bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting women's empowerment by changing intra‐household decision‐making: A mixed‐methods analysis of a field experiment in rural south‐west Tanzania
Authors: Lecoutere Els , Chu Lan
Published: November 2023

Motivation

In rural sub‐Saharan Africa, patriarchal social norms and customs often lead to unequal resource access, decision‐making power, and intra‐household power relations between women and men co‐heads of smallholder farm households. Household methodologies are gender‐transformative approaches that aim to achieve gender equality and empower women by improving intra‐household gender relations. Evidence of the impact of such approaches on women's empowerment is still scarce.

Purpose

We assess the effects of a programme that introduces participatory intra‐household decision‐making to challenge gender relations within households on women's empowerment. The programme was delivered to monogamous couples who head smallholder coffee‐farming households in rural south‐west Tanzania.

Methods and approach

We combine (quasi‐)experimental quantitative and qualitative methods to assess the programme's impact on women's empowerment and how that impact fits with women's valued domains of empowerment and individual pathways to empowerment.

Findings

Awareness‐raising couple seminars, the programme's least intensive intervention, increased women's access to livestock. Intensive coaching in participatory decision‐making increased women's control over household coffee income—a priority for women. Couple seminars increased women's highly valued involvement in strategic farm decisions—intensive coaching increased it further. Access to personal income, however, valued by women for independent decision‐making for their households' wellbeing, did not change.

Policy implications

Gender‐transformative approaches that challenge domestic gender relations can increase women's access to household income and resources, and increase their participation in farming decisions. Such approaches need to be complemented by interventions to increase women's human capital, knowledge of enterprises, and personal resources. Catering for women's diverse pathways towards empowerment may increase their effectiveness. Challenging deep gender norms requires long‐term engagement and trust between change agents and communities.
Reliability and validity of the Chinese version of the Copenhagen Multi‐Centre Psychosocial Infertility‐Fertility Problem Stress Scales
Authors: Gao Yiming , Wang Qing , Li Guopeng , Zhao Xiangyu , Qin Rui , Kong Linghua , Li Ping
Published: November 2023

Aims

The aim of this study is to introduce the Copenhagen Multi‐Centre Psychosocial Infertility (COMPI)‐Fertility Problem Stress Scales (COMPI‐FPSS) into China and test its applicability in Chinese infertile population.

Background

Infertility‐related stress not only influences patients' psychological well‐being but is also strongly associated with reduced pregnancy rates and poorer assisted conception outcomes, thus warranting focussed attention.

Design

The design used in this study is a cross‐sectional survey.

Methods

A total of 418 participants were recruited by convenience sampling from March to July 2022. The data were randomly divided into two parts: one for item analysis and exploratory factor analysis and the other for confirmatory factor analysis and reliability test. The critical ratio and homogeneity test were used to verify the differentiation and homogeneity of the COMPI‐FPSS; the construct validity was determined by explanatory and confirmatory factor analyses; Cronbach's α coefficient and Spearman–Brown coefficient were used to assess the reliability; and criterion validity was expressed using correlation coefficients for the Perceived Stress Scale and the Negative Affect Scale as the validity criteria.

Results

The revised Chinese version of COMPI‐FPSS has 11 items and 2 dimensions (i.e., personal stress domain and social stress domain). Exploratory factor analysis showed that the cumulative variance contribution rate of the two factors was 68.6%, and confirmatory factor analysis indicated that the model fitted well. The score of the COMPI‐FPSS was significantly and positively associated with perceived stress and negative affect. The Cronbach's α coefficient of the total scale was 0.905, and the Spearman–Brown coefficient was 0.836, explaining excellent reliability.

Conclusion

The revised Chinese version of COMPI‐FPSS shows good reliability and validity, and it can be used to evaluate the infertility‐related stress of infertile patients in China.
The views and perceptions of training in physical health care amongst mental health nurses, managers of mental health nurses and trainers: A systematically constructed narrative synthesis
Authors: Jabbie Lamin , Walshe Catherine , Ahmed Faraz
Published: November 2023

People with serious mental illness have higher morbidity and mortality rates compared with the general population. Mental health nurses are in an optimal position to address physical healthcare needs and inequalities experienced by this group. Research evidence suggests that mental health nurses may lack appropriate skills and confidence. The training needs of mental health nurses in physical health care of patients with serious mental illness and the perceived effectiveness of training that is provided to mental health nurses are explored in this review. A narrative synthesis approach (PROSPERO protocol registration ID=CRD42021230923) involved searching five electronic databases (PsycInfo, Cinahl, Embase, Medline and Web of Science) from 1990 to 2021. Study quality was assessed, and analysis and synthesis were initially deductively guided by a theoretical framework of training effectiveness prior to inductive data analysis. Eleven studies met the inclusion criteria. For studies examining perceived effectiveness of training, four themes were derived from the theoretical framework (individual trainee characteristics, work environment, learning outcomes, transfer of training to job) and further theme (service user factor) generated inductively. For studies examining training needs, three themes were derived inductively (knowledge and skills requirements, modality of training, service and healthcare factors). The study highlights the need for ongoing learning to improve practice. It also provides another perspective in terms of understanding the influence of service user factors (motivation and mental state) in designing and implementing of future training in mental health settings.
Initial clinical experience of atrial fibrillation ablation guided by a cryoballoon‐compatible, magnetic‐based circular catheter
Authors: Liao Yu , Bai Rong , Shatz Dalise Yi , Weiss J. Peter , Zawaneh Michael , Tung Roderick , Su Wilber
Published: November 2023

