bluuebunny/crossref_metadata_2025 huggingface dataset:
Prison Overcrowding and Harsh Conditions: Health and Human Rights Concerns to Persons in Custody, Staff, and the Community
Authors: Baffour Frank Darkwa , Francis Abraham P. , Chong Mark David , Harris Nonie
Published: December 2023

The article explored overcrowding in Ghana prisons and sought to understand its impact on the health and well-being of persons in custody and prison officers. Qualitative data from 38 participants who were serving terms or working in three prison facilities in Ghana revealed three themes, including (a) fear over the spread of communicable diseases, (b) limited access to basic resources, and (c) psychological and emotional burden, attributing them to overcrowding in the prisons. We discussed the findings from human rights and prison and public security perspectives and concluded that addressing overcrowding in prisons would ensure a healthy prison environment, which may have implications for the well-being and human rights of persons in custody, as well as public safety and the health of prison officers and the community. To achieve a healthy prison, policies should target prison depopulation and commitment from stakeholders to implement local and international prison rules and conventions.
E-waste by mobile Phones: A Case Study on the Consumption, Disposal Behavior, and Awareness of Consumers in Kolkata, India
Authors: Adhikari Kartik , Roy Amit Saha
Published: January 2024

Mobile phones, particularly smartphones, have become an indispensable part of our daily lives. Technological advancements and the availability of high-speed internet services have culminated in an enormous rise in the number of mobile phone users. Nowadays, as a result of constant advancements in mobile phone technology and other factors, a portion of consumers use more than one mobile phone. On the other hand, the actual lifespan of a mobile phone has reached nearly 4 years. As a result, mobile phone waste as a component of electronic waste has increased significantly over the last decade. From an environmental point of view, various carcinogenic chemical components may be released from mobile phones during the informal recycling process, drastically polluting our environment. According to our survey, while the majority of educated mobile phone users in Kolkata are aware of the adverse effects of electronic waste (e-waste), they typically choose less expensive and easier disposal solutions since they are not concerned about the recycling of mobile phones or e-waste. This study primarily highlighted mobile phone disposal behaviours in Kolkata, India. After reviewing the results of our questionnaire, we noticed numerous actual problems with customers’ disposal patterns for their obsolete mobile phones. In this article, we attempt to depict the current problem of e-waste generated from mobile phones in Kolkata.
Effects of Intersections on the Safety of Horizontal Curves
Authors: Xu Xingjing , Bejleri Ilir , Rodrigues Silva Karla , Srinivasan Sivaramakrishnan
Published: January 2024

Both horizontal curves and intersections are generally considered high-risk locations in roadway safety. Although extensive research has been conducted separately on the safety of curves and intersections, the safety performance of curves as affected by their spatial relationship with intersections has not been fully understood. Previous research has not examined this relationship because of the use of limited or pre-existing datasets that did not include intersection data in the analysis. This study addresses these gaps by analyzing the spatial relationship between curves and intersections, utilizing a large dataset of over 8,000 rural curves in Florida. The study performs a systemic analysis using this dataset and six years of statewide crash data of all injury severity levels and develops customized curve Safety Performance Functions based on various spatial relationships between curves and intersections. This study confirms that the previously identified risk factors such as traffic volume, curve radius and length, roadway speed limit, and functional classification have significant impacts on curve safety. More importantly, the study quantifies, for the first time in the literature, the influence of intersections on curves or close to curves on safety, demonstrating that curves with one or more intersections present a higher risk than curves with no intersections. The findings show that the presence of nearby intersections can increase the crash risk for curves with no intersections but can lead to a decrease in crashes for curves with one or multiple intersections. These findings can be utilized to determine high-risk curve locations for systemic safety analysis studies.
Evaluation of phase, microstructural and mechanical characteristics in stir casted AA6351-Gr-TiC hybrid metal matrix composites
Authors: Ali Shahazad , Murtaza Qasim , Gupta Pallav
Published: December 2023

