bluuebunny/crossref_metadata_2025 huggingface dataset:
Prehospital COVID-19 patients discharged at the scene – an observational study
Authors: Heinonen Kari , Kuisma Markku , Salmi Heli , Puolakka Tuukka
Published: December 2023

Background

Emergency medical services (EMS) were the first point of contact for many COVID-19 patients during the pandemic. The aim of this study was to investigate whether the non-conveyance decision of a COVID-19 patient was more frequently associated with a new EMS call than direct ambulance transport to the hospital.

Methods

All confirmed COVID-19 patients with an EMS call within 14 days of symptom onset were included in the study. Patients were compared based on their prehospital transport decision (transport vs. non-conveyance). The primary endpoint was a new EMS call within 10 days leading to ambulance transport.

Results

A total of 1 286 patients met the study criteria; of these, 605 (47.0%) were male with a mean (standard deviation [SD]) age of 50.5 (SD 19.3) years. The most common dispatch codes were dyspnea in 656 (51.0%) and malaise in 364 (28.3%) calls. High-priority dispatch was used in 220 (17.1%) cases. After prehospital evaluation, 586 (45.6%) patients were discharged at the scene. Oxygen was given to 159 (12.4%) patients, of whom all but one were transported.

A new EMS call leading to ambulance transport was observed in 133 (10.3%) cases; of these, 40 (30.1%) were in the group primarily transported and 93 (69.9%) were among the patients who were primarily discharged at the scene (p<.001). There were no significant differences in past medical history, presence of abnormal vital signs, or total NEWS score. Supplemental oxygen was given to 33 (24.8%) patients; 3 (2.3%) patients received other medications.

Conclusion

Nearly half of all prehospital COVID-19 patients could be discharged at the scene. Approximately every sixth of these had a new EMS call and ambulance transport within the following 10 days. No significant deterioration was seen among patients primarily discharged at the scene. EMS was able to safely adjust its performance during the first pandemic wave to avoid ED overcrowding.
Convenient method to improve efficiency of lymph node examination after gastrectomy with D2 lymphadenectomy for gastric cancer
Authors: Xiang Hanting , Dong Zhebin , Wu Hengmiao , He Yicheng , Chen Zhengwei , Chen Sangsang , Yu Weiming , Liang Chao
Published: December 2023

Background

The D2 procedure has been accepted as the standard treatment for advanced gastric cancer (GC) in East Asia. Determination of the number of lymph nodes (LNs) after gastrectomy may influence the pathological stage assessment of lymph node metastasis, significantly influencing prognostic evaluations and formulation of chemotherapy regimens.

Methods

Between January 2020 and January 2022, the medical files of 312 patients with clinical stage T0-4aN0-3M0 gastric cancer were reviewed retrospectively, and the patients were assigned to the normal group (lymph nodes were examined roughly), manual group (lymph nodes were manually examined meticulously), and device group (lymph nodes were examined by device). The clinical and pathologic characteristics, number of lymph nodes harvested, and the time required for lymph node examination was compared.

Results

A total of 312 gastric cancer patients (mean age 65.8 ± 10.3 years, 85 females and 227 males) underwent gastrectomy with curative intent at our department. Sex, age, body mass index (BMI), tumor size, clinical TNM stage, and pathologic TNM stage in the three groups showed no statistically significant differences (P > 0.05). The mean number of harvested lymph nodes in the normal, manual, and device group was 24.2, 36.6 and 35.2, respectively, which showed significant differences (P < 0.0001). The mean number of positive lymph nodes in the normal, manual, and device group was 3.5, 3.9 and 3.9, respectively (P = 0.99). The mean time consumption in device group was 15 min while the time consumption in manual group was 52.3 min, which showed a significant difference (P < 0.0001).

Conclusion

This improved lymph node examination method offers a simple approach that is worth promoting, and it can improve the number of harvested lymph nodes efficiently.
Kidney shape statistical analysis: associations with disease and anthropometric factors
Authors: Thanaj Marjola , Basty Nicolas , Cule Madeleine , Sorokin Elena P. , Whitcher Brandon , Srinivasan Ramprakash , Lennon Rachel , Bell Jimmy D. , Thomas E. Louise
Published: December 2023

Background

Organ measurements derived from magnetic resonance imaging (MRI) have the potential to enhance our understanding of the precise phenotypic variations underlying many clinical conditions.

Methods

We applied morphometric methods to study the kidneys by constructing surface meshes from kidney segmentations from abdominal MRI data in 38,868 participants in the UK Biobank. Using mesh-based analysis techniques based on statistical parametric maps (SPMs), we were able to detect variations in specific regions of the kidney and associate those with anthropometric traits as well as disease states including chronic kidney disease (CKD), type-2 diabetes (T2D), and hypertension. Statistical shape analysis (SSA) based on principal component analysis was also used within the disease population and the principal component scores were used to assess the risk of disease events.

