bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of using virtual reality on fatigue and mental workload as key determinants of perceived stress in neonatal intensive care staff: A randomized controlled trial feasibility study and protocol
Authors: Desai Saumil , Athalye‐Jape Gayatri , Bottcher Sarah , Campbell Catherine , Chiffings Debbie , Nathan Elizabeth , Fardinpour Ali , Kinnaird Lindsay , Bulsara Max , Rao Shripada
Published: February 2025

Background

Health care professionals (HCPs) in neonatal intensive care units (NICUs) are prone to significant stress, leading to deleterious mental health effects. Recently, some studies have explored virtual reality (VR) immersion experience to mitigate these risks. However, these studies vary in clinical settings, design and mental health parameters.

Aim

To report on the safety and feasibility of VR immersion experience in busy tertiary NICU HCPs.

Study Design

Ten eligible NICU HCPs without photosensitive epilepsy or cardiopulmonary disease participated. Participants underwent VR immersion (intervention arm; maximum of 15 min/session and 1 session/shift) during breaktimes in three consecutive shifts. They underwent a washout period, after which they completed 3 sessions as routine breaks (control arm) without VR experience. They completed pre–post break stress and survey questionnaires in both arms.

Results

Analyses comprised data from 28 VR immersion and 27 control arm sessions (nine participants completed three sessions in both arms and one participant completed one session in intervention arm only). All VR immersion sessions were ‘really liked’ (60.7%) or ‘liked’ (39.3%). As far as the usage of VR devices were concerned, majority were deemed to be ‘really easy’ (25%) or ‘easy’ (57.14%). Quality of VR environments were reported to be ‘Excellent’ (28.6%) or ‘good’ (60.71%) in majority of sessions. Experience of chosen VR environments were ‘really liked’ (46.42%) or ‘liked’ (50%). Most importantly, the impact of VR experience on enhancing the break was deemed to be ‘Yes, a lot’ (46.42%) or ‘Yes, a bit’ (39.28%) in most sessions. Participants reported ‘very minor’ side effects in three VR sessions, none requiring any therapeutic interventions. Rest of the sessions reported ‘no’ side effects.

Conclusions

VR immersion experience is safe and feasible in busy HCPs in a tertiary NICU. Future recommendations would be to compare VR immersion experience with other well‐being measures of staff.

Relevance to Clinical Practice

Virtual reality immersion experience could be utilized for stress reduction in NICU HCPs.
A descriptive investigation of alarm activation in a critical care setting
Authors: Nguyen Van , MacDonald Brendan , Cignarella Anthony , Miller Charne
Published: February 2025

Background

Alarm fatigue, a phenomenon referring to clinicians being desensitized to the high volume of monitoring alarms, can impact the working environment, clinical care and patient outcomes. Explorations and understandings of alarm fatigue have yet to be a focus of attention in the Australian context.

Aim

To describe the prevalence and type of alarms activated in intensive care and cardiac units in a major metropolitan hospital in Victoria, Australia.

Study Design

This study was a descriptive observation study of patient monitoring data gathered over a 1‐month time frame during April 2019. Data from the Philips Healthcare IntelliVue® Patient Monitoring system were extracted. After classifying the alarms into types (clinical or technical) and levels of urgency (lower or higher priority), further descriptive analysis was conducted to quantify the most prevalent alarms.

Results

During the study period, a total of 271 414 activated alarms were identified. The majority were clinical alarms (89.1%) compared with technical alarms (10.9%). Clinical alarms tended to be classified as high priority (55.1%); the most common were heart rate (36.7%) and premature ventricular contraction (18.8%). Technical alarms were predominantly electrocardiogram lead disconnection (89%). The frequency of alarms per patient‐bed day was highest in the acute cardiac unit (98 alarms) compared with the intensive care unit (67 alarms).

Conclusion

Staff education and a culture of individual alarm customization might influence the number of alarms activated in the study settings. Further research is also required to examine alarm fatigue in other Australian critical care settings, and responses to alarms by clinicians, and whether these responses are calibrated to detect clinical deterioration and sentinel events.

Relevance to Clinical Practice

A bundle of interventions should be in place to increase the accuracy of alarm monitoring and to reduce non‐actionable alarms in order to reduce the possible impacts on clinicians, patients and their families/visitors.
Host diversity mediates the influence of landscape structure on parasite communities in Cerrado agricultural landscapes
Authors: Teles Wanderson Siqueira , Regolin André Luis , de Andrade‐Silva Beatriz Elise , Maldonado Junior Arnaldo , Vilela Roberto do Val , Borges‐Almeida Karen , Pereira Marcio Junior , Araujo Matheus Lima , Collevatti Rosane Garcia
Published: February 2025

