bluuebunny/crossref_metadata_2025 huggingface dataset:
The sleep problems in individuals with Rett syndrome and their caregivers
Authors: Huang Cheng-Hsien , Wong Lee-Chin , Chu Yen-Ju , Hsu Chia-Jui , Wang Hsin-Pei , Tsai Wen-Che , Lee Wang-Tso
Published: June 2024

Sleep problems are prevalent among individuals with Rett syndrome. We aimed to investigate sleep problems in individuals with Rett syndrome and their caregivers. A total of 29 participants diagnosed with Rett syndrome and their respective 29 caregivers were included. The Children Sleep Habits Questionnaire (CSHQ), the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the actigraphy data collected from Actiwatch 2 were used to investigate the change of sleep pattern. Based on the CSHQ questionnaire, 75.9% (22/29) of the patients reported sleep disturbances. The younger patients exhibited higher CSHQ scores. Actigraphy data revealed that both young and older patients had short total sleep duration, low sleep efficiency, long sleep-onset latency, long awaking duration, and fragmented sleep. The caregivers reported significantly higher PSQI scores, mildly declined sleep efficiency, and shorter total sleep duration in the actigraphy study. Associations were identified between smaller head circumference and shorter total sleep duration, more severe motor dysfunction and longer wake after sleep onset, worsen scoliosis and more awakenings per night. Sleep efficiency was inversely associated with epilepsy and positively associated with somatic growth. Sleep disturbances are common and should be investigated in individuals with Rett syndrome and their caregivers.

Lay abstract

Sleep problems are common and impactful among individuals with Rett syndrome (RTT) and their caregivers. We examined the sleep patterns of 29 RTT patients and their primary caregivers using various assessment tools. The study found that a majority of the patients experienced sleep disturbances, with younger patients showing more sleep difficulties. Caregivers also reported poor sleep quality. The findings emphasize the need to address sleep problems in RTT management, as improving sleep quality can positively impact the well-being of individuals with RTT and their caregivers.
Do (too many) elections depress participation? How the position, frequency and nature of domestic ballots affect turnout in European Parliament elections
Authors: Briatte François , Kelbel Camille , Navarro Julien
Published: June 2024

In Europe, the multiplication of elections makes the election calendar a decisive issue given the decreasing participatory trend. Turnout is expected to be higher in simultaneous elections, while it lessens if several elections are held over a short period. The saliency of the preceding ballot may also affect participation in the next one. In this article, we argue that these temporal effects are crucial for European Parliament elections due to their second-order nature. We analyse how the position, frequency and nature of domestic ballots affect European Parliament elections turnout since 1979. Our results indicate that the participation level is less affected by the timing of elections than by their overall frequency. The type of preceding election also matters, although not the second-order nature per se.
Upselling through upgrading: The role of employee engagement
Authors: Yoo Hyunsoo , Cho Jihoon , Kim Youngju , Kim Hye-Jin
Published: June 2024

Although the literature on upselling has investigated different aspects of inducing upselling, there are limited discussions of the effect of past transactions on customers’ acceptance of upsells. Building on the expectation-confirmation and reference dependence theories, this study utilized mixed-effect regression analysis to explore the extent to which customers’ acceptance of upsells changes in response to their prior experience of unexpected gains via free upgrades. The results show that customers accept and spend more on upselling offers when they have experienced a free upgrade in a past transaction and that the effect of the free upgrade on upselling is positively moderated by the level of employee engagement.
Participative rights in Welsh primary schools: Unpicking the policy rhetoric
Authors: Murphy Alison , Roberts Louisa , Williams Jane , Chicken Sarah , Clement Jennifer , Waters-Davies Jane , Tyrie Jacky
Published: June 2024