Results

We show that CKD, T2D and hypertension were associated with kidney shape. Age was associated with kidney shape consistently across disease groups. Body mass index (BMI) and waist-to-hip ratio (WHR) were also associated with kidney shape for the participants with T2D. Using SSA, we were able to capture kidney shape variations, relative to size, angle, straightness, width, length, and thickness of the kidneys, within disease populations. We identified significant associations between both left and right kidney length and width and incidence of CKD (hazard ratio (HR): 0.74, 95% CI: 0.61–0.90,p < 0.05, in the left kidney; HR: 0.76, 95% CI: 0.63–0.92,p < 0.05, in the right kidney) and hypertension (HR: 1.16, 95% CI: 1.03–1.29,p < 0.05, in the left kidney; HR: 0.87, 95% CI: 0.79–0.96,p < 0.05, in the right kidney).

Conclusions

The results suggest that shape-based analysis of the kidneys can augment studies aiming at the better categorisation of pathologies associated with chronic kidney conditions.
Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer
Authors: Bobrzynski L , Sędłak K , Rawicz-Pruszyński K , Kolodziejczyk P , Szczepanik A , Polkowski W , Richter P , Sierzega M
Published: December 2023

Background

Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer.

Methods

Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients’ prognosis by Cox proportional hazards modelling.

Results

TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P < 0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 – 0.73, P < 0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781).

Conclusions

A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.
Significance of circulating tumor cells detection in tumor diagnosis and monitoring
Authors: Liu Yuanrui , Zhao Rong , Xie Zaichun , Pang Zhiyu , Chen Shengjie , Xu Qian , Zhang Zhanfeng
Published: December 2023

To detect circulating tumor cells (CTCs) in the peripheral blood of patients with tumor, and to analyze the significance of CTC detection in tumor diagnosis and monitoring. In the present study, peripheral blood was collected from 125 patients with tumor, and CTCs were isolated and identified. Differences in CTC number and subtype detection were analyzed for different tumor diseases and stages. CTCs were detected in 122 of the 125 patients with tumor, with a positive rate of 97.6%. The number of CTCs increases in patients with vascular metastasis. The number of mesenchymal CTCs increases in patients with lymph node or vascular metastasis. The average ratio of epithelial CTCs in each positive sample decreases in the later stages of cancer compared with the earlier stages, while the average ratio of mesenchymal CTCs increases in the later stages of cancer compared with the earlier stages. The results showed that CTCs with mesenchymal phenotypes are closely related to lymph node or vascular metastasis. CTC detection can help with early diagnosis of tumor diseases. Continuous monitoring of changes in CTCs number and subtypes can assist clinical judgment of tumor disease development status and prognosis.
Prevalence and factors associated with smartphone addiction among nursing postgraduates during the COVID-19 pandemic: a multilevel study from China’s mainland
Authors: Liu Jie , Yu Xingfeng , Kong Lingna , Zhou Xiaobo
Published: December 2023

Background

Smartphone addiction is prevalent among college students, and there is a concern that the COVID-19 pandemic may bring an increased prevalence of smartphone addiction due to constant online classes and repeat quarantine policies. This study aims to assess the prevalence and influencing factors of smartphone addiction among Chinese nursing postgraduates during the pandemic by examining variables, including loneliness, perceived stress, resilience, and sense of security.

Methods

This online cross-sectional survey recruited 224 nursing postgraduates in four cities in 2022, using Smartphone Addiction Scale for College Students, the Chinese version of Perceived Stress Scale, UCLA Loneliness Scale Version 3, Chinese version of the 10-item Connor-Davidson Resilience Scale, and the Security Questionnaire. Hierarchical regression analysis and logistic regression analysis were performed to explore the associated factors and predictors of smartphone addiction.

Results

During the COVID-19 pandemic, the prevalence of smartphone addiction was 10.41%. There was a positive correlation between smartphone addiction and loneliness, perceived stress (P < 0.001), and a negative relationship with resilience and sense of security (P < 0.001). The logistic regression analysis identified five risk factors that contribute to smartphone addiction, including daily duration of using a smartphone (3–5 h) (OR = 11.085, 95%CI = 1.21–101.79), numbers of smartphone (OR = 3.704, 95%CI = 1.33–10.30), perceived stress (OR = 1.163, 95%CI = 1.06–1.28), loneliness (OR = 1.071, 95%CI = 1.01–1.13), age of using a smartphone first time (OR = 0.754, 95%CI = 0.60–0.95). Two protective factors, resilience (OR = 1.098, 95%CI = 1.01–1.20) and sense of security (OR = 0.950, 95%CI = 0.90–1.00), were identified.

