bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare costs and use before and after opioid overdose in Veterans Health Administration patients with opioid use disorder
Authors: Joyce Vilija R. , Oliva Elizabeth M. , Garcia Carla C. , Trafton Jodie , Asch Steven M. , Wagner Todd H. , Humphreys Keith , Owens Douglas K. , Bounthavong Mark
Published: July 2023

Aims

To compare healthcare costs and use between United States (US) Veterans Health Administration (VHA) patients with opioid use disorder (OUD) who experienced an opioid overdose (OD cohort) and patients with OUD who did not experience an opioid overdose (non‐OD cohort).

Design

This is a retrospective cohort study of administrative and clinical data.

Setting

The largest integrated national health‐care system is the US Veterans Health Administration's healthcare systems.

Participants

We included VHA patients diagnosed with OUD from October 1, 2017 through September 30, 2018. We identified the index date of overdose for patients who had an overdose. Our control group, which included patients with OUD who did not have an overdose, was randomly assigned an index date. A total of 66 513 patients with OUD were included for analysis (OD cohort: n = 1413; non‐OD cohort: n = 65 100).

Measurements

Monthly adjusted healthcare‐related costs and use in the year before and after the index date. We used generalized estimating equation models to compare patients with an opioid overdose and controls in a difference‐in‐differences framework.

Findings

Compared with the non‐OD cohort, an opioid overdose was associated with an increase of $16 890 [95% confidence interval (CI) = $15 611–18 169; P < 0.001] in healthcare costs for an estimated $23.9 million in direct costs to VHA (95% CI = $22.1 million, $25.7 million) within the 30 days following overdose after adjusting for baseline characteristics. Inpatient costs ($13 515; 95% CI = $12 378–14 652; P < 0.001) reflected most of this increase. Inpatient days (+6.15 days; 95% CI, = 5.33–6.97; P < 0.001), inpatient admissions (+1.01 admissions; 95% CI = 0.93–1.10; P < 0.001) and outpatient visits (+1.59 visits; 95% CI = 1.34–1.84; P < 0.001) also increased in the month after opioid overdose. Within the overdose cohort, healthcare costs and use remained higher in the year after overdose compared with pre‐overdose trends.

Conclusions

The US Veterans Health Administration patients with opioid use disorder (OUD) who have experienced an opioid overdose have increased healthcare costs and use that remain significantly higher in the month and continuing through the year after overdose than OUD patients who have not experienced an overdose.
Clinical implications of NUP98::NSD1 fusion at diagnosis in adult FLT3‐ITD positive AML
Authors: Miyajima Toru , Onozawa Masahiro , Yoshida Shota , Miyashita Naoki , Kimura Hiroyuki , Takahashi Shogo , Yokoyama Shota , Matsukawa Toshihiro , Goto Hideki , Sugita Junichi , Fujisawa Shinichi , Hidaka Daisuke , Ogasawara Reiki , Mori Akio , Matsuoka Satomi , Shigematsu Akio , Wakasa Kentaro , Kasahara Ikumi , Saga Tomoyuki , Hashiguchi Junichi , Takeda Yukari , Ibata Makoto , Yutaka Tsutsumi , Fujimoto Katsuya , Kondo Takeshi , Teshima Takanori
Published: July 2023

Objectives

The cryptic fusion oncogene NUP98::NSD1 is known to be associated with FLT3‐ITD mutation in acute myeloid leukemia (AML), and an independent poor prognostic factor in pediatric AML. However, there are little data regarding the clinical significance of NUP98::NSD1 in adult cohort.

Methods

We conducted a multicenter retrospective study to investigate the prevalence, clinical characteristics, and prognostic impact of NUP98::NSD1 in adult FLT3‐ITD‐positive AML patients.

Results

In a total of 97 FLT3‐ITD‐positive AML patients, six cases (6.2%) were found to harbor the NUP98::NSD1 fusion transcript. NUP98::NSD1 positive cases had significantly higher platelet counts and a higher frequency of FAB‐M4 morphology than NUP98::NSD1 negative cases. NUP98::NSD1 was found to be mutually exclusive with NPM1 mutation, and was accompanied by the WT1 mutation in three of the six cases. The presence of NUP98::NSD1 fusion at the time of diagnosis predicted poor response to cytarabine‐anthracycline‐based intensive induction chemotherapy (induction failure rate: 83% vs. 36%, p = .038). Five of the six cases with NUP98::NSD1 underwent allogeneic hematopoietic stem cell transplantation (HSCT). Two of the five cases have successfully maintained remission, with one of them being rescued through a second HSCT.

Conclusions

Detecting NUP98::NSD1 in adult FLT3‐ITD‐positive AML is crucial to recognizing chemotherapy‐resistant group.
‘You have to be a certain sort of person’: An interpretative phenomenological analysis of mental health support workers' experiences of physical restraint in inpatient settings
Authors: Martin James
Published: July 2023

Physical restraint is a controversial practice in psychiatric inpatient settings. Research has clearly demonstrated its physical and psychological risks, but few studies investigate how mental health support workers understand their experiences of restraint use. This study uses interpretative phenomenological analysis to explore support workers' understanding of these experiences. The COREQ checklist was used to ensure explicit reporting of the study. Semi‐structured interviews were conducted with three participants and were then analysed using an interpretative phenomenological process. One superordinate theme emerged: ‘You have to be a certain sort of person’. Restraints require not only the ability to overcome one's emotions, but also the ability to connect with the person being restrained. The implications of these findings for psychiatric care provision and for further research are discussed.
Nonclinical evaluation of a Vitis vinifera extract towards a novel antiaging cosmetic ingredient
Authors: Reis Romulo Dragani , da Rosa Rafael , Pessa Lisandra Ravanelli , Ruch Werneck Guimarães Cristiano
Published: July 2023

Background

Skin aging is regulated by multiple physiological processes, such as oxidative stress. Natural products have been considered as a promising source of antioxidant compounds. As a result, few innovative products on the market based on natural products tackle additional underlying mechanisms of skin aging.

