bluuebunny/crossref_metadata_2025 huggingface dataset:
Paton Prize Lecture Winner 2024: Gordon Holmes and the Irish spirit of adventure: Lessons for modern thinkers
Authors: Roe Seán M.
Published: January 2025

This lecture is given in honour of Sir William Paton (1917–1993), physiologist, pharmacologist and Fellow of the Royal Society. His passion for the history of medicine led to generous donations to the Society, who consequently founded the Paton Prize Fund for historical research. After his death, this eponymous Prize Lecture was debuted in 1994. It has been a singular honour for me to acclaim the similarly influential Irish neurologist Gordon Morgan Holmes (1876–1965), whose work has been a particular preoccupation of mine for my entire career, since I first heard of him as an undergraduate in 1991. Holmes’ work on the World War I battlefield completely transformed neurology, in terms both of clinical practice and its knowledge base. Clinical techniques developed by him at that time remain established current practice, and his visual field maps were not superseded for 73 years. His legacy to neurology is extensive, with his editorship of the journal Brain from 1922 to 1937. He had a profound influence both here and across the Atlantic, evinced by global warm tributes published on his death in 1965. The Lecture concentrates on a confluence of events and circumstances existing in the Flanders trenches that met a man singularly suited to overcoming the challenges posed. He received training in neuroanatomy from the German anatomists and clinical skills from the British greats in the National Hospital Queen Square. Coupled with an Irish adventurousness and insatiable curiosity, this experience presaged advances that resonate >100 years on. His legacy speaks profoundly of curiosity, interdisciplinarity and reconciliation.
Multifractal Terrain Generation for Evaluating Autonomous Off-Road Ground Vehicles
Authors: Majhor Casey D. , Bos Jeremy P.
Published: January 2025

We present a multifractal artificial terrain generation method that uses the 3D Weierstrass–Mandelbrot function to control roughness. By varying the fractal dimension used in terrain generation across three different values, we generate 60 unique off-road terrains. We use gradient maps to categorize the roughness of each terrain, consisting of low-, semi-, and high-roughness areas. To test how the fractal dimension affects the difficulty of vehicle traversals, we measure the success rates, vertical accelerations, pitch and roll rates, and traversal times of an autonomous ground vehicle traversing 20 randomized straight-line paths in each terrain. As we increase the fractal dimension from 2.3 to 2.45 and from 2.45 to 2.6, we find that the median area of low-roughness terrain decreases by 13.8% and 7.16%, the median area of semi-rough terrain increases by 11.7% and 5.63%, and the median area of high-roughness terrain increases by 1.54% and 3.33%, respectively. We find that the median success rate of the vehicle decreases by 22.5% and 25% as the fractal dimension increases from 2.3 to 2.45 and from 2.45 to 2.6, respectively. Successful traversal results show that the median root-mean-squared vertical accelerations, median root-mean-squared pitch and roll rates, and median traversal times all increase with the fractal dimension.
Mechanical Degradation on Defective Lithium-Ion Batteries
Authors: Gao You , Hao Zhiwei , Jiang Yuxin , Yao Tianhong , Wang Lubing
Published: January 2025

Unavoidable minor electric vehicle collisions can cause defects and deformations in lithium-ion batteries (LIBs). The safety of such defective batteries is crucial for ensuring the overall safety and stability of battery systems. However, the usability of a defective battery and the mechanisms underlying the damage remain unclear. In this study, we focus on the mechanical performance of defective batteries, safety thresholds, and the associated failure mechanisms. Initially, two typical defective cells are prepared by quasi-static loading using different indenters. The mechanical responses of these cells are then assessed via quasi-static flat compression. Finally, a mechanical failure criterion for the battery is proposed based on the thickness of the separator. The effects of defect area and defect angle on the performance of defective cells are also discussed. These results provide valuable insights for the safety assessment and management of defective lithium-ion batteries.
Pitch perception in school-aged children: Pure tones, resolved and unresolved harmonics
Authors: Fung Jami , Whiteford Kelly L. , Mehta Anahita H. , Lau Bonnie K.
Published: January 2025

Pitch perception affects children's ability to perceive speech, appreciate music, and learn in noisy environments, such as their classrooms. Here, we investigated pitch perception for pure tones as well as resolved and unresolved complex tones with a fundamental frequency of 400 Hz in 8- to 11-year-old children and adults. Pitch perception in children was better for resolved relative to unresolved complex tones, consistent with adults. The younger 8- to 9-year-old children had elevated thresholds across all conditions, while the 10- to 11-year-old children had comparable thresholds to adults.
Response to “Comment on ‘similar susceptibility to temporary hearing threshold shifts despite different audiograms in harbor porpoises and harbor seals’ ” [J. Acoust. Soc. Am. 157, 538–541 (2025)]
Authors: Gransier Robin , Kastelein Ronald A.
Published: January 2025