Parasites are key elements in ecosystem functioning owing to their role in hosts’ population dynamics and abundance, regulation stabilizing trophic networks, and shaping community structure. Landscape changes can affect parasite communities because of changes in suitable microhabitats and on hosts’ community structure. In the Brazilian Cerrado, no study has so far analyzed the effects of intensive agricultural landscaping on helminth parasites of mammals. Here, we fill this knowledge gap, addressing the effects of landscape structure and the Sigmodontinae host's community structure on the richness and abundance of helminth parasites in agricultural landscapes. Using structural equation models, we found that the parasites’ richness and abundance are determined mainly by the rodent hosts’ community structure and are only indirectly affected by landscape structure. We found no direct effect of habitat fragmentation, habitat amount, and landscape compositional heterogeneity on the richness and abundance of helminth parasites, but they directly affected the hosts’ community. Moreover, we found no difference in both the host's and parasite's richness and abundance between crop growing and fallow seasons. Our results show that efforts to preserve helminth parasites may comprise landscape conservation strategies that preserve the biodiversity of the rodent hosts, including conservation and restoration of vegetation remnants at the landscape level.
Both Jasmonic Acid‐ and Abscisic Acid‐Mediated Signalling Pathways Regulate the Ovicidal Defence of Plants Against Phloem‐Feeding Insects
Authors: Gao Qing , Jin Nuo , Shen Zhifan , Guo Jingran , Lu Haiping , Han Shanjie , Xiao Wenhan , Lu Jing , Lou Yonggen
Published: February 2025

Plants perceive signals associated with herbivore eggs and in response initiate ovicidal defence. However, which phytohormone pathways regulate this defence and which defensive compounds dominate it remains largely unknown. Here, we found that the hatching rate of eggs of white‐backed planthopper (WBPH) Sogatella furcifera was significantly lower on a japonica rice variety P81 than an indica rice variety NB44. When infested by WBPH, P81 plants showed higher jasmonic acid (JA) and abscisic acid (ABA) responses than did NB44 plants; moreover, P81 plants produced the ovicidal compound benzyl benzoate and exhibited higher levels of some flavonoids, phenolamides, and volatiles than were found in NB44 plants. Impairing the ABA‐signalling pathway, especially the JA‐signalling pathway in P81 plants enhanced the survival of WBPH eggs. Decreasing levels of some flavonoids and phenolamides in P81 plants promoted WBPH egg survival. In vitro bioassays revealed that both naringenin and sakuranetin promote the ovicidal effect of benzyl benzoate on WBPH. The results demonstrate that JA‐ and ABA‐signalling pathways jointly regulate the rice ovicidal defence against WBPH, and that benzyl benzoate, as well as some other compounds, such as naringenin and sakuranetin, contribute to the mortality of WBPH eggs.
A self‐amplifying NO‐H2S loop mediates melatonin‐induced CBF‐responsive pathway and cold tolerance in watermelon
Authors: Guo Yanliang , Li Jiayue , Liu Lingling , Liu Jiahe , Yang Wanbang , Chen Yi , Li Chao , Yuan Li , Wei Chunhua , Ma Jianxiang , Zhang Yong , Yang Jianqiang , Luan Feishi , Zhang Xian , Li Hao
Published: February 2025

Melatonin is a pivotal bioactive molecule that enhances plant cold stress tolerance, but the precise mechanisms remain enigmatic. Here, we have discovered that overexpressing melatonin biosynthetic gene ClCOMT1 or applying exogenous melatonin activates the C‐repeat binding factor (CBF)‐responsive pathway and enhances watermelon cold tolerance. This enhancement is accompanied by elevated levels of nitric oxide (NO) and hydrogen sulfide (H2S), along with upregulation of nitrate reductase 1 (ClNR1) and L‐cysteine desulfhydrase (ClLCD) genes involved in NO and H2S generation respectively. Conversely, knockout of ClCOMT1 exhibits contrasting effects compared to its overexpression. Furthermore, application of sodium nitroprusside (SNP, a NO donor) and NaHS (a H2S donor) promotes the accumulation of H2S and NO, respectively, activating the CBF pathway and enhancing cold tolerance. However, knockout of ClNR1 or ClLCD abolished melatonin‐induced H2S or NO production respectively and abrogated melatonin‐induced CBF pathway and cold tolerance. Conversely, supplementation with SNP and NaHS restored the diminished cold response caused by ClCOMT1 deletion. Additionally, deletion of either ClNR1 or ClLCD eliminated NaHS‐ or SNP‐induced cold response, respectively. Overall, these findings suggest a reciprocal positive‐regulatory loop between ClNR1‐mediated NO and ClLCD‐mediated H2S, which plays a crucial role in mediating the melatonin‐induced enhancement of cold tolerance.
How Much Will a Pig Organ Transplant Cost? A Preliminary Estimate of the Cost of Xenotransplantation Versus Allotransplantation in the USA
Authors: Vasudev Krish , Cooper David Kempton Cartwright
Published: February 2025

We reviewed the costs of organ allotransplantation and attempted to estimate the potential costs of xenotransplantation (based on the premise that, when clinically established, the results of pig organ xenotransplantation would be at least equal to those of allotransplantation). The care of patients with end‐stage organ failure waiting for an allograft is expensive, particularly if chronic dialysis or mechanical support is required. Xenotransplantation has the potential to eliminate wait times for organ transplants, significantly reduce certain management costs, for example, chronic dialysis, and enable early transplantation before comorbidities develop or increase. The cost of the surgical procurement of a pig organ and its transplantation will be similar to that of allotransplantation, as will the cost of immunosuppressive therapy. The major “unknown” is the cost of purchasing a gene‐edited pig organ, which is likely to be considerable. We conclude that there will be significant cost savings for the pretransplant care of an individual patient, but these may be offset by the cost of the gene‐edited pig organ. However, the ready availability of an unlimited organ supply will greatly increase the number of transplants carried out each year, thus increasing the overall expenditure on transplantation.
A new upper bound for the growth factor in Gaussian elimination with complete pivoting
Authors: Bisain Ankit , Edelman Alan , Urschel John
Published: February 2025