Aims

The present work reports the nonclinical evaluation of a novel extract from the skin of V. vinifera fruits (codified as ACH37 extract), with the aim of supporting its use as an antiaging cosmetic ingredient candidate in clinical trials.

Methods

We employed enzymatic, phenotypic, and gene expression assays, both in vitro and ex vivo, to investigate the action of the ACH37 extract in different biological processes that could be related to skin aging mechanisms.

Results

The ACH37 extract was able to scavenge reactive oxygen species (DPPH, O2−), prevent inflammation (LPS‐ and UV‐induced COX‐2, IL‐1β, and IL‐8 expression), modulate extracellular matrix remodeling (inhibiting elastase, MMP‐1, MMP‐3, and MMP‐12, as well as associated expression), increase telomere length, telomerase activity, and reverse the UV‐induced suppression of genes involved in skin protection. In addition, the ACH37 extract permeated human skin explants and presented antioxidant efficacy ex vivo.

Conclusion

The results indicated that the ACH37 extract acts on multiple targets commonly related to skin aging, being a promising antiaging active ingredient candidate to be further investigated in clinical trials.
Neuromuscular exercise and counseling for treating recurrent low back pain in female healthcare workers—Findings from a 24‐month follow‐up study of a randomized controlled trial
Authors: Kolu Päivi , Suni Jaana H. , Tokola Kari , Raitanen Jani , Rinne Marjo , Taulaniemi Annika , Husu Pauliina , Kankaanpää Markku , Parkkari Jari
Published: July 2023

Background

Female healthcare workers have a high prevalence of low back pain (LBP)‐related sickness absence. Here, we report findings of a 24‐month follow‐up of a previously published 6‐month randomized controlled trial (RCT).

Methods

By adopting an RCT with 6 months of intervention and follow‐up at 6, 12, and 24 months, we assessed the maintenance of changes in the effectiveness (LBP and fear of pain) of the interventions (neuromuscular exercise [NME], back‐care counseling, both combined) using a generalized linear mixed model adjusted for baseline covariates. The incremental cost‐effectiveness ratio was calculated in terms of quality‐adjusted life years (QALY). A bootstrap technique was used to estimate the uncertainty around a cost‐effectiveness acceptability curve.

Results

Of the 219 females, 71% had data at 24 months. Between 6 and 24 months, LBP intensity (primary outcome) remained low in all intervention arms (−20% to −48%) compared to the control (−10% to −16%). Pain interfering with work remained low in the combined and exercise arms for up to 24 months. At 24 months, the total costs were lowest in the combined arm (€484 vs. €613–948, p < 0.001), as were the number of back‐related sickness absence days (0.16 vs. 1.14–3.26, p = 0.003). The analysis indicated a 95% probability of the combined arm to be cost‐effective per QALY gained at €1120.

Conclusions

Six months of weekly NME combined with four counseling sessions was cost‐effective for treating LBP and the effect was maintained over 24 months.

Trial registration

ClinicalTrials.gov, NCT01465698, 7/11/2011, prospective.
Non‐uniqueness of Leray–Hopf solutions to the forced fractional Navier–Stokes equations in three dimensions, up to the J. L. Lions exponent
Authors: Khor Calvin , Miao Changxing , Su Xiaoyan
Published: July 2023

In this paper, we show that for , there exists a force and two distinct Leray–Hopf flows solving the forced fractional Navier–Stokes equation starting from rest. This shows that the J. L. Lions exponent is sharp in the class of Leray–Hopf solutions for the forced fractional Navier–Stokes equation.
Abelianization and the Duistermaat–Heckman theorem
Authors: Crooks Peter , Weitsman Jonathan
Published: July 2023

We use the abelianization theorem of Crooks and Weitsman (2022) to prove a non‐abelian generalization of the Duistermaat–Heckman theorem for measures. Our main technical tools include the Gelfand–Cetlin data of Crooks and Weitsman (2022), examples of which are the Gelfand–Cetlin systems of Guillemin–Sternberg and generalizations thereof due to Hoffman–Lane.
Systematic single amino acid affinity tuning of CD229 CAR T cells retains efficacy against multiple myeloma and eliminates on-target off-tumor toxicity
Authors: Vander Mause Erica R. , Baker Jillian M. , Dietze Kenneth A. , Radhakrishnan Sabarinath V. , Iraguha Thierry , Omili Destiny , Davis Patricia , Chidester Sadie L. , Modzelewska Katarzyna , Panse Jens , Marvin James E. , Olson Michael L. , Steinbach Mary , Ng David P. , Lim Carol S. , Atanackovic Djordje , Luetkens Tim
Published: July 2023

