bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic Incidence of Knee Osteoarthritis After Isolated ACL Reconstruction Versus Combined ACL and ALL Reconstruction: A Prospective Matched Study from the SANTI Study Group
Authors: Freychet Benjamin , Hopper Graeme , Coulin Bennoit , El Helou Abdo , An Jaesung , Dutra Vieira Thais , Sonnery-Cottet Bertrand , Shatrov Jobe
Published: February 2024

Objectives:

The aim of this study was to evaluate the incidence of OA with isolated ACLR in comparison with ACLR with ALLR at medium-term follow-up. We hypothesized that there would be no differences between the groups.

Methods:

Patients who underwent ACLR 1 ALLR with hamstring tendon autograft between January 2011 and March 2012 were propensity matched to patients who underwent isolated ACLR with bone–patellar tendon–bone (BPTB) or hamstring tendon autograft in the same period. Medium-term radiographic evaluation was performed using the International Knee Documentation Committee (IKDC) radiographic OA grading scale, modified Kellgren-Lawrence grade, and the surface fit method to assess percentage of joint space narrowing. Clinical outcomes were assessed with the following measures: IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and ACL Return to Sport after Injury.

Results:

A total of 80 patients (42 ACLR 1 ALLR and 38 isolated ACLR) were analyzed with a mean follow-up of 104 months. There was no significant difference between groups for joint space narrowing in the medial or lateral tibiofemoral or lateral patellofemoral (PF) compartment. However, 36.8% in the isolated ACLR group versus 11.9% in the ACLR 1 ALLR group had narrowing of the medial PF compartment (P = .0118). A lateral meniscal tear increased the risk of lateral tibiofemoral narrowing by nearly 5 times (odds ratio, 4.9; 95% CI, 1.547-19.367; P = .0123). The risk of medial PF narrowing was .4-fold with an isolated ACLR (odds ratio, 4.8; 95% CI, 1.44-19.05; P = .0179). Between the isolated ACLR group and the ACLR 1 ALLR group, the secondary meniscectomy rate was 13.2% versus 11.9% (not significantly different). There was no difference between groups in KOOS, Tegner, or IKDC scores. There was also no difference between groups for grades of osteoarthritic change for any classification system. Patients who received a BPTB graft had medial PF joint narrowing in 66.7% of cases as compared with 11.9% in those who received ACLR 1 ALLR (P = 0.118).

Conclusions:

ACLR 1 ALLR did not increase the risk of OA in the lateral tibiofemoral compartment when compared with an isolated] ACLR at medium-term follow-up. Isolated ACLR using BPTB was associated with a significantly increased risk of medial PF joint space narrowing.
“Kids Have Taught Me. I Listen to Them”: Principals Legitimizing Student Voice in Their Leadership
Authors: Flores Osly J. , Ahn Joonkil
Published: February 2024

Few studies have shared insights on how principals invite student voice to enact equitable leadership practice. The purpose of this study was to explore the ways in which principals demonstrated their commitment to equity via advocating for student voice using in-depth interview data from six school principals in the United States. We present three findings that contribute to the field of leadership and student voice: (a) motivation for student voice, (b) desires and concerns for student future, and (c) student voice for authentic learning. This study advances how school leaders develop student democratic agency and critical consciousness through pursuing and welcoming student voice.
Perception of aesthetic impairment in patients with systemic sclerosis determined using a semi-quantitative scale and its association with disease characteristics
Authors: Farhat Méryem-Maud , Guerreschi Pierre , Morell-Dubois Sandrine , Deken Valérie , Labreuche Julien , Sanges Sebastien , Sobanski Vincent , Hachulla Eric , Cottencin Olivier , Launay David
Published: February 2024

Background:

Systemic sclerosis is a fibrotic disease. Body image assessments could be key in optimizing care; however, data are scarce. The main objective was to assess the perception of aesthetic impairment using a visual aesthetic evaluation scale in patients with systemic sclerosis compared with healthy subjects. The secondary objectives were to assess associations between the perception of aesthetic impairment and scores on standardized questionnaires for aesthetic impairment as well as clinical, psychological/quality of life, and functional parameters of patients with systemic sclerosis.

Methods:

This study evaluated and compared the perception of aesthetic impairment in two populations: patients with systemic sclerosis from a referral center at Lille Hospital, France, and healthy controls.

