bluuebunny/crossref_metadata_2025 huggingface dataset:
Colostomy‐site carcinoma with primitive phenotype in a rectal cancer patient after achieving pathological complete response with neoadjuvant chemoradiotherapy
Authors: Kodama Takayuki , Kanzawa Maki , Hasegawa Hiroshi , Tsukamoto Shuichi , Nishio Mari , Shigeoka Manabu , Koma Yu‐ichiro , Itoh Tomoo , Yokozaki Hiroshi
Published: December 2023

Herein, we report a rare case of a carcinoma with primitive phenotype (enteroblastic and/or hepatoid differentiation) occurring at a colostomy site. The patient was an elderly male who underwent neoadjuvant chemoradiotherapy for rectal cancer, followed by abdominoperineal resection. A biopsy specimen for the rectal carcinoma before neoadjuvant chemoradiotherapy was conventional tubular adenocarcinoma. Moreover, a pathological complete response was confirmed in the proctectomy specimen. However, a colostomy‐site tumor appeared 6 months after the proctectomy, and it was resected 1 year after the initial proctectomy. The colostomy‐site tumor comprised solid to focal glandular growth of atypical polygonal cells with clear to pale eosinophilic cytoplasm and was immunohistochemically positive for cytokeratin, spalt‐like transcription factor 4, glypican‐3, caudal type homeobox 2, and special AT‐rich sequence‐binding protein 2. Thus, the tumor was diagnosed as poorly differentiated adenocarcinoma with primitive phenotype, with suggested origin from the colorectal epithelium. Additionally, a multilocular cystic lesion comprising various types of epithelia was found adjacent to the tumor, suggestive of metaplasia or heterotopia. Changes in the histology and immunophenotype, and the findings of an adjacent cystic lesion suggest a metachronous tumor rather than a recurrence of the primary tumor.
Assembly of heterotrophic communities during spontaneous succession in quarries: invertebrates model groups and macromycetes
Authors: Walter Jan , Hradská Ivana , Kout Jiří , Vodička Stanislav , Matějková Ivona , Konvička Martin
Published: December 2023

Quarrying has a crucial impact on the environment, but it could enhance species diversity. Mining sites represent important refuges for countless species disappearing from homogenous landscapes. Our study focused on assemblages of heterotrophic communities such as moths (Lepidoptera), carabid beetles (Coleoptera: Carabidae), spiders (Araneae), and macromycetes (fungi: Basidiomycota, Ascomycota) in an active part of kaolin quarries and their immediate surroundings in the Pilsen region, Czech Republic. We compared differences between mined and unmined sites, sites with spontaneous succession and sites with replanted pine trees. In total, we recorded 178 moth, 63 spider, 27 carabid beetle, and 81 macromycetes species, including 21 Red‐listed species. The moths, carabid beetles, and macromycetes tended to inhabit unmined sites; on the contrary, open habitat spiders preferred open sites with replanted pine trees. Based on the life history traits analyses, moth species feeding on forbs and grasses prevail at the active part of kaolin quarries, where higher plant diversity was detected. Large body carabid beetles such as Carabus spp. favored unmined sites, as well as macromycetes with long‐lived fruit bodies. Open habitat and xerophilous spiders inhabited the replanted sites by pine trees where the sparse vegetation was obvious. Our results indicated that groups with radically different life histories such as moths, carabids, and macromycetes may react to mining remarkably similarly, although spiders, despite sharing predatory habits with the majority of carabids, reacted differently.
Modeling Contraception and Pregnancy in Malawi: A Thanzi La Onse Mathematical Modeling Study
Authors: Colbourn Tim , Janoušková Eva , Li Lin Ines , Collins Joseph , Connolly Emilia , Graham Matt , Jewel Britta , Kachale Fannie , Mangal Tara , Manthalu Gerald , Mfutso‐Bengo Joseph , Mnjowe Emmanuel , Mohan Sakshi , Molaro Margherita , Ng'ambi Wingston , Nkhoma Dominic , Revill Paul , She Bingling , Manning Smith Robert , Twea Pakwanja , Tamuri Asif , Phillips Andrew , Hallett Timothy B.
Published: December 2023

Malawi has high unmet need for contraception with a costed national plan to increase contraception use. Estimating how such investments might impact future population size in Malawi can help policymakers understand effects and value of policies to increase contraception uptake. We developed a new model of contraception and pregnancy using individual‐level data capturing complexities of contraception initiation, switching, discontinuation, and failure by contraception method, accounting for differences by individual characteristics. We modeled contraception scale‐up via a population campaign to increase initiation of contraception (Pop) and a postpartum family planning intervention (PPFP). We calibrated the model without new interventions to the UN World Population Prospects 2019 medium variant projection of births for Malawi. Without interventions Malawi's population passes 60 million in 2084; with Pop and PPFP interventions. it peaks below 35 million by 2100. We compare contraception coverage and costs, by method, with and without interventions, from 2023 to 2050. We estimate investments in contraception scale‐up correspond to only 0.9 percent of total health expenditure per capita though could result in dramatic reductions of current pressures of very rapid population growth on health services, schools, land, and society, helping Malawi achieve national and global health and development goals.
Preparation and performance analysis of Ti-25Nb-3Zr-2Sn-3Mo microarc oxidized macro-micro-nano tertiary structure film layers
Authors: Yan Xing , Wang Jingyi , Wang Cenyi , Xu Jia , Yu Sen , Li Yang , Zhang Yuan , Xie Guobin , Yang Mei
Published: December 2023

