bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Solar Hybrid Community Cooking System for Community Kitchens Serving 100-200 Meals/Day
Authors: Chinthamalla Rezeena , Sardeshpande Madhavi , Sardeshpande Vishal , Kumbhakarna Neeraj
Published: September 2024

This study explores the design and development of a solar hybrid community cooking system tailored for community kitchens serving 100–200 meals per day. The study focuses on a solar hybrid system under implementation at a tribal residential school in Gujarat, India, to cook meals for 80 tribal children. Solar hybrid steam-based cooking system involves generating steam using a combination of solar thermal compound parabolic collector (CPC) and photovoltaic (PV) energy sources. The expected savings from the solar hybrid cooking system is about USD 2088 / year for 300 days of operation in a year, with an order investment of USD 12000. The system’s potential reduction in carbon footprint will be approximately 4.95 tons of CO2 per year. The core objective of such integration is to provide nutritious and hygienic meals while reducing the cost of operation and the carbon footprint through solar hybrid technology.
Integration of Solar Distillation in Dairy Effluent Treatment: A Step Toward Reducing Carbon Footprint
Authors: Katekar Vikrant P. , Deshmukh Sandip S.
Published: September 2024

The present study deals with how solar distillation may minimise energy usage and the carbon footprint of traditional effluent treatment plants. From the experimental investigations, it has been found that solar distillation is an effective wastewater treatment approach. After effluent treatment, the water appeared clean and transparent. Even its foul smell was gone. The effluent and absorber plate temperatures varied similarly, with little difference. The maximum absorber plate and effluent temperatures were 70°C and 60°C. Average temperatures were 57°C and 55°C. The condenser glass cover, distiller bottom surface, and air temperatures showed similar changes. Up to 10 a.m., these temperatures were low but reached a maximum of 60°C, 49°C, and 41.1°C by the afternoon. Their average temperatures were 47°C, 42.3°C, and 38.8°C. At 2 p.m., with 836 W/m2 solar irradiation, the greatest hourly production was 0.337 kg/hr. Overall production was 1.69 kg per day for 0.45 square metres. The projected yield per square metre was 3–4 kg per day. Chemical analysis shows pH has increased from 5.1 to 7.2. The fact that the water went from acidic to alkaline shows that effluent treatment produces high-quality water. TDS reduced from 815 ppm to 80 ppm after effluent treatment, indicating fewer pollutants and better water quality. This study also showed that integrating the solar distillation system into the central effluent treatment plant reduced its load by 40%.
Model-Based Design and Economic Assessment of a Clean Grid-Independent Hydrogen Supply Station for a Bus Fleet
Authors: Bove Giovanni , Sorrentino Marco , Desideri Umberto
Published: September 2024

The imperative of achieving net zero emission (NZE) targets is central to the global sustainability agenda, particularly in the critical sector of urban bus fleets. This study explores transitioning fleets from traditional diesel to fuel cell (FC) propulsion, identifying the most economically viable option through a comprehensive methodology, including a total cost of ownership (TCO) analysis. Despite FC technology advancements, challenges persist due to unfavorable hydrogen price and high capital expenditures, necessitating innovative alternatives. The main objective is to introduce and validate the design of a clean grid-independent hydrogen supply station, a transformative solution envisioning a fleet powered by H2 generated from a proton exchange membrane electrolyzer (PEMEL) based renewable microgrid, overcoming challenges posed by H2 pricing and aligning with NZE goals.

The design process involves developing a tailored PEMEL-based microgrid for hydrogen production. Analyses include a simple payback (SPB) period evaluation and validation, comparing the proposed configuration with microgrid setups by other authors. Despite challenges, the grid concept associated with fleet renewal demonstrates real-world viability and economic benefits, providing a compelling case for adoption in urban bus fleet renewal. With a 40% reduction in TCO compared to FC bus renewal and a 10% reduction compared to diesel buses, it represents a sustainable and economically sound solution that significantly contributes to the global sustainability agenda.
Analysis of Electrochemical Capture of CO2 From Oceanwater Coupled With Hydrates-Based Seabed Sequestration
Authors: Hamalian Mark , Bhati Awan , Bahadur Vaibhav
Published: September 2024

Novel energy efficient and scalable carbon capture and sequestration technologies are critical to meeting the goals of the Paris Agreement. In this study, we present a first-order system-level assessment of an integrated carbon capture and carbon sequestration plant that couples electrochemical CO2 capture from oceanwater with co-located long-term carbon sequestration as CO2 hydrates (ice-like solids) on the seabed. Separate recent experimental results associated with electrochemical capture and hydrate formation form the basis for this energetics-focused analysis, which evaluates power consumption of all the key components associated with capture and sequestration. Hydrates can be formed from both pure water as well as seawater, and the implications of including a desalination plant to provide pure water for hydrate formation are studied. All analysis is conducted for a 1 plant which captures and sequesters 1 megaton CO2 annually. Our results indicate the carbon capture will consume significantly more energy than carbon sequestration despite the use of a low-energy consuming electrochemical technique. From a sequestration standpoint, there are clear benefits to forming hydrates at high pressures, since the elevated formation rates reduce the number of hydrate formation reactors significantly. It is also seen that the addition of a desalination plant to provide pure water for hydrate formation (which speeds up hydrate formation) will not affect the energetics of the overall process significantly; however the CAPEX and operational aspects of including a desalination plant need to be analyzed in greater detail. Overall, this study seeds a novel CCS concept which can be deployed via decommissioned oil-gas platforms to capture CO2 from surface oceanwater and store CO2 right below on the seabed after appropriate sealing (artificial or natural).
Heliostat Field and a Solid Particle Receiver Curtain Under Dynamic Conditions for CSP Plants
Authors: Nanclares Juan Camilo , Marton Matthew , Arias Jesus , Haynes Comas , Ordonez Juan C.
Published: September 2024

