bluuebunny/crossref_metadata_2025 huggingface dataset:
Cross-Validation Methods for Multisource Precipitation Datasets over the Sparse-Gauge Region: Applicability and Uncertainty
Authors: Ding Mingze , Shen Zhehui , Huang Ruochen , Liu Ying , Wu Hao
Published: April 2024

Evaluating the accuracy of various precipitation datasets over ungauged or even sparse-gauge areas is a challenging task. Cross-validation methods can evaluate three or more datasets based on the error independence from input data, without relying on ground observations. Here, the triple collocation (TC) method is employed to evaluate multisource precipitation datasets: China Gauge-based Daily Precipitation Analysis (CGDPA), model-based ERA5, and satellite-derived IMERG-Early, IMERG-Late, GSMaP in near–real time (GSMaP-NRT), and GSMaP moving vector with Kalman filter (GSMaP-MVK) over the Tibetan Plateau (TP). TC-based results show that ERA5 has better performances than satellite-only precipitation products over mountainous regions with complex terrains. For purely satellite-derived products, IMERG products outperform GSMaP products. Considering the potential existence of error dependencies among input datasets, caution should be exercised. Thus, it is necessary to introduce an alternative cross-validation method (generalized three-cornered hat) and explore the applicability of cross validation from the perspective of error independence. We found that cross-validation methods have high applicability in most TP regions with sparse-gauge density (accounting for about 80.1% of the total area). Additionally, we conducted simulation experiments to discuss the applicability and robustness of TC. The simulation results substantiated that cross validation can serve as a robust evaluation method over sparse-gauge regions. Although it is generally known that the cross-validation methods can be served in sparse-gauge regions, the application condition of different evaluation methods for precipitation products is identified quantitatively in TP now.

Significance Statement

Cross validation is a powerful assessment method for multisource precipitation datasets. This method is widely used by hydrologists in sparse-gauge or ungauged regions, like the African continent and the Tibetan Plateau (TP). However, as an indirect assessment method, the inherent uncertainty in cross validation warrants emphasis. Here, two cross-validation methods (the triple collocation method and the generalized three-cornered hat method) are employed to evaluate multisource precipitation datasets: China Gauge-based Daily Precipitation Analysis (CGDPA), model-based ERA5, and satellite-derived IMERG-Early, IMERG-Late, GSMaP in near–real time (GSMaP-NRT), and GSMaP moving vector with Kalman filter (GSMaP-MVK) over the TP. In this study, we not only assessed the current mainstream six precipitation datasets but also analyzed their uncertainties by combining these two cross-validation methods.
Computer Vision-Based Estimation of The Effects of Vibration in Slipform Paving
Authors: Yan Xiangdong , Fascetti Alessandro , Vandenbossche Julie M. , Darnell Megan
Published: April 2024

Slipform paving is a complex multistep process encompassing concrete pouring, vibration, consolidation, correction, and curing. One of the most critical aspects in the process is that the frequency and duration of vibration can influence the distribution of coarse aggregate particles in the cured concrete. However, there is still a fundamental lack of methodologies to formally characterize the interrelationships between vibration characteristics and the quality of the cured pavement. This study aims to address this issue by proposing a novel toolset for the assessment of the spatial features of coarse aggregate distribution in doweled pavements. This system is based on paver consolidation simulations and employs computer vision as the primary tool for analysis. The experimental protocol, recently developed by the authors, employs coarse aggregate particles color-coded by gradation to aid in recognizing the distribution of different granulometric sizes within the specimens. High-resolution, two-dimensional digital images obtained from cured specimens were used to analyze aggregate characteristics, orientation, and dispersion, with particular emphasis on quantifying the effect of the distance from the vibrator head on such parameters. The results showed that the proposed digital imaging processing techniques were capable of quantitatively characterizing the distribution of coarse aggregate particles in the specimens. Moreover, novel metrics were proposed to characterize the quality of the consolidation based on the digital image data.
Effect of Meniscal Tear Patterns and Preoperative Cartilage Status on Joint Space Width After Medial Opening-Wedge High Tibial Osteotomy
Authors: Kim Tae Woo , D’Lima Darryl D. , Moon Nam Hoon , Shin Won Chul , Suh Kuen Tak , Yun Mi Sook , Lee Sang-Min
Published: April 2024

Background:

Medial opening-wedge high tibial osteotomy (MOWHTO) is performed to treat young adults with medial compartment knee osteoarthritis associated with varus deformity. However, factors influencing joint space width (JSW) vary according to the type of medial meniscal tear and have not yet been completely elucidated.