After undergoing microarc oxidation, titanium alloys exhibit significantly enhanced biocompatibility, making them a subject of extensive research in the field of biomedical applications. In this study, a two-step microarc oxidation method was used to prepare a film layer with both macro-micro-nano tertiary structures on β-type titanium alloy Ti-3Zr-2Sn-3Mo-25Nb (TLM), using a phosphate-nitrate mixed electrolyte for the first step of microarc oxidation and a borate body electrolyte for the second step of microarc oxidation. The effects of NaOH concentration, microarc oxidation voltage, and time on the size and distribution of macropores prepared by microarc oxidation in the first step were investigated by SEM, energy dispersive spectroscopy, XRD, and metallurgical microscopy. The wettability of the prepared three-level structured film and its ability to induce hydroxyapatite deposition were evaluated through contact angle testing and simulated body fluid immersion experiments. The overall research findings indicate that the two-step microarc oxidation process yielded macropores with diameters ranging from 200 to 400 μm, along with micro-nanostructures measuring 2–15 μm and 10–100 nm. The increase in the NaOH concentration in the electrolyte decreased the size of the macropores. The increase in the microarc oxidation time increased the size of macropores; the voltage affected the distribution and number of macropores. The prepared macro-micro-nano tertiary structured membrane layers have excellent wettability and the ability to induce hydroxyapatite precipitation, indicating that they possess good biocompatibility. This study provides a reference for the medical development of alloys.
Mode matching-based beamforming with frequency-wise truncation order for concentric circular differential microphone arrays
Authors: Wang Jinfu , Yang Feiran , Li Junfeng , Sun Hongling , Yang Jun
Published: December 2023

It is desired that a fixed beamformer should maintain the frequency-invariant beampattern and achieve the high white noise gain (WNG), i.e., high robustness against the mismatch in practice. However, existing methods for the design of concentric circular differential microphone arrays (CCDMAs) cannot achieve a compromise between the high robustness and the frequency-invariant beampattern. To address this problem, a new analytical expression for the synthesized beampattern of CCDMAs is derived without any truncation error. Then CCDMAs are designed by matching mode coefficients of the approximated synthesized beampattern to that of the target differential beampattern, where an adjustable truncation order is utilized to enable a trade-off between the robustness and the beampattern distortion. A simple and effective procedure is presented to determine the frequency-wise truncation order. The proposed method reduces to three existing methods, i.e., the Jacobi–Anger method, the improved Jacobi–Anger method, and the minimum mean square error-based method, for a fixed truncation order, which in turn establishes a close connection with these methods and provides a unified view on the design of the CCDMAs. The superiority of the proposed method in terms of robustness and beampattern distortion is demonstrated through computer simulations.
An Analysis of Positional Generic and Individualized Speed Thresholds Within the Most Demanding Phases of Match Play in the English Premier League
Authors: Kavanagh Ronan , McDaid Kevin , Rhodes David , McDonnell Jack , Oliveira Rafael , Morgans Ryland
Published: December 2023

Objectives: To analyze the positional distances covered above generic and individualized speed thresholds within the most demanding phases of match play. Categorized by position, 17 English Premier League players’ match data were analyzed over 2 consecutive seasons (2019–20 and 2020–21). The most demanding phases of play were determined using a rolling average across 4 periods of 1, 3, 5, and 10 minutes. Distance covered in the time above the standard speed of 5.5 m/s was analyzed, with individualized metrics based on the maximal aerobic speed (MAS) test data. Results: Central defenders displayed lower values for high-intensity periods when compared with fullbacks, midfielders, and wide midfielders for both generic and individualized metrics. MAS during 1-minute periods was significantly higher for forwards when compared with central defenders (82.9 [18.9] vs 67.5 [14.8] for maximum high-speed running [HSR] and 96.0 [15.9] vs 75.7 [13.8] HSR for maximum MAS activity). The maximum effect size differences between the central midfielders, wide midfielders, and fullbacks for HSR and MAS measures under the maximum HSR criterion was 0.28 and 0.18 for the 1-minute period, 0.36 and 0.19 for the 3-minute period, 0.46 and 0.31 for the 5-minute period, and 0.49 and 0.315 for the 10-minute period. Conclusions: Individualized speed metrics may provide a more precise and comparable measure than generic values. Data appear to be consistent across playing positions except for central defenders. This information may allow practitioners to directly compare individualized physical outputs of non–central defenders during the most demanding phases of play regardless of the players’ positional group. This may provide coaches with important information regarding session design, training load, and fatigue monitoring.
Gut-resident microorganisms and their genes are associated with cognition and neuroanatomy in children
Authors: Bonham Kevin S. , Fahur Bottino Guilherme , McCann Shelley Hoeft , Beauchemin Jennifer , Weisse Elizabeth , Barry Fatoumata , Cano Lorente Rosa ,   The RESONANCE Consortium, Huttenhower Curtis , Bruchhage Muriel , D’Sa Viren , Deoni Sean , Klepac-Ceraj Vanja
Published: December 2023

