bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors of pediatric ocular trauma related to ophthalmic complications
Authors: Mori Takaaki , Kinoshita Masakazu , Nomura Osamu , Ihara Takateru
Published: June 2023

Background

Ocular injury is a leading cause of monocular blindness in children. However, data on the association of injury type with ophthalmological complications are lacking. This study aimed to investigate the risk factors of pediatric ocular injuries related to ophthalmological complications.

Methods

This retrospective, observational study was conducted in a pediatric emergency department (ED) in Japan from March 2010 to March 2021. Patients aged less than 16 years presenting with ocular trauma, diagnosed on the basis of the International Classification of Diseases 10: S05, 0–9, were enrolled. Emergency department follow‐up visits for the same complaint were excluded. The patients' sex, age, arrival time, injury mechanism, symptoms, examinations, diagnosis, history of urgent ophthalmological consultation, outcomes, and ophthalmological complications were investigated. The primary endpoints were the odds ratio (OR) and 95% confidence interval (CI) of the incidence of ophthalmological complications, defined as any new acute complaint or worsening/persistence of an initial complaint following or resulting from ocular trauma.

Results

In total, 469 patients were analyzed. The median age was 7.3 years; the interquartile range (IQR) was 3.1–11.5 years. The most common diagnosis was contusion (79.3%), followed by lamellar laceration (11.7%). Seven patients (1.5%) had ophthalmological complications during follow up. Bivariate analysis demonstrated that daytime ED visit, impact with a sharp object, animal‐related injury, visual impairment, decreased visual acuity, and open globe injury were factors significantly associated with ophthalmological complications.

Conclusion

Daytime ED visit, impact with a sharp object, animal‐related injury, visual impairment, decreased visual acuity, and open globe injury were independent factors of ophthalmological complications.
The geopolitical risk spillovers across BRICS countries: A quantile frequency connectedness approach
Authors: Hong Vo Duc , Dang Tam Hoang‐Nhat
Published: June 2023

This paper investigates the geopolitical risk spillovers among BRICS countries during the 1985–2022 period. We adopt the novel quantile frequency connectedness approach, which allows us to examine the risk transmission by frequency and quantile. The geopolitical risks spread more intensely among BRICS countries during extreme circumstances. The long‐term geopolitical risk spillovers are the main contributors to the overall spillovers. Additionally, we note that significant increases in spillovers are associated with remarkable political events. Russia is the most dominant country and the largest short‐term and long‐term geopolitical risk transmitter to other BRICS members during the research period.
High‐impact jumping mitigates the short‐term effects of low energy availability on bone resorption but not formation in regularly menstruating females: A randomized control trial
Authors: Hutson Mark J. , O'Donnell Emma , Brooke‐Wavell Katherine , James Lewis J. , Raleigh Conor J. , Carson Brian P. , Sale Craig , Blagrove Richard C.
Published: June 2023

Low energy availability (LEA) is prevalent in active individuals and negatively impacts bone turnover in young females. High‐impact exercise can promote bone health in an energy efficient manner and may benefit bone during periods of LEA. Nineteen regularly menstruating females (aged 18–31 years) participated in two three‐day conditions providing 15 (LEA) and 45 kcals kg fat‐free mass−1 day−1 (BAL) of energy availability, each beginning 3 ± 1 days following the self‐reported onset of menses. Participants either did (LEA+J, n = 10) or did not (LEA, n = 9) perform 20 high‐impact jumps twice per day during LEA, with P1NP, β‐CTx (circulating biomarkers of bone formation and resorption, respectively) and other markers of LEA measured pre and post in a resting and fasted state. Data are presented as estimated marginal mean ± 95% CI. P1NP was significantly reduced in LEA (71.8 ± 6.1–60.4 ± 6.2 ng mL−1, p < 0.001, d = 2.36) and LEA+J (93.9 ± 13.4–85.2 ± 12.3 ng mL−1, p < 0.001, d = 1.66), and these effects were not significantly different (time by condition interaction: p = 0.269). β‐CTx was significantly increased in LEA (0.39 ± 0.09–0.46 ± 0.10 ng mL−1, p = 0.002, d = 1.11) but not in LEA+J (0.65 ± 0.08–0.65 ± 0.08 ng mL−1, p > 0.999, d = 0.19), and these effects were significantly different (time by condition interaction: p = 0.007). Morning basal bone formation rate is reduced following 3 days LEA, induced via dietary restriction, with or without high‐impact jumping in regularly menstruating young females. However, high‐impact jumping can prevent an increase in morning basal bone resorption rate and may benefit long‐term bone health in individuals repeatedly exposed to such bouts.
Motherhood, Fatherhood, and the Gender Gap in Occupational Authority1
Authors: Glauber Rebecca
Published: June 2023

