bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative transcranial magnetic stimulation study: Assessing cortical excitability and plasticity in Alzheimer's disease, dementia with Lewy bodies and Frontotemporal dementia
Authors: Olğun Yeşim , Aksoy Poyraz Cana , Bozluolçay Melda , Gündüz Ayşegül , Poyraz Burç Çağrı
Published: December 2023

Background

Here, we aimed to investigate the roles of long‐term potentiation‐like (LTP‐like) plasticity using intermittent theta burst (iTBS) protocol and resting motor threshold (rMT) in the differential diagnosis of Alzheimer's disease (AD), diffuse dementia with Lewy bodies (DLB) and frontotemporal dementia (FTD).

Method

We enrolled 21 subjects with AD, 28 subjects with DLB, 14 subjects with FTD, and 33 elderly subjects with normal cognitive functions into the study. We recorded rMT and percentage amplitude change of motor evoked potentials (MEPs) after the iTBS protocol in each group.

Results

In patients with AD and DLB, the percentage amplitude change of MEPs, and rMTs were significantly lower than in healthy subjects. However, no significant difference was observed in individuals with FTD.

Conclusion

Our findings showed that transcranial magnetic stimulation measures, particularly rMTs and LTP‐like plasticity, may be potential biomarkers to distinguish between different dementia subtypes. Impaired motor cortical excitability and synaptic plasticity were more prominent in AD and DLB than in FTD. This aligns with the evidence that cortical motor networks are usually spared in FTDs in early‐to‐middle stages.
Quantifying the impact of different agroforestry systems on soil carbon fractions lability and long‐term carbon sequestration in Central Himalayas
Authors: Melkani Suraj , Singh Veer , Bhadha Jehangir H.
Published: December 2023

Soil Organic Carbon (SOC) is a key indicator for understanding the carbon dynamics in agroecosystems. Carbon fractions, on the other hand, can be more sensitive over short periods and can detect changes in the distribution and relationship patterns of SOC pools. To test this hypothesis nine, 16‐year‐old agroforestry systems (AFS) were tested and compared with control at 0–15 cm and 15–30 cm soil depths for K2Cr2O7 oxidizable carbon (SOC), pH, Electrical Conductivity (EC), Microbial Biomass Carbon (MBC) and carbon fractions, viz. very labile (C1frac), labile (C2frac), less labile (C3frac), and non‐labile (C4frac). Carbon lability index (CLI) and Stratification Ratio (SR) were calculated to assess the lability and vertical distribution of SOC. The study found that from the time of plantation, SOC stocks significantly improved in the range 19.82%–46.33% under different AFS with SOC sequestration ranging from 0.111 ± 0.002 to 0.697 ± 0.017 MgC ha−1 yr−1. Among different AFS, Bambusa vulgaris showed significantly higher SOC sequestration than all other treatments at both soil depths. AFS also demonstrated a significant improvement in SOC lability, leading to an increase in CLI by 0.08%–4.48% at 0–15 cm depth and a more pronounced improvement of 2.08%–18.32% at 15–30 cm depth. Among different AFS the highest improvement in CLI was observed in Bambusa vulgaris and the lowest in fallow land. The vertical distribution of carbon fractions in the soil was also affected by AFS, with the labile carbon fraction mostly concentrated in the topsoil layer as indicated by high SR values (1.133–1.203) for C1frac. The highly significant positive correlation (p < .05) of labile carbon fractions with SOC (r = .872** for C1frac, r = .900** for C2frac and r = .915** for C3frac) indicated the high dependence of SOC on labile carbon. The study revealed that AFS have the potential to significantly enhance carbon sequestration, while also impacting the lability and vertical distribution of SOC.
Agrarian financial ecologies: Centring land and labour in geographies of debt
Authors: Green W. Nathan
Published: December 2023

There is a growing interest in exploring contemporary financialisation in terms of the geographies of debt. Many economic geographers have adopted a financial ecologies approach to explain these geographies. While this approach provides analytical benefits, it nonetheless analyses debt almost exclusively in terms of consumer finance, thereby overlooking the relations of production in which many indebted households engage. To address this issue, I develop the agrarian financial ecologies concept, which both directs analysis towards the diversity of credit–debt relations in rural economies, and highlights the relationship between land, labour and debt in the process of agricultural production. I apply this concept to study farm household debt in Cambodia, where indebtedness has become a widespread problem among farmers facing rapid economic transformation in the countryside. By focusing on land and labour, I demonstrate how diverse credit–debt relations within Cambodia's agrarian financial ecology have produced uneven socio‐spatial outcomes, namely debt‐driven land dispossession. This paper advances geographic theory about the dynamics of value production, circulation and appropriation within geographies of debt. It also extends the empirical remit of existing financial ecologies scholarship by attending to the credit–debt relations that characterise many agrarian livelihoods today.
The use of hyperbaric oxygen therapy in the treatment of hand crush injuries
Authors: Chang Dun‐Hao , Hsieh Chi‐Ying , Chang Che‐Wei , Wang Hsu‐Hui , Chang Hou‐Tai
Published: December 2023