The growth factor in Gaussian elimination measures how large the entries of an LU factorization can be relative to the entries of the original matrix. It is a key parameter in error estimates, and one of the most fundamental topics in numerical analysis. We produce an upper bound of for the growth factor in Gaussian elimination with complete pivoting — the first improvement upon Wilkinson's original 1961 bound of .
Evaluation of the ACT Program Training for Psychologists and Social Workers
Authors: Lawrenz Priscila , Zirbes Linhares Isadora , Fernandes Soares Gabriela , Habigzang Luísa Fernanda
Published: February 2025

The goal of the present study is to evaluate the ACT Program Training for psychologists and social workers in Porto Alegre, Rio Grande do Sul (South of Brazil). It is a mixed and sequential study. A total of 18 professionals with an average age of 35.56 years (SD = 9.25) were included in the quantitative stage of the study. Six participants with an average age of 35.83 years (SD = 10.14) were also included in the qualitative stage. The instruments were: Sociodemographic Data Questionnaire; Course Reaction Scale; Tutor Performance Scale; Self-Assessment of Training Impact at Work; Learning Transfer Scale; Physical Punishment Beliefs Scale; and Semi-structured interview. Participants were satisfied with programming and usefulness of contents learned through training. Participation contributed to reduce legitimizing beliefs of physical punishment. Although participants were unable to implement the program due to difficulties imposed by COVID-19 pandemic, the contents were useful to assist parents.
Telesurgery and the importance of context
Authors: Heemeyer Florian , Boehler Quentin , Kim Minsoo , Bendok Bernard R. , Turcotte Evelyn L. , Batjer H. Hunt , Madder Ryan D. , Pereira Vitor M. , Nelson Bradley J.
Published: February 2025

Telesurgery has the potential to overcome geographical barriers in surgical care, encouraging its deployment in areas with sparse surgical expertise. Despite successful in-human experiments and substantial technological progress, the adoption of telesurgery remains slow. In this Review, we analyze the reasons for this slow adoption. First, we identify various contexts for telesurgery and highlight the vastly different requirements for their realization. We then discuss why procedures with high urgency and skill sparsity are particularly suitable for telesurgery. Last, we summarize key research areas essential for further progress. The goal of this Review is to provide the reader with a comprehensive analysis of the current state of telesurgery research and to provide guidance for faster adoption of this exciting technology.
Identification of glyoxalase A in group B
Streptococcus
and its contribution to methylglyoxal tolerance and virulence
Authors: Akbari Madeline S. , Joyce Luke R. , Spencer Brady L. , Brady Amanda , McIver Kevin S. , Doran Kelly S.
Published: February 2025

Group B
Streptococcus
(GBS) is a Gram-positive pathobiont that commonly colonizes the gastrointestinal and lower female genital tracts but can cause sepsis and pneumonia in newborns and is a leading cause of neonatal meningitis. Despite the resulting disease severity, the pathogenesis of GBS is not completely understood, especially during the early phases of infection. To investigate GBS factors necessary for bloodstream survival, we performed a transposon (Tn) mutant screen in our bacteremia infection model using a GBS
mariner
transposon mutant library previously developed by our group. We identified significantly underrepresented mutations in 623 genes that contribute to survival in the blood, including those encoding known virulence factors such as capsule, the β-hemolysin, and inorganic metal ion transport systems. Most of the underrepresented genes have not been previously characterized or studied in GBS, including
gloA
and
gloB,
which are homologs for genes involved in methylglyoxal (MG) detoxification. MG is a byproduct of glycolysis and a highly reactive toxic aldehyde that is elevated in immune cells during infection. Here, we observed MG sensitivity across multiple GBS isolates and confirmed that
gloA
contributes to MG tolerance and invasive GBS infection. We show specifically that
gloA
contributes to GBS survival in the presence of neutrophils and depleting neutrophils in mice abrogates the decreased survival and infection of the
gloA
mutant. The requirement of the glyoxalase pathway during GBS infection suggests that MG detoxification is important for bacterial survival during host-pathogen interactions.

IMPORTANCE

A transposon-mutant screen of group B
Streptococcus
(GBS) in a bacteremia mouse model of infection revealed virulence factors known to be important for GBS survival such as the capsule, β-hemolysin/cytolysin, and genes involved in metal homeostasis. Many uncharacterized factors were also identified including genes that are part of the metabolic pathway that breaks down methylglyoxal (MG). The glyoxalase pathway is the most ubiquitous metabolic pathway for MG breakdown and is only a two-step process using glyoxalase A (
gloA
) and B (
gloB
) enzymes. MG is a highly reactive byproduct of glycolysis and is made by most cells. Here, we show that in GBS, the first enzyme in the glyoxalase pathway, encoded by
gloA
, contributes to MG resistance and blood survival. We further demonstrate that GloA contributes to GBS survival against neutrophils
in vitro
and
in vivo
and, therefore, is an important virulence factor required for invasive infection.
Seneca Valley virus infection exploits DNA damage response to facilitate viral replication
Authors: Song Jiangwei , Li Zijian , Yang Jingjing , Ma Ruiyi , Wang Dan , Quan Rong , Wen Xuexia , Liu Jue
Published: February 2025