Introduction

The circular catheter compatible with current cryoballoon system for atrial fibrillation (AF) ablation is exclusively sensed by impedance‐based electro‐anatomical mapping (EAM) system, limiting the accuracy of maps. We aim to investigate the feasibility and safety of a magnetic‐based circular mapping catheter for AF ablation with cryoballoon.

Methods

Nineteen consecutive patients who underwent pulmonary vein isolation (PVI) with cryoballoon for paroxysmal or persistent AF were included. EAMs of left atrium (LA) created by the LASSOSTAR™NAV catheter (Lassostar map) before and after PVI were compared to that generated by a high‐density mapping catheter (Pentaray map) from different aspects including structural similarity, PV angle, LA posterior wall (LAPW) and low voltage areas (LVAs), and the amplitude of far field electrograms (FFEs) recorded by catheters.

Results

All patients had successful PVI without major complications. With similar mapping time and density, the LA volume calculated from the Pentaray map and Lassostar map were comparable. There were no significant differences in PV angle of all PVs and PW area (16.8 ± 3.2 vs. 17.1 ± 2.8, p = .516) between Pentaray map and Lassostar map. High structural similarity score was observed between two maps (0.783 in RAO/LAO view and 0.791 in PA view). Lassostar map detected lesser but not statistically significant extension of LVA (13.9% vs. 18.3%, p = .07). Amplitude of FFE was larger at the right superior PV on Lassostar map (0.21 ± 0.16 vs. 0.14 ± 0.11 mV, p = .041) compared to that on the Pentaray map.

Conclusion

In our initial experience, PVI with cryoballoon and magnetic‐based circular LASSOSTAR™NAV catheter was safe and effective based on the accurate LA geometry it created.
Akkermansia muciniphilaMucT attenuates sodium valproate‐induced hepatotoxicity and upregulation of Akkermansia muciniphila in rats
Authors: Cui Zhi , Xu Liang , Zhao Ming , Zhou Luping
Published: November 2023

In the previous study, we found that the oral sodium valproate (SVP) increased the relative abundance of Akkermansia muciniphila (A. muciniphila) in rats, and plasma aspartate transaminase (AST) and alanine aminotransferase (ALT) activities were positively correlated with A. muciniphila levels. This study aimed to further investigate the role of A. muciniphila in SVP‐induced hepatotoxicity by orally supplementing rats with the representative strain of A. muciniphila, A. muciniphila MucT. Additionally, the fresh faeces were incubated anaerobically with SVP to investigate the effect of SVP on faecal A. muciniphila in the absence of host influence. Results showed that A. muciniphila MucT ameliorated the hepatotoxicity and upregulation of A. muciniphila induced by SVP. SVP also induced a noteworthy elevation of A. muciniphila level in vitro, supporting the observation in vivo. Therefore, we speculate that A. muciniphila MucT may be a potential therapeutic strategy for SVP‐induced hepatotoxicity. In addition, the increased A. muciniphila induced by SVP may differ from A. muciniphila MucT, but further evidence is needed. These findings provide new insights into the relationships between A. muciniphila and SVP‐induced hepatotoxicity, highlighting the potential for different A. muciniphila strains to have distinct or even opposing effects on SVP‐induced hepatotoxicity.
Changes in surgery rates among hospitalized patients with inflammatory bowel disease in Japan from 2015 to 2019: A nationwide administrative database analysis
Authors: Yoshida Shoko , Imai Shinobu , Fushimi Kiyohide
Published: November 2023

Background and Aim

Treatment of inflammatory bowel disease (IBD), consisting of ulcerative colitis (UC) and Crohn's disease (CD), has advanced with the application of biologics or Janus kinase inhibitor (JAKi); however, some patients still need surgery. We assessed time trends of surgery and biologics or JAKi variety in Japan.

Methods

Patients hospitalized due to IBD were analyzed using Diagnosis Procedure Combination data between 2015 and 2019. Longitudinal trend analysis was performed for demographics, and interrupted time‐series analysis was performed to examine the association between surgery rates and an increase in the types of biologics or JAKi.

Results

Totally, 37 867 cases with UC and 35 493 cases with CD were analyzed. Over 5 years, the surgery rate decreased in both UC and CD. The proportion of biologics and JAKi usage increased in UC and stabilized in CD. Between decreasing surgery and expanding treatment options of biologic or JAKi, interrupted time‐series analysis results showed no significant correlation (level change in UC, −1.13, 95% confidence interval [CI]: −2.11 to −0.16, P = 0.0235; slope change in UC, −0.05, 95% CI: −0.26 to 0.16, P = 0.6372; level change in CD, −0.55, 95% CI: −1.82 to 0.71, P = 0.3815; slope change in CD, −0.22, 95% CI: −0.63 to 0.19, P = 0.2892).