Results:

This study included 88 patients (69 (78.4%) women) with a median age of 52 years and 88 controls (49 (55.7%) women) with a median age of 45 years. The perception of aesthetic impairment assessed using the aesthetic evaluation scale was poorer in systemic sclerosis patients than in controls (3.7 ± 0.3 vs 2.8 ± 0.3, p = 0.028) and was statistically correlated with assessments using the adapted satisfaction with appearance, a specific aesthetic impact assessment questionnaire for patients with systemic sclerosis. Patients with anxiety or depressive symptoms had significantly higher aesthetic evaluation scale scores. Systemic sclerosis patients with facial involvement and pitting scars had a worse perception of aesthetic impairment. Compared with healthy controls, systemic sclerosis patients had a worse perception of aesthetic impairment, especially systemic sclerosis patients with anxiety or depression and those with facial and hand involvement.

Conclusion:

The aesthetic evaluation scale appears to be an easy-to-use tool to evaluate body image. Correlations of the aesthetic evaluation scale score with psychological and quality of life parameters reflect the importance of these parameters for body image evaluation and its complex assessment.

Trial registration:

Clinical Trial NCT03271320 (Registered 9 January 2017, https://www.clinicaltrials.gov/ct2/show/NCT03271320?term=NCT03271320&cntry=FR&draw=2&rank=1 ).
Triple diffusive free magneto-convection of electro-conductive nanofluid from a vertical stretching sheet
Authors: Vasu Buddakkagari , Hussain Borbora Mustaque , Bég Osman Anwar , Gorla Rama Subba Reddy , Tripathi Jayati , Burby Matin
Published: February 2024

In the present investigation, an analysis is carried out to study the MHD triple diffusive free thermo-solutal convection boundary layer flow of an electro-conductive nanofluid flow over a vertical stretching sheet. This problem is relevant to magnetic nanomaterials fabrication operations in which multiple species in addition to nanoparticles are present. In addition to the nanoparticle diffusion, two different salts (species) having different properties are considered. A variable magnetic field is applied transverse to the vertical sheet. It is assumed that the surface is in contact with the hot magnetic nanofluid at a temperature which provides a variable heat transfer coefficient. Buongiorno’s model is employed for the nanofluid. It is also assumed that the Oberbeck-Boussinesq approximation is valid and the mixture of nanofluid and salts is homogenous and is in local thermal equilibrium. In addition, the thermal energy equation features cross-diffusion (Soret and Dufour) terms for both components of salts having different concentration. Appropriate similarity transformations are deployed to render the model non-dimensional. The emerging transformed dimensionless non-linear non-dimensional ordinary differential boundary value problem is solved with the robust bvp4c method in MATLAB. Validation with previous studies has been included for special cases of the general model. The simulations show that the addition of nanoparticles and salts, strongly modifies Temperature and nanoparticle and salt 1 and 2 concentrations. With stronger magnetic field the velocity is suppressed as is momentum boundary layer thickness whereas temperatures are boosted.
“Before I came to the hospice, I had nobody”. A qualitative exploration of what patients, family-caregivers, clinicians and volunteers valued most about home, day therapy or inpatient hospice services
Authors: Hughes Nicole Marie , Noyes Jane , Stringer Carys , Pritchard Trystan
Published: February 2024

Background:

Globally, the demand for hospice care continues to grow resulting in substantial resource burden. Whilst some countries are able to rely on fixed government contributions, statutory funding for palliative care in the United Kingdom is unequally distributed. These unstable funding streams and increased demand means that hospices need to evidence their value.

Objective:

This study explored the experiences of patients and family-caregivers to determine what they valued most from accessing hospice services in Wales.

Methods:

In this large multi-site qualitative study, 94 semi-structured interviews and 2 focus groups were conducted with hospice patients ( n = 45), family-caregivers ( n = 18), hospice staff ( n = 31) and volunteers ( n = 10). The audio recordings were transcribed verbatim and analysed using Framework analysis.

Results:

Seven themes described patient and family-caregiver experiences and what they valued most: relationships with staff and volunteers, greater support networks which reduced social isolation and loneliness, provision of information and advice which improved patient autonomy, symptom management and subsequent reduction in psychological distress, improvements in patient functionality, mobility and overall physical health and respite relief which promoted improved relationships.

