bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum neurofilament light chain is associated with disturbed limbic‐based functional connectivity in patients with anti‐NMDAR encephalitis
Authors: Chen Xiaodong , Fang Ling , Peng Fuhua , Wang Yuge , Dai Zhengjia , Wang Jinhui , Shu Yaqing , Qiu Wei
Published: October 2022

Anti‐N‐methyl‐d‐aspartate receptor (NMDAR) encephalitis shows a predilection for affecting the limbic system, but structural MRI in most patients is usually unremarkable. However, the functional connectivity reorganization of limbic nodes remains unknown. Serum neurofilament light chains (sNfL) are clinically linked with the disease severity and neurological disability of anti‐NMDAR encephalitis. However, the relationship between sNfL and limbic‐based functional architecture has not been explored. We consecutively recruited 20 convalescent patients with anti‐NMDAR encephalitis and 24 healthy controls from March 2018 to March 2021. Resting‐state functional MRI metrics, including fractional amplitude of low‐frequency fluctuation (fALFF), regional homogeneity (ReHo), and atlas‐based seed functional connectivity, were analyzed to investigate regional activities and functional connectivity alterations. Correlation analysis among functional connectivity, sNfL, Mini‐Mental State Examination (MMSE), and Montreal cognitive assessment outcomes were explored in patients. Compared with those of healthy controls, the fALFF and ReHo were consistently increased in regions of the posterior default mode network (DMN) hub, mainly the bilateral supramarginal gyrus and precuneus, in patients with anti‐NMDAR encephalitis (FWE‐corrected p < 0.05). Patients demonstrated disturbed functional organization characterized by reduced connectivity of the posterior DMN hub with the sensorimotor cortex and hypoconnectivity of the parahippocampal gyrus (PHG) with the right fusiform gyrus but extensively enhanced thalamocortical connectivity (FWE‐corrected p < 0.05). Furthermore, convalescent sNfL showed a positive correlation with enhanced thalamocortical connectivity (r = 0.4659, p = 0.0384). Onset sNfL with an independent linear correlation to convalescent MMSE performance (B coefficient, −0.013, 95% CI, −0.025 ~ −0.002, p = 0.0260) was positively correlated with intra‐DMN connectivity (r = 0.8969, p < 0.0001) and limbic‐sensory connectivity (r = 0.4866, p = 0.0346 for hippocampus seed and r = 0.5218, p = 0.0220 for PHG seed). Patients with anti‐NMDAR encephalitis demonstrated disturbed functional organization with substantial thalamocortical hyperconnectivity, that was positively correlated with convalescent sNfL. Onset sNfL showed a positive correlation with intra‐DMN connectivity and limbic‐sensory connectivity.

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Trend of serum beta‐human chorionic gonadotropin levels after medical abortion in the early first trimester of pregnancy
Authors: Choobun Thanapan , Maneeon Ronnarong
Published: October 2022

Aim

This study aimed to study serum beta‐human chorionic gonadotropin level trends after medical abortion using mifepristone and misoprostol in the early first trimester.

Methods

We enrolled women at ≤63 days of gestation who were indicated for pregnancy termination. We excluded women with incomplete abortions, nonviable pregnancies, extrauterine pregnancies, and contraindications for mifepristone/misoprostol use. Women received oral mifepristone (200 mg), followed by vaginal misoprostol (800 mcg) after 48 h. Serum beta‐human chorionic gonadotropin levels were monitored pre‐mifepristone administration (day 1); 48 h post‐mifepristone, pre‐misoprostol administration (day 3); day 10; and weekly after day 10, until negative beta‐human chorionic gonadotropin levels (<25 mIU/mL) were achieved.

Results

Among 39 enrolled women, 36 (92.3%) who underwent complete abortion without further interventions were included. The median gestational age was 51 (32–61) days. Three phases of beta‐human chorionic gonadotropin levels were observed: an increase of up to 5.1% within 48 h of taking mifepristone, before misoprostol administration; a rapid decline on day 10 (by 98.5% compared with initial levels); and a slow decline after day 10 until negative results were attained within 7 weeks.

Conclusion

Serum beta‐human chorionic gonadotropin levels minimally increased 48 h after taking mifepristone, rapidly declined within 1 week of misoprostol administration, and slowly declined until negative within 7 weeks post‐abortion.
Oral biofilm dysbiosis during experimental periodontitis
Authors: Ribeiro Apoena Aguiar , Jiao Yizu , Girnary Mustafa , Alves Tomaz , Chen Liang , Farrell Anna , Wu Di , Teles Flavia , Inohara Naohiro , Swanson Karen V. , Marchesan Julie T.
Published: October 2022

Objectives

We have previously characterized the main osteoimmunological events that occur during ligature periodontitis. This study aims to determine the polymicrobial community shifts that occur during disease development.

Methods

Periodontitis was induced in C57BL/6 mice using the ligature‐induced periodontitis model. Healthy oral mucosa swabs and ligatures were collected every 3 days from 0 to 18 days post‐ligature placement. Biofilm samples were evaluated by 16SrRNA gene sequencing (Illumina MiSeq) and QIIME. Time‐course changes were determined by relative abundance, diversity, and rank analyses (PERMANOVA, Bonferroni‐adjusted).