Solid particles are being pursued as the next generation collecting and storage media for central receiver concentrated solar power (CSP) systems. This paper studies the interactions between the CSP heliostat field and its free-falling particle receiver. A thermodynamic model to predict the receiver temperature is presented. Direct Normal Irradiance (DNI) and ambient temperature data for clear sky and partially cloudy sky days in each season are considered for Tucson, AZ. The heliostat and receiver parameters are representative of those of the Gen 3 Particle Pilot Plant (G3P3) developed by DOE and Sandia. The temperature distribution follows the trend of the irradiation profile for the selected day as anticipated, and increments in mass flow rate result in a lower outlet temperature of the curtain.
Biochemical characterization of
Mycobacterial
RNA polymerases
Authors: Cooper Stephanie L. , Requijo Ryan M. , Lucius Aaron L. , Schneider David A.
Published: September 2024

Tuberculosis is caused by the bacterium
Mycobacterium tuberculosis
(Mtb). While eukaryotic species employ several specialized RNA polymerases (Pols) to fulfill the RNA synthesis requirements of the cell, bacterial species use a single RNA polymerase (RNAP). To contribute to the foundational understanding of how Mtb and the related non-pathogenic mycobacterial species,
Mycobacterium smegmatis
(Msm), perform the essential function of RNA synthesis, we performed a series of
in vitro
transcription experiments to define the unique enzymatic properties of Mtb and Msm RNAPs. In this study, we characterize the mechanism of nucleotide addition used by these bacterial RNAPs with comparisons to previously characterized eukaryotic Pols I, II, and III. We show that Mtb RNAP and Msm RNAP demonstrate similar enzymatic properties and nucleotide addition kinetics to each other but diverge significantly from eukaryotic Pols. We also show that Mtb RNAP and Msm RNAP uniquely bind a nucleotide analog with significantly higher affinity than canonical nucleotides, in contrast to eukaryotic RNA polymerase II. This affinity for analogs may reveal a vulnerability for selective inhibition of the pathogenic bacterial enzyme.

IMPORTANCE

Tuberculosis, caused by the bacterium
Mycobacterium tuberculosis
(Mtb), remains a severe global health threat. The World Health Organization (WHO) has reported that tuberculosis is second only to COVID-19 as the most lethal infection worldwide, with more annual deaths than HIV and AIDS (
WHO.int
). The first-line treatment for tuberculosis, Rifampin (or Rifampicin), specifically targets the Mtb RNA polymerase. This drug has been used for decades, leading to increased numbers of multi-drug-resistant infections (Stephanie,
et al
). To effectively treat tuberculosis, there is an urgent need for new therapeutics that selectively target vulnerabilities of the bacteria and not the host. Characterization of the differences between Mtb enzymes and host enzymes is critical to inform these ongoing drug design efforts.
The
Sinorhizobium meliloti
nitrogen-fixing symbiosis requires CbrA-dependent regulation of a DivL and CckA phosphorelay
Authors: Bender Hayden A. , Huynh Roger , Puerner Charles , Pelaez Jennifer , Sadowski Craig , Kissman Elijah N. , Barbano Julia , Schallies Karla B. , Gibson Katherine E.
Published: September 2024

The cell cycle is a fundamental process involved in bacterial reproduction and cellular differentiation. For
Sinorhizobium meliloti
, cell cycle outcomes depend on its growth environment. This bacterium shows a tight coupling of DNA replication initiation with cell division during free-living growth. In contrast, it undergoes a novel program of endoreduplication and terminal differentiation during symbiosis within its host. While several DivK regulators at the top of its CtrA pathway have been shown to play an important role in this differentiation process, there is a lack of resolution regarding the downstream molecular activities required and whether they could be unique to the symbiosis cell cycle. The DivK kinase CbrA is a negative regulator of CtrA activity and is required for successful symbiosis. In this work, spontaneous symbiosis suppressors of Δ
cbrA
were identified as alleles of
divL
and
cckA
. In addition to rescuing symbiotic development, they restore wild-type cell cycle progression to free-living Δ
cbrA
cells. Biochemical characterization of the
S. meliloti
hybrid histidine kinase CckA
in vitro
demonstrates that it has both kinase and phosphatase activities. Specifically, CckA on its own has autophosphorylation activity, and phosphatase activity is induced by the second messenger c-di-GMP. Importantly, the CckA
A373S
suppressor protein of Δ
cbrA
has a significant loss in kinase activity, and this is predicted to cause decreased CtrA activity
in vivo
. These findings deepen our understanding of the CbrA regulatory pathway and open new avenues for further molecular characterization of a network pivotal to the free-living cell cycle and symbiotic differentiation of
S. meliloti
.

