bluuebunny/crossref_metadata_2025 huggingface dataset:
The Difficulties of Making Sport Policy Succeed: A Case Study of Sri Lanka
Authors: Jayawardhana Anupa , Crabtree Ruth , Piggin Joe
Published: September 2023

Although a new Sri Lankan sport policy framework was introduced in 2012, no research has been done to evaluate the implementation of the policy framework. Consequently, the purpose of this study was to evaluate and identify mitigating factors in achieving the strategic goals of the Sri Lankan sport policy framework. Qualitative data and a quantitative approach were used to analyse and investigate the sport policy framework. A questionnaire (N = 240) and interviews (N = 05) were utilised to gather data from sport participants, non-sport participants and top-level sport administrators. Both quantitative and qualitative analyses suggested that the goals of the national sport policy framework have not been achieved. Lack of financial support, deficiency of government provision, institutional structural issues, and negative attitudes of policy actors were identified as mitigating factors in the process of policy implication. Developing an umbrella organisation for coordinating sport and government’s support are vital to resolve those problems.
Workplace stressors & health outcomes: Health policy for the workplace
Authors: Goh Joel , Pfeffer Jeffrey , Zenios Stefanos A.
Published: September 2023

Extensive research focuses on the causes of workplace-induced stress. However, policy efforts to tackle the ever-increasing health costs and poor health outcomes in the United States have largely ignored the health effects of psychosocial workplace stressors such as high job demands, economic insecurity, and long work hours. Using meta-analysis, we summarize 228 studies assessing the effects of ten workplace stressors on four health outcomes. We find that job insecurity increases the odds of reporting poor health by about 50%, high job demands raise the odds of having a physician-diagnosed illness by 35%, and long work hours increase mortality by almost 20%. Therefore, policies designed to reduce health costs and improve health outcomes should account for the health effects of the workplace environment.
Improving Voting Systems’ User-Friendliness, Reliability, & Security
Authors: Byrne Michael D.
Published: September 2023

About half of Americans have limited confidence that their vote will be properly counted. These fears have focused attention on voting system reliability, security, and usability. Over the last decade, substantial research on voting systems has demonstrated that many systems are less usable and secure than they should be. Producing truly reliable voting systems demands more than just following the federal guidelines enacted in 2005 (which, although well intentioned, have failed to substantially improve current systems) or simply updating voting systems to electronic voting computers using monies allocated by the 2002 Help America Vote Act (HAVA). In fact, HAVA has inadvertently led to the purchase of systems that may have actually increased the vote error rate. Key reforms needed to deliver reliable voting systems include substantial testing for usability especially regarding the accurate capture of voter intent and the reduction of voter error rates, and measures to ensure the integrity of elections, such as election officials’ ability to secure ballots.
Behaviorally Informed Policies for Household Financial Decisionmaking
Authors: Madrian Brigitte C. , Hershfield Hal E. , Sussman Abigail B. , Bhargava Saurabh , Burke Jeremy , Huettel Scott A. , Jamison Julian , Johnson Eric J. , Lynch John G. , Meier Stephan , Rick Scott , Shu Suzanne B.
Published: September 2023

Low incomes, limited financial literacy, fraud, and deception are just a few of the many intractable economic and social factors that contribute to the financial difficulties that households face today. Addressing these issues directly is difficult and costly. But poor financial outcomes also result from systematic psychological tendencies, including imperfect optimization, biased judgments and preferences, and susceptibility to influence by the actions and opinions of others. Some of these psychological tendencies and the problems they cause may be countered by policies and interventions that are both low cost and scalable. We detail the ways that these behavioral factors contribute to consumers’ fiancial mistakes and suggest a set of interventions that the federal government, in its dual roles as regulator and employer, could feasibly test or implement to improve household financial outcomes in a variety of domains: retirement, short-term savings, debt management, the take-up of government benefits, and tax optimization.
Reducing the Health Toll from U.S. Workplace Stress
Authors: Goh Joel , Pfeffer Jeffrey , Zenios Stefanos A.
Published: September 2023

Many studies have documented that workplace stress can harm health. But in an open, competitive economy, can these harmful effects realistically be prevented? To find out, we used publicly available data to compare U.S. and European estimates of health care costs and mortality from workplace stress. We found that if the United States had workplace policies that were comparable to those of a European country of similar wealth, it would spend approximately $40 billion less on health care costs related to potentially preventable workplace stress than it spends now. These results suggest that focusing policy interventions on the workplace could help address soaring U.S. health care costs.
Rebuilding Trust between Police & Communities through Procedural Justice & Reconciliation
Authors: O'Brien Thomas C. , Tyler Tom R.
Published: September 2023