This paper presents the findings from the initial stage of an Economic and Social Research Council (ESRC) funded project which examines the pedagogic practices that embed young children’s participative rights in lower primary classrooms in Wales. An evaluation of relevant legislation and policy in Wales from 2000 to 2022 was undertaken to explicate the positioning of teachers and their responsibilities regarding children’s participative rights. Data analysis detailed here sets out the legislative and statutory context within which teachers work, as well as the curricular and pedagogic framework which steers classroom activity. The Welsh Government has, for two decades, been explicitly sympathetic to embedding children’s rights in policy development, yet there is limited research evidencing the changes in educational curricula and practice. The gap between policy intention and implementation is not unique to Wales and therefore of universal interest. We report that although there is evidence of the increased inclusion of children’s participative rights in more recent legislation and policy, the move to education about, through and for human rights is only significantly pronounced in recent reforms such as the Curriculum and Assessment (Wales) Act 2021. We advocate that the commitment to human rights education made in the Curriculum for Wales is perpetuated and ongoing critical appraisal of legislation and policy is needed, alongside further research to understand how that commitment is being interpreted in Welsh education settings.
The 3D-Printed Custom Elbow Prosthesis for Salvage Treatment of Complex Intra-Articular Distal Humerus Fracture Malunion
Authors: Pan Tommy , Monahan Kevin T. , Zavras Athan G. , Reynolds Michael J. , Weiser Michael , Hammarstedt Jon E. , Westrick Edward R.
Published: June 2024

Intra-articular fractures of the distal humerus are complex injuries that often require surgery with the goal of restoring elbow range-of-motion and function. Open reduction and internal fixation has been the preferred surgical modality; however, restoration of the medial and/or lateral columns can be complicated in fractures involving a major loss of the articular surface and bony structure. Over the past decade, 3-dimensional (3D) printing has made significant advances in the field of orthopedic surgery, specifically in guiding surgeon preoperative planning. Recently, the incorporation of 3D-printing has proven to provide a safe and reliable construct for the restoration of anatomy in complex trauma cases. We present a 47-year-old woman who sustained a complex, intra-articular distal humerus fracture with associated shearing of the capitellum that went onto malunion. Patient was treated with a patient-specific 3D-printed custom elbow prosthesis with excellent outcomes. Our goal was to shed light on the use of 3D-printing technology as a viable salvage option in treating complex, intra-articular distal humeral fractures associated with lateral condylar damage that subsequently went onto malunion.
Transradial stenting of left subclavian artery origin using shockwave intravascular lithotripsy balloon plasty: Technical report and literature review
Authors: Barkyoumb David , Kharbat Abdurrahman F , Orenday-Barraza José M , Pahuja Mohit , Shakir Hakeem J
Published: June 2024

Lesions of the subclavian artery often involve pathologic stenosis due to high degrees of calcification within the vessel wall. While endovascular angioplasty and stenting is generally the preferred method for obtaining flow reconstitution, calcification of the vessel wall has proven to significantly impair the efficacy of successful stent deployment. Shockwave intravascular lithotripsy (IVL) is a technology that has been very successful in addressing this challenge in other vascular territories, however its use has yet to be approved for supra-aortic vessels such as the subclavian artery. In this report, the use of IVL for a case of subclavian steal syndrome due to a highly stenosed left subclavian artery is described along with a review of the literature. Although several cases utilizing this technology in subclavian arteries have been reported, none have described the use of a left transradial approach. Therefore the purpose of this report is to demonstrate the efficacy of IVL for supra-aortic vessels so that its benefits can be expanded to a broader patient population.
Consumer curiosity: A bibliometric and bibliographic synthesis
Authors: Beck Marie
Published: June 2024

Curiosity is a concept studied particularly in psychology. Today, it is used by practitioners in marketing to support strategies of attractiveness, motivation, or to capture attention. This article proposes a multidisciplinary synthesis of this concept through a bibliometric analysis and a literature review. A conceptual framework is proposed for marketing researchers interested in curiosity, offering a new definition of the concept, its antecedents, and its effects. A research agenda prioritized by practitioners can serve as the basis for future work. Curiosity, traditionally explored in psychology, has found its place in marketing as a means for enhancing appeal, motivation, and attention. This article offers a comprehensive multidisciplinary overview of curiosity by combining bibliometric analysis and literature review. It introduces a new framework for marketing researchers interested in curiosity, presenting a fresh definition, its precursors, and outcomes. It also outlines a research agenda shaped by practitioners to guide future inquiries.
Breaking the disability: Turkish disabled athletes’ self-presentation performances on Instagram
Authors: Öztürk Muammer
Published: June 2024