In their Comment, Tougaard et al. [(2025). J. Acoust. Soc. Am. 157, 538–541] question our conclusion that despite their different audiograms, harbor seals (Phoca vitulina) and harbor porpoises (Phocoena phocoena) have similar susceptibility to temporary hearing threshold shift caused by loud sounds, and claim that our selection of data for analysis was biased. In this Response, we clarify our methods and uphold our original conclusions.
A Longitudinal Study of Organizational Stressors and Mental Health in the Irish Olympic Team Before and After the “Tokyo 2020” (2021) Olympic Games
Authors: Browne Jo-Anne , Paradis Kyle F. , Kirby Kate , Arnold Rachel
Published: January 2025

Aims: The primary aim of the present study was to assess the relationship between organizational stressors and mental health and well-being indicators of the Irish Olympic Team before and after the “Tokyo 2020” Olympic Games. A secondary aim was to examine the differences in mental health and well-being between the athletes and staff of Team Ireland pre- and post-Games. Method: The Irish Olympic Team comprised 271 members (116 athletes and 155 team staff). Participants were sent an online survey package 2 weeks pregames (Time 1) and 4 weeks postgames (Time 2). A total of 98 participants (36% response rate) responded at Time 1, and 70 participants (26% response rate) responded at Time 2. Measures included the Organizational Stressor Indicator for Sport Performers, the Mental Health Continuum–Short Form, and the Sport Mental Health Assessment Tool 1. Results: There was a significant inverse association between organizational stressors and mental well-being at both Time 1 (β = −0.46) and Time 2 (β = −0.35) and from pre- to post-Games (β = −0.48). There was a significant positive association between organizational stressors and risk of mental health symptoms at both Time 1 (β = 0.69) and Time 2 (β = 0.67) and from pre- to post-Games (β = 0.34). At Time 1, team staff (75%) reported significantly greater risk of mental health symptoms than athletes (50%); however, at Time 2, athletes (80%) reported significantly greater risk of mental health symptoms than staff (50%). The overall number of participants flourishing decreased from pre- (43%) to post-Games (31%). Conclusion: Findings have implications for mental health support provision, which tends to be athlete focused but might forget about team staff, and to consider preevent provision but to also not forget about postevent care.
Septic shock and meningitis caused by
Capnocytophaga canimorsus
(serovar B) in an immunocompetent patient: case report
Authors: Germuskova Zoja , Westerholt Marc , Ocias Lukas Frans
Published: January 2025

Background

Capnocytophaga canimorsus
, a Gram-negative rod found in the commensal oral microflora of dogs, is a rare cause of infection following a dog bite, with severe infections more commonly occurring in asplenic or immunocompromised patients. This is a rare case of septic shock and meningitis with a serovar B strain in an immunocompetent patient who passed away due to the infection.

Case Summary

A previously healthy man in his late 50s with no known immunodeficiencies was admitted to the hospital with fever and cognitive deficits after being bitten by a dog.
Capnocytophaga canimorsus
grew in his cerebrospinal fluid and blood cultures. Despite aggressive fluid therapy, antibiotics, and intensive care, the patient succumbed to the infection. The strain was later characterized as serovar B using whole genome sequencing.

Conclusion

Even immunocompetent patients are at risk of severe infection caused by
Capnocytophaga canimorsus
. These infections are an important differential diagnosis in patients presenting with fever following recent dog exposure with serovars A–C being the most common in human clinical isolates.
Carbapenem-resistant
Enterobacter hormaechei
uses mucus metabolism to facilitate gastrointestinal colonization
Authors: Sinha Ritam , Ottosen Elizabeth N. , Ngwaga Tshegofatso , Shames Stephanie R. , DiRita Victor J.
Published: January 2025

The emergence and global spread of carbapenem-resistant
Enterobacter cloacae
complex species present a pressing public health challenge. Carbapenem-resistant
Enterobacter
spp. cause a wide variety of infections, including septic shock fatalities in newborns and immunocompromised adults. The intestine may be a major reservoir for these resistant strains, either by facilitating contamination of fomites and transfer to susceptible individuals, or through translocation from the gut to the bloodstream. For this reason, we sought to establish a neonatal mouse model to investigate the mechanisms underpinning gut colonization by carbapenem-resistant
Enterobacter hormaechei
. We describe a new mouse model to study gut colonization by
Enterobacter
spp., leading to vital insights into the adaptation of carbapenem-resistant
E. hormaechei
to the gut environment during the early stages of intestinal colonization. We observed successful colonization and proliferation of
E. hormaechei
in the 5-day-old infant mouse gut, with primary localization to the colon following oral inoculation. We also uncovered evidence that
E. hormaechei
uses mucus as a carbon source during colonization of the colon. Our findings underscore the importance of oxygen-dependent metabolic pathways, including the pyruvate dehydrogenase complex and
N-
acetyl-D-glucosamine metabolism, in gut colonization and proliferation, which aligns with previous human studies. These insights are essential for developing novel therapeutic strategies that can serve as decolonization therapies in at-risk populations.