Hyperbaric oxygen therapy (HBOT) has been used as an adjuvant treatment for crush injury because it can improve tissue hypoxia and stimulate wound healing. However, the actual role of HBOT in crush hand injury is still unknown. This study is to assess the efficacy of HBOT for crush hand patients, as well as the impact of HBOT initiation timing. Between 2018 and 2021, 72 patients with crush hand injury were retrospectively reviewed. The patients were divided into the HBOT and control group, and each group had 36 patients. The average session of HBOT was 18.2 (5–32 sessions) per patient, and no patient had a complication related to the treatment. The two groups had similar demographics, but HBOT group had larger injured area (73.6 ± 51.0 vs. 48.2 ± 45.5 cm2, p = 0.03). To better control the confounding factors, we performed the subgroup analysis with cut‐off injured area of 50 cm2. In the patients with smaller injured area (≦50 cm2), the HBOT group had shorter wound healing time (29.9 ± 12.9 vs. 41.0 ± 18.9 days, p = 0.03). The early HBOT group (first session ≤72 h post‐operatively) had shorter hospital stay (8.1 ± 6.4 vs. 15.5 ± 11.4 days, p = 0.04), faster wound healing (28.7 ± 17.8 vs. 41.1 ± 18.1 days, p = 0.08) and less operations (1.54 ± 0.78 vs. 2.41 ± 1.62, p = 0.06) although the latter two didn't achieve statistical significance. HBOT is safe and effective in improving wound healing of hand crush injury. Early intervention of HBOT may be more beneficial. Future research is required to provide more evidence.
Using evidence to identify teaching strategies to improve student competencies
Authors: Hartley Lou Ann
Published: December 2023

Background

Organizational assessment revealed opportunities to develop a critical mass of faculty educated about EBP and integrate competencies into practice. The faculty orientation online program did not include information about the EBP process, teaching strategies, or student competencies.

Purpose

The purpose of this EBP project was to investigate the best teaching strategies that foster student competencies.

Implementation Plan

Based on the evidence, an online EBP module was developed including the best teaching strategies for instruction of EBP, the student competencies that must be mastered and teaching barriers that must be overcome. The results and implementation plan were presented to leaders and faculty Online Council for feedback, approval, and buy‐in.

Outcomes

Twenty‐five faculty completed the EBP online module over 1 year providing examples for teaching strategies that related EBP to clinical practice, teaching methods that engaged students and examples of assignments that promoted student competency.

Implications for Practice

Using evidence to develop an EBP module for faculty orientation to online teaching provided a cost‐effective way to develop a critical mass of faculty educated in EBP teaching strategies and methods that foster student competencies.
The spectrum of a twisted commutative algebra
Authors: Snowden Andrew
Published: December 2023

A twisted commutative algebra is (for us) a commutative ‐algebra equipped with an action of the infinite general linear group. In such algebras, the “‐prime” ideals assume the duties fulfilled by prime ideals in ordinary commutative algebra, and so it is crucial to understand them. Unfortunately, distinct ‐primes can have the same radical, which obstructs one from studying them geometrically. We show that this problem can be eliminated by working with super vector spaces: doing so provides enough geometry to distinguish ‐primes. This yields an effective method for analyzing ‐primes.
Dynamical reverse folding and residual gas expansion models of flexible thin films
Authors: Wang Xiaoheng , Xiao Zhihe , Ren Hongmei , He Zepeng , Li Haorong , Fu Debin
Published: December 2023

To examine the folding and deployment characteristics of flexible thin film structures in a vacuum environment, a dynamic reverse folding method based on the target structure and an inflation-based deployment method based on the residual gas expansion are proposed. The dynamic characteristics of the flexible thin film structure during the folding process are characterized using the finite element method. Further, the residual gas is used to inflate and unfold the folded structure, and the response characteristics of gas pressure and film volume are obtained. Compared with the thin film unfolding test in a vacuum tank, for a spherical thin film of the same size, under the action of residual gas at 0.05 MPa, when unfolding for 0.34 s, the unfolded volume of the thin film is obtained to be approximately 0.0367 m3, reaching 90.2% of the total unfolded volume of the spherical film in the experiment. Overall, the proposed methods can serve as a design reference for the analysis and optimization of flexible thin films.
Intertwining Influences on Perceptions of Risk, Pain, and Injury in Sport: A Close Study of a Chinese New Immigrant Mother–Daughter Pair
Authors: Liu Lucen , Choo Liyun Wendy
Published: December 2023