Conclusion:

This is the largest study to explore what patients and family-caregivers value from hospice care. Findings indicate that hospice care provides a truly needs-led and strengths-based service to those who are nearing and at the end-of-life, which is highly valued by patients and family members.
“It represents her in play” parental and child views on toys that represent disability
Authors: Ali Leanne , Jones Siân E
Published: February 2024

Toys representing disability are now commercially available, yet there has been limited exploration of parental perspectives on these toys. This study explored parents’ and carers’ views of toys that represented disability through a pre-registered online survey of N = 83 parents of children aged between 0 and 14 years old. In a repeated measures design, parents viewed images of commercially available toys. We measured their child’s previous direct contact with a disabled person, their perceived likelihood that their child would enjoy playing with that toy, and parents’ open-ended views on why they thought their child would or would not enjoy that toy. We found that significantly more parents of older disabled children and younger non-disabled children thought their child would choose to play with representative dolls. Open-ended responses indicated that this finding may have occurred because parents of disabled children (vs non-disabled children) valued the representation afforded by the toys. In this way, we show that parents value representation and accessibility particularly when they are a parent of a disabled child themselves. Our study highlights when parents may bring disability-representative toys into the toy box in ways that promote inclusion.
Epidemiology of acute stroke presentations to an emergency ambulance service
Authors: Loudon W. , Bosley E. , Wong A. , Tippett V.
Published: February 2024

Objective

Stroke is a devastating condition with significant societal and personal costs. Attempts to improve outcomes have increasingly focussed on improvements in prehospital care of these patients. This study aims to provide an epidemiologic profile of stroke presentations to an ambulance service.

Methods

A descriptive quantitative analysis of linked administrative and clinical patient data across prehospital, hospital, and death records from a two-year period (2016–2017), was used to profile the acute stroke cohort transported by ambulance in Queensland, Australia. The epidemiologic profile of patients and sub-type of stroke is presented.

Results

There were 17,603 presentations of suspected acute stroke in Queensland during the study period amongst 2,078,140 ambulance responses. A total of 11,578 patients had a confirmed diagnosis of stroke at the time of their final discharge. Of this population 49.8% suffered an Acute Ischaemic Stroke, 12.9% had intracerebral haemorrhage, 4.5% had subarachnoid haemorrhage and 32.8% were transient ischaemic attack. Of those with acute ischaemic stroke (AIS) 9.2% were due to a large vessel occlusion. The three-month stroke related fatality rate was 10%.

Conclusion

This study demonstrated a lower annual presentation rate of stroke, to an emergency ambulance service, than would be expected based on population studies while the overall mortality rate amongst this population was higher. The reasons for these differences warrant further investigation.
Urban Theory by and for Whom? Engaged Research, Authorship and Transformation Beyond the Academy
Authors: Taylor Myfanwy
Published: February 2024

This paper engages with Loretta Lees‘ suggestion that this journal include research collaborators beyond the academy as commentators in its urban dialogues. In it, I highlight the contortions and contradictions involved in extracting individual scholarly outputs from collaborative research, drawing on my experiences as a doctoral researcher in the UK. These challenges are intimately entangled with key questions posed by Loretta about who counts as an urban scholar or theorist, and what urban theor(ies) are – or might be – for. The difficulties involved in publishing engaged and collaborative research in academic formats contribute to its marginalision within critical urban studies, robbing the discipline of the particular understandings and possibilities it can open up. Making space for engaged dialogue beyond the academy within this journal can help to open up the production and circulation of urban knowledge to a greater diversity of perspectives and interests, creating a more hospitable environment for engaged, collaborative and activist research within the academy. Such a shift invites authors to bring their multiple subjectivities and identities into urban dialogues – as modelled by Loretta – challenging conventions designed to separate and elevate academic knowledge from the diverse others it depends upon. Extending urban dialogue to non-academic collaborators can therefore help to connect critical urban research with the communities and interests in whose name it claims to operate.
Inhibition of valve mesenchymal stromal cell calcium deposition by bFGF through alternative polyadenylation regulation of the CAT gene
Authors: Zhang Jiajun , Wu Jun , Gao Yuan , Fan Xingli , Liu Xiaohong , Zhang Guanxin , Tang Yangfeng , Han Lin
Published: February 2024

Objective

Calcific aortic valve disease (CAVD) is the leading cause of angina, heart failure, and death from aortic stenosis. However, the molecular mechanisms of its progression, especially the complex disease-related transcriptional regulatory mechanisms, remain to be further elucidated.

Methods

This study used porcine valvular interstitial cells (PVIC) as a model. We used osteogenic induced medium (OIM) to induce calcium deposition in PVICs to calcify them, followed by basic fibroblast growth factor (bFGF) treatment to inhibit calcium deposition. Transcriptome sequencing was used to study the mRNA expression profile of PVICs and its related transcriptional regulation. We used DaPars to further examine alternative polyadenylation (APA) between different treatment groups.