The demand for advanced materials with enhanced mechanical properties for various engineering applications has spurred research into hybrid metal matrix composites. This study aims to explore the influence of incorporating Gr-TiC reinforcement particles into the AA6351 metal matrix. The fabrication process involved adding different weight percentages of Gr-TiC (0.5-0.5, 1.0-1.0, 1.5-1.5, and 2.0-2.0 wt%) to the AA6351 metal matrix using the liquid metallurgy technique. Comprehensive analyses were conducted on the fabricated samples to assess their phase, microstructure, EDS, density, hardness, tensile strength and fractured morphology. X-ray diffraction analysis showed that the interfacial bonding between the matrix and reinforcement particles caused a preparatory stage of development. Moreover, scanning electron microscopy confirmed that the reinforcement particles were uniformly distributed throughout the aluminum matrix. Due to the presence of graphite and porosity in the fabricated samples, the density of the aluminum metal matrix decreased. The samples with a reinforcement proportion of 2.0 wt% graphite and 2.0 wt% TiC exhibited the lowest density of 2.61 gram/cc. The maximum levels of hardness, engineering ultimate tensile strength, and true ultimate tensile strength were observed at a weight percentage of 1.0 wt% for both Gr and TiC, with values of 85 HRC, 206.7 N/mm2, and 260.43 N/mm2 respectively.
Credibility of misinformation source moderates the effectiveness of corrective messages on social media
Authors: Zeng Huai-Kuan , Lo Shih-Yu , Li Shu-Chu Sarrina
Published: December 2023

To examine how different features of corrective messages moderate individuals’ attitudes toward misinformation on social media, a 2 (misinformation source credibility: high vs low) × 2 (corrective message source: algorithmic vs peer correction) × 2 (correction type: factual elaboration vs simple rebuttal) between-subjects experiment was conducted. To reduce perceived credibility and respondents’ attitudes toward the misinformation, peer corrections were more effective than algorithmic corrections for misinformation from a source with lower credibility; for misinformation from a highly credible source, the superiority effect of peer corrections was still significant on perceived credibility but not on respondents’ attitudes toward the misinformation. For the fact-checking tendency, we did not find a robust effect about how different features of corrective messages interacted. Our findings provide important insights into message design in combatting misinformation on social media.
News Media Representations: Audience Perceptions of News Frames About Latinxs and Hispanics
Authors: Rendon Hector
Published: December 2023

This study includes a survey of 1,077 participants to explore the audiences’ perceptions of news representations about the largest minoritized group in the United States: Latinxs and Hispanics. The findings suggest that news exposure, age, ethnicity, education, and income are significant variables for the public to perceive more positive portrayals of Latinxs/Hispanics. Also, some negative stereotypical interpretations of Latinx/Hispanic news frames continue to be pervasive. The results point to the need for updated theoretical approaches focused on the role of media in the minoritization process of ethnoracial populations.
ADHD in Adults: Does Age at Diagnosis Matter?
Authors: Hutt Vater Chloe , DiSalvo Maura , Ehrlich Alyssa , Parker Haley , O’Connor Hannah , Faraone Stephen V. , Biederman Joseph
Published: January 2024

Objective:

To provide additional information about clinical features associated with adult ADHD in patients diagnosed in childhood compared to those first diagnosed in adulthood.

Method:

We stratified a sample of adults with ADHD into patients diagnosed in childhood versus adulthood and compared demographic and clinical characteristics.

Results:

We found similar clinical features in adults diagnosed in childhood and adults diagnosed in adulthood. Among those diagnosed in adulthood, 95% reported symptom onset in youth. Our results do not support the hypothesis that ADHD diagnosed in adulthood is due to misinterpreting symptoms of other disorders as ADHD. They also suggest incorporating behavioral signs of executive dysfunction into diagnostic criteria for ADHD in adults may increase diagnostic sensitivity.

Conclusion:

These results support the validity of ADHD diagnoses in adulthood, as these adults show similar clinical profiles to those diagnosed in youth. Our results also suggest that if adult-onset ADHD exists, it is rare.
Trends in cervical cancer screening in Norway 2012–2017: a comparison study of non-immigrant and immigrant women
Authors: Enden Marta Røttingen , Møen Kathy , Igland Jannicke , Diaz Esperanza
Published: January 2024

Aims:

Immigrant women in Norway have lower cervical cancer screening participation than non-immigrant women. Our aim in this study was to assess whether the observed increase in screening participation during 2012–2017 was different between Norwegian-born women and immigrant women.

Methods:

Data were collected from three national registries. The study included 1,409,561 women, categorized according to country of birth and immigrant background: (i) Norway, Norwegian parents; (ii) Norway, immigrant parent(s); (iii) Europe, excluding Norway; (iv) Africa; (v) Asia, including Turkey; and (vi) other countries. Trends and differences between groups were analyzed using Poisson regression analyses with adjustments for variables other studies have found to influence screening participation. Trends were assessed by including half-years as a continuous variable in the models and reported as prevalence ratios with 95% confidence intervals.

Results:

Screening participation increased in all groups, but was not statistically significant among women from Africa in the adjusted model. The highest increase was among Norwegian women, with a 2.2% increase per year. Interaction tests showed significantly smaller increases in screening among women born in Europe ( p interaction < 0.0001), Africa ( p interaction < 0.0001), Asia ( p interaction < 0.0001), and countries in the “Other” category ( p interaction = 0.004). There was also a smaller increase among Norwegian-born women with one or more immigrant parent(s), but this was not significant ( p interaction = 0.178).

