI 4.2% to 60.3%, p=0.03). We report a significant difference between HICs and LMICs in only two of the eight predictor variables studied. Interestingly, we observed large variation in vaccine securitywithinHICs, with Canada, Israel and Japan being frequent outliers, and within LMICs, with India standing out.

Conclusion

Our data suggest a stronger relationship between vaccine security and ‘downstream’ supply chain variables compared with ‘upstream’ variables. However, multiple outliers and the lack of an even stronger relationship suggests that there is no magic bullet for vaccine security. To boost vaccine resilience, countries must be well governed and strategically reinforce deficient aspects of their supply chains. Modest strength in multiple domains may be the best approach to counteracting the effect of an unfamiliar, novel pathogen.
Lessons learned from COVID-19 modelling efforts for policy decision-making in lower- and middle-income countries
Authors: Owek Collins J , Guleid Fatuma Hassan , Maluni Justinah , Jepkosgei Joyline , Were Vincent O , Sim So Yoon , Cw Hutubessy Raymond , Hagedorn Brittany L , Nzinga Jacinta , Oliwa Jacquie
Published: November 2024

Introduction

The COVID-19 pandemic had devastating health and socioeconomic effects, partly due to policy decisions to mitigate them. Little evidence exists of approaches that guided decisions in settings with limited pre-pandemic modelling capacity. We thus sought to identify knowledge translation mechanisms, enabling factors and structures needed to effectively translate modelled evidence into policy decisions.

Methods

We used convergent mixed methods in a participatory action approach, with quantitative data from a survey and qualitative data from a scoping review, in-depth interviews and workshop notes. Participants included researchers and policy actors involved in COVID-19 evidence generation and decision-making. They were mostly from lower- and middle-income countries (LMICs) in Africa, Southeast Asia and Latin America. Quantitative and qualitative data integration occurred during data analysis through triangulation and during reporting in a narrative synthesis.

Results

We engaged 147 researchers and 57 policy actors from 28 countries. We found that the strategies required to use modelled evidence effectively include capacity building of modelling expertise and communication, improved data infrastructure, sustained funding and dedicated knowledge translation platforms. The common knowledge translation mechanisms used during the pandemic included policy briefs, face-to-face debriefings and dashboards. Some enabling factors for knowledge translation comprised solid relationships and open communication between researchers and policymakers, credibility of researchers, co-production of policy questions and embedding researchers in policymaking spaces. Barriers included competition among modellers, negative attitude of policymakers towards research, political influences and demand for quick outputs.

Conclusion

We provide a contextualised understanding of knowledge translation for LMICs during the COVID-19 pandemic. Furthermore, we share key lessons on how knowledge translation from mathematical modelling complements the broader learning agenda related to pandemic preparedness and long-term investments in evidence-to-policy translation. Our findings led to the co-development of a knowledge translation framework useful in various settings to guide decision-making, especially for public health emergencies.
Trans and gender diverse identities in adolescent health research: making the most of imperfect data
Authors: Soneson Emma , O'Leary Shona , Fazel Mina
Published: November 2024

Advancing adolescent health research necessitates deliberate design and analysis that accurately captures the rapidly evolving world in which adolescents live and the ways in which they understand and express themselves and their experiences. In thisPerspective, we reflect on how researchers might approach existing, imperfect data in a way that is accurate and inclusive of trans and gender diverse (TGD) adolescents. Drawing on our experience of running a large school-based survey of health and well-being (the OxWell Student Survey) and extensive coproduction with three TGD adolescents (‘youth advisors’), we present considerations for critically appraising, processing and analysing quantitative gender data to better reflect adolescents’ lived experiences. Specific topics discussed include how to assess the strengths and limitations of existing gender data; how to generate meaningful research data from free-text gender descriptions (and the implications of not doing so); and how to analyse data from TGD adolescents, including for those who choose not to disclose their gender. We conclude with a set of 10 recommendations, coproduced with the three youth advisors, for those working with ‘imperfect’ gender data.
Physician perspectives of clinical performance feedback and impact on well-being: a qualitative exploration
Authors: Levoy Emily , Vilendrer Stacie , Dang Rebecca , Nasr Annette S , Luu Jacklyn , Tawfik Daniel , Shanafelt Tait
Published: November 2024

Objectives

Providing clinical performance feedback to physicians is an established method to improve care, but the impact on physician well-being is unclear. This evaluation aimed to better understand physician perspectives on clinical feedback and its potential impact on well-being.