Results

We successfully induced calcium deposition of PVICs through OIM. Subsequently, mRNA-seq was used to identify differentially expressed mRNAs for three different treatments: control, OIM-induced and OIM-induced bFGF treatment. Global APA events were identified in the OIM and bFGF treatment groups by bioinformatics analysis. Finally, it was discovered and proven that catalase (CAT) is one of the potential targets of bFGF-induced APA regulation.

Conclusion

We described a global APA change in a calcium deposition model related to CAVD. We revealed that transcriptional regulation of the CAT gene may contribute to bFGF-induced calcium deposition inhibition.
Selecting a randomization method for a multi-center clinical trial with stochastic recruitment considerations
Authors: Sverdlov Oleksandr , Ryeznik Yevgen , Anisimov Volodymyr , Kuznetsova Olga M. , Knight Ruth , Carter Kerstine , Drescher Sonja , Zhao Wenle
Published: February 2024

Background

The design of a multi-center randomized controlled trial (RCT) involves multiple considerations, such as the choice of the sample size, the number of centers and their geographic location, the strategy for recruitment of study participants, amongst others. There are plenty of methods to sequentially randomize patients in a multi-center RCT, with or without considering stratification factors. The goal of this paper is to perform a systematic assessment of such randomization methods for a multi-center 1:1 RCT assuming a competitive policy for the patient recruitment process.

Methods

We considered a Poisson-gamma model for the patient recruitment process with a uniform distribution of center activation times. We investigated 16 randomization methods (4 unstratified, 4 region-stratified, 4 center-stratified, 3 dynamic balancing randomization (DBR), and a complete randomization design) to sequentially randomize $$n=500$$

n
=
500

patients. Statistical properties of the recruitment process and the randomization procedures were assessed using Monte Carlo simulations. The operating characteristics included time to complete recruitment, number of centers that recruited a given number of patients, several measures of treatment imbalance and estimation efficiency under a linear model for the response, the expected proportions of correct guesses under two different guessing strategies, and the expected proportion of deterministic assignments in the allocation sequence.

Results

Maximum tolerated imbalance (MTI) randomization methods such as big stick design, Ehrenfest urn design, and block urn design result in a better balance–randomness tradeoff than the conventional permuted block design (PBD) with or without stratification. Unstratified randomization, region-stratified randomization, and center-stratified randomization provide control of imbalance at a chosen level (trial, region, or center) but may fail to achieve balance at the other two levels. By contrast, DBR does a very good job controlling imbalance at all 3 levels while maintaining the randomized nature of treatment allocation. Adding more centers into the study helps accelerate the recruitment process but at the expense of increasing the number of centers that recruit very few (or no) patients—which may increase center-level imbalances for center-stratified and DBR procedures. Increasing the block size or the MTI threshold(s) may help obtain designs with improved randomness–balance tradeoff.

Conclusions

The choice of a randomization method is an important component of planning a multi-center RCT. Dynamic balancing randomization with carefully chosen MTI thresholds could be a very good strategy for trials with the competitive policy for patient recruitment.
Radiographers’ perspectives on interactional processes during older persons diagnostic medical imaging encounters: a qualitative study
Authors: Ding Kevin , Makanjee Chandra
Published: February 2024

Background

Within a diagnostic medical imaging context, an interaction encompasses communication, physical contact and emotional support. These intricacies are an integral part in achieving a successful medical imaging outcome. An increasing ageing population presents unique challenges and leads to a higher demand for medical imaging services. There is a paucity of literature exploring the specialised knowledge and skills required by radiographers to service optimal person-centred care for elderly patients. The purpose of the study was to explore radiographers’ perspectives on interactional processes during older persons diagnostic medical imaging encounters.

Methods

The study used a qualitative exploratory research design with a descriptive approach to gain insights from 12 purposively sampled Australian radiographers, through open-ended interviews conducted online or by telephone. Verbatim transcripts were produced, and a thematic analysis employed until data saturation had been reached.