Sociological research on sport risk, pain, and injury primarily focuses on young, Western, high-performance male athletes in organized sport. In contrast, ethnic minority women’s experiences with sporting pain and injury, and risk perceptions are often underrepresented. This paper presents a close study of a Chinese new immigrant mother’s risk rationality and practices as related to her daughter’s sporting experiences in New Zealand. A conceptual framework of “neoliberal ethnic discourses of risk” was used to explore how intertwining factors of ethnicity, gender, and immigrant identity, influenced participants’ preferences for particular sports, and their perception and experiences of risk, pain, and injury. This study invites sports sociologists and organizations to consider how cultural and gendered discourses influenced Chinese new immigrant women’s sporting participation in host countries, such as New Zealand, especially why the group might be less active and more resistant to particular sports and physical activities while strongly favoring others.
Disorder-tunable entanglement at infinite temperature
Authors: Dong Hang , Desaules Jean-Yves , Gao Yu , Wang Ning , Guo Zexian , Chen Jiachen , Zou Yiren , Jin Feitong , Zhu Xuhao , Zhang Pengfei , Li Hekang , Wang Zhen , Guo Qiujiang , Zhang Junxiang , Ying Lei , Papić Zlatko
Published: December 2023

Emerging quantum technologies hold the promise of unravelling difficult problems ranging from condensed matter to high-energy physics while, at the same time, motivating the search for unprecedented phenomena in their setting. Here, we use a custom-built superconducting qubit ladder to realize non-thermalizing states with rich entanglement structures in the middle of the energy spectrum. Despite effectively forming an “infinite” temperature ensemble, these states robustly encode quantum information far from equilibrium, as we demonstrate by measuring the fidelity and entanglement entropy in the quench dynamics of the ladder. Our approach harnesses the recently proposed type of non-ergodic behavior known as “rainbow scar,” which allows us to obtain analytically exact eigenfunctions whose ergodicity-breaking properties can be conveniently controlled by randomizing the couplings of the model without affecting their energy. The on-demand tunability of quantum correlations via disorder allows for in situ control over ergodicity breaking, and it provides a knob for designing exotic many-body states that defy thermalization.
Genetic suppressor screen identifies Tgp1 (glycerophosphocholine transporter), Kcs1 (IP
6
kinase), and Plc1 (phospholipase C) as determinants of inositol pyrophosphate toxicosis in fission yeast
Authors: Bednor Lauren , Sanchez Ana M. , Garg Angad , Shuman Stewart , Schwer Beate
Published: December 2023

The inositol pyrophosphate metabolite 1,5-IP
8
governs repression of fission yeast phosphate homeostasis genes
pho1
,
pho84
, and
tgp1
by lncRNA-mediated transcriptional interference. Asp1 pyrophosphatase mutations that increase IP
8
levels elicit precocious lncRNA termination, leading to derepression of the
PHO
genes. Deletions of the Asp1 pyrophosphatase domain result in growth impairment or lethality via IP
8
agonism of transcription termination. It was assumed that IP
8
toxicity ensues from dysregulation of essential genes. In this study, a suppressor screen revealed that IP
8
toxicosis of Asp1 pyrophosphatase mutants is caused by: (i) a >40-fold increase in the expression of the inessential
tgp1
gene encoding a glycerophosphodiester transporter and (ii) the presence of glycerophosphocholine in the growth medium. The suppressor screen yielded missense mutations in two upstream enzymes of inositol polyphosphate metabolism: the phospholipase C enzyme Plc1 that generates IP
3
and the essential Kcs1 kinase that converts IP
6
to 5-IP
7
, the immediate precursor of IP
8
.
Association of homelessness and diet on the gut microbiome: a United States-Veteran Microbiome Project (US-VMP) study
Authors: Hoisington Andrew J. , Stearns-Yoder Kelly A. , Stamper Christopher E. , Holliday Ryan , Brostow Diana P. , Penzenik Molly E. , Forster Jeri E. , Postolache Teodor T. , Lowry Christopher A. , Brenner Lisa A.
Published: December 2023

Military veterans account for 8% of homeless individuals living in the United States. To highlight associations between history of homelessness and the gut microbiome, we compared the gut microbiome of veterans who reported having a previous experience of homelessness to those from individuals who reported never having experienced a period of homelessness. Moreover, we examined the impact of the cumulative exposure of prior and current homelessness to understand possible associations between these experiences and the gut microbiome. Microbiome samples underwent genomic sequencing and were analyzed based on alpha diversity, beta diversity, and taxonomic differences. Additionally, demographic information, dietary data, and mental health history were collected. A lifetime history of homelessness was found to be associated with alcohol use disorder, substance use disorder, and healthy eating index compared to those without such a history. In terms of differences in gut microbiota, beta diversity was significantly different between veterans who had experienced homelessness and veterans who had never been homeless (
P
= 0.047, weighted UniFrac), while alpha diversity was similar. The microbial community differences were, in part, driven by a lower relative abundance of
Akkermansia
in veterans who had experienced homelessness (mean; range [in percentages], 1.07; 0–33.9) compared to veterans who had never been homeless (2.02; 0–36.8) (
P
= 0.014, ancom-bc2). Additional research is required to facilitate understanding regarding the complex associations between homelessness, the gut microbiome, and mental and physical health conditions, with a focus on increasing understanding regarding the longitudinal impact of housing instability throughout the lifespan.