Does motherhood diminish women's occupational authority and widen the gender gap among contemporary workers in the U.S.? The current study answers this question using data from the Occupational Information Network and 15 waves of panel data from the National Longitudinal Survey of Youth 1997 (2002–2019). Fixed effects' regressions show that married and unmarried mothers are less likely than their childless peers to have occupational authority. The motherhood penalty is larger for women with two or more children than one child. Men fare differently, as fatherhood is associated with a small increase in married men's likelihood of working in occupations with authority. Fixed effects regressions with individual slopes show that this association for men is not causal. Instead, married men may have additional children in response to an increase in their occupational authority. All told, parenthood widens the gender gap in authority. This study builds on theories of gendered families and gendered organizations to argue that mothers are systematically underrepresented in occupations with high levels of authority. Because people with authority make hiring, promotion, pay, and policy decisions, the underrepresentation of mothers may perpetuate other forms of labor market inequalities.
Doomed from the Let‐Go: Postincarceration Strategies for Managing Monetary Debt
Authors: Black Timothy , Caporale Lacey
Published: June 2023

Monetary sanctions are an integral and expanding part of the criminal legal system, even though most of the population under community supervision are indigent. Reentering citizens often leave imprisonment with considerable debt that accumulates from court costs and fees, supervision fees, child support arrears, motor vehicle, and other forms of debt. In this article, we examine how an indigent population of reentering citizens make sense of the totality of their debt, prioritize paying their debts, and develop strategies to increase their personal autonomy within the constraints of family dependence, debt, and state supervision. We track 30 men released from an Alternative Incarceration Facility in Cleveland, Ohio and use case studies to illustrate the strategies men adopted within a set of personal contingencies, including the nature of their debt, the extent of family support, their personal skills and resources, access to jobs, probation requirements, relationships with probation officers, and the exercise of judicial discretion. Our study demonstrates how risk‐taking is baked into the criminal legal system and how this keeps reentering citizens in a perpetual state of carceral vulnerability.
NIGT1.4 maintains primary root elongation in response to salt stress through induction of ERF1 in Arabidopsis
Authors: Hu Yunfei , Zeng Li , Lv Xiaodong , Guo Junhua , Li Xiaoyan , Zhang Xiaohua , Wang Dan , Wang Jingya , Bi Jinlong , Julkowska Magdalena M. , Li Bo
Published: June 2023

Plants employ various molecular mechanisms to maintain primary root elongation upon salt stress. Identification of key functional genes, therein, is important for improving crop salt tolerance. Through analyzing natural variation of the primary root length of Arabidopsis natural population under salt stress, we identified NIGT1.4, encoding an MYB transcription factor, as a novel contributor to maintained root growth under salt stress. Using both T‐DNA knockout and functional complementation, NIGT1.4 was confirmed to have a role in promoting primary root growth in response to salt stress. The expression of NIGT1.4 in the root was shown induced by NaCl treatments in an ABA‐dependent manner. SnRK2.2 and 2.3 were shown to interact with and phosphorylate NIGT1.4 individually. The growth of the primary root of snrk2.2/2.3/2.6 triple mutant was shown sensitive to salt stress, which was similar to nigt1.4 plants. Using DNA affinity purification sequencing, ERF1, a known positive regulator for primary root elongation and salt tolerance, was identified as a target gene for NIGT1.4. The transcriptional induction of ERF1 by salt stress was shown absent in nigt1.4 background. NIGT1.4 was also confirmed to bind to the promoter region of ERF1 by yeast one‐hybrid experiment and to induce the expression of ERF1 by dual‐luciferase analysis. All data support the notion that salt‐ and ABA‐elicited NIGT1.4 induces the expression of ERF1 to regulate downstream functional genes that contribute to maintained primary root elongation. NIGT1.4‐ERF1, therefore, acts as a signaling node linking regulators for stress resilience and root growth, providing new insights for breeding salt‐tolerant crops.
Altered methionine metabolism impacts phenylpropanoid production and plant development in Arabidopsis thaliana
Authors: Shin Doosan , Perez Veronica C. , Dickinson Gabriella K. , Zhao Haohao , Dai Ru , Tomiczek Breanna , Cho Keun Ho , Zhu Ning , Koh Jin , Grenning Alexander , Kim Jeongim
Published: June 2023

Phenylpropanoids are specialized metabolites derived from phenylalanine. Glucosinolates are defense compounds derived mainly from methionine and tryptophan in Arabidopsis. It was previously shown that the phenylpropanoid pathway and glucosinolate production are metabolically linked. The accumulation of indole‐3‐acetaldoxime (IAOx), the precursor of tryptophan‐derived glucosinolates, represses phenylpropanoid biosynthesis through accelerated degradation of phenylalanine ammonia lyase (PAL). As PAL functions at the entry point of the phenylpropanoid pathway, which produces indispensable specialized metabolites such as lignin, aldoxime‐mediated phenylpropanoid repression is detrimental to plant survival. Although methionine‐derived glucosinolates in Arabidopsis are abundant, any impact of aliphatic aldoximes (AAOx) derived from aliphatic amino acids such as methionine on phenylpropanoid production remains unclear. Here, we investigate the impact of AAOx accumulation on phenylpropanoid production using Arabidopsis aldoxime mutants, ref2 and ref5. REF2 and REF5 metabolize aldoximes to respective nitrile oxides redundantly, but with different substrate specificities. ref2 and ref5 mutants have decreased phenylpropanoid contents due to the accumulation of aldoximes. As REF2 and REF5 have high substrate specificity toward AAOx and IAOx, respectively, it was assumed that ref2 accumulates AAOx, not IAOx. Our study indicates that ref2 accumulates both AAOx and IAOx. Removing IAOx partially restored phenylpropanoid content in ref2, but not to the wild‐type level. However, when AAOx biosynthesis was silenced, phenylpropanoid production and PAL activity in ref2 were completely restored, suggesting an inhibitory effect of AAOx on phenylpropanoid production. Further feeding studies revealed that the abnormal growth phenotype commonly observed in Arabidopsis mutants lacking AAOx production is a consequence of methionine accumulation.
Generative tensions: Undergraduates' experience of Geography in US universities
Authors: Dutta Madhumita , McSweeney Kendra
Published: June 2023