T cells expressing chimeric antigen receptors (CARs) have shown remarkable therapeutic activity against different types of cancer. However, the wider use of CAR T cells has been hindered by the potential for life-threatening toxicities due to on-target off-tumor killing of cells expressing low amounts of the target antigen. CD229, a signaling lymphocyte-activation molecule (SLAM) family member, has previously been identified as a target for CAR T cell–mediated treatment of multiple myeloma (MM) due to its high expression on the surfaces of MM cells. CD229 CAR T cells have shown effective clearance of MM cells in vitro and in vivo. However, healthy lymphocytes also express CD229, albeit at lower amounts than MM cells, causing their unintended targeting by CD229 CAR T cells. To increase the selectivity of CD229 CAR T cells for MM cells, we used a single amino acid substitution approach of the CAR binding domain to reduce CAR affinity. To identify CARs with increased selectivity, we screened variant binding domains using solid-phase binding assays and biolayer interferometry and determined the cytotoxic activity of variant CAR T cells against MM cells and healthy lymphocytes. We identified a CD229 CAR binding domain with micromolar affinity that, when combined with overexpression of c-Jun, confers antitumor activity comparable to parental CD229 CAR T cells but lacks the parental cells’ cytotoxic activity toward healthy lymphocytes in vitro and in vivo. The results represent a promising strategy to improve the efficacy and safety of CAR T cell therapy that requires clinical validation.
Nicotinamide enhances natural killer cell function and yields remissions in patients with non-Hodgkin lymphoma
Authors: Cichocki Frank , Zhang Bin , Wu Cheng-Ying , Chiu Emily , Day Abderrahman , O’Connor Roddy S. , Yackoubov Dima , Simantov Ronit , McKenna David H. , Cao Qing , Defor Todd E. , Janakiram Murali , Wangen Rose , Cayci Zuzan , Snyder Nathaniel , Kumar Akhilesh , Grzywacz Bartosz , Hwang Justin , Geffen Yona , Miller Jeffrey S. , Maakaron Joseph , Bachanova Veronika
Published: July 2023

Allogeneic natural killer (NK) cell adoptive transfer has shown the potential to induce remissions in relapsed or refractory leukemias and lymphomas, but strategies to enhance NK cell survival and function are needed to improve clinical efficacy. Here, we demonstrated that NK cells cultured ex vivo with interleukin-15 (IL-15) and nicotinamide (NAM) exhibited stable induction of
l
-selectin (CD62L), a lymphocyte adhesion molecule important for lymph node homing. High frequencies of CD62L were associated with elevated transcription factor forkhead box O1 (FOXO1), and NAM promoted the stability of FOXO1 by preventing proteasomal degradation. NK cells cultured with NAM exhibited metabolic changes associated with elevated glucose flux and protection against oxidative stress. NK cells incubated with NAM also displayed enhanced cytotoxicity and inflammatory cytokine production and preferentially persisted in xenogeneic adoptive transfer experiments. We also conducted a first-in-human phase 1 clinical trial testing adoptive transfer of NK cells expanded ex vivo with IL-15 and NAM (GDA-201) combined with monoclonal antibodies in patients with relapsed or refractory non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) (NCT03019666). Cellular therapy with GDA-201 and rituximab was well tolerated and yielded an overall response rate of 74% in 19 patients with advanced NHL. Thirteen patients had a complete response, and 1 patient had a partial response. GDA-201 cells were detected for up to 14 days in blood, bone marrow, and tumor tissues and maintained a favorable metabolic profile. The safety and efficacy of GDA-201 in this study support further development as a cancer therapy.
Piscine Vitamin D Receptors Vdra/Vdrb in the Absence of Vitamin D Are Utilized by Grass Carp Reovirus for Promoting Viral Replication
Authors: Song Yun Jie , Zhang Jie , Xiao Jun , Feng Hao , Xu Zhen , Nie Pin , Chang Ming Xian
Published: July 2023

Grass carp reovirus (GCRV) is the causative agent of grass carp hemorrhagic disease, which seriously harms freshwater fish. Although many positive or negative regulators of GCRV infection have been identified in teleosts, little is known about the molecular mechanisms by which GCRV utilizes host factors to generate its infectious compartments beneficial for viral replication and infection.
Complications and risk factors on midline catheters’ follow-up about non-ICU patients: study protocol for a multicentre observational study (the midDATA study)
Authors: Derouin Yvan , Le Thuaut Aurélie , Dauvergne Jérome , Cinotti Raphaël , Cartron Emmanuelle
Published: July 2023

Introduction

The midline catheter (MC) is an increasingly popular device used commonly for patients with difficult venous access or those who require infusion for more than 6 days. Little is known about complications such as infection, thrombosis or occlusion for inpatient and home care patient. This protocol presents the follow-up of non-intensive care unit patients with an MC. The aim is to identify complications and search for risk factors associated with these complications.

Method and analysis

A prospective observational design is used for the follow-up of 2000 patients from 13 centres in France. Each practitioner (inserting clinician, anaesthetist nurse, hospital nurse and home nurse) will fill out a logbook to report each care made (eg, number of saline flushes, dress maintenance) on the MC and if any complications occurred. The incidence of complications (ie, infections, thrombosis or occlusions) will be expressed by the total number of events per 1000 catheter days. The period of recruitment began in December 2019 for a duration of 2 years. An extension of the inclusion period of 1 year was obtained.

Ethics and dissemination

This study received the approval of the Committee for the Protection of Persons of Nord Ouest IV (No EudraCT/ID-RCB : 2019-A02406-51). It was registered at clinical trials (NCT04131088). It is planned to communicate results at conferences and in a peer-reviewed journal.

Trial registration number

NCT04131088.
Levelling the learning ground for healthcare professionals across the world through SIMBA: a mixed-methods study
Authors: Malhotra Kashish , Ali Anisah , Soran Vina , Ogiliev Tamzin , Zhou Dengyi , Melson Eka , Davitadze Meri ,   The SIMBA and CoMICs team, Kempegowda Punith
Published: July 2023

Objectives

To compare the acceptance, strengths and limitations of Simulation via Instant Messaging-Birmingham Advance (SIMBA) in low/middle-income countries (LMICs) and high-income countries (HICs), on healthcare professionals’ professional development and learning.

Design

Cross-sectional study.