Seneca Valley virus (SVV) is an emerging pathogen that causes severe vesicular diseases in swine, posing a significant threat to the global pork industry. DNA and RNA viruses manipulate the host DNA damage response (DDR) to modulate cellular machinery and facilitate their life cycles. However, the interaction between the host DDR and SVV infection remains unexplored. Here, we aimed to comprehensively investigate the DDR and DNA repair signaling pathways during SVV infection. We found that SVV infection causes DNA damage and triggers distinct DDR signaling pathways, including ataxia telangiectasia-mutated (ATM) kinase, ATM-Rad3-related kinase, and DNA-dependent protein kinase. However, it failed to induce the formation of γH2AX and 53BP1 foci, resulting in unrepaired DNA damage. Furthermore, we found that SVV 2B and 2C proteins can activate DDR signaling pathways and impair DNA repair. SVV-induced DDR triggered NF-κB signaling accompanied by upregulation of pro-inflammatory cytokines, as evidenced by the inhibition of ATM kinase, abolished SVV-induced NF-κB activation. Inhibition of the ATM pathway attenuated SVV replication. These findings expand our understanding of host DDR manipulation during viral infection and provide crucial insights into a novel mechanism exploited by SVV to regulate the inflammatory response for efficient replication.

IMPORTANCE

DDR is a cellular machinery that senses and repairs host DNA lesions to maintain genome integrity. Viruses have evolved diverse strategies to manipulate host DDR for replicative efficiency. SVV is an emerging virus that causes vesicular diseases in pigs and severely threatens the swine industry. However, the interaction between SVV and DDR remains unclear. Here, we found that SVV modulates host DDR pathways to facilitate viral replication. Our results demonstrated that SVV infection causes DNA damage, activates ATM-mediated DNA double-strand break response, and impedes DNA repair. SVV 2B and 2C proteins induced DNA damage and activated the DDR pathway while impairing repair mechanisms. This study revealed a fine-tuned molecular mechanism of SVV-modulated DDR that contributes to viral replication, facilitating deeper insight into SVV replication.
Clade 2.3.4.4b H5N1 neuraminidase has a long stalk, which is in contrast to most highly pathogenic H5N1 viruses circulating between 2002 and 2020
Authors: Hermann Enikő , Krammer Florian
Published: February 2025

Since 2020, H5N1 highly pathogenic avian influenza (HPAI) viruses of clade 2.3.4.4b have been rapidly spreading in wild birds but have also caused a large number of mammalian infections and more than 70 known human cases. Importantly, this H5N1 clade has also crossed the species barrier into dairy cattle in the US in late 2023/early 2024. The neuraminidase (NA) protein of the N1 subtype can feature truncations in its stalk domain, which have been identified as putative virulence factors in poultry but seem to have a negative impact on transmission in mammals. Since its emergence, the vast majority of HPAI H5N1 A/goose/Guangdong/1/1996-lineage isolates have featured this truncated version of the NA stalk domain. Here, we report that this changed with the 2020 expansion of clade 2.3.4.4b H5N1 and that the majority of isolates—including the strains circulating in dairy cattle—feature a long NA stalk domain.

IMPORTANCE

While the truncated version of the N1 neuraminidase stalk domain may be associated with increased virulence in poultry, the long version of the stalk domain has been associated with increased transmissibility in mammals. The vast majority of highly pathogenic H5N1 of clade 2.3.4.4b that is currently circulating globally features the long stalk version of the neuraminidase, which may increase the risk for these viruses to become human-to-human transmissible.
Antibodies with specificity to glycan motifs that decorate OMV cargo proteins
Authors: Kim Hyun Young , Rothenberger Christina M. , Davey Mary E. , Yu Manda
Published: February 2025

Porphyromonas gingivalis
is a major etiological agent of periodontal disease, and infections with this bacterium are associated with systemic pathologies, including atherosclerosis, rheumatoid arthritis, and Alzheimer’s disease.
P. gingivalis
has a variety of immune evasion mechanisms and exhibits highly variable cell surface characteristics that are strain dependent, complicating the development of effective vaccines and therapeutics. Here, we show that a subset of immunoglobulin M (IgM) antibodies in antiserum raised against
P. gingivalis
strain W83 selectively recognize the outer membrane vesicles (OMVs). Pre-adsorption with a mutant strain lacking an OMV-specific lipoprotein (PG1881) that has been shown to be glycosylated significantly enhanced IgM specificity toward PG1881 and the OMVs. In addition, the IgM reactivity against the OMVs derived from a mutant lacking enzymes required for O-glycosylation was markedly reduced, indicating that the IgM targets the glycan motifs on proteins carried on OMVs. Importantly, the IgM exhibited specific recognition of OMVs from both
P. gingivalis
and
Porphyromonas endodontalis
, while showing low reactivity toward other genera belonging to the phylum Bacteroidetes. This study revealed a potential host evasion strategy and highlights the potential for utilizing O-glycans in vaccine development and OMV-targeted antibodies in therapeutic interventions to combat
P. gingivalis
infections.

IMPORTANCE

O-glycosylation of cell surface proteins by bacteria is known to play a role in various functions including colonization and immune evasion. This study highlights the identification of IgM antibodies that specifically recognize O-glycosylated proteins that are selectively carried on outer membrane vesicles (OMVs). The findings suggest a potential host evasion mechanism and open new avenues for using OMVs in vaccine development and targeting O-glycans with antibodies as a therapeutic strategy against the subgingival pathobiont
P. gingivalis
.
Association between maternal sociodemographic characteristics and exclusive mother’s own milk feeding in preterm infants: a cohort study using data from the National Neonatal Research Database
Authors: Ryan Melissa-Sue , Szatkowski Lisa , Doubatty Arrisonia , Ojha Shalini
Published: February 2025

Objective

To ascertain the sociodemographic and geographical determinants of exclusive and no mother’s own milk (MOM) feeding for infants <34 weeks’ gestational age (GA) in England and Wales.