Results

Microbial differences between health and periodontal inflammation were observed at all phylogenic levels. An evident microbial community shift occurred in 25 genera during the advancement of “gingivitis” (3–6 days) to periodontitis (9–18 days). From day 0 to 18, dramatic changes were identified in Streptococcus levels, with an overall decrease (54.04%–0.02%) as well an overall increase of Enterococcus and Lactobacillus (23.7%–73.1% and 10.1%–70.2%, respectively). Alpha‐diversity decreased to its lowest at 3 days, followed by an increase in diversity as disease advancement. Beta‐diversity increased after ligature placement, indicating that bone loss develops in response to a greater microbial variability (p = 0.001). Levels of facultative and strict anaerobic bacteria augmented over the course of disease progression, with a total of eight species significantly different during the 18‐day period.

Conclusion

The data supports that murine gingival inflammation and alveolar bone loss develop in response to microbiome shifts. Bacterial diversity increased during progression to bone loss. These findings further support the utilization of the periodontitis ligature model for microbial shift analysis under different experimental conditions.
Modelling oil price shocks and exchange rate behaviour in Nigeria – A regime‐switching approach
Authors: Ayinde Taofeek Olusola , Adeyemi Farouq Adekunmi , Ali‐Balogun Busrah Agbaje
Published: October 2022

Consequent upon the intermittent variations in the global oil prices over the years and its attendant effects on exchange rate dynamics of oil‐rich economies, the study investigates the regime‐switching behaviour of oil price shocks and exchange rate behaviour in Nigeria. The period of investigation spans 1980q1 – 2020q4 and the technique of analysis is the Markov‐Switching Dynamic Regression. Predicated on an extended portfolio balancing theory, the unit‐root test with structural break confirms break points in the data. The Markov‐Switching Dynamic Regression shows the presence of two regimes of low and high global oil price shocks in the data. Additional results show that expectation plays a huge role in the oil price and exchange rate nexus in Nigeria and that the regime of low global oil price comes with more shock effects than that of high global price of oil. With short memory property, both the low and high global prices of oil exhibit high persistence level above 70 percent but the duration of persistence for the latter is half‐life the former. The study recommends that the monetary authority should introduce exchange rate policy surprise and further diversify the economy from oil dependence.
The hybrid power generation and balancing energy supply–demand for rural village in Ethiopia
Authors: Gezahegn Getachew Tesfaye , Hatiye Samuel Dagalo , Ayana Melkamu Teshome , Ayalew Abebe Temesgen , Minda Thomas Torora
Published: October 2022

Ethiopia has a wide range of environmentally‐friendly, renewable energy resources that can assist the country to overcome its rural electricity problems. The Hybrid Optimization Model for Multiple Energy Resources (HOMER) software package was used to evaluate the viability of solar, hydro and wind hybrid power generation for a remote community in Ethiopia's Geba catchment. The hydrologic, climatic and demographic data were used to analyze the community's electrical supply and demand. Using survey data from chosen residences, the community's hourly and daily electricity demands were calculated. Two or more schemes were investigated besides the standalone scheme to assess the hybrid system's capacity. Wind, micro‐hydro and solar can generate an average annual power of 96.8, 272.4 and 161.8 kW, respectively. A mix of energy sources can meet the community's electricity demand. During peak demand periods, however, the hybrid system's mean hourly variability in power production showed inadequacy, which could be remedied by power stored in the battery and generator output. The economic analysis showed that the hybrid system proposed here is less expensive, indicating that hybrid energy generation might be employed to electrify Ethiopia's remote settlements. We advise decision‐makers and power authorities to use hybrid systems for rural electrification.
A Premier League Football in the Community Program’s “New” Coaches and Support Systems: Practitioner Reflections
Authors: Crisp Philippe , Brackley Paul
Published: October 2022

In the United Kingdom, many sport coaching career paths are considered to be focused on skills development, competence, and leadership within the context of performance. However, sport coaching also sits substantially within the community and youth sectors, where sport is seen to facilitate various social policy issues. Aligning nonperformance-related coaching contexts to existing formal qualifications schemes is problematic, given they frequently emphasize athlete and team performance. While an emerging base of studies examining community sports coaching exists, further insight and perspectives of in situ learning and coach support in this context are needed. Using observations, evaluation, and feedback centered on practitioner competence and confidence, and conducted over a 2-year period with 13 new community/grassroots sports coaches working with Albion in the Community (the official charity of Brighton and Hove Albion Football Club), we present some of the key findings and principles that we believe underlined their practice. These principles related to how, despite the majority being appropriately qualified at national governing bodies Level 2, they generally needed additional support and expertise for their specific (community) operational environment in terms of outcomes, practice design, and challenging what was seen as a focus on providing competitive (team) environments above individual player development.
Depression, Anxiety, and Help-Seeking Among NCAA Division III Athletes at a Historically Women’s College
Authors: Kraus Aidan D. , Tibbetts Erica
Published: October 2022