Setting

Online (either mobile or computer/ laptop or both).

Participants

462 participants (LMICs: 29.7%, n=137 and HICs: 71.3%, n=325) were included.

Interventions

Sixteen SIMBA sessions were conducted between May 2020 and October 2021. Doctors-in-training solved anonymised real-life clinical scenarios over WhatsApp. Participants completed pre-SIMBA and post-SIMBA surveys.

Primary and secondary outcome measures

Outcomes were identified using Kirkpatrick’s training evaluation model. LMIC and HIC participants’ reactions (level 1) and self-reported performance, perceptions and improvements in core competencies (level 2a) were compared using the χ2test. Content analysis of open-ended questions was performed.

Results

Postsession, there were no significant differences in application to practice (p=0.266), engagement (p=0.197) and overall session quality (p=0.101) between LMIC and HIC participants (level 1). Participants from HICs showed better knowledge of patient management (LMICs: 77.4% vs HICs: 86.5%; p=0.01), whereas participants from LMICs self-reported higher improvement in professionalism (LMICs: 41.6% vs HICs: 31.1%; p=0.02). There were no significant differences in improved clinical competency scores in patient care (p=0.28), systems-based practice (p=0.05), practice-based learning (p=0.15) and communication skills (p=0.22), between LMIC and HIC participants (level 2a). In content analysis, the major strengths of SIMBA over traditional methods were providing individualised, structured and engaging sessions.

Conclusions

Healthcare professionals from both LMICs and HICs self-reported improvement in their clinical competencies, illustrating that SIMBA can produce equivalent teaching experiences. Furthermore, SIMBA’s virtual nature enables international accessibility and presents potential for global scalability. This model could steer future standardised global health education policy development in LMICs.
Factors associated with emergency department avoidance during the COVID-19 pandemic and alternatives sought: a cross-sectional, telephone-based survey of frequent emergency department users in Beirut, Lebanon
Authors: Mahmassani Dina , El Helou Christelle , El Remlawi Akram , Mghames Abdo , Mneimne Omar , Hitti Eveline
Published: July 2023

Objectives

To explore avoidant behaviour of frequent emergency department (ED) users, reasons behind ED avoidance and healthcare-seeking behaviours in avoiders during the COVID-19 pandemic.

Design and setting

Cross-sectional, telephone-based survey administered between March and August 2021 at a tertiary care centre in Beirut, Lebanon.

Participants

Frequent ED users (defined as patients who visited the ED at least four times during the year prior to the first COVID-19 case in Lebanon).

Primary and secondary outcome measures

The primary outcome was ED avoidance among frequent ED users. Secondary outcomes included reasons behind ED avoidance and healthcare-seeking behaviours in avoiders.

Results

The study response rate was 62.6% and 286 adult patients were included in the final analysis. Within this sample, 45% (128/286) of the patients reported avoidant behaviour. Male patients were less likely to avoid ED visits than female patients (adjusted OR (aOR), 0.53; 95% CI 0.312 to 0.887). Other independent variables associated with ED avoidance included university education (aOR, 1.76; 95% CI 1.004 to 3.084), concern about contracting COVID-19 during an ED visit (aOR, 1.31; 95% CI 1.199 to 1.435) and underlying lung disease (aOR, 3.39; 95% CI 1.134 to 10.122). The majority of the patients who experienced acute complaints and avoided the ED completely (n=56) cited fear of contracting COVID-19 as the main reason (89.3% (50/56)). Most of the ED avoiders (83.9% (47/56)) adopted alternatives for seeking acute medical care, including messaging/calling a doctor (46.4% (26/56)), visiting a clinic (25.0% (14/56)), or arranging for a home visit (17.9% (10/56)). Of the avoiders, 64.3% (36/56) believed that the alternatives did not impact the quality of care, while 30.4% (17/56) reported worse quality of care.

Conclusions

Among frequent ED users, ED avoidance during COVID-19 was common, especially among women, those with lung disease, those with university-level education and those who reported fear of contracting COVID-19 in the ED. While some patients resorted to alternative care routes, telemedicine was still underused in our setting. Developing strategies to reduce ED avoidance, especially in at-risk groups, may be warranted during pandemics.
Outcomes and complications of nonagenarians undergoing cardiac surgery: a scoping review protocol
Authors: Ludski Jarryd , Carp Bradly , Makar Tim , Yii Michael , Lee Dong-Kyu , Weinberg Laurence
Published: July 2023

Introduction

Continually rising life expectancy and a shift towards an ageing population are resulting in an increasing population of nonagenarians. By 2030, the global population of nonagenarians is expected to exceed 30 million. The incidence of symptomatic cardiac disease is reported to occur in 25% of those aged over 75 years. Therefore, the number of nonagenarians undergoing cardiac surgery is also expected to increase. A linear relationship between advanced age and surgical risk has previously been demonstrated; however, it is not yet known whether this knowledge extends to the perioperative course and mortality of nonagenarians undergoing cardiac surgery. This scoping review aims to review the literature, assess whether a deficiency exists in the published literature and potentially identify knowledge gaps to guide future efforts to improve the understanding of nonagenarians undergoing cardiac surgery.

Methods and analysis

Following the relevant aspects of the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review guidelines, electronic databases of MEDLINE, EMBASE and the Cochrane Library will be systematically searched, with additional reference tracking of eligible studies. Studies reporting the outcomes of nonagenarians undergoing open cardiac surgery or minimally invasive cardiac surgery requiring cardiopulmonary bypass will be included. Screening and data extraction will be performed by two reviewers independently. The data will be analysed and summarised descriptively with a narrative approach. Qualitative data that capture quality-of-life outcomes will be subjected to thematic analysis where feasible. Additionally, reporting results will highlight similarities and differences in nonagenarian selection for surgery.

