bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of cervical softening and the prediction of preterm birth (STIPP): protocol for a prospective cohort study
Authors: Breuking Sofie , Oudijk Martijn A , van Eekelen Rik , de Boer Marjon A , Pajkrt Eva , Hermans Frederik
Published: November 2023

Introduction

Preterm birth (PTB) is among the leading causes of perinatal and childhood morbidity and mortality. Therefore, accurate identification of pregnant women at high risk of PTB is key to enable obstetric healthcare professionals to apply interventions that improve perinatal and childhood outcomes. Serial transvaginal cervical length measurement is used to screen asymptomatic pregnant women with a history of PTB and identify those at high risk for a recurrent PTB. Cervical length measurement, fetal fibronectin test or a combination of both can be used to identify women at high risk of PTB presenting with symptoms of threatened PTB. The predictive capacity of these methods can be improved. Cervical softening is a precursor of cervical shortening, effacement and dilatation and could be a new marker to identify women a high risk of PTB. However, the predictive value of cervical softening to predict spontaneous PTB still needs to be determined.

Methods and analysis

This is a single-centre, prospective cohort study, conducted at the Amsterdam University Medical Centers in the Netherlands. Cervical softening will be investigated with a non-invasive CE-marked device called the Pregnolia System. This device has been developed to evaluate consistency of the cervix based on tissue elasticity. Two different cohorts will be investigated. The first cohort includes women with a history of spontaneous PTB <34 weeks. These women undergo biweekly measurements between 14 and 24 weeks of gestation. The second cohort includes women with symptoms of threatened PTB. These women will receive the measurement once at presentation between 24 and 34 weeks of gestation. The primary outcome is spontaneous PTB before 34 weeks for women with a history of PTB and delivery within 7 days for women with threatened PTB. The minimum sample size required to analyse the primary outcome is 227 women in the cohort of women with a history of PTB and 163 women in the cohort of women with symptoms of threatened PTB. Once this number is achieved, the study will be continued to investigate secondary objectives.

Ethics and dissemination

The study is approved by the Medical Ethics Committee of Amsterdam UMC (METC2022.0226). All patients will give oral and written informed consent prior to study entry. Results will be disseminated via a peer-reviewed journal.

Trial registration number

NCT05477381.
Initial prescriptions and medication switches of biological products: an analysis of prescription pathways and determinants in the Swiss healthcare setting
Authors: Wirth Kevin , Boes Stefan , Näpflin Markus , Huber Carola , Blozik Eva
Published: November 2023

Objectives

Biological products have contributed to extraordinary advances in disease treatments over the last decade. However, the cost-saving potential of imitator products, so-called biosimilars, is still under-researched in Switzerland. This study aims to assess biosimilars’ prescriptions at treatment initiation and their determinants, as well as biological therapy switches.

Design

The study included all patients who had at least one biosimilar available on the market at the time when they were prescribed a biological product. We analysed longitudinal data for biosimilar prescriptions in Switzerland using descriptive statistics and logistic regression to quantify the associations with individual, pharmaceutical and provider-related variables.

Setting

The analysis is based on de-identified claims data of patients with mandatory health insurance at Helsana, one of the Swiss health insurance companies with a substantial enrollee base in mandatory health insurance.

Participants

Overall, 18 953 patients receiving at least one biological product between 2016 and 2021 were identified.

Outcome measures

We differentiated between initial prescriptions and follow-up prescriptions. Our regression focused on initial prescriptions due to evidence indicating that patients tend to follow the medication prescribed at therapy initiation.

Results

Although biosimilars’ market share was low (28.6%), the number of prescriptions has increased (from 1016 in 2016 to 6976 in 2021). Few patients with medication switches (n=1492, 8.5%) were detected. Increased relative price difference (difference in the price of available biosimilars relative to price of corresponding reference product) was associated with decreased probability of biosimilar prescriptions, whereas male sex, an increase of available imitator drugs on the market, larger packaging sizes, and prescriptions from specialists or physicians in outpatient settings were associated with increased biosimilar use.

Conclusion

The low number of biosimilar prescriptions, despite the proliferating biosimilar market, indicates a high potential for biosimilar diffusion. The findings indicate that patients typically adhere to the therapy options initially chosen and are less inclined to make changes following the initiation of treatment. Our research highlights the need for awareness initiatives to improve understanding among patients and physicians, enabling informed, shared decision-making about biosimilar prescriptions.
Exploring the challenges of public health nurses in the management of infertility in Northern Ghana: a qualitative descriptive study
Authors: Kuug Anthony Kolsabilik , Sindiwe James , Jardien-Baboo Sihaam
Published: November 2023

Objective

To explore the challenges public health nurses (PNHs) face in managing infertility in rural settings of the Talensi and Nabdam districts in the Upper East Region of Ghana.

Design

The study adopted a qualitative descriptive design approach where PHNs who worked in rural settings were interviewed using a semistructured interview guide. Thematic analysis was employed to analyse the data.

Setting

Primary healthcare setting in the Upper East Region of Ghana.