IMPORTANCE

Although there are known stressors related to homelessness as well as chronic health conditions experienced by those without stable housing, there has been limited work evaluating the associations between microbial community composition and homelessness. We analyzed, for the first time, bacterial gut microbiome associations among those with experiences of homelessness on alpha diversity, beta diversity, and taxonomic differences. Additionally, we characterized the influences of diet, demographic characteristics, military service history, and mental health conditions on the microbiome of veterans with and without any lifetime history of homelessness. Future longitudinal research to evaluate the complex relationships between homelessness, the gut microbiome, and mental health outcomes is recommended. Ultimately, differences in the gut microbiome of individuals experiencing and not experiencing homelessness could assist in identification of treatment targets to improve health outcomes.
Root-associated bacterial communities and root metabolite composition are linked to nitrogen use efficiency in sorghum
Authors: Chai Yen Ning , Qi Yunhui , Goren Emily , Chiniquy Dawn , Sheflin Amy M. , Tringe Susannah G. , Prenni Jessica E. , Liu Peng , Schachtman Daniel P.
Published: December 2023

The development of cereal crops with high nitrogen use efficiency (NUE) is a priority for worldwide agriculture. In addition to conventional plant breeding and genetic engineering, the use of the plant microbiome offers another approach to improving crop NUE. To gain insight into the bacterial communities associated with sorghum lines that differ in NUE, a field experiment was designed comparing 24 diverse
Sorghum bicolor
lines under sufficient and deficient nitrogen (N). Amplicon sequencing and untargeted gas chromatography–mass spectrometry were used to characterize the bacterial communities and the root metabolome associated with sorghum genotypes varying in sensitivity to low N. We demonstrated that N stress and sorghum type (energy, sweet, and grain sorghum) significantly impacted the root-associated bacterial communities and root metabolite composition of sorghum. We found a positive correlation between sorghum NUE and bacterial richness and diversity in the rhizosphere. The greater alpha diversity in high NUE lines was associated with the decreased abundance of a dominant bacterial taxon,
Pseudomonas
. Multiple strong correlations were detected between root metabolites and rhizosphere bacterial communities in response to low N stress. This indicates that the shift in the sorghum microbiome due to low N is associated with the root metabolites of the host plant. Taken together, our findings suggest that host genetic regulation of root metabolites plays a role in defining the root-associated microbiome of sorghum genotypes differing in NUE and tolerance to low N stress.

IMPORTANCE

The development of crops that are more nitrogen use-efficient (NUE) is critical for the future of the enhanced sustainability of agriculture worldwide. This objective has been pursued mainly through plant breeding and plant molecular engineering, but these approaches have had only limited success. Therefore, a different strategy that leverages soil microbes needs to be fully explored because it is known that soil microbes improve plant growth through multiple mechanisms. To design approaches that use the soil microbiome to increase NUE, it will first be essential to understand the relationship among soil microbes, root metabolites, and crop productivity. Using this approach, we demonstrated that certain key metabolites and specific microbes are associated with high and low sorghum NUE in a field study. This important information provides a new path forward for developing crop genotypes that have increased NUE through the positive contribution of soil microbes.
Parent-reported health outcomes at preschool age in preterm survivors: a population-based cohort study
Authors: MacDonald Sydney , Stratas Alexandra , Synnes Anne R , Sandila Navjot , Campbell-Yeo Marsha , Shah Prakesh S , Ghotra Satvinder
Published: December 2023

Objective

Literature on health status (HS) and health-related quality of life of preterm survivors at preschool age is sparse. Further, little is known about the relationship between parent-reported HS outcomes and standardised neurodevelopmental outcomes measured in preterm survivors at preschool age. Our objective was to evaluate parent-reported child HS outcomes and their relationship to neurodevelopmental outcomes at 36 months of age in very preterm survivors.

Design

Prospective population-based cohort study.

Setting

Perinatal follow-up programme.

Patients

Infants <31 weeks’ gestational age born from 2014 to 2016.

Outcome measures

Parents completed the Health Status Classification System for Pre-School Children questionnaire at 36 months. At the same age, neurodevelopmental assessments were completed to determine neurodevelopmental impairment (NDI). NDI was categorised as none, ‘mild’ or ‘significant’ (moderate or severe cerebral palsy, Bayley Scales of Infant and Toddler Development - Third Edition <70, blind or required hearing aid).

Results

Of 118 children, 87 (73.7%) parents reported their child had an HS concern (mild: 61 (51%); moderate: 16 (13.6%); and severe: 10 (8.5%)). Mild and significant NDIs were observed in 17 (14.4%) and 14 (11.9%) children, respectively. For the 14 (12%) children with significant NDI, 7 (50.0%) parents reported severe and 4 (28.6%) reported moderate concerns. Conversely, for 26 (22%) children with parent-reported moderate to severe concerns, 11 (42.3%) met the criteria for significant NDI. There was a moderate positive correlation between parental concern and NDI status (Spearman correlation=0.46, p<0.0001).

