bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial Tumor Size and Narrow-Band Image Findings Estimate Growth Speed in Duodenal Tumors
Authors: Hirose Takashi , Kakushima Naomi , Minami Yoshiyuki , Furune Satoshi , Ishikawa Eri , Sawada Tsunaki , Maeda Keiko , Yamamura Takeshi , Furukawa Kazuhiro , Nakamura Masanao , Nakaguro Masato , Kawashima Hiroki
Published: July 2024

Introduction: Recently, the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs) including adenomas and superficial duodenal carcinomas has increased. Various endoscopic treatment methods have also been reported for SNADETs, but there are few reports on the natural history. The aim of this study was to analyze factors related to tumor growth and determine the characteristics of SNADETs which need early therapeutic intervention. Methods: A single-center, retrospective study was performed on the medical records of 309 patients with SNADETs who underwent endoscopic or surgical resection between January 2010 and May 2021. Of these, 41 patients who were followed up for more than 1 year by endoscopy were analyzed. The primary outcome was an analysis of the tumor growth speed. Secondary outcomes were the relationship between the tumor growth speed and mucin phenotype, tumor size and findings of magnifying endoscopy with narrow-band imaging (M-NBI). Results: The observation period was 24 months (13–182). Tumor growth speed was 1.1 mm/year (0–21.6). Tumor diameter ≥10 mm at first detection (p = 0.004; odds ratio 19.5 [2.03–186.96]) and mixed type by M-NBI (p = 0.036; odds ratio 9.69 [1.05–89.88]) were identified as risk factors of tumors growing at a rate of ≥3 mm/year. There was no statistically significant difference in the speed of tumor growth between the different mucin immunohistochemical phenotypes. Conclusion: Initial tumor size and findings of M-NBI are useful to predict tumor growth and consider early intervention.
Development of Quality Indicators to Evaluate the Quality of Care for People with Differences of Sex Development
Authors: Jürgensen Martina , Rapp Marion , Schnoor Maike , Heidenreich Andreas , Döhnert Ulla , Scherf Jannick , Hiort Olaf , Katalinic Alexander ,   DSDCare Study Group
Published: July 2024

Introduction: Achieving evidence-based, high-quality medical care is the overarching goal of healthcare quality management. Quality indicators (QIs) serve as proxies to show whether good quality is reached or not. This article describes the development of QI for the evaluation of healthcare quality in the area of differences of sex development (DSD). Methods: Following the model of Donabedian, the aim was to develop QI to assess defined relevant aspects of the quality of structures, processes, and outcomes of care in DSD. Ten DSD clinical centres and two self-advocacy groups in Germany included in the DSDCare project were involved in the development of the QI and a benchmarking system. The development of the QI involved several structured steps: analysis of guidelines and recommendations, literature review, qualitative interviews with key stakeholders in the field of DSD, and patients or their carers. QIs were discussed in a multi-stage systematic consensus process and assessed in terms of their relevance, feasibility, and practicability. Results: In a multi-stage systematic consensus process involving medical and psychological experts from a range of disciplines, people with DSD and their families, and representatives of self-advocacy groups, we have developed a set of 37 QIs (22 structure, seven process, and eight outcome quality). The QIs serve to evaluate care in the field of DSD and may add to the German criteria for certification of Centres for Rare Conditions formulated by the National Action League for People with Rare Diseases (NAMSE) in this area of expertise. Conclusion: We have succeeded in developing and jointly adopting a set of QIs that consider a wide range of perspectives on the quality of care for people with DSD and their families. These QIs have been found to be relevant, feasible, and practicable, and they are now used for a yearly quality benchmarking in the participating DSD centres.
Single Construct Suppression and Replacement Gene Therapy for the Treatment of All
CALM1
-,
CALM2
-, and
CALM3
-Mediated Arrhythmia Disorders
Authors: Hamrick Samantha K. , Kim C.S. John , Tester David J. , Gencarelli Manuela , Tobert Kathryn E. , Gluscevic Martina , Ackerman Michael J.
Published: July 2024

BACKGROUND:

CaM (calmodulin)-mediated long-QT syndrome is a genetic arrhythmia disorder (calmodulinopathies) characterized by a high prevalence of life-threatening ventricular arrhythmias occurring early in life. Three distinct genes (
CALM1
,
CALM2
, and
CALM3
) encode for the identical CaM protein. Conventional pharmacotherapies fail to adequately protect against potentially lethal cardiac events in patients with calmodulinopathy.

METHODS:

Five custom-designed
CALM1
-,
CALM2
-, and
CALM3
-targeting short hairpin RNAs (shRNAs) were tested for knockdown (KD) efficiency using TSA201 cells and reverse transcription-quantitative polymerase chain reaction. A dual-component suppression and replacement (SupRep)
CALM
gene therapy (CALM-SupRep) was created by cloning into a single construct
CALM1
-,
CALM2
-, and
CALM3-specific shRNAs that produce
KD (suppression) of each respective gene and a shRNA-immune
CALM1
cDNA (replacement). CALM1-F142L, CALM2-D130G, and CALM3-D130G induced pluripotent stem cell-derived CMs were generated from patients with CaM-mediated long-QT syndrome. A voltage-sensing dye was used to measure action potential duration at 90% repolarization (APD90).