Participants

The study participants were 15 PHNs working in primary health centres with a mean age of 36.9 years (SD=6.40).

Results

This study revealed that couples with infertility issues face challenges in seeking care for their condition. The challenges expressed by the participants that affect individual and couples’ access to infertility care were (1) lack of material and human resources, (2) lack of specialists and guides for infertility treatment and (3) inadequate and inconsiderate communication.

Conclusion

This study provides evidence of the challenges experienced by PHNs in managing infertility among couples. Adequate measures are therefore required to ameliorate these challenges to improve care provision for couples with infertility.
Effect of music on preoperative anxiety using the Hamilton State-Trait Anxiety Inventory (STAI) in patients undergoing cataract surgery in the University of Nigeria Teaching Hospital, Ituku Ozalla
Authors: Ezepue Chukwubuike Obiora , Anyatonwu Obinna Princewill , Duru Christian Chukwuka , Odini Franklin , Onoh Chidimma , Nwachukwu Nwamaka , Oguonu Chukwunonso Afam
Published: November 2023

Introduction

To determine the effectiveness of music in allaying preoperative anxiety in patients scheduled for and undergoing surgery for age-related cataract.

Methods

This is a randomised interventional study of individuals aged 50 years and above who were scheduled for and undergoing cataract surgery under regional anaesthesia, with music (test group) randomly matched with similar individuals undergoing the same procedure but without music (control group). The surgeries were performed at the Ophthalmology Theatre of the University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria. Using a systematic random sampling method, a total of 98 patients were selected into two groups. Both groups completed the State-Trait Anxiety Inventory (STAI) Questionnaire at baseline, immediately on entrance into the preoperative room and 5 min after intervention. The first group listened to music while the second group did not listen to music. Results were analysed using the SPSS V.20 and analysis of variance was used to compare means of variables measured at baseline, preoperative before intervention and preoperative after intervention. Categorical variables were compared using the χ2test. Student’s t-test was used to analyse the continuous variables.

Results

There was an increase in the anxiety scores in the two groups on entrance into the preoperative room, however, 5 min into intervention, there was a significant decrease in the anxiety scores in the music group and a progressive increase in the anxiety scores in the group without music.

Conclusion

Music has a positive effect on preoperative anxiety evidenced by the indirect effect of music on the STAI anxiety scores.
Use of a media campaign to improve access to contraception in Nigeria amid the COVID-19 pandemic: a cross-sectional survey
Authors: Adeoye Oluwatosin , Odeh Roselyn , Nwala Anthony , Edet Fidelis , Raji Mopelola , Ahmadu Hasiya , Songo Raymond , Balogun Fausiat , Idogho Omokhudu , Anyanti Jennifer
Published: November 2023

Introduction

The total lockdown used to curtail COVID-19 infection in Nigeria disrupted access to contraception. Society for Family Health facilitated access to sexual reproductive healthcare information through an Omni-media campaign during the COVID-19 lockdown. The effect of this campaign was subsequently assessed.

Methods

The cross-sectional survey was done among 3200 respondents, 15–49 years old from Lagos, Kano, Oyo and Kaduna states. Data were analysed using the SPSS V.21. Level of statistical significance was set at p value <0.05.

Results

41% of the respondents were aware of the campaign and 31.8% were directly reached with the messages. Oral contraceptive pills were the most heard-about contraception type (82.9%), and where to get contraception during the lockdown was the most common message (44.2%). Of those reached with the messages, 346 procured at least one form of contraceptive method, and 303 of these persons procured online. Respondents ≤34 years were more likely to procure contraception online compared with the older age groups (OR=3.23, 95% CI 1.01–1.52, p<0.003), unmarried respondents were more likely to procure contraception online compared with the married ones (OR=5.31, 95% CI 1.11–1.32, p<0.001), while respondents residing in the southern part of the country were more likely to procure contraception online compared with those residing in the northern part (OR=23.55, 95% CI 1.18–1.38, p<0.001).

Conclusions

Online channel can be a viable potential avenue for contraceptive access, especially for the unmarried and young people, and the population generally.
Burden, determinants and treatment status of metabolic syndrome among older adults in India: a nationally representative, community-based cross-sectional survey
Authors: Basu Saurav , Thirunavukarasu Arun James , Maheshwari Vansh , Zode Mrunali , Hassan Refaat
Published: November 2023

Introduction

Metabolic syndrome is a significance driver of mortality and morbidity in India, but nationally representative data regarding disease burden and treatment status are lacking. Here, a cross-sectional study was undertaken to establish national and regional estimates of disease burden and explore reasons for lack of treatment of component conditions of metabolic syndrome in Indian older adults (45 years and older).

Methods

A cross-sectional study was undertaken using data from the first wave of the Longitudinal Ageing Study in India (2017–2018). Data for 66 606 individuals aged 45 years and above were analysed. The primary outcome was metabolic syndrome prevalence, defined by the National Cholesterol Education Programme ATP III criteria as an individual having any three of four component conditions: diabetes mellitus (DM), hypertension, abdominal obesity and hypercholesterolaemia. The secondary outcome of this study was treatment status of patients with component conditions.