Conclusions

Collectively, our study found that during the COVID-19 pandemic, smartphone addiction was prevalent among nursing postgraduates, and loneliness and perceived stress are important risk factors for smartphone addiction. Therefore, administrators should adopt targeted interventions to reduce smartphone addiction and the negative impacts on the psychological well-being of nursing postgraduates during a sudden outbreak of a national epidemic crisis.
Analysis of factors that promote the participation of patients with chronic diseases in shared decision making on medication: a cross-sectional survey in Hubei Province, China
Authors: Hu Qijun , Feng Zhanchun , Zong Qiao , Wang Jia , Zheng Zehao , Feng Da
Published: December 2023

Background

Shared decision making (SDM) improves the health status of patients with chronic diseases, especially in the condition of poly-medicated patients. This study aims to find the factors associated with participation of patients with chronic diseases in SDM on medication.

Methods

A total of 1,196 patients with chronic diseases were selected in Hubei Province of China using cluster sampling methods. The random forest method was applied to rank the importance of independent variables by Mean Decrease Gini and out-of- bag (OOB) curve. Multivariate logistic regression was used to explore the independent variables’ effect direction and relative hazard.

Results

In this study, 5.18% of patients used patient-directed decision making (PDM, a decision-making model led by patients), 37.79% of patients used SDM (a collaborative decision-making model by patients and doctors), and 57.02% of patients used doctor-directed decision making (DDM, or paternalistic decision making, a decision-making model led by doctors). The random forest analysis demonstrated that the top 5 important factors were age, education, exercise, disease course, and medication knowledge. The OOB curve showed that the error rate reached minimum when top 5 variables in importance ranking composed an optimal variable combination. In multivariate logistic regression, we chose SDM as a reference group, and identified medication knowledge (OR = 2.737, 95%CI = 1.524 ~ 4.916) as the influencing factor between PDM and SDM. Meanwhile, the influencing factors between DDM and SDM were age (OR = 0.636, 95%CI = 0.439 ~ 0.921), education (OR = 1.536, 95%CI = 1.122 ~ 2.103), exercise (OR = 1.443, 95%CI = 1.109 ~ 1.877), disease course (OR = 0.750, 95%CI = 0.584 ~ 0.964), and medication knowledge (OR = 1.446, 95%CI = 1.120 ~ 1.867).

Conclusion

Most Chinese patients with chronic diseases used DDM during their medication decision-making, and some patients used PDM and SDM. The participation in SDM should be taken seriously among elderly patients with lower education levels. The SDM promotion should focus on transformation of patients’ traditional perception and enhance their medication knowledge.
Thoughts, perceptions and concerns of coastal residents regarding the discharge of tritium-containing treated water from the Fukushima Daiichi Nuclear Power Plant into the Pacific Ocean
Authors: Hande Varsha , Orita Makiko , Matsunaga Hitomi , Kashiwazaki Yuya , Xiao Xu , Schneider Thierry , Lochard Jacques , Taira Yasuyuki , Takamura Noboru
Published: December 2023

Background

As a part of the decontamination process after the Fukushima Daiichi Nuclear Power Plant accident of 2011, 1.32 million tonnes of tritium-containing water will be discharged from the power plant into the Pacific Ocean. Although radiobiological impacts of the treated water discharge on the public and the environment were reported to be minimal, Tomioka and Okuma locals expressed unease regarding the long-term recovery of their towns, which are economically dependent on the agricultural, fishery, and tourism sectors. This study presents thoughts, perceptions and concerns of Tomioka and Okuma locals regarding the discharge of FDNPP-treated water containing tritium into the Pacific Ocean to facilitate a more inclusive decision-making process that respects local stakeholder interests.

Methods

Conducted from November to December 2022, surveys were mailed to current residents and evacuees aged 20 years or older registered with the town councils.

Results

Out of 1268 included responses, 71.5% were from those > 65 years. 65.6% were unemployed, 76.2% routinely visited hospitals, and 85.5% did not live with children. 61% did not want to return to Okuma/Tomioka. Anxiety about radiation-related health effects (38.7%), consuming food produced in Okuma/Tomioka (48.0%) and genetic effects (45.3%) were low. >50% reported poor physical and mental health. 40% were acceptive, 31.4% were unsure, and 29.7% objected to the discharge plans. Multinomial regression analysis revealed that, compared to acceptive responders, those who objected were more likely to be female, unemployed, and have anxiety about radiation-related genetic effects and poor mental health. Unsure responders were similarly more likely to be female, anxious about radiation-related genetic effects and have poor mental health.