RESULTS:

Following shRNA KD efficiency testing, a candidate shRNA was identified for
CALM1
(86% KD),
CALM2
(71% KD), and
CALM3
(94% KD). The APD90 was significantly prolonged in CALM2-D130G (647±9 ms) compared with CALM2-WT (359±12 ms;
P
<0.0001). Transfection with
CALM
-SupRep shortened the average APD90 of CALM2-D130G to 457±19 ms (66% attenuation;
P
<0.0001). Additionally, transfection with
CALM
-SupRep shortened the APD90 of CALM1-F142L (665±9 to 410±15 ms;
P
<0.0001) and CALM3-D130G (978±81 to 446±6 ms;
P
<0.001).

CONCLUSIONS:

We provide the first proof-of-principle suppression-replacement gene therapy for CaM-mediated long-QT syndrome. The CALM-SupRep gene therapy shortened the pathologically prolonged APD90 in
CALM1
-,
CALM2
-, and
CALM3-variant
CaM-mediated long-QT syndrome induced pluripotent stem cell-derived CM lines. The single CALM-SupRep construct may be able to treat all calmodulinopathies, regardless of which of the 3 CaM-encoding genes are affected.
Impact of State Telehealth Parity Laws for Private Payers on Hypertension Medication Adherence Before and During the COVID-19 Pandemic
Authors: Zhang Donglan , Lee Jun Soo , Popoola Adebola , Lee Sarah , Jackson Sandra L. , Pollack Lisa M. , Dong Xiaobei , Therrien Nicole L. , Luo Feijun
Published: July 2024

BACKGROUND:

Telehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension medication adherence remains uncertain.

METHODS:

Data from the 2016 to 2021 Merative MarketScan Commercial Claims and Encounters Database were used to construct the study cohort, which included nonpregnant individuals aged 25 to 64 years with hypertension. We coded telehealth parity laws related to hypertension management in all 50 US states and the District of Columbia, distinguishing between payment and coverage parity laws. The primary outcomes were measures of antihypertension medication adherence: the average medication possession ratio; medication adherence (medication possession ratio ≥80%); and average number of days of drug supply. We used a generalized difference-in-differences design to examine the impact of these laws.

RESULTS:

Among 353 220 individuals (mean [SD] age, 49.5 (7.1) years; female, 45.55%), states with payment parity laws were significantly linked to increased average medication possession ratio by 0.43 percentage point (95% CI, 0.07–0.79), and an increase of 0.46 percentage point (95% CI, 0.06–0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI, 0.11–4.17) in prescription supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, gross domestic product per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI, 0.19–4.07) in days of prescription supply but did not significantly increase the average medication possession ratio or probability of medication adherence.

CONCLUSIONS:

State telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.
Cardiovascular Health Starts in the Womb
Authors: Falkner Bonita , Alexander Barbara T. , Nuyt Anne-Monique , South Andrew M. , Ingelfinger Julie
Published: July 2024

Hypertension has largely been viewed as a disorder of adulthood. Historically, blood pressure (BP) was not routinely measured in children because hypertension was considered uncommon in childhood. It was not until the 1970s that it was apparent that in childhood BP levels were normally lower compared with those in adults, were related to age and growth, and that abnormal BP in children needed different definitions. Based on the distribution of BP levels in available child cohorts, the 95th percentile of BP levels became the definition of hypertension in children and adolescents—an epidemiological definition. Subsequent clinical and epidemiological research identified associated risk factors in childhood that linked abnormal BP in youth with hypertension in adulthood. In the 1980s, the Barker hypothesis, based on observations that low birth weight could be linked to cardiovascular disease in adulthood, promoted further research spanning epidemiological, clinical, and basic science on the childhood origins of hypertension. This review focuses on recent findings from both longitudinal maternal-child cohorts and experimental models that examine both maternal and offspring conditions associated with risks of subsequent cardiovascular disease.
The Effects of Convolution Reverberation on the Emotional Characteristics of Musical Instrument Sounds
Authors: Mo Ronald K. , Horner Andrew
Published: July 2024

Previous work has shown that the emotional characteristics of musical instrument sounds are significantly changed with parametric reverberation. But do the parametric reverberation results also apply to real concert hall reverberation? This article considers the effects of reverberation time on the emotional characteristics of instrument sounds with convolution reverberation. We compared eight musical instruments and ten emotional characteristics over five hall impulse responses ranging from the one-second Royal National Theatre to the five-second King's College Chapel. The results showed that convolution reverberation had more pronounced effects on emotional characteristics compared with parametric reverberation. This makes sense, since convolution reverberation is often regarded as warmer, more natural, and smoother than parametric reverberation. The latter is often regarded as blander by comparison. Halls with shorter reverberation times emphasized the emotional characteristics Angry and Comic, whereas medium reverberation times emphasized the characteristics Happy, Heroic, and Shy, and longer reverberation times emphasized the characteristics Calm, Mysterious, Romantic, Sad, and Scary. Although the results were more pronounced for convolution reverberation compared with parametric reverberation, there was also a striking agreement in their results, and the correlation coefficient between them was 0.654 over all emotional characteristics. This strong correlation indicates that reverberation time has a remarkably consistent effect on the emotional characteristics regardless of whether using convolution or parametric reverberation—a reflection of their deep underlying functional similarities despite their fundamentally different implementations.
Checklist of marine Bivalvia (Mollusca) from Brazil, with descriptive analyses of their bathymetric and geographical distribution
Authors: PASSOS FLÁVIO DIAS , BATISTÃO ALAN RODRIGO , LIMA LUAN LUCAS CARDOSO
Published: July 2024