Results

The three themes that emerged from the data analysis were: (1) optimising care and communication, (2) expectations and preconceptions and (3) physical and emotional comfort and safety. Generally, the approach to undertaking older persons examinations entailed more adaptive and flexible competencies and skills in comparison to the familiarised routine diagnostic medical imaging encounters with the younger cohort. Radiographers shared aspects on striking a balance between efficiency and proficiency with the elderly patient needs, preferences, values, safety and well-being considerations. This required swift, complex decision-making and judgement calls due to the unpredictable nature of the context in which the elderly person was situated. The result was the adaptation of examination protocols through equipment manipulation, with minimal disruptions to emotional and physical comfort, achieved through interventions and support strategies.

Conclusion

The results highlight the many considerations for radiographers during a short clinical interaction. There is optimism in adding value to the elderly persons experience through a complex interactional process. It is anticipated that the identified skills will inform on best practice principles to achieve an elderly person-centred care medical imaging outcome.
Latent class of multidimensional dependency in community-dwelling older adults: evidence from the longitudinal ageing study in India
Authors: Marbaniang Strong P. , Chungkham Holendro Singh
Published: February 2024

Background

Existing studies have used ADL and IADL separately as measures of dependency. However, dependency is a heterogeneous and complex issue, and the dependency of each older adult is a synergistic combination of several functional activities. In this study, we assess the pattern of multidimensional dependency of older adults based on ADL, IADL, visual impairment, difficulty in climbing a flight of stairs, pushing or pulling objects, depressive symptoms, cognitive impairment, marital status, and economic distress. It is important to classify the dependency status of older adults because this will be key to evaluating the needs for care, and plan services that effectively cater for the needs of the older adults. The classification into different latent classes means that older adults within each class have the same needs of dependency but different needs between the latent classes. Our objective is to identify patterns of multidimensional dependency in older adults.

Methods

Data from the Longitudinal Ageing Study in India (LASI) Wave-1, was used, the analytical sample consisted of 32,827 individuals of age 45 years and above. LCA was used to identify the multidimensional dependency class. LCA was conducted in R statistical package, using the poLCA package. The optimal number of classes was selected based on the comparison of model fit statistics. Independent variables were incorporated to explore the association between these variables and the latent class.

Results

Based on nine indicator variables, three latent classes were identified: “Active Older adults”, “Moderately independent” and “Psychological and physically impaired”. The “Active older adults” profile is comprised of older adults who have a very low probability of needing help for any ADL, IADL and other activities. The “Moderately independent” class were characterized as those older adults who were visually impaired but less likely to need help for IADL activities. The “Psychological and physically impaired”, the smallest of all classes, comprised of older adults with poor dependency status.

Conclusions

In this study, we found that the dependency status of older adults which is based on several domains of functional activity has been classified into three distinct classes. These three classes have distinct physical, psychological, economic, and socio-demographic characteristics in terms of activities in which help is required.
PulmoNet: a novel deep learning based pulmonary diseases detection model
Authors: Abdulahi AbdulRahman Tosho , Ogundokun Roseline Oluwaseun , Adenike Ajiboye Raimot , Shah Mohd Asif , Ahmed Yusuf Kola
Published: February 2024

Pulmonary diseases are various pathological conditions that affect respiratory tissues and organs, making the exchange of gas challenging for animals inhaling and exhaling. It varies from gentle and self-limiting such as the common cold and catarrh, to life-threatening ones, such as viral pneumonia (VP), bacterial pneumonia (BP), and tuberculosis, as well as a severe acute respiratory syndrome, such as the coronavirus 2019 (COVID-19). The cost of diagnosis and treatment of pulmonary infections is on the high side, most especially in developing countries, and since radiography images (X-ray and computed tomography (CT) scan images) have proven beneficial in detecting various pulmonary infections, many machine learning (ML) models and image processing procedures have been utilized to identify these infections. The need for timely and accurate detection can be lifesaving, especially during a pandemic. This paper, therefore, suggested a deep convolutional neural network (DCNN) founded image detection model, optimized with image augmentation technique, to detect three (3) different pulmonary diseases (COVID-19, bacterial pneumonia, and viral pneumonia). The dataset containing four (4) different classes (healthy (10,325), COVID-19 (3,749), BP (883), and VP (1,478)) was utilized as training/testing data for the suggested model. The model’s performance indicates high potential in detecting the three (3) classes of pulmonary diseases. The model recorded average detection accuracy of 94%, 95.4%, 99.4%, and 98.30%, and training/detection time of about 60/50 s. This result indicates the proficiency of the suggested approach when likened to the traditional texture descriptors technique of pulmonary disease recognition utilizing X-ray and CT scan images. This study introduces an innovative deep convolutional neural network model to enhance the detection of pulmonary diseases like COVID-19 and pneumonia using radiography. This model, notable for its accuracy and efficiency, promises significant advancements in medical diagnostics, particularly beneficial in developing countries due to its potential to surpass traditional diagnostic methods.
Understanding rapid implementation from discovery to scale: Rwanda’s implementation of rotavirus vaccines and PMTCT in the quest to reduce under-5 mortality
Authors: Sayinzoga Felix , Hirschhorn Lisa R. , Ntawukuriryayo Jovial Thomas , Beyer Caroline , Donahoe Kateri B. , Binagwaho Agnes
Published: February 2024