Conclusions:

The gap in screening participation and the increasing differences in trends suggest that healthcare services do not reach all women in Norway to the same extent. One should attempt to improve this while working toward further increasing screening participation for all.
Primary tumor consolidative therapy improves the outcomes of patients with advanced EGFR-mutant lung adenocarcinoma treated with first-line osimertinib
Authors: Wu Jia-Jun , Tseng Jeng-Sen , Zheng Zhe-Rong , Chu Cheng-Hsiang , Chen Kun-Chieh , Lin Mong-Wei , Huang Yen-Hsiang , Hsu Kuo-Hsuan , Yang Tsung-Ying , Yu Sung-Liang , Chen Jin-Shing , Ho Chao-Chi , Chang Gee-Chen
Published: January 2024

Background:

Patients with advanced epidermal growth factor receptor ( EGFR)-mutant lung adenocarcinoma (LAD) inevitably experience drug resistance following treatment with EGFR-tyrosine kinase inhibitors (TKIs).

Objectives:

We aimed to analyze the effect of primary tumor consolidative therapy (PTCT) on patients treated with first-line osimertinib.

Design and methods:

This retrospective cohort study was conducted in patients with advanced stage III or stage IV LAD with EGFR-sensitizing mutations (exon 19 deletion or L858R mutation) with disease control after first-line osimertinib. A curative dose of primary tumor radiotherapy or primary tumor resection was classified as PTCT. We compared the progression-free survival (PFS) and overall survival (OS) of patients with and without PTCT.

Results:

This study included 106 patients with a median age of 61.0 years, and of those, 42% were male and 73.6% were never-smokers. Exon 19 deletion was observed in 67.9%, 30.2% had a programmed cell death ligand 1 (PD-L1) tumor proportion score <1%, 33.0% had brain metastasis, and 40.6% had oligometastasis. In all, 53 (50%) patients underwent PTCT. Patients who underwent PTCT demonstrated significantly better PFS [30.3 (95% confidence interval (CI), 24.1–36.4) versus 18.2 (95% CI, 16.1–20.2) months; p = 0.005] and OS [not reached versus 36.7 (95% CI, 32.5–40.9) months; p = 0.005] than patients who did not. A multivariate analysis showed that PTCT was an independent factor associated with better PFS [hazard ratio (HR), 0.22; 95% CI, 0.10–0.49; p < 0.001] and OS [HR, 0.10; 95% CI, 0.01–0.82; p = 0.032]. The PFS benefits of PTCT were consistent across subgroups, and the HR tended to be lower in patients aged <65 years, males, smokers, stage IVB disease, L858R, PD-L1 expression ⩾1%, non-oligometastasis, and brain metastasis.

Conclusion:

Of the patients with advanced EGFR-mutant LAD, those who underwent PTCT had a significantly better survival outcome than those who did not. The survival benefits were consistent across different subgroups.
Prevalence and Predictors of Post-Acute COVID-19 Symptoms in Italian Primary Care Patients
Authors: Foresta Andreana , Ojeda-Fernández Luisa , Augurio Claudia , Guanziroli Cecilia , Tettamanti Mauro , Macaluso Giulia , Lauriola Paolo , Nobili Alessandro , Roncaglioni Maria Carla , Baviera Marta
Published: January 2024

Background:

Despite all the progress in the management of acute COVID-19, it is still not clear why some people continue to experience symptoms after recovery. Using data from a self-administered online survey, we assessed the prevalence and predictors of post-acute COVID-19 in an unselected population followed by GPs.

Methods:

Patients ≥18 years with a confirmed COVID-19 diagnosis were included. The survey collected information on demographics, risk factors, COVID-19 course and symptomatology. Fatigue and Quality of Life questionnaires were also administered. Descriptive statistics were used to describe patients’ characteristics, stratified as acute and post-acute COVID-19. Logistic regression models were used to assess the association between clinical characteristics and post-acute COVID-19.

Results:

A total of 1108 surveys were analyzed. Nearly 29% of patients reported post-acute COVID-19. The more persistent symptoms were fatigue, memory and concentration impairment. Adjusted Odds Ratio (OR) showed a significantly higher probability of post-acute COVID-19 for women compared to men (OR 1.9, 95% CI 1.4-2.5), for age >50 years than ≤50 years (OR 1.6, 95% CI 1.2-2.2), for BMI > 25 compared to BMI ≤ 25 (OR 1.6, 95% CI 1.1-2.1) and those with autoimmune diseases, compared to those without (OR 1.8 95% CI 1.1-2.9). In addition, a significant association was found with COVID-19 hospitalization, anxiety and allergies. We found that post-acute COVID-19 patients showed a higher fatigue and a worst quality of life.