After revising the literature and consulting the pertinent virtual databases, we here list all Brazilian marine bivalves currently considered as valid and include data on their geographical and bathymetrical distribution. The list contains 516 indigenous and nine introduced species. Among the former, 461 species are autobranchs and 64 are protobranchs. They belong to 42 superfamilies, nine of them containing at least 20 species each; there are 77 families, twelve of which contain at least 15 species; most of these more speciose groups are typical from shallow waters (e.g., Tellinoidea and Veneroidea) and/or have been reviewed taxonomically (Nuculanoidea and Cuspidarioidea). There are 368 species which live exclusively on the continental shelf, 86 are only known from deep water and 68 species have a wide bathymetric distribution. More than half of the 368 continental-shelf species have a wide geographic distribution; 40 species are exclusive to the Brazilian province, the others also occur in the Caribbean and/or Argentine shelf waters; those from the Caribbean need more investigation. Important knowledge gaps remain for Brazilian Galeommatoidea and Nuculoidea, deep-sea species of Mytilidae, Teredinidae, and Arcidae; the Poromyidae, Limopsidae, Propeamussiidae, and Thyasiridae appear to be underrepresented. Compared to 29 world regional faunas of marine bivalves, the Brazilian diversity ranks in the ninth position.
Quantifying Uncertainty in Atmospheric Winds Retrieved from Optical Flow: Dependence on Weather Regime
Authors: Yanovsky Igor , Posselt Derek J. , Wu Longtao , Hristova-Veleva Svetla
Published: July 2024

This study explores the performance of a dense optical flow method in comparison to pattern-matching techniques for retrieving atmospheric motion vectors (AMVs) from water vapor images. Using high-resolution simulated datasets that represent various weather phenomena, we assess the performance of these methods across different weather regimes, time intervals, and pressure levels and quantify the uncertainties associated with retrieved winds. The optical flow algorithm consistently outperforms the feature matching approach. Notably, it produces wind speeds and AMVs that closely resemble the wind fields from the simulations, and unlike the feature matching algorithm, the optical flow algorithm exhibits consistent performance across different time intervals. In contrast, the feature matching approach yields vector fields that exhibit oversmoothing in certain areas and erratic behavior in others, while also producing less detailed, regionally constant speed maps. Furthermore, unlike feature matching, the optical flow method effectively calculates AMV near regions with missing data, generating a dense AMV field for every pixel in a pair of images. This superior performance and flexibility significantly influence the planning for future satellite missions aimed at retrieving atmospheric winds. As such, our work plays a critical role in determining the mission architecture and projected instrument performance for future atmospheric wind retrieval satellite missions. The study underscores the potential of the optical flow algorithm as a robust and efficient approach for atmospheric motion retrieval, thus contributing to advances in climate research and weather prediction.

Significance Statement

This research investigates the efficacy of two methods, optical flow and feature matching, for detecting atmospheric winds, referred to as atmospheric motion vectors, from satellite images of water vapor. Employing detailed simulated datasets that replicate real-world weather patterns, we found that optical flow consistently outperforms feature matching in various aspects. Notably, the optical flow method is not only more precise but also maintains its accuracy across different scenarios. These insights are critical for the design of future satellite missions focused on advancing our understanding of the atmosphere and enhancing weather predictions. This study contributes to advancements in climate research and supports improved weather forecasting, benefiting both scientific and societal needs.
Ageing in networks: The unbounded geographies of non-migrant and migrant older adults
Authors: Ho Elaine Lynn-Ee , Chua Vincent , Feng Chen-Chieh
Published: July 2024

We propose ‘ageing in networks’ as an optic that shows how the social networks of older adults extend beyond their residential neighbourhoods to extra-local and transnational settings. The paper brings together literature on ageing and social networks in mobilities and migration research to identify shared thematic framings between non-migrant and migrant older adults. Our approach broadens the analytical frame to encapsulate how ageing individually and in communities takes place through local and international mobility and via digital technologies. Ageing in networks also illuminates the importance of connecting their social protection needs with those of the people in their care assemblages.
Clustering-based theoretical line loss calculation method for low-voltage transformer areas containing a high percentage of wind power distribution networks
Authors: Xuke Cheng , Ping Li , Guanfeng Zhang , Junjie Sun , Junjie Qiao , Xiaofang Meng
Published: July 2024