Results

Metabolic syndrome was found to have an overall weighted prevalence of 4.83% (n=3630, 95% CI 4.24 to 5.51). Females, urban residents, obese individuals and physically inactive people exhibited greater prevalence. The most prevalent component of metabolic syndrome was hypertension followed by abdominal obesity, DM and hypercholesterolaemia. 8.85% metabolic syndrome patient reported no treatment for component conditions, while 17.58% reported only partial treatment. Elderly individuals between 60 and 69 (crude relative risk ratios, cRRR 2.20, 95% CI 1.20 to 4.01) and 80 years and above (cRRR 7.48, 95% CI 1.99 to 28.16), urban residents (cRRR 2.45, 95% CI 1.48 to 4.05), those from richer monthly per capita consumption expenditure quintiles (cRRR 2.55, 95% CI 1.00 to 6.47) and those with additional comorbidities (cRRR 2.17, 95% CI 1.28 to 3.70) were more likely to report comprehensive treatment.

Conclusions

This study highlights a substantial prevalence of metabolic syndrome in older adults in India and reveals remarkable disparities in provision of treatment. Better prevention, earlier detection and improved provision of treatment are urgently required to combat the rising prevalence of metabolic syndrome and reduce the burden of cardiovascular disease in India.
Isolated small airways obstruction predicts future chronic airflow obstruction: a multinational longitudinal study
Authors: Knox-Brown Ben , Potts James , Santofimio Valentina Quintero , Minelli Cosetta , Patel Jaymini , Abass Najlaa Mohammed , Agarwal Dhiraj , Ahmed Rana , Mahesh Padukudru Anand , BS Jayaraj , Denguezli Meriam , Franssen Frits , Gislason Thorarinn , Janson Christer , Juvekar Sanjay K , Koul Parvaiz , Malinovschi Andrei , Nafees Asaad Ahmed , Nielsen Rune , Paraguas Stefanni Nonna M , Buist Sonia , Burney Peter GJ , Amaral Andre F S
Published: November 2023

Background

Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life.

Methods

We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF25–75) if a result was less than the lower limit of normal (<LLN) in the presence of a normal forced expiratory volume in 1 s to FVC ratio (FEV1/FVC). We also used the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) to define small airways obstruction. We defined chronic airflow obstruction as post-bronchodilator FEV1/FVC<LLN. We performed mixed effects regression analyses to model the association between baseline isolated small airways obstruction and chronic airflow obstruction at follow-up. We assessed discriminative and predictive ability by calculating the area under the receiver operating curve (AUC) and Brier score. We replicated our analyses in 26 512 participants of the UK Biobank study.

Results

Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF25-75less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV3/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF25-75was better than the FEV3/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study.

Conclusion

Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.
Skating on thin ice? Mental health and well-being in women’s ice hockey
Authors: Johansson Hanna , Malmborg Julia S , Ekengren Johan , Lind John , Ivarsson Andreas
Published: November 2023

Objectives

First, to map the prevalence of symptoms of positive mental health, anxiety, depression and sleep difficulties, along with the coexistence of these symptoms, among players in the Swedish Women’s Hockey League (SDHL). Second, to investigate relationships between these mental health symptoms and demographic variables (ie, age, injuries, dual careers), social support and psychological flexibility.

Methods

Players from nine teams in SDHL (n=182; mean age 22.3±SD 4.8, range 16–35) participated in this cross-sectional study. An online survey, including validated self-assessment questionnaires, conducted data collection. The questionnaires were distributed just before the play-offs started in the 2022–2023 season. Mental health variables were presented as descriptive statistics, and associations were investigated through multivariate binary logistic regression analyses.

Results

The response rate was 91%. Moderate or severe symptoms were reported among 29.7% for sleep difficulties, 20.9% for anxiety and 18.1% for depression. Nineteen per cent reported comorbidities. Sixty percent reported flourishing mental health. Lower psychological flexibility was associated with lower odds of flourishing mental health and higher odds of symptoms of anxiety, depression and sleep difficulties. Social support was associated with higher odds of flourishing mental health and lower odds of sleep difficulties.

Conclusion

6 of every 10 players reported not reaching the ideal state of mental health (ie, flourishing mental health without mental illness). Mental health symptoms were statistically significantly associated with psychological flexibility and social support, suggesting that these factors will be beneficial to consider when preventing mental illness and promoting mental health in this population.
Response to physical activity of females with multiple sclerosis throughout the menstrual cycle: a protocol for a randomised crossover trial (EMMA Project)
Authors: Rubio-Arias Jacobo Á , Ramos-Campo Domingo J , Romero-Parra Nuria , Andreu-Caravaca Luis , Martínez-Rodríguez Alejandro , Esteban-García Paula , López-Liria Remedios , Molina-Torres Guadalupe , Ventura-Miranda Maria Isabel , Martos-Bonilla Ana , Rando-Martín Alberto , Carrasco-Poyatos Maria , Alacid Fernando , Ferrer-Contreras María del Carmen , Cupeiro Rocio
Published: November 2023