Ethics and dissemination

Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.
Risky sexual practice and associated factors among adult people living with HIV/AIDS in public hospitals of Kembata Tambaro Zone, Southern Ethiopia: a cross-sectional study
Authors: Bekele Zelalem , Mussa Ibsa , Assefa Yonas , Abera Negash , Amerga Ermias Woldie , Girma Addisu , Ayele Awugchew Teshome , Mengesha Melkamu Merid
Published: July 2023

Objective

This study assessed the magnitude of risky sexual practices and associated factors among adult people living with HIV (PLHIV) attending antiretroviral clinics in public hospitals in Kembata Tembaro Zone, southern Ethiopia.

Design

A cross-sectional study was conducted.

Setting

A hospital-based study was conducted among adult PLHIV in the Kambata Tambaro Zone, southern Ethiopia.

Participants

300 men and women aged 15 years and older who had been receiving HIV/AIDS care and support in four public hospitals participated in this study.

Study outcome

Risky sexual practice was the study outcome. It was defined based on responses to four items: multiple sexual partnerships, casual sex, consistent condom use and sex under the influence of alcohol. Risky sexual practice was defined based on a ‘yes’ response to any of the four items.

Results

Of the adult PLHIV who were sexually active in the 6 months preceding the survey, 75.7% (95% CI: 70.5% to 80.2%) engaged in at least one risky sexual practice, with 3.3% (95% CI: 1.8% to 6.1%) engaged in three or more. A positive attitude towards condom use and being on antiretroviral therapy for over 10 years were correlated with low odds of risky sexual practices. There was a higher likelihood of risky sexual behaviour among those who kept their HIV status secret and did not bring up using a condom before sexual contact. Whereas, those with a positive attitude towards condom use had a reduced risk of engaging in risky sexual practices.

Conclusion

A considerable proportion of adult PLHIV engage in risky sexual practices. Efforts directed at removing barriers to disclosing HIV status to partners and promoting condom use discussion among sexual partners could reduce the burden of risky sexual practices and the onward transmission of HIV.
Mapping the literature on decision regret in patients with non-communicable diseases (NCDs): a scoping review protocol
Authors: Brera Alice Silvia , Arrigoni Cristina , Magon Arianna , Conte Gianluca , Belloni Silvia , Bonavina Luigi , Caruso Rosario , Pasek Małgorzata
Published: July 2023

Introduction

Decision regret refers to feelings of remorse or dissatisfaction with a decision made regarding the treatment. Mapping the meaningful aspects of decision regret in patients with non-communicable diseases (NCDs) is necessary to provide a comprehensive understanding of the phenomenon and inform the development of effective interventions to address it. For this reason, this protocol aimed to describe the methodological aspects of a scoping review focused on mapping all the meaningful aspects of decision regret in patients with NCDs and provide a conceptual and comprehensive framework of the phenomenon.

Methods and analysis

The study described in this protocol will be performed following the Joanna Briggs Institute (JBI) methodology for scoping reviews. The anticipated starting time is July/August 2023 and the anticipated end of the review is June 2024. This scoping review will include quantitative, qualitative, primary and secondary literature, as well as grey literature on decision regret in patients with NCDs. The systematic search will be performed by consulting PubMed, Embase, Scopus, CINAHL, the Cochrane Library and Google Scholar. English-language articles from any context will be eligible for inclusion. Two independent reviewers will take part in an iterative process of evaluating literature, choosing papers and extracting data. Disagreements among reviewers will be solved through consensus meetings. Results will be presented in relation to the review question by employing tables, figures and narrative summaries.

Ethics and dissemination

This scoping review did not require ethical approval since it involves a literature review and does not include new data collection from human participants. The results of the review will provide a summary of the available literature on decision regret experienced by patients with NCDs, which is crucial for developing preventive educational interventions in situations where multiple therapeutic options are available.
Systematic review of preoperative and intraoperative colorectal Anastomotic Leak Prediction Scores (ALPS)
Authors: Venn Mary L , Hooper Richard L , Pampiglione Tom , Morton Dion G , Nepogodiev Dmitri , Knowles Charles H
Published: July 2023

Objective

To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical decision-making. Anastomotic leak (AL) is the most feared complication of colorectal surgery. Individualised leak risk could guide anastomosis and/or diverting stoma.

Methods

Systematic search of Ovid MEDLINE and Embase databases, 30 October 2020, identified existing ALPS and validation studies. All records including >1 risk factor, used to develop new, or to validate existing models for preoperative or intraoperative use to predict colorectal AL, were selected. Data extraction followed CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies guidelines. Models were assessed for applicability for surgical decision-making and risk of bias using Prediction model Risk Of Bias ASsessment Tool.

Results

34 studies were identified containing 31 individual ALPS (12 colonic/colorectal, 19 rectal) and 6 papers with validation studies only. Development dataset patient populations were heterogeneous in terms of numbers, indication for surgery, urgency and stoma inclusion. Heterogeneity precluded meta-analysis. Definitions and timeframe for AL were available in only 22 and 11 ALPS, respectively. 26/31 studies used some form of multivariable logistic regression in their modelling. Models included 3–33 individual predictors. 27/31 studies reported model discrimination performance but just 18/31 reported calibration. 15/31 ALPS were reported with external validation, 9/31 with internal validation alone and 4 published without any validation. 27/31 ALPS and every validation study were scored high risk of bias in model analysis.

Conclusions

Poor reporting practices and methodological shortcomings limit wider adoption of published ALPS. Several models appear to perform well in discriminating patients at highest AL risk but all raise concerns over risk of bias, and nearly all over wider applicability. Large-scale, precisely reported external validation studies are required.