Purpose:

To examine changes in JSW according to the type of medial meniscal tear after MOWHTO and analyze the influencing factors.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study was conducted on 134 patients who underwent MOWHTO for medial osteoarthritis and were followed up for >2 years. The patients were classified into 3 groups based on medial meniscal status: intact, nonroot tear, and root tear. The authors then measured the JSW preoperatively and at 3 months, 6 months, 1 year, and >2 years postoperatively; analyzed whether the change in JSW varied according to meniscal status; and determined the association of these changes with the preoperative cartilage grade of the medial femoral condyle (MFC) and medial tibial plateau (MTP). International Knee Documentation Committee (IKDC) scores were used to evaluate clinical function.

Results:

Of the 134 patients, the medial meniscus was intact in 29 patients, a nonroot tear was observed in 58 patients, and a root tear was observed in 47 patients. Postoperatively, JSW increased for all groups, but the timing of the increase varied between the groups ( P < .001). JSW increased the most 6 months postoperatively in the intact group and 3 months postoperatively in the nonroot tear and root tear groups ( P < .001). Additionally, the increase in JSW was the greatest in the root tear group. Preoperatively, MFC and MTP cartilage status differed among the groups; MTP status did not affect the JSW, but MFC status did ( P < .001). The IKDC score increased from the preoperative to postoperative time point in all groups, but there was no significant difference between groups.

Conclusion:

The authors observed that the amount and timing of increase in JSW were dependent on the pattern of medial meniscal tear observed when MOWHTO was performed. In addition, the cartilage grade of MFC before surgery was associated with changes in JSW. The IKDC score was not significantly different between groups. However, a longer follow-up period is needed to analyze the correlation with the meniscal tear pattern and JSW.
Mitigation effect of guide vanes on the vortex-induced vibration of a long-span closed-box girder suspension bridge
Authors: Li Ming , Yang Xiongwei , Zhang Haicheng , Zhang Hao , Zhang Tianyi , Li Mingshui
Published: April 2024

This paper investigates the VIV responses and triggering mechanisms of a closed-box girder by wind tunnel experiments and computational fluid dynamics (CFD) simulations. The effects of handrails, gantry rails, and guide vanes (GVs) on the mitigation of VIV are analyzed. The results show that large-scale vortices shed from handrails and gantry rails result in large heaving VIV responses. The torsional VIV occurs due to the alternate vortex shedding in the wake. A handrail with a higher porosity near the upper deck surface is highly effective in suppressing VIV responses, especially for heaving VIV. Gantry rails installed at the medial position of the lower deck surface can mitigate torsional VIV to a large extent. GVs installed inside the gantry rails can mitigate torsional VIV much more significantly than one installed outside. For the girder with high-porosity handrails and GVs installed inside the gantry rails, the large-scale vortices generated by the handrails disappear, and the scale of the vortices induced by the GVs is notably reduced, thereby eliminating the heaving VIVs. Additionally, the vortex scale is reduced in the wake region, while the distance between the girder and vortex shedding increases. This effect significantly reduces torsional VIVs.
Vibration response of in-vacuo tuneable structured fabrics
Authors: Rustighi Emiliano , Gardonio Paolo , Baldini Sofia , Malacarne Ciro , Perini Matteo
Published: April 2024

This paper presents a first survey on the vibration response of beam-like specimens formed by a vacuum plastic bag with single-layer or double-layer 3D-printed structured fabrics encompassing spherical-octahedra, octahedra and cubes truss-like rigid elements. The study reports a comprehensive analysis of the bending stiffness and energy dissipation properties with respect to the level of vacuum as well as the type and number (single or double) of overlapped fabrics. In this context, it first presents a quasi-static analysis of the bending stiffness and energy dissipation of the specimens. Then, it provides a comprehensive overview of the specimens dynamic properties with respect to measurements of the dynamic stiffness frequency response function and with reference to measurements of hysteresis loops at three characteristic frequencies, namely below, at and above the fundamental bending resonance frequency of the beam-like specimens. The study shows that the bending stiffness and thus the fundamental bending resonance frequency of the specimens can be suitably varied by increasing the level of vacuum in the bags. The specimens made with cubic mails show the highest bending stiffness and fundamental resonance frequency. Also, the specimens with double layer mails show much higher bending stiffness and fundamental resonance frequency. The level of vacuum has little effect on the energy loss, which, in general, is characterised by rather low loss factors. This suggests that once the fabric jams, there is little friction between the particles and the principal damping mechanism is offered by the material energy dissipation in the unit particles.
Immediate postoperative keratitis caused by Rhizopus species following standard CXL for keratoconus: A case report and literature review
Authors: Venugopal Anitha , Ravindran Meenakshi
Published: April 2024

Purpose

To report the first case of Rhizopus sp keratitis in a 15-year-old male patient who had undergone a conventional Epi-off CXL procedure for progressive keratoconus.