Conclusion

The poor mental health of the locals, connected to high levels of risk perception and anxiety about the loss of economic opportunities related to the discharge plans, must be addressed. The 30-year discharge process could handicap local industries and hamper post-disaster socioeconomic recovery due to the circulation of false rumours among consumers. These results highlight the need to actively involve residents in the towns’ recovery process to address local concerns. The focus should be on the judicious combination of transparent science with the human aspect of recovery and narratives highlighting dialogues between local stakeholders and experts to enable the locals and the general public to make informed decisions about their protection and future.
Alveolar macrophage-derived gVPLA2 promotes ventilator-induced lung injury via the cPLA2/PGE2 pathway
Authors: Han Hanghang , Xie Qiuwen , Shao Rongge , Li Jinju , Du Xueke
Published: December 2023

Background

Ventilator-induced lung injury (VILI) is a clinical complication of mechanical ventilation observed in patients with acute respiratory distress syndrome. It is characterized by inflammation mediated by inflammatory cells and their secreted mediators.

Methods

To investigate the mechanisms underlying VILI, a C57BL/6J mouse model was induced using high tidal volume (HTV) mechanical ventilation. Mice were pretreated with Clodronate liposomes to deplete alveolar macrophages or administered normal bone marrow-derived macrophages or Group V phospholipase A2 (gVPLA2) intratracheally to inhibit bone marrow-derived macrophages. Lung tissue and bronchoalveolar lavage fluid (BALF) were collected to assess lung injury and measure Ca2 + concentration, gVPLA2, downstream phosphorylated cytoplasmic phospholipase A2 (p-cPLA2), prostaglandin E2 (PGE2), protein expression related to mitochondrial dynamics and mitochondrial damage. Cellular experiments were performed to complement the animal studies.

Results

Depletion of alveolar macrophages attenuated HTV-induced lung injury and reduced gVPLA2 levels in alveolar lavage fluid. Similarly, inhibition of alveolar macrophage-derived gVPLA2 had a similar effect. Activation of the cPLA2/PGE2/Ca2 + pathway in alveolar epithelial cells by gVPLA2 derived from alveolar macrophages led to disturbances in mitochondrial dynamics and mitochondrial dysfunction. The findings from cellular experiments were consistent with those of animal experiments.

Conclusions

HTV mechanical ventilation induces the secretion of gVPLA2 by alveolar macrophages, which activates the cPLA2/PGE2/Ca2 + pathway, resulting in mitochondrial dysfunction. These findings provide insights into the pathogenesis of VILI and may contribute to the development of therapeutic strategies for preventing or treating VILI.
Whole-exome sequencing explored mechanism of selpercatinib resistance in RET-rearranged lung adenocarcinoma transformation into small-cell lung cancer: a case report
Authors: Peng Yan , Zheng Zhu , Zewen Wang , Yanan Liu , Mingyan Zhang , Meili Sun
Published: December 2023

Small cell transformation was one mechanism by which EGFR-mutation NSCLC acquired resistance after tyrosine kinase inhibitors (TKIs) treatment. A few reports of small cell transformation occurred in other oncogene-driven lung cancers. We found the first case of transformation of a RET-rearranged lung adenocarcinoma to SCLC after selpercatinib, a novel highly selective RET TKIs. Whole-exome sequencing (WES) was used to explore alteration in gene expression in tumor tissue at initial diagnosis and after transformation into small cell carcinoma. We found that transformed into SCLC tumor tissue had inactivation of RB1 and TP53, with RET fusion was still present. In addition, the APOBEC family of cytidine deaminases appeared amplification. Although RET rearrangement still existed, using another RET TKIs was ineffective, and etoposide plus platinum might be an effective rescue treatment.
Age and sex related change in tooth enamel thickness of maxillary incisors measured by cone beam computed tomography
Authors: Al-Zahawi Abdulsalam Rashid , Ibrahim Rawa Omar , Talabani Ranjdar Mahmood , Dawood Shilan Nawzad , Garib Didar Sadiq Hama , Abdalla Ako Omer
Published: December 2023

Background

To measure adequate enamel thickness of maxillary incisors in planning enamel reduction for a porcelain laminate veneer restoration in relation to chronological age and sex by using cone beam computed tomography (CBCT) in an Iraqi subpopulation.

Methods

From 81 CBCT images, 324 maxillary incisors were examined. Enamel thickness was measured at both mesial and distal regions of the tooth in three different levels: cervical, middle, and incisal (occlusal) 1/3 at a sagittal section. Measurements were made for the following tooth areas using CBCT: facial enamel thickness at 1, 3, and 5 mm from the cementoenamel junction (CEJ), palatal enamel thickness at 5 mm from the CEJ (5 mm P), facial and palatal enamel thickness at the incisal edge (IFP), mid incisal enamel thickness (IET), and the incisal edge enamel-pulp distance (IEPD). Relationships of enamel thickness with age and sex were evaluated using Independent t-test, Mann–Whitney U-test and the Pearson correlation coefficient, a simple linear regression analysis used for statistical analysis.