In many societies around the world, segments of the public strongly distrust legal and political authorities. Regardless of how the distrust arises, it lessens the possibilities for future social cohesion, democratic governance, and successful economic development—factors that define strong communities. How can authorities build trust amid a legacy of distrust? In this review, the authors focus on relations between the police and communities and draw on two psychological literatures that articulate evidence-informed trust-building strategies. One, the procedural justice approach, concentrates on the fair and respectful exercise of authority during everyday interactions between individuals. The other, reconciliation, involves gestures that are carried out at the community level with the expressed intention of addressing past injustice and that promise changes in an authority's future relations with a community. This review concludes with policy recommendations, drawn from both literatures, describing a process of trust building that involves substantive improvements in procedural justice combined with reconciliatory gestures that signal a sincere intent to increase trust through service to communities.
How Behavioral Science Can Empower Parents to Improve Children's Educational Outcomes
Authors: Bergman Peter
Published: September 2023

Parents powerfully influence their children's educational outcomes. Yet psychological and informational barriers impede parents’ ability to engage with their children in ways that improve outcomes: parents tend to have inflated perceptions of their children's performance, which can deter them from taking helpful steps to effectively support their learning, and parenting is complex. Limited cognitive bandwidth for coping with complexities can steer parents’ attention away from actions that have long-term benefits for their children and toward actions yielding immediate returns. Poor school-to-parent communication and poverty exacerbate all of these problems. In this article, the author demonstrates how providing timely, actionable information to parents can lower these barriers and help parents engage with their children more productively from kindergarten through high school. Moreover, providing this information can improve educational outcomes at low cost.
Inciviiity Awareness Could save Lives
Authors: Li Xilin , Hsee Christopher K. , Wang Li
Published: September 2023

We introduce the idea of deterring undesirable behaviors by raising incivility awareness—sensitivity to when one is violating norms of civil behavior. We demonstrate that this approach is effective in deterring pedestrians from crossing intersections at red lights, which is a serious worldwide safety problem. In three field experiments conducted at urban intersections (involving more than 12,000 total observations), we found that posting signs raising pedestrians’ incivility awareness significantly reduced red-light crossing rates. We also found that the incivility-awareness message of “Crossing at the red light is uncivil” made those signs more effective than signs with messages that emphasized the importance of not crossing at a red light (“Don't cross at the red light”), civil behavior (“Waiting for the green light is civil”), safety (“Waiting for the green light is good for safety”), and danger (“Crossing at the red light is bad for safety”).
Nudge versus sludge in gambling warning labels: How the effectiveness of a consumer protection measure can be undermined
Authors: Newall Philip W. S. , Walasek Lukasz , Ludvig Elliot A. , Rockloff Matthew J.
Published: September 2023

Legal gambling is a large industry in many countries. One way some governments try to protect people from losing more than they can afford is by requiring warning labels on gambling machines and their online equivalents. Prominent labels that make the odds of winning clear serve as nudges: They promote a beneficial behavior (such as deciding that the risk of losing money is too high) without interfering with choice (such as by restricting the availability of gambling). However, if gambling operators use labels that are difficult to understand, find, or read, those messages instead hamper decision-making and thus become sludge. In this article, we report on new research into whether gambling labels in the world's largest regulated online gambling market (the United Kingdom) are more consistent with nudge or sludge. We found that gambling operators overwhelmingly used sludge strategies when posting required gambling warning labels: For instance, they framed the message using a confusing format, applied a small font size to the text, and placed the warning on obscure help screens. We therefore propose that public policy officials throughout the world establish requirements for the wording and presentation of gambling warning labels to ensure that gamblers are well-informed about the odds they face.
Representing the Caste-oppressed: Exploring Rettaimalai Srinivasan’s Anti-caste Endeavours in the Tamil Public Space
Authors: Sivaramane Dhivya
Published: September 2023

In the late nineteenth and early twentieth century colonial India, at a time when the high caste nationalists created a political imagery of Indians, as equals striving for a free India, there arose an anti-caste narrative that brought forth experiences of caste discrimination, throwing light on an Indian socio-polity that was unequal for the caste-oppressed. One such important voice, that emerged despite the marginalising conditions of those times, was that of the lesser-known, yet a powerful one—Rettaimalai Srinivasan (1860–1945) from the colonial Madras province (present Tamil Nadu). His autobiography Jeeviya Charittira Surukkam is a seminal work in describing his role as a political leader and civil rights legislator in representing the demands of the caste- oppressed. By viewing the untouchability/caste question from the political perspective, Srinivasan used the platform of political representation to debate on and frame legislations affecting civil liberties for the caste-oppressed, therein envisioning a Tamil public space that was free of oppressive caste practices. The efforts of Rettaimalai Srinivasan bear testimony to the power of education, law and political representation in bringing forth anti-caste articulations into the public arena, pointing to a scenario where the caste-oppressed leaders were makers of their own history and of how their assertions were crucial in equalising the Tamil public space. In representing the cause of the caste-oppressed, Srinivasan draws attention to their non-caste/casteless culture history and politicises it to demand a humane society for the caste-oppressed. This article is thus an attempt to survey the anti-caste endeavours of Rettaimalai Srinivasan in the colonial Tamil region.
European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention—part 2: flunarizine
Authors: Deligianni Christina I. , Sacco Simona , Ekizoglu Esme , Uluduz Derya , Gil-Gouveia Raquel , MaassenVanDenBrink Antoinette , Ornello Raffaele , Sanchez-del-Rio Margarita , Reuter Uwe , Versijpt Jan , de Vries Tessa , Hussain Muizz , Zeraatkar Dena , Lampl Christian
Published: September 2023