We reflect on Geography in the US university by focusing on the paths taken by undergraduates into and beyond our classrooms. Those paths reveal aspects of Geography that appear unique to this national context, and include the structural barriers to US students' entry into Geography, from their highly uneven exposure to Geography in school to their unfamiliarity with it as a university degree. Yet many students still manage to find the field, with the troubling exception of Black and Indigenous students. We also highlight the paradox whereby graduates of this ‘invisible’ field are in high demand within government and industry, even as their training encourages them to simultaneously critique the tight coupling of Geography with those structures of power. We suggest that these are the distinctive and constitutive attributes of Geography in US universities that shape undergraduates and the geographies that they take out into the world.
Enhanced catalytic levofloxacin degradation via persulfate activation over amorphous potassium ferricyanide@ZIF‐67 nanocages
Authors: Wang Min , Liu Zhanmeng
Published: June 2023

A facile method was used to synthesize amorphous potassium ferricyanide (PF)@ZIF‐67 nanocages, a novel metal–organic framework derivative. The structure, composition and morphology of PF@ZIF‐67 were analysed by scanning electron microscopy, transmission electron microscope, X‐ray diffraction and X‐ray photoelectron spectroscopy. The results show that PF@ZIF‐67 nanoparticles were successfully prepared and its nanostructure has high crystallinity. The prepared materials were employed as heterogeneous persulfate catalysts for the degradation of levofloxacin (LEV). The effects of some key parameters including sodium persulfate (PS) dosage, PF@ZIF‐67, initial solution pH and reaction time on LEV degradation were investigated. PF@ZIF‐67 showed higher catalytic capacity for LEV degradation compared to ZIF‐67, implying the iron‐cobalt synergy in the material. Under the optimized conditions of 8.4‐mM PS, 0.5 g/L PF@ZIF‐67 at an initial solution pH of 7.2, 85.8% of LEV could be removed within 240 min. The quenching experiments suggest that sulfate radicals were the predominant reactive species.
Cutaneous changes in diabetic patients: Primed for aberrant healing?
Authors: Chen Vivien Y. , Siegfried Lindsey G. , Tomic‐Canic Marjana , Stone Rivka C. , Pastar Irena
Published: June 2023

Cutaneous manifestations affect most patients with diabetes mellitus, clinically presenting with numerous dermatologic diseases from xerosis to diabetic foot ulcers (DFUs). Skin conditions not only impose a significantly impaired quality of life on individuals with diabetes but also predispose patients to further complications. Knowledge of cutaneous biology and the wound healing process under diabetic conditions is largely limited to animal models, and studies focusing on biology of the human condition of DFUs remain limited. In this review, we discuss the critical molecular, cellular, and structural changes to the skin in the hyperglycaemic and insulin‐resistant environment of diabetes with a focus specifically on human‐derived data. Elucidating the breadth of the cutaneous manifestations coupled with effective diabetes management is important for improving patient quality of life and averting future complications including wound healing disorders.
Solar Air Conditioning Case Studies for Qatar Climate Conditions
Authors: Al-Azba Mohammed , Cen Zhaohui , Abotaleb Ahmed
Published: June 2023

Air conditioning (AC) is crucial for comfortable living in countries with challenging desert climates like Qatar. In the face of such harsh conditions, cooling applications account for up to 70% of energy consumption in residential buildings. Given the high-energy demand for cooling and the region's abundant solar resources, rooftop photovoltaics (PVs) can offer an ideal sustainable solution, as peak solar supply closely aligns with the electricity demand. This study aims to enhance the feasibility, effectiveness, and system design for solar ACs in Qatar's climate conditions. A simulation model is developed to evaluate different setups of solar AC systems, utilizing local historical weather data. Optimization strategies are explored and validated for the purpose of minimizing the need for costly battery storage. Results demonstrate the efficacy of these techniques, with potential reductions in battery capacity needs of up to 15% through heat inertia management and matching of energy supply and demand. The complete elimination of battery storage is found to be possible but would be at the expense of slight compromises in end-of-day indoor comfort, which can be addressed by cooling storage solutions.
Numerical and Experimental Study on Caudal Fin Oscillation Mode in Hemispherical Space
Authors: Wang Shuyan , Han Yu , Wu Zhiming , Huang Zhiliang
Published: June 2023