IMPORTANCE

Bloodstream infections caused by
Enterobacter
spp. pose a significant clinical threat. The intestine acts as the primary site for colonization and serves as a reservoir for infection. To combat this pathogen, it is crucial to understand how carbapenem-resistant
Enterobacter
spp. colonize the gut, as such knowledge can pave the way for alternative therapeutic targets. In this study, we developed a novel neonatal mouse model for gastrointestinal colonization by
Enterobacter
spp. and discovered that mucus plays a key role as a carbon source during colonization. Additionally, we identified two mucus catabolism pathways that contribute to intestinal colonization by carbapenem-resistant
E. hormaechei
. This new mouse model offers valuable insights into host-pathogen interactions and helps identify critical gastrointestinal fitness factors of
Enterobacter
, potentially guiding the development of vaccines and alternative therapeutic strategies to minimize intestinal carriage in patient populations at risk of infection with
Enterobacter
spp.
Minimal methimazole exposure-induced fatal pancytopenia
Authors: Au Xiu Ying , Kapsner Patricia L , Shrestha Nancy , Schade David
Published: January 2025

This case highlights that refractory pancytopenia leading to death can occur with methimazole treatment even at a very low cumulative dose and after a very short duration of exposure. In addition, the standard treatments to correct the pancytopenia may not be effective and a bone marrow transplant may be required. Current American Thyroid Association guidelines do not recommend routine monitoring of the complete blood count in patients receiving thionamides because of the rapidity of the onset of agranulocytosis and the lack of positive evidence that such monitoring would be useful. Patient education concerning the clinical adverse effects of pancytopenia should be stressed before drug initiation. Patients should discontinue thionamides immediately and seek medical treatment if they develop anaemia, fever, pharyngitis, severe infection or easy bruising. Physicians need to be aware that pancytopenia from methimazole is not dose-related and be alert to any patient signs or symptoms of infection. Subspecialty consultation will be required.
Change in subjective well-being and the associated costs of a woman-targeted presbyopia correction programme among older craftswomen in Zanzibar: a cost-outcome and scenario analysis
Authors: Chan Ving Fai , Othman Omar Juma , Yong Ai Chee , Graham Christine , Price-Sanchez Carlos , Pillai Bhagyalaxmi Shivalingam , Holland Eleanor , McConnell Emma , Jones Jamison , Farmer Adrianna , Martins Michelle Fernandes , Shah Kajal , Mulewa Damaris , Graham Ronnie , Mashayo Eden , Omar Fatma
Published: January 2025

Background

A pilot eyecare programme aimed to address the urgent eye health needs of older Zanzibari craftswomen. We investigated the impact of correcting presbyopia on their subjective well-being (SWB) 6 months post-correction and assessed the cost-effectiveness of a women-targeted presbyopia correction programme.

Methods

This study involved Zanzibari craftswomen aged 40 and older with presenting and corrected distance visual acuity better than 6/12 in both eyes and were presbyopic. Using a before–after method, we assessed SWB on a 10-point scale before and after providing free spectacles. Mean SWB scores and differences pre-correction and post-correction were calculated. Programme costs were analysed to determine the cost per SWB score gained and the monthly cost for each SWB score improvement. Additionally, scenario analysis estimated costs for 12 approaches.

Results

Of 282 craftswomen, 209 met the eligibility criteria. SWB scores significantly increased from 3.34 to 8.14 post correction (p<0.001). Screening costs totalled US$12 885.84, with an average cost of US$45.69 per craftswoman screened and US$61.66 per presbyopia identification. The total programme cost was US$14,574.69. One hundred fifty-four craftswomen experienced increased SWB, with a total of 747 score gains. Achieving one SWB score improvement cost an average of US$19.50, with a monthly average cost of US$3.40 per improvement. Utilising woman screeners, organised transport and ready-made spectacles appeared to be the most cost-effective approach.

Conclusion

Correcting presbyopia through a targeted eyecare programme significantly enhanced SWB among craftswomen. While the programme seems cost-effective, further research is warranted to explore long-term economic benefits and definitively assess cost-effectiveness in larger studies.
Neuropathic corneal pain following refractive surgery: risk factors, clinical manifestations, imaging and proteomic characteristics
Authors: Teo Calesta Hui Yi , Liu Chang , Lee Isabelle Xin Yu , Lin Molly Tzu-Yu , Liu Fengyi , Toh Charmaine Jan Li , Koh Siew Kwan , Lu Da Qian , Lam Thomas Chuen , Zhou Lei , Tong Louis , Mehta Jodhbir , Liu Yu-Chi
Published: January 2025

Background/aims

To identify the risk factors for neuropathic corneal pain (NCP) following corneal refractive surgery and to report its clinical manifestations, imaging and proteomic characteristics.

Methods

This 1 year prospective cohort study included 100 eyes that underwent small incision lenticule extraction (SMILE) or laser-assisted in situ keratomileusis (LASIK). Ocular surface assessments, in-vivo confocal microscopy scans, tear neuromediators and proteomics analyses were performed. NCP was assessed using the ocular pain assessment survey. Univariate and multivariate analyses were conducted to identify the risk factors associated with postoperative NCP.