PROSPERO registration number

CRD42020164804.
Parkinson’s disease: symptoms and medications at the end of life
Authors: Wilson Elisabeth Alice , King-Oakley Emily , Richfield Edward William
Published: July 2023

Objectives

People with Parkinson’s disease (PwP) have a high palliative symptom burden throughout their disease course, equivalent to advanced malignancy. We aim to establish trends in symptom frequency and prescribing in the 72 hours prior to death for PwP.

Methods

Retrospective case note review of PwP who died between February 2019 and September 2020.

Results

51 patients were included. 60.78% of patients (n=31) had agitation and 58.82% (n=30) had pain in the final 72 hours. Patients with cognitive impairment were 4.67 times more likely to experience agitation (p=0.035) compared with those without, with higher total midazolam doses (29.18 mg vs 11.4 mg, p=0.21). Terminal motor symptoms were recorded in three patients. 28.57% of patients received the recommended dose of rotigotine for dopaminergic therapy.

Conclusions

PwP have a significant symptom burden at the end of life (EOL) with levels of terminal agitation at the higher end of those expected in the general population. There was a trend towards higher doses of sedation, rather than analgesia, in people with coexistent cognitive impairment.

Terminal stiffness, despite being seldom documented in the literature, is an important although infrequent symptom.

Rotigotine use at EOL remains commonplace and better understanding of its effect and dosing is required.
Enabling Trust in Cross-Organisational Data Sharing for EMU Maintenance: A Double-Blockchain Solution
Authors: Zhang Tie , Wang Ying , Huang Lei , Zhou Tao
Published: July 2023

With the trend for smart maintenance for the electric multiple unit (EMU), there is a critical need for cross-organisational data sharing amongst multiple stakeholders. Traditional centralised solutions may not ensure sufficient trust for data sharing. In the maintenance field, blockchain technology has been introduced to improve security and privacy. However, the current blockchain solutions for data sharing are solely based on public chain or consortium chain, which may have the limitation of low transaction processing rate. Moreover, multiple levels of decentralisation are required in cross-organisational data sharing. For the purpose of providing multiple types of ledger’s governance and a performance improvement, this paper presents a method for developing EMU maintenance data sharing solution based on double blockchain. The method is validated using a case study in Shanghai EMU depot. The proposed solution adopts practical byzantine fault tolerance (PBFT) as the consensus mechanism. Interplanetary file system (IPFS) is introduced to reduce the payload of big data storage.
Data from Sex-specific associations between body mass index and thyroid cancer incidence among Korean adults
Authors: Kim Kyoung-Nam , Kim Kyungsik , Lee Sangjun , Park Sue K.
Published: July 2023

Abstract
Background: The potential differences by sex in the association between body mass index (BMI) and thyroid cancer risk remain unconfirmed.
Methods: Data from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) (2002–2015; population size = 510,619) and the Korean Multi-center Cancer Cohort (KMCC) data (1993–2015; population size = 19,026) were used. We constructed Cox regression models, adjusted for potential confounders, to evaluate the association between BMI and thyroid cancer incidence in each cohort, and assessed the consistency of the results.
Results: In the NHIS-HEALS, 1,351 and 4,609 incident thyroid cancer cases occurred during the follow-up among men and women, respectively. Compared to BMI of 18.5–22.9 kg/m2, BMI of 23.0–24.9 (N of cases = 410, hazard ratio [HR] = 1.25, 95% confidence interval [CI]: 1.08–1.44), 25.0–29.9 (N of cases = 522, HR = 1.32, 95% CI: 1.15–1.51), and ≥30.0 kg/m2 (N of cases = 48, HR = 1.93, 95% CI: 1.42–2.61) were associated with an increased risk of incident thyroid cancer among males. Among females, BMI of 23.0–24.9 (N of cases = 1,300, HR = 1.17, 95% CI: 1.09–1.26) and 25.0–29.9 (N of cases = 1,406, HR = 1.20, 95% CI: 1.11–1.29) were associated with incident thyroid cancer. The analyses using the KMCC demonstrated results consistent with wider CIs.
Conclusions: Sex-differences in the associations between BMI and thyroid cancer incidence were observed in Korean cohorts.
Impact: BMI <23 kg/m2 may help prevent incident thyroid cancer, especially among men.
White Matter Integrity and Chronic Poststroke Upper Limb Function: An ENIGMA Stroke Recovery Analysis
Authors: Domin Martin , Hordacre Brenton , Hok Pavel , Boyd Lara A. , Conforto Adriana B. , Andrushko Justin W. , Borich Michael R. , Craddock Richard C. , Donnelly Miranda R. , Dula Adrienne N. , Warach Steven J. , Kautz Steven A. , Lo Bethany P. , Schranz Christian , Seo Na Jin , Srivastava Shraddha , Wong Kristin A. , Zavaliangos-Petropulu Artemis , Thompson Paul M. , Liew Sook-Lei , Lotze Martin
Published: July 2023

BACKGROUND:

Integrity of the corticospinal tract (CST) is an important biomarker for upper limb motor function following stroke. However, when structurally compromised, other tracts may become relevant for compensation or recovery of function.

METHODS:

We used the ENIGMA Stroke Recovery data set, a multicenter, retrospective, and cross-sectional collection of patients with upper limb impairment during the chronic phase of stroke to test the relevance of tracts in individuals with less and more severe (laterality index of CST fractional anisotropy ≥0.25) CST damage in an observational study design. White matter integrity was quantified using fractional anisotropy for the CST, the superior longitudinal fascicle, and the callosal fibers interconnecting the primary motor cortices between hemispheres. Optic radiations served as a control tract as they have no a priori relevance for the motor system. Pearson correlation was used for testing correlation with upper limb motor function (Fugl-Meyer upper extremity).