Conclusions

Parental HS concerns only moderately correlated with the NDI status. Of the 12% of children with significant NDI, only half of the parents reported severe HS concerns.
Serum osmolality was non-linearly associated with the risk of all-cause and cardiovascular mortality in patients with diabetes
Authors: Hu Tingting , Li Chenglin , Wang Tao , Liu Hailang , Geng Jin , Gong Aifeng
Published: December 2023

Aims

This study aimed to evaluate the relationship between both low and high osmolarity and the risk of all-cause and cause-specific mortality in diabetic population.

Methods

All participants were included from the National Health and Nutrition Examination Survey 1999–2014. Baseline serum osmolality was determined from laboratory tests and cause of death from national death records. HRs and 95% CIs for all-cause mortality and cardiovascular mortality in diabetes were estimated using Cox proportional regression analysis. The non-linear relationship was explored using restricted cubic splines regression.

Results

Among 7622 individuals with diabetes, 1983 (12.4%) died during a total of 3.26 thousand person-years of follow-up. Compared with the reference category (281–284 mmol/kg), the multivariable-adjusted HRs and 95% CIs for all-cause mortality were 1.27 (1.16–1.40; p<0.001) in the lowest osmolality category (<201 mmol/kg) and 1.18 (1.09–1.28; p<0.001) in the highest osmolality category (>312 mmol/kg). Restricted cubic splines results showed that serum levels of osmolality had a U-shaped association with the risk of all-cause mortality, and L-shaped relationship with the risk of cardiovascular death.

Conclusions

Both low osmolality and high osmolality were predictive of increased all-cause mortality in patients with diabetes, supporting a U-shaped relationship. Also, a lower serum osmolality increased the risk of cardiovascular mortality.
The health inequity and socioeconomic inequality faced by adolescent girls and women on the move living with or at high risk of HIV infection, during the COVID-19 pandemic in Nigeria
Authors: Lamontagne Erik , Nyako Hasiya Yunusa , Enemo Amaka , Sunday Aaron , Muhammad Amira , Abdullah Rilwan Mohammed , Okiwu Henry , Undelikwo Veronica , Ogbozor Pamela , Amusan Oluwaranmilowo , Alaba Oluwatoyin , Undelikwo Gabriel , Takpa Koubagnine , Ashefor Greg , Kavanagh Matthew , Foláyan Morẹ́nikẹ́ Oluwátóyìn
Published: December 2023

Background

We assessed if women and girls on the move living with or at high risk of HIV faced increased health inequity and socioeconomic inequalities during the COVID-19 pandemic compared with other vulnerable women and girls.

Methods

We used data collected through a survey conducted in Nigeria between June and October 2021. Women and girls living with or at risk of HIV were recruited voluntarily, using a combination of venue-based and snowball sampling. We performed multivariable logistic regression models per mobility and HIV status to determine associations between health inequity, socioeconomic inequalities and macrosocial characteristics.

Findings

There were 3442 participants, of which 700 were on the move. We found no statistical difference between HIV-negative women and girls on the move and those not on the move. On the opposite, we found substantial differences in health inequity and socioeconomic inequalities between women and girls on the move living with HIV and those not on the move living with HIV. There are very strong associations between being a woman or girl on the move living with HIV and facing economic precarity (aOR 6.08, 95% CI 1.94 to 19.03), food insecurity (aOR 5.96, 95% CI 2.16 to 16.50) and experiencing more gender-based violence since COVID-19 started (aOR 5.61, 95% CI 3.01 to 10.47).

Interpretation

Being a woman or girl on the move and living with HIV compound increased health and socioeconomic vulnerabilities. The COVID-19 crisis seems to have exacerbated inequalities and gender-based violence. These findings call for more feminist interventions to protect women on the move living with HIV during health crises.
Association between dementia risk and ulcerative colitis, with and without colectomy: a Swedish population-based register study
Authors: Garcia-Argibay Miguel , Hiyoshi Ayako , Montgomery Scott
Published: December 2023

Objective

This study aims to investigate the association of ulcerative colitis (UC) with all-cause dementia and assess differences in those with and without a total colectomy.

Design, setting and participants

This Swedish prospective register-based study comprised 4.8 million individuals aged at least 59 years between 1964 and 2018 with the linkage of several Swedish national registers.

Primary and secondary outcome measures

Individuals with dementia were defined according to International Classification of Diseases diagnostic codes and Anatomical Therapeutic Classification codes for medication prescriptions. Fitting Cox hazards models, the risk of developing all-cause dementia in individuals with and without UC was estimated. Further, we compared the risk of all-cause dementia among those with and without a colectomy.

Results

Among 4 821 488 individuals (52.6% females) followed for 84.1 million person-years between 1964 and 2018, the incidence rate of all-cause dementia was 63.90 (63.73–64.07) events per 10 000 person-years in individuals without UC, 94.80 (92.04–97.64) among those with UC, 95.01 (92.25–97.86) in those with UC but without colectomy and 63.42 (40.92–98.31) in those with UC and a colectomy. Adjusted Cox models showed an increased all-cause dementia risk in individuals with UC (HR 1.07, 95% CI 1.04 to 1.10). We found no differences between unexposed individuals and those with UC and a colectomy (HR 0.89, 95% CI 0.57 to 1.38).