Methods

A 15-year-old male studying at school presented with defective vision in both eyes recently. He was diagnosed with progressive keratoconus in the right eye more than left eye. After the conventional CXL procedure, the patient developed corneal ulcer on third postoperative day.

Results

The microbiological diagnosis of both BCL and ulcer revealed Rhizopus sp. The patient responded to topical antifungals, and the ulcer entirely healed with a large central scar.

Conclusion

Rhizopus keratitis is rare in a healthy individual. Ours is the first case report of Rhizopus keratitis in patient undergone CXL.
“A perfect storm”: Autistic experiences of menopause and midlife
Authors: Brady Miranda J , Jenkins Christine A , Gamble-Turner Julie M , Moseley Rachel L , Janse van Rensburg Margaret , Matthews Rose J
Published: April 2024

Previous research indicates that menopause can be an extremely difficult transition for some autistic people. This study asks how autistic people experience menopause and how they can better access services, support and information; autistic Community Research Associates played an important role in each stage of the research. Online focus groups and interviews were conducted with 24 autistic participants who lived in Canada ( n = 13) or the United Kingdom ( n = 11) and had experience with the menopausal transition. Transcripts were coded and analysed by four team members using reflexive thematic analysis. Four themes and eight subthemes were identified: (1) Complexity, multiplicity and intensity of symptoms (0 subthemes); (2) Life experience and adversity converging at midlife (three subthemes); (3) The importance of knowledge and connection (two subthemes); and (4) Barriers to support and care (three subthemes). Limitations include a potential sample bias towards difficult experiences of menopause. The majority of our sample had a late diagnosis or discovery of autism, and their experiences might not generalize to wider autistic populations. This research may help autistic people prepare for menopause and recognize symptoms earlier. Hearing about the experiences of others may let autistic people who struggle with menopause know they are not alone.

Lay abstract

Previous studies report that menopause can be a very difficult transition for some autistic people. This study focuses on how autistic people experience menopause and what support and information might help them. Autistic Community Research Associates played an important role in the research and co-authored this article. We held four focus groups and eight interviews online with 24 autistic participants who lived in either Canada ( n = 13) or the United Kingdom ( n = 11). We analysed participant conversations using a method called reflexive thematic analysis. Participants described many intense challenges during menopause. Four themes and eight subthemes were identified across participant groups: (1) Complexity, multiplicity and intensity of symptoms (0 subthemes); (2) Life experience and adversity converging at midlife (three subthemes); (3) The importance of knowledge and connection (two subthemes); and (4) Barriers to support and care (three subthemes). The experiences of our participants may not be the same as other autistic people, and the study could have been more inclusive of diverse autistic groups. However, hearing about the experiences of others may provide reassurance to autistic people who struggle with menopause and let them know they are not alone.
Identification of damaged member in a truss structure using acoustic emission technique aided by SVM
Authors: Roy Parikshit , Bhanu Kiran Gudipati , Saha Neetika , Topdar Pijush
Published: April 2024

Structures are prone to damage, and detecting them at their very initiation is extremely important for taking corrective measures. Truss is a very important civil engineering structure having a complex geometry: width and thickness being very small compared to the length of a member and the presence of discontinuities in the form of joints. Most of the existing techniques identify damages after they have grown to a substantial degree. For early detection of damages, the acoustic emission (AE) technique may be used effectively as the initiation of damage itself results in the emission of AE wave, analysis of which may lead to detection of the damage. Additionally, signature behavior of the virgin structure is not necessary, unlike many other nondestructive testing methods. Existing studies largely use the time of arrival (TOA) of AE wave at the sensor location(s) in the formulation for damage localization. However, TOA is significantly affected by reflected waves from the edges of truss members and attenuation of signal strength during its passage through joints. In addition, TOA suffers from a lack of objectivity in prescribing the relevant threshold value. Accordingly, damage localization may be affected. In this context, a machine learning approach is very promising if appropriate signal features are used for training. Accordingly, in the present study, an effort is made to develop a support vector machine model for the localization of a truss member, where damage has been initiated. The model is trained and then tested using different sets of experimental data, collected from a laboratory-scale truss. The results of the localization, as predicted by the model, are found to be encouraging when compared with the physical observation.
Perception of Farmers as Investors Towards Various Investment Avenues: An Empirical Analysis
Authors: Kapoor Samridhi , H Shushma
Published: April 2024