The relationship between multiple sclerosis (MS) and females is a crucial aspect in the development of the disease, with the ovarian hormonal cycle being a sensitive stage, especially in females with relapsing-remitting multiple sclerosis. The objectives of the study are to identify moderating variables that modify satisfaction with physical activity practice throughout the menstrual cycle (MC) in females in or out of their MC, during high-intensity interval training (HIIT) and strength training sessions and to compare the acute effects of different types of physical activity sessions in females with and without MS. This protocol is the methodology used in the EMMA Study, a randomised, single-blind crossover trial study conducted in females with MS who were matched 1:1, based on age, lifestyle factors and country of residence, with females without MS, to analyse the effect of physical activity practice on satisfaction, functionality, fatigue and inflammatory profile through their MC. Participants will visit the facilities approximately 10 times (4 preliminary familiarisation visits and 6 visits to carry out a physical activity session in each phase of the MC) for 3–4 months. A total sample of 30 females (15 females without MS and 15 with MS) is necessary for the study. The evaluation will comprise clinical, nutritional and psychological interviews, including different variables. It is hypothesised during the luteal phase, females with MS are expected to exhibit different acute responses to HIIT and strength training sessions as compared with females without the disease. Before starting the study, all participants will read and sign an informed consent form. Trial registration number: This research protocol is registered with ClinicalTrials.gov to ensure transparency and accessibility of study information (NCT06105463). The university’s ethics committee number for this study is UALBIO2022/048.
Understanding the malignant potential of gastric metaplasia of the oesophagus and its relevance to Barrett’s oesophagus surveillance: individual-level data analysis
Authors: Black Emily L , Ococks Emma , Devonshire Ginny , Ng Alvin Wei Tian , O’Donovan Maria , Malhotra Shalini , Tripathi Monika , Miremadi Ahmad , Freeman Adam , Coles Hannah ,   Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) Consortium, Fitzgerald Rebecca C
Published: November 2023

Objective

Whether gastric metaplasia (GM) of the oesophagus should be considered as Barrett’s oesophagus (BO) is controversial. Given concern intestinal metaplasia (IM) may be missed due to sampling, the UK guidelines include GM as a type of BO. Here, we investigated whether the risk of misdiagnosis and the malignant potential of GM warrant its place in the UK surveillance.

Design

We performed a thorough pathology and endoscopy review to follow clinical outcomes in a novel UK cohort of 244 patients, covering 1854 person years of follow-up. We complemented this with a comparative genomic analysis of 160 GM and IM specimens, focused on early molecular hallmarks of BO and oesophageal adenocarcinoma (OAC).

Results

We found that 58 of 77 short-segment (
<
3 cm) GM (SS-GM) cases (75%) continued to be observed as GM-only across a median of 4.4 years of follow-up. We observed that disease progression in GM-only cases and GM+IM cases (cases with reported GM on some occasions, IM on others) was significantly lower than in the IM-only cases (Kaplan-Meier, p=0.03). Genomic analysis revealed that the mutation burden in GM is significantly lower than in IM (p<0.01). Moreover, GM does not bear the mutational hallmarks of OAC, with an absence of associated signatures and driver gene mutations. Finally, we established that GM found adjacent to OAC is evolutionarily distant from cancer.

Conclusion

SS-GM is a distinct entity from SS-IM and the malignant potential of GM is lower than IM. It is questionable whether SS-GM warrants inclusion in BO surveillance.
In vivo ameliorative effects of vitamin E against hydralazine-induced lupus
Authors: Githaiga Fiona Muthoni , Omwenga George Isanda , Ngugi Mathew Piero
Published: November 2023

Objective

In this study, we investigated the in vivo ameliorative effects of vitamin E in a hydralazine-induced lupus model, which closely resembles SLE in humans. We aim to shed light on its potential as a therapeutic agent for managing SLE.

Methods

Forty BALB/c mice were used in this study. Hydralazine hydrochloride was orally administered in a concentration of 25 mg/kg to the five mice groups once weekly for a period of 5 weeks to induce a lupus-like condition. The untreated group was the normal control group. To confirm the development of lupus, an ANA test was conducted. After the mice tested positive for ANA, drug treatments commenced. The negative control group did not receive any drug treatment. The treatments included prednisolone, methotrexate and vitamin E, all administered at a concentration of 25 mg/kg, with a higher dose of vitamin E (50 mg/kg) also administered.

Results

Notably, on day 35, after drug treatment, we observed that mice that received vitamin E at a dosage of 50 mg/kg (3.01±0.100) had a slight decrease in lymphocyte hydrogen peroxide radicals when compared with the group receiving 25 mg/kg of vitamin E (3.30±0.100) (p<0.05). This finding suggests that the scavenging potential of vitamin E is dose dependent.