The paper proposes a theoretical line loss calculation method for low-voltage terrace areas with a high proportion of wind power access. The method is based on two-stage hybrid clustering. The operating parameters of the station area are processed, and SOM- K-means hybrid clustering is used to determine the typical scenarios and time segments of typical monthly wind power curves. A theoretical model for calculating line loss power in distribution networks based on hybrid clustering is proposed. Additionally, a theoretical model for calculating line loss rate is suggested for different modes with a high proportion of wind power participation. Finally, this paper verifies the validity of its method and model by applying them to an actual station area with wind power output and load curve, completing the theoretical calculation, and comparing the results with those of the tidal method. This provides a fast and accurate calculation method for theoretical line loss calculation.
Impact of a regulatory target and external factors on the waste efficiency of Italian municipalities
Authors: Daraio Cinzia , Di Leo Simone , Simar Léopold
Published: July 2024

Due to increasing consumption and urbanisation, urban waste management and recycling are a primary concern in Italy. Italian waste collection underwent significant reform with the introduction of a sorted collection target of 65% of total collected waste in Legislative Decree No. 152/2006. In this article, we analyse the effect of this regulatory target on the efficiency of waste collection in 275 Italian municipalities in the years 2016–2019. We estimate the coefficients of the cost efficiencies of the sorted and unsorted waste without assuming functional forms for the efficient frontier or the distribution of efficiency. Our findings suggest that municipalities that met the 65% sorted waste target demonstrated higher efficiency as costs increased, whereas those that failed to meet the target demonstrated higher inefficiency as costs increased. Strong effects emerged for population and urban economic development on the success of waste collection, whereas only marginal effects were observed for population density and city size. To improve the situation of municipalities that are not meeting the 65% target, we propose several policy measures, including ‘neighbourhood solidarity’.
Children in the New Testament
Authors: Allen Amy L.
Published: July 2024

This article situates recent scholarship related to children and metaphors of childhood within a global context. It attends to the importance of childist criticism, located primarily in Europe and the United States, in the growth of study of children in the New Testament in recent decades, while attending to parallel work on the role of children in the New Testament, particularly in relation to contextualized readings, in the global South. Specific attention is given to the use of language in defining children and childhood both within and outside the biblical context; overviews of biblical childhood; and the roles and representations of children in New Testament texts. The essay concludes by looking forward to future opportunities for research and collaboration.
Predictive factors of postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to intensive care unit: a retrospective cohort study
Authors: Yu Shujing , Wei Kaiyuan , Zhou Dawei , Lin Qing , Li Tong
Published: July 2024

Background

The epidemiology and risk factors for postoperative complications related to free flap reconstruction in head and neck cancer patients admitted to the Intensive Care Unit (ICU) are unknown.

Methods

We performed a retrospective cohort study of patients with free flap reconstruction of head and neck cancer between September 2015 and April 2023 admitted to the ICU of Beijing Tongren Hospital. The univariate and multivariate analyses were used to explore the risk factors for postoperative complications related to free flap reconstruction admitted to ICU, including flap necrosis, bleeding, fistula, and infection.

Results

A total of 239 patients were included in this study, and 38 (15.9%) patients had postoperative complications related to free flap reconstruction. The median length of ICU stay was 1 day (interquartile range, 1–2 days). Multivariate analysis found that low BMI (P < 0.001), high postoperative CRP (P = 0.005), low hemoglobin (P = 0.012), and inadequate fluid intake (P < 0.05) were independent risk factors for complications.

Conclusions

Postoperative complications related to free flap reconstruction were common in this ICU population. Careful fluid management and monitoring of CRP and hemoglobin levels may reduce complications.
New Trauma Score versus Kampala Trauma Score II in predicting mortality following road traffic crash: a prospective multi-center cohort study
Authors: Damulira John , Muhumuza Joshua , Kabuye Umaru , Ssebaggala Godfrey , Wilson Michael Lowery , Bärnighausen Till , Lule Herman
Published: July 2024

Introduction

Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population.

Objectives

To compare NTS to the modified Kampala Trauma Score (KTS II) in the prediction of 30-day mortality, and injury severity amongst patients sustaining road traffic crashes in Ugandan low-resource settings.

Methods

Multi-center prospective cohort study of patients aged 15 years and above. Of the 194 participants, 85.1% were males with a mean age of 31.7 years. NTS and KTS II were determined for each participant within 30-minutes of admission and followed-up for 30 days to determine their injury outcomes. The sensitivity, specificity, and area under receiver operating characteristics curve (AUC) for predicting mortality were compared between the two trauma scores using SPSS version 22. Ethical clearance: Research and Ethics Committee of Kampala International University Western Campus (Ref No: KIU-2022-125).

Results

The injury severity classifications based on NTS vs. KTS II were mild (55.7% vs. 25.8%), moderate (29.9% vs. 30.4%), and severe (14.4% vs. 43.8%). The mortality rates for each injury severity category based on NTS vs. KTS II were mild (0.9% v 0%), moderate (20.7% vs. 5.1%), and severe (50% vs. 28.2%). The AUC was 0.87 for NTS (95% CI 0.808–0.931) vs. 0.86 (95% CI 0.794–0.919) for KTS II respectively. The sensitivity of NTS vs. KTS II in predicting mortality was 92.6% (95% CI: 88.9–96.3) vs. 70.4% (95% CI: 63.0-77.8) while the specificity was 70.7% (95% CI: 64.2–77.2) vs. 78.4% (95% CI: 72.1–84.7) at cut off points of 17 for NTS and 6 for KTS II respectively.