Emerging evidence implicates gut microbial metabolism in neurodevelopmental disorders, but its influence on typical neurodevelopment has not been explored in detail. We investigated the relationship between the microbiome and neuroanatomy and cognition of 381 healthy children, demonstrating that differences in microbial taxa and genes are associated with overall cognitive function and the size of brain regions. Using a combination of statistical and machine learning models, we showed that species including
Alistipes obesi
,
Blautia wexlerae
, and
Ruminococcus gnavus
were enriched or depleted in children with higher cognitive function scores. Microbial metabolism of short-chain fatty acids was also associated with cognitive function. In addition, machine models were able to predict the volume of brain regions from microbial profiles, and taxa that were important in predicting cognitive function were also important for predicting individual brain regions and specific subscales of cognitive function. These findings provide potential biomarkers of neurocognitive development and may enable development of targets for early detection and intervention.
The Epistemic Value of Gain of Function Experiments
Authors: Casadevall Arturo , Fang Ferric C. , Imperiale Michael J.
Published: December 2023

The phrase “gain of function” (GOF) has recently acquired a negative connotation in experimental biology by its association with risky science. Whereas much of the discussion on the relative merits of GOF-type experiments has focused on their risk-benefit equation, relatively little has been said about their epistemic value. In this article, we recount how GOF experiments were critical for establishing DNA as the genetic material, the identification of cellular receptors, and the role of oncogenes in cancer research. Today, many of the products of the biomedical revolution such as synthetic insulin, growth factors, and monoclonal antibodies are the result of GOF experiments where cells were given the new function of synthesizing medically important products. GOF experiments and complementary loss of function experiments are epistemically powerful tools for establishing causality in biology.
Acceptance of COVID-19 vaccine and associated factors among healthcare workers in Katsina state: a cross-sectional study in Northwest Nigeria
Authors: Abubakar Ahmed Tijani , Suleiman Kabir , Ahmad Suleiman Idris , Yahaya Shamsuddeen Suleiman , Bello Umar Ibrahim , Suleiman Bello Abdullahi , Haladu Suleiman Ahmed , Al-Mustapha Ahmad Ibrahim , Abubakar Musa Imam
Published: December 2023

Objectives

Healthcare workers were prioritised to receive the COVID-19 vaccine in Nigeria. Administration of COVID-19 vaccination in Nigeria was challenging because of a lack of trust in vaccine safety and vaccine effectiveness among healthcare workers, who are expected to provide reliable information about vaccines and vaccine-preventable diseases in the communities. Hence, their acceptance and attitudes towards COVID-19 preventive practices could influence the acceptance of the vaccine by the local population. This cross-sectional study assessed the acceptance of the COVID-19 vaccine among healthcare workers in Katsina State. We predicted the variables that increased the vaccine acceptance using logistic regression analysis.

Setting

This hospital-based study was conducted at primary, secondary and tertiary healthcare facilities in Nigeria.

Participants

A total of 793 healthcare workers were included in this study. Of these, 65.4% (n=519) were male.

Outcome measures

To assess acceptance of COVID-19 vaccine measures, and factors increasing acceptance among healthcare workers.

Results

Of the healthcare workers, 80% (638) were tested for the SARS-CoV-2, of whom 10.8% (n=65) tested positive. Approximately 97% (n=765) of them believed that the COVID-19 vaccine was safe, and 90% (n=714) received the first dose of the vaccine. Healthcare workers between 30 and 39 years were more likely to accept the vaccine (aOR: 7.06; 95% CI 2.36 to 21.07; p<0.001). Those who had been tested for COVID-19 were more likely (aOR:7.64; 95% CI 3.62 to 16.16; p<0.001) to accept the vaccine.

Conclusions

Our findings showed that the age and prior COVID-19 testing were the main factors influencing the acceptance of the COVID-19 vaccine. There was high acceptance of the COVID-19 vaccine among healthcare workers in Katsina State, Nigeria. Future studies should focus on the completion of doses and serological testing for immunity.
Gaawaadhi Gadudha: understanding how cultural camps impact health, well-being and resilience among Aboriginal adults in New South Wales, Australia—a collaborative study protocol
Authors: Yashadhana Aryati , Zwi Anthony B , Brady Brooke , De Leeuw Evelyne , Kingsley Jonathan , O'Leary Michelle , Raven Miri , Serova Nina , Topp Stephanie M , Fields Ted , Foster Warren , Jopson Wendy , Biles Brett
Published: December 2023

Introduction

The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in ‘cultural camps’ held on sites of cultural significance promotes health and well-being.

Methods and analysis

The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples’ t-tests or χ2analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a ‘Model of Cultural Health’ that will be refined through a Delphi process with experts, stakeholders and policymakers.