IMPORTANCE

Sinorhizobium meliloti
is a soil bacterium able to form a nitrogen-fixing symbiosis with certain legumes, including the agriculturally important
Medicago sativa
. It provides ammonia to plants growing in nitrogen-poor soils and is therefore of agricultural and environmental significance as this symbiosis negates the need for industrial fertilizers. Understanding mechanisms governing symbiotic development is essential to either engineer a more effective symbiosis or extend its potential to non-leguminous crops. Here, we identify mutations within cell cycle regulators and find that they control cell cycle outcomes during both symbiosis and free-living growth. As regulators within the CtrA two-component signal transduction pathway, this study deepens our understanding of a regulatory network shaping host colonization, cell cycle differentiation, and symbiosis in an important model organism.
Antimicrobial susceptibility to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients
Authors: Verkaik Nelianne J. , Wielders Cornelia C. H. , den Boer Hans , Langerak Diana , Vogel Marius , Witteveen Sandra , de Haan Angela , Bos Jeroen , van Westreenen Mireille , Notermans Daan W. , Hendrickx Antoni P. A. ,   on behalf of the participating laboratories,   on behalf of the SWAB Working Group Surveillance of Antimicrobial Resistance
Published: September 2024

Since March 2022, an increase was observed in multidrug-resistant microorganisms (MDRO), associated with the hospital transfer of Ukrainian patients. The goal was to collect phenotypic susceptibility data and assess clinical implications. Carbapenemase-producing Enterobacterales (CPE,
n
= 96),
Pseudomonas aeruginosa
(CPPA,
n
= 20), and carbapenem-resistant
Acinetobacter baumannii–calcoaceticus
(CRAB,
n
= 6) from Ukrainian patients were obtained from March to December 2022 from the Dutch MDRO surveillance. Antimicrobial susceptibility testing was performed using broth microdilution (BMD) when available, fosfomycin agar dilution, disk diffusion (DD) for cefiderocol, and diverse gradient strips. All isolates were sequenced with Illumina next-generation sequencing. For meropenem, aminoglycosides, ceftazidime–avibactam, ceftolozane–tazobactam, and imipenem–relebactam, susceptibility rates were low (0%–30%), due to the high number of
bla
NDM
-positive isolates (79/122; 65%). For cefiderocol, results depended on reading with or without microcolonies, applying EUCAST or CLSI breakpoints, and whether DD or BMD was used; e.g., for
Klebsiella pneumoniae
, 30%–97% were susceptible. For colistin, 103/111 (93%) non-intrinsically resistant CPE/CPPA/CRAB isolates were susceptible. For most CPE, a low minimal inhibitory concentration (MIC) of <0.5 mg/L was measured for tigecycline and ceftazidime–avibactam–aztreonam. For CPPA, cefiderocol tested susceptible in 65%–100% of isolates. For CRAB, ampicillin–sulbactam MICs were ≥128 mg/L; for sulbactam–durlobactam, 1–2 mg/L. Admission in a Ukrainian hospital in the last year was a risk factor for MDRO, and majority were screening isolates (79%). There is extensive phenotypic resistance to last-resort antibiotics in MDRO from Ukrainian patients. Interpretation of cefiderocol susceptibility results depends on several variables. When treating patients recently admitted in Ukraine, suspected for Gram-negative bacterial infection, this should be taken into consideration.

IMPORTANCE

Since March 2022, multidrug-resistant microorganisms associated with Ukrainian patients have been detected in national surveillance systems of several European countries. We studied the phenotypic antimicrobial susceptibility to last-resort antibiotics of multidrug-resistant microorganisms from Ukrainian patients in the Netherlands and assessed clinical implications. Our research revealed that there was extensive phenotypic resistance to last-resort antibiotics. Healthcare professionals should be aware of multidrug-resistant microorganisms when treating patients recently admitted in Ukraine, suspected for Gram-negative bacterial infection.
Phenylacetic acid metabolic genes are associated with
Mycobacteroides abscessus
dominant circulating clone 1
Authors: Ross Brittany N. , Evans Emma , Whiteley Marvin
Published: September 2024

Mycobacteroides abscessus
(MAB) causes lung infections in people with cystic fibrosis (pwCF), and infecting strains show significant genetic variability both between and within individuals. MAB isolates can be divided into dominant clonal clusters (DCCs) or non-clustering groups and can present as smooth or rough colonies on agar plates. Both DCCs and the rough colony morphology have been linked to increased pathogenicity, but the mechanisms are unclear. This study explored the genomes of MAB isolates collected from individuals within the CF@LANTA CF center along with publicly available genomes to identify genes associated with more pathogenic MAB DCCs. Sixty-eight isolates from 26 CF individuals colonized by MAB were morphotyped and sequenced, with almost half of these isolates being members of DCC group 1 (DCC1). While lung function was not significantly impacted by colonization with DCC1 or rough isolates, 102 genes were specifically associated with DCC1 isolates. These genes were enriched for functions in sulfur-based DNA modification, DNA integration, and phenylacetic acid (PAA) catabolism. PAA is produced by the human gut microbiota and found throughout the human body. We show that strains containing PAA metabolic genes allow MAB to use PAA as a sole carbon and energy source. Although the benefits of PAA metabolic genes and other enriched pathways remain unclear, these findings highlight genes associated with emerging MAB CF strains.