Objective

Novel disease-specific and mechanism-based treatments sharing good evidence of efficacy for migraine have been recently marketed. However, reimbursement by insurers depends on treatment failure with classic anti-migraine drugs. In this systematic review and meta-analysis, we aimed to identify and rate the evidence for efficacy of flunarizine, a repurposed, first- or second-line treatment for migraine prophylaxis.

Methods

A systematic search in MEDLINE, Cochrane CENTRAL, and ClinicalTrials.gov was performed for trials of pharmacological treatment in migraine prophylaxis, following the Preferred Reporting Items for Systematic Reviews (PRISMA). Eligible trials for meta-analysis were randomized, placebo–controlled studies comparing flunarizine with placebo. Outcomes of interest according to the Outcome Set for preventive intervention trials in chronic and episodic migraine (COSMIG) were the proportion of patients reaching a 50% or more reduction in monthly migraine days, the change in monthly migraine days (MMDs), and Adverse Events (AEs) leading to discontinuation.

Results

Five trials were eligible for narrative description and three for data synthesis and analysis. No studies reported the predefined outcomes, but one study assessed the 50% reduction in monthly migraine attacks with flunarizine as compared to placebo showing a benefit from flunarizine with a low or probably low risk of bias. We found that flunarizine may increase the proportion of patients who discontinue due to adverse events compared to placebo (risk difference: 0.02; 95% CI -0.03 to 0.06).

Conclusions

Published flunarizine trials predate the recommended endpoints for evaluating migraine prophylaxis drugs, hence the lack of an adequate assessment for these endpoints. Further, modern-day, large‐scale studies would be valuable in re-evaluating the efficacy of flunarizine for the treatment of migraines, offering additional insights into its potential benefits.
Efficacy and safety of intranasal agents for the acute treatment of migraine: a systematic review and network meta-analysis
Authors: Li Guanglu , Duan Shaojie , Zhu Tiantian , Ren Zhiying , Xia Hui , Wang Ziyao , Liu Lei , Liu Zunjing
Published: September 2023

Background

Intranasal agents may be ideal for the treatment of migraine patients. Many new acute intranasal-specific therapies have been developed, but few of them have been directly compared. The aim of this network meta-analysis (NMA) was to compare the efficacy and safety of various intranasal agents for the treatment of acute migraine in adult patients.

Methods

The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to 15 August 2023. Randomized controlled trials (RCTs) using intranasal agents (no restrictions on dose, formulation, dosing regimen or timing of the first dose) to treat adult patients with acute migraine were included. The primary efficacy endpoint was pain freedom at 2 h, and the primary safety endpoint was adverse events (AEs). The analysis process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Nineteen studies (21 RCTs, 9738 participants) were included. Compared to the placebo, 5 mg of zolmitriptan using a conventional liquid nasal spray device was the most effective for pain freedom at 2 h [odds ratio (OR): 4.67, 95% confidence interval (CI): 3.43 to 6.43] and 24 h (OR: 5.49, 95% CI: 3.58 to 8.42) among all the interventions. Butorphanol nasal spray 1 mg was the most effective (OR: 8.62, 95% CI: 1.11 to 66.92) for pain freedom at 1 h, but with low-quality evidence. DFN-02 presented the highest freedom from nausea (OR: 4.95, 95% CI: 1.29 to 19.01) and phonophobia (OR: 5.36, 95% CI: 1.67 to 17.22) at 2 h, albeit with lower odds of achieving complete pain freedom. ROX-828 showed the highest improvement in freedom from photophobia at 2 h (OR: 4.03, 95% CI: 1.66 to 9.81). Dihydroergotamine nasal spray was significantly associated with the highest risk of AEs (OR: 9.65, 95% CI: 4.39 to 21.22) and was not recommended for routine use. Zavegepant nasal spray demonstrated the lowest risk of AEs (OR: 2.04, 95% CI: 1.37 to 3.03). The results of sensitivity analyses for the primary endpoints (pain freedom at 2 h and AEs) were generally consistent with those of the base case model.

Conclusions

Compared with other new intranasal-specific therapies in treating migraine attacks, zolmitriptan nasal spray 5 mg was the most effective agent for pain freedom at 2 h. Zavegepant nasal spray 10 mg had the fewest adverse side effects.
Genome sequencing-based transcriptomic analysis reveals novel genes in Peucedanum praeruptorum
Authors: Song Cheng , Zhang Yingyu , Zhang Yunpeng , Yi Shanyong , Pan Haoyu , Liao Ranran , Wang Yuanyuan , Han Bangxing
Published: September 2023

Background

Peucedanum praeruptorum Dunn, a traditional Chinese herbal medicine, contains coumarin and volatile oil components that have clinical application value. However, early bolting often occurs in the medicinal materials of Apiaceae plants. The rhizomes of the medicinal parts are gradually lignified after bolting, resulting in a sharp decrease in the content of coumarins. At present, the link between coumarin biosynthesis and early bolting in P. praeruptorum has not been elucidated.