Conclusions

NTS was more sensitive but its specificity for purposes of 30-day mortality prediction was lower compared to KTS II. Thus, in low-resourced trauma environment where time constraints and pulse oximeters are of concern, KTS II remains superior to NTS.
Chronic inflammatory demyelinating polyneuropathy following COVID-19 vaccination: a case report and literature review
Authors: Bahramy Mohammad Ali , Hashempour Zahra , Shahriarirad Reza
Published: July 2024

Background

Severe post-vaccination neurological complications are rare. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an immune-mediated polyneuropathy affecting the peripheral nerve roots, which is not well described as a post-vaccination side effect. Here, we present a rare complication of vaccination against SARS-CoV-2, reaching a diagnosis of CIDP.

Case presentation

A 67-year-old diabetic male presented with lower extremity paresthesia and weakness following the third dose of the Sinopharm (BBIBP-CorV) vaccine. Despite initial dismissal as a diabetic complication, symptoms escalated, affecting all extremities. Electromyography study revealed abnormal spontaneous activity with chronic reinnervation changes, which was more significant in the lower extremities. Based on the clinical course, radiographic imaging, and laboratory data, a diagnosis of CIDP with severe axonal demyelinating features was established. Treatment with intravenous immunoglobulin (IVIg), prednisolone, and azathioprine resulted in marked improvement of the upper extremities but limited recovery in distal lower extremity muscles.

Conclusion

Although CIDP is a rare complication following COVID-19 vaccination, it should be considered in the differential diagnosis. Timely diagnosis of vaccine-induced CIDP is challenging, and any delay can adversely affect treatment response in affected patients.
Factors affecting the quality of life in pregnant women with diabetes: the mediating effect of illnesses acceptance
Authors: Fathnezhad-Kazemi Azita , Seifinadergoli Zahra , Ahmadi Mohaddeseh
Published: July 2024

Introduction

Gestational diabetes, as a disorder of carbohydrate metabolism, is considered one of the most common metabolic complications in pregnancy. The diagnosis of diabetes in pregnancy leads to changes in lifestyle, and the treatments employed can affect various aspects of pregnant women’s lives, including their quality of life. The present study aimed to investigate the relationship between self-efficacy and the mediating effect of illness acceptance on the quality of life in pregnant women diagnosed with diabetes during pregnancy.

Materials and methods

This cross-sectional study was conducted on 240 pregnant women diagnosed with diabetes who were selected by convenience sampling method. Quality of life tools (SF12), the Acceptance of Illness Scale (AIS), and the Sherer self-efficacy scale were used to collect data.

Results

The mean (SD) of quality of life, self-efficacy, and disease acceptance were 57.36 (6.63), 51.75 (7.44), and 29.07 (7.69), respectively. In the single-variable regression analysis, self-efficacy and disease acceptance variables could predict 20.6% (β = 0.457, P < 0.001) and 14.4% (β = 0.385, P < 0.001) of the variations in quality of life, respectively. In the multiple regression model, by entering the two main variables (self-efficacy and Acceptance of Illness), demographic characteristics, three disease knowledge variables, health status from an individual perspective, and type of treatment, the variables could explain 25% of the changes of the quality of life (R2adj 0.25, P < 0.001=). Income status and self-efficacy had the highest impact among the variables. According to the results of path analysis, the total effect of self-efficacy on the quality of life of pregnant women with diabetes was 0.711.

Conclusion

The overall quality of life in women with diabetes was moderate, and self-efficacy, illness acceptance, and income status were predictors of overall quality of life. Self-efficacy can influence the quality of life by affecting disease acceptance. The findings highlight the importance of designing educational programs and providing midwifery services to increase self-efficacy and illness acceptance to improve the quality of life of pregnant women with diabetes.
HIV-related cognitive disorders in children in Kinshasa (Democratic Republic of Congo)
Authors: Maboso Ekolo Esther , Masaya Mupuala Aimée , Mabiala Bodi Joseph , Nkuadiolandu Adolphine , Manyanga Tshibasu Pierre
Published: July 2024

Objectives

HIV-infected individuals are at increased risk of neurocognitive disorders compared with the general population. Studies suggest that, despite the combination of antiretroviral drugs, HIV infection causes immune activation leading to significant neural damage; however, there is little data on HIV-infected young people in our country.

Methodology

This is a comparative cross-sectional study conducted between November 2020 and March 2021 on two hundred and sixteen children aged 6–15 years, including 106 HIV-positive children and 108 healthy children. Cognitive performance was assessed using the Differential Ability Scale Second Edition (DAS-II).

Results

HIV-infected children showed lower cognitive scores than control children in the subtest group of verbal ability (82.1% vs. 43.5%); non-verbal ability (84.9% vs. 45.4%); spatial ability (79.2% vs. 21.3%) and generall conceptual ability (GCA) (88.7% vs. 43.5%). The children in the control group had significantly higher ability scores in the diagnostic tests and in school achievement, and the difference was statistically significant.