IMPORTANCE

A primary challenge in treating bacterial infections is the wide spectrum of disease and genetic variability across bacterial strains. This is particularly evident in
Mycobacteroides abscessus
(MAB), an emerging pathogen affecting people with cystic fibrosis (pwCF). MAB exhibits significant genetic diversity both within and between individuals. However, seven dominant circulating clones (DCCs) have emerged as the major cause of human infections, demonstrating increased pathogenicity. Understanding the mechanisms underlying this increased pathogenicity and the associated genetic factors is crucial for developing novel treatment strategies. Our findings reveal that specific genes are associated with the DCC1 isolate of MAB, many of which are implicated in antimicrobial susceptibility or virulence.
Improving breast cancer multidisciplinary meetings through streamlining with protocol-based management
Authors: Sinha Aaditya Prakash , Badawy Katie , Shifa Belul , Peterson Zhane , Attia Mohamed , Pinder Sarah , Purushotham Arnie
Published: September 2024

Objectives

Multidisciplinary meetings (MDMs) are part of standard of care for patients with cancer. Streamlining is essential for high-quality care and efficiency. This study evaluated the feasibility of implementing a protocol to remove patients with benign breast disease from discussion at the MDM.

Methods

A prospective review of 218 MDMs evaluated patients with benign breast disease over 22 months. This was followed by a protocol implementation phase over 54 MDMs (6.5 months). Patients meeting specific criteria were excluded from discussion.

Results

On average, each MDM consisted of 37 patients, 34.2% of whose conditions were benign and potentially could have been removed from discussion. The implementation phase showed 708/2248 patients (32.5%) were benign of which 631 cases (89%) met the eligibility criteria and were removed from the MDM list allowing more time for discussion of complex cases.

Conclusion

Implementing a protocol can safely exclude patients with benign disease from MDM discussion.
Trends in under-five mortality rate in China, 1996–2020: a Joinpoint regression and correlation analysis
Authors: Lv Jian-Min , Chen Nan , He Xi-Ning , Tian Ya-Feng , Zhang Jie , Fan Qiao-Rong , Ma Qiong , Li Hong-Xia
Published: September 2024

Objectives

To analyse annual trends of the under-five mortality rate (U5MR) and main cause-specific U5MR in China from 1996 to 2020 and to assess the potential correlation of the healthcare system and health expenditure with the U5MR in China.

Design

A retrospective observational study using national data from 1996 to 2020. Joinpoint regression was employed to model U5MR trends and Pearson correlation analysis was conducted to examine the relationship between healthcare system factors, health expenditure and U5MR.

Setting

Nationwide study covering both rural and urban populations across China over a 25-year period.

Results

The U5MR in China experienced a three-stage decline from 1996 to 2020 with an average annual percentage rate change (AAPC) of −7.27 (p<0.001). The AAPC of the rural U5MR (−7.07, p<0.001) was higher than that in urban areas (−5.57, p<0.001). Among the five main causes, the decrease in pneumonia-caused U5MR was the fastest while the decreases in congenital heart disease and accidental asphyxia were relatively slow. The rates of hospital delivery (r=−0.981, p<0.001), neonatal visits (r=−0.848, p<0.001) and systematic health management (r=−0.893, p<0.001) correlated negatively with U5MR. The proportion of government health expenditure in the total health expenditure (THE) correlated negatively with the national U5MR (r=−0.892, p<0.001) while the proportion of out-of-pocket health expenditure in THE correlated positively (r=0.902, p<0.001).

Conclusion

China made significant advances in reducing U5MR from 1996 to 2020. The rural–urban gap in U5MR has narrowed, though rural areas remain a key concern. To further reduce U5MR, China should focus on rural areas, pay more attention to congenital heart disease and accidental asphyxia, further improve its health policies, and continue to increase the government health expenditure.
Efficacy of selenium supplementation for patients with Graves' hyperthyroidism during methimazole treatment: protocol for a systematic review and meta-analysis
Authors: Yuan Shuo , Wen Qing , Li Mingxing
Published: September 2024

Introduction

The most common cause of hyperthyroidism, Graves' disease is a common organ-specific autoimmune disease. Selenium is an essential trace element of the human body that is mainly concentrated in the thyroid gland and is involved in the synthesis and metabolism of thyroid hormones. Most studies have shown that the level of selenium is closely related to the occurrence and development of thyroid diseases, and selenium supplementation can help improve thyroid function. This study aims to evaluate the efficacy of selenium supplementation for patients with Graves' hyperthyroidism during methimazole treatment.

Methods and analysis

We will search the electronic databases including PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Chinese Biomedical Literature, and the time was deadline to December 2023. To evaluate the efficacy of methimazole combined with selenium supplementation in the treatment of Graves' hyperthyroidism, randomised controlled trials will be included. The Cochrane Collaboration’s risk of bias tool will be used to assess the quality of all included studies, and the baseline data of all the studies are extracted by the authors. A random-effects model or a fixed-effects model is used to analyse the outcomes. The primary outcomes are the levels of selenium, triiodothyronine, free thyroxine and thyroid-stimulating hormone (TSH), whereas the secondary outcomes include TSH receptor antibody, thyroid peroxidase antibody and thyroglobulin antibody.