Conclusion

The findings are consistent with previous evidence suggesting a slightly increased dementia risk among individuals with UC. This study provided no evidence of further risk increase of dementia among those who had a colectomy.
Assessment of patient satisfaction level in the State University of Haiti Hospital and responsible factors: a cross-sectional mixed-methods study protocol
Authors: Millien Hugins , Joseph Thaïmye
Published: December 2023

Introduction

Over the past few years, the healthcare industry has undergone a significant transformation where patients’ perceptions of healthcare have gained a huge importance in assessing quality. Considering that it is now highly competitive, their contentment is a vital aspect in improving performance. However, practitioners in developing countries have traditionally overlooked the importance of patient views in healthcare, and this neglect is particularly prevalent in low-resource settings such as the State University of Haiti Hospital. The aim of this study is to assess patient satisfaction and identify influencing factors.

Methods and analysis

We will conduct a mixed-methods cross-sectional survey at Haiti’s largest hospital centre from January to August 2024. First, patient satisfaction will be assessed using RAND Corporation’s 18-Item-Patient Satisfaction Questionnaire, a valid self-administered questionnaire with strong potential for use in different settings. It will be translated into Creole and then tested in a pilot study. Second, a qualitative study based on individual interviews will explore patients’ views on the care they have received. Data analysis will include descriptive statistics, χ2tests, logistic regression and thematic analysis.

Ethics and dissemination

Ethical approval is granted from the Laboratoire Médecine Ethique et Société. Findings will be published in a corresponding peer-reviewed journal, shared with hospital staff and students. Social media posts, blog posts and conference debates will also be considered.
Implementation of a Scalable Online Weight Management Programme in Clinical Settings: Protocol for the PROPS 2.0 Programme (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0)
Authors: Cho JoAnn , Noonan Sarah H , Fay Richard , Apovian Caroline M , McCarthy Ashley C , Blood Alexander J , Samal Lipika , Fisher Naomi , Orav John E , Plutzky Jorge , Block Jason P , Bates David Westfall , Rozenblum Ronen , Tucci Michela , McPartlin Marian , Gordon Willam J , McManus Katherine D , Morrison-Deutsch Cheryl , Scirica Benjamin M , Baer Heather J
Published: December 2023

Introduction

There is an urgent need for scalable strategies for treating overweight and obesity in clinical settings. PROPS 2.0 (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0) aims to adapt and implement the combined intervention from the PROPS Study at scale, in a diverse cross-section of patients and providers.

Methods and analysis

We are implementing PROPS 2.0 across a variety of clinics at Brigham and Women’s Hospital, targeting enrolment of 5000 patients. Providers can refer patients or patients can self-refer. Eligible patients must be ≥20 years old and have a body mass index (BMI) of ≥30 kg/m2or a BMI of 25–29.9 kg/m2plus another cardiovascular risk factor or obesity-related condition. After enrolment, patients register for the RestoreHealth online programme/app (HealthFleet Inc.) and participate for 12 months. Patients can engage with the programme and receive personalized feedback from a coach. Patient navigators help to enrol patients, enter updates in the electronic health record, and refer patients to additional resources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is guiding the evaluation.

Ethics and dissemination

The Mass General Brigham Human Research Committee approved this protocol. An implementation guide will be created and disseminated, to help other sites adopt the intervention in the future.

Trial registration number

NCT0555925.
Risk factors of incontinence-associated dermatitis in older adults: a protocol for systematic review and meta-analysis
Authors: Fan Siyue , Jiang Hongzhan , Shen Jiali , Lin Huihui , Yang Liping , Yu Doudou , Chen Lijuan
Published: December 2023

Introduction

Due to their ageing skin, older adults are more likely to develop incontinence-associated dermatitis (IAD). Although previous attempts to look at the risk factors for IAD in older adults were done, methodological barriers hindered an in-depth understanding. By investigating risk factors for IAD in the ageing population, the development of precise clinical interventions and guidance could be facilitated, which in turn would enhance patient care standards for incontinence management in this target group. To address this knowledge gap, this systematic review with meta-analysis aims to explore the major risk elements linked to IAD among older adults.

Methods and analysis

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols are adhered to in this systematic review and meta-analysis. To achieve its objectives, a comprehensive search strategy PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Chinese Scientific Journal Database (VIP database), WanFang Data Knowledge Service Platform, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, along with other relevant sources published until 18 July 2023 in both English and Chinese languages will be performed. The screening of articles, data abstraction and risk of bias evaluation will be done by two impartial reviewers. RevMan V.5.3 software will be used for data synthesis. The quality of the included study will be assessed using the Newcastle-Ottawa Quality Assessment tool and the Agency for Healthcare Research and Quality. TheI2test will identify the heterogeneity.