Ethics and dissemination

The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders.
Cold, dark and malnourished: a cross-sectional analysis of the relationship between energy poverty and household burden of malnutrition in sub-Saharan Africa
Authors: Dake Fidelia A A , Christian Aaron K
Published: December 2023

Objective

Energy poverty contributes to the general well-being of households; however, there is representational paucity on its role in household nutrition across sub-Saharan Africa (SSA). This study examined the influence of different domains of energy poverty and a Multidimensional Energy Poverty Index (MEPI) on household burden of malnutrition in SSA.

Setting

Secondary data from the most recent Demographic and Health Survey conducted in 18 SSA countries were analysed.

Design

A cross-sectional design was used to examine the relationship between household energy poverty and household burden of malnutrition.

Methods

Different dimensions of household energy poverty and an MEPI were computed from the sources of energy used for cooking, lighting, entertainment and accessing information by households. Household burden of malnutrition was coded as a binary categorical dependent variable using indicators of undernutrition, overnutrition and anaemia among women of reproductive age (15–49 years) and children under five years in the household.

Results

More than nine in ten households were energy poor in terms of cooking fuel and about three in four were energy poor in terms of lighting. Considering the various domains of energy poverty, lack of electricity for lighting, using biofuels, not owning a refrigerator/freezer, not owning a television/radio and not owning a mobile phone were associated with increased odds of a household experiencing undernutrition. Similarly, deprivation in these domains was associated with a lower likelihood of households experiencing overnutrition, the only exception being using biofuels. Overall, households that were most energy poor on the MEPI were more likely to be undernourished and double and triple burden malnutrition households but less likely to suffer from overnutrition.

Conclusion

These results highlight the complex and multifaceted nature of the relationship between energy poverty and household burden of malnutrition and provides guidance for appropriate interventions to address energy poverty and malnutrition in SSA.
Protocol for the PORT study: short-term perioperative rehabilitation to improve outcomes in cardiac valvular surgery – a randomised control trial
Authors: Zhou Haofeng , Liu Fengyao , Liu Yuanhui , He Xuyu , Ma Huan , Xu Mingyu , Wang Haochen , Zhang Guolin , Cai Xiangyu , Chen Ji-Yan , Guo Lan , Chen Jimei
Published: December 2023

Introduction

Perioperative rehabilitation (PORT) has shown a positive effect on patients undergoing cardiac surgery. However, there are minimal data on the impact of short-term PORT in cardiac surgery, which is associated with higher postoperative morbidity and mortality. The trial will assess the efficacy of short-term PORT in reducing in-hospital mortality, postoperative pulmonary complications and length of stay, compared with the usual care in cardiac surgical patients.

Methods and analysis

This is a single-centre prospective, randomised, open, controlled trial with a 1:1 ratio. Consecutive 800 adult patients undergoing elective valve surgery will be randomised to either usual care or in-hospital short-term PORT that consists of education, inspiratory muscle training, active cycle of breathing techniques and early mobilisation. The primary outcome of this study will be a composite of in-hospital all-cause mortality, incidence of postoperative pulmonary complications and the ratio of postoperative hospitalisation >7 days.

Ethics and dissemination

The PORT study was granted by the Medical Research Ethics Committee of Guangdong Provincial People’s Hospital in August 2018. Findings will be disseminated to patients, clinicians and commissioning groups through peer-reviewed publication.

Trial registration number

NCT03709511.
Active close contact investigation of tuberculosis through computer-aided detection and stool Xpert MTB/RIF among people living in Oromia Region, Ethiopia (CADOOL Study): protocol for a prospective, cross-sectional study
Authors: Segala Francesco Vladimiro , Nigussa Worku , Guido Giacomo , Kenate Birhanu , Facci Enzo , Tsegaye Ademe , Gulo Berhanu , Manenti Fabio , Bobosha Kidist , Cotugno Sergio , Asmare Azmach Biset , Cavallin Francesco , Tilahun Melaku , Miccio Maddalena , Abdissa Alemseged , Putoto Giovanni , Saracino Annalisa , Di Gennaro Francesco
Published: December 2023

Introduction

Pulmonary tuberculosis (TB) is an infectious disease with high incidence in low-income countries (LICs); it remains one of the infectious diseases with the highest mortality in the world, especially in LICs. It is crucial to recognise and diagnose TB as soon as possible, but microbiological tests on sputum are not always sensitive enough. New methods for an early diagnosis of TB are needed. In this study, we will investigate the role of two different tests to detect TB in Ethiopia (where the prevalence of TB is high): molecular search for TB in stool samples with Xpert assay and detection of pulmonary TB signs on chest X-rays with CAD4TB technology.

Methods and analysis

A prospective diagnostic test accuracy study during TB active contact investigation will be conducted. In the referral hospital in Southwest Shoa Zone, Oromia Region, Ethiopia, patients with pulmonary TB and a sputum sample positive forMycobacterium tuberculosisand household contacts of at least 4 years of age will be enrolled, with a target sample size of 231 patients. Trained staff will label household contacts as ‘possible TB’ cases or not according to their symptoms; when TB is possible, a stool Xpert and computer-aided detection on chest X-ray will be performed, alongside standard diagnostic methods, assessing the diagnostic accuracy of CAD4TB compared with Xpert MTB/RIF during TB contact investigation and the accuracy of stool Xpert compared with sputum Xpert.