This study explored depression, anxiety, and help-seeking at a National Collegiate Athletic Association Division III historically women’s college in the United States, while taking into account gender identities outside of male and female. An online survey including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and help-seeking measures were completed by 109 student-athletes. Participants’ ages ranged from 18 to 22. Within the sample, 59.7% of participants identified as LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, among other identities) and 8.3% identified as genderqueer/gender-nonconforming. A total of 33.0% of the participants reported symptoms of depression, while 28.5% reported symptoms of anxiety. Genderqueer/gender-nonconforming athletes reported higher rates of anxiety than athletes who identified as women. Higher rates of depression and anxiety were related to higher levels of formal help-seeking. The results indicate that student-athletes at a historically women’s college may be experiencing higher levels of depression and anxiety than student-athletes in other contexts and have more positive views toward help-seeking. Student-athletes who identify outside of the gender binary may be at higher risk for anxiety.
Factors That Reduce Parental Concern for Concussion Risks in Youth Tackle Football
Authors: McGlynn Joseph , Richardson Brian K. , Boneau Rebecca D.
Published: October 2022

This study sought to identify factors that reduce parental concern of concussion risks for children who play youth tackle American football. Interviews were conducted with parents who allowed children between the ages of 10 and 15 years to play on tackle football teams. Factors that reduced parental concern included advances in equipment safety and helmet technology, active parental monitoring and relationship building with coaches, and social comparisons to other youth athletes regarding their own child’s athleticism and ability to avoid injury. Although these factors reduced parents’ concern for concussion risks, the findings highlight biases that influence parental risk judgments, suggest that interventions to reduce concussions must account for competing narratives of concussion prevention, and offer recommendations for improving education efforts focused on player safety in contact sports.
Indications that the Antimycotic Drug Amphotericin B Enhances the Impact of Platelets on Aspergillus
Authors: Rambach Günter , Striednig Bianca , Neurauter Magdalena , Hermann Martin , Würzner Reinhard , Lass-Flörl Cornelia , Speth Cornelia
Published: October 2022

Platelets are currently thought to harbor antimicrobial functions and might therefore play a crucial role in infections, e.g., those caused byAspergillusor mucormycetes. The incidence of invasive fungal infections is increasing, particularly during the coronavirus disease 2019 (COVID-19) pandemic, and such infections continue to be life-threatening in immunocompromised patients.
The Roles of the Two-Component System, MtrAB, in Response to Diverse Cell Envelope Stresses in
Dietzia
sp. DQ12-45-1b
Authors: Qin Xiaoyu , Zhang Kaiduan , Nie Yong , Wu Xiao-Lei
Published: October 2022

The multilayered cell envelope is the first line of bacterial defense against various extreme environments. Bacteria utilize a large number of sensing and regulatory systems to maintain cell envelope homeostasis under multiple stress conditions.
Singapore Grouper Iridovirus VP131 Drives Degradation of STING-TBK1 Pathway Proteins and Negatively Regulates Antiviral Innate Immunity
Authors: Zhang Ya , Gao Xiaolin , Yang Xinmei , Wang Yu , Wang Wenji , Huang Xiaohong , Qin Qiwei , Huang Youhua
Published: October 2022

STING has been identified as a critical factor participating in the innate immune response which recruits and phosphorylates TBK1 and IFN regulatory factor 3 (IRF3) to induce IFN production and defend against viral infection. However, viruses also distort the STING-TBK1 pathway to negatively regulate the IFN response and facilitate viral replication.
Diverse RNA Viruses Associated with Diatom, Eustigmatophyte, Dinoflagellate, and Rhodophyte Microalgae Cultures
Authors: Charon Justine , Kahlke Tim , Larsson Michaela E. , Abbriano Raffaela , Commault Audrey , Burke Joel , Ralph Peter , Holmes Edward C.
Published: October 2022

Our knowledge of the diversity of RNA viruses infecting microbial algae—the microalgae—is minimal. However, describing the RNA viruses infecting these organisms is of primary importance at both the ecological and economic scales because of the fundamental roles these organisms play in aquatic environments and their growing value across a range of industrial fields.
The Urethral Microbiota of Men with and without Idiopathic Urethritis
Authors: Plummer Erica L. , Ratten Larissa K. , Vodstrcil Lenka A. , Murray Gerald L. , Danielewski Jennifer A. , Fairley Christopher K. , Garland Suzanne M. , Chow Eric P. F. , Bradshaw Catriona S.
Published: October 2022

Nongonococcal urethritis (NGU) is the commonest genital tract syndrome in men and is nearly universally presumptively treated with an antibiotic. Common causes of NGU include
Chlamydia trachomatis
and
Mycoplasma genitalium
, but in more than 50% of cases, an infectious cause is not identified.
Identification of Cyclic-di-GMP-Modulating Protein Residues by Bidirectionally Evolving a Social Behavior in Pseudomonas fluorescens
Authors: Kessler Collin , Kim Wook
Published: October 2022