Study design

Retrospective cohort study using the National Neonatal Research Database (2016–2022). We calculated unadjusted and mutually adjusted ORs for exclusive and no MOM feeding throughout an infant’s neonatal stay, by maternal age group, ethnicity and deprivation quintile. Neonatal Operational Delivery Network and unit were included as random effects, and the adjusted models included other potential confounders such as gestational age and mode of delivery.

Results

Among the 90 730 infants, 11 962 (13.2%) were exclusively MOM fed, while 9018 (9.9%) never received MOM. The odds of exclusive MOM feeding increased with decreasing maternal social deprivation (OR for least deprived vs most deprived quintile 2.16, 95% CI 2.01 to 2.33), while the odds of no MOM decreased (OR 0.33, 95% CI 0.30 to 0.36). The odds of exclusive MOM feeding were lower for Asian/Asian-British mothers compared with white mothers (OR 0.88, 95% CI 0.82 to 0.95). The odds of never receiving MOM were lower for Black, Asian and mixed ethnicities compared with white mothers. Infants of mothers aged 26–35 years had the highest odds of exclusive MOM feeding. There was a geographical variation in feeding practices with a north-south divide in the prevalence of never receiving MOM. There was a significant variation in feeding practices between neonatal units.

Conclusion

Provision of MOM to preterm infants in England and Wales is associated with maternal sociodemographic characteristics.
Impact of sleep on postpartum health outcomes: a systematic review and meta-analysis
Authors: Khan-Afridi Zain , Ruchat Stephanie-May , Jones Paris A T , Ali Muhammad Usman , Matenchuk Brittany A , Leonard Sierra , Jantz Andrew WE , Vander Leek Kier , Maier Lauren E , Osachoff Laura , Hayman Melanie J , Forte Milena , Sivak Allison , Davenport Margie H
Published: February 2025

Objective

To examine the impact of postpartum sleep interventions and postpartum sleep on maternal health outcomes.

Design

Systematic review with random-effects meta-analysis. Online databases were searched on 12 January 2024.

Study eligibility criteria

Studies of all designs (except case studies and reviews) in all languages were eligible if they contained information on the population (individuals up to 1-year post partum), sleep interventions/exposures including (type, duration, frequency, alone or in combination with other components), comparator (control or different duration, frequency or type of sleep intervention) and outcomes: mental health, cardio-metabolic, postpartum weight retention (PPWR), low back pain and pelvic girdle pain, breastfeeding and urinary incontinence.

Results

60 studies (n=20 684) from 14 countries were included. ‘High’ certainty of evidence showed that sleep interventions were associated with a greater decrease in depressive symptom severity compared with no intervention (five randomised controlled trials; n=992; standardised mean difference −0.27, 95% CI −0.40 to –0.14; small effect). Sleep interventions had no impact on the odds of developing depression (‘moderate’ certainty of evidence) or anxiety or anxiety symptom severity (‘low’ certainty of evidence). Additionally, ‘low’ certainty of evidence demonstrated no effect on cardiometabolic outcomes (systolic blood pressure, diastolic blood pressure, mean arterial pressure), anthropometric measures (maternal weight, body mass index) or prevalence of exclusive breastfeeding. ‘Low’ certainty of evidence from observational studies found that high-quality sleep reduces the odds of developing anxiety and reduces the severity of depression and anxiety symptoms. ‘Low’ and ‘very low’ certainty of evidence from observational studies found that shorter sleep duration is associated with greater PPWR.

Conclusions

Postpartum sleep interventions reduced the severity of depression symptoms.
Telehealth Programme for the Education and Enrichment of Relational Skills (PEERS) for adolescents with acquired and congenital brain injuries: a protocol for mixed-methods randomised trial
Authors: Sakzewski Leanne , Gilmore Rose , Hilton Nicola , Goodman Sarah , Whittingham Koa , Barfoot Jacqui , Thompson Bianca , Keramat Afroz , Boyd Roslyn N
Published: February 2025

Introduction

For adolescents with brain injury, challenges with social function often persist into adulthood, impacting social participation and quality of life. The Programme for the Education and Enrichment of Relational Skills (PEERS) is a manualised group-based intervention with preliminary evidence demonstrating improved social knowledge and participation for adolescents with acquired brain injury or cerebral palsy when delivered face to face. The recent COVID-19 pandemic and challenges for families living outside metropolitan centres to access the programme suggest a telehealth delivered PEERS should be explored. This study aims to compare telehealth PEERS to usual care in a mixed-methods randomised waitlist-controlled trial to determine preliminary efficacy to improve social functioning and secondarily to determine acceptability, feasibility, cost and contextual factors impacting the implementation.