Conclusions:

These findings suggest the need for tailored personalized strategies to improve the management of patients with post-acute COVID-19.
Black, No Question Mark: Black Student Organizations, (Multi)Racial Awakenings, and Reflective Resistance in Multiracial Families
Authors: Loblack Angelica C.
Published: December 2023

The increasing visibility of multiracial college students has catalyzed debate about the need for organizations to better address the racialized experiences of these students. These debates are fueled by scholarship highlighting multiracial students’ feelings of exclusion and alienation from race-oriented student organizations. Yet, much of this research is predicated on the aggregated experiences of all multiracial students with minimal, or no specific attention to those who both have Black ancestry and indicate involvement in Black student organizations (BSOs). To fill this gap, I draw on interviews with 21 Black multiracial college students involved in BSOs to examine how they interpret the impacts of their involvement. In doing so, I elucidate how BSOs operate as critical activation sites for (multi)racial awakenings, through which students develop deeper understandings of and attachments to Blackness as well as demonstrate strengthened commitments to antiracism. I then introduce reflective resistance to account for the ways that these (multi)racial awakenings informed shifts in students’ navigation of intrafamilial relationships, leading many to adopt strategies meant to dismantle, confront, and even resist the racist logics perpetuated by loved ones. Black multiracial students’ engagement in reflective resistance illustrates how BSO involvement not only impacts understandings of race and racism but also provides the tools necessary to critically reflect and resist anti-Blackness in students’ social, political, and intimate lives.
Valuation of Heritage Tourism Sites in West Bengal (India): An Application of Travel Cost Approach
Authors: Baitalik Anirban , Bhattacharjee Tanmoyee
Published: December 2023

This study focuses on assessing the values of heritage sites in West Bengal, India, with a particular emphasis on the post-lockdown period in the wake of the COVID-19 pandemic. The heritage temple town of Bishnupur in the Bankura district was purposively chosen as the primary research site. Both primary and secondary data sources were utilized. Secondary data were collected from official publications of the Ministry of Tourism, Government of India, the Department of Tourism, Government of West Bengal and other pertinent grey literature sources. Primary data were gathered through structured interviews with a sample of tourists. Analytical tools, including descriptive statistics, semi-log regression models, ANOVA, zonal travel cost method and contingent valuation method, were employed for data analysis. Findings reveal that Bishnupur’s heritage temples primarily attract tourists from nearby areas, particularly within the same district, during the post-lockdown period. Notably, tourists expressed a high level of satisfaction with their experiences, and this satisfaction was found to be significantly associated with their willingness to contribute financially for further improvements and conservation efforts in the heritage sites. This study provides valuable insights into the recreational values of selected tourist sites and tourists’ willingness to pay for their continued enhancement, preservation and management. These insights are particularly pertinent in the context of the post-lockdown period caused by the COVID-19 pandemic. They offer guidance for decision-makers and stakeholders involved in the development and preservation of heritage tourism in West Bengal, India, serving as a valuable resource for informed policy and strategy formulation.
Left main and three vessels spontaneous coronary artery dissection as an incidental finding in young man with history of Hodgkin’s lymphoma-a case report
Authors: Kavyani Raheleh , Salari Soheila , Norozi Zeinab , Hosseini Saeid , Abdi Saifullah , Rai Alireza , Maleki Majid
Published: January 2024

Background

Spontaneous coronary artery dissection is a rare and important cause of myocardial infarction, especially in young women without other coronary artery disease. This arterial dissection can occur within or between any of the 3 layers.

Its predisposing factors include connective tissue diseases (Marfone syndrome, Ehlers-Danlos syndrome), vasculitis (polyarteritis nodosa, systemic lupus erythematosus, and Kawasaki disease), atherosclerosis and fibromuscular dysplasia.

Clinical presentations of spontaneous coronary artery dissection are wide spectrum from asymptomatic to acute coronary disease, sustained ventricular arrhythmia and sudden cardiac death.

Case presentation

We describe A 33-year-old man with history of Hodgkin’s lymphoma five years earlier that became a candidate for Patent foramen ovale closure due to recurrent embolic cerebrovascular accident. Before the intervention, coronary angiography incidentally showed dissection in the left main and all major coronary arteries.