Microbial communities comprise densely packed cells where competition for space and resources is fierce. Aging colonies of
Pseudomonas fluorescens
are known to repeatedly produce mutants with two distinct phenotypes that physically work together to spread away from the overcrowded population.
Clinical and Molecular Characterizations of Carbapenem-Resistant Klebsiella pneumoniae Causing Bloodstream Infection in a Chinese Hospital
Authors: Zhang Na , Qi Lihua , Liu Xiong , Jin Meiling , Jin Yuan , Yang Xiaojing , Chen Jiali , Qin Shiyu , Liu Fangni , Tang Yue , Jia Ruizhong , Zhang Xiushan , Wang Yong , Guo Jinpeng , Liu Jie , Wang Changjun , Chen Yong
Published: October 2022

CRKP-BSI is demonstrated to cause high mortality. In this study, we demonstrated that ST11 CRKP strains might carry many virulent genes.
Parasitemia Levels in Trypanosoma cruzi Infection in Spain, an Area Where the Disease Is Not Endemic: Trends by Different Molecular Approaches
Authors: Flores-Chavez Maria D. , Abras Alba , Ballart Cristina , Ibáñez-Perez Ismael , Perez-Gordillo Pilar , Gállego Montserrat , Muñoz Carmen , Moure Zaira , Sulleiro Elena , Nieto Javier , García Diez Emilia , Simón Lorena , Cruz Israel , Picado Albert
Published: October 2022

Currently, molecular equipment has been introduced into many health care centers, even in low-income countries. PCR, qPCR, and loop-mediated isothermal amplification (LAMP) are becoming more accessible for the diagnosis of neglected infectious diseases.
Safe, Effective, and Inexpensive Clearance of
Mycoplasma
Contamination from Cultures of Apicomplexan Parasites with Sparfloxacin
Authors: Malave-Ramos Darlene R. , Kennedy Kit , Key Melanie N. , Dou Zhicheng , Kafsack Björn F. C.
Published: October 2022

These findings will be useful to laboratories maintaining apicomplexan parasites
in vitro
, especially in low-resource environments, where the high cost of commercial products creates an economic barrier for detecting and eliminating mycoplasma from culture.
Supplemental Material: Constraints on the thermal evolution of metamorphic core complexes from the timing of high-pressure metamorphism on Naxos, Greece
Authors: Lamont Thomas N. , al. et
Published: October 2022

Further method details of U–(Th)–Pb geochronology and thermal modelling and complete U–(Th)–Pb analyses.
Contact tracing using real-time location system (RTLS): a simulation exercise in a tertiary hospital in Singapore
Authors: Ng Guan Yee , Ong Biauw Chi
Published: October 2022

Objective

We aim to assess the effectiveness of contact tracing using real-time location system (RTLS) compared with the conventional (electronic medical records (EMRs)) method via an emerging infectious disease (EID) outbreak simulation exercise. The aims of the study are: (1) to compare the time taken to perform contact tracing and list of contacts identified for RTLS versus EMR; (2) to compare manpower and manpower-hours required to perform contact tracing for RTLS versus EMR; and (3) to extrapolate the cost incurred by RTLS versus EMR.

Design

Prospective case study.

Setting

Sengkang General Hospital, a 1000-bedded public tertiary hospital in Singapore.

Participants

1000 out of 4000 staff wore staff tags in this study.

Interventions

A simulation exercise to determine and compare the list of contacts, time taken, manpower and manpower-hours required between RTLS and conventional methods of contact tracing. Cost of both methods were compared.

Primary and secondary outcome measures

List of contacts, time taken, manpower required, manpower-hours required and cost incurred.

Results

RTLS identified almost three times the number of contacts compared with conventional methods, while achieving that with a 96.2% reduction in time taken, 97.6% reduction in manpower required and 97.5% reduction in manpower-hours required. However, RTLS incurred significant equipment cost and might take many contact tracing episodes before providing economic benefit.

Conclusion

Although costly, RTLS is effective in contact tracing. RLTS might not be ready at present time to replace conventional methods, but with further refinement, RTLS has the potential to be the gold standard in contact tracing methods of the future, particularly in the current pandemic.
International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents
Authors: Houchens Nathan , Saint Sanjay , Petrilli Christopher , Kuhn Latoya , Ratz David , De Lott Lindsey , Zollinger Marc , Sax Hugo , Kamata Kazuhiro , Kuriyama Akira , Tokuda Yasuharu , Fumagalli Carlo , Virgili Gianni , Fumagalli Stefano , Chopra Vineet
Published: October 2022

Objective

The patient–physician relationship impacts patients’ experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings.

Setting

20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA.

Participants

Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices.

Primary and secondary outcome measures

The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics.

Results

The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only.

Conclusions

Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context.
Entrustable professional activities in nursing education: a scoping review protocol
Authors: Alexander Nicholas , Maaz Asja , Peters Harm , Kottner Jan
Published: October 2022

Introduction

Entrustable professional activities were introduced in medical education more than 15 years ago. EPAs define units of professional practice that can be fully entrusted to sufficiently competent professionals. Today, EPAs have been developed and implemented in many health professions, as the concept is useful in bridging the gap between competency-based education and the daily tasks health professions have to deal with in the workplace. While some evidence exists in medical education, the role of EPAs in nursing education is not yet fully understood. Therefore, the overall aim of this scoping review is to describe the current body of evidence regarding EPA implementation in nursing education.