Methods and analysis

In this single-centre mixed-methods randomised waitlist-controlled trial, 32 adolescents with brain injury, aged 11–17 years attending mainstream high school and their caregivers will be randomised to receive either (a) telehealth PEERS once/week for 1.5 hours for 14 weeks or (b) usual care (UC). UC is highly variable in Australia but often comprises fortnightly occupational therapy, physiotherapy or speech therapy. The waitlist group will then receive PEERS following the 26-week retention time point. Measures will be administered at baseline, 14 weeks (immediately post) and then 26 and 52 weeks post baseline. The primary outcome is self-reported performance and satisfaction with social goals on the Canadian Occupational Performance Measure at 14 weeks. Secondary outcomes include self and parent-reported social competence, frequency of get-togethers with peers, self-report knowledge of social skills, frequency of peer victimisation and quality of life. An implementation evaluation will be done to determine acceptability, feasibility, cost and identify barriers and facilitators in the implementation of the intervention and map these against the Consolidated Framework for Implementation Research. This study will assess the unit costs of implementing the PEERS from an Australian health system perspective.

Ethics and dissemination

The Children’s Health Queensland Hospital and Health Service and The University of Queensland Human Research Ethics Committees have approved this study. Findings will be disseminated in peer-reviewed journals and conference presentations.

Trial registration number

ACTRN1263000082606.
Prioritisation of functional needs for ICU intelligent robots in China: a consensus study based on the national survey and nominal group technique
Authors: Cui Zhen , Yan Yufeng , Wang Hao , Bai Ying , Zhang Liu , Yu Miaomiao , Zhang Fan , Yuan Xin , Wang Shuya , Ouyang Bo , Wu Xinbao
Published: February 2025

Objective

This study aims to define the prioritisation of the needs for an intelligent robot’s functions in the intensive care unit (ICU) from a clinical perspective.

Design

This study introduces a nominal group technique.

Setting

This study uses national setting.

Participants

This study includes a total of 851 respondents from 34 provinces in China who participated in the survey. A nominal group of 12 members was organised by the research group; there were seven experts with a background in critical care, two junior attending physicians with a background in critical care and three experienced nurses.

Results

A total of 50 needed intelligent robot functions in ICUs were obtained from the questionnaire data. Through three rounds of nominal group voting and discussion, a consensus was reached on 44 items, which were categorised into 29 high-priority needs, 13 medium-priority needs and two low-priority needs. The functionalities in areas such as ‘sleep and pain assessment,’ ‘monitoring of sedation, agitation, and delirium,’ and ‘robot-assisted rehabilitation and physical therapy’ were particularly favoured by the ICU medical and nursing staff.

Conclusions

This study has defined the functional needs and priorities for ICU intelligent robots from the perspective of ICU clinical medical and nursing staff. It has been concluded that ‘disease assessment function’ and ‘rehabilitation and physical therapy’ are most needed by clinical doctors and nurses. The results presented in this study could serve as a useful reference for future research and development of medical robots.
All the voices we cannot hear: a taxonomy of why some populations’ experiences are missing from health and care quality evidence and the Toolkit for Assessing Under Representation in User Surveys (TAURUS)
Authors: Graham Chris , King Jenny , Lerway Clare , Poots Alan J
Published: February 2025

Background

Patient and public voices are vital for understanding the quality of health and care. However, many healthcare providers, commissioners, decision-makers and researchers cannot hear the voices of all people within diverse populations, with different groups excluded from patient experience data collections and analyses for a variety of causes—some of which are overlooked or misunderstood. Exclusion and under-representation can be particularly problematic for disadvantaged people and marginalised communities, and risk exacerbating existing inequalities.

Key messages

We posit a taxonomy of causes of exclusion and under-representation in research involving patient and public voice: (1) Non-access: people are excluded because they cannot or do not access a service in the first place. (2) Non-invitation: health research and feedback programmes may not include invitations for some groups, despite being eligible, or use language that is inappropriate. (3) Non-response: some communities are less likely to respond to requests for feedback. (4) Non-identification: sometimes the structure and content of data do not allow the identification of distinct groups in data collections. (5) Non-review: sometimes data are available and yet not analysed. We provide aToolkit for Assessing Under Representation in User Surveysto prompt conversations.

Conclusions

These causes result in under-representation that creates knowledge gaps for quality and equity. Overcoming this requires strategic approaches with a commitment to equity and inclusion, supported by resources in collecting and using data with an appropriate range of methodologies. Providers should undertake equalities impact assessments around new data collections, using the taxonomy to identify and minimise potential sources of under-representation and ensure that voices are heard and acted on.
Influence of tobacco smoking and alcohol drinking on dysmenorrhoea: a cross-sectional analysis of data from the Taiwan Biobank
Authors: Kuo Cheng-Shing , Wang Kuang-Te , Lai Jerry Cheng-Yen , Chen Shaw-Ji
Published: February 2025

Objectives

Dysmenorrhoea, characterised by severe menstrual cramps, affects between 50% and 90% of women of reproductive age and considerably lowers their quality of life.

Design

Cross-sectional study.

Setting

This study explored the influence of tobacco smoking and alcohol consumption on dysmenorrhoea, using data from the Taiwan Biobank.

Participants

Our analysis involved 8567 individuals and examined the associations between dysmenorrhoea and variables such as alcohol consumption, tobacco smoking, demographic characteristics and lifestyle behaviours through multivariable logistic regression.

Results

The findings reveal a significant association between concurrent alcohol and tobacco use and increased dysmenorrhoea risk, with adjusted ORs suggesting higher risk levels for dual users compared with those who only smoke or drink (adjusted OR (95% CI) both alcohol and tobacco: 3.19 (1.51 to 6.72); only tobacco: 1.21 (0.89 to 1.63); only alcohol: 1.06 (0.53 to 2.13)). Additionally, factors such as higher education level and early menarche were associated with increased dysmenorrhoea risk, whereas regular exercise and multiparity exerted a protective effect against the condition (adjusted OR (95% CI) higher education: 1.43 (1.19 to 1.71); early menarche: 1.37 (1.14 to 1.64); regular exercise: 0.77 (0.64 to 0.93); multiparity: 0.64 (0.52 to 0.77)).