Conclusions

Based on our hypothesis, chemoradiotherapy-induced arteriopathies could be consider as a predisposing factor for spontaneous coronary artery dissection.
Changes in estimated glomerular filtration rate before and after the first visit for atrial fibrillation
Authors: Yasuoka Ryobun , Sakurane Hiroyuki , Okune Mana , Tanaka Motohide , Nagano Tomoya , Maruyama Masahiro , Nakazawa Gaku , Kurita Takashi
Published: January 2024

Background

Although the development of atrial fibrillation (AF) and the progression of chronic kidney disease are known to be interrelated, it remains unclear when and how renal function changes during the clinical course of AF.

Methods

This study retrospectively enrolled 131 patients who were able to collect data on estimated glomerular filtration rate (eGFR) at least five times during the 500 days before and 500 days after the first visit (baseline) of new-onset AF, respectively. To investigate the temporal relationship between the development of AF and the beginning of worsening renal function (WRF), a piecewise regression model was applied to the eGFR time series data. The time point at which the slopes of the two regression lines changed (inflection -point), the slope before and after the inflection-point (β1 and β2, respectively), and the difference in slope (Δβ) were estimated. The presence of WRF was defined as having the inflection-point at which both Δβ and β2 were < − 0.0083 mL/min/1.73 m2/day (corresponding to 3.03 mL/min/1.73 m2/year), and the corresponding the inflection-point was defined as the beginning of WRF.

Results

WRF was detected in 54 (41.2%) patients. The beginning of WRF were distributed at various times, but most frequently (23 of 54 patients) within 100 days before and after baseline. The presence of WRF was not associated with age, heart failure, or baseline eGFR, but was associated with positive β1 (odds ratio 30.5, 95% confidence interval 11.1–83.9, P < 0.01).

Conclusion

In nearly half of AF patients with WRF, the beginning of WRF was observed within a few months before or after the first visit for AF. Patients with a positive eGFR slope before the onset of AF are more likely to develop WRF after the onset of AF, suggesting that potential kidney damage may be underlying.
Building pathology capacity in sub-Saharan Africa to improve breast cancer diagnosis and treatment: training laboratory technicians in high-quality manual immunohistochemistry
Authors: Setiawan Linda , Graef Katy , Schmolze Dan , Alem Alemwosen , Taylor Lesley
Published: January 2024

Background

To address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC).

Methods

A quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022–2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar.

Results

Two hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p =  < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria.

Conclusions

Our program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.
Treatment of children with refractory/relapse high risk langerhans cell histiocytosis with the combination of cytarabine, vindesine and prednisone
Authors: Wang Wenqian , Ge Jian , Ma Honghao , Lian Hongyun , Cui Lei , Zhao Yunze , Li Zhigang , Wang Tianyou , Zhang Rui
Published: January 2024

Background

The patients with multisystem and risk organ involvement Langerhans cell histiocytosis (MS-RO + LCH) have poor prognosis. The patients with MS-LCH who failed front-line therapy have a high mortality rate and the standard salvage treatment has not been established. The combination of cytarabine (Ara-c), vincristine (VCR) and prednisone might be effective for refractory/relapse MS-RO + LCH, with low toxicity.

Methods

We retrospectively analyzed pediatric refractory/relapse MS-RO + LCH patients treated with the low-dose Ara-c (100mg/m2/d×5days) or high-dose Ara-c (500mg/m2/d×5days) combined with vindesine (VDS) and prednisone in a single center. The efficacy, outcomes and adverse events were analyzed.

Results

From January 2013 to December 2016, 13 patients receiving the low-dose Ara-c chemotherapy (LAC) and 7 patients receiving the high-dose Ara-c chemotherapy (HAC) were included in the study. 11 (84.6%) of the 13 patients treated with the LAC regimen and 6 (85.7%) of the 7 patients treated with the HAC regimen had response after four courses of the therapy. All patients in the study were alive during follow-up and the 3-year event-free survival rate (EFS) was 53.7% and 85.7% in the LAC and HAC groups. The most frequent adverse event was Grade 1/2 myelosuppression, which was observed in 38.5% (5/13) and 42.9% (3/7) of the patients receiving the LAC and HAC regimen.