Despite the abundance of studies exploring athletes’ self-presentation on social media, there is a notable scarcity of research focused on the self-presentation performances of disabled athletes within these digital spaces. This study investigates the self-presentation performances of disabled athletes representing Turkey in international competitions, on Instagram. By employing a netnographic approach, 645 highlighted stories from the Instagram of 5 athletes (female = 3 and male = 2) were subjected to analysis. The findings of the study reveal a distinction: Female athletes tend to emphasize their on-stage performances, whereas male athletes direct attention to their off-stage performances. In their on-stage performances, athletes gravitate toward showcasing posts related to awards earned from competitions. Conversely, in their off-stage performances, they opt to highlight familial and interpersonal relationships. This study has determined that disabled athletes prefer to highlight their on-stage performances on Instagram. This platform functions as a realm of validation for their accomplishments.
Differential gains from news use in Kenya, Nigeria, Ethiopia, and Zimbabwe: Variations in the moderating influence of political talk on engagement
Authors: Adegbola Oluseyi , Aromona Olushola , Elega Adeola Abdulateef
Published: June 2024

A limited but growing body of research has explored the role of media and communication in cultivating engaged citizens in the new and established democracies in Sub-Saharan Africa. Using representative data from the World Values Survey, this study advances the existing research by examining the differential gains model across four countries that differ in terms of democratization, including Kenya, Nigeria, Ethiopia, and Zimbabwe. Findings suggest that the moderating effect of political talk on the association between news use and political engagement likely varies across countries that differ in terms of democratization. Specifically, we find support for the differential gains model across all forms of political engagement in Kenya, limited support in Nigeria and Ethiopia, and no support for the model in Zimbabwe. Implications for theory and suggestions for future inquiry are discussed.
Systems dynamics and causal configurations: Using dynamic pattern synthesis for macroeconomic comparative research
Authors: Alemna David , Haynes Philip
Published: June 2024

Dynamic Pattern Synthesis (DPS) provides a new longitudinal method for evaluating the impacts of macroeconomic and public policy interventions. Situated within complexity theory and critical realism, it has evolved from the established methods of Cluster Analysis and Configurational Modelling approaches. Dynamic Pattern Synthesis identifies case convergence and divergence (using quantitative techniques), while remaining close to the qualitative uniqueness of each case. In this paper, the DPS approach is used to consider macroeconomic convergence across Sub-Saharan Africa during the Millennium Development Goals, and the possible impacts of IMF interventions in stimulating long-term macroeconomic outcomes. The findings reveal a high degree of economic instability experienced across the region and varying responses to an external shock. The importance of ‘outliers’ and inconsistency in country convergence are also observed. The DPS method highlights the importance of individual country experiences in relation to external shocks. When factoring in IMF interventions, the findings highlight multiple paths to a given policy outcome, rather than a single optimal economic strategy. This opens up the debate on policy issues associated with economic complexity, including how best to create an overall environment of stability that might promote convergence and reduce the instability that undermines planning and investment.
Structural Reconfiguration of Firms toward Industrialization in Southeast Asia
Authors: Thai Huy-Cuong Vo , Lo Shihmin
Published: June 2024