Results

Combining the genome sequencing and the previous transcriptome sequencing results, we reanalyzed the differential transcripts of P. praeruptorum before and after bolting. A total of 62,088 new transcripts were identified, of which 31,500 were unknown transcripts. Functional classification and annotation showed that many genes were involved in the regulation of transcription, defense response, and carbohydrate metabolic processes. The main domains are the pentatricopeptide repeat, protein kinase, RNA recognition motif, leucine-rich repeat, and ankyrin repeat domains, indicating their pivotal roles in protein modification and signal transduction. Gene structure analysis showed that skipped exon (SE) was the most dominant alternative splicing, followed by the alternative 3’ splice site (A3SS) and the alternative 5’ splice site (A5SS). Functional enrichment of differentially expressed genes showed that these differentially expressed genes mainly include transmembrane transporters, channel proteins, DNA-binding proteins, polysaccharide-binding proteins, etc. In addition, genes involved in peroxisome, hexose phosphate pathway, phosphatidylinositol signaling system, and inositol phosphate metabolism pathway were greatly enriched. A protein-protein interaction network analysis discoverd 1,457 pairs of proteins that interact with each other. The expression levels of six UbiA genes, three UGT genes, and four OMT genes were higher during the bolting stage. This observation suggests their potential involvement in the catalytic processes of prenylation, glycosylation, and methylation of coumarins, respectively. A total of 100 peroxidase (PRX) genes were identified being involved in lignin polymerization, but only nine PRX genes were highly expressed at the bolting stage. It is worth noting that 73 autophagy-related genes (ATGs) were first identified from the KEGG pathway-enriched genes. Some ATGs, such as BHQH00009837, BHQH00013830, and novel8944, had higher expression levels after bolting.

Conclusions

Comparative transcriptome analysis and large-scale genome screening provide guidance and new opinions for the identification of bolting-related genes in P. praeruptorum.
Effect of ammonium stress on phosphorus solubilization of a novel marine mangrove microorganism Bacillus aryabhattai NM1-A2 as revealed by integrated omics analysis
Authors: Lu Zhaomei , He Sheng , Kashif Muhammad , Zhang Zufan , Mo Shuming , Su Guijiao , Du Linfang , Jiang Chengjian
Published: September 2023

Background

Phosphorus is one of the essential nutrients for plant growth. Phosphate-solubilizing microorganisms (PSMs) can alleviate available P deficiency and enhance plant growth in an eco-friendly way. Although ammonium toxicity is widespread, there is little understanding about the effect of ammonium stress on phosphorus solubilization (PS) of PSMs.

Results

In this study, seven PSMs were isolated from mangrove sediments. The soluble phosphate concentration in culture supernatant of Bacillus aryabhattai NM1-A2 reached a maximum of 196.96 mg/L at 250 mM (NH4)2SO4. Whole-genome analysis showed that B. aryabhattai NM1-A2 contained various genes related to ammonium transporter (amt), ammonium assimilation (i.e., gdhA, gltB, and gltD), organic acid synthesis (i.e., ackA, fdhD, and idh), and phosphate transport (i.e., pstB and pstS). Transcriptome data showed that the expression levels of amt, gltB, gltD, ackA and idh were downregulated, while gdhA and fdhD were upregulated. The inhibition of ammonium transporter and glutamine synthetase/glutamate synthase (GS/GOGAT) pathway contributed to reducing energy loss. For ammonium assimilation under ammonium stress, accompanied by protons efflux, the glutamate dehydrogenase pathway was the main approach. More 2-oxoglutarate (2-OG) was induced to provide abundant carbon skeletons. The downregulation of formate dehydrogenase and high glycolytic rate resulted in the accumulation of formic acid and acetic acid, which played key roles in PS under ammonium stress.

Conclusions

The accumulation of 2-OG and the inhibition of GS/GOGAT pathway played a key role in ammonium detoxification. The secretion of protons, formic acid and acetic acid was related to PS. Our work provides new insights into the PS mechanism, which will provide theoretical guidance for the application of PSMs.
In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study
Authors: Thietart Sara , Rozes Antoine , Tubach Florence , Marot Stéphane , Marcelin Anne-Geneviève , Raux Mathieu , Vallet Hélène , Riou Bruno , Boddaert Jacques , Zerah Lorène
Published: September 2023

Background

Mortality is high in older patients hospitalized with COVID-19. Previous studies observed lower mortality during the Omicron wave, yet no data is available on older patients. The objective was to compare in-hospital mortality between the Omicron and previous waves in older patients hospitalized with COVID-19.