Conclusions

A combination of Ara-c, VDS and prednisone was effective and safe for some patients with refractory/relapse MS-RO + LCH. The high-dose Ara-c regimen was associated with a numerically higher EFS rate.
Thrombosis of acute superior mesenteric artery in a patient with breast cancer receiving toremifene therapy: a case report and literature review
Authors: Wang Ximei , Zhou Runhe , Gao Dezong
Published: January 2024

It is widely recognized that cancer itself is related to increased risk of thromembolism. Venous thromboembolism is relatively common in breast cancer patients, but arterial thrombosis, especially acute superior mesenteric artery thrombosis (SMAT) associated with chemotherapy or endocrinotherapy, rarely occurs in breast cancer patients. There were few reports about acute SMAT in cancer patients who underwent chemotherapy, but no reports of acute SMAT caused by endocrine-therapy. We reported a 54-year-old patient with acute SMAT during toremifene treatment after breast cancer surgery. She underwent 4 cycles chemotherapy of TC regimen, then accepted toremifen endocrinotherapy because of positive estrogen receptor. She suffered from acute SMAT after 2 months toremifen treatment. Therefore, we consider that this case of acute SMAT may be a rare adverse event of toremifen. In view of the high risk and rarity of acute SMAT caused by toremifene, we suggest that except for venous thrombosis, arterial thrombosis in special position (ATSP) should be kept in mind during use of toremifene. Once a thrombotic event occurs, toremifene should be stopped immediately.
Assessment of clinical competence of graduating medical students and associated factors in Ethiopia
Authors: Dejene Daniel , Ayalew Firew , Yigzaw Tegbar , Woretaw Alemseged , Versluis Marco , Stekelenburg Jelle
Published: January 2024

Background

Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.

Methods and materials

A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value < 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.

Results

Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.

Conclusions

Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates’ licensing examinations is also a way forward.
Development of the EVIBEC Learning Outcomes Framework to support the delivery of evidence-based practice curricula in health care professional programmes: a codesign approach
Authors: Redmond Catherine , Farrell Robin , Cunningham Catriona , Dineen Andrea , Foley Shane , O’Donnell Deirdre , O’Reilly Sharleen , Stokes Diarmuid , O’Neill Emma
Published: January 2024

Background

All healthcare professional education programmes must adopt a systematic approach towards ensuring graduates achieve the competencies required to be an evidence-based practitioner. While a list of competencies for evidence-based practice exist, health care educators continue to struggle with effectively integrating the necessary competencies into existing curricula. The purpose of this project was to develop an open access cross-discipline, learning outcomes framework to support educators in integrating the teaching, learning and assessment required to ensure all graduates of health care professional programmes can achieve the necessary evidence-based practice competencies.

Methods

An interdisciplinary team of health care professional educators and a librarian completed a review of the health professions literature on the teaching and assessment of evidence-based practice. The literature, coupled with the teams’ collective experiences in evidence-based education and research, were used to identify relevant teaching, learning and evidence-based competency frameworks to inform the project design. The guide and toolkit for experience-based co-design developed by the National Health Service Institute for Innovation and Improvement was adopted for this study ( Institute for Innovation and Improvement: Experience Based Design: Guide & Tools In. Leeds: NHS; 2009.). A four-step approach involving three online participatory co-design workshops and a national validation workshop was designed. Students (n = 33), faculty (n = 12), and clinical educators (n = 15) participated in formulating and mapping learning outcomes to evidence-based competencies.

Results

Through a rigorous, systematic co-design process the Evidenced-based Education Collaborative (EVIBEC) Learning Outcomes Framework was developed. This framework consists of a series of student-centred learning outcomes, aligned to evidence-based practice competencies, classified according to the 5 As of EBP and mapped to the cognitive levels of Bloom’s taxonomy. Associated learning activities for each step of EBP are suggested.

Conclusions

A consensus-based, student-centred learning outcomes framework aligned to a contemporary set of EBP core competencies has been developed. The freely accessible EVIBEC framework may support entry level health care professional EBP education, by informing EBP curriculum development and offering the potential for interdisciplinary approaches to and sharing of valuable teaching and learning resources. Co-design proved an effective method in creating and refining this framework.
Quantitative association between lead exposure and amyotrophic lateral sclerosis: a Bayesian network-based predictive study
Authors: Yu Wenxiu , Yu Fangfang , Li Mao , Yang Fei , Wang Hongfen , Song Han , Huang Xusheng
Published: January 2024

Background

Environmental lead (Pb) exposure have been suggested as a causative factor for amyotrophic lateral sclerosis (ALS). However, the role of Pb content of human body in ALS outcomes has not been quantified clearly. The purpose of this study was to apply Bayesian networks to forecast the risk of Pb exposure on the disease occurrence.

Methods

We retrospectively collected medical records of ALS inpatients who underwent blood Pb testing, while matched controlled inpatients on age, gender, hospital ward and admission time according to the radio of 1:9. Tree Augmented Naïve Bayes (TAN), a semi-naïve Bayes classifier, was established to predict probability of ALS or controls with risk factors.