Farmers are among the many small investors in India who may save money and invest in various avenues. It is yet to be determined how farmers and ‘the agrarians’ in India perceive different investment opportunities. The present study fills this gap in the investment avenues literature. Surveys and interviews were used to gather primary data, and secondary data sources comprised of journal papers, books and articles. The reliability of the scale and the internal consistency of the variables were evaluated using Cronbach’s alpha. The study employed one-way analysis of variance and rank correlation to assess its goals. The findings of the study show that significant deciding variables for choosing an investment include money, safety, time, trust and risk preferences. The results also highlighted the fact that older, higher-earning farmers and agrarians prefer investing only in bank deposits and postal savings accounts for reasons of safety and security. The findings of the study will help develop an investing tool that meets the needs of the national economy, financial institutions, the government and certain groups like farmers and agrarians while also being appropriate for them.
The Impact of COVID-19 Pandemic on E-commerce: Primary Evidence from India
Authors: M Hazir Ali , Dogga Satyanarayana Murthy , Dinesh Sharma Ajay , Kuruva Mahendra Babu
Published: April 2024

This study aims to examine the impact of the COVID-19 pandemic on the e-commerce market in India. The pandemic had a detrimental effect on India’s economic growth, with trade and commerce being one of the worst affected segments of the economy. While the COVID-19-induced lockdown across the country severely affected significant retail chains and micro-retailers, it also created a boom in the e-commerce market. In this context, a survey was conducted across India to study the impact of COVID-19 on e-commerce in India using primary data. The results after data analysis clearly suggested that the post-pandemic period witnessed a significant rise in all spheres of the e-commerce market, and public familiarity with this concept also increased, which eventually resulted in an increase in both demand for and revenue from e-commerce.
Exploring Innovation and Public Health Priorities Within the Realm of Medical Sociology of India During COVID-19 Pandemic
Authors: Parekh Pratham
Published: April 2024

In the context of the ongoing COVID-19 pandemic, the Indian medical innovation ecosystem confronted substantial challenges in meeting the pressing healthcare requirements of the nation. These challenges demand a comprehensive examination to discern the critical issues in Indian Medical Sociology about medical innovations. The primary objective of this study is to assess the intricate interplay between the approaches employed in drug and vaccine development and their consequential effects on affordability and accessibility. Concurrently, it aims to evaluate the efficacy of the existing policy measures affecting social divisions that have emerged because the supply-driven health system has exacerbated. A qualitative research methodology has been adopted for this inquiry, utilising thematic analysis to dissect the intricacies of the Indian medical innovation ecosystem. The study unfurls the following noteworthy discoveries that contribute to a nuanced understanding of the landscape: (a) it becomes evident that the predominant focus within the Indian medical innovation ecosystem revolves around creating affordable medical technologies and pharmaceuticals, often overshadowing the pursuit of cutting-edge advancements. (b) The strategies employed in developing drugs and vaccines exhibit a conspicuous inclination towards products that promise higher profits, subsequently giving rise to issues associated with affordability and accessibility. (c) While policy measures have been implemented with the intent of addressing the concern of affordability, their actual efficacy in ensuring equitable access to medical innovations raises significant doubts. (d) A discernible imbalance emerges between India's industrial and public health priorities, with economic growth overshadowing the imperative of bridging the existing social disparities. These insights collectively underline the imperative for strategic policy interventions, a more balanced approach to development, and establishing a multi-institutional framework. These actions are essential to confront the challenges related to affordability, accessibility and the aggravated social divisions that persist within the ecosystem. The study brings out the indispensable importance of cultivating a socially responsible and all-encompassing medical innovation ecosystem, not only as a means to address the prevailing healthcare challenges but also to foster an environment that guarantees equitable access to transformative medical innovations for all segments of society.
Decision theoretical foundations of clinical practice guidelines: an extension of the ASH thrombophilia guidelines
Authors: Djulbegovic Benjamin , Hozo Iztok , Guyatt Gordon
Published: April 2024