Results

Significant differences (P < 0.05) were found in terms of an inverse association between enamel thickness and chronological age at all measurements above the CEJ and the regression model for the mid-incisal enamel thickness was (R2 of 0.4). In contrast, there was an increase in IFP, palatal, and IPED enamel thickness with age. Also, significant differences were found in enamel thickness between males and females, the enamel being thicker in females in relation to facial enamel thickness, enamel palatal thickness above CEJ and IET, while for IEPD, the enamel thickness was greater in males compared to females.

Conclusion

The measurements for enamel thickness outcome variables in relation to chronological age revealed significant differences for each measured distance and there were statistically significant differences in enamel thickness between males and females at all measurements except at IFP. These results demonstrate that CBCT can be used for noninvasive, accurate measurements of enamel thickness in both sex.
The impact of immediate versus delayed mini-screw placement on alveolar bone preservation and bone density following tooth extraction: evidence from a canine model
Authors: Jahanbin Arezoo , Eslami Neda , Salari Sedigh Hamideh , Ghazi Narges , Hosseini Zarch Seyed Hossein , Hoseinzadeh Melika , Moayedi Sedigheh
Published: December 2023

The aim of this study was to evaluate the impact of mini-screw placement on the alveolar ridge using a split-mouth design. Twelve beagles underwent bilateral extraction of their lateral teeth. In the immediate group, a mini-screw was unilaterally placed approximately 3–4 mm below the alveolar crest of the extraction site on the experimental side. The delayed group received mini-screws six weeks after tooth extraction. On average, the dogs were sacrificed after 11 weeks, and the maxillary bones were excised and scanned using cone-beam computed tomography (CBCT). Histopathological examinations were conducted to assess inflammation and bone formation scores. The results showed that in the immediate group, bone height was significantly greater on the intervention side compared to the control side (p < 0.05), whereas there was no significant difference in the delayed group. In both groups, there was a significant increase in bone density around the mini-screws compared to the control sides (p < 0.05). Mini-screw insertion led to a significant enhancement of bone growth in both groups (p < 0.05), with no notable differences between the two groups. The mini-screws did not have any impact on bone inflammation or width. Overall, both immediate and delayed mini-screw placement in the extraction socket positively influenced bone dimensions, density, and histological properties. However, immediate insertion was more effective than delayed placement in preserving vertical bone height, despite delayed insertion resulting in higher bone density.
Evaluating an addiction medicine unit in Sudbury, Ontario Canada: a mixed-methods study protocol
Authors: Morin Kristen A. , Ghartey Karla , Bodson Adele , Sirois Alexandra , Leary Tara
Published: December 2023

Background

In response to the escalating global prevalence of substance use and the specific challenges faced in Northern Ontario, Canada, an Addiction Medicine Unit (AMU) was established at Health Sciences North (HSN) in Sudbury. This protocol outlines the approach for a comprehensive evaluation of the AMU, with the aim of assessing its impact on patient outcomes, healthcare utilization, and staff perspectives.

Methods

We conducted a parallel mixed-method study that encompassed the analysis of single-center-level administrative health data and primary data collection, including a longitudinal observational study (target n = 1,200), pre- and post-admission quantitative interviews (target n = 100), and qualitative interviews (target n = 25 patients and n = 15 staff). We implemented a participatory approach to this evaluation, collaborating with individuals who possess lived or living expertise in drug use, frontline staff, and decision-makers across the hospital. Data analysis methods encompass a range of statistical techniques, including logistic regression models, Cox proportional hazards models, Kaplan-Meier curves, Generalized Estimating Equations (GEE), and thematic qualitative analysis, ensuring a robust evaluation of patient outcomes and healthcare utilization.

Discussion

This protocol serves as the foundation for a comprehensive assessment designed to provide insights into the AMU’s effectiveness in addressing substance use-related challenges, reducing healthcare disparities, and improving patient outcomes. All study procedures have been meticulously designed to align with the ethical principles outlined in the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. The findings will be disseminated progressively through committees and working groups established for this research, and subsequently published in peer-reviewed journals. Anticipated outcomes include informing evidence-based healthcare decision-making and driving improvements in addiction treatment practices within healthcare settings.
Ensuring leadership at the operational level of a health system in protracted crisis context: a cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo
Authors: Bigirinama Rosine N. , Makali Samuel L. , Mothupi Mamothena C. , Chiribagula Christian Z. , St Louis Patricia , Mwene-Batu Pacifique L. , Bisimwa Ghislain B. , Mwembo Albert T. , Porignon Denis G.
Published: December 2023

Background

This study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC.

Methods

A qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC’s health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service’s Leadership Academy. From these themes, a secondary analysis extracted emerging subthemes.

Results

The study has revealed deficiencies regarding management and organization of the health zones, internal collaboration within their management teams as well as collaboration between these teams and the health zone’s external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership.