Attaining multidimensional movements, such as cruising, diving, and turning, is a crucial challenge in the development of bionic robotic fish. When only focusing on caudal fin movements, the caudal fin of a tuna generates significant lateral and propulsive forces and weak lift, while in contrast, the caudal fin of a dolphin generates significant lift and propulsive forces and weak lateral forces. The paper introduces a novel caudal fin oscillation mode for the hemispherical space, which extends the caudal fin oscillation features observed in tuna and dolphin to a broader range of organisms. First, we presented the concept of hemispherical space caudal fin oscillation mode, and demonstrated the principle of lift distribution through theoretical calculations. Moreover, we detailed the force distribution obtained by the robotic fish under different caudal fin oscillation modes through numerical simulations. Finally, we experimentally validated the feasibility of the hemispherical space caudal fin oscillation mode. The results indicate that by modifying the oscillation mode of the caudal fin in bionic robotic fish, it is possible to distribute the lift generated by the fin movement to various forces that aid in achieving multidimensional movement, including propulsive, lateral, and lift forces.
Training Characteristics and Competitive Demands in Women Road Cyclists: A Systematic Review
Authors: Herrero-Molleda Alba , Álvarez-Álvarez María José , Floría Pablo , García-López Juan
Published: June 2023

Purpose: To identify the main training characteristics and competitive demands in women’s road cycling. Methods: A systematic search was conducted on 5 databases according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The articles had to be primary studies, written after 1990 with a sample of competitive women between the ages of 15 and 50. The Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales were used. Results: The search yielded 1713 articles, of which 20 were included. Studies on training and competitive demands (n = 5) found that both external and internal loads are higher in women than in men. Studies on strength and endurance training (n = 5) showed that both velocity-based and heavy-load strength training programs performed at least 2 days per week and including 3 to 4 lower-body exercises improved performance. Altitude-training studies (n = 3) found that “Live High–Train Low” was effective to increase performance during the first 9 days after the training camp. The 7 remaining studies focused on a range of topics. The methodological quality was strong for 12 studies and moderate for 8. In contrast, the level of evidence was high in 7 and low in the other 13. Conclusions: Endurance training and competitive demands in women’s road cycling are higher than those of men. Strength training is effective in women when the frequency, intensity, and number of exercises are appropriate, while altitude training should be completed a few days before competing. Further studies are warranted to better define the participants’ competitive level, using a methodological design with a higher level of evidence.
IKK promotes naïve T cell survival by repressing RIPK1-dependent apoptosis and activating NF-κB
Authors: Carty Fiona , Layzell Scott , Barbarulo Alessandro , Islam Farjana , Webb Louise V. , Seddon Benedict
Published: June 2023

The inhibitor of κB kinase (IKK) complex regulates the activation of the nuclear factor κB (NF-κB) family of transcription factors. In addition, IKK represses extrinsic cell death pathways dependent on receptor-interacting serine/threonine-protein kinase 1 (RIPK1) by directly phosphorylating this kinase. Here, we showed that peripheral naïve T cells in mice required the continued expression of IKK1 and IKK2 for their survival; however, the loss of these cells was only partially prevented when extrinsic cell death pathways were blocked by either deleting
Casp8
(which encodes the apoptosis-inducing caspase 8) or inhibiting the kinase activity of RIPK1. Inducible deletion of
Rela
(which encodes the NF-κB p65 subunit) in mature CD4
+
T cells also resulted in loss of naïve CD4
+
T cells and in reduced abundance of the interleukin-7 receptor (IL-7R) encoded by the NF-κB target
Il7r
, revealing an additional reliance upon NF-κB for the long-term survival of mature T cells. Together, these data indicate that the IKK-dependent survival of naïve CD4
+
T cells depends on both repression of extrinsic cell death pathways and activation of an NF-κB–dependent survival program.
Eliminating infection by promoting bacterial growth
Authors: VanHook Annalisa M.
Published: June 2023

Host reactive nitrogen species maintain intracellular
Salmonella
in an antibiotic-tolerant, persister state.
To Test or Not? Xpert MTB/RIF as an Alternative to Smear Microscopy to Guide Line Probe Assay Testing for Drug-Resistant Tuberculosis
Authors: Pillay S. , de Vos M. , Sohn H. , Ghebrekristos Y. , Dolby T. , Warren R. M. , Theron G.
Published: June 2023

Xpert MTB/RIF (Xpert) revolutionized tuberculosis (TB) diagnosis. Laboratory decision making on whether widely-used reflex drug susceptibility assays (MTBDR
plus
, first-line resistance; MTBDR
sl
, second-line) are conducted is based on smear status, with smear-negative specimens often excluded. We performed receiver operator characteristic (ROC) curve analyses using bacterial load information (smear microscopy grade, Xpert-generated semi-quantitation categories and minimum cycle threshold [C
Tmin
] values) from Xpert rifampicin-resistant sputum for the prediction of downstream line probe assay results as “likely non-actionable” (no resistance or susceptible results generated).
Physical violence during pregnancy in sub-Saharan Africa: why it matters and who are most susceptible?
Authors: Ahinkorah Bright Opoku , Aboagye Richard Gyan , Seidu Abdul-Aziz , Boadu Frimpong James , Hagan John Elvis , Budu Eugene , Yaya Sanni
Published: June 2023

Objective

The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub-Saharan Africa (SSA).