Decision analysis can play an essential role in informing practice guidelines. The American Society of Hematology (ASH) thrombophilia guidelines have made a significant step forward in demonstrating how decision modeling integrated within Grading of Recommendations Assessment, Developing, and Evaluation (GRADE) methodology can advance the field of guideline development. Although the ASH model was transparent and understandable, it does, however, suffer from certain limitations that may have generated potentially wrong recommendations. That is, the panel considered 2 models separately: after 3 to 6 months of index venous thromboembolism (VTE), the panel compared thrombophilia testing (A) vs discontinuing anticoagulants (B) and testing (A) vs recommending indefinite anticoagulation to all patients (C), instead of considering all relevant options simultaneously (A vs B vs C). Our study aimed to avoid what we refer to as the omitted choice bias by integrating 2 ASH models into a single unifying threshold decision model. We analyzed 6 ASH panel's recommendations related to the testing for thrombophilia in settings of “provoked” vs “unprovoked” VTE and low vs high bleeding risk (total 12 recommendations). Our model disagreed with the ASH guideline panels’ recommendations in 4 of the 12 recommendations we considered. Considering all 3 options simultaneously, our model provided results that would have produced sounder recommendations for patient care. By revisiting the ASH guidelines methodology, we have not only improved the recommendations for thrombophilia but also provided a method that can be easily applied to other clinical problems and promises to improve the current guidelines’ methodology.
The potentiating effect of intravenous dexamethasone upon preemptive pudendal block analgesia for hypospadias surgery in children managed with Snodgrass technique: a randomized controlled study
Authors: Khalifa Sonia Ben , Slimene Ahmed Ben , Blaiti Hajer , Kaddour Refka , Hassen Amjed Fekih , Pardessus Pierre , Brasher Christopher , Dahmani Souhayl
Published: April 2024

Introduction

Evidence regarding the potentiating effects of intravenous dexamethasone on peripheral regional anesthesia in children is sparse. The objective of the current study was to investigate the potentiating effect of intravenous dexamethasone upon pudendal block during surgical correction of hypospadias using Snodgrass technique.

Methods

The study consisted of a monocentric, randomized controlled, double-blinded study. Patients were randomized to receive either intravenous dexamethasone 0.15 mg.kg− 1 (D group) or a control solution (C group). Both groups received standardized anesthesia including a preemptive pudendal block performed after the induction of anesthesia. The primary outcome was the proportion of patients needing rescue analgesia. Secondary outcomes were other pain outcomes over the first 24 postoperative hours.

Results

Overall, 70 patients were included in the study. Age were 24 [24; 36] and 26 [24; 38] months in the D and C groups, respectively (p = 0.4). Durations of surgery were similar in both groups (60 [30; 60], p = 1). The proportion of patients requiring rescue analgesia was decreased in the D group (23% versus 49%, in D and C groups respectively, p = 0.02). The first administration of rescue analgesia was significantly delayed in the D group. Postoperative pain was improved in the D group between 6 and 24 h after surgery. Opioid requirements and the incidence of vomiting did not significantly differ between groups.

Conclusion

Associating intravenous dexamethasone (0.15 mg.kg− 1) to pudendal block during hypospadias surgery improves pain control over the first postoperative day. Further studies are needed in order to confirm these results.

ClinicalTrials.gov Identifier

NCT03902249.

A. What is already known

dexamethasone has been found to potentiate analgesia obtained with regional anesthesia in children.

B. What this article adds

intravenous dexamethasone was found to improve analgesia with a preemptive pudendal block during hypospadias surgery.

C. Implications for translation

results of this study indicate that intravenous dexamethasone could be used as an adjunct to pudendal block.
The causal relationship between thoracic aortic aneurysm and immune cells: a mendelian randomization study
Authors: Liu Guoli , Pan Sha , Xia Hongli , Li Mincai , Wu Ansen
Published: April 2024

One of the pathogenic causes of thoracic aortic aneurysm (TAA), a dangerous vascular condition that can cause aortic rupture, is autoimmune disorders. Currently, immune cell clustering is becoming more and more refined, and the specific immune cell phenotypes involved are yet unknown. Here, we want to clarify the causal link between TAA risk and 731 immune cell traits. There was a Mendelian randomization analysis (MR). We discovered that the presence of TAA led to an increase in CD45 on CD33− HLA-DR− myeloid cells, an increase in CD45 on natural killer cells, and a decrease in FSC-A on granulocytes after applying FDR correction. Our research also revealed a strong correlation between the incidence of TAA and an increase in immune cells with CD3 on CD39+ CD4+, and CD25 on IgD− CD27− phenotypes. Through genetic techniques, our research has shown the intimate relationship between immune cells and TAA, offering direction for future clinical investigations.
Exploring paramedic perspectives on emergency medical service (EMS) delivery in Alberta: a qualitative study
Authors: Newton Janna , Carpenter Travis , Zwicker Jennifer
Published: April 2024

Purpose

Emergency Medical Services (EMS) in Alberta are facing critical challenges. This qualitative study aims to describe and understand the frontline perspective regarding system level issues and propose provider-informed policy recommendations.