Conclusions

In Japan, from 2015 to 2019, the use of biologics or JAKi increased for UC and slightly decreased for CD, while the number of surgeries decreased in both. Our findings suggest that more widespread use of biologics or JAKi therapy could reduce surgeries in patients with IBD.
Computed tomography and guidelines‐based human–machine fusion model for predicting resectability of the pancreatic cancer
Authors: Yimamu Adilijiang , Li Jun , Zhang Haojie , Liang Lidu , Feng Lei , Wang Yi , Zhou Chenjie , Li Shulong , Gao Yi
Published: November 2023

Background and Aim

The study aims to develop a hybrid machine learning model for predicting resectability of the pancreatic cancer, which is based on computed tomography (CT) and National Comprehensive Cancer Network (NCCN) guidelines.

Method

We retrospectively studied 349 patients. One hundred seventy‐one cases from Center 1 and 92 cases from Center 2 were used as the primary training cohort, and 66 cases from Center 3 and 20 cases from Center 4 were used as the independent test dataset.

Semi‐automatic module of ITK‐SNAP software was used to assist CT image segmentation to obtain three‐dimensional (3D) imaging region of interest (ROI). There were 788 handcrafted features extracted for 3D ROI using PyRadiomics. The optimal feature subset consists of three features screened by three feature selection methods as the input of the SVM to construct the conventional radiomics‐based predictive model (cRad). 3D ROI was used to unify the resolution by 3D spline interpolation method for constructing the 3D tumor imaging tensor. Using 3D tumor image tensor as input, 3D kernelled support tensor machine‐based predictive model (KSTM), and 3D ResNet‐based deep learning predictive model (ResNet) were constructed. Multi‐classifier fusion ML model is constructed by fusing cRad, KSTM, and ResNet using multi‐classifier fusion strategy. Two experts with more than 10 years of clinical experience were invited to reevaluate each patient based on their CECT following the NCCN guidelines to obtain resectable, unresectable, and borderline resectable diagnoses. The three results were converted into probability values of 0.25, 0.75, and 0.50, respectively, according to the traditional empirical method. Then it is used as an independent classifier and integrated with multi‐classifier fusion machine learning (ML) model to obtain the human–machine fusion ML model (HMfML).

Results

Multi‐classifier fusion ML model's area under receiver operating characteristic curve (AUC; 0.8610), predictive accuracy (ACC: 80.23%), sensitivity (SEN: 78.95%), and specificity (SPE: 80.60%) is better than cRad, KSTM, and ResNet‐based single‐classifier models and their two‐classifier fusion models. This means that three different models have mined complementary CECT feature expression from different perspectives and can be integrated through CFS‐ER, so that the fusion model has better performance. HMfML's AUC (0.8845), ACC (82.56%), SEN (84.21%), SPE (82.09%). This means that ML models might learn extra information from CECT that experts cannot distinguish, thus complementing expert experience and improving the performance of hybrid ML models.

Conclusion

HMfML can predict PC resectability with high accuracy.
Recycled or reusable: A multi‐method assessment of eco‐friendly packaging in online retail
Authors: Frommeyer Britta , Koch Julia , Scagnetti Carla , Lorenz Manuel , Schewe Gerhard
Published: November 2023

The rapid growth of online retail increases the demand for packaging. Although packaging is necessary to fulfill logistic and marketing functions, it fosters the depletion of resources, is often used carelessly, and thus negatively impacts the environment. Eco‐friendly packaging variants could provide a solution to this problem. Since many stakeholders must be involved to promote their use, this study develops a conceptual framework that reconciles their different perspectives and combines these with an environmental assessment to facilitate the transition to more sustainable online retail. We apply a multi‐method research approach to investigate the different views. We use qualitative interviews and website analyses to capture the perspective of online retailers, conduct an online survey (n = 1491) to investigate consumers’ perceptions of various product and transport packaging alternatives, and perform a life cycle assessment (LCA) of these options. The findings reveal that online retailers lack knowledge regarding consumer preferences and the environmental impact of packaging. The consumer survey shows a strong preference for packaging made from recycled paper and general avoidance of plastic packaging. The LCA results reveal that recycled and reusable variants are environmentally beneficial. The findings are interpreted in light of the relationships assumed in the conceptual framework. From a theoretical perspective, our results indicate that online retailers are concerned about the signaling role of packaging and that consumers refer to heuristic cues when deciding between packaging variants. We reconcile the different perspectives to propose strategies that contribute to a broader distribution of eco‐friendly packaging in online retail.
Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers
Authors: Traynor Nicole M. , Hughes Melanie , Wood Angela , Onslow Gillian , Edwards Karen , Clements Jessica , Kohlhoff Jane
Published: November 2023

Aim

To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes.

Design

Qualitative study using semi‐structured interviews.

Methods

Semi‐structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis.

Results

Mothers reported short‐term improvements in their child's presenting issues (e.g. feeding to sleep, night‐time waking, co‐sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent–clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term.