Results

A total of 140 inpatients were included in this study. The whole blood Pb levels of ALS patients (57.00 μg/L) were more than twice as high as the controls (27.71 μg/L). Using the blood Pb concentrations to calculate probability of ALS, TAN produced the total coincidence rate of 90.00%. The specificity, sensitivity of Pb for ALS prediction was 0.79, or 0.74, respectively.

Conclusion

Therefore, these results provided quantitative evidence that Pb exposure may contribute to the development of ALS. Bayesian networks may be used to predict the ALS early onset with blood Pb levels.
Predictors of antipsychotics switching among ambulatory patients with schizophrenia in Ethiopia: a multicenter hospital-based cross-sectional study
Authors: Kiflu Mekdes , Azale Telake , Gubae Kale , Agegnew Wondm Samuel , Mebratu Ephrem , EliasErgena Asrat , Abubeker Ousman , Mekonnen Gizework Alemnew
Published: January 2024

Introduction

A change of therapy from one to another antipsychotic medication is currently the main challenge of therapy. This study aimed to assess the prevalence of antipsychotic medication switches and determinants among patients with schizophrenia in Northwest Ethiopia.

Methods

Multi-center hospital-based cross-sectional study was conducted at five Comprehensive Specialized Hospitals found in Northwest Ethiopia from April 30, 2021, to August 30, 2021. Data were extracted from both patients’ medical charts and interviews. Data were entered into Epi-data software version 3.5.1 and exported to SPSS version 25.0 for analysis. A multivariable logistic regression model was fitted to identify factors associated with medication regimen switch. The level of significance of the study was kept at a p-value of 0.05 with a 95% confidence interval.

Result

A total of 414 patients are involved in the study, and 188 (45.5%) of patients switched antipsychotics within one year. The unavailability of the medication is the commonest reason for switching. Being male [AOR = 2.581, 95% CI (1.463, 4.552)], having relapse [AOR = 2.341,95% CI (1.169,4.687)], history of hospitalization in the past year [AOR = 3.00,95% CI (1.478,5.715)] and taking typical antipsychotics [AOR = 3.340, CI (1.76, 6.00)] had a significant association with antipsychotics switching.

Conclusions and recommendations

There is a high prevalence of antipsychotic switches among schizophrenia patients. Prescribers need to be careful while dosing, selecting, and switching antipsychotics, hence may help reduce discontinuation and unnecessary switch and thus achieve optimal clinical management.
Weight change following diagnosis with psychosis: a retrospective cohort study in Greater Manchester, UK
Authors: Heald Adrian , Daly Chris , Warner-Levy John Julian , Williams Richard , Meehan Cheyenne , Livingston Mark , Pillinger Toby , Hussain Lamiece , Firth Joseph
Published: January 2024

Introduction

Weight gain in the months/years after diagnosis/treatment of severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased risk of cardiometabolic diseases. There is limited data on the longer-term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a retrospective study on weight change over the 5 years following an SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on comparing non-affective psychosis (NAP) vs affective psychosis (AP) diagnoses.

Methods

We undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) or affective psychosis (AP). We analysed body mass index (BMI) change in the 5-year period following the first prescription of antipsychotic medication. All individuals had taken an antipsychotic agent for at least 3 months. The 5-year follow-up point was anywhere between 2003 and 2023.

Results

We identified 9125 people with the diagnoses above. NAP (n = 5618; 37.3% female) mean age 49.9 years; AP (n = 4131; 60.5% female) mean age 48.7 years. 27.0% of NAP were of non-White ethnicity vs 17.8% of AP individuals. A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for AP. There were no significant differences in baseline BMI profile. In a subsample with HbA1c data (n = 2103), mean HbA1c was higher in NAP at baseline (40.4 mmol/mol in NAP vs 36.7 mmol/mol for AP). At 5-year follow-up, there was similarity in both the overall % of individuals in the obese ≥ 30 kg/m2 category (39.8% NAP vs 39.7% AP), and % progressing from a normal healthy BMI transitioned to obese/overweight BMI (53.6% of NAP vs 55.6% with AP). 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7% with AP. At 5-year follow-up for NAP, 83.1% of those with BMI ≥ 30 kg/m2 stayed in this category vs 81.5% of AP.