Conclusion

Cognitive impairment remains a significant complication in HIV-positive children, as suggested by low cognitive scores in more than half of our participants. This is an unresolved issue with implications for survival, quality of life and daily functioning in these children. It is important that clinicians are able to identify and manage these cognitive deficits.
The global burden, risk and inequality of maternal obstructed labor and uterine rupture from 1990 to 2019
Authors: Yan Mingxing , Li Hui , Zheng Xinye , Li Feng , Gao Chen , Li Liying
Published: July 2024

Background

Obstructed labor (OL) and uterine rupture (UR) are common obstetric complications. This study explored the burden, risk factors, decomposition, and health inequalities associated with OL and UR to improve global maternal health.

Methods

This was a cross-sectional analysis study including data on OL and UR from the Global Burden of Diseases, and Risk Factors Study (GBD) 2019. The main outcome measures included the number and age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), prevalence, and deaths.

Results

The global burden of OL and UR has declined, with a decrease in incidence (number in 2019: 9,410,500.87, 95%UI 11,730,030.94 to 7,564,568.91; ASR in 2019: 119.64 per 100,000, 95%UI 149.15 to 96.21; estimated annual percentage change [EAPC] from 1990 to 2019: -1.34, 95% CI -1.41 to -1.27) and prevalence over time. However, DALYs (number in 2019: 999,540.67, 95%UI 1,209,749.35 to 817,352.49; ASR in 2019: 12.92, 95%UI 15.63 to 10.56; EAPC from 1990 to 2019: -0.91, 95% CI -1.26 to -0.57) and deaths remain significant. ASR of DALYs increased for the 10–14 year-old age group (2.01, 95% CI 1.53 to 2.5), the 15–19 year-old age group (0.07, 95% CI -0.47 to 0.61), Andean Latin America (3.47, 95% CI 3.05 to 3.89), and Caribbean (4.16, 95% CI 6 to 4.76). Iron deficiency was identified as a risk factor for OL and UR, and its impact varied across different socio-demographic indices (SDIs). Decomposition analysis showed that population growth primarily contributed to the burden, especially in low SDI regions. Health inequalities were evident, the slope and intercept for DALYs were − 47.95 (95% CI -52.87 to -43.02) and − 29.29 (95% CI -32.95 to -25.63) in 1990, 39.37 (95%CI 36.29 to 42.45) and 24.87 (95%CI 22.56 to 27.18) in 2019. Concentration indices of ASR-DALYs were − 0.2908 in 1990 and − 0.2922 in 2019.

Conclusion

This study highlights the significant burden of OL and UR and emphasizes the need for continuous efforts to reduce maternal mortality and morbidity. Understanding risk factors and addressing health inequalities are crucial for the development of effective interventions and policies to improve maternal health outcomes globally.
Evaluation of kikuyu grass wetland for wastewater treatment efficiency from malt factory, Ethiopia
Authors: Tibebe Dessie , Ambelu G/ Hiwot , Kassa Yezbie
Published: July 2024

Background

The majority of existing industries in Ethiopia discharge untreated effluents into nearby water bodies, streams and open land. The wastewater generated by Gondar malt factory (GMF) was disposed freely and join a natural wetland implemented for the treatment of the wastewater. The objective of the study was to analyze and characterize wastewater from GMF and to evaluate the effectiveness of the wetland for the treatment purpose.

Methods

Different Physicochemical quality indicators (color, turbidity pH, temperature, Total Dissolved solids, Total Suspended solids, total solid, conductivity, alkalinity, hardness, nitrate, phosphate, sulfate, free chlorides, heavy metals-(Cd, Cr, Fe, Mn, and Pb)and Biological Oxygen Demand were measured according to the standard procedures. Data was analyzed using Statistical Package for Social Sciences (SPSS-25). Analysis of Variance (ANOVA) was used to find whether significant differences existed in the different sampling stations for the parameters studied. P value less than 0.05 was considered to show significant difference.

Results

The results of this study revealed that most of the quality indicators were improved in value after the water passed through the wetland except for alkalinity M, sulfite, Mn, temperature and pH. From ANOVA result, it was noted that there was a significant mean difference between the stations except for chromium, manganese and lead. The result showed that the wetland plays a great role in the removal of pollutants where the best performance was obtained at removal efficiency of 96.188% PO4HR,75.63% Nitrate,>99% Cl2, ammonia and nitrite 99.99%, 92.77% sulfate,84.36% Total hardness,87.43% color, and for others it is ranged between 30 and 60%.