Methods and analysis

A two-stage screening process will be used during the search phase, in order to screen retrieved abstracts and titles that focus primarily on the discussion of EPA in nursing education in all languages within the last two decades. The electronic databases, OVID (Embase and PubMed combined) and EBSCOhost (CINHAL and ERIC combined), as well as grey literature will be searched. The search period ranges from 1 January 1995 to 31 December 2021. Data will be extracted according to study design, context (geographical location and type of nursing programme), details of EPAs mentioned (title, specifications, limitations and competency domains), as well as evidence of implementation, outcomes and effect sizes.

Ethics and dissemination

Ethical approval is not required as this review will be using previously collected data. Review findings will be published in a peer-reviewed journal and presented at scientific conferences.
Measuring negative emotional responses to climate change among young people in survey research: a systematic review protocol
Authors: Martin Gina , Cosma Alina , Roswell Tasha , Anderson Martin , Leslie Kathleen , Card Kiffer G , Closson Kalysha , Kennedy Angel M , Gislason Maya K
Published: October 2022

Introduction

Many young people report experiencing negative emotional responses to their awareness of climate change and the threats it poses to their future. With that, an increasing number of survey instruments have been developed to examine young people’s negative emotional responses to their awareness of climate change. This report describes a protocol for a systematic review that aims to identify, synthesise and critically appraise how negative emotional responses to climate change among young people have been measured in survey research. The research questions addressed in this review are: (1) How has negative emotional responses to climate change been defined and measured among young people? (2) How do survey instruments measuring young people’s negative emotional responses to climate change vary in terms of reliability and validity? (3) What factors are associated with negative emotional responses to climate change among young people?

Methods and analysis

Seven academic databases (CINAHL, ERIC, MEDLINE, PsycINFO, Web of Science, Scopus, and Environment Complete) will be searched to retrieve studies published between 1 January 2006 and 31 March 2022 and published in English. Studies including survey instruments that measure negative emotional responses among young people (aged 10–24 years) will be eligible for inclusion. Targeted journals will be hand-searched. This review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic reviews. The methodological quality, in terms of reliability and validity, of the included studies will be assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist for risk of bias of patient-reported outcome measures. To rate the quality of the instruments, we will use a modified Grading of Recommendations, Assessment, Development and Evaluations technique defined by the COSMIN guidelines.

Ethics and dissemination

Ethical approval is not applicable for this study. We will disseminate the findings through publication in peer-reviewed journals and presentations.

PROSPERO registration number

CRD42022295733.
Association between sexual and reproductive health education in peer group and comprehensive knowledge of HIV among adolescent girls in rural eastern Ethiopia: a community-based cross-sectional study
Authors: Fasil Nebiyou , Worku Alemayehu , Oljira Lemessa , Tadesse Amare Worku , Berhane Yemane
Published: October 2022

Objectives

This study examined the association between sexual and reproductive health (SRH) education in peer-group discussion and comprehensive knowledge of HIV among young adolescent girls in rural eastern Ethiopia.

Design

The study analysed data from a large quasi-experimental study involving 3290 young adolescent girls aged 13–17 years. The intervention targeted adolescent girls aged 10–14 years. Data were collected using a comprehensive HIV knowledge tool adopted from the demographic and health survey questionnaire. Multi-level mixed-effect logistic regression analysis was employed to examine associations using STATA/SE V.14 statistical software.

Setting

West Hararghe, rural Ethiopia.

Participants

3290 adolescent girls.

Results

Magnitude of comprehensive knowledge of HIV among those who received SRH education and those who did not receive SRH education was 16.78% (95% CI 14.41% to 19.45%) and 14.01% (95% CI 12.38% to 15.81%), respectively. Overall, 14.84% (95% CI 13.4.% to 16.39%) of the adolescent girls aged 13–17 years had comprehensive knowledge of HIV. The odds of having comprehensive HIV knowledge were higher (1.36 times) among adolescent girls who received SRH education compared with those who did not receive SRH education (adjusted OR 1.36, 95% CI 1.01 to 1.84) after controlling for selected potential confounders. Odds of having comprehensive HIV knowledge were also higher (1.73 times) among older adolescent girls (adjusted OR 1.733 95% CI 1.098 to 2.735) and (3.89 times) among those who attended secondary school (adjusted OR=3.889 95% CI 1.836 to 8.235) compared with young adolescent girls and the uneducated, respectively.

Conclusions

Comprehensive knowledge of HIV among young adolescent girls was very low. Providing SRH education for young adolescent girls improved their comprehensive knowledge of HIV in rural eastern Ethiopia. Initiating sexual education at an early age would benefit HIV prevention efforts.
Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review
Authors: MacRae Clare , Fisken Harry William , Lawrence Edward , Connor Thomas , Pearce Jamie , Marshall Alan , Lawson Andrew , Dibben Chris , Mercer Stewart W , Guthrie Bruce
Published: October 2022

Objectives

Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or area mediators of service use.