Conclusion

The results of this real-world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, while 43% maintain a healthy weight in the first 5 years following antipsychotic prescription.
Proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis after selective posterior thoracolumbar/lumbar fusion: risk factors and predictive index
Authors: Bai Jinyi , Liu Shu , Liu Chen , Zhao Yingchuan , Li Ming
Published: January 2024

Background

Although several studies have reported that selective posterior thoracolumbar/lumbar (TL/L) fusion can yield satisfactory results in Lenke 5C adolescent idiopathic scoliosis (AIS), the proximal junctional kyphosis (PJK) is still a common complication that occurs after surgery. The purpose of this study is to analyse the risk factors for postoperative proximal junctional kyphosis in Lenke 5C patients who underwent selective posterior TL/L fusion and explore whether PJK can be predicted.

Methods

A total of 83 AIS patients with Lenke 5C curves who met the inclusion criteria were analysed. All patients were divided into two groups based on the occurrence of postoperative PJK. Univariate and multivariate analyses were used to identify independent factors significantly associated with PJK, and an PJK index was proposed and verified.

Results

PJK was observed in 27 of 83 (32.5%) patients in the study. Preoperative thoracic kyphosis (TK) and the immediate postoperative proximal junctional angle (PJA) were the primary factors identified by the binary logistic regression analysis. The PJK index was defined as 1.1× preoperative TK + 2.3× immediate postoperative PJA. The receiver operating characteristics curve indicated that the occurrence rate of PJK was 85% and non-occurrence rate was 82% when the PJK index was greater than 42.

Conclusion

Large preoperative TK and a large immediate postoperative PJA play important roles in the development of PJK in Lenke 5C patients treated with selective posterior thoracolumbar/lumbar fusion. The PJK index can be used to predict the occurrence of PJK with high accuracy. To prevent the occurrence of PJK, we should pay attention to the TLK, and preserving more posterior proximal intervertebral elements at the upper instrumented vertebral level would be an important part of corrective surgery; however, moderate correction of the lumbar curve is recommended.
Development and external validation of a nomogram for predicting postoperative adverse events in elderly patients undergoing lumbar fusion surgery: comparison of three predictive models
Authors: Wang Shuai-Kang , Wang Peng , Li Zhong-En , Li Xiang-Yu , Kong Chao , Lu Shi-Bao
Published: January 2024

Background

The burden of lumbar degenerative diseases (LDD) has increased substantially with the unprecedented aging population. Identifying elderly patients with high risk of postoperative adverse events (AEs) and establishing individualized perioperative management is critical to mitigate added costs and optimize cost-effectiveness to the healthcare system. We aimed to develop a predictive tool for AEs in elderly patients with transforaminal lumbar interbody fusion (TLIF), utilizing multivariate logistic regression, single classification and regression tree (hereafter, “classification tree”), and random forest machine learning algorithms.

Methods

This study was a retrospective review of a prospective Geriatric Lumbar Disease Database (age ≥ 65). Our outcome measure was postoperative AEs, including prolonged hospital stays, postoperative complications, readmission, and reoperation within 90 days. Patients were grouped as either having at least one adverse event (AEs group) or not (No-AEs group). Three models for predicting postoperative AEs were developed using training dataset and internal validation using testing dataset. Finally, online tool was developed to assess its validity in the clinical setting (external validation).

Results

The development set included 1025 patients (mean [SD] age, 72.8 [5.6] years; 632 [61.7%] female), and the external validation set included 175 patients (73.2 [5.9] years; 97 [55.4%] female). The predictive ability of our three models was comparable, with no significant differences in AUC (0.73 vs. 0.72 vs. 0.70, respectively). The logistic regression model had a higher net benefit for clinical intervention than the other models. A nomogram based on logistic regression was developed, and the C-index of external validation for AEs was 0.69 (95% CI 0.65–0.76).

Conclusion

The predictive ability of our three models was comparable. Logistic regression model had a higher net benefit for clinical intervention than the other models. Our nomogram and online tool (https://xuanwumodel.shinyapps.io/Model_for_AEs/) could inform physicians about elderly patients with a high risk of AEs within the 90 days after TLIF surgery.
Dimension independent data sets approximation and applications to classification
Authors: Guidotti Patrick
Published: January 2024

We revisit the classical kernel method of approximation/interpolation theory in a very specific context from the particular point of view of partial differential equations. The goal is to highlight the role of regularization by casting it in terms of actual smoothness of the interpolant obtained by the procedure. The latter will be merely continuous on the data set but smooth otherwise. While the method obtained fits into the category of RKHS methods and hence shares their main features, it explicitly uses smoothness, via a dimension dependent (pseudo-)differential operator, to obtain a flexible and robust interpolant, which can adapt to the shape of the data while quickly transitioning away from it and maintaining continuous dependence on them. The latter means that a perturbation or pollution of the data set, small in size, leads to comparable results in classification applications. The method is applied to both low dimensional examples and a standard high dimensioal benchmark problem (MNIST digit classification).