Methods

This retrospective observational multicenter cohort study used the Greater Paris University Hospitals Group’s data warehouse (38 hospitals). Patients aged ≥ 75 years with a confirmed COVID-19 diagnosis and hospitalized from March 2020 to January 2022 were included. The study period was divided into five waves. The fifth wave (January 1st to 31st 2022) was considered as the Omicron wave as it was the predominant variant (≥ 50%), and was compared with waves 1 (March-July 2020), 2 (August-December 2020), 3 (January-June 2021) and 4 (July-December 2021). Primary outcome was in-hospital mortality. Secondary outcome was occurrence of ICU admission or in-hospital death. Multivariate logistic regression was performed, with a sensitivity analysis according to variant type.

Results

Of the 195,084 patients hospitalized with COVID-19, 19,909 patients aged ≥ 75 years were included (median age 85 [IQR 79–90] years, 53% women). Overall in-hospital mortality was 4,337 (22%), reaching 345 (17%) during wave 5. Waves 1 and 3 were significantly associated with increased in-hospital mortality in comparison with wave 5 (adjusted Odds Ratios aOR 1.42 [95%CI 1.21–1.66] and 1.56 [95%CI 1.33–1.83] respectively). Waves 1 to 3 were associated with an increased risk of occurrence of ICU admission or in-hospital death in comparison with wave 5: aOR 1.29 [95% CI 1.12 to 1.49] for wave 1, aOR 1.25 [95% CI 1.08 to 1.45] for wave 2 and aOR 1.56 [95% CI 1.36 to 1.79] for wave 3. Sensitivity analysis found that Omicron variant was associated with decreased mortality, in comparison with previous variants.

Conclusions

Mortality was lower during the 5th Omicron wave in the older population, but remained high, implying that this variant could be considered as “milder” but not “mild”. This persistently high mortality during the 5th Omicron wave highlights the importance of including older patients in clinical trials to confirm the benefit/risk balance of COVID-19 treatments in this fragile population.
Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study
Authors: Gao Feng , Liu Gang , Ge Yufeng , Tan Zhelun , Chen Yimin , Peng Weidong , Zhang Jing , Zhang Xinyi , He Jiusheng , Wen Liangyuan , Wang Xianhai , Shi Zongxin , Hu Sanbao , Sun Fengpo , Gong Zishun , Sun Mingyao , Tian Maoyi , Zhu Shiwen , Yang Minghui , Wu Xinbao
Published: September 2023

Objective

To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90).

Methods

Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups.

Results

A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90–102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05).

Conclusions

For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.
Early discontinuation of combination antibiotic therapy in severe community-acquired pneumonia: a retrospective cohort study
Authors: Guillot Pauline , Delamaire Flora , Gacouin Arnaud , Painvin Benoit , Piau Caroline , Reizine Florian , Lesouhaitier Mathieu , Tadié Jean-Marc , Maamar Adel
Published: September 2023

Background

Severe community-acquired pneumonia (SCAP) is commonly treated with an empiric combination therapy, including a macrolide, or a quinolone and a β-lactam. However, the risk of Legionella pneumonia may lead to a prolonged combination therapy even after negative urinary antigen tests (UAT).

Methods

We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality.

Results

Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis.

Conclusion

Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia.
Updated beliefs and shaken confidence: evidence from vaccine hesitancy caused by experiencing “COVID arm”
Authors: Fukai Taiyo , Kawata Keisuke , Nakabayashi Masaki
Published: September 2023

Background

Public health depends largely on people’s knowledge, beliefs, or behaviors regarding their health and medical treatments. Although works based on the health belief model have shown that public beliefs about medical treatments affect willingness to take the treatments, little is known about the effects of changes in beliefs on attitudes toward treatment. How one’s past experiences relate to one’s beliefs about a given medical treatment is worth considering.

Methods

We implemented an online panel survey in February 2021 and March 2022 in Japan before and after COVID-19 vaccines were administered to the public within the country. We exploited delayed localized hypersensitivity reactions to COVID-19 vaccines, namely, “COVID arm”, as an exogenous shock to investigate the relationship between past negative experiences and current beliefs about medical treatments or science. “COVID arm” was an unexpected side effect and thus likely caused updated beliefs about the vaccine. Out of the nonprobability sample of 15,000 respondents in the first wave in February 2021, 9,668 respondents also responded to the second wave conducted in March 2022. Outcome variables were whether experiencing “COVID arm” affected the respondents’ 1) confidence in vaccine safety, 2) willingness to take the next dose of COVID-19 vaccines, 3) acknowledgment of the importance of vaccination, and 4) confidence in science. We measured the impact of experience with “COVID arm” on changes in the probability that survey respondents would respond affirmatively to questions posed about the issues listed above.