Design

A qualitative design using semi-structured interviews was undertaken. Data were analysed via consensus coding using an inductive–deductive approach informed by Clinical Performance Feedback Intervention Theory. Findings were used to develop a novel framework describing the relationship between feedback and well-being.

Setting

Interviews were conducted in a large academic medical centre from June–September 2021.

Participants

We conducted 25 semi-structured interviews with general outpatient and inpatient paediatricians and internists.

Results

Physicians felt that feedback supported well-being based on its perceived purpose (intended to promote professional growth vs serving an alternative purpose), which they discerned based on feedback content (aligned with physician priorities vs not aligned), validity (accurate vs inaccurate), actionability (specific vs not, within a physician’s sphere of control vs not) and delivery (supportive vs punitive). The Clinical Performance Feedback Well-Being Model is presented to understand how feedback and recipient variables impact well-being.

Conclusions

Attention to the process and content of physician clinical performance feedback may advance both the quality of care and physician well-being.
Differential target multiplexed spinal cord stimulation in patients with Persistent Spinal Pain Syndrome Type II: a study protocol for a 12-month multicentre cohort study (DETECT)
Authors: Goudman Lisa , De Smedt Ann , Eldabe Sam , Rigoard Philippe , Billot Maxime , Roulaud Manuel ,   DETECT consortium, Moens Maarten
Published: November 2024

Introduction

Differential target multiplexed spinal cord stimulation (DTM SCS) is a new stimulation paradigm for chronic pain management with the aim of modulating glial cells and neurons in order to rebalance their interactions. Animal studies revealed positive effects of this type of stimulation; however, studies in humans are still scarce, pointing towards the need for an evaluation of the effectiveness and safety of DTM SCS in clinical settings. Furthermore, the differential target multiplexed (DTM) algorithm consists of a combination of several programmes, which will presumably consume more energy from the spinal cord stimulation (SCS) battery. Therefore, the objective of DETECT is to investigate the feasibility, effectiveness and safety of DTM SCS in patients with Persistent Spinal Pain Syndrome Type II through a longitudinal cohort study.

Methods and analysis

DETECT is a prospective multicentre cohort study (n≥250) with a follow-up until 12 months after receiving DTM SCS. The study initiated in October 2021 and is currently still recruiting patients. Self-reporting outcome variables were evaluated at baseline (before SCS) and at 1, 6 and 12 months of DTM SCS. The primary effectiveness endpoint is overall pain intensity, measured with the visual analogue scale. Secondary effectiveness outcome measures are back pain intensity, leg pain intensity, disability, health-related quality of life, pain medication use, functional disability, clinical holistic responder status, self-management, impression of change, work status, pain catastrophising, symptoms of central sensitisation, anxiety, depression and healthcare utilisation. Time spent in different body postures and SCS stimulation parameters will be read out from the pulse generator. The prevalence of technical issues, recharge frequency, (serious) adverse events and the proportion of successful DTM trials will be collected as well. Longitudinal mixed models will be calculated to evaluate the effectiveness of DTM SCS over time.

Ethics and dissemination

The study protocol was approved by the central Ethics Committee of the Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (B.U.N.1432021000563) and the Ethics Committees of each participating centre. Research findings will be disseminated to key stakeholders through peer-reviewed publications in scientific journals and presentations to clinical audiences.