Conclusion

This nurse‐led telehealth program was viewed positively by parents and the study identified a number of areas for improvement.

Implications for the profession and/or Patient care

Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent–nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period.

Impact

The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service.

Reporting method

The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.
The Women Farmer Stress Inventory: Examining women farmer stress in the United States Corn Belt
Authors: Nichols Carly E. , Davis Jonathan
Published: November 2023

Purpose

While women identifying as primary farmers have increased in the United States, there has not been research focused on the antecedents of stress and quality of life among women farmers in particular. This study set out to construct a Women Farmer Stress Inventory (WFSI), test its dimensionality, and assess its criterion‐related validity by looking at its relationship with subjective wellbeing as measured by the Satisfaction with Life Scale (SWLS). We then examined sociodemographic and farm‐level correlates to assess their relationship with stress.

Methods

We utilized responses from a random sample of 592 Iowan women farmers who responded to a mailout survey that included the WFSI. We conducted exploratory factor analysis to identify the factorial structure of the WFSI, and used linear regression to evaluate how sociodemographic and farm‐level characteristics were related to each factor.

Results

The analysis revealed 5 unique factors that reflected different aspects of women farmer stress: time pressures and workload, environmental concern, external stressors from governments and market, interpersonal relationships, and rural amenities. All factors except rural amenities had high levels of internal consistency (Cronbach's alpha >0.80) and were validated using the external criteria of SWLS measures. Young age, being married, and engagement in off‐farm work, and smaller farm size were associated with greater levels of stress across most domains.

Conclusion

The WFSI is a promising tool that shows high internal consistency and is validated with life satisfaction. Our study also finds certain sociodemographic and farm characteristics associated with different stress domains, which could inform both future research and community‐based interventions.
Why do owls have it worse? Mediating role of self‐perceptions in the links between diurnal preference and features of mental health
Authors: Gorgol Joanna , Stolarski Maciej , Nikadon Jan
Published: November 2023

Recent research provides evidence for the negative social perceptions of evening chronotypes and their consequences on mental health. However, there is a lack of studies indicating whether these negative, socially shared beliefs may become internalized in negative self‐perceptions of evening‐types (E‐types). The present article provides a seminal empirical analysis of the role of self‐liking and self‐competence in the associations between chronotype and both depressiveness and well‐being. In the first part of the study, the participants completed the Composite Scale of Morningness. On the basis of the chronotype cut‐off criteria for Composite Scale of Morningness distribution, 100 individuals were classified as morning‐types (M‐types) and 66 individuals as E‐types. Therefore, 166 participants (80 women and 86 men) aged 18–36 years (M ± SD: 29.27 ± 4.81 years) took part in the second part of the study, and completed questionnaires measuring self‐liking, self‐competence, life satisfaction, positive and negative affect, and depressiveness. Results show that E‐types scored lower in self‐liking, self‐competence and subjective well‐being, and higher in depressive symptoms than M‐types. Controlling for age and gender, we obtained significant mediation effects, showing that the relationship between chronotype and subjective well‐being might stem from the lower levels of self‐liking and self‐competence among E‐types, and that the relationship between chronotype and depressive symptoms might stem from the lower level of self‐liking among E‐types. Our results suggest that self‐liking and self‐competence are important antecedents of lower well‐being and higher depressiveness reported by E‐types. Socially shared stereotypes of M‐types and E‐types can be internalized by the extreme chronotypes, which may significantly affect their psychological health.
Factors involved in the one‐year changes in the tracheal diameter of patients with amyotrophic lateral sclerosis undergoing tracheostomy positive pressure ventilation
Authors: Shibasaki Nobuhiko , Konishi Kaoru , Miyagawa Tetsuo , Numayama Takaya
Published: November 2023

Background

Tracheostomy positive pressure ventilation (TPPV) is associated with complications in patients with amyotrophic lateral sclerosis (ALS), particularly tracheostomy tube‐related problems.

Aim

To determine the frequency of patients with ALS who received TPPV that have tracheal enlargement and factors associated with changes in tracheal diameter.

Methods

We included 43 patients with ALS undergoing TPPV who were admitted at Sayama Neurological Hospital in October 2019. The tracheal diameter at the height of the tracheostomy tube cuff was measured radiographically at specific time points. Tidal volume, inspiratory maximum pressure (PIP), dynamic lung compliance (Cdyn), tracheostomy tube cuff data, and patient demographic information and data were also collected.

Results

The frequency of tracheomegaly was 60.5% at the initial data collection. The differences in tracheal diameter between the first measurement, after 12 months, and between 3 and 12 months were significant. ΔTracheal diameter correlated with TPPV duration, PIP, Cdyn, ΔPIP, ΔCdyn, and tracheal diameter. Multiple regression analysis, with Δtracheal diameter as the objective variable and TPPV duration, Cdyn, and tracheal diameter as explanatory variables, revealed an adjusted R‐square value of 0.36.