Results

Experiencing “COVID arm” significantly lowered confidence in the safety of vaccination by 4.3 percentage points, which was approximately 6% of the sample mean for the first wave, and lowered the probability of taking a second dose of the COVID-19 vaccine by 1.5 percentage points. These adverse impacts were observed after conditioning background characteristics and prior confidence in vaccination. Experiencing “COVID arm” affected neither the acknowledged importance of vaccination nor confidence in science in a statistically significant way.

Conclusions

An unexpected and uncomfortable shock regarding beliefs about a treatment decreases willingness to take the treatment. An appropriate public health policy should account for this effect.

Trial registration

The survey was preregistered with the American Economic Association’s RCT Registry (Fukai et al., 2022).
Tracking the geographical origin of Plasmodium falciparum causing a rare severe case of malaria imported into Palestine, a zero-indigenous case area
Authors: Al-Jawabreh Anas , Ereqat Suheir , Al-Jawabreh Amer , Al-Jawabreh Ahmed , Al-Jawabreh Hanan , Nasereddin Abedelmajeed
Published: September 2023

Background

Malaria cases in non-endemic zero-indigenous case areas are most likely to have been imported whatever of the route of importation. In countries recently declared malaria-free and now without local transmission, imported cases remain a threat to re-introduction of the disease and a burden on the health system.

Case presentation

Three days after returning from a long trip to malaria- endemic countries; Abyei-Sudan, Chad and Uganda, a 41-year-old male resident from Jericho, Palestine, suffered paroxysms of fever, general fatigue, myalgia, arthralgia, headache, and a strong desire to vomit. Thin and thick Giemsa-stained blood smears were prepared and examined microscopically using oil immersion. Immature trophozoites (ring forms) were seen to parasitize approximately 10% of the erythrocytes revealing hyperparasitemia equivalent to > 100,000 parasites/ µl indicating severe malaria [1, 2]. The double chromatin configuration (headphones) and accolé (applique) position are both indicative of Plasmodium falciparum infection. The 18S rRNA- PCR targeting the rPLU6-rPLU5 region was used to confirm the diagnosis. The next-generation sequencing (NGS) method was carried out according to the manufacturer’s instructions (Illumina® DNA Prep, (M) Tagmentation kit (20060060), Illumina) to identify Plasmodium spp. Furthermore, NGS produced a whole-genome sequence of 22.8Mbp of the 14 chromosomes and 25Kbp of the apicoplast. A BLAST search of the apicoplast DNA and selected chromosomal DNA revealed that P. falciparum was the causative agent. The merozoite surface protein-1 (msp-1) was used to construct a phylogenetic tree of 26 P. falciparum, including the one isolated from the patient from Jericho, which clustered with the Sudanese isolate indicating genetic relatedness between the two.

Conclusion

The travel history together with signs and symptoms of malaria, followed by prompt diagnosis using conventional microscopic inspection of Giemsa-stained films together with molecular DNA tracking tools like msp-1 were key means in tracking the place of origin of infection in the case of travel to multiple destination.
Retinal functional and structural changes in patients with Parkinson’s disease
Authors: Elanwar Rehab , Al Masry Hatem , Ibrahim Amna , Hussein Mona , Ibrahim Sahar , Masoud Mohammed M.
Published: September 2023

Background

Visual dysfunction have been well reported as one of the non-motor symptoms in Parkinson’s disease (PD). The aim of this study was to evaluate the functional and structural changes in the retina in patients with PD, and to correlate these changes with disease duration and motor dysfunction.

Methods

For this case–control study, we recruited patients fulfilling the diagnostic criteria for idiopathic PD according to British Brain Bank criteria, aged between 50 and 80 years. Age- and sex-matched healthy controls aged between 50 and 80 years were also recruited. Motor function for PD patients was assessed using Modified Hoehn and Yahr staging scale (H & Y staging) and Unified Parkinson’s Disease Rating Scale (UPDRS). Optical Coherence Tomography (OCT) and full field electroretinogram (ff-ERG) were done to all participants.

Results

Data from 50 patients and 50 healthy controls were included in the analysis. Patients with idiopathic Parkinson's had significantly reduced peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell complex (GCC) thickness compared to healthy controls (P-value < 0.05 in all parameters). They also had significantly delayed latency and reduced amplitude in both dark-adapted rods and the light-adapted cone for both a & b waves compared to healthy controls (P-value < 0.001 in all parameters). There were statistically significant negative correlations between disease duration, and left superior, right inferior and right & left average RNFL thickness [(r) coef. = -0.327, -0.301, -0.275, and -0.285 respectively]. UPDRS total score was negatively correlated with the amplitude of light-adapted of both RT and LT a & b wave and with dark-adapted RT b-wave latency [(r) coef. = -0.311, -0.395, -0.362, -0.419, and -0.342].