Results

The incidence of NCP was 13.3% and 10.5% after SMILE and LASIK, respectively (p=0.70). In SMILE, preoperative manifest refractive spherical equivalent (MRSE) and spherical power (both p=0.02) were significantly higher in the NCP compared with the non-NCP group. In LASIK, NCP eyes had a significantly lower corneal nerve fibre length (CNFL) (p=0.02), lower nerve fractal dimension (p=0.003), higher nerve fibre width (p=0.04) and larger neuroma area (p=0.04) than non-NCP eyes. In SMILE, higher preoperative MRSE was a significant risk factor for postoperative NCP (95% CI: 0.48—1.96, p=0.04). An MRSE greater than −8.0 diopter was 9.57 times more likely to develop postoperative NCP (OR=9.57, p=0.002). In LASIK, lower preoperative corneal nerve fibre density (95% CI:0.13—1.11, p=0.05) and CNFL (95% CI:0.09—1.25, p=0.05) were significant risk factors for postoperative NCP. Significant increases in tear nerve growth factor, calcitonin gene-related peptide, Frizzled class receptor 7 and nucleoside-diphosphate kinase three were observed in postoperative NCP.

Conclusions

The reported characteristics and risk factors would identify patients susceptible to NCP after corneal refractive surgery.
Latest revisions to the International Health Regulations will fail to prevent future travel chaos
Authors: Lee Kelley , Piper Julianne
Published: January 2025

The poor management of public health risks associated with travel by most countries proved among the most contentious issue areas during the COVID-19 pandemic. Evidence from previous outbreaks suggested travel restrictions were largely unnecessary and counterproductive to timely reporting. This led to initial WHO recommendations against the use of travel restrictions. Substantial evidence of the role of human travel in spreading SARS-CoV-2 worldwide throughout the evolving pandemic supported new thinking about the use of different types of travel measures (ie, screening, restrictions, quarantine, immunity documentation) to limit the introduction of SARS-CoV-2 into jurisdictions with low incidence and onward transmission. However, governments failed to work together, undermining public health goals. In addition, profound secondary impacts were caused by uncoordinated, frequently changing and poorly evidenced use of travel measures. Alongside the need to better understand what, when and how travel measures should be used during public health emergencies of international concern, improved global governance is required. Recently adopted revisions to the International Health Regulations (IHR), notably Article 43, failed to change current rules and commitments. Travel measures are also not being addressed in the negotiation of a pandemic agreement. Evolving evidence from COVID-19 supports a risk-based approach but global consensus on a standardised methodology remains needed. Setting aside further IHR revision, this methodology and guidelines could be advanced through a WHO technical working group. A risk-based decision instrument that incorporates pathogen and jurisdictional characteristics, and public health and social, political and economic risk analysis could then be developed as a new IHR annex.
Burden of micronutrient deficiency among patients with type 2 diabetes: systematic review and meta-analysis
Authors: Mangal Daya Krishan , Shaikh Nida , Tolani Himanshu , Gautam Diksha , Pandey Anuj Kumar , Sonnathi Yeshwanth , Gupta Shiv Dutt , Kalra Sanjay , Sharma Kamlesh Chand , Prasad Jagdish , Tewari Rajeev , Anwar Fahmina
Published: January 2025

Background

Micronutrient deficiencies are a significant issue worldwide, particularly in South Asia and sub-Saharan Africa. These deficiencies can impact glucose metabolism and insulin signalling pathways, potentially leading to the beginning and advancement of type 2 diabetes (T2D). This study is a comprehensive assessment of the burden of multiple micronutrient deficiencies among T2D patients. The aim of the study is to resolve conflicting evidence from previous studies that mainly focused on one specific micronutrient.

Methods

The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines and the Cochrane Handbook. This comprehensive literature search explored Embase, ProQuest, PubMed, Scopus, Cochrane Library, Google Scholar, LILACS and the grey literature, and studies that met the inclusion criteria. A pre-piloted data extraction sheet was used to extract data for relevant study outcomes and characteristics. Results were produced by R V.4.3.2 (R Core Team 2023 using general packages such as tidyverse, and specific packages such as meta and metafor.

Results

The analysis included 132 studies with 52 501 participants. The pooled prevalence of multiple micronutrient deficiency (vitamins, minerals and electrolytes) was 45.30% (95% CI 40.35% to 50.30%) among T2D patients. The pooled prevalence (48.62%, 95% CI 42.55 to 54.70) was higher in women with T2D than in men. Vitamin D was the most prevalent micronutrient deficiency (60.45%, 95% CI 55% to 65%), followed by magnesium (41.95%, 95% CI 27% to 56%). B12 deficiency (28.72%, 95% CI 21.08% to 36.37%) was higher in the metformin consuming group. The prevalence of micronutrient deficiency varied across WHO regions.

Conclusions

Micronutrient deficiencies were common in T2D patients, the most common being vitamin D deficiency. Women were more likely to be affected by micronutrient deficiency than men. These studies were hospital based and the findings of this systematic review may be used with caution due to inherent selection bias. Diversity of foods, lifestyle choices and cultural practices may contribute to geographic variations in micronutrient deficiency.