Conclusions

Despite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.
Intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, West Shoa zone, Ethiopia 2022
Authors: Atinafu Wabi Temesgen , Tilahun Kefyalew Naniye , Yilma Tesfahun Melese , Mekonnen Zeleke Abebaw , Walle Agmasie Damtew , Adem Jibril Bashir
Published: December 2023

Background

Mental health problems are the most common morbidities of women during the prenatal period. In LMICs mobile phones have been identified as a good vehicle for monitoring individuals with a high risk of mental health conditions. However, evidence is scarce and the purpose of this study was to assess the intention to use a mobile phone to receive mental health support and its predicting factors among women attending antenatal care at public health facilities in Ambo town, Ethiopia 2022.

Methods and materials

An institutional-based cross-sectional study design was conducted from May 20th to June 20th, 2022. A total of 715 prenatal women were included and a systematic random sampling technique was employed. An interviewer-administered structured questionnaire was used. Collected data was exported to SPSS version 25 for the descriptive part, and AMOS 26 structural equation modeling was also used to describe and assess the degree and significance of relationships between variables.

Results

A total of 699 (97.8% response rate) responded to complete all the questionnaires. About 530 (77.3%) 95% CI (74%-80.3%) of women intended to use a mobile phone to receive mental health support. The perceived usefulness has a positive effect on attitude (β = 0.391, p < 0.001) and intention to use (β = 0.253, p < 0.001). The perceived ease of use influences perceived usefulness (β = 0.253, p < 0.001) and attitude β = 0.579, p < 0.001). The intention to use is positively affected by attitude (β = 0.662, p < 0.001).Trust has a positive effect on perceived usefulness (β = 0.580, p < 0.001) and intention to use (β = 0.113, p = 0.005). Subjective norm has a direct positive effect on perceived usefulness (β = 0.248, p < 0.001). Attitude serves as a partial mediator between perceived usefulness and intention to use and a complete mediating role between perceived ease of use and intention to use.

Conclusion

The level of intention to use a mobile phone among prenatal women is relatively high and attitude, perceived usefulness, and trust had direct positive effects on intention to use a mobile phone. Therefore, hospitals and healthcare providers should take proactive measures to implement the strategies and policies for providing mobile phone-based mental health support to prenatal women in remote areas.
Development of early prediction model of in-hospital cardiac arrest based on laboratory parameters
Authors: Ding Xinhuan , Wang Yingchan , Ma Weiyi , Peng Yaojun , Huang Jingjing , Wang Meng , Zhu Haiyan
Published: December 2023

Background

In-hospital cardiac arrest (IHCA) is an acute disease with a high fatality rate that burdens individuals, society, and the economy. This study aimed to develop a machine learning (ML) model using routine laboratory parameters to predict the risk of IHCA in rescue-treated patients.

Methods

This retrospective cohort study examined all rescue-treated patients hospitalized at the First Medical Center of the PLA General Hospital in Beijing, China, from January 2016 to December 2020. Five machine learning algorithms, including support vector machine, random forest, extra trees classifier (ETC), decision tree, and logistic regression algorithms, were trained to develop models for predicting IHCA. We included blood counts, biochemical markers, and coagulation markers in the model development. We validated model performance using fivefold cross-validation and used the SHapley Additive exPlanation (SHAP) for model interpretation.

Results

A total of 11,308 participants were included in the study, of which 7779 patients remained. Among these patients, 1796 (23.09%) cases of IHCA occurred. Among five machine learning models for predicting IHCA, the ETC algorithm exhibited better performance, with an AUC of 0.920, compared with the other four machine learning models in the fivefold cross-validation. The SHAP showed that the top ten factors accounting for cardiac arrest in rescue-treated patients are prothrombin activity, platelets, hemoglobin, N-terminal pro-brain natriuretic peptide, neutrophils, prothrombin time, serum albumin, sodium, activated partial thromboplastin time, and potassium.

Conclusions

We developed a reliable machine learning-derived model that integrates readily available laboratory parameters to predict IHCA in patients treated with rescue therapy.
Harm reduction stories: leveraging graphic medicine to engage veterans in substance use services within the VA
Authors: Harvey Leah H. , Branch-Elliman Westyn , Boudreau Jacqueline , Sliwinski Samantha K. , Gifford Allen L. , Ho Minh Q. , Dinges Elizabeth , Hyde Justeen
Published: December 2023

Background

Harm reduction strategies can decrease morbidity and mortality associated with substance use. Various barriers limit conversation around substance use between clinicians and patients. Graphic medicine techniques can inform and encourage patient-centered conversations about substance use. We describe the co-development of a harm reduction-focused graphic medicine comic that depicts the infectious risks associated with injection drug use and patient-centered approaches to providing education about potential risk mitigation strategies.