Design

We analysed cross-sectional data of 108971 women in sexual unions from the most recent Demographic and Health Surveys of 26 countries in SSA. The predictors of physical violence were examined using a multilevel binary logistic regression. All the results were presented as adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs).

Setting

Twenty-six countries in SSA.

Participants

108 971 women who had ever been pregnant.

Outcome measure

Physical violence during pregnancy.

Results

Physical violence was identified in 6.0% of pregnant women in SSA. The highest prevalence (14.0%) was reported in South Africa, while Burkina Faso recorded the lowest (2.1%). Women who had primary (aOR=1.26, 95% CI=1.15, 1.38) and secondary education (aOR=1.15, 95% CI=1.01,1.32); those who were cohabiting (aOR=1.21, 95% CI=1.11, 1.32); those who were working (aOR=1.17, 95% CI=1.08, 1.28); and those whose partners had primary (aOR=1.15, 95% CI=1.04, 1.28) and secondary education (aOR=1.14, 95% CI=1.01, 1.28) were more likely to experience physical violence during pregnancy compared with those who had no formal education; those who were married; those who were not working, and those whose partners had no formal education, respectively. Moreover, women whose partners consumed alcohol (aOR=2.37, 95% CI=2.20, 2.56); those who had parity of four or more (aOR=2.06, 95% CI=1.57, 2.72); and those who perceived intimate partner violence (IPV) as a culturally accepted norm (aOR=1.55, 95% CI=1.44, 1.67) had higher odds of experiencing physical violence during pregnancy compared to those whose partners did not consume alcohol, those with parity zero, and those who did not perceive IPV as culturally accepted, respectively. On the contrary, women who were aged 35-39, those who were of the richest wealth index, and those in rural areas had reduced odds of experiencing physical violence during pregnancy.

Conclusion

Based on the findings, community leaders are encouraged to liaise with law enforcement agencies to strictly enforce laws on gender-based violence by prosecuting perpetrators of IPV against pregnant women as a deterrent. Also, intensifying education on what constitutes IPV and the potential consequences on the health of pregnant women, their children, and their families will be laudable. Improving the socioeconomic status of women may also help to eliminate IPV perpetration against women at their pregnancy stage.
High-risk fertility behaviour and undernutrition among children under-five in sub-Saharan Africa: a cross-sectional study
Authors: Seidu Abdul-Aziz , Hagan Jnr John Elvis , Budu Eugene , Aboagye Richard Gyan , Okyere Joshua , Sakyi Barbara , Adu Collins , Ahinkorah Bright Opoku
Published: June 2023

Objective

The study examined high-risk fertility behaviour and its association with under-five undernutrition in sub-Saharan Africa (SSA).

Design

We conducted a cross-sectional analysis of data from 32 sub-Saharan African countries’ Demographic and Health Surveys. A weighted sample of 110 522 mother-child pairs was included in final analysis. Multilevel binary logistic regression was used to examine the association between high-risk fertility behaviour and undernutrition. The results were presented using adjusted odds ratio (aOR) with their respective 95% confidence intervals (CIs).

Setting

Thirty-two countries in SSA.

Outcome measure

Stunting, wasting, and underweight.

Results

The pooled prevalence of stunting was 31.3%, ranging from 15.0% in Gabon to 51.7% in Burundi. Wasting was highest among children from Burkina Faso (19.1%) and lowest among those from South Africa (1.6%). The overall prevalence of wasting was 8.1%. The prevalence of underweight was 17.0%, with the highest among children in Niger (37.1%) and lowest in South Africa (4.8%). Mothers who gave birth at the age less than 18 years and those with short birth interval were more likely to have their children being stunted, wasted, and underweight. The odds of stunting and wasting were high among children born to women with high parity. However, maternal age at birth more than 34 was associated with lower odds of childhood underweight as against those with age at birth less than 34.

Conclusion

Countries in SSA are encouraged to address the issue of maternal age at birth less than 18, high parity, and shorter birth intervals in order to meet the Global Nutrition targets, which aim to achieve a 40% reduction in the number of stunted children under the age of 5 and to reduce and maintain childhood wasting to less than 5% by 2025.
Evaluating TESLA-G, a gamified, telegram-delivered, quizzing platform for surgical education in medical students: protocol for a pilot randomised controlled trial
Authors: Ng Matthew Song Peng , Jabir Ahmad Ishqi , Ng Tony De Rong , Ang Yi-Ian , Chia Jeng Long , Tan Darren Ngiap Hao , Lee James , Mahendran Dinesh Carl Junis , Tudor Car Lorainne , Chia Clement Luck Khng
Published: June 2023

Introduction

Online multiple-choice question (MCQ) quizzes are popular in medical education due to their ease of access and ability for test-enhanced learning. However, a general lack of motivation among students often results in decreasing usage over time. We aim to address this limitation by developing Telegram Education for Surgical Learning and Application Gamified (TESLA-G), an online platform for surgical education that incorporates game elements into conventional MCQ quizzes.