Trial registration

PROSPERO CRD42023439780.
Descriptive retrospective cross-sectional study of rehabilitation care for poststroke users in Québec during the COVID-19 pandemic
Authors: Vakil Palak , Ferré Perrine , Higgins Johanne , Beaulieu Louis-David , Milot Marie-Helene , Boudrias Marie-Hélène
Published: January 2025

Objectives

During the COVID-19 pandemic, designated rehabilitation centres were established in the province of Québec, where strict sociosanitary measures such as isolation and mandatory personal protection equipment requirements were followed. This study aimed to describe the impact of the pandemic on rehabilitation care indicators for poststroke users with (COV+) and without (COV−) COVID-19 infection in designated rehabilitation centres compared with those admitted in the previous year (pre-COV).

Method

A retrospective analysis of 292 medical files was performed in 3 rehabilitation centres. Demographic characteristics were collected, as well as indicators routinely collected in acute care and rehabilitation such as length of stay (LOS), the Functional Independence Measure and a number of physical/occupational therapy (PT/OT) sessions. Non-parametric statistical tests were used to compare variables among the three groups.

Results

COV+ users were older than COV− and pre-COV ones (p<0.01) and were more disabled on admission to a rehabilitation centre (p<0.01). They also exhibited longer LOS in acute care prior to rehabilitation (p<0.001) and were more often rehospitalised (p<0.002) during the course of their stay in the rehabilitation centre. Despite longer rehabilitation stays (p<0.001) and more PT/OT sessions, COV+ users remained more disabled at discharge (p<0.002). COV− users showed rehabilitation care indicators resembling the ones of pre-COV despite spending less time in rehabilitation.

Conclusions

Patients who had a stroke infected with COVID-19 exhibited greater vulnerability on admission to rehabilitation. They required more care and services during their rehabilitation period. However, this additional support did not enable them to achieve the same level of recovery as COV− and pre-COV users. This underscores the added impact of the disease on already impaired patients and highlights the specific needs of COV+ users undergoing rehabilitation.
Lived experiences of patients with advanced pancreatic cancer on patient-reported outcomes (PROs) management: a qualitative phenomenological study in Southwest China
Authors: Chen Ping , Hou Wanting , Li Changlin , Liang Qingyue , Ma Li , Zhao Xiumei , Yi Cheng
Published: January 2025

Objectives

To explore the lived experiences of patients with advanced pancreatic cancer enrolled in a patient-reported outcomes (PROs) management programme and to preliminarily understand how PROs management influences various aspects of patient care and overall quality of life.

Design

A qualitative phenomenological study.

Setting

A national cancer care centre in Southwest China specialised in cancer care, with a comprehensive PROs management programme.

Participants

15 participants diagnosed with advanced pancreatic cancer.

Results

Five key themes emerged from our interviews, including enhanced communication with healthcare providers, attributed to the structured nature of PROs; increased perceived sense of care, with patients feeling more valued and heard; PROs management facilitated better treatment decision-making, with patients feeling more involved and empowered; improved communication with family members, aiding in better understanding and support; and varied perceptions of the impact on quality of life, with some noting improvements in specific aspects like symptom management, while others were uncertain about the overall benefit.

Conclusions

PROs management plays a significant role in improving communication between patients with advanced pancreatic cancer and their healthcare providers, enhancing patients’ involvement in treatment decisions, and potentially improving family dynamics. However, the impact of PROs management on the overall quality of life of patients remains complex and individualised. The findings suggest that further research with a more diverse patient population is needed to fully understand the implications of PROs management in advanced cancer care.
Prevalence of musculoskeletal disorders among garment workers: a systematic review and meta-analysis
Authors: Gebrye Tadesse , Mbada Chidozie , Apeagyei Phoebe , Fatoye Francis
Published: January 2025

Background

Garment workers are at high risk of musculoskeletal disorders (MSDs) due to repetitive physical tasks, long working hours and varying workstations. As there is no existing epidemiological overview of MSDs among garment workers, this systematic review aimed to evaluate the global evidence on prevalence of MSDs in this population.

Methods

A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus and Web of Science electronic databases were searched to identify studies published in English up to November 2022. Random-effects meta-analysis was used to estimate pooled prevalence.

Results

The search yielded 258 published studies, of which 14 were deemed relevant and were included in this review. The included studies reported prevalence from India (n=3), Bangladesh (n=2), Ethiopia (n=2), Thailand (n=2), Botswana (n=1), Iran (n=1), Sri Lanka (n=1), Cambodia (n=1) and Denmark (n=1) and involved 15 029 garment workers. Most of the included studies (79%) were assessed to be methodologically sound (low risk of bias). The mean age of participants ranged from 24.2 to 40 years. The prevalence of MSDs ranged from 15.5% to 92%. The pooled prevalence of MSDs from nine studies was 65.6% (95% CI 44.5% to 51.9%). Low back pain and neck pain were reported as the common MSDs in the included studies.

Conclusions

The findings highlight the considerable risk of MSDs, especially low back and neck pain, linked to repetitive tasks, extended hours and inconsistent workstations. Given the heavy toll of MSDs on this workforce, targeted interventions and ergonomic improvements are crucial to mitigate the risks and improve garment workers’ well-being.
Self-reported sexually transmitted infections and associated factors among sexually active men in East Africa: a multilevel analysis of recent demographic and health surveys
Authors: Negussie Yohannes Mekuria , Fente Bezawit Melak , Asmare Zufan Alamrie , Asnake Angwach Abrham , Bezie Meklit Melaku , Asebe Hiwot Atlaye , Seifu Beminate Lemma
Published: January 2025

Background

Sexually transmitted infections (STIs) are a significant global health challenge, demanding attention and intervention. Despite many STIs being manageable, their asymptomatic nature poses a formidable threat to both mental and physical well-being. This silent impact can lead to substantial morbidity and mortality, which is particularly pronounced in East Africa.