Conclusion

This study suggests that vitamin E supplementation, especially at a higher dose (50 mg/kg), holds promise in ameliorating lupus-like conditions. These findings warrant further exploration and may offer a potential avenue for improving the disease status of patients experiencing SLE.
Prevalence of physical health comorbidities and long-term functional outcomes among community-reintegrated veterans following lower limb amputation in Sri Lanka
Authors: Wijekoon Ashan , Gamage Dona D , Jayawardana S
Published: November 2023

Introduction

Lower limb amputation (LLA) poses significant health challenges, including physical health comorbidities (PHCs) and functional limitations. Military veterans, who typically undergo traumatic LLA at a young age, endure these challenges for an extended period. Understanding the extent of these challenges is vital to designing tailored and feasible postamputation care for them. In this study, we evaluated the prevalence of PHCs and long-term functional outcomes among community-reintegrated veterans following LLA in Sri Lanka.

Methods

A comparative cross-sectional study was conducted in five districts in Sri Lanka. Prevalence of PHCs and functional outcomes were compared between community-reintegrated veterans with war-related traumatic LLA and a matched able-bodied cohort. Data on PHCs were collected from participants’ medical records and through a self-administered questionnaire. Timed-Up-and-Go (TUG) and 2 min walk test (2MWT) were used to compare functional outcomes between the groups. Veterans’ functional level was identified using the K-level classification.

Results

Veterans were active prosthetic users who had undergone LLA >10 years ago. Sixty-six (77.6%) veterans reported experiencing phantom limb pain. A significantly higher prevalence of diabetes mellitus (34.2%), hypertension (22.4%), knee osteoarthritis (18.8%), knee pain (20%) and back pain (69.4%) was observed among veterans compared with the able-bodied group (p<0.05). Veterans demonstrated significantly lower levels of functional mobility (2MWT: mean (SD): 113.6 (14.8); increased risk of falling (TUG): mean (SD): 10.6 (1.8)) compared with able-bodied individuals (150.8 (11.9) and 7.2 (0.9), respectively, p<0.001). The majority of the veterans belonged to the K3 functional level (71.8%).

Conclusions

The higher prevalence of PHCs and impaired functional outcomes underscores the multifaceted health challenges faced by veterans with LLA living in low-resource community settings with limited access to rehabilitation. These findings provide insights into the unique rehabilitation needs of individuals with similar backgrounds, informing the design and implementation of tailored rehabilitation interventions.
The association between COVID-19 infection and incident atrial fibrillation: results from a retrospective cohort study using a large US commercial insurance database
Authors: Berman Adam , Iglesias Maximiliano , Khanna Rahul , Beaulieu Tara
Published: November 2023

Background

We sought to examine a 1-year incidence of atrial fibrillation (AF) among patients with SARS-CoV-2 virus (COVID-19) in comparison to those with non-COVID-19 acute upper respiratory infection (AURI).

Methods

Patients with a diagnosis of COVID-19 (in any setting) between April 2020 and June 2021 were identified in Optum Clinformatics. Two comparator cohorts were constructed: an ‘AURI pandemic’ cohort (AURI diagnosis between April 2020 and June 2021) and an ‘AURI prepandemic’ cohort (AURI diagnosis between January 2018 and December 2018). One-year incidence of AF was compared among: COVID-19 versus AURI pandemic cohort; COVID-19 versus AURI prepandemic cohort; and AURI pandemic versus AURI prepandemic cohort. For each comparison, we applied a matching weights technique to balance covariates. Logistic regression was used to compare the odds of incident AF among the matched cohorts.

Results

When comparing the matched COVID-19 (n=102 227) cohort with the AURI pandemic (n=102 101) cohort, higher incidence of AF was observed among the COVID-19 cohort (2.2% vs 1.2%; p<0.001; OR 1.83; 95% CI 1.72 to 1.95). Similar findings were observed for the COVID-19 (n=169 687) versus AURI prepandemic (n=169 486) comparison (2.7% vs 1.6%; p<0.001; OR 1.70; 95% CI 1.63 to 1.78). When comparing the AURI pandemic (n=1 26 392) versus AURI prepandemic (n=1 26 394) cohort, no significant differences in incident AF were observed (1.1% vs 1.2%; p=0.133; OR 0.95, 95% CI 0.90 to 1.01).