Ethics and dissemination

This study has been approved by the Oromia Health Bureau Research Ethics Committee (ref no BFO/MBTFH/1-16/100023). All information obtained will be kept confidential. Selected investigators will have access to data, while international partners will sign a dedicated data protection agreement. Eligible participants will receive brief information about the study before being asked to participate and they will provide written informed consent. Results will be disseminated through peer-reviewed journals.

Trial registration number

NCT05818059.
Evaluation of functional vision and eye-related quality of life in children with congenital ectopia lentis: a prospective cross-sectional study
Authors: Liang Xiaolin , Zheng Danying , Young Charlotte Aimee , Ma Yiyuan , Ling Lirong , Zou Minjie , Liu Siyuan , Zhang Xinyu , Jin Guangming
Published: December 2023

Objectives

This study aims to evaluate the effect of congenital ectopia lentis (CEL) on functional vision and eye-related quality of life (ER-QOL) in children and their families using the Paediatric Eye Questionnaire (PedEyeQ).

Design

A questionnaire survey administered via in-person interviews of patients with CEL and their parents.

Participants

51 children with CEL and 53 visually normal controls accompanied by 1 parent completed the survey questionnaires for the study from March 2022 to September 2022.

Outcome measures

PedEyeQ domain scores. Functional vision and ER-QOL of children and their families were evaluated by calculating and comparing the Rasch domain scores of the PedEyeQ.

Results

PedEyeQ domain scores were significantly worse with CEL compared with controls (p<0.01 for each), with the exception of the Proxy Social domain among children aged 0–4 years (p=0.283). Child PedEyeQ greatest differences were in the functional vision domain (5–11 years, −20 points (95% CI −27 to −12)) and frustration/worry domain (12–17 years, −41 (95% CI −37 to −6)). Proxy PedEyeQ greatest differences were in the functional vision domain (0–4 years, −34 (95% CI −45 to −22)) and frustration/worry domain (5–11 years, −27 (95% CI −39 to −14); 12–17 years, −37(95% CI (−48 to −26))). Parent PedEyeQ greatest difference was in the ‘worry about child’s eye condition’ (−57 (95% CI (−63 to −51))).

Conclusions

In this study, children with CEL had reduced functional vision and ER-QOL compared with controls. Parents of children with CEL also experience reduced quality of life.
Development and application of simulation modelling for orthopaedic elective resource planning in England
Authors: Harper Alison , Monks Thomas , Wilson Rebecca , Redaniel Maria Theresa , Eyles Emily , Jones Tim , Penfold Chris , Elliott Andrew , Keen Tim , Pitt Martin , Blom Ashley , Whitehouse Michael R , Judge Andrew
Published: December 2023

Objectives

This study aimed to develop a simulation model to support orthopaedic elective capacity planning.

Methods

An open-source, generalisable discrete-event simulation was developed, including a web-based application. The model used anonymised patient records between 2016 and 2019 of elective orthopaedic procedures from a National Health Service (NHS) Trust in England. In this paper, it is used to investigate scenarios including resourcing (beds and theatres) and productivity (lengths of stay, delayed discharges and theatre activity) to support planning for meeting new NHS targets aimed at reducing elective orthopaedic surgical backlogs in a proposed ring-fenced orthopaedic surgical facility. The simulation is interactive and intended for use by health service planners and clinicians.

Results

A higher number of beds (65–70) than the proposed number (40 beds) will be required if lengths of stay and delayed discharge rates remain unchanged. Reducing lengths of stay in line with national benchmarks reduces bed utilisation to an estimated 60%, allowing for additional theatre activity such as weekend working. Further, reducing the proportion of patients with a delayed discharge by 75% reduces bed utilisation to below 40%, even with weekend working. A range of other scenarios can also be investigated directly by NHS planners using the interactive web app.

Conclusions

The simulation model is intended to support capacity planning of orthopaedic elective services by identifying a balance of capacity across theatres and beds and predicting the impact of productivity measures on capacity requirements. It is applicable beyond the study site and can be adapted for other specialties.
Factors affecting antenatal screening for HIV in Nepal: results from Nepal Demographic and Health Surveys 2016 and 2022
Authors: Sabin Lucie , Saville Naomi , Dixit Devkota Madhu , Haghparast-Bidgoli Hassan
Published: December 2023

Objectives

Antenatal screening for HIV remains low in Nepal. Identifying factors associated with the uptake of antenatal screening is essential to increase uptake and prevent mother-to-child transmission (MTCT). This study investigated the effects of individual-level and district-level characteristics on the utilisation of antenatal screening for HIV in Nepal and how these effects changed between 2016 and 2022.

Design

We used publicly available cross-sectional data from 2016 to 2022 Nepal Demographic and Health Surveys.

Setting

Stratified, multistage, random sampling was used to collect nationally representative data.

Participants

1978 and 2007 women aged 15–49 years who gave birth in the 2 years preceding the surveys.