Ethics and dissemination

There is no need for ethical approval. Individual patient information or the rights of participants will not be compromised by this protocol. The findings will either be published in a peer-reviewed journal.

PROSPERO registration number

CRD42023442585.
Classification of diabetic maculopathy based on optical coherence tomography images using a Vision Transformer model
Authors: Cai Liwei , Wen Chi , Jiang Jingwen , Liang Congbi , Zheng Hongmei , Su Yu , Chen Changzheng
Published: December 2023

Purpose

To develop a Vision Transformer model to detect different stages of diabetic maculopathy (DM) based on optical coherence tomography (OCT) images.

Methods

After removing images with poor quality, a total of 3319 OCT images were extracted from the Eye Center of the Renmin Hospital of Wuhan University and randomly split the images into training and validation sets in a 7:3 ratio. All macular cross-sectional scan OCT images were collected retrospectively from the eyes of DM patients from 2016 to 2022. One of the OCT stages of DM, including early diabetic macular oedema (DME), advanced DME, severe DME and atrophic maculopathy, was labelled on the collected images, respectively. A deep learning (DL) model based on Vision Transformer was trained to detect four OCT grading of DM.

Results

The model proposed in our paper can provide an impressive detection performance. We achieved an accuracy of 82.00%, an F1 score of 83.11%, an area under the receiver operating characteristic curve (AUC) of 0.96. The AUC for the detection of four OCT grading (ie, early DME, advanced DME, severe DME and atrophic maculopathy) was 0.96, 0.95, 0.87 and 0.98, respectively, with an accuracy of 90.87%, 89.96%, 94.42% and 95.13%, respectively, a precision of 88.46%, 80.31%, 89.42% and 87.74%, respectively, a sensitivity of 87.03%, 88.18%, 63.39% and 89.42%, respectively, a specificity of 93.02%, 90.72%, 98.40% and 96.66%, respectively and an F1 score of 87.74%, 84.06%, 88.18% and 88.57%, respectively.

Conclusion

Our DL model based on Vision Transformer demonstrated a relatively high accuracy in the detection of OCT grading of DM, which can help with patients in a preliminary screening to identify groups with serious conditions. These patients need a further test for an accurate diagnosis, and a timely treatment to obtain a good visual prognosis. These results emphasised the potential of artificial intelligence in assisting clinicians in developing therapeutic strategies with DM in the future.
Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system
Authors: Reynolds Courtney A , Nair Vishnu , Villaflores Chad , Dominguez Katherine , Arbanas Julia Cave , Treasure Madeline , Skootsky Samuel , Tseng Chi-Hong , Sarkisian Catherine , Patel Arpan , Ghassemi Kevin , Fendrick A Mark , May Folasade P , Mafi John N
Published: December 2023

Objectives

Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) ‘eMeasure’ to detect low-value EGDs.

Design

Retrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019.

Setting

Outpatient primary care and gastroenterology clinics at a large, urban, academic health centre.

Participants

Adult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019.

Main outcome measures

EGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett’s oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure’s validity. We estimated EGD costs using Medicare physician and facility fee rates.

Results

Among 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure’s sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients’ out-of-pocket costs.

Conclusions

We developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at the point of care.
Why it is hard to use PROMs and PREMs in routine health and care
Authors: Benson Tim
Published: December 2023

Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) show the results of healthcare activities as rated by patients and others. Patients or their proxies record feedback using questionnaires. These can enhance quality for all and tailored care for individuals. This paper describes obstacles that inhibit widespread use of PROMs and PREMs and some potential solutions.

Implementation is a prerequisite for any innovation to succeed. Health and care services are complex and people need to be engaged at every level. Most people are cautious about proven innovations such as PROMs and PREMs but champions and leaders can help them engage. The NASSS framework (reasons for Non-adoption, Abandonment and failure to Scale up, Spread or Sustain digital health innovations) helps indicate that implementation is complex why it may be resisted.

The Plan-Do-Study-Act (PDSA) approach aids implementation and helps ensure that everyone knows who should do what, when, where, how and why. Noise is an under-appreciated problem, especially when tracking patients over time such as before and after treatment. Interoperability of PROMs and PREMs with electronic health records should use Fast Health Interoperability Resources and internationally accepted coding schemes such as SNOMED CT and LOINC.

Most projects need multiple measures to meet the needs of everyone involved. Measure selection should focus on their relevance, ease of use, and response rates.

If these problems are avoided or mitigated, PROMs and PREMs can help deliver better patient outcomes, patient experience, staff satisfaction and health equity.
Steroid-sparing effect of belimumab: results from a retrospective observational study of real-world data
Authors: Worley Karen , Milligan Scott , Rubin Bernard
Published: December 2023

Objective

Comparison of oral corticosteroid (OCS) use in patients with SLE in a US rheumatology network pre- and post-belimumab initiation.