Conclusion

The retinal structure and function were significantly affected in patients with PD in comparison to healthy controls. There was a significant impact of disease duration on retinal thickness, and there was a significant negative correlation between the degree of motor dysfunction in patients with PD and retinal function.
SIMOA-based analysis of plasma NFL levels in MCI and AD patients: a systematic review and meta-analysis
Authors: Sahrai Hadi , Norouzi Ali , Hamzehzadeh Sina , Majdi Alireza , Kahfi-Ghaneh Rana , Sadigh-Eteghad Saeed
Published: September 2023

Background

The single-molecule array assay (SIMOA)-based detection of neurofilament light (NFL) chain could be useful in diagnosing mild cognitive impairment (MCI) and Alzheimer’s disease (AD). This meta-analysis aimed to evaluate the circulating concentration of NFL in AD and MCI patients compared with healthy controls using the SIMOA technique.

Methods

To this end, Google Scholar, PubMed, Scopus, Web of Science, and the reference lists of relevant articles were systematically searched for studies reporting serum NFL chain levels in healthy controls, MCI, and AD patients. Appropriate statistical methods were employed to achieve the study purpose.

Results

Fifteen eligible studies including 3086 patients were pooled out of a total of 347 publications. Fixed effect model analysis showed that NFL chain level was significantly higher in the serum of patients with MCI (0.361 SMD, 95% CI, 0.286–0.435, p = 0.000, I2 = 49.179) and AD (0.808 SMD, 95% CI, 0.727–0.888, p = 0.000, I2 = 39.433) compared with healthy individuals. The analysis also showed that the NFL chain levels in plasma were significantly different between patients with MCI and AD (0.436 SMD, 95% CI, 0.359–0.513, p = 0.000, I2 = 37.44). The overall heterogeneity of the studies was modest.

Conclusions

This study highlights the potential of serum NFL chain detected using SIMOA in differentiating MCI, AD, and healthy controls.
Association between surgical extent and recurrence in unilateral intermediate- to high-risk papillary thyroid cancer
Authors: Xu Siyuan , Huang Hui , Dong Huilei , Wang Xiaolei , Xu Zhengang , Liu Shaoyan , Liu Jie
Published: September 2023

Background

Guidelines recommend total thyroidectomy (TT) to facilitate radioactive ablation and serological follow-up for intermediate- to high-risk papillary thyroid carcinoma (PTC). However, the association between surgical extent and tumor recurrence in these patients has not been well validated. We aimed to examine the association between the extent of surgery and recurrence in patients with completely resected unilateral intermediate- to high-risk PTC.

Methods

Patients with completely resected unilateral PTC from 2000 to 2017 in a single institute were reviewed. Those who had extrathyroidal extension (ETE) or lymph node metastasis (LNM, cN1 or pN1 > 5 lymph nodes involved) were included for analysis. Cox proportional hazards models were applied to measure the association between surgical extent and recurrence-free survival (RFS) while adjusting for patient demographic, clinicopathological and treatment variables.

Results

A total of 4550 patients (mean[SD] age, 43.0[11.7] years; 3379 women[74.3%]) were included. Of these patients, 2262(49.7%), 656(14.4%), 1032(22.7%), and 600 (13.2%) underwent lobectomy, TT, lobectomy + neck dissection (ND) and TT + ND, respectively. With a median follow-up period of 68 months, after multivariate adjustment, lobectomy was associated with a compromised RFS compared with other surgical extents (HR[95%CI], TT 0.537[0.333–0.866], P = 0.011, lobectomy + ND 0.531[0.392–0.720] P < 0.0001, TT + ND 0.446[0.286–0.697] P < 0.0001). RFS was similar between the two extents with ND (lobectomy + ND, HR [95%CI], 1.196 [0.759–1.885], P = 0.440).

Conclusion

Lobectomy alone is associated with an elevated recurrence risk in patients with unilateral intermediate- to high-risk PTC compared with larger surgical extents. However, lobectomy and ND may provide similar tumor control compared with the conventional approach of TT and ND.
An EMT-related genes signature as a prognostic biomarker for patients with endometrial cancer
Authors: Yu Yonghui , Zhang Yiwen , Li Zhi , Dong Yongshun , Huang Hongmei , Yang Binyao , Zhao Eryong , Chen Yongxiu , Yang Lei , Lu Jiachun , Qiu Fuman
Published: September 2023

Background

The epithelial-mesenchymal transition (EMT) plays an indispensable role in the development and progression of Endometrial cancer (EC). Nevertheless, little evidence is reported to uncover the functionality and application of EMT-related molecules in the prognosis of EC. This study aims to develop novel molecular markers for prognosis prediction in patients with EC.

Methods

RNA sequencing profiles of EC patients obtained from The Cancer Genome Atlas (TCGA) database were used to screen differential expression genes (DEGs) between tumors and normal tissues. The Cox regression model with the LASSO method was utilized to identify survival-related DEGs and to establish a prognostic signature whose performance was evaluated by Kaplan–Meier curve, receiver operating characteristic (ROC) and calibration curve. Eventually, functional enrichment analysis and cellular experiments were performed to reveal the roles of prognosis-related genes in EC progression.