Ethics and dissemination

Ethics approval is not required since no original data will be collected. The results of this study will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42023410999
Clinical efficacy and therapeutic mechanism of active ‘five-tone’ speech therapy compared with conventional speech-language therapy for treatment of post-stroke aphasia: protocol for a randomised controlled trial
Authors: Wang Mengxue , Ni Jinglei , Lin Bingbing , Huang Jia
Published: September 2024

Introduction

Aphasia is a common dysfunction among patients with stroke that can severely affect daily life. Listening to the ‘five-tone’ melodies of traditional Chinese medicine can improve some of the language functions of patients with post-stroke aphasia; however, passive listening may limit its clinical efficacy. In this study, we transform the passive listening five-tone melodic therapy of traditional Chinese medicine into an active five-tone speech therapy. This randomised controlled trial aims to investigate the clinical efficacy of active five-tone speech therapy in the treatment of post-stroke aphasia, such as language function, daily communication ability and communication efficiency, as well as investigate the therapeutic mechanism of this innovative therapy by electroencephalogram and MRI.

Methods and analysis

The study is a multicentric, randomised, parallel-assignment, single-blind treatment study. 70 participants will be recruited from the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine and the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine and randomly assigned to two groups, the five-tone speech therapy group and the control group, at a 1:1 ratio. The control group will receive 20 sessions of conventional speech-language therapy, while the five-tone speech therapy group will receive 20 sessions of five-tone speech therapy in addition to conventional speech-language therapy. The primary outcome measure for this study will be the score on Western Aphasia Battery. Secondary outcomes include communicative abilities in daily living, percentage of correct information units and correct information units per minute, as well as resting-state electroencephalogram, event-related potentials and MRI data. All outcomes will be evaluated at 0 weeks (before intervention) and at 4 weeks (after 20 intervention sessions).

Ethics and dissemination

Ethical approval of this study was granted by the ethics committees of the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine (2023KY-009-01) and the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (2023-kl-010). Recruitment commenced on 24 April 2023. Informed consent will be obtained from all participants of the trial (or from their legal guardians, where applicable). The outcomes of the trial will be disseminated through peer-reviewed publications.

Trial registration number

ChiCTR2300069257.
Suicidal behaviours and associated factors among residents of Jimma Town, Southwest Ethiopia: a community-based cross-sectional study
Authors: Tessema Selamawit Alemayehu , Torba Alemayehu Negash , Tesfaye Elias , Alemu Bezaye , Oblath Rachel
Published: September 2024

Introduction

Suicidal behaviour is a major public health concern in Africa and a cause of premature mortality. The availability of community epidemiological data in Ethiopia is limited. This study assessed the prevalence of suicidal behaviour and its associated factors in Jimma Town, Southwest Ethiopia.

Methods

Using the Suicide Behaviour Questionnaire-Revised (SBQ-R), a community-based cross-sectional survey was conducted between September and November 2021. Multistage sampling was used to screen 636 participants for suicidal behaviour. The association between suicidal behaviour and other variables was explored using binary and multivariable logistic regression analyses.

Results

The overall estimated prevalence of suicidal behaviour of the respondents in the study was 7.9% (95% CI 5.9% to 10.3%), using the SBQ-R score (>7). One-third of the individuals with lifetime attempts encountered stigma. Multivariable logistic regression models indicated that being female (AOR 2.81, 95% CI 1.48 to 5.31), having depression (AOR 6.9, 95% CI 1.98 to 24.57), family history of mental illness (AOR 4.11, 95% CI 1.38 to 12.19), poor social support (AOR 3.86, 95% CI 1.23 to 12.15) and good coping efficacy (AOR 0.91, 95% CI 0.88 to 0.94))were significantly associated for suicidal behaviour with p value less than 0.05.

Conclusion

The overall prevalence of suicidal behaviour was relatively higher in this population than in other studies done in Ethiopia. In addition, the current study indicates the presence of suicide stigma, which further influences poor health-seeking behaviours. The factors significantly associated with suicidal behaviour in this study included being female, having a family history of mental illness, poor social support, poor coping self-efficacy and depressive symptoms. Findings warrant the attention of policy-makers in early screening of depression, developing preventive measures targeting risk factors and enhancing access to mental healthcare services.
Are Ethiopian health facilities providing diabetes services capable of managing tuberculosis? Policy implications for introducing diabetes and tuberculosis collaborative care
Authors: Asmamaw Getahun , Minwagaw Tefera , Samuel Mastewal , Ayenew Wondim
Published: September 2024

Objective

This study aimed to assess the availability and preparedness of health facilities offering diabetes mellitus (DM) to manage tuberculosis (TB) in Ethiopia.

Design

Secondary data analysis of institution-based cross-sectional national survey data.

Setting

Data were obtained from the 2021–2022 Ethiopian Service Provision Assessment (ESPA) survey which includes all active health facilities in Ethiopia.

Participants

This study included all health facilities that provide DM services (both diagnosis and treatment) and recently collected DM data during the 2021–2022 ESPA survey.