Background

Over the last eight decades, many evidence-based interventions (EBIs) have been developed to reduce amenable under-5 mortality (U5M). Implementation research can help reduce the lag between discovery and delivery, including as new EBIs emerge, or as existing ones are adapted based on new research. Rwanda was the first low-income African country to implement the rotavirus vaccine (RTV) and also adopted Option B+ for effective prevention of mother-to-child transmission (PMTCT) before the World Health Organization’s (WHO) recommendation. We use implementation research to identify contextual factors and strategies associated with Rwanda’s rapid uptake of these two EBIs developed or adapted during the study period.

Methods

We conducted a mixed methods case study informed by a hybrid implementation research framework to understand how Rwanda outperformed regional and economic peers in reducing U5M, focusing on the implementation of health system-delivered EBIs. The research included review of existing literature and data, and key informant interviews to identify implementation strategies and contextual factors that influenced implementation outcomes. We extracted relevant results from the broader case study and used convergent methods to understand successes and challenges of implementation of RTV, a newly introduced EBI, and PMTCT, an adapted EBI reflecting new research.

Results

We found several cross-cutting strategies that supported the rapid uptake and implementation of PMTCT, RTV, and leveraging facilitating contextual factors and identifying and addressing challenging ones. Key implementation strategies included community and stakeholder involvement and education, leveraging of in-country research capacity to drive adoption and adaptation, coordination of donors and implementing partners, data audit and feedback of coverage, a focus on equity, and integration into pre-existing systems, including community health workers and primary care. The availability of donor funding, culture of evidence-based decision-making, preexisting accountability systems, and rapid adoption of innovation were facilitating contextual factors.

Conclusion

Implementation strategies which are generalizable to other settings were key to success in rapidly achieving high acceptability and coverage of both a new and an evolving EBI. Choosing strategies which leverage their facilitating factors and address barriers are important for other countries working to accelerate uptake of new EBIs and implement needed adaptations based on emerging evidence.
Embedded implementation research in programming at scale – the new normal to be!
Authors: Peterson Stefan Swartling
Published: February 2024

If you want to run faster, don’t just buy a new pair of shoes; also consider your training methods and where you run.

This supplement examines six countries that have run faster than others in reducing under-five mortality, taking an implementation research approach, with country case studies done with local researchers and local institutions. Key generalizable learnings are to choose and adapt implementation strategies to context, design strategies to target the most vulnerable, systematically learn from implementation experience, and to leverage non-health-sector contributions.

Embedding implementation research in programming has the potential to greatly improve and accelerate the contextualization and implementation of evidence-based child survival interventions to improve equity in coverage and overall effectiveness in reducing under-five mortality. It is now time to build such capacity in local institutions at scale, and incentives for concerned stakeholders to make this the new normal. Regional institutions should now take the lead in making this happen, not just in individual institutions and countries, but across entire regions, supported by global partners.

Trial registration N/A.
Using implementation research to understand lessons in reducing child mortality
Authors: Binagwaho Agnes , Hirschhorn Lisa R.
Published: February 2024

Under-5 mortality decreased significantly worldwide between 2000 and 2015, but there is still progress to be made, particularly in lower- and middle-income countries. This supplement shares the work over the last four years on a project to understand how six countries (Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal) were more successful in decreasing child mortality than many of their regional and economic peers. The use of implementation research across these countries identifies common implementation strategies and contextual factors that can facilitate or impede successful implementation of an evidence-based intervention and explores a common pathway to implementation. The work highlights how the use of implementation research to understand the “how” and the “why” behind countries’ success provides important actionable knowledge and lessons to country-level decision-makers, donors, and implementers as we arrive at the midpoint of the Sustainable Development Goal era.
Recognition of others’ interoceptive states in those with and without eating disorders
Authors: Gajperia Chandni , McBride Jennifer , Treasure Janet , Cardi Valentina , Brewer Rebecca
Published: February 2024

Background

The ability to recognize one’s own emotions is associated with one’s ability to recognize others’ emotions. Beyond the domain of emotion, however, the relationship between recognition of one’s own internal states (interoception) and others’ interoceptive states has not been investigated, either in the typical population or clinical groups with interoceptive difficulties (e.g. eating disorders; EDs).