Objective

To investigate the prevalence and factors associated with self-reported STIs among sexually active men in East Africa.

Design

Cross-sectional study design.

Setting

10 East African countries.

Participants

66 833 sexually active men.

Primary outcome measure

Self-reported STI in the 12 months preceding the survey. A multilevel mixed-effects logistic regression model was fitted to identify factors associated with self-reported STIs. An adjusted OR with the corresponding 95% CI was used to estimate the strength of the association, and statistical significance was set at a p value <0.05.

Results

The pooled prevalence of self-reported STIs among sexually active men in East Africa was 5.22% (95% CI: 5.34, 5.69). Being married, having multiple sexual partners excluding a spouse and being informed about STIs were significantly associated with higher odds of self-reported STIs. However, being aged 44 years and above, having a higher education level, starting sex after the age of 20, being circumcised and being a rural resident were associated with lower odds of self-reported STIs.

Conclusion

The prevalence of self-reported STIs was higher than the findings from most previous studies. It is essential to educate men about STIs and increase awareness of the risks associated with having multiple sexual partners. Implementing targeted public health initiatives for men with lower education levels, as well as devising strategies to address factors that elevate the risk of STI contraction, is also crucial.
Screening for social anxiety disorder in students of Jordan universities after COVID-19 pandemic: a cross-sectional survey study
Authors: Alhemedi Ahlam J , Beni Yonis Othman , Allan Hadeel , abu Mohsen Ghalia , Almasri Ayham , Abdulrazzeq Haitham , Khasawneh Islam , El-khateeb Osama , Naser Abdallah Y
Published: January 2025

Objective

To examine the prevalence rate of social anxiety disorder (SAD) among university students in Jordan after the COVID-19 pandemic and its associated predictors.

Design

A cross-sectional online survey study that was conducted in Jordan between January and December 2023.

Setting: Universities in Jordan.

Participants

Healthy university students from any specialty currently enrolled at a Jordanian university.

Primary outcome measure

The prevalence rate of SAD, which was assessed using the Social Phobia Inventory.

Results

A total of 851 university students participated in this study. More than half of them (65%) were women. The mean age of the study participants was 21.9 (2.7) years. The majority of them (70.6%) were studying medical fields. The median number of times the study participants got infected with COVID-19 was 1.0 (IQR: 0.0–2.0). The median number of viewing hours spent on social networking sites was 4.0 (IQR: 3.0–6.0). The median SAD score was 19 (IQR: 10–32) out of 68, which represents 27.9% of the maximum attainable score. Up to 45.4% of the study participants were susceptible to SAD, with 12.5% of the study participants reporting severe to very severe SAD symptoms. Students older than 21.9 years were 32% less likely to report SAD symptoms compared with younger students (p<0.01).

Conclusion

Jordanian universities students are increasingly likely to report SAD symptoms. The data show how important it is for universities to recognise and deal with this mental health issue. Focused treatments and support networks could help students with social anxiety problems to deal with them.
Multicentre adaptive randomised trial of GvHD prophylaxis following unrelated donor stem cell transplantation comparing Thymoglobulin versus calcineurin inhibitor-based or sirolimus-based post-transplant cyclophosphamide (Methods of T cell Depletion, MoTD trial)
Authors: Chakraverty Ronjon , Kempshall Emma , Dignan Fiona , Bloor Adrian , Collin Matthew , Raj Kavita , Davies Jeff , Potter Victoria , Malladi Ram , Smith Siobhan , Gates Simon , Gaskell Charlotte , Bishop Rebecca , Hodgkinson Andrea , Smith Gabrielle
Published: January 2025

Introduction

Graft-versus-host disease (GvHD) remains a major complication of allogeneic stem cell transplantation (allo-SCT), affecting 30–70% of patients (representing 800 new patients per year in the UK). The risk is higher in patients undergoing unrelated allo-SCT. About 1 in 10 patients die as a result of GvHD or through complications of its treatment. In patients who survive GvHD and or the complications of treatment, about 1 in 3 patients develop chronic GvHD which has a negative impact on quality of life (QoL). Many transplant protocols use alemtuzumab or anti-thymocyte globulin (ATG) in combination with a calcineurin inhibitor (CNI) and mycophenolate mofetil as GvHD prophylaxis; however, the outcomes of these treatments are complicated by high rates of infection and therefore the development of improved GvHD prophylaxis strategies represents a major unmet need.