Primary and secondary outcome measures

We used multilevel models to estimate associations between antenatal screening and potential factors influencing it in 2016 and 2022. We used districts as a random effect and looked at the intraclass correlation coefficients to disentangle the geographical effects. To distinguish barriers to HIV screening from barriers to accessing antenatal care (ANC) services, we performed similar analyses with whether the woman attended at least one ANC visit as the dependent variable.

Results

Factors associated with antenatal screening have not changed significantly between 2016 and 2022. Higher uptake of HIV screening was found among women with higher education, the pregnancy being desired later and women who had four or more ANC visits. Being from a poorer family and having low knowledge of MTCT and the medicines to prevent transmission were associated with lower uptake. From the supply side, no factors had a significant effect on antenatal screening. Factors associated with antenatal screening and those associated with any ANC were different. Our results also showed a partial importance of geographical factors on screening uptake.

Conclusions

Our results supported that antenatal screening could be improved by enhancing access to information and improving the availability of free screening.
Acoustic stimulation for relieving pain during venipuncture: a systematic review and network meta-analysis
Authors: Yamada Yosuke , Kitamura Mineaki , Inayama Emi , Kishida Masatsugu , Kataoka Yuki , Ikenoue Tatsuyoshi
Published: December 2023

Objectives

To assess whether acoustic stimulations relieve venipuncture pain and determine which stimulation is the most effective type.

Design

Systematic review and network meta-analysis.

Data sources

PubMed, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the International Clinical Trials Registry Platform databases were systematically searched in September 2023.

Study selection

Randomised controlled trials evaluating the efficacy of acoustic stimulations on patients undergoing venipuncture were eligible. Acoustic stimulations were classified into seven categories: five types of acoustic stimulations (music medicine (researcher selected), music medicine (patient selected), music therapy, sounds with linguistic meaning and sounds without linguistic meaning) and two controls (only wearing headphones and no treatment).

Primary and secondary outcome measures

Primary outcomes included self-reported pain intensity assessed during venipuncture and treatment cost, and secondary outcomes were self-reported mental distress and adverse events.

Results

Of 6406 citations, this network meta-analysis included 27 studies including 3416 participants; the mean age was 31.5 years, and 57% were men. Among the five types of acoustic stimulations, only musical interventions, such as music medicine (patient selected) (standardised mean difference (SMD) −0.44 (95% CI: −0.84 to –0.03); low confidence), music medicine (researcher selected) (SMD −0.76 (95% CI: −1.10 to –0.42); low confidence) and music therapy (SMD −0.79 (95% CI: −1.44 to –0.14); low confidence), were associated with improved pain relief during venipuncture compared with no treatment. No significant differences existed between the types of acoustic stimulations. Free-of-charge acoustic stimulations were provided to patients, and no specific adverse events were reported. In many studies, the risk of bias was rated high because of the difficulty of blinding the intervention to the participants and the self-reported pain outcome.

Conclusions

Music interventions were associated with reduced venipuncture pain. Comparisons between types of acoustic stimulations revealed no significant differences. Therefore, music intervention could be a safe and inexpensive pain relief method for venipuncture.

PROSPERO registration number

CRD42022303852.
Social prescribing for children and young people with neurodisability and their families initiated in a hospital setting: a systematic review
Authors: Gordon Katie , Gordon Laura , Basu Anna Purna
Published: December 2023

Objectives

Social prescribing (SP) is a non-medical intervention in which professionals refer patients to a link worker (LW), who connects them with appropriate support. Children and young people (CYP) with neurodisability often have unmet needs and may bypass community initiatives. We undertook a review of hospital-initiated SP for CYP with neurodisability.

Design

Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and using Mixed Methods Appraisal Tool.

Data sources

Medline, PsycINFO, PsycARTICLES, Embase, CINAHL, Scopus, Web of Science and FutureNHS, searched from 1 January 2000 to 19 October 2023, with no language restrictions.

Eligibility criteria

Studies describing SP interventions for CYP (ages 0–25 years) with neurodisability/neurodivergence. Exclusions: interventions outside of secondary care; with no description; or no LW.

Data extraction and synthesis

Two researchers independently screened references. Data were charted, summarised, quality assessments performed and narratively reviewed.

Results

After removal of duplicates, 518 references were identified. Following screening, eight articles (covering five SP schemes) were included. Rahiet alconnected 68 families of CYP newly diagnosed with visual impairment to a community LW. Families needed information about social and educational services, and emotional support. Healthcare professionals had more time for clinical issues. Six papers described three different digital interventions supporting in total 86 CYP with traumatic brain injury and their families. Wadeet al(2004, 2005a, 2005b) provided a website with core and individualised sessions, and weekly therapist support. Wadeet al(2018) provided a smartphone application, website and weekly meetings with an online coach. These interventions boosted social behaviours. Wadeet al(2014, 2015) found that online family problem-solving therapy improved overall child functioning compared with self-guided resources. Toutainet al(2009) provided non-medical support to 11 children with fetal alcohol syndrome and their mothers. No outcome data were provided. Studies reported benefits to health, well-being, healthcare usage, knowledge, skills, satisfaction and service delivery.

Conclusion

Literature describing hospital-initiated SP schemes for CYP with neurodisability, while sparse, suggests potential benefit.