Method

This study investigated recognition of one’s own and others’ internal states in adults with and without eating disorders, using a high frequency visual noise paradigm. Participants completed self-report measures of interoception, alexithymia (difficulties recognising one’s own emotional internal states) and ED symptomatology, and the Heartbeat Counting Task measure of cardiac interoceptive accuracy.

Results

Alexithymia was significantly negatively correlated with recognition of others’ interoceptive states. EDs were not associated with difficulties recognising others’ interoceptive states.

Conclusions

The ability to recognise one’s own emotional internal states is associated with the recognition of others’ interoceptive states, which may contribute to social skills and the ability to care for others.
Modelling climate change impacts on the spatial distribution of anthrax in Zimbabwe
Authors: John Learnmore , Shekede Munyaradzi Davis , Gwitira Isaiah , Mazhindu Aldridge Nyasha , Pfukenyi Davies Mubika , Chikerema Silvester
Published: February 2024

Background

In Zimbabwe, anthrax is endemic with outbreaks being reported almost annually in livestock, wildlife, and humans over the past 40 years. Accurate modelling of its spatial distribution is key in formulating effective control strategies. In this study, an Ensemble Species Distribution Model was used to model the current and future distribution of anthrax occurrence in Zimbabwe.

Methods

Bioclimatic variables derived from the Beijing Climate Centre Climate System Model were used to model the disease. Collinearity testing was conducted on the 19 bioclimatic variables and elevation to remove redundancy. Variables that had no collinearity were used for anthrax habitat suitability modelling. Two future climate change scenarios for different Representative Concentration Pathways (RCP), RCP4.5 and RCP8.5 were used. Model evaluation was done using true skill, Kappa statistics and receiver operating characteristics.

Results

The results showed that under current bioclimatic conditions, eastern and western districts of Zimbabwe were modelled as highly suitable, central districts moderately suitable and southern parts marginally suitable for anthrax occurrence. Future predictions demonstrated that the suitable (8%) and highly suitable (7%) areas for anthrax occurrence would increase under RCP4.5 scenario. In contrast, a respective decrease (11%) and marginal increase (0.6%) of suitable and highly suitable areas for anthrax occurrence were predicted under the RCP8.5 scenario. The percentage contribution of the predictors varied for the different scenarios; Bio6 and Bio18 for the current scenario, Bio2, Bio4 and Bio9 for the RCP4.5 and Bio3 and Bio15 for the RCP8.5 scenarios.

Conclusions

The study revealed that areas currently suitable for anthrax should be targeted for surveillance and prevention. The predicted future anthrax distribution can be used to guide and prioritise surveillance and control activities and optimise allocation of limited resources. In the marginally to moderately suitable areas, effective disease surveillance systems and awareness need to be put in place for early detection of outbreaks. Targeted vaccinations and other control measures including collaborative ‘One Health’ strategies need to be implemented in the predicted highly suitable areas. In the southern part where a high decrease in suitability was predicted, continued monitoring would be necessary to detect incursions early.
Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions
Authors: Pettican Anna , Southall-Edwards Robert , Reinhardt Gina Yannitell , Gladwell Valerie , Freeman Paul , Low William , Copeland Robert , Mansfield Louise
Published: February 2024

Background

Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently.

Methods

The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM’s design, implementation and/or delivery. Data was analysed using Braun and Clarke’s reflexive thematic analysis.

Results

Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change.

Conclusions

These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.
Factors associated with oral health service utilization among young people in southern China
Authors: Cai Yunquan , Zeng Shaobo , Hu Yimei , Xiao Lingfeng , Liao Yanqing , Yan Zihui , Zha Wenxiang , Gu Junwang , Wang Qi , Hao Ming , Wu Chunmei
Published: February 2024

Objectives

To identify the patterns and influencing factors of oral health service utilization among college students, and further to provide scientific evidence for policy making on oral health education and behavioral interventions for the college population.

Methods

The study population was college students in Southern China. Totally 678 students participated in the survey. A self-designed questionnaire based on Anderson’s model (predisposing factors, enabling factors, need factors) was used to survey college students. Descriptive statistics, χ2 test, and logistic regression were used to analyze influence factors of oral health service utilization among college students.