Conclusion

Tracheomegaly and more enlarged tracheal diameters over time were more frequently observed in patients with ALS receiving TPPV. Furthermore, the trachea dilates over time and the tracheal diameter was related to baseline TPPV time, Cdyn, and tracheal diameter. Patients with shorter baseline TPPV duration, higher baseline Cdyn, and smaller baseline tracheal diameter were more likely to have larger tracheal diameters. Therefore, early prevention is important.
Evolution of ventricular and valve function in patients with right ventricular pacing – A randomized controlled trial comparing leadless and conventional pacing
Authors: Garweg Christophe , Duchenne Jürgen , Vandenberk Bert , Mao Yankai , Ector Joris , Haemers Peter , Poels Patricia , Voigt Jens‐Uwe , Willems Rik
Published: November 2023

Background

Leadless pacemakers (PMs) were recently introduced to overcome lead‐related complications. They showed high safety and efficacy profiles. Prospective studies assessing long‐term safety on cardiac structures are still missing.

Objective

The purpose of this study was to compare the mechanical impact of Micra with conventional PM on heart function.

Methods

We conducted a non‐inferiority trial in patients with an indication for single chamber ventricular pacing. Patients were 1:1 randomized to undergo implantation of either Micra or conventional monochamber ventricular pacemaker (PM). Patients underwent echocardiography at baseline, 6 and 12 months after implantation. Analysis included left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and valve function. N‐terminal‐pro hormone B‐type natriuretic peptide (NT‐pro‐BNP) levels were measured at baseline and 12 months.

Results

Fifty‐one patients (27 in Micra group and 24 in conventional group) were included. Baseline characteristics were similar for both groups. At 12 months, (1) the left ventricular function as assessed by LVEF and GLS worsened similarly in both groups (∆LVEF −10 ± 7.3% and ∆GLS +5.7 ± 6.4 in Micra group vs. −13.4 ± 9.9% and +5.2 ± 3.2 in conventional group) (p = 0.218 and 0.778, respectively), (2) the severity of tricuspid valve regurgitation was significantly lower with Micra than conventional pacing (p = 0.009) and (3) median NT‐pro‐BNP was lower in Micra group (970 pg/dL in Micra group versus 1394 pg/dL in conventional group, p = 0.041).

Conclusion

Micra is non inferior to conventional PMs concerning the evolution of left ventricular function at 12‐month follow‐up. Our data suggest that Micra has a comparable mechanical impact on the ventricular systolic function but resulted in less valvular dysfunction.
The Airy equation with nonlocal conditions
Authors: Normatov B. , Smith D. A.
Published: November 2023

We study a third‐order dispersive linear evolution equation on the finite interval subject to an initial condition and inhomogeneous boundary conditions but, in place of one of the three boundary conditions that would typically be imposed, we use a nonlocal condition, which specifies a weighted integral of the solution over the spatial interval. Via adaptations of the Fokas transform method (or unified transform method), we obtain a solution representation for this problem. We also study the time periodic analog of this problem, and thereby obtain long time asymptotics for the original problem with time periodic boundary and nonlocal data.
Linear alopecia in pediatrics: RCM and dermoscopy reveal diagnostic cues
Authors: Wang Ying , Chen Lixin , Qin Bei , Li Qinfeng
Published: November 2023

Background

Alopecia areata (AA), trichotillomania (TM), nevus sebaceous (NS), and linear scleroderma en coup de sabre (LSCS) can all present with a patch of linear alopecia, making diagnosis challenging. The purpose of this study was to combine reflectance confocal microscopy (RCM) and dermoscopy in the diagnosis of these lesions in children.

Methods

A total of 36 patients with linear alopecia were enrolled, of whom 14 had AA, seven had TM, nine had NS, and six had LSCS. We evaluated the characteristics and distinguishing features of the four conditions using RCM and dermoscopy.

Results

The key to differential diagnosis was the dermal Hair follicle density in the dermis was decreased in AA, and the size and density of the follicular openings were normal in TM. In NS, the major features were petal‐like and frogspawn‐like structures. In LSCS, dermal papillary rings, sebaceous glands, and follicles were partially or completely missing, and abundant fibrous material was distributed in the dermis. Dermoscopy revealed alopecia, and all four conditions resulted in decreased hair density. AA patients exhibited yellow dots, black dots, and exclamation mark hairs. TM patients presented with irregularly broken hairs and blood spots. Both NS and LSCS patients exhibited an absence of follicular openings; NS patients demonstrated whitish and yellowish round structures, while an atrophic area with white patches, linear vessels, and no yellow or black dots was observed in LSCS patients

Conclusion

RCM combined with dermoscopy can provide additional information on disease states and differentiate between AA, TM, NS, and LSCS.
Empowering medical students through collaborative writing sessions
Authors: Chapman Helena J. , Veras‐Estévez Bienvenido A.
Published: November 2023

Background

Scientific writing and critical appraisal of the literature are fundamental skills for future physicians. However, these skills have been inconsistently prioritised across medical curricula, leaving medical trainees to seek these skills through continuing education courses.

Approach

We conducted a series of complementary collaborative writing sessions (introductory workshop with 3‐month practical sessions) with direct supervision to medical trainees (medical students and recent medical graduates) in the Dominican Republic between 2017 and 2020. We also examined medical trainees' perceptions of  these collaborative writing sessions, as a mechanism to advance technical writing and critical analysis skills for their professional training and personal growth.