Conclusions

Our study also highlights the complex interactions between lifestyle factors and dysmenorrhoea, underscoring the need for targeted interventions and lifestyle modifications to mitigate the condition’s effects. Future research should employ longitudinal designs for causal inference and to explore the mechanisms underlying the associations observed in this study.
Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis
Authors: Xu Leqing , Wu Yike , Li Jiyifan , Ding Yanan , Chow Junwei , Li Longzhou , Liu Haiyang , Wang Zihan , Gong Tingting , Li Yue , Ma Guo
Published: February 2025

Objectives

Assess the efficacy and safety profiles of different sodium-glucose cotransporter-2 inhibitors (SGLT2is) as an add-on to metformin in type 2 diabetes mellitus (T2DM) patients.

Design

Bayesian network meta-analysis.

Data sources

PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov were searched before 18 December 2024.

Eligibility criteria

Randomised controlled trials (RCTs) evaluating T2DM patients taking one of 12 SGLT2is as add-on therapy to metformin. Efficacy outcomes focused on glycated haemoglobin (HbA1c) reduction, fasting plasma glucose (FPG) reduction and weight loss (WL). Safety outcomes included adverse events (AEs), serious AEs (SAEs), hypoglycaemia, urinary tract infections (UTI) and genital infections (GI).

Data extraction and synthesis

Two investigators independently extracted data. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool (V.2.0) for RCTs.

Results

23 RCTs involving 9144 patients and 11 SGLT2is were included. Compared with placebo, most SGLT2is reduced HbA1c (mean difference (MD), −0.45~−0.80%), FPG (MD, −0.78~−2.02 mmol/L) and body weight (MD, −0.88~−2.67 kg). Only 10 mg of henagliflozin increased the incidence of AEs, and none of the included interventions increased the risks of SAEs or UTIs. 50 mg of empagliflozin exhibited higher risks of hypoglycaemia. Only 10 mg of empagliflozin increased the risk of GI. According to the surface under the cumulative ranking values, SGLT2is with optimal efficacy and safety were 15 mg of ertugliflozin in HbA1c reduction, 300 mg of canagliflozin in FPG reduction, WL and hypoglycaemia, 400 mg of sotagliflozin in total AEs, 10 mg of ertugliflozin and 150 mg of ipragliflozin in SAEs, 12.5 mg of ipragliflozin in UTI and 1 mg of ertugliflozin in GI.

Conclusions

As add-on therapy, SGLT2is demonstrated favourable antidiabetic efficacy and acceptable safety. 300 mg of canagliflozin was the best option among the included interventions considering favourable glucose control and WL. Some novel SGLT2is (eg, henagliflozin) exhibited promising efficacy and safety profiles, but more research is needed to validate the findings.
Lived experiences of gynaecological cancer survivors in Oman: a qualitative study
Authors: Al-Awaisi Huda , Moshtohry Aya , Al Balushi Muna , Bureny Ikram
Published: February 2025

Objective

A significant number of patients with gynaecological cancers survive their disease and are considered cured. However, the diagnosis of cancer and its treatment can affect quality of life adversely. We sought to explore the lived experiences of women surviving gynaecological cancers in Oman.

Methods

Omani patients with gynaecological cancers who had completed their treatment more than 1 year ago and were following up in the medical oncology clinic at a major cancer centre in Oman were interviewed. A qualitative study design was employed using face-to-face semistructured individual interviews. To prevent recall bias, women diagnosed with cancer within the past 5 years only were included. The sample size was determined using data saturation, where data collection revealed no new information. All interviews were tape recorded and transcribed verbatim. Transcripts were analysed using a standardised thematic analysis approach.

Results

Four main themes emerged: ‘Beliefs and attitudes’; ‘Living with Treatment Complications’; ‘Living with cancer’ and ‘Coping with the Cancer Journey’.

Conclusions

The diagnosis of cancer had a profound effect on the lives of women with gynaecological cancer. The diagnosis negatively affected their lives throughout their cancer journey due to social role changes, fertility and sexual problems. Religion and social support played major roles in coping with the disease. This is the first study describing the lived experiences of Muslim and Omani survivors of gynaecological cancers and may help to determine their survivorship needs.
Factors related to risky alcohol consumption and binge drinking in Spanish college students: a cross-sectional study
Authors: Ramón-Arbués Enrique , Antón-Solanas Isabel , Blázquez-Ornat Isabel Rosario , Gómez-Torres Piedad , García-Moyano Loreto , Benito-Ruiz Eva
Published: February 2025

Objectives

The aim of this study was to determine the prevalence of risky alcohol consumption and regular binge drinking, and their associated factors, in Spanish college students.

Design

A cross-sectional study was conducted.

Setting

This study took place at a private university in a northern region of Spain.

Participants

A total of 330 Spanish undergraduate university students enrolled in the 2022–2023 academic year voluntarily agreed to participate in this investigation.

Primary and secondary outcome measures

Data collection included sociodemographic information and health-related behaviours. The Alcohol Use Disorders Identification Test was used to assess alcohol consumption. Logistic regression models were used to identify independent predictors for risky alcohol consumption and regular binge drinking.