Conclusion

Patients diagnosed with COVID-19 were found to be at a higher risk of incident AF as compared with those with AURI. Timely diagnosis and appropriate treatment of AF may potentially mitigate the burden of AF conferred by COVID-19.
Derivation and validation of four patient clusters in Still’s disease, results from GIRRCS AOSD-study group and AIDA Network Still Disease Registry
Authors: Ruscitti Piero , Masedu Francesco , Vitale Antonio , Di Cola Ilenia , Caggiano Valeria , Di Muzio Claudia , Cipriani Paola , Valenti Marco , Berardicurti Onorina , Navarini Luca , Iacono Daniela , Pantano Ilenia , Mauro Daniele , Ciccia Francesco , Rossi Silvia , De Stefano Ludovico , Monti Sara , Bugatti Serena , Montecucco Carlomaurizio , Caso Francesco , Costa Luisa , Prete Marcella , Perosa Federico , Iagnocco Annamaria , Atzeni Fabiola , Guggino Giuliana , Giardini Henrique , Antonelli Isabele Parente de Brito , Almaghlouth Ibrahim A , Asfina Kazi , Direskeneli Haner , Alibaz-Oner Fatma , Sevik Gizem , Tufan Abdurrahman , Sfikakis Petros P , La Torre Francesco , Hinojosa-Azaola Andrea , Martín-Nares Eduardo , Torres-Ruiz Jiram , Ragab Gafaar , Maggio Maria Cristina , Makowska Joanna , Del Giudice Emanuela , Bartoloni Elena , Emmi Giacomo , Govoni Marcello , Lo Gullo Alberto , Lopalco Giuseppe , Simonini Gabriele , Fotis Lampros , Ogunjimi Benson , Tharwat Samar , Frediani Bruno , Maier Armin , Carubbi Francesco , Dagna Lorenzo , Erten Sukran , Gidaro Antonio , Hernández-Rodríguez José , Sfriso Paolo , Fabiani Claudia , Giacomelli Roberto , Cantarini Luca
Published: November 2023

Background

Different patient clusters were preliminarily suggested to dissect the clinical heterogeneity in Still’s disease. Thus, we aimed at deriving and validating disease clusters in a multicentre, observational, prospective study to stratify these patients.

Methods

Patients included in GIRRCS AOSD-study group and AIDA Network Still Disease Registry were assessed if variables for cluster analysis were available (age, systemic score, erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and ferritin). K-means algorithm with Euclidean metric and Elbow plot were used to derive an adequate number of clusters.

Results

K-means clustering assessment provided four clusters based on means standardised according to z-scores on 349 patients. All clusters mainly presented fever, skin rash and joint involvement. Cluster 1 was composed by 115 patients distinguished by lower values of age and characterised by skin rash myalgia, sore throat and splenomegaly. Cluster 2 included 128 patients identified by lower levels of ESR, ferritin and systemic score; multiorgan manifestations were less frequently observed. Cluster 3 comprised 31 patients categorised by higher levels of CRP and ferritin, they were characterised by fever and joint involvement. Cluster 4 contained 75 patients derived by higher values of age and systemic score. Myalgia, sore throat, liver involvement and life-threatening complications, leading to a high mortality rate, were observed in these patients.

Conclusions

Four patient clusters in Still’s disease may be recognised by a multidimensional characterisation (‘Juvenile/Transitional’, ‘Uncomplicated’, ‘Hyperferritinemic’ and ‘Catastrophic’). Of interest, cluster 4 was burdened by an increased rate of life-threatening complications and mortality, suggesting a more severe patient group.
Initiating advance care planning at admission: a brief intervention to increase goals of care discussions in geriatric trauma patients in an urban level I trauma center
Authors: Hwang Franchesca , Son Joohee , Ensor Kelsey , Goulet Nicole , Brown Allison , Victory Jesse , Tyrie Leslie
Published: November 2023

Objectives

The burden of geriatric trauma continues to rise. Older trauma patients experience higher morbidity and mortality and thus benefit from early goals of care (GOC) discussions and advance care planning (ACP). The American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) recommends holding a family meeting within 72 hours of admission when treating geriatric trauma patients. At our level I trauma center, we sought to increase early GOC discussions by implementing a new history and physical (H&P) note template for geriatric trauma patients.

Methods

Patients (aged >65 years) admitted to the trauma surgery service (≥24 hours) were included in the study. The intervention was a change in the H&P note template to include confirmation of code status or previous ACP and identification of a healthcare proxy. Primary outcomes were the rates of recognizing a pre-existing Do-Not-Resuscitate (DNR) status/advanced directives at admission and of documentation of a GOC discussion within 72 hours. Outcomes from a 3-month period (March–May) during the pre-intervention (2021) and post-intervention (2022) periods were compared.

Results

The pre-intervention and post-intervention groups had 107 and 150 patients, respectively. We observed an increase in recognition of pre-existing DNR code status at time of admission from 50% to 95% (p=0.003) and documentation of a GOC discussion within 72 hours from 17% to 83% (p<0.0001). We also observed a trend showing that new DNR orders were placed more frequently in the post-intervention period (9% vs 17%, p=0.098). The in-hospital mortality was not significantly different.

Conclusions

The importance of GOC discussions and ACP documentation for geriatric trauma patients is evident, but its completion can be challenging. Our intervention of a new H&P note template increased GOC discussions, and this implementation may be feasible in other trauma centers to comply with the ACS-TQIP Geriatric Trauma Management Guidelines.

Level of evidence

Level III.
Optimizing resource utilization: palliative care consultations in critically ill pediatric trauma patients
Authors: Goswami Julie , Baxter Jacob , Schiltz Brenda M , Elsbernd Terri A , Arteaga Grace M , Klinkner Denise B
Published: November 2023

Objectives

The American College of Surgeons Trauma Quality Improvement Program (TQIP) and Committee on Trauma released a best practice guideline for palliative care in trauma patients in 2017. Utilization of pediatric palliative care services for pediatric trauma patients has not been studied. We sought to identify patients who received the consultation and develop criteria for patients who would benefit from these resources at our institution.