Methods

19 semi-structured one-on- one interviews were conducted with Primary or Advanced Care Paramedics (PCP/ACP) across Alberta. Participants were asked to share their perspectives, experiences and recommendations in relation to EMS response times and the working environment. Interviews were analyzed using thematic analysis to identify themes and subthemes.

Results

Two core themes were identified as areas of concern: poor response times and the EMS working environment, which each influence and impact the other. Within response times, paramedics highlighted specific difficulties with ED offloading, a lack of resources, low-acuity calls, and rural challenges. In terms of the EMS working environment, four subthemes were apparent including attrition, unhealthy culture, organizational barriers and the need for paramedic empowerment. Providers made many recommendations including creating and expanding emergency mobile integrated health (MIH) branches, sharing 811 and 911 responses, and enforcing ED target offload times amongst other suggestions.

Conclusions

While response times are a key and highly visible problem, there are many critical factors like the EMS working environment that degrade patient care and cause concern amongst frontline practitioners. Multifaceted policy changes are to be explored to reduce disfunction within EMS services, enhance the well-being of the workforce and deliver improved patient care. Specific EMS-oriented policies are important for moving forward to reduce transfers to EDs, but the broader health system which is over capacity is causing downstream effects into EMS must be addressed by government and health administrators.
Asking the generalist – evaluation of a General Practice rounding and consult service
Authors: Schmalstieg-Bahr Katharina , MacDonald Sophia , Pohontsch Nadine , Debus Sebastian , Scherer Martin
Published: April 2024

Background

Vascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications.

Methods

The GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz’ qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional “as needed” GP-consult service.

Results

15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes.

Conclusions

A GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults.

Trial registration

Not applicable.
Exploring treatment outcomes in Stage II-III rectal cancer patients undergoing neoadjuvant therapy at a tertiary care center in Pakistan: a comprehensive analysis of pathological outcomes
Authors: Soomro Misbah Younus , Khan Saqib Raza , Muhammad Hafiz , Ahmad Sujjawal , Zehra Nawazish , Ali Insia , Samar Mirza Rameez , Hameed Arif , Moosajee Munira , Rashid Yasmin Abdul
Published: April 2024

Background

Rectal cancer treatment has transformed in recent years, with neoadjuvant treatment (NT) and total neoadjuvant treatment (TNT) aiming to enhance pathological responses. This pioneering study in our country delves into rectal cancer management, offering crucial insights by examining pathological outcomes in patients treated with the NT and TNT approach, shaping the evolving landscape.

Methods

In this retrospective-cohort study spanning January 2017 to December 2022 at a tertiary care hospital in Pakistan, ethical approval was obtained to examine outcomes of two treatments. Patients were divided into TNT (chemoradiation and pre-surgery 5 FU-based chemotherapy) and NT (chemoradiation, surgery, and subsequent 5 FU-based chemotherapy). The primary end-point was response rates—no response, pathological complete response (pCR), near complete response (near CR), and partial response (PR). The Chi-Square Test for Independence assessed the association between treatment response and type (TNT or NT). Data analysis used STATA MP 64; significance was set at p < 0.05 for all two-tailed tests.

Results

We analyzed 77 patients, 60 underwent standard neoadjuvant chemoradiation, and 17 followed the total neoadjuvant approach. Predominantly male, most were > 65 with ECOG 0–1. The TNT group showed higher response rates (76% vs 62%, p = 0.039), with 40.38% achieving pCR. In the overall population, pCR and near-CR were similar (27.2% vs 26%), while PR were 14%. Treatment characteristics correlated significantly with chemotherapy type, concurrent chemoradiation, LVI, PNI, and T, N, M staging (p < 0.05). Median overall survival was not reached, and mean survival was 89.1 months (CI: 95.0 to 83.3). Side effects varied, with notable differences in neuropathy, diarrhea, oral mucositis, and thrombocytopenia between NT and TNT groups.

Conclusion

Our study adds to evidence favoring neoadjuvant approaches in managing rectal cancer in pakistan. Demonstrating a favorable pcr rate, ongoing research with extended follow-up is essential, given the dynamic landscape of rectal cancer treatment for improved patient outcomes.
Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns)
Authors: Baas Melanie A.M. , Stramrood Claire A.I. , Molenaar Jolijn E. , van Baar Petra M. , Vanhommerig Joost W. , van Pampus Maria G.
Published: April 2024

Background

Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support.

Methods

In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5).

Results

The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient.