Methods and analysis

This online, pilot randomised control trial will be conducted over 2 weeks. Fifty full-time undergraduate medical students from a medical school in Singapore will be recruited and randomised into an intervention group (TESLA-G) and an active control group (non-gamified quizzing platform) with a 1:1 allocation ratio, stratified by year of study.

We will evaluate TESLA-G in the area of endocrine surgery education. Our platform is designed based on Bloom’s taxonomy of learning domains: questions are created in blocks of five questions per endocrine surgery topic, with each question corresponding to one level on Bloom’s taxonomy. This structure promotes mastery while boosting student engagement and motivation. All questions are created by two board-certified general surgeons and one endocrinologist, and validated by the research team. The feasibility of this pilot study will be determined quantitatively by participant enrolment, participant retention and degree of completion of the quizzes. The acceptability of the intervention will be assessed quantitatively by a postintervention learner satisfaction survey consisting of a system satisfaction questionnaire and a content satisfaction questionnaire. The improvement of surgical knowledge will be assessed by comparing the scores of preintervention and postintervention knowledge tests, which consist of separately created questions on endocrine surgery. Retention of surgical knowledge will be measured using a follow-up knowledge test administered 2 weeks postintervention. Finally, qualitative feedback from participants regarding their experience will be obtained and thematically analysed.

Ethics and dissemination

This research is approved by Singapore Nanyang Technological University (NTU) Institutional Review Boards (Reference Number: IRB-2021-732). All participants will be expected to read and sign a letter of informed consent before they are considered as recruited into the study. This study poses minimal risk to participants. Study results will be published in peer-reviewed open-access journals and presented in conference presentations.

Trial registration number

NCT05520671.
Group-based active artistic interventions for adults with primary anxiety and depression: a systematic review
Authors: Barnish Maxwell S , Nelson-Horne Rebecca V
Published: June 2023

Objectives

This systematic review examined the potential benefit of all group-based performing arts interventions for primary anxiety and/or depression.

Setting

Scholarly literature from any country or countries globally.

Data sources

Three key bibliographic databases, Google Scholar and relevant citation chasing.

Primary and secondary outcome measures

Depression and/or anxiety symptom severity, well-being, quality of life, functional communication or social participation.

Results

Database searches returned a total of 63 678 records, of which 56 059 remained following dededuplication. From these database searches, a total of 153 records proceeded to full-text screening. These were supplemented by 18 additional unique full-text screening records from Google Scholar searches and citation chasing (12% of total). From a total of 171 records at the full-text screening stage, 12 publications (7%) were eligible for inclusion in this systematic review, each reporting on a separate study. Published from 2004 to 2021, these studies involved a total of 669 participants with anxiety and/or depression from nine countries and covered five broad artistic modalities: dance, music therapy, art therapy, martial arts and theatre. Dance was the most studied artistic modality (five studies), while there were three studies on art therapy, two on music therapy and one each on martial arts and theatre. The evidence was clearest for a benefit of arts therapies on depression and/or anxiety symptoms.

Conclusions

This systematic review addresses all group-based active arts interventions in a focused population of primary anxiety and/or depression. The evidence suggests that the arts may be a useful therapeutic medium in this population. However, a substantial limitation of the evidence base is the lack of studies directly comparing different artistic modalities. Moreover, not all artistic modalities were assessed for all outcome domains. Therefore, it is not currently possible to determine which artistic modalities are most beneficial for which specific outcomes.
Non-inferiority trial of a shorter (7 days) compared with a longer (14 days) duration of antimicrobial therapy for the treatment of bacteraemic urinary sepsis, measured by microbiological success after the completion of therapy: a substudy protocol for the Bacteraemia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) multicentre randomised controlled trial
Authors: Rogers Benjamin A , Fowler Robert , Harris Patrick N A , Davis Joshua S , Pinto Ruxandra L , Bhatia Dwivedi Dhiraj , Rishu Asgar , Shehabi Yahya , Daneman Nick
Published: June 2023

Introduction

The BALANCE study is a randomised clinical trial (3626 participants) designed to assess the non-inferiority of 7 days (short-course) antibiotic therapy compared with 14 days of therapy for bacteraemia using the pragmatic endpoint of 90-day survival. Based on pilot study data, approximately 30% of enrolees will have a urinary tract infection (UTI) as the source of bacteraemia.

Methods and analysis

We aim to assess the non-inferiority of short-course antibiotic therapy for patients with bacteraemia UTIs.

Participating sites in four countries will be invited to join this substudy. All participants of this substudy will be enrolled in the main BALANCE study. The intervention will be assigned and treatment administered as specified in the main protocol.

We will include participants in this substudy if the probable source of their infection is a UTI, as judged by the site principal investigator, and they have a urine microscopy and culture indicative of a UTI. Participants will be excluded if they have an ileal loop, vesicoureteric reflux or suspected or confirmed prostatitis.

The primary outcome is the absence of a positive culture on a test-of-cure urine sample collected 6–12 days after cessation of antimicrobials, with a non-inferiority margin of 15%. Secondary outcomes include the clinical resolution of infection symptoms at test-of-cure.