Methods

The institutional pediatric trauma registry was queried to identify all admissions age 0–17 years old to the pediatric intensive care unit (PICU) or trauma ICU (TICU) from 2014 to 2021. Demographic and clinical features were obtained from the registry. Electronic medical records were reviewed to identify and review consultations to the ComPASS team. A clinical practice guideline (CPG) for palliative care consultations was developed based on the TQIP guideline and applied retrospectively to patients admitted 2014–2021. The CPG was then prospectively applied to patients admitted from March through November 2022.

Results

A total of 399 patients were admitted to the PICU/TICU. There were 30 (7.5%) deaths, 20 (66.7%) within 24 hours of admission. Palliative care consultations were obtained in 21 (5.3%). Of these, 10 (47.6%) patients were infants/toddlers <age 2 years, all had traumatic brain injury, 3 (14.3%) were for suspected child abuse, and many were for “goals of care” or family meetings. When the CPG was applied retrospectively, 109 (27.3%) patients met criteria for consultation. After 8 months of prospective implementation of this CPG, palliative care consultation was obtained in 25% (7 of 28) of pediatric trauma patients admitted to the ICU.

Conclusion

Our results demonstrate underused potential of the palliative care team to impact the hospital course of critically ill pediatric trauma patients. Ongoing studies will analyze the utility of CPG implementation for early involvement of palliative services in critically ill pediatric trauma patients.

Level of Evidence

Level III (retrospective cohort)
Achieving balanced transfusion early in critically bleeding trauma patients: an observational study exploring the effect of attending trauma surgical presence during resuscitation
Authors: Gaski Iver Anders , Naess Paal Aksel , Baksaas-Aasen Kjersti , Skaga Nils Oddvar , Gaarder Christine
Published: November 2023

Background

After 15 years of damage control resuscitation (DCR), studies still report high mortality rates for critically bleeding trauma patients. Adherence to massive hemorrhage protocols (MHPs) based on a 1:1:1 ratio of plasma, platelets, and red blood cells (RBCs) as part of DCR has been shown to improve outcomes. We wanted to assess MHP use in the early (6 hours from admission), critical phase of DCR and its impact on mortality. We hypothesized that the presence of an attending trauma surgeon during all MHP activations from 2013 would contribute to improving institutional resuscitation strategies and patient outcomes.

Methods

We conducted a retrospective analysis of all trauma patients receiving ≥10 RBCs within 6 hours of admission and included in the institutional trauma registry between 2009 and 2019. The cohort was divided in period 1 (P1): January 2009–August 2013, and period 2 (P2): September 2013–December 2019 for comparison of outcomes.

Results

A total of 141 patients were included, 81 in P1 and 60 in P2. Baseline characteristics were similar between the groups for Injury Severity Score, lactate, Glasgow Coma Scale, and base deficit. Patients in P2 received more plasma (16 units vs. 12 units; p<0.01), resulting in a more balanced plasma:RBC ratio (1.00 vs. 0.74; p<0.01), and platelets:RBC ratio (1.11 vs. 0.92; p<0.01). All-cause mortality rates decreased from P1 to P2, at 6 hours (22% to 8%; p=0.03), at 24 hours (36% vs 13%; p<0.01), and at 30 days (48% vs 30%, p=0.03), respectively. A stepwise logistic regression model predicted an OR of 0.27 (95% CI 0.08 to 0.93) for dying when admitted in P2.

Conclusions

Achieving balanced transfusion rates at 6 hours, facilitated by the presence of an attending trauma surgeon at all MHP activations, coincided with a reduction in all-cause mortality and hemorrhage-related deaths in massively transfused trauma patients at 6 hours, 24 hours, and 30 days.

Level of evidence

IV.
Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study
Authors: Cai Bin Bin , Wang Dong Pi
Published: November 2023

Objective

Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery.

Methods

In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children’s hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs.

Results

Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery.

Conclusion

Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.
Hexa-algebras and related algebraic structures
Authors: Belhaj Mohamed Mohamed
Published: November 2023

In this paper, we introduce the notion of hexa-algebra. These are associative algebras where the product can be decomposed as the sum of six operations satisfying 21 axioms. We present the quasi-shuffle algebra and the tensor product of a dendriform and a tridendriform algebra as examples of hexa-algebras. We study the relation with ennea algebras and with other algebraic structures and we construct hexa-algebra structures from Rota–Baxter operators.
On Zariski spaces of free acts over semigroups
Authors: Naghipoor Mohammad Ali
Published: November 2023

This study is concerned with the collections of prime and radical subacts of free acts over a semigroup [Formula: see text] The collection of all prime subacts of any free act is topologized with two topologies as generalizations of the notion of the Zariski topology in rings and semigroups. Moreover, the interplay between some algebraic properties and some topological properties of the spectrum of free acts is investigated. In particular, the conditions under which the set of all prime subacts of free acts is a spectral space are studied. Also, it is shown that a certain type of Zariski space of free acts is isomorphic to a lattice of radical subacts.
Jacobi–Jordan-admissible algebras and pre-Jacobi–Jordan algebras
Authors: Baklouti Amir , Benayadi Saïd , Makhlouf Abdenacer , Mansour Saber
Published: November 2023