RESULTS:

From 1235 available data sets, 166 were selected (by imaging, Fugl-Meyer upper extremity, covariates, stroke location, and stage) for analyses. Only individuals with severe CST damage showed a positive association of fractional anisotropy in both callosal fibers interconnecting the primary motor cortices (
r
[21]=0.49;
P=
0.025) and superior longitudinal fascicle (
r
[21]=0.51;
P=0
.018) with Fugl-Meyer upper extremity.

CONCLUSIONS:

Our data support the notion that individuals with more severe damage of the CST depend on residual pathways for achieving better upper limb outcome than those with less affected CST.
A real-world cost-effectiveness study of vancomycin versus linezolid for the treatment of late-onset neonatal sepsis in the NICU in China
Authors: Xie Linjun , Ding Leyun , Tang Lian , Yang Zuming , Wu Dan , Wang Wenjuan , Mao Juehui , Shi Lu , Liu Chun , Duan Lufen , Xu Jinhui , Zhou Qin , Sun Jiantong , Ding Xinyuan
Published: July 2023

Background and objective

Currently, the detection rates of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCoNS) in the blood cultures of neonates with sepsis exceed the national average drug resistance level, and vancomycin and linezolid are the primary antibacterial drugs used for these resistant bacteria according to the results of etiological examinations. However, a comprehensive evaluation of their costs and benefits in late-onset neonatal sepsis in a neonatal intensive care unit (NICU) has not been conducted. This study aimed to compare the cost and effectiveness of vancomycin and linezolid in treating neonatal sepsis in the NICU.

Methods

A cost-effectiveness analysis of real-world data was carried out by retrospective study in our hospital, and the cost and effectiveness of vancomycin and linezolid were compared by establishing a decision tree model. The drug doses in the model were 0.6 g for linezolid and 0.5 g for vancomycin. The cost break down included cost of medical ward, NICU stay, intravenous infusion of vancomycin or linezolid, all monitoring tests, culture tests and drugs. The unit costs were sourced from hospital information systems. The effectiveness rates were obtained by cumulative probability analysis. One-way sensitivity analysis was used to analyze uncertain influencing factors.

Results

The effectiveness rates of vancomycin and linezolid in treating neonatal sepsis in the NICU were 89.74% and 90.14%, respectively, with no significant difference. The average cost in the vancomycin group was ¥12261.43, and the average cost in the linezolid group was ¥17227.96. The incremental cost effectiveness was ¥12416.33 cost per additional neonate with treatment success in the linezolid group compared to vancomycin group at discharge. Factors that had the greatest influence on the sensitivity of the incremental cost-effectiveness ratio were the price of linezolid and the effectiveness rates.

Conclusions

The cost for treatment success of one neonate in linezolid group was ¥5449.17 more than that in vancomycin group, indicating that vancomycin was more cost-effective. Therefore, these results can provide a reference for a cost effectiveness treatment scheme for neonatal sepsis in the NICU.
Hyperparameter optimization method based on dynamic Bayesian with sliding balance mechanism in neural network for cloud computing
Authors: Zhang Jianlong , Wang Tianhong , Wang Bin , Chen Chen , Wang Gang
Published: July 2023

Hyperparameter optimization (HPO) of deep neural networks plays an important role of performance and efficiency of detection networks. Especially for cloud computing, automatic HPO can greatly reduce the network deployment cost by taking advantage of the computing power. Benefiting from its global-optimal search ability and simple requirements, Bayesian optimization has become the mainstream optimization method in recent years. However, in a non-ideal environment, Bayesian method still suffers from the following shortcomings: (1) when search resource is limited, it can only achieve inferior suboptimal results; (2) the acquisition mechanism cannot effectively balance the exploration of parameter space and the exploitation of historical data in different search stages. In this paper, we focused on the limited resources and big data provided by the cloud computing platform, took the anchor boxes of target detection networks as the research object, employed search resource as a restraint condition, and designed a dynamic Bayesian HPO method based on sliding balance mechanism. The dynamism of our method is mainly reflected in two aspects: (1) A dynamic evaluation model is proposed which uses the cross-validation mechanism to evaluate the surrogate model library and select the best model in real time; (2) A sliding balance mechanism is designed based on resource constraints to seek a balance between exploration and exploitation. We firstly augment the recommended samples of probability of improvement acquisition function by using k-nearest neighbor method, then introduce Hausdorff distance to measure the exploration value and match sampling strategy with resource utilization, which makes it slide smoothly with resource consumption to establish a dynamic balance of exploration to exploitation. The provided experiments show that our method can quickly and stably obtain better results under the same resource constraints compared with mature methods like BOHB.