Conclusions

The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.
Identification and bioinformatics analysis of lncRNAs in serum of patients with ankylosing spondylitis
Authors: Kou Jianqiang , Bie Yongchen , Liu Mingquan , Wang Liqin , Liu Xiangyun , Sun Yuanliang , Zheng Xiujun
Published: April 2024

Objectives

The aim of this study was to explore the long non-coding RNA (lncRNA) expression profiles in serum of patients with ankylosing spondylitis (AS). The role of these lncRNAs in this complex autoimmune situation needs to be evaluated.

Methods

We used high-throughput whole-transcriptome sequencing to generate sequencing data from three patients with AS and three normal controls (NC). Then, we performed bioinformatics analyses to identify the functional and biological processes associated with differentially expressed lncRNAs (DElncRNAs). We confirmed the validity of our RNA-seq data by assessing the expression of eight lncRNAs via quantitative reverse transcription polymerase chain reaction (qRT-PCR) in 20 AS and 20 NC samples. We measured the correlation between the expression levels of lncRNAs and patient clinical index values using the Spearman correlation test.

Results

We identified 72 significantly upregulated and 73 significantly downregulated lncRNAs in AS patients compared to NC. qRT-PCR was performed to validate the expression of selected DElncRNAs; the results demonstrated that the expression levels of MALAT1:24, NBR2:9, lnc-DLK1-35:13, lnc-LARP1-1:1, lnc-AIPL1-1:7, and lnc-SLC12A7-1:16 were consistent with the sequencing analysis results. Enrichment analysis showed that DElncRNAs mainly participated in the immune and inflammatory responses pathways, such as regulation of protein ubiquitination, major histocompatibility complex class I-mediated antigen processing and presentation, MAPkinase activation, and interleukin-17 signaling pathways. In addition, a competing endogenous RNA network was constructed to determine the interaction among the lncRNAs, microRNAs, and mRNAs based on the confirmed lncRNAs (MALAT1:24 and NBR2:9). We further found the expression of MALAT1:24 and NBR2:9 to be positively correlated with disease severity.

Conclusion

Taken together, our study presents a comprehensive overview of lncRNAs in the serum of AS patients, thereby contributing novel perspectives on the underlying pathogenic mechanisms of this condition. In addition, our study predicted MALAT1 has the potential to be deeply involved in the pathogenesis of AS.
A qualitative study of the experiences of interdisciplinary nurses during the COVID-19 outbreak following the announcement of the “Ten new guidelines” in China
Authors: Huang Li-Li , Wang Wei-Fen , Hong Wei-Wen , Huang Xian-Dan , Guan Xian-Hua
Published: April 2024

Background

On December 7, 2022, the Joint Prevention and Control Mechanism of China’s State Council released the “Ten New Guidelines” to optimize the coronavirus disease 2019 (COVID-19) prevention policies further. This signaled a broader shift from “dynamic clearing” to “coexisting with the virus” nationwide.

Objective

This study aims to examine the experiences and perspectives of interdisciplinary nurses during the COVID-19 outbreak in China after the implementation of the “Ten New Guidelines”. The goal is to understand the challenges faced by this unique nursing group and inform organizational support to bolster their well-being and resilience.

Methods

Two tertiary hospitals in southeastern Zhejiang Province were selected, with interdisciplinary nurses chosen as subjects. A constructivist qualitative research approach was employed, using semi-structured face-to-face interviews. Research data were collected through interviews and analyzed using content analysis.

Results

Fifteen interdisciplinary nurses were included in this study. The analysis revealed four main themes and nine sub-themes. The main themes were: (1) ineffective organizational support (inadequate organizational care, poor PPE, excessive workload), (2) physiological distress after contracting COVID-19 (extreme physical fatigue, leakage of urine due to severe coughing), (3) fear of being wrong (fear of being reprimanded in public, psychological anxiety), and (4) family responsibility anxiety (difficulty of loyalty and filial piety, obligations to their children).

Conclusion

We provide new evidence that organizations must proactively address the support, training, and communication needs of staff, particularly interdisciplinary nurses, to supplement epidemic containment. This is also essential in helping mitigate the work-family conflicts such roles can create.
Multilocus pathogenic variants contribute to intrafamilial clinical heterogeneity: a retrospective study of sibling pairs with neurodevelopmental disorders
Authors: Bozkurt-Yozgatli Tugce , Pehlivan Davut , Gibbs Richard A. , Sezerman Ugur , Posey Jennifer E. , Lupski James R. , Coban-Akdemir Zeynep
Published: April 2024

Background

Multilocus pathogenic variants (MPVs) are genetic changes that affect multiple gene loci or regions of the genome, collectively leading to multiple molecular diagnoses. MPVs may also contribute to intrafamilial phenotypic variability between affected individuals within a nuclear family. In this study, we aim to gain further insights into the influence of MPVs on a disease manifestation in individual research subjects and explore the complexities of the human genome within a familial context.