Trial registration number

NCT05068011.
Factors affecting the feasibility of post-authorisation RCTs for conditionally authorised anticancer medicines: a multistakeholder perspective from a qualitative focus group study
Authors: van Hattem Christine C , de Jong Amos J , de Groot Jolien S , Hoekman Jarno , Broekman K Esther , Sonke Gabe S , van Hennik Paula B , Bloem Lourens T
Published: November 2024

Objective

The collection of comprehensive data from post-authorisation trials for conditionally authorised anticancer medicines is frequently delayed. This raises questions about the feasibility of post-authorisation randomised controlled trials (RCTs) that aim to address remaining uncertainties. Therefore, this study explored factors that facilitate or impede the feasibility of post-authorisation RCTs from the perspective of stakeholders directly involved in the design, medical-ethical approval, and conduct of these RCTs.

Design

We conducted four qualitative focus groups (FGs).

Setting

FG discussions focused on the oncology setting in European context.

Participants

Twenty-eight European patients, physicians, medical ethicists and pharmaceutical industry representatives participated in the FGs.

Intervention

Respondents were informed about the topic and the purpose of the FGs before and at the start of FG discussions. An FG script was used to guide the discussion, which was informed by 14 semi-structured interviews with various stakeholders.

Results

We identified factors with the potential to impact feasibility related to trial design, trial conduct, factors external to a trial and post-authorisation interaction with regulators. Factors that may be particularly relevant for the post-authorisation setting include the choice of relevant endpoints and the inclusion of a fair comparator (trial design), strategies to increase patients’ and physicians’ willingness to participate (trial conduct), and external factors relating to a medicine’s commercial availability, the presence of competing medicines and trials and the perceptions about clinical equipoise. Post-authorisation interaction with regulators about how to obtain comprehensive data was deemed necessary in cases where a post-authorisation RCT seems infeasible.

Conclusions

Based on the identified factors, our findings suggest that patient recruitment and retention could be assessed more in-depth during regulatory feasibility assessments at the time of granting conditional marketing authorisation and that sponsors and regulators should better inform patients and physicians about the remaining uncertainties for conditionally authorised medicines and the necessity for post-authorisation RCTs. By enhancing the evaluation of trial feasibility, timely completion of post-authorisation RCTs may be facilitated to resolve the remaining uncertainties within a reasonable timeframe.
Association between a healthy lifestyle and the prevalence of depression in radiology residents in China: findings from a nationwide survey
Authors: Peng Yuting , Chen Jiashen , Jiang Maoqing , Han Li-Yuan , Yang Zhenghan , Wang Zhenchang , Wang Peicheng , Li Hange , Zhu Jiming , Zhang Jingfeng , Zheng Jianjun
Published: November 2024

Objective

The relationship between a healthy lifestyle and depression in radiology residents remains poorly understood. This study aims to investigate the relationship between a healthy lifestyle and depressive symptoms in radiology residents in a nationwide survey.

Design

Cross-sectional study.

Setting

The survey was conducted among radiology residents undergoing training in China between December 2020 and April 2021. This encompassed a total of 215 municipalities and 406 training centres.

Participants

3677 radiology residents in 31 provinces of China.

Primary and secondary outcome measures

The primary outcome was Healthy Lifestyle Score (HLS). A multiple logistic regression analysis was performed to evaluate the association between lifestyle factors and depressive symptoms. Additionally, the weighted quantile sum (WQS) index was utilised to identify the lifestyle factor that had the greatest impact on depressive symptoms.

Results

The study sample consisted of 3677 participants, among whom the prevalence of depression was 34.7%. Participants were categorised based on their Health Lifestyle Score (HLS) into three groups: low HLS (LHLS), moderate HLS (MHLS) and high HLS (HHLS), with proportions of 8.0%, 79.8% and 12.2%, respectively. Those with LHLS were found to have a significantly higher risk of depression (OR: 5.21, 95% CI: 3.72 to 7.30) and a more severe level of depression (p for trend<0.001) compared with those with HHLS. Furthermore, the Well-being Quality of Life Index (WQS) showed a significant association with depression (OR: 0.34, 95% CI: 0.28 to 0.40), with sleep being identified as the most significant factor contributing to a healthy lifestyle.