Ethics and dissemination

The study has been approved in conjunction with the main BALANCE study through the relevant ethics review process at each participating site. We will disseminate the results through the Australasian Society for Infectious Diseases, Canadian Critical Care Trials Group, the Association for Medical Microbiology and Infectious Diseases Canada Clinical Research Network (AMMI Canada CRN) and other collaborators.

Universal trial number

U1111-1256-0874.

Main BALANCE trial registration

NCT03005145.

Trial registration number

Australian Clinical Trial Register: ACTRN12620001108909.
Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial
Authors: Kappen Pablo R , Mos M I , Jeekel Johannes , Dirven Clemens M F , Kushner Steven A , Osse Robert-Jan , Coesmans Michiel , Poley Marten J , van Schie Mathijs S , van der Holt Bronno , Klimek M , Vincent Arnaud J P E
Published: June 2023

Objectives

Delirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes.

Design

Prospective randomised controlled trial.

Setting

Single centre, conducted at the neurosurgical department of the Erasmus Medical Center, Rotterdam, the Netherlands.

Participants

Adult patients undergoing craniotomy were eligible.

Interventions

Patients in the intervention group received preferred recorded music before, during and after the operation until day 3 after surgery. Patients in the control group were treated according to standard of clinical care.

Primary and secondary outcome measures

Primary outcome was presence or absence of postoperative delirium within the first 5 postoperative days measured with the Delirium Observation Screening Scale (DOSS) and, in case of a daily mean score of 3 or higher, a psychiatric evaluation with the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Secondary outcomes included anxiety, heart rate variability (HRV), depth of anaesthesia, delirium severity and duration, postoperative complications, length of stay and location of discharge.

Results

We enrolled 189 patients (music=95, control=94) from July 2020 through September 2021. Delirium, as assessed by the DOSS, was less common in the music (n=11, 11.6%) than in the control group (n=21, 22.3%, OR:0.49, p=0.048). However, after DSM-5 confirmation, differences in delirium were not significant (4.2% vs 7.4%, OR:0.47, p=0.342). Moreover, music increased the HRV (root mean square of successive differences between normal heartbeats, p=0.012). All other secondary outcomes were not different between groups.

Conclusion

Our results support the efficacy of music in reducing the incidence of delirium after craniotomy, as found with DOSS but not after DSM-5 confirmation, substantiated by the effect of music on preoperative autonomic tone. Delirium screening tools should be validated and the long-term implications should be evaluated after craniotomy.

Trial registration number

Trialregister.nl: NL8503 and ClinicalTrials.gov:NCT04649450.
Adverse birth outcome case definitions associated with maternal HIV and antiretroviral drug use in pregnancy: a scoping review protocol
Authors: Dube Kopano Rebaona , Powis Kathleen M , McCaul Michael , de Beer Shani Tamlyn , Slogrove Amy L
Published: June 2023

Introduction

The global antiretroviral therapy era has led to a decline in the number of children newly acquiring HIV and an increase in the number of children who are HIV-exposed and uninfected (HEU). This shift has prompted extensive research focussing on health and survival outcomes of children who are HEU. Study findings, particularly in relation to adverse birth outcomes, have been disparate, inconclusive and have not always been generalisable. Thus, the objectives of this scoping review are (1) to identify and extract definitions used for the adverse birth outcome terms ‘low birth weight’, ‘small for gestational age’, ‘stillbirth’ and ‘preterm birth’; (2) to compare the characteristics of studies from which birth outcome definitions were extracted by (a) temporal periods and (b) study country setting (high-income vs low-income and middle-income countries); (3) to use content analysis to map and describe the temporal and geographic distribution of the definitions used and construct a logical model of their evolution.

Methods and analysis

The online databases of PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library and CINHAL/EBSCOhost will be used to identify published and grey literature from 2011 to 2022 to identify definitions for the adverse birth outcome terms ‘low birth weight’, ‘small for gestational age’, ‘stillbirth’ and ‘preterm birth’. A three-step process of (1) duplicate removal, (2) title and abstract screening and (3) full text screening will be used to select included studies. The extracted data will be used to conduct a comparative analysis, content analysis and construct a logic model.

Ethics and dissemination

This review will be used to inform a consensus process around the development of harmonised definitions for the specified adverse birth outcomes. Our dissemination plan includes presentations, publications as well as the development infographics and a resource hub. The study is approved by the Human Research Ethics Committee of Stellenbosch University.
Effect of bariatric surgery on atherogenicity and insulin resistance in patients with obesity class II: a prospective study
Authors: Shadnoush Mahdi , Rajabian Tabesh Mastaneh , Asadzadeh-Aghdaei Hamid , Hafizi Nadia , Alipour Meysam , Zahedi Hoda , Mehrakizadeh Ali , Cheraghpour Makan
Published: June 2023

Objective

Enormous efforts have been made to evaluate reliable, simple and practical indicators for predicting patients at risk of progression of cardiovascular disease events, whereby bariatric surgery has remained understudied. Thus, we performed this study to assess the effect of bariatric surgery procedures on atherogenicity and insulin resistance indicators.

Design

Cohort study.