Outcome measures

The service availability was computed as the percentage of facilities offering DM services to provide TB management. The preparedness of these facilities for managing TB was measured using three service tracer indicators (staff training and guidelines, diagnostics and essential medicines used in TB management) defined by the WHO Service Availability and Readiness Assessment Manual. The extent of preparedness was categorised as low level (<50%), moderate level (≥50% to 75%) and high level (≥75%). A descriptive statistic was employed to present the study findings.

Results

Only 170 out of 338 facilities were reported to provide DM services across the country, with 136 (70%) also offering TB management services. Among these facilities, the majority were health centres (n=82; 60.1%), publicly owned (n=98; 72.0%), rural (n=83; 60.7%) and located in the Oromia region (n=53; 39.0%). Regarding preparedness, facilities offering DM services had an overall moderate to high preparedness for managing TB, with 47 (27.5%), 53 (31.1%) and 70 (41.3%) facilities classified as low-level, moderate-level and high-level preparedness, respectively. Specifically, these facilities were less prepared in the domains of ‘trained staff and guidelines’ and ‘diagnostics’, but had better preparedness in providing first-line TB drugs, with an overall score of 79.7%.

Conclusions

Although the percentage availability of TB services in facilities offering DM services and their preparedness was unsatisfactory compared with WHO standards, Ethiopia has a greater capacity to implement WHO strategies to reduce the burden of TB-DM comorbidity. However, given the high epidemiological risk and the high burden of both diseases in the country, our findings emphasise the urgent necessity to establish and implement a collaborative TB-DM care plan to integrate TB services within facilities providing DM care.
Prevention of adverse HIV treatment outcomes: machine learning to enable proactive support of people at risk of HIV care disengagement in Tanzania
Authors: Xie Zhongming , Hu Huiyu , Kadota Jillian L , Packel Laura J , Mlowe Matilda , Kwilasa Sylvester , Maokola Werner , Shabani Siraji , Sabasaba Amon , Njau Prosper F , Wang Jingshen , McCoy Sandra I
Published: September 2024

Objectives

This study aimed to develop a machine learning (ML) model to predict disengagement from HIV care, high viral load or death among people living with HIV (PLHIV) with the goal of enabling proactive support interventions in Tanzania. The algorithm addressed common challenges when applying ML to electronic medical record (EMR) data: (1) imbalanced outcome distribution; (2) heterogeneity across multisite EMR data and (3) evolving virological suppression thresholds.

Design

Observational study using a national EMR database.

Setting

Conducted in two regions in Tanzania, using data from the National HIV Care database.

Participants

The study included over 6 million HIV care visit records from 295 961 PLHIV in two regions in Tanzania’s National HIV Care database from January 2015 to May 2023.

Results

Our ML model effectively identified PLHIV at increased risk of adverse outcomes. Key predictors included past disengagement from care, antiretroviral therapy (ART) status (which tracks a patient’s engagement with ART across visits), age and time on ART. The downsampling approach we implemented effectively managed imbalanced data to reduce prediction bias. Site-specific algorithms performed better compared with a universal approach, highlighting the importance of tailoring ML models to local contexts. A sensitivity analysis confirmed the model’s robustness to changes in viral load suppression thresholds.

Conclusions

ML models leveraging large-scale databases of patient data offer significant potential to identify PLHIV for interventions to enhance engagement in HIV care in resource-limited settings. Tailoring algorithms to local contexts and flexibility towards evolving clinical guidelines are essential for maximising their impact.
Perceptions of genomic newborn screening: a cross-sectional survey conducted with UK medical students
Authors: Seed Lydia , Scott Anna , Pichini Amanda , Peter Michelle , Tadros Shereen , Sortica da Costa Cristine , Hill Melissa
Published: September 2024

Background

With the potential to identify a vast number of rare diseases soon after birth, genomic newborn screening (gNBS) could facilitate earlier interventions and improve health outcomes. Designing a gNBS programme will involve balancing stakeholders’ opinions and addressing concerns. The views of medical students—future clinicians who would deliver gNBS—have not yet been explored.

Methods

We conducted a nationwide online survey of UK medical students via the REDCap platform. Perceptions of gNBS, including scope of testing and potential benefits and drawbacks, were explored using a mix of multiple-choice questions, Likert scales, visual analogue scales and free-text questions.

Results

In total, 116 medical students across 16 universities participated. Overall, 45% supported gNBS, with a positively skewed mean support score of 3.24 (SD 1.26, range: 1.0–5.0), and 55% felt it relevant to their future practice. Almost all agreed that infant-onset and childhood-onset diseases and conditions with effective treatments should be included. Most felt that earlier interventions and personalised care would be the most important benefit of gNBS. Other perceived benefits included earlier diagnoses, diagnosing more patients and enabling research for new treatments. However, several perceived challenges were highlighted: risk of genomic discrimination, incidental or uncertain findings, data security and breaching children’s future autonomy. Students expressed conflicting opinions on the psychological impact on families, but most were concerned about a lack of support due to current resource limitations in health services. Students frequently reported having insufficient knowledge to form an opinion, which may reflect gaps in genomics education at medical school and the current lack of evidence base for gNBS.