Conclusion

The study establishes a significant association between an LHLS (long and irregular work hours) and an elevated risk of depressive symptoms among the participants, emphasising the crucial role of sleep in this relationship. These findings underline the importance of promoting a healthy lifestyle, specifically emphasising the need for adequate sleep, among radiology residents.
Systematic review and meta-analysis assessing the status of carotid intima–media thickness and lipid profiles in type 2 diabetes mellitus
Authors: Mashaba Reneilwe Given , Phoswa Wendy , Maimela Eric , Lebelo Sogolo , Modjadji Perpetua , Mokgalaboni Kabelo
Published: November 2024

Objectives

Carotid intima–media thickness (CIMT) is a measurement for subclinical atherosclerosis and has been associated with overall cardiovascular diseases, especially in type 2 diabetes mellitus (T2DM). We aimed to assess the status of carotid health and lipid profile in T2DM.

Design

This systematic review and meta-analysis synthesised data published from clinical studies.

Data sources

Google Scholar, PubMed and Scopus were searched from inception to 18 January 2024.

Eligibility criteria for selecting studies

Studies conducted in patients with T2DM and those without T2DM were included. Studies conducted in T2DM adults evaluating carotid status and lipid profile were considered.

Data extraction and synthesis

Two authors independently used standardised methods to comprehensively search, screen and extract data from all relevant studies. The risk of bias was assessed using the Newcastle-Ottawa checklist. Meta-analysis was conducted using Review Manager and metaHun through random effects models. The random effect model was used due to high heterogeneity.

Results

Evidence was analysed from 57 studies with a sample size of 29 502 (8254 T2DM and 21 248 people without T2DM). There was a significantly higher CIMT, with a standardised mean difference (SMD) of 1.01 (95% CI 0.75, 1.26, p<0.00001). Additionally, there was an elevated triglyceride (TG) (SMD=1.12, 95% CI 0.82, 1.41, p<0.00001), total cholesterol (TC), (SMD=0.24, 95% CI 0.02, 0.46, p=0.03) and low-density lipoprotein-cholesterol (LDL-C), (SMD=0.35, 95% CI 0.11, 0.59, p=0.004) in patients with T2DM compared with those without T2DM. Furthermore, a significant decrease in high-density lipoprotein cholesterol (HDL-C) was observed in the T2DM compared with people without T2DM, SMD=−0.79, 95% CI−0.96, –0.62, p<0.00001). Age, body mass index and hypertension were associated with increased CIMT and TG and decreased HDL-C in T2DM. Additionally, age, gender and hypertension were associated with an increased LDL-C in T2DM.

Conclusion

Our findings suggest that an increased CIMT is accompanied by increased TG, TC, LDL-C and HDL-C reduction in patients with T2DM.

PROSPERO registration number

CRD42023451731.
Current and potential contributions of large-scale food fortification to meeting micronutrient requirements in Senegal: a modelling study using household food consumption data
Authors: Adams Katherine P , Engle-Stone Reina , Wibberley Brent , Tsang Becky L , Tarini Ann , Beye Maguette , Rowe Laura A
Published: November 2024

Introduction

Micronutrient deficiencies are common among women of reproductive age (WRA) and children in Senegal. Large-scale food fortification (LSFF) can help fill gaps in dietary intake.

Methods

We used household food consumption data to model the contributions of existing LSFF programmes (vitamin A-fortified refined oil and iron and folic acid-fortified wheat flour) and the potential contributions of expanding these programmes to meeting the micronutrient requirements of WRA (15–49 7 years) and children (6–59 months).