PROSPERO registration number

CRD42022384188.
Impact of heat on mental health emergency visits: a time series study from all public emergency centres, in Curitiba, Brazil
Authors: Corvetto Julia Feriato , Federspiel Andrea , Sewe Maquins Odhiambo , Müller Thomas , Bunker Aditi , Sauerborn Rainer
Published: December 2023

Objectives

Quantify the risk of mental health (MH)-related emergency department visits (EDVs) due to heat, in the city of Curitiba, Brazil.

Design

Daily time series analysis, using quasi-Poisson combined with distributed lag non-linear model on EDV for MH disorders, from 2017 to 2021.

Setting

All nine emergency centres from the public health system, in Curitiba.

Participants

101 452 EDVs for MH disorders and suicide attempts over 5 years, from patients residing inside the territory of Curitiba.

Main outcome measure

Relative risk of EDV (RREDV) due to extreme mean temperature (24.5°C, 99th percentile) relative to the median (18.02°C), controlling for long-term trends, air pollution and humidity, and measuring effects delayed up to 10 days.

Results

Extreme heat was associated with higher single-lag EDV risk of RREDV1.03(95% CI 1.01 to 1.05—single-lag 2), and cumulatively of RREDV1.15 (95% CI 1.05 to 1.26—lag-cumulative 0–6). Strong risk was observed for patients with suicide attempts (RREDV1.85, 95% CI 1.08 to 3.16) and neurotic disorders (RREDV1.18, 95% CI 1.06 to 1.31). As to demographic subgroups, females (RREDV1.20, 95% CI 1.08 to 1.34) and patients aged 18–64 (RREDV1.18, 95% CI 1.07 to 1.30) were significantly endangered. Extreme heat resulted in lower risks of EDV for patients with organic disorders (RREDV0.60, 95% CI 0.40 to 0.89), personality disorders (RREDV0.48, 95% CI 0.26 to 0.91) and MH in general in the elderly ≥65 (RREDV0.77, 95% CI 0.60 to 0.98). We found no significant RREDVamong males and patients aged 0–17.

Conclusion

The risk of MH-related EDV due to heat is elevated for the entire study population, but very differentiated by subgroups. This opens avenue for adaptation policies in healthcare: such as monitoring populations at risk and establishing an early warning systems to prevent exacerbation of MH episodes and to reduce suicide attempts. Further studies are welcome, why the reported risk differences occur and what, if any, role healthcare seeking barriers might play.
Abstracts from international Emergency Medicine Journals
Authors: Production EMJ
Published: December 2023

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
UK doctors’ strikes 2023: not only justified but, arguably, supererogatory
Authors: McConnell Doug , Mann Darren
Published: December 2023

The 2023 doctors’ strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors’ strikes are morally impermissible but show that they all fail. The most we can conclude from such arguments is that doctors’ strikes are morally permissible in a narrower range of circumstances than strikes in other sectors.

We then outline two independent but compatible justifications for doctors’ strikes, one that appeals to doctors’ interests in fair pay and working conditions and one that appeals to doctors’ duty to protect public health. We also suggest that doctors’ strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors’ strikes. We conclude that they are justified and there is a case for considering them supererogatory.
Rituximab leading to an atypical presentation of neuroborreliosis and false negative serology
Authors: Lorentzen Åslaug Rudjord , Berg Kristine Karlsrud , Ljøstad Unn
Published: December 2023

Two patients, recently treated with the B-cell-depleting monoclonal antibody, rituximab, had 2–3 months of progressive systemic symptoms; comprehensive investigations did not clarify the diagnosis. Transient radicular pain at disease onset had suggested neuroborreliosis, but seronegativity and an atypical clinical course made this unlikely. However, PCR identifiedBorrelia burgdorferiDNA in cerebrospinal fluid, establishing the diagnosis of neuroborreliosis. Both the clinical picture and the laboratory findings can be atypical in people with neuroborreliosis who have recently been treated with rituximab. In B-cell depleted patients living in endemic areas, one should suspect neuroborreliosis even when the typical symptoms are drowned out by more atypical symptoms; PCR should be used as a diagnostic supplement when the serological response is uncertain or absent.
Physiology quiz competition: the game of education or entertainment?
Authors: Mistry Hardikkumar Amrutbhai , Pathak Narendra , Desai Dhvani , Dulera Sharvil , Mandli Rachana
Published: December 2023

The Physiology Quiz Competition is a method of teaching and learning that provides education with entertainment in a medical college. It increases students’ interest in the subject of Physiology and helps them to understand and learn the subject effectively.
The FXYD1 protein plays a protective role against pulmonary hypertension and arterial remodeling via redox and inflammatory mechanisms
Authors: Hansen Thomas S. , Karimi Galougahi Keyvan , Tang Owen , Tsang Michael , Scherrer-Crosbie Marielle , Arystarkhova Elena , Sweadner Kathleen , Bursill Christina , Bubb Kristen J. , Figtree Gemma A.
Published: December 2023