Results

40.0% of participants reported risky alcohol consumption, and 26.7% were classified as regular binge drinkers. Factors associated with risky alcohol consumption included smoking (OR=3.54, 95% CI 2.03 to 6.14) and problematic internet use (OR=2.10, 95% CI 1.24 to 3.53). Conversely, being older than 30 years was associated with a lower likelihood (OR=0.22, 95% CI 0.08 to 0.60). Regular binge drinking was associated with living outside the family home (OR=2.78, 95% CI 1.56 to 4.95), smoking (OR=3.53, 95% CI 1.94 to 6.40) and problematic internet use (OR=2.19, 95% CI 1.23 to 3.89). In contrast, being female (OR=0.50, 95% CI 0.27 to 0.94) and being over 30 years old (OR=0.28, 95% CI 0.10 to 0.86) were inversely associated.

Conclusions

Risky alcohol consumption and binge drinking are relatively common among Spanish university students. Interventions to promote responsible alcohol consumption among this population should be implemented in collaboration with other stakeholders.
Effects of aspirin and omega-3 fatty acids on age-related macular degeneration in ASCEND-Eye: a randomised placebo-controlled trial in a population with diabetes
Authors: Sammons Emily , Bowman Louise , Stevens William , Buck Georgina , Hammami Imen , Parish Sarah , Armitage Jane
Published: February 2025

Purpose

Aspirin and omega-3 fatty acids (FAs) are potential disease modifiers of age-related macular degeneration (AMD), but previous studies have produced inconsistent findings. Randomised evidence for the efficacy and safety of aspirin and omega-3 FAs on AMD is presented in this study.

Design

ASCEND-Eye is a substudy of eye effects in the 2×2 factorial design ASCEND (A Study of Cardiovascular Events iN Diabetes) double-blind, randomised, placebo-controlled trial for the primary prevention of cardiovascular events. Reports of AMD diagnoses were sourced from 6 monthly ASCEND follow-up questionnaires and a Visual Function Questionnaire.

Participants

15 480 UK adults at least 40 years of age with diabetes but no evident cardiovascular disease.

Interventions

100 mg aspirin daily versus placebo and, separately, 1 g omega-3 FAs daily versus placebo.

Main outcome measure

The first post-randomisation reports of AMD.

Results

During 7.4 years of follow-up, 122 (1.6%) participants randomised to aspirin were reported as having AMD, compared with 138 (1.8%) randomised to placebo (rate ratio 0.88; 95% CI 0.69 to 1.12; p=0.31). AMD occurred in 130 (1.7%) participants randomised to omega-3 FAs, compared with 130 (1.7%) randomised to placebo (rate ratio 0.99; 95% CI 0.78 to 1.27; p=0.99).

Conclusion

No clinically-meaningful effects of aspirin or omega-3 FAs on AMD were found. Although the study had very limited statistical power to detect clinically relevant effects, these data overcome some methodological limitations of previous observational studies, providing randomised evidence of both treatments on AMD, which could contribute to future meta-analyses.

Trial registration number

ISRCTN60635500andNCT00135226.
Healthcare professionals’ attitudes towards digital health interventions and perspectives on digital health inequalities in cardiometabolic care: a qualitative study
Authors: Ramasawmy Mel , Sunkersing David , Poole Lydia , Blandford Ann , Gill Paramjit , Khunti Kamlesh , Modha Shivali , Patel Kiran , Potts Henry , Sajid Madiha , Khan Nushrat , Banerjee Amitava
Published: February 2025

Background

The ue of digital health interventions (DHIs) for the management of cardiometabolic diseases has increased but may exacerbate existing health inequalities. Healthcare professionals (HCPs) play a vital role in recommending and supporting healthcare users to use these tools. There is a need to understand the role of HCPs in managing the implementation of digital health in communities at risk of health inequalities.

Objective

To explore the views of HCPs regarding digital health and its impact on health inequalities, focusing on cardiometabolic diseases and the South Asian population in the UK.

Design

We conducted online semi-structured interviews and focus groups with HCPs. These explored HCPs’ experiences and attitudes towards digital health, their perceptions of healthcare users’ barriers and facilitators to use such tools, as well as digital inequalities among specific healthcare user groups, and the impact of the COVID-19 pandemic on their practice in relation to digital health. After informed consent, transcription and coding, a reflexive thematic approach was taken for analysis.

Setting

Primary, community and secondary care provided for cardiometabolic disease in the UK.

Participants

HCPs in general practice (n=3), cardiometabolic specialities (n=3), pharmacy (n=4) and other practices (n=8).

Results

HCPs recognised the potential benefits of DHIs to improve access and delivery of care and healthcare user outcomes but described several barriers to successful implementation. HCPs demonstrated a good understanding of the challenges their healthcare users face in relation to wider inequalities, barriers to health behaviours and healthcare access, and digital health. Of particular concern was the impact of increasing reliance on digital interventions in healthcare on the exclusion of some population groups. Participants recommended improvement of the design and implementation of DHIs offered to healthcare users through working with at-risk populations throughout the process. Finally, participants emphasised the importance of ensuring non-digital services remained available to ensure equitable access to health and social care.

Conclusions

HCPs described the complexities of delivering care to underserved communities. DHIs were identified as a potential way to improve health outcomes for some, while over-reliance risked exacerbating inequalities. HCPs made recommendations related to design, implementation and engaging target populations and provided practical examples to address digital health inequalities, such as working with other sectors to take a community approach.