Design

Systematic review reported using the synthesis without meta-analysis framework.

Data sources

Twelve electronic databases (1 January 2000–21 September 2021): MEDLINE/OVID, Embase, Global Health, PsycINFO, ASSIA, CAB Abstracts, Science Citation Index Expanded/ISI Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the Cochrane Library, and OpenGrey.

Eligibility criteria

Adults aged ≥16 years, with multimorbidity. Exposure(s) were household and/or area determinants of health. Outcomes were ED attendance and/or hospitalisation. The literature search was limited to publications in English.

Data extraction and synthesis

Independent double screening of titles and abstracts to select relevant full-text studies. Methodological quality was assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale tool. Given high study heterogeneity, narrative synthesis was performed.

Results

After deduplication, 10 721 titles and abstracts were screened, and 142 full-text articles were reviewed, of which 10 were eligible for inclusion. In people with multimorbidity, household food insecurity was associated with hospitalisation (OR 1.58 (95% CI 1.06 to 2.36) in concordant multimorbidity). People with multimorbidity living in the most versus least deprived areas attended ED more frequently (8.9% (95% CI 8.6 to 9.1) in most versus 6.3% (95% CI 6.1 to 6.6) in least), had higher rates of hospitalisation (26% in most versus 22% in least), and higher probability of hospitalisation (6.4% (95% CI 5.8 to 7.2) in most versus 4.2% (95% CI 3.8 to 4.7) in least). There was non-conclusive evidence that household income is associated with ED attendance and hospitalisation. No statistically significant relationships were found between marital status, living with others with multimorbidity, or rurality with ED attendance or hospitalisation.

Conclusions

There is some evidence that household and area contexts mediate associations of multimorbidity with ED attendance and hospitalisation, but firm conclusions are constrained by the small number of studies published and study design heterogeneity. Further research is required on large population samples using robust analytical methods.

PROSPERO registration number

CRD42021283515.
The need for a complex systems approach in rural health research
Authors: Hulme Adam , Thompson Jason , Brown Andrew , Argus Geoff
Published: October 2022

On a global scale, many major rural health issues have persisted for decades despite the introduction of new health interventions and public health policies. Although research efforts have generated valuable new knowledge about the aetiology of health, disease and health inequities in rural communities, rural health systems remain to be some of the most deprived and challenged in both the developing and developed world. While the reasons for this are many, a significant factor contributing to the current state of play is the pressing need for methodological innovation and relevant scientific approaches that have the capacity to support the translation of novel solutions into ‘real world’ rural contexts. Fortunately, complex systems approaches, which have seen an increase in popularity in the wider public health literature, could provide answers to some of the most resilient rural health problems in recent times. The purpose of this article is to promote the value and utility of a complex systems approach in rural health research. We explain the benefits of a complex systems approach and provide a background to the complexity sciences, including the main characteristics of complex systems. Two popular computational methods are described. The next step for rural health research involves exploring how a complex systems approach can help with the identification and evaluation of new and existing solutions to policy-resistant rural health issues. This includes generating awareness around the analytical trade-offs that occur between the use of traditional scientific methods and complex systems approaches.
Approach to systematically examine the usefulness of quality measures in practice: Minnesota’s nursing home quality indicators and scoring approach
Authors: Xu Dongjuan , Lewis Teresa , Rurka Marissa , Arling Greg
Published: October 2022

Background

Healthcare quality measurement systems, which use aggregated patient-level quality measures to assess organisational performance, have been introduced widely. Yet, their usefulness in practice has received scant attention. Using Minnesota nursing home quality indicators (QIs) as a case example, we demonstrate an approach for systematically evaluating QIs in practice based on: (a) parsimony and relevance, (b) usability in discriminating between facilities, (c) actionability and (d) construct validity.

Methods

We analysed 19 risk-adjusted, facility-level QIs over the 2012–2019 period. Parsimony and relevance of QIs were evaluated using scatter plots, Pearson correlations, literature review and expert opinions. Discrimination between facilities was assessed by examining facility QI distributions and the impact of the distributions on scoring. Actionability of QIs was assessed through QI trends over time. Construct validity was assessed through exploratory factor analysis of domain structure for grouping the QIs.

Results

Correlation analysis and qualitative assessment led to redefining one QI, adding one improvement-focused QI, and combining two highly correlated QIs to improve parsimony and clinical relevance. Ten of the QIs displayed normal distributions which discriminated well between the best and worst performers. The other nine QIs displayed poor discrimination; they had skewed distributions with ceiling or floor effects. We recommended scoring approaches tailored to these distributions. One QI displaying substantial improvement over time was recommended for retirement (physical restraint use). Based on factor analysis, we grouped the 18 final QIs into four domains: incontinence (4 QIs), physical functioning (4 QIs), psychosocial care (4 QIs) and care for specific conditions (6 QIs).

Conclusion

We demonstrated a systematic approach for evaluating QIs in practice by arriving at parsimonious and relevant QIs, tailored scoring to different QI distributions and a meaningful domain structure. This approach could be applied in evaluating quality measures in other health or long-term care settings.
Blockades of effector T cell senescence and exhaustion synergistically enhance antitumor immunity and immunotherapy
Authors: Liu Xia , Si Fusheng , Bagley David , Ma Feiya , Zhang Yuanqin , Tao Yan , Shaw Emily , Peng Guangyong
Published: October 2022

Background

Current immunotherapies still have limited successful rates among cancers. It is now recognized that T cell functional state in the tumor microenvironment (TME) is a key determinant for effective antitumor immunity and immunotherapy. In addition to exhaustion, cellular senescence in tumor-infiltrating T cells (TILs) has recently been identified as an important T cell dysfunctional state induced by various malignant tumors. Therefore, a better understanding of the molecular mechanism responsible for T cell senescence in the TME and development of novel strategies to prevent effector T cell senescence are urgently needed for cancer immunotherapy.

Methods

Senescent T cell populations in the TMEs in mouse lung cancer, breast cancer, and melanoma tumor models were evaluated. Furthermore, T cell senescence induced by mouse tumor and regulatory T (Treg) cells in vitro was determined with multiple markers and assays, including real-time PCR, flow cytometry, and histochemistry staining. Loss-of-function strategies with pharmacological inhibitors and the knockout mouse model were used to identify the potential molecules and pathways involved in T cell senescence. In addition, melanoma mouse tumor immunotherapy models were performed to explore the synergistical efficacy of antitumor immunity via prevention of tumor-specific T cell senescence combined with anti-programmed death-ligand 1 (anti-PD-L1) checkpoint blockade therapy.

Results

We report that both mouse malignant tumor cells and Treg cells can induce responder T cell senescence, similar as shown in human Treg and tumor cells. Accumulated senescent T cells also exist in the TME in tumor models of lung cancer, breast cancer and melanoma. Induction of ataxia-telangiectasia mutated protein (ATM)-associated DNA damage is the cause for T cell senescence induced by both mouse tumor cells and Treg cells, which is also regulated by mitogen-activated protein kinase (MAPK) signaling. Furthermore, blockages of ATM-associated DNA damage and/or MAPK signaling pathways in T cells can prevent T cell senescence mediated by tumor cells and Treg cells in vitro and enhance antitumor immunity and immunotherapy in vivo in adoptive transfer T cell therapy melanoma models. Importantly, prevention of tumor-specific T cell senescence via ATM and/or MAPK signaling inhibition combined with anti-PD-L1 checkpoint blockade can synergistically enhance antitumor immunity and immunotherapy in vivo.

Conclusions

These studies prove the novel concept that targeting both effector T cell senescence and exhaustion is an effective strategy and can synergistically enhance cancer immunotherapy.
Crip the elders and get out of white privilege free
Authors: Swartz Leslie
Published: October 2022

The question of identity positioning in relation to engagement with issues of social exclusion is complex. I am a white non-disabled South African man working on disability and care issues. I reflect on my representation of my parents, through memoirs and of Elsa Joubert, a doyenne of African writing. My depiction of these people as profoundly affected by disability and illness provides me as a privileged white scholar a way of marking my difference from stereotypical oppressive positioning. Though my rhetorical manoeuvres do not undercut the intention of my work, they point to broader, difficult questions about positioning and identity politics. I use my links to and concern with disability and illness to signal my appreciation of difference and exclusion, but questions of power and positioning remain.
Understanding the value of art prompts in an online narrative medicine workshop: an exploratory-descriptive focus group study
Authors: Choe Nancy S
Published: October 2022

Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address the needs of healthcare providers and receivers. With the COVID-19 pandemic having had a profound impact on the healthcare workforce with an already high burn-out rate, multimodal arts interventions may help address the holistic dimensions of well-being. While empirical evidence supports the use of arts-based interventions in promoting healthcare workers’ well-being and personal growth, art prompts are underexplored and underused in narrative medicine. Moreover, protocols and frameworks adopted in extant research on this topic are inconsistent, resulting in replication and validation challenges. These issues have motivated this exploratory-descriptive study with 11 narrative medicine practitioners to examine the use of short art prompts in an online narrative medicine workshop.

The art prompts leveraged art therapy’s Expressive Therapies Continuum (ETC) model, which uses the inherent properties of art materials, media and methods to elicit specific levels of information processing and creative experiences. The study aimed to understand how art prompts differ from writing prompts and explore the value art prompts could add to narrative medicine if any. Qualitative analyses revealed that art prompts in narrative medicine increase positive feelings and promote creativity and insight. Specifically, art prompts allowed participants to use sensorimotor functions, enter a flow-like state, be challenged and inspired by novelty and uncertainty, and experience a sense of play and personal discovery.
Operator mixing in massless QCD-like theories and Poincarè–Dulac theorem
Authors: Becchetti Matteo , Bochicchio Marco
Published: October 2022

Recently, a differential-geometric approach to operator mixing in massless QCD-like theories – that involves canonical forms, obtained by means of gauge transformations, based on the Poincarè–Dulac theorem for the system of linear differential equations that defines the renormalized mixing matrix in the coordinate representation $$Z(x,\mu )$$