The main purpose of this paper is to study Jacobi–Jordan-admissible algebras and some particular classes like pre-Jacobi–Jordan algebras. First, we provide characterizations of Jacobi–Jordan algebras by means of oxidation process. Then, we discuss Jacobi–Jordan-admissible algebras for which we obtain a surprising characterization as 3-power anti-associative algebras. Moreover, we introduce a concept of [Formula: see text]-anti-associative algebra, generalizing anti-associative algebras and prove that they are equivalent to Jacobi–Jordan-admissible algebras. Furthermore, we study the structure of pre-Jordan–Jacobi algebras which form a particular class of Jacobi–Jordan-admissible algebras. Moreover, an inductive description by a process of oxidation is provided for an interesting particular class of pre-Jacobi–Jordan algebras, called strong pre-Jacobi–Jordan algebras.
Exploiting Network Structure in Multi-criteria Distributed and Competitive Stationary-resource Searching
Authors: Lin Fandel , Hsieh Hsun-Ping
Published: November 2023

Transportation between satellite cities or inside the city center has always been a crucial factor in contributing to a better quality of life. This article focuses on multi-criteria distributed and competitive route planning for stationary resources in regions where neither real-time nor historical availability of the targeted resource is accessible. We propose an inference-than-planning approach, with an availability inference for stationary resources in areas with no sensor coverage and a distributed routing where no information is shared among agents. We leverage the inferred availability and network structure in the searching space to suggest a two-stage algorithm with three relaxing policies: adjacent cruising, on-orbital annealing, and orbital transitioning. We take two publicly accessible parking-slot datasets from San Francisco and Melbourne for evaluation. Overall results show that the proposed availability inference model can retain decent performance. Furthermore, our proposed routing algorithm maintains the quality of solutions by achieving the Pareto-optimal between searching experience and resource utilization among baseline and state-of-the-art methods under various circumstances.
Improving Automated Program Repair with Domain Adaptation
Authors: Zirak Armin , Hemmati Hadi
Published: November 2023

Automated Program Repair (APR) is defined as the process of fixing a bug/defect in the source code, by an automated tool. APR tools have recently experienced promising results by leveraging state-of-the-art Neural Language Processing (NLP) techniques. APR tools such as TFix and CodeXGLUE that combine text-to-text transformers with software-specific techniques are outperforming alternatives, these days. However, in most APR studies, the train and test sets are chosen from the same set of projects (i.e., when APR fixes a bug in the test set from project A, the model has already seen example fixed bugs from project A in the training set). In the real world, however, APR models are meant to be generalizable to new and different projects. Therefore, there is a potential threat that reported APR models with high effectiveness perform poorly when the characteristics of the new project or its bugs are different than the training set’s (“Domain Shift”).

In this study, we first define the problem of domain shift in automated program repair. Next, we measure the potential damage of domain shift on two recent APR models (TFix and CodeXGLUE). Based on this observation, we then propose a domain adaptation framework that can adapt an APR model for a given target project. We conduct an empirical study with three domain adaptation methods
FullFineTuning
,
TuningWithLightWeightAdapterLayers
, and
CurriculumLearning
and two APR models on 2,672 bugs from 12 projects.

The results show that our proposed framework on average can improve the effectiveness of TFix by 13.05% and CodeXGLUE by 48.78%, in terms of “Exact Match”. Through experiments, we also show that the framework provides high efficiency and reliability (in terms of “Exposure Bias”). Using synthetic data to domain adapt TFix and CodeXGLUE on the projects with no data (Zero-shot learning), also results in an average improvement of 5.76% and 17.62% for TFix and CodeXGLUE, respectively.
Abakus: Accelerating
k
-mer Counting with Storage Technology
Authors: Wu Lingxi , Zhou Minxuan , Xu Weihong , Venkat Ashish , Rosing Tajana , Skadron Kevin
Published: November 2023

This work seeks to leverage Processing-with-storage-technology (PWST) to accelerate a key bioinformatics kernel called
k
-mer counting, which involves processing large files of sequence data on the disk to build a histogram of fixed-size genome sequence substrings and thereby entails prohibitively high I/O overhead. In particular, this work proposes a set of accelerator designs called Abakus that offer varying degrees of tradeoffs in terms of performance, efficiency, and hardware implementation complexity. The key to these designs is a set of domain-specific hardware extensions to accelerate the key operations for
k
-mer counting at various levels of the SSD hierarchy, with the goal of enhancing the limited computing capabilities of conventional SSDs, while exploiting the parallelism of the multi-channel, multi-way SSDs. Our evaluation suggests that Abakus can achieve 8.42×, 6.91×, and 2.32× speedup over the CPU-, GPU-, and near-data processing solutions.