Methods

We formed a co-design group of veterans with lived experience with substance use, physicians, health services researchers, and community-based harm reduction leaders. Over the course of ten sessions, the co-design team developed a storyline and key messages, reviewed draft content and worked with a graphic designer to develop a comic incorporating the veterans’ input. During each session, co-design leads presented drafts of the comic and invited feedback from the group. The comic was edited and adapted via this iterative process.

Results

The comic depicts a fictionalized clinical vignette in which a patient develops an injection-related abscess and presents to their primary care provider. The dialogue highlights key healthcare principles, including patient autonomy and agency, and highlights strategies for safer use, rather than emphasizing abstinence. Feedback from co-design group participants highlights lessons learned during the development process.

Discussion

Graphic medicine is ideally suited for a patient-centered curriculum about harm reduction. This project is one of several interventions that will be integrated into VA facilities nationally to support incorporation of harm reduction principles into the care of persons who inject drugs.
Assessment of two brands of fentanyl test strips with 251 synthetic opioids reveals “blind spots” in detection capabilities
Authors: Hayes Kathleen L. , Lieberman Marya
Published: December 2023

Background

Fentanyl test strips (FTS) are a commonly deployed tool in drug checking, used to test for the presence of fentanyl in street drug samples prior to consumption. Previous reports indicate that in addition to fentanyl, FTS can also detect fentanyl analogs like acetyl fentanyl and butyryl fentanyl, with conflicting reports on their ability to detect fentanyl analogs like Carfentanil and furanyl fentanyl. Yet with hundreds of known fentanyl analogs, there has been no large-scale study rationalizing FTS reactivity to different fentanyl analogs.

Methods

In this study, 251 synthetic opioids—including 214 fentanyl analogs—were screened on two brands of fentanyl test strips to (1) assess the differences in the ability of two brands of fentanyl test strips to detect fentanyl-related compounds and (2) determine which moieties in fentanyl analog chemical structures are most crucial for FTS detection. Two FTS brands were assessed in this study: BTNX Rapid Response and WHPM DanceSafe.

Results

Of 251 screened compounds assessed, 121 compounds were detectable at or below 20,000 ng/mL by both BTNX and DanceSafe FTS, 50 were not detectable by either brand, and 80 were detectable by one brand but not the other (n = 52 BTNX, n = 28 DanceSafe). A structural analysis of fentanyl analogs screened revealed that in general, bulky modifications to the phenethyl moiety inhibit detection by BTNX FTS while bulky modifications to the carbonyl moiety inhibit detection by DanceSafe FTS.

Conclusions

The different “blind spots” are caused by different haptens used to elicit the antibodies for these different strips. By utilizing both brands of FTS in routine drug checking, users could increase the chances of detecting fentanyl analogs in the “blind spot” of one brand.
Correlation between controlled ovarian stimulation protocols and euploid blastocyst rate in pre-implantation genetic testing for aneuploidy cycles
Authors: Huang Bixia , Li Hui , Xu Bin , Li Ning , Wang Xiaofei , Li Yanping , Zhao Jing
Published: December 2023

Background

Several studies have explored which COS protocol yields a higher blastocyst euploidy rate, but findings have been inconsistent. The present study aimed to explore whether controlled ovarian stimulation (COS) protocols was associated with euploid blastocyst rate in pre-implantation genetic testing for aneuploidy (PGT-A) cycles.

Methods

The study was a retrospective study where data were obtained from three reproductive medicine centers. The study included PGT-A cycles with the GnRH-a, GnRH-ant, or PPOS protocols, and the data on patient demographics, protocols, and embryonic outcomes were collected for the PGT-A cycles performed between January 2019 and August 2022.

Results

This study included 457 PGT-A cycles from three reproductive medicine centers, with 152, 126, and 179 cycles performed using the PPOS, GnRH-a, and GnRH-ant protocols, respectively. The baseline characteristics of the three groups show no significant differences were observed in female BMI, infertility type, and infertility duration among the PPOS, GnRH-a, and GnRH-ant protocol groups. The study found no significant association between Gn dosage, Gn duration, and blastocyst euploidy. The mean number of euploidy blastocysts in PPOS protocol was significantly lower than that of GnRH-a protocol and GnRH-ant protocol (0.75 ± 0.92 vs. 1.79 ± 1.78 vs. 1.80 ± 1.67). The euploidy rate per biopsy blastocyst (48.4% vs. 49.1% vs. 33.1%), per oocyte retrieved (15.0% vs. 14.7% vs. 10.5%), and per MII oocyte (17.7% vs. 16.4% vs. 11.7%) were significantly higher in the cycles using the GnRH-ant and GnRH-a protocols than that of PPOS protocol group. Regression analyses indicated that, compared with the PPOS protocol, the GnRH-ant protocol was positively associated with the euploid blastocyst rate and the mean number of euploid blastocysts, whereas the GnRH-a protocol showed no such relationship.