Z
(
x
,
μ
)

– has been proposed in [1]. Specifically, it has been determined under which conditions a renormalization scheme exists where $$Z(x,\mu )$$

Z
(
x
,
μ
)

may be set in a diagonal canonical form that is one-loop exact to all perturbative orders – the nonresonant diagonalizable $$\frac{\gamma _{0}}{\beta _{0}}$$

γ
0

β
0

case (I) –. Moreover, the remaining cases, (II), (III) and (IV), of operator mixing, where such diagonalization is not possible, have also been classified in [1]. Accordingly, if $$\frac{\gamma _{0}}{\beta _{0}}$$

γ
0

β
0

, with $$\gamma (g)=\gamma _{0} g^{2}+\cdots $$

γ

(
g
)

=

γ
0

g
2

+
⋯

the matrix of the anomalous dimensions and $$\beta (g)=-\beta _{0} g^{3} + \cdots $$

β

(
g
)

=
-

β
0

g
3

+
⋯

the beta function, either is diagonalizable but a resonant condition for its eigenvalues and the system holds (II) or is nondiagonalizable and nonresonant (III), or is nondiagonalizable and resonant (IV), $$Z(x,\mu )$$

Z
(
x
,
μ
)

is nondiagonalizable. In the cases (II), (III) and (IV), we demonstrate that its canonical form may be factorized into the exponential of a linear combination of upper triangular nilpotent constant matrices with coefficients that asymptotically in the UV are logs of the running coupling, i.e., asymptotically loglogs of the coordinates, and a diagonal matrix as in the nonresonant diagonalizable case (I). Hence, its ultraviolet asymptotics differs intrinsically from the case (I) and, for asymptotically free theories, this is the closest analog of logCFTs. We also work out actual physics realizations of the cases (I) and (II), while we argue that the cases (III) and (IV) are ruled out by a unitarity argument in the gauge-invariant sector.
Light $$Z^\prime $$ and Dirac fermion dark matter in the $$B-L$$ model
Authors: Nath Newton , Okada Nobuchika , Okada Satomi , Raut Digesh , Shafi Qaisar
Published: October 2022

We consider a $$U(1)_{B-L}$$

U

(
1
)

B
-
L

model with a $$Z^\prime $$

Z
′

portal Dirac fermion dark matter (DM) $$\chi $$
χ
of low mass which couples very weakly to the $$B - L$$

B
-
L

gauge boson $$Z^\prime $$

Z
′

. An arbitrary $$B-L$$

B
-
L

charge $$Q\ne \pm 1, \pm 3$$

Q
≠
±
1
,
±
3

of the DM $$\chi $$
χ
ensures its stability. Motivated by the sensitivity reach of forthcoming “Lifetime Frontier” experiments, we focus on the $$Z^\prime $$

Z
′

mass, $$m_{Z^\prime }$$

m

Z
′

, in the sub-GeV to few GeV range. To evaluate the DM relic abundance, we examine both the freeze-out and freeze-in DM scenarios. For the freeze-out scenario, we show that the observed DM abundance is reproduced near the $$Z^\prime $$

Z
′

resonance, $$m_\chi \simeq m_{Z^\prime }/2$$

m
χ

≃

m

Z
′

/
2

, where $$m_\chi $$

m
χ

is the DM mass. For the freeze-in scenario, we focus on $$m_\chi \ll m_{Z^\prime }$$

m
χ

≪

m

Z
′

. We show that for a fixed value of $$m_{Z^\prime }$$

m

Z
′

, $$g_{BL}$$

g

BL

values roughly scale as 1/Q to reproduce the observed DM abundance. For various Q values in the range between $$10^{-6}$$

10

-
6

and $$10^2$$

10
2

, we show that the gauge coupling values $$g_{BL}$$

g

BL

needed to reproduce the observed DM abundance lie in the search reach of future planned and/or proposed experiments such as FASER, Belle-II, LDMX, and SHiP. In the freeze-in case, the Q values to realize observable $$g_{BL}$$

g

BL

values are found to be much smaller than that in the freeze-out case.
Closed string radiation from the interacting fractional-dressed Dp-branes with the transverse motions
Authors: Daniali Hamidreza , Kamani Davoud
Published: October 2022

We determine the boundary states, associated with a fractional Dp-brane in the presence of the Kalb–Ramond field and a U(1) gauge potential. The background spacetime is the non-compact orbifold $$ {\mathbb {R}}^{1, 21} \otimes {\mathbb {R}}^4/ {\mathbb {Z}}_2$$

R

1
,
21

⊗

R

4

/

Z
2

. Besides, the brane has a transverse velocity. We compute the radiation amplitude of a massless closed string from the interaction of two fractional Dp-branes with the previous background fields. The branes have been dressed by different fields and have transverse motions. The total radiation amplitude will be investigated for large inter-brane separation. Finally, the graviton, Kalb–Ramond (axion) and dilaton emissions will be distinctly studied. Our calculations are in the context of the bosonic string theory.