Graphical Abstract
Τα δημοτικά τραγούδια του Βάβδου Χαλκιδικής
Authors: Παπαχρήστου Ιωάννης
Published: July 2023

Ο σκοπός της παρούσας έρευνας είναι να εξετάσει μουσικολογικά τα δημοτικά τραγούδια του Βάβδου Χαλκιδικής στο πλαίσιο μιας εθνομουσικολογικής προσέγγισης. Η έρευνα στοχεύει στην αναζήτηση και αποκρυπτογράφηση του πυρήνα των βαβδινών δημοτικών τραγουδιών και την αποτύπωσή του σε μουσική σημειογραφία ευρωπαϊκής μουσικής με ειδικά σύμβολα που υποδηλώνουν τα ιδιαίτερα διαστήματα της δημοτικής μουσικής. Με αυτόν τον τρόπο διεξάγεται μια δομική-μετρική- τροπική-συντακτική ανάλυση η οποία αποσκοπεί στο να καταστήσει τα άυλα-«ιδεατά μουσικά κείμενα» του προφορικού μας υλικού σε γραπτά κείμενα, κατάλληλα αποκρυπτογραφημένα για ειδική μελέτη. Τα βασικά εργαλεία διεξαγωγής της μελέτης είναι το αρχειακό ηχητικό υλικό, οι συνεντεύξεις και η έρευνα πεδίου. Εφαρμόζεται η ποιοτική εθνογραφική μέθοδος για τη συγκέντρωση δεδομένων σε βάθος χρόνου. Η έρευνα παρουσιάζει αποτελέσματα που μας οδηγούν στην επίγνωση της ομορφιάς και της αξίας της δημοτικής μας παράδοσης. Επιπλέον, μας διαφωτίζει για την κοσμοθεωρία των ανθρώπων που διατήρησαν αυτήν τη μουσική πολιτισμική κληρονομιά. Επίσης, μας βοηθάει να αντιληφθούμε τη λειτουργικότητα αυτής της μουσικής παράδοσης στο επικοινωνιακό πλαίσιο της αγροτοποιμενικής κοινότητας του τέλους του 19ου και των αρχών του 20ού αιώνα. Τέλος, εκτός από την καταγραφή και τη διάσωση της μουσικής κληρονομιάς, στοιχείο της εθνικής μας ταυτότητας, με τη συγκεκριμένη μελέτη προσδοκούμε την ευαισθητοποίηση απέναντι στην πολιτισμική ετερότητα και την ισοτιμία στην παγκόσμια κοινότητα των λαών. Κρίνεται απαραίτητη η χαρτογράφησή της που έχει ως στόχο τη διαφύλαξη της ευρωπαϊκής πολιτιστικής πολυμορφίας.
Evaluation of the frequency of e-cigarette usage among high school students and factors that influence vaping. Adolescents’ knowledge of chemical composition of e-cigarettes and side effects
Authors: Sejnowska Natalia , Dobko Katarzyna , Frącz Gabriela , Glac Agata , Kuliga Klaudia , Musz Kinga , Socha Agnieszka , Surowiec Agata , Śnieżek Kinga , Zając Anna
Published: July 2023

Introduction: E-cigarettes, also known as electronic cigarettes, pose a new public health challenge. Their growing popularity and availability have raised concerns about potential health risks for young people. Vaping may also become a new addiction among young people. 

Aim: The aim of the study was to assess the popularity of e-cigarette use among high school students and factors that influence vaping. Adolescents' knowledge of chemical composition of e-cigarettes and side effects was analyzed. 

Materials and methods: The survey was conducted among 323 people in the age range of 15 to 19 years old. The study group consisted of students from one of the high schools in Krosno. An anonymous online survey was used to conduct the study.

Results: 59% of the youth surveyed had tried an e-cigarette. 35,7% of non-smokers say they want to try vaping in the future. Most adolescents start their tobacco initiation with e-cigarettes. 62,2% are passive smokers and regularly inhale the vapor. 89% say it is easy to access e-cigarettes. Young people are aware of the harmfulness of e-cigarettes - 88,2%, and that they should not be used during pregnancy - 97%.

Conclusions: High school students are very likely to use e-cigarettes. Every other student has used them actively or passively. Increasing students' awareness of the side effects of vaping and identifying symptoms of addiction. Conversations with a pediatrician and health education lessons at school could have a huge impact on the decrease in e-cigarette usage by the youth.
Ideal Friendship, Actual Friends
Authors: Coleman Martin
Published: July 2023

Friendship, on George Santayana’s account, is a form of human society made possible by consciousness of ideals while simultaneously rooted in the experience of embodied creatures spontaneously drawn to each other. His philosophical and autobiographical writings on friendship (particularly his friendship with Frank Russell) exemplify a practice of cultivating wisdom and suggest how we can come to understand our own actual friendships and the opportunities for self-knowledge and sanity in them.
Pollination ecology of an important medicinal plant Hellenia speciosa (J.Koenig) S.R.Dutta of Asiatic tropics
Authors: SAMANTA ARABINDA , BERA BUBAI , KARMAKAR PRAKASH
Published: July 2023

Abstract. Samanta A, Bera B, Karmakar P. 2023. Pollination ecology of an important medicinal plant Hellenia speciosa (J.Koenig) S.R.Dutta of Asiatic tropics. Biodiversitas 24: 3152-3161. Plants often show various floral traits that help them to achieve reproductive fitness. Floral adaptive traits help to maximize the possibility of outcrossing, even for clonally propagated plants. Furthermore, seed setting through successful pollination increases genetic diversity in clonal populations. This present study aimed to describe the flowering phenology, flower biology, pollinators, and breeding system of Hellenia speciosa, a perennial herb with rhizomes from the Costaceae family. According to our study, a pollen-ovule ratio of 210:1 indicates that the plant tends to facultative autogamy; however, the plant exhibits traits such as a large landing labellum for pollinators, bilabiate floral architecture, nototribic blossoms, a prominent nectar guide, abundant floral nectar (27.64±2.661 µL/flower), and high seed set through xenogamy (68.6± 3.07 standard error) to improve reproductive success through outcrossing. Here, the plant is pollinated by two hymenopteran members, namely Xylocopa auripennis and Amegilla zonata. Despite its ample nectar production, the plant is hardly visited by any honey bee species. GCMS analysis of floral nectar found 2-hexanol and derivatives of xylose were probably responsible for pollinator specificity and honey bee exclusion events, respectively.