Methods and analysis

The Methods of T-Cell Depletion trial is a prospective, multicentre, adaptive randomised trial in patients undergoing reduced intensity-conditioned unrelated donor allo-SCT. The trial will compare the novel GvHD prophylaxis regimens post-transplant cyclophosphamide (PTCy) in combination with a CNI or sirolimus (PTCy-CNI or PTCy-sirolimus, respectively) to a current standard-of-care GvHD prophylaxis involving the use of Thymoglobulin (a specific brand of ATG containing rabbit polyclonal antibodies). The primary outcome measure is GvHD-free, relapse-free survival at 1 year. Secondary outcomes include cumulative incidence of acute grade II-IV GvHD at 1 year, cumulative incidence of moderate and severe chronic GvHD at 1 year, overall survival at 1 year and cumulative incidence of non-relapse mortality at 1 year.

Ethics and dissemination

The protocol was approved by the West Midlands, Edgbaston Research Ethics Committee (20/WM/0195); initial approval was received on 11 September 2020, current protocol version (V.4.0) approval on 25 July 2023. The Medicines and Healthcare products Regulatory Authority also approved all protocol versions. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.

Trial registration number

EudraCT Number: 2019-002419-24.

ISRCTN Number: 50290131.
Metabolically healthy overweight/obesity with no metabolic abnormalities and incident hyperglycaemia in Chinese adults: analysis of a retrospective cohort study
Authors: Gao Qin , Liang Boya , Li Hongmin , Xie Ruining , Xu Yaru , Tong Yeqing , Jiang Shunli
Published: January 2025

Objectives

To explore whether metabolically healthy overweight (MHOW) and/or metabolically healthy obesity (MHO) increase hyperglycaemia risk in a Chinese population with a broad age range.

Design

Retrospective cohort study.

Setting

Secondary analysis of data from the DATADRYAD database, comprising health check records of participants from 32 regions and 11 cities in China between 2010 and 2016.

Participants

A total of 47 391 metabolically healthy participants with none of the metabolic abnormalities were selected.

Outcome measures

Hyperglycaemia includes incident diabetes and impaired fasting glucose (IFG). Diabetes was diagnosed with fasting blood glucose ≥7.0 mmol/L and typical clinical symptoms and/or on self-report during follow-up. The fasting plasma glucose level of IFG was from 5.6 to 6.9 mmol/L.

Results

With an average follow-up of 3.06 years, 5274 participants (11.13%) developed hyperglycaemia over 144 804 person-years, with an incidence rate of 36.42 per 1000 person-years. Adjusted model revealed a higher risk of incident hyperglycaemia in the MHOW group (HR=1.23, 95% CIs 1.16 to 1.30) and the MHO group (HR=1.49, 95% CI 1.33 to 1.67) compared with the metabolically healthy normal weight group. With 1 unit increase of body mass index, the risk of hyperglycaemia increased by 6% (HR=1.06, 95% CI 1.04 to 1.07). The stratified analyses and interaction tests showed the robustness of the association, and there was a stronger association in women (p for interaction<0.001).

Conclusions

The MHOW and MHO phenotypes were positively associated with a higher risk of hyperglycaemia in this population, and the association was particularly stronger in women.
Relationship between multiple morbidities and performance on the Timed Up and Go test in elderly patients: a cross-sectional study
Authors: Tariq Arsalan , Zadeh Sayed Alireza Mousavi , Ammar Muhammad , Mousavizadeh Nafisehsadat , Hajary Arash , Mohamadi Somayeh
Published: January 2025

Objective

To investigate how various morbidities affect older patients’ performance on the Timed Up and Go (TUG) test.

Design

Cross-sectional study.

Setting

The seven government hospitals of Lahore, Pakistan, included are major tertiary care centres, representing an older patient population of Punjab, Pakistan.

Method

160 elderly participants completed the TUG test, frailty evaluations and Charlson Comorbidity Index (CCI) scoring to assess mobility, frailty and comorbidity burden. The Student’s t-test analysed differences between TUG groups (<10 vs ≥10 s). Multivariate linear regression pinpointed key predictors of CCI scores. All analyses were performed using SPSS software.

Results

A total of 160 participants (mean age: 67.2±6.9 years and body mass index (BMI): 28.7±4.9 kg/m²) were included. Those with TUG test times under 10 s had lower CCI scores (5.06±1.8) and frailty index (0.15±0.07), compared with those with longer times (CCI: 8.6±4.3 and frailty index: 0.42±0.1). Multivariate regression analysis revealed that TUG time (β=0.342, p=0.001), frailty index (β=0.680, p=0.003), age (β=0.128, p=0.002) and BMI (β=0.098, p=0.027) were significant predictors of CCI. Additionally, higher Mini-Mental State Examination scores (β=−0.092, p=0.017) were associated with lower comorbidity burden. These results highlight mobility, frailty and cognitive function as a predictors of comorbidities in the elderly.