Evaluation

Participants described the perceived enabling factors of the collaborative writing sessions that led to their publications as: (1) detailed agenda; (2) direct mentorship; (3) effective teamwork; (4) personal investment and dedication; and (5) future vision.

Implications

These collaborative writing sessions, consisting of a viable agenda and timeline, direct mentorship with timely feedback, and team dynamics, are recognised as an innovative model for medical trainees in the Dominican Republic. This academic model and approach can be adapted to meet the specific needs of health professional students across the globe. By mastering these fundamental written communication skills, medical trainees can contribute to research and policy development, lead health education initiatives, advocate for best clinical practices in patient care, and mentor the next generation of trainees.
Zoonotic transmission of diphtheria toxin‐producing Corynebacterium ulcerans
Authors: Hillan Adeline , Gibbs Tristan , Weaire‐Buchanan Graham , Brown Tracy , Pang Stanley , McEvoy Suzanne P. , Parker Erica
Published: November 2023

Background

Diphtheria caused by toxin‐producing Corynebacterium ulcerans is a re‐emerging human disease that can cause local and systemic sequelae. In Australia, toxigenic diphtheria is a rare notifiable communicable disease, due to high‐vaccination coverage. The public health management of cutaneous cases of toxigenic C. ulcerans varies between jurisdictions, as opposed to the more uniform public health response to toxigenic Corynebacterium diphtheriae presenting as respiratory or laryngeal diphtheria.

Aim

To report a case of zoonotically acquired C. ulcerans, review evidence on the zoonotic reservoir and reported transmission events, and examine public health guidelines for the management of human and animal contacts.

Methods and Results

In this case report, we detail our case investigation, treatment and public health management, including contact tracing and an approach to animal testing. We successfully identified companion canines as probable sources for the human case, with WGS confirming the link. The zoonotic disease link of C. ulcerans to domestic and agricultural animals is established in the literature; however, the management of animal contacts in human cases is inconsistent with jurisdictional or national guidelines.

Conclusions

While a rare disease, a consistent approach to public health management is warranted to systematically elucidate the disease source and improve understanding of transmission.
Age Differences in a Combined Walking and Grasping Task
Authors: Mason Andrea H. , Padilla Alejandra S. , Pickett Kristen A.
Published: November 2023

Previous studies have identified patterns of coordinated control when adults combine gait and grasping. What remains unclear is whether the coordination of these two tasks differs between adolescent and adult groups. Groups of adults and adolescents were asked to walk across an instrumented gait mat in three conditions: walk forward, walk and grasp a small target, and walk and grasp a large target. Spatiotemporal measures of gait/gait variability and grasp/grasp variability were quantified. Both adolescents and young adults exhibited decreased velocity, decreased step-extremity ratio, and increased percent of gait cycle spent in double support when grasping compared to walking alone. The major influence of grasping was seen during the final step before grasp in both groups. Change scores between walk forward and walk and grasp conditions were larger for adolescents. Furthermore, spatiotemporal measures of gait and grasping were more variable in adolescents. These results suggest that superimposing grasp onto gait is more challenging for adolescents than young adults. The challenges associated with combining these two tasks is particularly evident in the last step prior to object contact and suggests that the increased planning and execution demands required to perform these coordinated skills affects adolescents to a greater extent than young adults.
The TMEM16A anion channel as a versatile regulator of vascular tone
Authors: Tammaro Paolo
Published: November 2023

The TMEM16A channel represents a key depolarizing mechanism in arterial smooth muscle and contractile pericytes, where it is activated by several endogenous contractile agonists. In this issue of
Science Signaling
, Mata-Daboin
et al.
demonstrate a previously unidentified role for TMEM16A in endothelial cells for acetylcholine-mediated vasorelaxation. Collectively, TMEM16A serves as a transducer of vasoactive stimuli to enable fine modulation of vessel tone.
Bacterial heterogeneity and antibiotic persistence: bacterial mechanisms utilized in the host environment
Authors: Cotten Katherine L. , Davis Kimberly Michele
Published: November 2023

Antibiotic persistence, or the ability of small subsets of bacteria to survive prolonged antibiotic treatment, is an underappreciated cause of antibiotic treatment failure. Over the past decade, researchers have discovered multiple different stress responses and mechanisms that can promote antibiotic persistence. However, many of these studies have been completed in culture-based systems that fail to truly replicate the complexities of the host environment, and it is unclear whether the mechanisms defined in
in vitro
studies are applicable during host infection. In this review, we focus our discussion on recent studies that utilize a mixture of
ex vivo
culture systems and animal models to understand what stressors in the host environment are important for inducing antibiotic persistence. Different host stressors are involved depending on the anatomical niche the bacteria reside in and whether the host immune system is primed to generate a more robust response against bacteria, which can result in differing downstream effects on antibiotic susceptibility. Bacterial pathogens can also utilize specific strategies to reprogram their metabolism, which is vital for transitioning into an antibiotic-persistent state within host tissues. Importantly, we highlight that more attention is needed to establish guidelines for
in vivo
work on antibiotic persistence, particularly when identifying antibiotic-persistent subpopulations and distinguishing these phenotypes from antibiotic tolerance. Studying antibiotic persistence in the context of the host environment will be crucial for developing tools and strategies to target antibiotic-persistent bacteria and increase the efficacy of antibiotic treatment.
Bietti’s crystalline dystrophy: genotyping and deep qualitative and quantitative phenotyping in preparation for clinical trials
Authors: Li Qian , Wang Cong , Zhang Shengjuan , Fu Zhongjie , Jiao Xiaodong , Jin Zi-Bing , Hejtmancik James Fielding , Peng Xiaoyan
Published: November 2023