Results

Without fortification, apparent inadequacy of household diets for meeting micronutrient requirements exceeded 70% for vitamin A, thiamin, riboflavin, folate and zinc, was 61% for iron among WRA (43% among children) and was ~25% for vitamin B12. At estimated current compliance, fortified refined oil was predicted to reduce vitamin A inadequacy to ~35% and could further reduce inadequacy to ~25% if compliance with the standard improved. Fortified wheat flour at estimated current compliance reduced iron and, especially, folate inadequacy, but improvements in compliance would be necessary to achieve the full potential. Beyond existing programmes, expanding wheat flour fortification to include additional micronutrients was predicted to have a modest impact on thiamin and riboflavin inadequacies and larger impacts on vitamin B12and, especially, zinc inadequacies. Adding a programme to import fortified rice could further reduce inadequacies of multiple micronutrients (generally by >10 percentage points), although potential risk of high intake of vitamin A, folic acid and zinc among children should be carefully considered. With both wheat flour and rice fortification, predicted prevalence of vitamin A, iron and zinc inadequacy remained above 25% in some regions, pointing to the potential need for coordinated, targeted micronutrient interventions to fully close gaps.

Conclusions

When considered alongside evidence on the cost and affordability of these programmes, this evidence can help inform the development of a comprehensive micronutrient intervention strategy in Senegal.
Depletion of conventional CD4+T cells is required for robust priming and dissemination of tumor antigen-specific CD8+T cells in the setting of anti-CD4 therapy
Authors: Ramirez Delaney E , Dragnev Christo P C , Searles Tyler G , Spicer Nathaniel , Chen Tiffany , Lines J Louise , Hawkes Aaron R , Davis Wilson L , Mohamed Asmaa , Shirai Keisuke , Phillips Joseph D , Rosato Pamela C , Huang Yina H , Turk Mary Jo
Published: November 2024

Background

Overcoming immune suppression is a major barrier to eliciting potent CD8+T cell responses against cancer. Treatment with anti-CD4 monoclonal antibody is an effective means for eliminating CD4+Foxp3+regulatory (Treg) cells in preclinical models and has also demonstrated efficacy in early clinical trials. However, the underlying basis for treatment efficacy, more specifically the implications of codepleting other CD4-expressing cell compartments in tumor-bearing hosts, is not well understood.

Methods

Tumor-bearing mice were treated with anti-CD4 versus other therapies that preserve helper T cell function, and the priming, tissue distribution, and maintenance of tumor antigen-specific CD8 T cells were assessed. Antibody blockade and transgenic mouse models were used to determine the mechanisms of CD8 T cell priming. Single-cell RNA-sequencing (scRNAseq) was used to further characterize CD8 T cells that are primed by anti-CD4 therapy and to identify immunosuppressive CD4 T cell subsets in human melanoma following immune checkpoint blockade (ICB).

Results

Comparing anti-CD4 to dual ICB therapy, we show that anti-CD4 facilitates more robust priming of TCF-1+, IL-2-producing, tumor-specific CD8+T cells that disseminate to tissues and form memory. By decoupling priming from homeostatic proliferation and associated cytokines, we find that anti-CD4 functions independently of creating homeostatic space for CD8+T cells. We also show that depletion of CD4-expressing antigen-presenting cell subsets is not required for anti-CD4 efficacy. Instead, robust tumor-specific CD8+T cell priming and memory generation required the removal of total antigen-specific CD4+T cells, including both Tregs and CD4+Foxp3-negative conventional (Tconv) cells. In particular, the elimination of CD4+Tconv cells was necessary for the accumulation and maturation of conventional type-1 dendritic cells in tumor-draining LNs, which were required for CD8+T cell priming. Accordingly, anti-CD4 treatment restored CD8+T cell responses in mice cotreated with dual ICB. scRNAseq of melanoma tumors from patients who received ICB revealed the presence of Tr1 and Treg subsets, as well as CD4+Tconv subsets that lacked clear transcriptional evidence of helper differentiation.

Conclusions

These findings underscore the underappreciated benefit of depleting CD4+Tconv cells to promote systemic primary and memory CD8+T cell responses against cancer.