Conclusion

Our study highlights a significant relationship between mobility, frailty and cognitive function with the comorbidity burden in older adults. Incorporating these metrics into routine care can guide targeted interventions, promoting healthier ageing and improved quality of life.
Synovial biomarkers in the diagnosis of post-traumatic osteoarthritis following anterior cruciate ligament and meniscus injuries: protocol for a systematic review
Authors: Oliveira João Pedro , Mendes João Castro , Casanova José , Fonseca Fernando , Ferreira Mendes Alexandrina , Donato Helena
Published: January 2025

Introduction

This review aims to synthesise research evidence regarding biomarkers in the synovial fluid that may predict the risk of post-traumatic osteoarthritis (PTOA) in young adults. Considering the high prevalence of knee joint injuries, particularly among youth sports athletes, this review will focus on anterior cruciate ligament and/or meniscal ruptures. These injuries are highly associated with PTOA, with studies indicating that even with surgical reconstruction, 50%–80% of affected individuals develop knee PTOA within a 10-year follow-up.

Methods and analysis

The results of this systematic review will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Diagnostic Test Accuracy guidelines. Comprehensive electronic searches will be conducted across five platforms: four bibliographic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and Embase) and ClinicalTrials.gov registry. These searches will use combinations of predefined keywords, such as “knee”, “synovial fluid”, “post-traumatic osteoarthritis”, “anterior cruciate ligament”, “meniscus”, “trauma”, “inflammation” and “biomarker”. We will include randomised clinical trials, non-randomised prospective or retrospective clinical studies, case controls, cohort studies and case series, ranging from database inception to 30 June 2024 and published in English. Two independent reviewers will screen and evaluate the retrieved studies to determine their eligibility. Any reviewer disagreements will be resolved through discussion and consensus or, if necessary, by consultation with a third reviewer. The data will be extracted from the included studies and analysed, with the risk of bias assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A narrative synthesis will be performed to evaluate the strength and consistency of the findings, considering both the methodological quality of the included studies and the reliability of the results.

Ethics and dissemination

Ethical approval is not required for this review as it is a secondary study based on public and published data. The findings from this work will be submitted for publication in a peer-reviewed journal and presented at relevant academic conferences. Any amendments to the protocol arising from deviations during the study’s execution will be documented and reported in the final publication.

PROSPERO registration number

CRD42024534272.
Developing a set of key principles for care planning within older adult care homes: study protocol for a modified Delphi survey
Authors: Taylor Jonathan , Caprioli Thais , Damant Jacqueline , Hamashima Yuri , Jasim Sarah , Smith Nick , Toma Madalina
Published: January 2025

Background

Older adult care homes in England are required to develop care plans on behalf of each of their residents and to make these documents available to those who provide care. However, there is a lack of formal agreement around the key principles that should inform the development of care plans in care homes for older adults. Using a modified Delphi survey, we intend to generate consensus on a set of key principles that should inform the care planning process.

Methods and analysis

A two-stage modified Delphi survey will be used to try to reach a consensus on a set of key principles to inform care planning within older adult care homes in England. An interdisciplinary panel of approximately 50 people with experience in care planning will be convened and invited to provide feedback on a set of key principles. We will use an iterative, quasi-anonymous, multistage approach with controlled feedback. In the first round, panellists will be asked to provide feedback on a draft document whose contents have been informed by a systematic scoping review and consultations with care home staff. The first round will be administered and subsequently analysed. The results from the first round will be fed back to the panel members and panellists will be asked to complete a second survey. In each round, panel members will use a 5-point unipolar scale to rate their agreement with the item. Consensus will be considered if ≥75% of participants rate an item as 4–5.

Ethics and dissemination

This study to which this protocol relates has been granted ethical approval by the University of Kent’s Division for the Study of Law, Society and Social Justice Research Committee Ethics Panel (reference: 1006) on 9 April 2024. The results of this project will be disseminated through conferences and one or more peer-reviewed journals. In a subsequent research phase, the research team plans to share the key principles document developed through this modified Delphi survey with care home residents and their families and friends. We plan to invite their feedback through a series of focus groups with a view to developing a related document for the family and friends of care home residents.
Barriers and enablers encountered by bereaved informal motor neuron disease (MND) caregivers when trying to access bereavement support: a qualitative cross-sectional thematic analysis of semistructured interviews with 6–36 months postbereavement informal MND caregivers in the UK
Authors: Braben Liberty , Khatiwada Deepsi , Cramond Laura , Bradley Belinda F , Chhetri Suresh K.
Published: January 2025

Background

Caregivers of people with motor neuron disease (MND) face more negative consequences of caregiving than other terminal illnesses. The impact of this caregiver burden can negatively influence bereavement outcomes.

Objectives

This study aims to explore the support needs of caregivers of people with MND, the types of bereavement services they use, or the reasons for not using bereavement services, and understanding the opportunities and barriers to accessing bereavement services.

Design

The design of the study was a qualitative interview study using thematic analysis following the method of Braun and Clarke (2006).

Setting and participants

Twenty bereaved caregivers of people with MND were purposively sampled. Participants were recruited through the Lancashire and South Cumbria MND Care and Research Centre.

Results

Thematic analysis revealed four overarching themes: (1) type of support accessed, (2) the importance of people who understand, (3) barriers to accessing support, and (4) being (un)prepared for death and afterwards.

Conclusions

Caregivers of people with MND require people who understand their unique needs to support them, alongside professional support, to prepare them for the death of their loved one and beyond. Barriers to accessing support included the need for in-person support, insufficient financial support or signposting to relevant services and being unprepared for death and bereavement.