Results

The utilization rate of oral health service in the past 12 months was 30.2%. The primary type of oral health service was treatment (59.6%), and only 12.8% were for prevention. There were 39% of the participants having oral health diseases, of which dental caries (25.7%) and oral bleeding (22.2%) were the main problems. The results from logistic regression analysis revealed that students with better beliefs (OR = 1.84, 95% CI:=1.02–3.43), frequent consumption of sugary drinks (OR = 2.90, 95% CI:=1.90–4.47), teeth brushing frequency > = 2 times per day (OR = 2.09, 95% CI = 1.24–3.61), frequent floss utilization (OR = 2.63, 95% CI = 1.21–5.76), dental caries (OR = 2.07, 95% CI = 1.35–3.17) used oral health services higher, while those lived in rural areas (OR:0.52, 95% CI = 0.34–0.80), and had only a fair concern (OR = 0.48, 95% CI = 0.31–0.74) or no concern (OR = 0.26, 95% CI = 0.08–0.67) on oral health utilized oral health services lower.

Conclusions

Chinese college students demonstrate some knowledge and attitudes towards oral health. However, they tend to neglect oral hygiene and have limited understanding of their own oral issues. Furthermore, the utilization of oral services, such as treatment, remains remarkably low, despite the availability of long-term and favorable health insurance policies. The utilization of oral health services among college students is influenced by various factors, including residing in rural areas, consuming sugary beverages on a daily basis, brushing teeth at least twice a day, and practicing flossing.
Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol
Authors: Wu Juntian , Siddiqui Fahad Javaid , Mak Charles Chia Meng , Chua Ivan Si Yong , Thangayah Jeevan Raaj , Tan Esther Xi Xiang , Seet Huey Ying , Rao Adriel Kailing , Tan Hann Yee , Mohamed Asif , Hartman Mikael , Leong Benjamin Sieu-Hon , Ong Marcus Eng Hock , Mao Desmond Renhao
Published: February 2024

Background

The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy—in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions.

Methods

Employing a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores.

Discussion

Confronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT’s efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model’s prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations.

Trial Registration

ClinicalTrials.gov, NCT 04447079. Initiated on 25 June 2020.
Local heterogeneity of normal lung parenchyma and small airways disease are associated with COPD severity and progression
Authors: Bell Alexander J. , Pal Ravi , Labaki Wassim W. , Hoff Benjamin A. , Wang Jennifer M. , Murray Susan , Kazerooni Ella A. , Galban Stefanie , Lynch David A. , Humphries Stephen M. , Martinez Fernando J. , Hatt Charles R. , Han MeiLan K. , Ram Sundaresh , Galban Craig J.
Published: February 2024

Background

Small airways disease (SAD) is a major cause of airflow obstruction in COPD patients and has been identified as a precursor to emphysema. Although the amount of SAD in the lungs can be quantified using our Parametric Response Mapping (PRM) approach, the full breadth of this readout as a measure of emphysema and COPD progression has yet to be explored. We evaluated topological features of PRM-derived normal parenchyma and SAD as surrogates of emphysema and predictors of spirometric decline.

Methods

PRM metrics of normal lung (PRMNorm) and functional SAD (PRMfSAD) were generated from CT scans collected as part of the COPDGene study (n = 8956). Volume density (V) and Euler-Poincaré Characteristic (χ) image maps, measures of the extent and coalescence of pocket formations (i.e., topologies), respectively, were determined for both PRMNorm and PRMfSAD. Association with COPD severity, emphysema, and spirometric measures were assessed via multivariable regression models. Readouts were evaluated as inputs for predicting FEV1 decline using a machine learning model.

Results

Multivariable cross-sectional analysis of COPD subjects showed that V and χ measures for PRMfSAD and PRMNorm were independently associated with the amount of emphysema. Readouts χfSAD (β of 0.106, p < 0.001) and VfSAD (β of 0.065, p = 0.004) were also independently associated with FEV1% predicted. The machine learning model using PRM topologies as inputs predicted FEV1 decline over five years with an AUC of 0.69.

Conclusions

We demonstrated that V and χ of fSAD and Norm have independent value when associated with lung function and emphysema. In addition, we demonstrated that these readouts are predictive of spirometric decline when used as inputs in a ML model. Our topological PRM approach using PRMfSAD and PRMNorm may show promise as an early indicator of emphysema onset and COPD progression.