Methods

This retrospective cohort study (GSK Study 214140) used data from the Patient-Important Outcomes Data Repository (PIONEER)-Rheumatology database. Eligible adults with SLE initiated belimumab between 1 January 2012 and 30 June 2021, and had available data for >180 days pre- and >360 days post-belimumab initiation. The index was the date of belimumab initiation. Changes in OCS use were measured by: proportion of patients receiving OCS; mean total OCS dose/patient; mean total number of OCS days supplied/patient; mean daily OCS dose for days supplied/patient; the proportion of patients with OCS doses of ≤5 mg/day and ≤7.5 mg/day for days supplied. These changes were assessed between period (P)1 (6 months pre-index) and P2 (first 6 months post-index) and P3 (second 6 months post-index) in patients with OCS use in P1 who persisted with belimumab at each assessed period.

Results

Overall, 608 patients received belimumab for 180 days (full analysis set (FAS)) and 492 for 360 days. Most patients were female (92.8%); 70.4% had moderate SLE. In P1, 56.3% of FAS patients and 54.5% of patients who persisted with belimumab for 360 days received OCS.

Among patients receiving OCS in P1, significantly fewer patients received OCS in P2 (78.4%) and P3 (64.9%) vs P1 (100.0%). Significant reductions from P1 were observed in P2 and P3 in the mean total OCS dose/patient, the mean OCS daily dose for days supplied and the proportions of patients with OCS dose of ≤5 mg/day and ≤7.5 mg/day, and the mean total OCS days supplied/patient in P3 only.

Conclusions

This analysis showed significant reductions in OCS dose and use in patients with SLE who persisted with belimumab, providing more real-world evidence for belimumab’s steroid-sparing effect.
Vortices in a parity-invariant Maxwell–Chern–Simons model
Authors: De Lima W. B. , De Fabritiis P.
Published: December 2023

In this work, we propose a parity-invariant Maxwell–Chern–Simons [Formula: see text] model coupled with two charged scalar fields in [Formula: see text] dimensions, and show that it admits finite-energy topological vortices. We describe the main features of the model and find explicit numerical solutions for the equations of motion, considering different sets of parameters and analyzing some interesting particular regimes. We remark that the structure of the theory follows naturally from the requirement of parity invariance, a symmetry that is rarely envisaged in the context of Chern–Simons theories. Another distinctive aspect is that the vortices found here are characterized by two integer numbers.
Retaining Black Women in Computing: A Comparative Analysis of Interventions for Computing Persistence
Authors: Fisk Susan R. , Watts Brittany , Dress Courtney , Lee Charlotte , Rorrer Audrey , McKlin Tom , Barnes Tiffany , Payton Jamie
Published: December 2023

Black women remain severely underrepresented in computing despite ongoing efforts to diversify the field. Given that Black women exist at the intersection of both racial and gendered identities, tailored approaches are necessary to address the unique barriers Black women face in computing. However, it is difficult to quantitatively evaluate the efficacy of interventions designed to retain Black women in computing, since samples of computing students typically contain too few Black women for robust statistical analysis. Using about a decade of student survey responses from an National Science Foundation–funded Broadening Participation in Computing alliance, we use regression analyses to quantitatively examine the connection between different types of interventions and Black women’s intentions to persist in computing and how this compares to other students (specifically, Black men, white women, and white men). This comparison allows us to quantitatively explore how Black women’s needs are both distinct from—and similar to—other students. We find that career awareness and faculty mentorship are the two interventions that have a statistically significant, positive correlation with Black women’s computing persistence intentions. No evidence was found that increasing confidence or developing skills/knowledge was correlated with Black women’s computing persistence intentions, which we posit is because Black women must be highly committed and confident to pursue computing in college. Last, our results suggest that many efforts to increase the number of women in computing are focused on meeting the needs of white women. While further analyses are needed to fully understand the impact of complex intersectional identities in computing, this large-scale quantitative analysis contributes to our understanding of the nuances of Black women’s needs in computing.
ArieL
: Adversarial Graph Contrastive Learning
Authors: Feng Shengyu , Jing Baoyu , Zhu Yada , Tong Hanghang
Published: December 2023

Contrastive learning is an effective unsupervised method in graph representation learning. The key component of contrastive learning lies in the construction of positive and negative samples. Previous methods usually utilize the proximity of nodes in the graph as the principle. Recently, the data-augmentation-based contrastive learning method has advanced to show great power in the visual domain, and some works have extended this method from images to graphs. However, unlike the data augmentation on images, the data augmentation on graphs is far less intuitive and it is much harder to provide high-quality contrastive samples, which leaves much space for improvement. In this work, by introducing an adversarial graph view for data augmentation, we propose a simple but effective method,
Adversarial Graph Contrastive Learning
(
ArieL
), to extract informative contrastive samples within reasonable constraints. We develop a new technique called
information regularization
for stable training and use subgraph sampling for scalability. We generalize our method from node-level contrastive learning to the graph level by treating each graph instance as a super-node.
ArieL
consistently outperforms the current graph contrastive learning methods for both node-level and graph-level classification tasks on real-world datasets. We further demonstrate that
ArieL
is more robust in the face of adversarial attacks.