Results

A total of 540 EMT-related DEGs in EC were screened, and subsequently a four-gene risk signature comprising SIRT2, SIX1, CDKN2A and PGR was established to predict overall survival of EC. This risk signature could serve as a meaningfully independent indicator for EC prognosis via multivariate Cox regression (HR = 2.002, 95%CI = 1.433–2.798; P < 0.001). The nomogram integrating the risk signature and clinical characteristics exhibited robust validity and performance at predicting EC overall survival indicated by ROC and calibration curve. Functional enrichment analysis revealed that the EMT-related genes risk signature was associated with extracellular matrix organization, mesenchymal development and cellular component morphogenesis, suggesting its possible relevance to epithelial-mesenchymal transition and cancer progression. Functionally, we demonstrated that the silencing of SIX1, SIRT2 and CDKN2A expression could accelerate the migratory and invasive capacities of tumor cells, whereas the downregulation of PGR dramatically inhibited cancer cells migration and invasion.

Conclusions

Altogether, a novel four-EMT-related genes signature was a potential biomarker for EC prognosis. These findings might help to ameliorate the individualized prognostication and therapeutic treatment of EC patients.
Treatment sequences and prognostic/predictive factors in metastatic pancreatic ductal adenocarcinoma: univariate and multivariate analyses of a real-world study in Europe
Authors: Taieb Julien , Seufferlein Thomas , Reni Michele , Palmer Daniel H. , Bridgewater John A. , Cubillo Antonio , Prager Gerald W. , Vermeire Alice , Hédouin-Biville Fabienne , Teng Zhaoyang , Macarulla Teresa
Published: September 2023

Background

Real-world data on treatment patterns/outcomes for metastatic pancreatic cancer (mPAC) are limited. This study aims to assess real-world treatment patterns, survival outcomes, and prognostic/predictive factors in patients with mPAC.

Methods

Retrospective, observational, chart-review involving medical oncologists and gastroenterologists from five European countries. Physicians reported information on disease and patient characteristics, diagnosis, and treatment for patients diagnosed with mPAC from January-October 2016. Outcomes included median progression-free survival (mPFS), median overall survival (mOS), and the impact of baseline performance status on survival. Univariate/multivariate regression analyses were undertaken to identify prognostic/predictive factors.

Results

Three hundred four physicians and 3432 patients were included. First-line therapies included modified (m)FOLFIRINOX (28.4%), gemcitabine + nab-paclitaxel (28.0%), and gemcitabine monotherapy (23.0%). Frequent second-line therapies were gemcitabine monotherapy (25.0%), fluorouracil (5-FU) + oxaliplatin (21.8%), and gemcitabine + nab-paclitaxel (16.7%). Most frequent first- to second-line treatment sequences were gemcitabine + nab-paclitaxel followed by fluoropyrimidine combinations. Longest unadjusted estimated mOS was observed with (m)FOLFIRINOX followed by gemcitabine-based combinations (19.1 months). Multivariate analysis identified significant prognostic/predictive factors for OS and PFS including performance status and carbohydrate antigen 19–9 (CA 19–9) levels.

Conclusions

Treatment and treatment sequences were generally in accordance with guidelines at the time of the study. Identification of prognostic/predictive factors for survival may help inform the individualised management of mPAC patients in the future.
Factors associated with afebrile presentation and delayed defervescence of bacterial meningitis in children under 3 years of age: a multi-centre retrospective analysis
Authors: He Lin , Li Haijing , Zhang Zhigang , Ge Hejia , Wang Hongwei , Zhu Mengquan , Xu Zhiwei , Zhang Jiening , Fang Sheng , Hu Chuanze , Qian Lijun , Xu Huifang , Yao Yinna , Yuan Shengfu , Zhu Jiajun , Lu Chaosheng , Zheng Jishan , Li Junsheng , Jiang Qi , Xu Huiqing , Chen Lihua , Shang Shiqiang , Chen Yinghu
Published: September 2023

Background

This multi-center study aimed to identify factors affecting fever and delayed defervescence in bacterial meningitis (BM) patients under 3 years of age because of the variability of fever in this patient population.

Methods

Only BM patients under 3 years treated at 49 centers in China from November 2018 to end-April 2021 were included in the study. Univariate and multivariate logistic regression analyses were performed to determine factors associated with afebrile presentation and fever of delayed defervescence.

Results

A total of 863 BM patients under 3 years were included in the study. Coagulase negative staphylococcus was associated with afebrile presentation (OR = 1.176), while septicaemia and ear-nose-throat infections were associated with fever (P < 0.05). The patients with fever were assigned into early and delayed defervescence groups based on defervescence time (less than and more than or equal to one week). Furthermore, Streptococcus agalactiae meningitis (OR = 1.124), concomitant gastrointestinal infection (OR = 1.276), encephalomalacia (or = 1.339), and subdural effusion (OR = 1.454) were independently associated with delayed defervescence (all P < 0.05).

Conclusions

The findings can aid in the efficient utilization of fever in auxiliary diagnosis and evaluating the condition of the disease.