Conclusion

the study concluded that GMF wetland was almost effective and had potential in treatment of the wastewater from the discharging facilities (especially for nutrients, alkalinity P, hardness, color and chloride). It is recommended that wetlands should be conserved and used as wastewater treatment facility.
‘It depends on where you were born…here in the North East, there’s not really many job opportunities compared to in the South’: young people’s perspectives on a North-South health divide and its drivers in England, UK
Authors: Fairbrother Hannah , Woodrow Nicholas , Holding Eleanor , Crowder Mary , Griffin Naomi , Er Vanessa , Dodd-Reynolds Caroline , Egan Matt , Scott Steph , Summerbell Carolyn , Rigby Emma , Kyle Philippa , Knights Nicky , Quirk Helen , Goyder Elizabeth
Published: July 2024

Background

Improving the public’s understanding of how regional and socioeconomic inequalities create and perpetuate inequalities in health, is argued to be necessary for building support for policies geared towards creating a more equal society. However, research exploring public perceptions of health inequalities, and how they are generated, is limited. This is particularly so for young people. Our study sought to explore young people’s lived experiences and understandings of health inequalities.

Methods

We carried out focus group discussions (n = 18) with 42 young people, aged 13–21, recruited from six youth organisations in England in 2021. The organisations were located in areas of high deprivation in South Yorkshire, the North East and London. Young people from each organisation took part in three interlinked focus group discussions designed to explore their (i) perceptions of factors impacting their health in their local area, (ii) understandings of health inequalities and (iii) priorities for change. Due to the Covid-19 pandemic, most discussions took place online (n = 15). However, with one group in the North East, we carried out discussions face-to-face (n = 3). Data were analysed thematically and we used NVivo-12 software to facilitate data management.

Results

Young people from all groups demonstrated an awareness of a North-South divide in England, UK. They described how disparities in local economies and employment landscapes between the North and the South led to tangible differences in everyday living and working conditions. They clearly articulated how these differences ultimately led to inequalities in people’s health and wellbeing, such as linking poverty and employment precarity to chronic stress. Young people did not believe these inequalities were inevitable. They described the Conservative government as prioritising the South and thus perpetuating inequalities through uneven investment.

Conclusions

Our study affords important insights into young people’s perceptions of how wider determinants can help explain the North-South health divide in England. It demonstrates young people’s contextualised understandings of the interplay between spatial, social and health inequalities. Our findings support calls for pro-equity policies to address the structural causes of regional divides in health. Further research, engaging young people in deliberative policy analysis, could build on this work.
Preoperative analysis of factors associated with prolonged pneumoretroperitoneum time during retroperitoneal laparoscopic nephroureterectomy for upper tract urothelial carcinoma
Authors: Yanagi Masato , Kiriyama Tomonari , Akatsuka Jun , Endo Yuki , Takeda Hayato , Hamasaki Tsutomu , Nishimura Taiji , Kondo Yukihiro
Published: July 2024

Background

Prolonged laparoscopic nephroureterectomy (LNU) for upper tract urothelial cancer (UTUC) can increase the frequency of intravesical recurrence after surgery. Therefore, it is important for urological surgeons to have knowledge on preoperative risk factors for prolonged LNU. However, few studies have investigated the risk factors for prolonged LNU. We hypothesized that the quantity of perirenal fat affects the pneumoretroperitoneum time (PRT) of retroperitoneal LNU (rLNU). This study aimed to investigate the preoperative risk factors for prolonged PRT during rLNU.

Methods

We reviewed the data of 115 patients who underwent rLNU for UTUC between 2013 and 2021. The perirenal fat thickness (PFT) observed on preoperative computed tomography (CT) images was used to evaluate the perinephric fat quantity. Preoperative risk factors for PRT during rLNU were analyzed using logistic regression models. The cutoff value for PRT was determined based on the median time.The cutoff values for fat-related factors influencing PRT were defined according to receiver operating characteristic curve analysis.

Results

The median PRT for rLNU was 182 min (interquartile range, 155–230 min). The cutoff values of posterior, lateral, and anterior PFTs were 15 mm, 24 mm, and 6 mm, respectively. Multivariate analysis revealed that a posterior PFT ≥ 15 mm (odds ratio [OR], 2.72; 95% confidence interval, 1.04–7.08; p = 0.0410) was an independent risk factor for prolonged PRT.

Conclusions

Thick posterior PFT is a preoperative risk factor for prolonged PRT during rLNU. For patients with UTUC and thick posterior PFT, surgeons should develop optimal surgical strategies, including the selecting an expert surgeon as a primary surgeon and the selecting transperitoneal approach to surgery or open surgery.
Pharmacological non-hormonal treatment options for male infertility: a systematic review and network meta-analysis
Authors: Al Wattar Bassel H. , Rimmer Michael P. , Teh Jack J. , Mackenzie Scott C. , Ammar Omar F. , Croucher Carolyn , Anastasiadis Eleni , Gordon Patrick , Pacey Allan , McEleny Kevin , Sangster Phillipa
Published: July 2024

Background

Male factor infertility affect up to 50% of couples unable to conceive spontaneously. Several non-hormonal pharmacological treatments have been proposed to boost spermatogenesis and increase chances of conception in men with infertility. Still, no clear evidence exists on the most effective treatment strategy.

Objective

We aimed to compare the effectiveness of non-hormonal pharmacological treatment options for men with infertility using a systematic review and network meta-analysis.