Methods

We conducted a systematic reanalysis of exome sequencing data and runs of homozygosity (ROH) regions of 47 sibling pairs previously diagnosed with various neurodevelopmental disorders (NDD).

Results

We found siblings with MPVs driven by long ROH regions in 8.5% of families (4/47). The patients with MPVs exhibited significantly higher FROH values (p-value = 1.4e-2) and larger total ROH length (p-value = 1.8e-2). Long ROH regions mainly contribute to this pattern; the siblings with MPVs have a larger total size of long ROH regions than their siblings in all families (p-value = 6.9e-3). Whereas the short ROH regions in the siblings with MPVs are lower in total size compared to their sibling pairs with single locus pathogenic variants (p-value = 0.029), and there are no statistically significant differences in medium ROH regions between sibling pairs (p-value = 0.52).

Conclusion

This study sheds light on the significance of considering MPVs in families with affected sibling pairs and the role of ROH as an adjuvant tool in explaining clinical variability within families. Identifying individuals carrying MPVs may have implications for disease management, identification of possible disease risks to different family members, genetic counseling and exploring personalized treatment approaches.
Decreased serpin C1 in extracellular vesicles predicts response to methotrexate treatment in patients with pulmonary sarcoidosis
Authors: Kraaijvanger Raisa , Janssen Bonás Montse , Grutters Jan C. , Paspali Ioanna , Veltkamp Marcel , de Kleijn Dominique P. V. , van Moorsel Coline H. M.
Published: April 2024

Background

Sarcoidosis is a systemic granulomatous disease of unknown etiology primarily affecting the lungs. Treatment is needed when disease symptoms worsen and organ function deteriorates. In pulmonary sarcoidosis, prednisone and methotrexate (MTX) are the most common anti-inflammatory therapies. However, there is large inter-patient variability in response to treatment, and predictive response markers are currently lacking.

Objective

In this study, we investigated the predictive potential of biomarkers in extracellular vesicles (EVs) isolated from biobanked serum of patients with pulmonary sarcoidosis stored prior to start of therapy.

Methods

Protein concentrations of a four-protein test panel of inflammatory proteins were measured in a discovery (n = 16) and replication (n = 129) cohort of patients with sarcoidosis and 47 healthy controls. Response to therapy was defined as an improvement of the absolute score of > 5% forced vital capacity (FVC) and/or > 10% diffusion lung of carbon monoxide (DLCO) after 24 weeks compared to baseline (before treatment).

Results

Serum protein levels differed between EV fractions and serum, and between sarcoidosis cases and controls. Serpin C1 concentrations in the low density lipid particle EV fraction were lower at baseline in the group of patients with a good response to MTX treatment in both the discovery cohort (p = 0.059) and in the replication cohort (p = 0.032). EV Serpin C1 showed to be a significant predictor for response to treatment with MTX (OR 0.4; p = 0.032).

Conclusion

This study shows that proteins isolated from EVs harbor a distinct signal and have potential as new predictive therapy response biomarkers in sarcoidosis.
Factors associated with malaria vaccine uptake in Nsanje district, Malawi
Authors: Simbeye Atusaye J. , Kumwenda Save , Cohee Lauren M. , Omondi Dickens , Masibo Peninah K. , Wao Hesborn , Awandu Shehu S.
Published: April 2024

Background

Malaria remains a significant global health burden affecting millions of people, children under 5 years and pregnant women being most vulnerable. In 2019, the World Health Organization (WHO) endorsed the introduction of RTS,S/AS01 malaria vaccine as Phase IV implementation evaluation in three countries: Malawi, Kenya and Ghana. Acceptability and factors influencing vaccination coverage in implementing areas is relatively unknown. In Malawi, only 60% of children were fully immunized with malaria vaccine in Nsanje district in 2021, which is below 80% WHO target. This study aimed at exploring factors influencing uptake of malaria vaccine and identify approaches to increase vaccination.

Methods

In a cross-sectional study conducted in April–May, 2023, 410 mothers/caregivers with children aged 24–36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine.

Results

Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08–6.51 and OR: 1.89, 95%CI 1.18–3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06–0.25 and OR: 0.30, 95%CI 0.03–0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive.

Conclusion

Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities’ education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa.