bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between the Patient Protection and Affordable Care Act and healthcare affordability among US adults with intellectual disability
Authors: Vaitsiakhovich N. , Landes S. D.
Published: May 2023

Background

Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access.

Methods

Using a pre‐ACA 2011–2013 sample and a post‐ACA implementation 2014–2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost.

Results

The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow‐up medical care and eyeglasses due to cost in the post‐ACA years.

Conclusions

The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow‐up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.
Pepper homeobox abscisic acid signalling‐related transcription factor 1, CaHAT1, plays a positive role in drought response
Authors: Baek Woonhee , Bae Yeongil , Lim Chae Woo , Lee Sung Chul
Published: May 2023

Abscisic acid (ABA) signalling triggers drought resistance mediated by SNF1‐related kinase 2s (SnRK2s), which transmits stress signals through the phosphorylation of several downstream factors. However, these kinases and their downstream targets remain elusive in pepper plants. This study aimed to isolate interacting partners of CaSnRK2.6, a homologue of Arabidopsis SnRK2.6/OST1. Among the candidate proteins, we identified a homeodomain‐leucine zipper (HD‐Zip) class II protein and named it CaHAT1 (Capsicum
annuum
homeobox
ABA signalling related‐
transcription factor
1). CaHAT1‐silenced pepper and ‐overexpression (OE) transgenic Arabidopsis plants were generated to investigate the in vivo function of CaHAT1 in drought response. Following the application of drought stress, CaHAT1‐silenced pepper plants exhibited drought‐sensitive phenotypes with reduced ABA‐mediated stomatal closure and lower expression of stress‐responsive genes compared with control plants. In contrast, CaHAT1‐OE transgenic Arabidopsis plants showed the opposite phenotypes, including increased drought resistance and ABA sensitivity. CaHAT1, particularly its N‐terminal consensus sequences, was directly phosphorylated by CaSnRK2.6. Furthermore, CaSnRK2.6 kinase activity and CaSnRK2.6‐mediated CaHAT1 phosphorylation levels were enhanced by treatment with ABA and drought stress. Taken together, our results indicated that CaHAT1, which is the target protein of CaSnRK2.6, is a positive regulator of drought stress response. This study advances our understanding of CaHAT1–CaSnRK2.6 mediated defence mechanisms in pepper plants against drought stress.
Feminism and activism across borders: A roundtable
Authors: Florvil Tiffany N. , Marino Katherine M. , Siegel Mona L.
Published: May 2023

This roundtable explores women's and feminist activism and advocacy across borders over the past century. Invited by Peace & Change, the participants are experts in women's, gender, diasporic, transnational, and global history, and they bring their recent and current research to bear on the following questions.
Random dynamics and limiting behaviors for 3D globally modified Navier–Stokes equations driven by colored noise
Authors: Caraballo Tomás , Chen Zhang , Yang Dandan
Published: May 2023

This paper is mainly concerned with the long‐term random dynamics for the nonautonomous 3D globally modified Navier–Stokes equations with nonlinear colored noise. We first prove the existence of random attractors of the nonautonomous random dynamical system generated by the solution operators of such equations. Then we establish the existence of invariant measures supported on the random attractors of the underlying system. Random Liouville‐type theorem is also derived for such invariant measures. Moreover, we further investigate the limiting relationship of invariant measures between the above equations and the corresponding limiting equations when the noise intensity approaches to zero. In addition, we show the invariant measures of such equations with additive white noise can be approximated by those of the corresponding equations with additive colored noise as the correlation time of the colored noise goes to zero.
Class numbers, cyclic simple groups, and arithmetic
Authors: Cheng Miranda C. N. , Duncan John F. R. , Mertens Michael H.
Published: May 2023

Here, we initiate a program to study relationships between finite groups and arithmetic–geometric invariants in a systematic way. To do this, we first introduce a notion of optimal module for a finite group in the setting of holomorphic mock Jacobi forms. Then, we classify optimal modules for the cyclic groups of prime order, in the special case of weight 2 and index 1, where class numbers of imaginary quadratic fields play an important role. Finally, we exhibit a connection between the classification we establish and the arithmetic geometry of imaginary quadratic twists of modular curves of prime level.
Effects of salt and stress on blood pressure parameters and antioxidant enzyme function in the heart and aorta of borderline hypertensive rats
Authors: Savić Bojana , Brkljačić Jelena , Glumac Sofija , Šarenac Olivera , Murphy David , Blagojević Duško , Japundžić‐Žigon Nina , Dušić Zorana Oreščanin
Published: May 2023

Hypertension and its complications are a leading cause of death in the human population. Several factors can contribute to development of hypertension, such as genetic predisposition, high salt intake and environmental stressors, underlying oxidative stress as one of its key trademarks. We studied the effects of increased salt intake and chronic stress on blood pressure parameters and the activity and protein levels of antioxidant enzymes in the heart and aorta of borderline hypertensive rats (BHRs) with genetic susceptibility to hypertension. All animals were randomized into four groups: (1) Wistar rats kept in baseline conditions; (2) BHRs kept in baseline conditions; (3) BHRs drinking 0.9% saline solution; and (4) BHRs drinking 0.9% saline solution and exposed to repeated heterotypic stress. The BHRs exhibited significantly higher blood pressure, mitochondrial superoxide dismutase (SOD2) and catalase (CAT) protein levels and lower glutathione peroxidase (GPx) and glutathione reductase (GR) activities in the aorta, followed by lower CAT and GPx protein levels and higher CAT and GR activities in the heart, compared with normotensive Wistar rats. In the BHR aorta, high salt intake elevated CAT and GPx activities, and when combined with stress it increased GPx and GR activities. In BHR hearts, high salt intake provoked lower CAT activity. Adding repeated stress to salt treatment further decreased CAT activity, in addition to Cu2+–Zn2+ superoxide dismutase (SOD1) and GR activities. The protein level of CAT was lower, whereas SOD2 and GPx increased. Overall, our results suggest that BHR hearts are better adapted to oxidative pressure, compared with the aorta, when exposed to salt and stress.
The Hypersonic Missile Gap
Authors: Abrams Michael
Published: May 2023

Though hypersonic cruise missiles represent the most bleeding edge of weapons development and promise to be the most versatile, they face the biggest technological challenges. The U.S. military is funding various research efforts.
Combinational Framework for Classification of Bearing Faults in Rotating Machines
Authors: Kumar Sujit , Ganga D.
Published: May 2023

In rotating machines, roller bearings are important and prone to frequent faults. Hence, accurate classification of bearing faults is significant in the maintenance of machines. Toward this, a framework using the combination of signal processing, machine learning, and deep learning algorithms has been proposed in contrast to traditional approaches for the accurate identification of bearing faults. The benefits of each algorithm have been reaped in the proposed framework to overcome challenges met in fault identification. In this, ensemble empirical mode decomposition is applied on bearing vibration signals to reduce nonstationarity and noise. The 12 intrinsic mode function (IMF) signals of 24k length obtained for three bearing conditions at four different speeds constituted feature space of dimension [36*8*24,000]. IMFs that have the highest correlation coefficient with raw vibration signals are selected as features [3*8*24,000], and intelligent algorithms are applied. Application of principal component analysis on selected IMF feature space resulted in extraction of significant feature space retaining temporal characteristics along two major components [3*2*24,000]. Considering the temporal dependence of faults in signals, a stacked long short-term memory (LSTM) deep network is chosen and trained with extracted features to improve fault classification. The performance of this developed framework has been evaluated for different metrics of the stacked LSTM model. The proposed framework also satisfactorily surpassed the performance of the stacked LSTM model trained with raw data, capable of auto-feature learning. The comparative results inclusive of models in relevant literature illustrate the efficacy of developed combinational framework in handling dynamic vibration data for precise classification of bearing faults.
Dual Quaternions Representation of Lagrange's Dynamic Equations
Authors: Cohen Avraham , Taub Benjamin , Shoham Moshe
Published: May 2023

This paper introduces for the first time, the Lagrange's dynamic equations in dual number quaternion form. Additionally, Rayleigh's dissipation function in dual quaternion form is introduced here allowing for the accounting of dissipative (non-conservative) forces such as motion through a viscous fluid, friction, and spring damping force. As an example, dual quaternions are used here to derive the Lagrange dynamic equations of a robot manipulator.
Isotropic plasma-thermal atomic layer etching of aluminum nitride using SF6 plasma and Al(CH3)3
Authors: Wang Haozhe , Hossain Azmain , Catherall David , Minnich Austin J.
Published: May 2023

We report the isotropic plasma atomic layer etching (ALE) of aluminum nitride using sequential exposures of SF6 plasma and trimethylaluminum [Al(CH3)3]. ALE was observed at temperatures greater than 200 °C, with a maximum etch rate of 1.9 Å/cycle observed at 300 °C as measured using ex situ ellipsometry. After ALE, the etched surface was found to contain a lower concentration of oxygen compared to the original surface and exhibited a ∼35% decrease in surface roughness. These findings have relevance for applications of AlN in nonlinear photonics and wide bandgap semiconductor devices.
Coseismic river avulsion on surface rupturing faults: Assessing earthquake-induced flood hazard
Authors: McEwan Erin , Stahl Timothy , Howell Andrew , Langridge Rob , Wilson Matthew
Published: May 2023

Surface-rupturing earthquakes can produce fault displacements that abruptly alter the established course of rivers. Several notable examples of fault rupture–induced river avulsions (FIRAs) have been documented, yet the factors influencing these phenomena have not been examined in detail. Here, we use a recent case study from New Zealand’s 2016 Kaikōura earthquake to model the coseismic avulsion of a major braided river subjected to ~7-m vertical and ~4-m horizontal offset. We demonstrate that the salient characteristics of the avulsion can be reproduced with high accuracy by running a simple two-dimensional hydrodynamic model on synthetic (pre-earthquake) and “real” (post-earthquake) deformed lidar datasets. With adequate hydraulic inputs, deterministic and probabilistic hazard models can be precompiled for fault-river intersections to improve multihazard planning. Flood hazard models that ignore present and potential future fault deformation may underestimate the extent, frequency, and severity of inundation following large earthquakes.
Effects of local domestication warrant attention in honey bee population genetics
Authors: Lin Zheguang , Zhu Zhongxu , Zhuang Mingliang , Wang Zhi , Zhang Yi , Gao Fuchao , Niu Qingsheng , Ji Ting
Published: May 2023

Honey bees,
Apis mellifera
, have for millennia been managed and exploited by humans and introduced into most suitable regions worldwide. However, given the lack of records for many introduction events, treating
A. mellifera
populations as native would predictably bias genetic studies regarding origin and evolution. Here, we used the Dongbei bee, a well-documented population, introduced beyond the natural distribution range approximately 100 years ago, to elucidate the effects of local domestication on animal population genetic analyses. Strong domestication pressure was detected in this population, and the genetic divergence between Dongbei bee and its ancestral subspecies was found to have occurred at the lineage level. Results of phylogenetic and time divergence analyses could consequently be misinterpreted. Proposing new subspecies or lineages and performing analyses of origin should thus strive to eliminate anthropogenic effects. We highlight the need for definitions of landrace and breed in honey bee sciences and make preliminary suggestions.
Complete Genome Sequence of Corynebacterium ulcerans Strain TSU-28, Harboring Two Diphtheria Toxin Genes, Isolated from a Patient with Diphtheria-Like Symptoms
Authors: Kawase Jun , Sekizuka Tsuyoshi , Sakai Tomotake , Fujisawa Naoki , Iwaki Masaaki , Kimura Miyuki , Kuroda Makoto
Published: May 2023

Diphtheria toxin-producing
Corynebacterium ulcerans
is an emerging zoonotic pathogen that causes severe disease in humans. Here, we report the complete genome sequence of
C. ulcerans
strain TSU-28, harboring two diphtheria toxin genes, which was isolated from the throat of a patient with diphtheria-like symptoms in 2019 in Japan.
Supplemental Material: Do microcontinents nucleate subduction initiation?
Authors: Zhu Mingshuai , Yan Zhiyong , al. et
Published: May 2023

Numerical modeling method, Table S1, and Figures S1–S3.  
Supplemental Material: Iron, boron, and sulfur isotope constraints on the ore-forming process of subseafloor replacement-style volcanogenic massive sulfide systems
Authors: Xiao Bing , Chen Huayong , al. et
Published: May 2023

Table S1: Locations of samples collected for Fe, S, and B isotope, and EPMA analyses. Table S2: The Fe isotope compositions of whole-rock and minerals (pyrite, chalcopyrite, and chlorite) from the Ashele deposit. Table S3: The S isotope compositions of pyrite and chalcopyrite from the Ashele deposit. Table S4: The B isotope compositions of tourmaline from the Ashele deposit. Table S5: EPMA data of chlorite and tourmaline from the Ashele deposit.
Supplemental Material: The origin of high-silica granites and rare metal mineralization: Insights from geochemistry and U-Pb-Sr-Nd-Hf-O isotopes of Early Cretaceous granitoids in the southern Great Xing’an Range, NE China
Authors: Wu Hao-Ran , Ge Wen-chun , et al.
Published: May 2023

Figure S1: Photographs (A) and photomicrographs (B) of Weilasituo ZK granites. Figure S2: Photographs of Weilasituo ZK granites. Figure S3: Photomicrographs of Weilasituo (A–C) BD granites and (D–I) ZK granites. Figure S4: Photomicrographs of (A) Damuchu quartz monzonite porphyry and (B) Baocun granodiorites. Figure S5: Photomicrographs of Zalute (A) quartz diorite and (B) monzogranite. Table S1: LA-ICP-MS U-Pb zircon data of the Cretaceous HSGs from the SGXRMB. Table S2: Major (wt%) and trace (ppm) elements of the Cretaceous HSGs from the SGXRMB. Table S3: Whole-rock Sr-Nd-Hf isotopic compositions of the Cretaceous HSGs from the SGXRMB. Table S4: Zircon Hf-O isotopic compositions of the Cretaceous HSGs from the SGXRMB.
Supplemental Material: Late Cenozoic deformation in the U.S. southern Colorado Front Range revealed by river profile analysis and fluvial terraces
Authors: Marder Eyal , al. et
Published: May 2023

Text S1: Methods additional information. Figure S1. Slope-drainage area plot for 100 m streamwise distance increments along the eastern Rockies drainage network (grey points) overlain by log-binned averages of the raw data (purple squares). Figure S2: Result from the variance minimization method used to calculate θ_ref=0.41 for the eastern Rockies drainage network. Figure S3: Flexural response of the Arkansas River valley across the western High Plains under T_e = 5 km, 10 km, and 15 km. Table S1: Summary of terrace strath elevations and alluvial fill thicknesses as measured in the field.
Physical and cognitive impairments in people suffering from long COVID: protocol for a longitudinal population-based cohort study
Authors: Zahouani Imane , Desmeules François , Perreault Kadija , Campeau-Lecours Alexandre , Best Krista , Beaulieu-Bonneau Simon , Paquette Jean-Sébastien , Deslauriers Simon , Daigle Nicolas , Drouin Gilles , Tittley Jean , Gagnon Marie-Andrée , Salmam Imane , Brouillard Sarah-Maude , Lepage Katherine , Roy Jean-Sébastien
Published: May 2023

Introduction

Approximately 33% of people who contracted COVID-19 still experience symptoms 12 weeks after infection onset. This persistence of symptoms is now considered a syndrome itself called ‘long COVID’. Evidence regarding long COVID and its cognitive and physical impacts is growing, but the literature is currently lacking objectively measured data to guide towards adapted healthcare trajectories. The objectives are to describe the physical and cognitive impairments experienced by individuals living with long COVID using self-reported and clinical objective measures, and to compare the evolution over time of the physical and cognitive state between adults living with long COVID (at least one physical or cognitive COVID-19 symptom for more than 12 weeks following infection; long COVID group), people who developed COVID-19 but did not experience persistent symptoms (short COVID group) and people who did not develop COVID-19 (control group).

Methods and analysis

In this longitudinal cohort study, 120 participants will be recruited in each group. Variables will be collected through three evaluation sessions over 6 months (baseline, 3 months, 6 months). Variables include self-administered questionnaires on health-related quality of life, comorbidity, sleep, pain, anxiety, depressive symptoms, fatigue and cognitive function, as well as objective measures of cognitive (attention, memory, executive functioning) and physical (grip strength, balance, gait speed, gait endurance, VO2, frailty) functions. Activity, heart rate and sleep will be monitored with a fitness tracker watch for 7 days following evaluation sessions. Maximum-likelihood analyses of variance (ANOVAs) will be used to compare data at baseline between groups. Repeated measures ANOVAs will be used to compare the longitudinal performance variations across groups of the self-reported and clinical variables.

Ethics and dissemination

Ethics committees of the CIUSSS de la Capitale-Nationale and CIUSSS de l’Est-de-l’Île-de-Montréal approved the project. Results will be disseminated through clinical and community platforms as well as through peer-reviewed manuscripts and international conferences.

Trial registration number

NCT05216536.
Separate and combined effects of long-term GIP and GLP-1 receptor
activation in patients with type 2 diabetes: a structured summary of a study
protocol for a double-blind, randomised, placebo-controlled clinical
trial
Authors: Helsted Mads M , Gasbjerg Lærke S , Vilsbøll Tina , Nielsen Casper K , Forman Julie L , Christensen Mikkel B , Knop Filip K
Published: May 2023

Introduction

Due to reports of severely reduced insulinotropic effect of the
incretin hormone glucose-dependent insulinotropic polypeptide (GIP) in
type 2 diabetes (T2D), GIP has not been considered therapeutically
viable. Recently, however, tirzepatide, a novel dual incretin receptor
agonist (activating the GIP receptor and the glucagon-like peptide 1
(GLP-1) receptor) has demonstrated greater glucose and body
weight-lowering properties as compared to GLP-1 receptor agonist
therapy. The contribution of GIP receptor activation to effects of
tirzepatide remains unknown. We will evaluate the glucose-lowering
effect of exogenous GIP in the context of pharmacological GLP-1 receptor
activation in patients with T2D.

Methods and analysis

In this randomised, double-blind, four-arm parallel,
placebo-controlled trial, 60 patients with T2D will be included (18–74
of age; on diet and exercise and/or metformin therapy only; glycated
haemoglobin 6.5–10.5% (48–91 mmol/mol)). Participants will be randomised
to an 8-week run-in period with subcutaneous (s.c.) placebo or
semaglutide injections once-weekly (0.5 mg). Participants will then be
randomised to 6 weeks’ add-on treatment with continuous s.c. placebo or
GIP infusion (16 pmol/kg/min). The primary endpoint is change in mean
glucose levels (assessed by 14-day continuous glucose monitoring) from
the end of the run-in period to end of trial.

Ethics and dissemination

The present study was approved by the Regional Committee on Health
Research Ethics in the Capitol Region of Denmark (identification no.
H-20070184) and by the Danish Medicines Agency (EudraCT no.
2020-004774-22). All results, positive, negative and inconclusive, will
be disseminated at national and/or international scientific meetings and
in peer-reviewed scientific journals.

Trial registration numbers

NCT05078255 and U1111-1259-1491.
Instruments for assessing quality policies and strategies in health systems: a scoping review protocol
Authors: Pellense Márcia Cunha da Silva , Gama Zenewton André da Silva
Published: May 2023

Introduction

The World Organization recommends to implement National Quality Policies and Strategies in health systems, but few instruments have been proposed to assess and monitor these quality interventions at the system level. This study will map and compare instruments for the assessment of quality policies and strategies in health systems around the world.

Methods and analysis

This is a scoping review protocol developed according to the Joanna Briggs Institute’s manual and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The search for articles will be performed in the following Embase, Medline/Pubmed, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature. Searches will also be conducted on Google Scholar and grey literature (www.opengrey.eu). A descriptive analysis of studies mapped by analysis categories will be performed. The results will be presented through a narrative summary of the mapped findings to verify how the results correlate with the objective and research question of the review.

Ethics and dissemination

The study does not require an ethical review due to its nature. The submission of results for publication in a peer-reviewed journal and presentation at a scientific conference is expected.

Link to the protocol record in the Open Science Framework (OSF)

https://DOI.org/10.17605/OSF.IO/2KMTS
Efficacy of a digital mental health intervention embedded in routine care compared with treatment as usual in adolescents and young adults with moderate depressive symptoms: protocol for randomised controlled trial
Authors: Szigethy Eva , Wolfson David , Sinclair-McBride Keneisha , Williams Kelly , Jhe Grace , Lee Erica H , Bialostozky Mario , Wallace Meredith , Bhatnagar Sonika , Demaso DR , Yealy Donald M , Hollenbach Kathryn
Published: May 2023

Introduction

There are unmet mental health needs of depressed adolescents and young adults (AYAs) across the USA. Behavioural technology adequately integrated into clinical care delivery has potential to improve care access and efficiency. This multisite randomised controlled trial evaluates how a coach-enhanced digital cognitive behavioural intervention (dCBI) enhances usual care for depressed AYAs in paediatric practices with minority enriched samples.

Methods and analysis

Participants (n=750) ages 16–22 who meet threshold criteria for depressive severity (Patient Health Questionnaire-9; PHQ-9 score 10-24) will be recruited through paediatric practices across three academic institutions (Boston, Pittsburgh and San Diego). Participants will be randomised to 12 weeks of dCBI+treatment as usual (TAU) (n=450) or TAU alone (n=300) in outpatient paediatric practices. Assessments will be completed at baseline, 6 weeks and 12 weeks with the primary outcome being improvement in clinician-rated and self-reported depressive severity (Children’s Depression Rating Scale—Revised and PHQ-9) and secondary outcomes being self-reported suicidal ideation (item 9 on PHQ-9), anxiety severity (Generalised Anxiety Disorder), general quality of life (Satisfaction with Life Scale) and general functioning (Children’s Global Assessment Scale). The study design is an intent-to-treat mixed effects regression with group, and covariates nested within the sites.

Ethics and dissemination

All participants or their parent/guardian (under 18 years or unemancipated) will give informed consent to a study team member. All data are expected to be collected over 18 months. The Institutional Review Board (IRB) is a board at each institution in the United States that reviews and monitors research involving human subjects. IRB approval from the University of Pittsburgh was obtained on 30 November 2021 (STUDY21080150), from the University of California San Diego’s Human Research Protection Program IRB on 14 July 2022 (802047), and from the Boston Children’s Hospital IRB on 25 October 2022 (P00040987). Full study results are planned to be published within 2 years of initial study recruitment (October 2024). Dissemination of findings will occur in peer-reviewed journals, professional conferences and through reports to participating entities and stakeholders.

Trial registration number

NCT05159713; ClinicalTrials.gov
Dose and administration time of indocyanine green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): study protocol for a randomised clinical trial
Authors: López-Sánchez Jaime , Garrosa-Muñoz Sonsoles , Pardo Aranda Fernando , Gené Škrabec Clara , López Pérez Ricardo , Rodríguez-Fortúnez Patricia , Sánchez Santos José Manuel , Muñoz-Bellvís Luis
Published: May 2023

Background

One of the most severe complications in laparoscopic cholecystectomy (LC) is intraoperative bile duct injury (BDI). Despite its low incidence, the medical implications for the patient can be serious. Besides, BDI can also generate significant legal issues in healthcare. Different techniques have been described to reduce the incidence of this complication, and near-infrared fluorescence cholangiography with indocyanine green (NIRFC-ICG) is one of the latest additions. In spite of the great interest aroused by this procedure, there are currently great disparities in the usage or administration protocols of ICG.

Methods and analysis

This is a randomised, multicentre, per-protocol analysis, open clinical trial with four arms. The estimated duration of the trial is 12 months. The aim of the study is to analyse whether there are differences between the dose and administration ICG intervals to obtain good-quality NIRFC during LC. The primary outcome is the degree of identification of critical biliary structures during LC. In addition, different factors will be analysed that may have an influence on the results of this technique.

Ethics and dissemination

The trial will be conducted according to the recommendations for Clinical Trials in the Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects and the recommendations of the Spanish Agency of Medicines and Medical Devices (AEMPs) for clinical trials. This trial was approved by the local institutional Ethics Committee and the AEMPs. The results of the study will be presented to the scientific community through publications, conferences or other means.

EudraCT number

2022-000904-36.

Protocol version

V.1.4, 2 June 2022

Trial registration number

NCT05419947.
Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study
Authors: Coakley Niamh , Wiese Anel , O'Leary Paula , Bennett Deirdre
Published: May 2023

Context

Factors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead.

Objective

To explore the experience of commencing practice for these new doctors with this increased near-peer support.

Design

We used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year’s interns.

Setting

University College Cork, one of six medical schools in Ireland.

Participants

Nine newly qualified medical doctors.

Main outcome measures

An exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor.

Results

Participants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety.

Conclusions

Enhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.
Investigating post-mild traumatic brain injury neuromuscular function and musculoskeletal injury risk: A protocol for a prospective, observational, case–controlled study in service members and active individuals
Authors: Lynall Robert C , Wasser Joseph G , Brooks Daniel I , Call Jarrod A , Hendershot Brad D , Kardouni Joseph R , Schmidt Julianne D , Mauntel Timothy C
Published: May 2023

Introduction

Musculoskeletal injury (MSKI) risk is increased following mild traumatic brain injury (mTBI). Increased MSKI risk is present up to 2 years following post-mTBI return-to-duty/activity relative to both non-mTBI peers and to their pre-mTBI selves across a range of populations, including military service members, and professional, college and high school athletes. Despite the well documented increased post-mTBI MSKI risk, the underlying neuromuscular mechanisms contributing to this increased risk have yet to be definitively determined. A number of potential mechanisms have been suggested (eg, aberrant kinematics, dynamic balance impairments, lower voluntary muscle activation), but none have been confirmed with a comprehensive, prospective study. This study aims to: (1) elucidate the neuromuscular control mechanisms following mTBI that contribute to increased MSKI risk, and (2) prospectively track patient outcomes (up to 12 months; MSKI occurrences and patient-reported outcomes (PRO)).

Methods and analysis

This is a multicentre prospective, case-matched control observational study to identify deficiencies in neuromuscular function following mTBI that may contribute to increased MSKI risk. Participants (aim to recruit 148, complete data collection on 124) will be classified into two cohorts; mTBI and control. All participants will undergo longitudinal (initial, 6 weeks post-initial, 12 weeks post-initial) comprehensive three-dimensional biomechanical (jump-landing; single leg hop; cut; gait), neuromuscular (interpolated twitch technique, muscular ramp contraction) and sensory (joint repositioning; light touch sensation) assessments to elucidate the underlying neuromuscular control mechanisms post-mTBI that may contribute to increased MSKI. Occurrences of MSKI and PROs (National Institutes of Health Patient-Reported Outcome Measurement Information System: Physical Function, Pain Interference, Depression, Anxiety; Brief Resilience Scale; Tampa Scale of Kinesiophobia), will be tracked monthly (up to 1 year) via electronic data capture platforms.

Ethics and dissemination

The study received approval from the Walter Reed National Military Medical Center Institutional Review Board. Results will be made available to the associated funding agency and other researchers via conference proceedings and journal articles.

Trial registration number

NCT05122728.
Cash plus programming and intimate partner violence: a qualitative evaluation of the benefits of group-based platforms for delivering activities in support of the Ethiopian government’s Productive Safety Net Programme (PSNP)
Authors: Buller Ana Maria , Pichon Marjorie , Hidrobo Melissa , Mulford Michael , Amare Tseday , Sintayehu Wastina , Tadesse Seifu , Ranganathan Meghna
Published: May 2023

Objectives

Intimate partner violence (IPV) is a public health challenge but there is evidence that cash and cash ‘plus’ interventions reduce IPV. An increasingly popular design feature of these kind of interventions is the group-based modality for delivering plus activities, however, evidence of the mechanisms through which this modality of delivery impacts IPV is limited. We explore how the group-based modality of delivering plus activities that complemented the Government of Ethiopia’s Productive Safety Net Programme contributed to modifying intermediate outcomes on the pathway to IPV.

Design

Qualitative study using in-depth interviews and focus group discussions between February and March 2020. Data were analysed using a thematic content and gender lens approach. Findings were interpreted, refined and drafted in collaboration with our local research partners.

Setting

Amhara and Oromia regions in Ethiopia.

Participants

In total 115 men and women beneficiaries from the Strengthen PSNP4 Institutions and Resilience (SPIR) programme took part in the study. Fifty-eight were interviewed and 57 took part in 7 focus group discussions.

Results

We found that Village Economic and Social Associations—through which SPIR activities were delivered—improved financial security and increased economic resilience against income shocks. The group-based delivery of plus activities to couples appeared to enhance individual agency, collective power and social networks, which in turn strengthened social support, gender relations and joint decision-making. Critical reflective dialogues provided a reference group to support the shift away from social norms that condone IPV. Finally, there appeared to be gender differences, with men highlighting the financial benefits and enhanced social status afforded by the groups, whereas women’s accounts focused primarily on strengthened social networks and social capital.

Conclusion

Our study offers important insights into the mechanisms by which the group-based delivery of plus activities affects intermediate outcomes on the pathway to IPV. It underscores the importance of the modality of delivery in such programmes, and suggests that policy-makers should consider gender-specific needs as men and women might differentially benefit from interventions that enhance social capital to generate gender transformative impacts.
Clinical features and novel technologies for prehospital detection of intracerebral haemorrhage: a scoping review protocol
Authors: Almubayyidh Mohammed , Alghamdi Ibrahim , Parry-Jones Adrian Robert , Jenkins David
Published: May 2023

Introduction

The detection of intracerebral haemorrhage (ICH) in the prehospital setting without conventional imaging technology might allow early treatment to reduce haematoma expansion and improve patient outcomes. Although ICH and ischaemic stroke share many clinical features, some may help in distinguishing ICH from other suspected stroke patients. In combination with clinical features, novel technologies may improve diagnosis further. This scoping review aims to first identify the early, distinguishing clinical features of ICH and then identify novel portable technologies that may enhance differentiation of ICH from other suspected strokes. Where appropriate and feasible, meta-analyses will be performed.

Methods

The scoping review will follow the recommendations of the Joanna Briggs Institute Methodology for Scoping Reviews as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A systematic search will be conducted using MEDLINE (Ovid), EMBASE (Ovid) and CENTRAL (Ovid). EndNote reference management software will be used to remove duplicate entries. Two independent reviewers will screen titles, abstracts and full-text reports according to prespecified eligibility criteria using the Rayyan Qatar Computing Research Institute software. One reviewer will screen all titles, abstracts and full-text reports of potentially eligible studies, while the other reviewer will independently screen at least 20% of all titles, abstracts and full-text reports. Conflicts will be resolved through discussion or by consulting a third reviewer. Results will be tabulated in accordance with the scoping review’s objectives along with a narrative discussion.

Ethics and dissemination

Ethical approval is not required for this review, as it will only include published literature. The results will be published in an open-access, peer-reviewed journal, presented at scientific conferences and form part of a PhD thesis. We expect the findings to contribute to future research into the early detection of ICH in suspected stroke patients.
Impact of prestroke physical activity and citalopram treatment on poststroke depressive symptoms: a secondary analysis of data from the TALOS randomised controlled trial in Denmark
Authors: Vestergaard Sigrid Breinholt , Damsbo Andreas Gammelgaard , Blauenfeldt Rolf Ankerlund , Johnsen Søren Paaske , Andersen Grethe , Mortensen Janne Kaergaard
Published: May 2023

Objectives

To investigate the association between prestroke physical activity and depressive symptoms up to 6 months after stroke and examine if citalopram treatment modified the association.

Design

A secondary analysis of data from the multicentre randomised controlled trial The Efficacy of Citalopram Treatment in Acute Ischemic Stroke (TALOS).

Setting and participants

TALOS was conducted at multiple stroke centres in Denmark from 2013 to 2016. It enrolled 642 non-depressed patients with first-ever acute ischaemic stroke. Patients were eligible for this study if a prestroke physical activity level was assessed by the Physical Activity Scale for the Elderly (PASE).

Interventions

All patients were randomised to citalopram or placebo for 6 months.

Outcomes

Depressive symptoms 1 and 6 months after stroke measured on the Major Depression Inventory (MDI) ranging from 0 to 50.

Results

A total of 625 patients were included. Median (IQR) age was 69 (60–77) years, 410 (65.6%) were men, 309 (49.4 %) received citalopram and median (IQR) prestroke PASE score was 132.5 (76–197). Higher prestroke PASE quartile, compared with the lowest PASE quartile, was associated with fewer depressive symptoms both after 1 month (mean difference third quartile −2.3 (−4.2, –0.5), p=0.013, mean difference fourth quartile −2.4 (−4.3, –0.5), p=0.015) and 6 months after stroke (mean difference third quartile −3.3 (−5.5, –1.2), p=0.002, mean difference fourth quartile −2.8 (−5.2, –0.3), p=0.027). There was no interaction between citalopram treatment and prestroke PASE score on poststroke MDI scores (p=0.86).

Conclusions

A higher prestroke physical activity level was associated with fewer depressive symptoms 1 and 6 months after stroke. Citalopram treatment did not seem to modify this association.

Trial registration numbers

NCT01937182(ClinicalTrials.gov) and 2013-002253-30 (EUDRACT).
Addressing bias in artificial intelligence for public health surveillance
Authors: Flores Lidia , Kim Seungjun , Young Sean D
Published: May 2023

Components of artificial intelligence (AI) for analysing social big data, such as natural language processing (NLP) algorithms, have improved the timeliness and robustness of health data. NLP techniques have been implemented to analyse large volumes of text from social media platforms to gain insights on disease symptoms, understand barriers to care and predict disease outbreaks. However, AI-based decisions may contain biases that could misrepresent populations, skew results or lead to errors. Bias, within the scope of this paper, is described as the difference between the predictive values and true values within the modelling of an algorithm. Bias within algorithms may lead to inaccurate healthcare outcomes and exacerbate health disparities when results derived from these biased algorithms are applied to health interventions. Researchers who implement these algorithms must consider when and how bias may arise. This paper explores algorithmic biases as a result of data collection, labelling and modelling of NLP algorithms. Researchers have a role in ensuring that efforts towards combating bias are enforced, especially when drawing health conclusions derived from social media posts that are linguistically diverse. Through the implementation of open collaboration, auditing processes and the development of guidelines, researchers may be able to reduce bias and improve NLP algorithms that improve health surveillance.
Polymorphic variants involved in methylation regulation: a strategy to discover risk loci for pancreatic ductal adenocarcinoma
Authors: Corradi Chiara , Lencioni Giulia , Gentiluomo Manuel , Felici Alessio , Latiano Anna , Kiudelis Gediminas , van Eijck Casper H J , Marta Katalin , Lawlor Rita T , Tavano Francesca , Boggi Ugo , Dijk Frederike , Cavestro Giulia Martina , Vermeulen Roel C H , Hackert Thilo , Petrone Maria Chiara , Uzunoğlu Faik Güntac , Archibugi Livia , Izbicki Jakob R , Morelli Luca , Zerbi Alessandro , Landi Stefano , Stocker Hannah , Talar-Wojnarowska Renata , Di Franco Gregorio , Hegyi Péter , Sperti Cosimo , Carrara Silvia , Capurso Gabriele , Gazouli Maria , Brenner Hermann , Bunduc Stefania , Busch Olivier , Perri Francesco , Oliverius Martin , Hegyi Péter Jeno , Goetz Mara , Scognamiglio Pasquale , Mambrini Andrea , Arcidiacono Paolo Giorgio , Kreivenaite Edita , Kupcinskas Juozas , Hussein Tamas , Ermini Stefano , Milanetto Anna Caterina , Vodicka Pavel , Kiudelis Vytautas , Hlaváč Viktor , Soucek Pavel , Theodoropoulos George E , Basso Daniela , Neoptolemos John P , Nóbrega Aoki Mateus , Pezzilli Raffaele , Pasquali Claudio , Chammas Roger , Testoni Sabrina Gloria Giulia , Mohelnikova-Duchonova Beatrice , Lucchesi Maurizio , Rizzato Cosmeri , Canzian Federico , Campa Daniele
Published: May 2023

Introduction

Only a small number of risk factors for pancreatic ductal adenocarcinoma (PDAC) has been established. Several studies identified a role of epigenetics and of deregulation of DNA methylation. DNA methylation is variable across a lifetime and in different tissues; nevertheless, its levels can be regulated by genetic variants like methylation quantitative trait loci (mQTLs), which can be used as a surrogate.

Materials and methods

We scanned the whole genome for mQTLs and performed an association study in 14 705 PDAC cases and 246 921 controls. The methylation data were obtained from whole blood and pancreatic cancer tissue through online databases. We used the Pancreatic Cancer Cohort Consortium and the Pancreatic Cancer Case–Control Consortium genome-wide association study (GWAS) data as discovery phase and the Pancreatic Disease Research consortium, the FinnGen project and the Japan Pancreatic Cancer Research consortium GWAS as replication phase.

Results

The C allele of 15q26.1-rs12905855 showed an association with a decreased risk of PDAC (OR=0.90, 95% CI 0.87 to 0.94, p=4.93×10−8in the overall meta-analysis), reaching genome-level statistical significance. 15q26.1-rs12905855 decreases the methylation of a 'C-phosphate-G' (CpG) site located in the promoter region of theRCCD1antisense (RCCD1-AS1) gene which, when expressed, decreases the expression of the RCC1 domain-containing (RCCD1) gene (part of a histone demethylase complex). Thus, it is possible that the rs12905855 C-allele has a protective role in PDAC development through an increase ofRCCD1gene expression, made possible by the inactivity ofRCCD1-AS1.

Conclusion

We identified a novel PDAC risk locus which modulates cancer risk by controlling gene expression through DNA methylation.
Cripping the pain scale: literary and biomedical narratives of pain assessment
Authors: Mellor Neko
Published: May 2023

This article analyses the literary representation of pain scales and assessment in two chronic pain narratives: ‘The Pain Scale’, a lyric essay by Eula Biss, and essays from Sonya Huber’s collectionPain Woman Takes Your Keys, and Other Essays from a Nervous System. Establishing first a brief history of methods attempting to quantify pain before my close reading, I read both Biss’ and Huber’s accounts as performative explorations of the limitations of using linear pain scales for pain which is recursive and enduring. Considering both texts as cripistemologies of chronic pain, my literary analysis attends to their criticism of the pain scale, including its implicit reliance on imagination and memory, and how its unidimensionality and synchronic focus prove inadequate for lasting pain. For Biss, this surfaces as a quiet critique of numbers and a disturbance of their fixity, while Huber’s criticism employs the motif of pain’s legibility across multiple bodies to spell out alternative meanings of chronic pain.

Crucially, this article proposes a crip and embodied approach for reading and responding to accounts of chronic pain’s measurement, including Biss’ and Huber’s literary accounts, and the biomedical account of pains scales which this article reads alongside them. The article’s analysis draws on my personal experience of chronic pain, neurodivergence and disability to demonstrate the generativity of an embodied approach to literary analysis. Rather than bowing to the impulse to impose false coherence on my reading of Biss and Huber, my article foregrounds the impact of the re-reading, misreading, cognitive dissonance and breaks necessitated by chronic pain and processing delays on this analysis. In bringing an ostensibly crip methodology to bear on readings of chronic pain, I hope to invigorate discussions on reading, writing and knowing chronic pain in the critical medical humanities.