Conclusion

Although some support for gNBS was demonstrated, ethicolegal and social challenges were raised, emphasising a need for ongoing discussions about the implications of gNBS.
Comparative effectiveness trial of metformin versus insulin for the treatment of gestational diabetes in the USA: clinical trial protocol for the multicentre DECIDE study
Authors: Venkatesh Kartik K , MacPherson Cora , Clifton Rebecca G , Powe Camille E , Bartholomew Anna , Gregory Donna , Trinh Anne , McAlearney Ann Scheck , Fiechtner Lauren G , Catalano Patrick , Rice Donna , Cross Sharon , Kutay Huban , Gabbe Steven , Grobman William A , Costantine Maged M , Battarbee Ashley N , Boggess Kim , Katukuri Vivek , Eichelberger Kacey , Esakoff Tania , Feghali Maisa N , Harper Lori , Kaimal Anjali , Kole-White Martha , Mendez-Figueroa Hector , Mlynarczyk Malgorzata , Sciscione Anthony , Shook Lydia , Sobhani Nasim C , Stamilio David M , Werner Erika , Wiegand Samantha , Zera Chloe A , Zork Noelia M , Saade George , Landon Mark B
Published: September 2024

Introduction

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the affected pregnant individual and the infant exposed in utero. One in four individuals with GDM will require pharmacotherapy to achieve glycaemic control. Injectable insulin has been the mainstay of pharmacotherapy. Oral metformin is an alternative option increasingly used in clinical practice. Both insulin and metformin reduce the risk of adverse pregnancy outcomes, but comparative effectiveness data from a well-characterised, adequately powered study of a diverse US population remain lacking. Because metformin crosses the placenta, long-term safety data, in particular, the risk of childhood obesity, from exposed children are also needed. In addition, the patient-reported experiences of individuals with GDM requiring pharmacotherapy remain to be characterised, including barriers to and facilitators of metformin versus insulin use.

Methods and analysis

In a two-arm open-label, pragmatic comparative effectiveness randomised controlled trial, we will determine if metformin is not inferior to insulin in reducing adverse pregnancy outcomes, is comparably safe for exposed individuals and children, and if patient-reported factors, including facilitators of and barriers to use, differ between metformin and insulin. We plan to recruit 1572 pregnant individuals with GDM who need pharmacotherapy at 20 US sites using consistent diagnostic and treatment criteria for oral metformin versus injectable insulin and follow them and their children through delivery to 2 years post partum. More information is available atwww.decidestudy.org.

Ethics and dissemination

The Institutional Review Board at The Ohio State University approved this study (IRB: 2024H0193; date: 7 December 2024). We plan to submit manuscripts describing the results of each study aim, including the pregnancy outcomes, the 2-year follow-up outcomes, and mixed-methods assessment of patient experiences for publication in peer-reviewed journals and presentations at international scientific meetings.

Trial registration number

NCT06445946.
Macular exudate in idiopathic intracranial hypertension affects outer retina and visual acuity
Authors: Cao Le , Wang Hang , Kwapong William Robert , Wan Jincheng , Yan Yuying , Liu Guina , Liu Rui , Hu Fayun , Wu Bo
Published: September 2024

Background

Optical coherence tomography (OCT) is suggested as a potential tool for retinal biomarkers in idiopathic intracranial hypertension (IIH). We explored how macular exudate (ME) affects retinal structure in IIH and investigated its relationship with their clinical features.

Methods

Patients diagnosed with IIH and matched controls were enrolled. ME detection was done on fundus photography; swept-source OCT was used to image and measure the retinal sublayer thicknesses, including the retinal nerve fibre layer, ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL) and outer retinal layer (ORL). IIH patients underwent lumbar puncture where intracranial pressure (ICP) was assessed.

Results

195 eyes from 98 IIH patients (42 eyes had ME) and 224 eyes from 112 controls were included. IIH patients had thicker INL and ORL compared with controls (both p<0.001) while IIH eyes with ME had thicker INL and ORL thicknesses compared with eyes without ME (both p<0.05). In IIH patients, the retinal sublayer thicknesses correlated with their ICP levels, and GCIPL thickness correlated with visual acuity (VA). Furthermore, ME was associated with higher ICP, worse papilledema and lower VA (all p<0.001).

Conclusion

ME affects retinal thickness in IIH patients and is associated with more severe clinical features in IIH. OCT may provide biomarkers informative of clinical changes in IIH. Further longitudinal studies are needed to explore the evolution of ME and its relationship to VA and retinal structure.
Evaluation of a training programme on the management of infectious and sharp healthcare waste in Tunisia
Authors: Chelly Souhir , Saffar Sonia , Mabrouk Rihab , ltaif Imen , Ammar Asma , Ezzi Olfa , Njah Mansour , Mahjoub Mohamed
Published: September 2024

Introduction

The management of healthcare waste is a crucial issue for public health and the environment. To minimise risks, it is essential to ensure that the management of healthcare waste is meticulously applied. Additionally, among the evaluation methods adopted by the hospital hygiene department to monitor the degree of compliance. The aim of this study was to assess the degree of compliance with healthcare waste management before and after a training and support programme.