Setting, participants and outcome measures

Four hundred and forty-three class II obese (severely obese) patients who underwent sleeve gastrectomy, Roux-en-Y gastric bypass, or one anastomosis gastric bypass were followed up for 12 months after surgery. Atherosclerosis-related indicators were evaluated at baseline, as well as 6 and 12 months after surgery.

Results

Atherogenic index of plasma, lipoprotein combine index, atherogenic coefficient, cholesterol index, Castelli’s risk indices I and II, and triglyceride to high-density lipoprotein-cholesterol ratio (p<0.01) improved after 12 months. Additionally, bariatric surgery yielded a significantly reduced triglyceride glucose index. There was no significant difference between procedures in terms of indicators. The Spearman correlation test showed a significant inverse correlation between weight plus fat mass and atherosclerosis-related indicators as well as a positive correlation between percentage of excess weight loss and these indicators.

Conclusions

This study demonstrated three bariatric surgery procedures’ ability to improve atherogenicity and insulin resistance in patients with obesity class II. The anti-atherogenicity effects can be partly assigned to the reduction of body weight and adipose tissue. Nevertheless, further studies with larger sample sizes and longer follow-ups are required to confirm our results.
Visual prognosis and complications of congenital ectopia lentis: study protocol for a hospital-based cohort in Zhongshan Ophthalmic Center
Authors: Xu Pusheng , Ng Kityee , Jin Ling , Young Charlotte Aimee , Liu Siyuan , Liang Xiaolin , Liu Zhenzhen , Zhang Xinyu , Jin Guangming , Zheng Danying
Published: June 2023

Introduction

Congenital ectopia lentis (CEL) is a rare ocular disease characterised by the dislocation or displacement of the lens. Patients with mild lens dislocations can be treated with conservative methods (eg, corrective eyeglasses or contact lenses). In contrast, patients with severe CEL usually require surgical management. However, few studies have focused on the visual prognosis and complications in conservative and surgical management of patients. This study aims to investigate the prognosis and complications in patients with CEL with conservative and surgical management, which is vital for CEL management, especially the choice of surgical timing and surgical method.

Methods and analysis

A cohort study will be conducted at Zhongshan Ophthalmic Center. We plan to recruit 604 participants diagnosed with CEL and aged ≥3 years old. Patients with mild lens subluxation and stable visual conditions will be included in the non-surgical group and follow-up at 1, 2 and 3 years after enrolment. Patients with severe lens subluxation who accept CEL surgery will be included in the surgical group. Different surgical techniques, including phacoemulsification, in-the-bag intraocular lens implantation (with or without capsular tension ring) and trans-scleral fixation, will be used depending on the severity of dislocation. Patients will be followed up at 3 months, and 1, 2 and 3 years postoperatively. Over a 5-year follow-up period, patients will receive a detailed ocular examination, including optometry, biological measurement, specular microscopy, ultrasound biomicroscopy, anterior segment and posterior segment optical coherence tomography (OCT), OCT angiography, echocardiography and questionnaires on vision-related quality of life. The primary outcome is the change of best-corrected visual acuity and the incidence of complications in both groups.

Ethics and dissemination

Ethics approval was obtained from the ethics committee of the Zhongshan Ophthalmic Center (number: 2022KYPJ207). Study findings will be published in a peer-reviewed journal.

Trial registration number

NCT05654025.
Health literacy and musculoskeletal disorders in adolescents: a scoping review
Authors: Veshovda Solveig , Eik Hedda , Andersen Marit Helen , Jahre Henriette , Riiser Kirsti
Published: June 2023

Objectives

Health literacy (HL) related to musculoskeletal disorders (MSDs) in adolescents is a field with limited previous evidence. This study aimed to review and synthesise studies on MSDs and HL as well as various dimensions of HL in adolescents.

Design

Scoping review in accordance with Arksey and O’Malleys framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Search strategy

The search strategy was performed in the following databases in November 2021 (initial search) and December 2022 (updated search); Medline, EMBASE, PsychINFO, Cochrane, CINAHL, ERIC, Web of Science and Google Scholar. Eligible studies involving MSDs and HL or either of the HL dimensions related to finding, understanding, appraising or applying health information in adolescents were considered. Any dimension of HL studied, the outcome measure(s) used to assess HL and the type of MSD examined were charted, reviewed and synthesised. A directed content analysis was used for the subjective interpretation of text data.

Results

A total of 16 841 studies were identified and 33 were eligible for inclusion. Ten articles presented HL with a definition or description in the theoretical background. The remaining 23 studies involved finding, understanding, appraising or applying health information, without using the term ‘health literacy’. Most of the studies addressed how adolescentsunderstand(n=32), andapply(n=23) health information, while few studies focused on how theyfind(n=11) andappraise(n=7) musculoskeletal health information.

Conclusion

Few studies have addressed HL and MSDs in adolescents explicitly, while most studies have considered dimensions of HL. Our findings suggest that there is important work to be done to align conceptual understandings with the measurement of HL in adolescents and that further research should be carried out to explore how HL is distributed among adolescents with MSDs and how adolescents living with MSDs report their HL.