Methods

We searched MEDLINE, EMBASE, and CENTRAL until October 2023 for randomised/quasi-randomised trials that evaluated any non-hormonal pharmacological treatment options for men with idiopathic semen abnormalities or those with hypogonadism. We performed pairwise and network meta-analyses using a random effect model. We assessed risk of bias, heterogeneity, and network inconsistency. We calculated the mean rank and the surface under the cumulative ranking curve (SUCRA) for each intervention the maximum likelihood to achieve each of reported outcomes. We reported primarily on sperm concentration and other important semen and biochemical outcomes using standardised mean difference (SMD) and 95% confidence-intervals(CI).

Results

We included 14 randomised trials evaluating four treatments (Clomiphene citrate, Tamoxifen, Aromatase inhibitors, anti-oxidants) and their combinations in 1342 men. The overall quality of included trials was low. Sperm concentration improved with clomiphene compared to anti-oxidants (SMD 2.15, 95%CI 0.78–3.52), aromatase inhibitor (SMD 2.93, 95%CI 1.23–4.62), tamoxifen (SMD − 1.96, 95%CI -3.57; -0.36) but not compared to placebo (SMD − 1.53, 95%CI -3.52- 0.47). Clomiphene had the highest likelihood to achieve the maximum change in sperm concentration (SUCRA 97.4). All treatments showed similar effect for sperm motility, semen volume, and normal sperm morphology. FSH levels showed significant improvement with clomiphene vs.anti-oxidant (SMD 1.48, 95%CI 0.44–2.51) but not compared to placebo. The evidence networks for LH and testosterone suffered from significant inconsistency (p = 0.01) with similar trend of improvement with clomiphene compared to other treatments but not compared to placebo.

Conclusion

There is insufficient evidence to support the routine use of Clomiphene, tamoxifen, and aromatase inhibitors to optimise semen parameters in men with infertility. Future randomised trials are needed to confirm the efficacy of clomiphene in improving fertility outcomes in men.

PROSPERO

CRD42023430179.
Nurses’ opinions on euthanasia in Spain: an evaluation using a new version of the EAS
Authors: Lerma-García Daniel , Parra-Fernández María Laura , Romero-Blanco Cristina , Olmo-Mora María Soledad , Onieva-Zafra María Dolores
Published: July 2024

Background

Bioethical dilemmas at the end of life have led to regularization processes for the provision of medical assistance in dying patients in different countries. Since the regulation of euthanasia in Spain in 2021, the euthanasia act has been included as one of the benefits of the health system, which has undergone uneven development and implementation in different autonomous communities. The aim of this study was to review the Spanish version of the Euthanasia Attitude Scale following the partial modification of four items.

Methods

A cross-sectional study was conducted with a non-probabilistic sample of Spanish health workers from Islas Baleares. A self-reported sociodemographic questionnaire and the Euthanasia Attitude Scale were used for data collection. The psychometric properties of the scale were assessed, including reliability and validity, using a confirmatory factor analysis and a parallel analysis.

Results

The Cronbach's alpha of the EAS was α = 0.892, which implies good internal consistency. According to the confirmatory factor analysis, a Kaiser–Meyer–Olkin–value of 0.938 was obtained, and the result of Bartlett's test of sphericity was < 0.001. The questionnaire included four loading factors, which explained up to 56.99% of the variance. The parallel analysis revealed three significant factors and a fourth, less interpretative factor.

Conclusions

The EAS-ES-R is a valid instrument for assessing the attitudes toward euthanasia of both trainees and practicing health professionals. It may also be of vital importance in detecting training, support and implementation needs for laws regulating euthanasia in Spain.
Learning from a crisis: a qualitative study on how nurses reshaped their work environment during the COVID-19 pandemic
Authors: de Vos Annemarie J. B. M. , de Kok Eline , Maassen Susanne M. , Booy Monique , Weggelaar-Jansen Anne Marie J. W. M.
Published: July 2024

Background

The global nursing shortages exacerbated by the COVID-19 pandemic necessitated a drastic reorganization in nursing practices. Work routines, the composition of teams and subsequently mundane nursing practices were all altered to sustain the accessibility and quality of care. These dramatic changes demanded a reshaping of the nurses’ work environment. The aim of this study was to explore how nurses reshaped their work environment in the early stages of the COVID-19 pandemic.

Methods

A descriptive study comprising 26 semi-structured interviews conducted in a large Dutch teaching hospital between June and September 2020. Participants were nurses (including intensive care unit nurses), outpatient clinic assistants, nurse managers, and management (including one member of the Nurse Practice Council). The interviews were analysed with open, axial, and selective coding.

Results

We identified five themes: 1) the Nursing Staff Deployment Plan created new micro-teams with complementary roles to meet the care needs of COVID-19 infected patients; 2) nurse-led adaptations effectively managed the increased workload, thereby ensuring the quality of care; 3) continuous professional development ensured adequate competence levels for all roles; 4) interprofessional collaboration resulted in experienced solidarity, a positive atmosphere, and increased autonomy for nurses; and, 5) supportive managers reduced nurses’ stress and improved work conditions.

Conclusions

This study showed that nurses positively reshaped their work environment during the COVID-19 pandemic. They contributed to innovative solutions in an environment of equal interprofessional collaboration, which led to greater respect for their knowledge and competencies, enhanced their autonomy and improved management support.