Methods

This is a pre-experimental study based on two audits of healthcare waste management at Farhat Hached University Hospital in Sousse, Tunisia. All medical, surgical and laboratory departments were included. The first audit was carried out, followed by training of the responsible staff, which was carried out according to a cycle of training and coaching hygiene technicians, and finally, a second audit was conducted. The compliance rate is compared between 2021 and 2022.

Results

When comparing the averages of the compliance percentages for the four audit areas, there was a statistically significant improvement between the years 2021 and 2022 in the availability of equipment and consumables required for the management of infectious and sharp healthcare waste (p=0.029) as well as intramural transport (p=0.014).

Conclusion

The study highlights the central role of effective waste management training in promoting compliance, awareness and responsible practices. Constant attention and training are essential to maintain progress at Farhat Hached University Hospital. This helps create safer care environments, better public health outcomes and long-term sustainability.
Factors associated with cost of adverse events in the intensive care unit: an economic evaluation performed in Bogotá, Colombia
Authors: Rincón López Juliana Vanessa , Diaz Rojas Jorge Augusto , Estrada-Orozco Kelly
Published: September 2024

Background

The costs of adverse health events represent a significant burden of disease. Management of these adverse events also entails high costs to healthcare systems, reaching up to US$110 516.25 in some countries. The intensive care unit is a context where they occur most frequently, with some studies reporting rates as high as 50% of the population. It is of utmost importance to examine which aspects of the care process related to patients or the events themselves have the most significant impact on costs. The objective of this economic evaluation is to establish the clinical and healthcare factors that determine the cost of adverse events in the intensive care units of two university hospitals in Bogotá, Colombia.

Methods

We carried out an economic analysis study evaluating the clinical factors of patient care and institutions that have the most impact on the costs of adverse events. The population consisted of patients treated in the intensive care units of two university hospitals in Bogotá during 2019 and 2022. The outcome variable was the costs of adverse events, measured as direct costs through the perspective of the institutions providing health services. To estimate the direction and degree of association between clinical variables, adverse events and care with the costs of adverse events, a generalised linear regression gamma link function log was performed.

Results

A total of 369 patients were included, 232 men (62.9%) and 137 women (37.1%), with a median age of 63 years. The median APACHE II classification system score was 13 points, and the median Charlson comorbidity index was 5. Of the adverse events, 252 (68.29%) were passively reported, 223 (60.43%) were preventable and 267 events (72.36%) were non-serious. The events had a median cost of US$54.32 per patient, and the variables related to higher cost were overall hospital stay, stay until the event, Charlson comorbidity index, reporting system, severity, overall stay until the event, musculoskeletal major disease categories, and events related to safe care, pharmacovigilance and technovigilance.

Conclusion

This study was able to establish that overall hospital stay, Charlson index, reporting system and severity are positively related to the costs of adverse events. The factors that were found to be associated with lower costs were length of stay until the event, admission diagnosis related to the musculoskeletal system, and presenting an event related to safe care, pharmacovigilance and technovigilance.
Exercise training improves cardiovascular fitness in dilated cardiomyopathy caused by truncating titin variants
Authors: Flensted Ida Finsen , Stemmerik Mads Godtfeldt , Skriver Sofie Vinther , Axelsen Kasper Holst , Christensen Alex Hørby , Lundby Carsten , Bundgaard Henning , Vissing John , Vissing Christoffer Rasmus
Published: September 2024

Background

Participation in regular exercise activities is recommended for patients with chronic heart failure. However, less is known about the effect of exercise in patients with genetic dilated cardiomyopathy (DCM). We sought to examine the effect of vigorousintensity training on physical capacity in patients with DCM caused by truncating titin variants (TTNtv).

Trial design

Non-randomised clinical pre-post trial of exercise training.

Methods

Individuals with DCM-TTNtv were included from outpatient clinics for inherited cardiac diseases. The trial consisted of 8 weeks of usual care followed by 8 weeks of regular vigorous-intensity cycling exercise, enclosed by three test days. The primary outcome was change in peak oxygen uptake (VO2). Secondary outcomes included change in blood volume, total haemoglobin mass, measures of systolic function and cardiac output/stroke volume during exercise.

Results

Thirteen out of 14 included participants (43% women, age 48±11 years, body mass index: 30±6 kg/m2) completed the trial. In the exercise training period, peak VO2increased by +1.9 mL/kg/min (95% CI +0.9 to +2.9, p=0.002). Compared with usual care, exercise training improved peak VO2by +2.9 mL/kg/min (95% CI +1.2 to +4.5, p=0.002), corresponding to a 10% increase. Adaptations to exercise training included an increase in resting cardiac output (+0.8 L/min, p=0.042), total blood volume (+713 mL, p<0.001), total haemoglobin mass (+73 g, p<0.001), and improved left ventricular (LV) systolic function (LV ejection fraction: +3.2% (p=0.053) and global longitudinal strain: −2.0% (p=0.044)). No exercise-related adverse events or change in plasma biomarkers of cardiac or skeletal muscle damage were observed.

Conclusions

Our study shows that vigorous intensity exercise training improved peak VO2in patients with DCM-TTNtv. Exercise training was associated with improved LV systolic function and increased blood volume and oxygen carrying capacity. Future research should investigate the effect of long-term exercise in this group.

Trial registration number

NCT05180188.