Purpose

To qualitatively and quantitatively characterise the genotypes and phenotypes of Bietti’s crystalline dystrophy (BCD) in a cohort of patients.

Design

Cross-sectional and observational study.

Methods

Clinically confirmed BCD patients were recruited for genotyping and phenotyping. Multiple retinal imaging modalities were employed. Atrophy in the fovea was adopted as major consideration for staging strategy, while percentage area of autofluorescence (AF) atrophy (PAFA) in the macula was determined for quantitation.

Results

In 74 clinically diagnosed BCD patients, c.802–8_810del17insGC was shown the predominant variant of theCYP4V2gene (allele frequency 55.4%). Sixty-two cases (123 eyes) with full imaging data were classified according to a modified criterion into stages 1 (n=8, 6.50%), 2A (n=9, 7.32%), 2B (n=17, 13.82%), 3A (n=30, 24.39%) and 3B (n=59, 47.97%). The eyes of the stage 2B were particularly deemed ‘high risk’ due to atrophy near fovea, while in stage 3A, though with remarkable foveal atrophy, preserved retinal pigment epithelium/photoreceptor islands near the fovea were found in 14 eyes. A tendency of increase in PAFA with age was found (rs=0.31, p=0.014). Significant PAFA increase was shown through stages 1 to 3B, and best-corrected visual acuity (BCVA, Logarithm of the Minimum Angle of Resolution) was shown to moderately correlate with PAFA (rs=0.56, p<0.001).

Conclusion

The PAFA might be an efficient biomarker for BCD severities correlating with BCVA. The highly heterogeneous chorioretinopathy and BCVA of BCD cases appear to be associated with disease stages, progression types and patients’ ages. Foveal involvement should be of a major concern for consideration of potential therapeutic intervention.
Capability and feasibility of the Global Alignment of Immunisation Safety Assessment in pregnancy criteria for the assessment of pregnancy and birth outcomes in Kinshasa, Democratic Republic of the Congo: a prospective cohort study
Authors: Arena Patrick J , Gadoth Adva , Nkamba Dalau Mukadi , Dzogang Camille , Hoff Nicole , Barrall Angelica L , Kampilu David , Beia Michael , Wong Hui-Lee , Anderson Steven , Kaba Didine , Rimoin Anne W
Published: November 2023

Introduction

There is an urgent need to investigate the capabilities of active surveillance in strengthening the development of pharmacovigilance (PV) systems in low-resource settings. Here, we assess the capability and feasibility of prospectively collected data to document maternal immunisation and adverse birth outcomes across delivery centres in Kinshasa, Democratic Republic of the Congo (DRC) according to the Global Alignment of Immunisation Safety Assessment in pregnancy (GAIA) definitions.

Methods

We conducted a facility-based prospective cohort study that enrolled mothers via convenience sampling either during their antenatal care visit or following their delivery. Demographic and clinical information as well as postpartum details related to the index pregnancy were collected after delivery; all mothers were also contacted via telephone 30 days postdelivery to determine if certain outcomes occurred after health facility discharge. Adverse birth outcomes of interest and maternal tetanus immunisation were categorised according to the GAIA criteria, and the level and impact of loss to follow-up (LTFU) was also evaluated.

Results

The study population consisted of 2675 mothers. The proportion of adverse birth outcomes ranged from 1.6% (for neonatal death) to 15.8% (for small for gestational age). Evidence of maternal tetanus immunisation during the index pregnancy was found for 637 mothers of newborns with any adverse birth outcome. GAIA diagnostic certainty was high for low birth weight and preterm birth, but much lower for stillbirth and neonatal bloodstream infections. Additionally, LTFU was high: only 47.9% of all mothers were successfully followed up via phone call.

Conclusion

Our investigation highlighted some of the challenges associated with the utilisation of the GAIA criteria in (prospective) observational studies within health facilities in Kinshasa, DRC (eg, data quality, LTFU and selection bias). Nevertheless, active surveillance remains a promising tool for future PV activities in DRC and beyond.
Child pedestrian crossing behaviour and associated risk factors in school zones: a video-based observational study in Kampala, Uganda
Authors: Osuret Jimmy , Van Niekerk Ashley , Kobusingye Olive , Atuyambe Lynn , Nankabirwa Victoria
Published: November 2023

Background

Pedestrian crashes, often occurring while road crossing and associated with crossing behaviour, make up 34.8% of road casualties in Uganda. This study determined crossing behaviour and associated factors among child pedestrians around primary schools in Kampala, Uganda.