This is the first study to show that deficiency of the FXYD1 protein is associated with pulmonary hypertension. FXYD1 expression is lower in the lungs of people with idiopathic pulmonary artery hypertension. FXYD1 deficiency results in both left and right ventricular functional impairment. Finally, FXYD1 may endogenously protect the heart from oxidative and inflammatory injury.
Experimental Study on the Effect of In/Out Radial-Finned Heat Sink with PCM under Constant and Intermittent Power Mode in Power LEDs
Authors: Ramesh Thangamani , Praveen Ayyappan Susila , Pillai Praveen Bhaskaran , Salunkhe Sachin , Ragab Adham E. , Hussein Hussein M. A. , Davim Paulo
Published: December 2023

The findings of the experimental study into optimizing the heat transfer rate of a PCM-based heat sink for high-power LEDs are presented in this work. The study investigated five heat sink types, with and without PCM. The LED case and junction temperatures, LED module temperatures, heat storage and release rate analyses, analyses of three types of cyclic operation modes, luminous flux, and heat sink thermal resistance were all examined independently. The results indicated that the PCM-based LED heat sink had improved thermal performance. The LED junction temperature of the PCM-equipped E-20 heat sink is nine degrees Celsius lower at 10 W than that of the heat sink without PCM. Furthermore, the E-20 heat sink with PCM extends the LED module’s critical lifespan. As a bonus, the E-20 with PCM had a 38.19 percent lower thermal resistance at 10 W than the E-20 without PCM. According to these results, the heat sink E-20 emits 715 lm at 10 W when operated without a phase-change material (PCM). With the same input power, the luminous flux of an E-20 equipped with a heat sink and a phase-change material (PCM) is 750 lm, a gain of 4.7%. Finally, clearly recommend the heat E-20 sink with PCM suitable for high-power LED thermal management system.
Semi-supervised Learning for Automatic Modulation Recognition Using Haar Time–Frequency Mask and Positional–Spatial Attention
Authors: Liu Hui , Zhong Dan , Guo Yuanpu , Xu Zehong , Wu Zhenlin , Gao Chunxian
Published: December 2023

Automatic modulation recognition plays an important role in many military and civilian applications, including cognitive radio, spectrum sensing, signal surveillance, and interference identification. Due to the powerful ability of deep learning to extract hidden features and perform classification, it can extract highly separative features from massive signal samples. Considering the condition of limited training samples, we propose a semi-supervised learning framework based on Haar time–frequency (HTF) mask data augmentation and the positional–spatial attention (PSA) mechanism. Specifically, the HTF mask is designed to increase data diversity, and the PSA is designed to address the limited receptive field of the convolutional layer and enhance the feature extraction capability of the constructed network. Extensive experimental results obtained on the public RML2016.10a dataset show that the proposed semi-supervised framework utilizes 1% of the given labeled data and reaches a recognition accuracy of 92.09% under 6 dB signals.
High Quality of Early Ischemic Stroke Care but Poorer Clinical Outcomes among Patients with a History of Mental Illness
Authors: Mackenhauer Julie , Christensen Erika Frischknecht , Andersen Grethe , Mainz Jan , Johnsen Søren Paaske
Published: December 2023

Objectives. The aim of this study was to compare early stroke care and clinical outcomes among patients with and without a history of mental illness. Materials/Methods. A nationwide registry-based cohort study of patients with acute ischemic stroke treated in a tax-financed healthcare system. We used process and outcome measures from the Danish Stroke Registry 2007-2018 combined with the data from multiple Danish registries. We combined the process measures in two composite measures: an opportunity-based score (the proportion of all relevant process measures fulfilled for each patient) and an all-or-none score (the proportion of patients fulfilling all relevant process measures). Patients were categorized according to severity of mental health history. Results. We included 117 548 admissions with acute ischemic stroke: 20.8%, 3.5%, and 3.4% of admissions concerned patients with a history of minor, moderate, or major mental illness, respectively. Patients received a median of 85.7% (IQR, 66.7; 100.0) of the relevant processes (opportunity-based score). Patients with a history of mental illness were less likely to receive guideline-recommended acute stroke care within the defined time frames; however, differences were not clinically relevant. Patients with a history of mental illness were significantly more likely to die within 30 days, compared to patients with no history of mental illness: Risk ratios (RR) for 30-day mortality adjusted for age, sex, and country of origin were 1.31 (CI, 1.25; 1.37) for minor, 1.18 (CI, 1.05; 1.33) for moderate, and 1.44 (CI, 1.30; 1.60) for major mental illness. The corresponding adjusted RRs for recurrent stroke/TIA were 1.69 (CI, 1.58; 1.80) for minor, 1.39 (CI, 1.19; 1.61) for moderate, and 1.36 (CI, 1.17; 1.59) for major mental illness. The associations were weakened for 30-day mortality but not recurrent stroke/TIA after additional adjustment for potential mediating factors (comorbidity and stroke severity). Conclusion. More than one-quarter of patients with ischemic stroke had a history of mental illness. The overall performance of acute stroke care was high in all groups. Mental illness was associated with a higher risk of death and recurrent stroke compared to patients without a history of mental illness which may at least partly be due to a more adverse prognostic profile at the time of admission, including a higher stroke severity.