Limitations and reasons for caution

The main limitation of this study was the retrospective design. Although this study also used other tests to account for confounding factors and reduce potential bias, multiple tests have its own weaknesses.

Conclusions

GnRH-ant protocol was the most effective for PGT-A cycles. The findings emphasize the need for personalized treatment strategies, considering patient demographics, and optimizing COS protocols to enhance the chances of successful outcomes in ART procedures.
Progress and challenges in implementing non-communicable disease policies in Sudan
Authors: Elhadi Yasir Ahmed Mohammed
Published: December 2023

Non-communicable diseases (NCD) pose a substantial global public health challenge, representing the leading cause of morbidity and mortality worldwide. This study investigates the progress and challenges in implementing NCD policies in Sudan. Document analysis following the ready your materials, extract data, analyse data and distil your findings (READ) approach, was utilized to review published literature and reports. Data from the NCD Progress Monitor showed that the percentage of NCD-related mortality had increased from 32% in 2015 to 54% in 2022. Sudan’s progress in implementing NCD policies has been slow and challenging; eight of the 19 NCD target indicators had never been fully achieved, and only five targets were fully achieved in the year 2022. However, these figures may be underestimated due to the lack of robust NCD information systems. Like many countries, Sudan faces challenges in implementing NCD policies, particularly those targeting healthy diets, medications and data management systems. This may be linked to the prolonged history of conflict, shortage of trained health personnel, limited resources and lack of robust NCD surveillance systems in the country. The ongoing devastating war and destruction of the healthcare system infrastructure in Sudan further intensified these challenges. Prioritizing NCD policies and programmes during the anticipated post-conflict health system reforms is crucial for enhancing NCD prevention and outcomes in Sudan.
Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review
Authors: Semahegn Agumasie , Manyazewal Tsegahun , Hanlon Charlotte , Getachew Eyerusalem , Fekadu Bethelhem , Assefa Esubalew , Kassa Munir , Hopkins Michael , Woldehanna Tassew , Davey Gail , Fekadu Abebaw
Published: December 2023

Background

An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review.

Methods

The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question.

Results

A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms.

Conclusion

Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.
Silencing HOXC13 exerts anti-prostate cancer effects by inducing DNA damage and activating cGAS/STING/IRF3 pathway
Authors: Li Maozhang , Bai Guangwei , Cen Yi , Xie Qitong , Chen Jiahong , Chen Jia , Chen Qingbiao , Zhong Weide , Zhou Xiaobo
Published: December 2023

Background

Advanced prostate cancer (PCa) will develop into castration-resistant prostate cancer (CRPC) and lead to poor prognosis. As the primary subtype of CRPC, CRPC-AR accounts for the major induction of PCa heterogeneity. CRPC-AR is mainly driven by 25 transcription factors (TFs), which we speculate may be the key factors driving PCa toward CRPC. Therefore, it is necessary to clarify the key regulator and its molecular mechanism mediating PCa progression.

Methods

Firstly, we downloaded transcriptomic data and clinical information from TCGA-PRAD. The characteristic gene cluster was identified by PPI clustering, GO enrichment, co-expression correlation and clinical feature analyses for 25 TFs. Then, the effects of 25 TFs expression on prognosis of PCa patients was analyzed using univariate Cox regression, and the target gene was identified. The expression properties of the target gene in PCa tissues were verified using tissue microarray. Meanwhile, the related mechanistic pathway of the target gene was mined based on its function. Next, the target gene was silenced by small interfering RNAs (siRNAs) for cellular function and mechanistic pathway validation. Finally, CIBERSORT algorithm was used to analyze the infiltration levels of 22 immune cells in PCa patients with low and high expression of target gene, and validated by assaying the expression of related immunomodulatory factor.

Results

We found that HOX family existed independently in 25 TFs, among which HOXC10, HOXC12 and HOXC13 had unique clinical features and the PCa patients with high HOXC13 expression had the worst prognosis. In addition, HOXC13 was highly expressed in tumor tissues and correlated with Gleason score and pathological grade. In vitro experiments demonstrated that silencing HOXC13 inhibited 22RV1 and DU145 cell function by inducing cellular DNA damage and activating cGAS/STING/IRF3 pathway. Immune infiltration analysis revealed that high HOXC13 expression suppressed infiltration of γδ T cells and plasma cells and recruited M2 macrophages. Consistent with these results, silencing HOXC13 up-regulated the transcriptional expression of IFN-β, CCL2, CCL5 and CXCL10.

Conclusion

HOXC13 regulates PCa progression by mediating the DNA damage-induced cGAS/STING/IRF3 pathway and remodels TIME through regulation of the transcription of the immune factors IFN-β, CCL2, CCL5 and CXCL10.