Methods

We conducted a cross-sectional study in 2022 among 2100 primary school children. Data on their crossing behaviour were collected using video recordings from cameras staged at the crossing points of 21 schools. We estimated prevalence ratios (PR) with their corresponding 95% CIs using a modified Poisson regression model for the association between unsafe behaviour and the predictors.

Results

The prevalence for each of 5 unsafe child pedestrian behaviour was 206 (25.8%) for crossing outside the crosswalk, 415 (19.8%) for failing to wait at the kerb, 238 (11.3%) for failing to look for vehicles, 361 (17.2%) for running and 235 (13%) for crossing between vehicles. There was a higher likelihood of crossing outside the crosswalk when an obstacle was present (adjusted PR (aPR) 1.8; 95% CI 1.40 to 2.27) and when children crossed alone (aPR 1.5; 95% CI 1.13 to 2.06). Children who crossed without a traffic warden (aPR 2; 95% CI 1.40 to 2.37) had a significantly higher prevalence of failing to wait at a kerb.

Conclusion

These findings reveal the interaction between child pedestrians, vehicles and the environment at crossings. Some factors associated with unsafe child pedestrian behaviour were the presence of an obstacle, crossing alone and the absence of a traffic warden. These findings can help researchers and practitioners understand child pedestrian crossing behaviour, highlighting the need to prioritise targeted safety measures.
Effects of extreme drought–rainfall on slope failure mechanisms: centrifuge modelling
Authors: Zhong Haiyi , Wang Yikai , Zhang Shuai , Zhang Qi , Ng Charles Wang Wai
Published: November 2023

The extreme drought–rainfall seesaw is projected to occur with an increasing frequency. However, there still lacks a thorough understanding of its impacts on slope behaviour, in which desiccation crack plays a key role. To address this issue, a centrifuge test was conducted to investigate the effects of drought-induced desiccation crack on slope instability under extreme rainfall. During the test, the non-cracked slope was firstly subjected to extreme rainfall with 100-year return period. Subsequently, a long-term drying was applied to induce desiccation crack, and hence forming a cracked slope. The cracked slope is then subjected to an identical extreme rainfall. The non-cracked slope only exhibits swelling deformation, whereas for the cracked slope, a slip surface (2 m in depth) is clearly observed to initiate from one deep crack at crest. The global sliding failure of the cracked slope is mainly related to preferential flow, which could result in soil shear strength reduction.
Comparison of seasonality of urban grime in three southern Ontario cities
Authors: Huang Yao Yan , McLay Emma M. , Donaldson D. James
Published: November 2023

Urban grime refers to films made of a complex chemical mixture of organics and inorganics deposited on outdoor surfaces. The specific chemical composition of such films can vary considerably due to geographic and seasonal influences. We compared the seasonal change of grime’s water-soluble inorganic ion content in a rural (Thamesford), suburban (Oshawa), and urban city (Toronto) in southern Ontario, Canada. Sodium, calcium, chloride, nitrate, and sulfate amounts in grime were collected and quantified over four seasons in Oshawa, ON and Thamesford, ON and compared with results from a previous study in Toronto to elucidate differences. We found that all three regions displayed a clear seasonality in sodium and chloride consistent with winter road salt inputs and chloride loss in summer. Mole fractions of sulfate were consistently the lowest of the measured ions, and NO3 −/SO4 2− ratios showed a winter–spring minimum and summer–fall maximum. Urban–rural differences in the seasonal changes of ionic mole ratios suggest that additional chloride displacement by nitrate occurs within grime in Toronto that is not present in the two other rural/suburban cities in the same region.
Hamiltonian analysis for new massive gravity
Authors: Escalante Alberto , Ocaña-García P. Fernando
Published: November 2023

A detailed canonical analysis for three- dimensional massive gravity is performed. The construction of the fundamental Dirac brackets, the complete structure of the constraints and the counting of the physical degrees of freedom are reported. In addition, it is shown that the extended Hamiltonian is healed from Orstrogradki’s instabilities.
Einstein–Bumblebee-dilaton black hole solution
Authors: Lessa L. A. , Silva J. E. G.
Published: November 2023

We obtain new black hole solutions in a Einstein–Bumblebee-scalar theory. By starting with a Einstein–Bumblebee theory in ($$D+d$$

D
+
d

) dimensions, the scalar dilaton field and its interaction with the gravitational and Bumblebee fields are obtained by Kaluza–Klein (KK) reduction over the extra dimensions. Considering the effects of both the Bumblebee vacuum expectation value (VEV) and the fluctuations over the VEV, we obtained new charged solutions in $$(3+1)$$

(
3
+
1
)

dimensions. For a vanishing dilaton, the black hole turned out to be a charged de Sitter-Reissner–Nordstrom solution, where the transverse mode is the Maxwell field and the longitudinal mode is the cosmological constant. The stability of these new solutions is investigated by means of the analysis of the black hole thermodynamics. The temperature, entropy, and heat capacity show that these modified black holes are thermodynamic stable.