Small and Medium Manufacturing Enterprises have emerged to play a crucial part in the context of industrialization and globalization, despite fierce competition and rapid change. However, in the extant studies, what drives Southeast Asia enterprises to reconfigure themselves and how well they cope with external challenges remains to be determined. Therefore, this research investigates structural reconfiguration as dynamic capabilities and conducts an empirical study for small and medium manufacturing firms in Southeast Asia. The World Bank Enterprise Survey, conducted between 2014 and 2016, collected information from 1,184 manufacturing firms used in the research on structural reconfiguration. The hierarchical regression model helps to create prediction equations to test structural reconfiguration as the mediators of organizational efficiency and business environment on firm performance. The findings demonstrate how structural reconfiguration is influenced by organizational efficiency and business obstacles. Furthermore, labor efficiency and competitive obstacles provide the most significant moderating effect on structural reconfiguration through dissolution. Finally, structural recombination has the potential to improve firm performance through direct and indirect impacts.
Remineralization Rate of Lytic Lesions of the Spine in Multiple Myeloma Patients Undergoing Radiation Therapy
Authors: Zijlstra Hester , te Velde Jens P. , Striano Brendan M. , Groot Olivier Q. , de Groot Tom M. , Raje Noopur , Patel Chirayu , Husseini Jad , Delawi Diyar , Kempen Diederik H. R. , Verlaan Jorrit-Jan , Schwab Joseph H.
Published: June 2024

Study Design

Retrospective cohort study.

Objective

In general, Multiple Myeloma (MM) patients are treated with systemic therapy including chemotherapy. Radiation therapy can have an important supportive role in the palliative management of MM-related osteolytic lesions. Our study aims to investigate the degree of radiation-induced remineralization in MM patients to gain a better understanding of its potential impact on bone mineral density and, consequently, fracture prevention. Our primary outcome measure was percent change in bone mineral density measured in Hounsfield Units (Δ% HU) between pre- and post-radiation measurements, compared to non-targeted vertebrae.

Methods

We included 119 patients with MM who underwent radiotherapy of the spine between January 2010 and June 2021 and who had a CT scan of the spine at baseline and between 3-24 months after radiation. A linear mixed effect model tested any differences in remineralization rate per month (βdifference) between targeted and non-targeted vertebrae.

Results

Analyses of CT scans yielded 565 unique vertebrae (366 targeted and 199 non-targeted vertebrae). In both targeted and non-targeted vertebrae, there was an increase in bone density per month (βoverall = .04; P = .002) with the largest effect being between 9-18 months post-radiation. Radiation did not cause a greater increase in bone density per month compared to non-targeted vertebrae (βdifference = .67; P = .118).

Conclusion

Our results demonstrate that following radiation, bone density increased over time for both targeted and non-targeted vertebrae. However, no conclusive evidence was found that targeted vertebrae have a higher remineralization rate than non-targeted vertebrae in patients with MM.
Book review: Gautam Pingali, Indigenous Question, Land Appropriation, and Development: Understanding the Conflict in Jharkhand, India
Authors: Ranjan Alok
Published: June 2024

Gautam Pingali, Indigenous Question, Land Appropriation, and Development: Understanding the Conflict in Jharkhand, India. Routledge, 2023, 162 pp., ₹995 (Hardcover). ISBN: 9781032585246.
The promise of interspecies desegregation: Allying with capybaras against gated communities in Buenos Aires’ wetlands
Authors: Dicenta Mara
Published: June 2024

Nordelta is an exclusive gated community in Buenos Aires built over the wetlands of the Paraná Delta that has encroached on more-than-human bodies and lands through racialized discourses and infrastructures. In this article, I analyze a controversy that arose in 2021 when crowds of capybaras started roaming freely in the community. The event triggered a robust social media response that, I argue, generated popular epistemic tools to enlist capybaras into categories of multispecies endangerment and dispossession. In addition, I delve into the emergence of the communitarian territory of Punta Querandí, which, at the borders of Nordelta, seeks to repair segregation and encroachment for humans and other-than-humans. Drawing on scholarship on animals, race, and the built environment, I employ an ethnographically informed analysis of social media, archival documents, and interviews to explore the two cases as responses to racial capitalism and real extractivism in contemporary Argentina, shedding light into what I term “the promise of interspecies desegregation.”
Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): a mixed-methods systematic review
Authors: Lin Kai , Yao Mi , Ji Xinxin , Li Rouyan , Andrew Lesley , Oosthuizen Jacques , Sim Moira , Chen Yongsong
Published: June 2024

Background

Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence.

Methods

Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist.

Results

A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden.

Conclusions

This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.
Preliminary study on AI-assisted diagnosis of bone remodeling in chronic maxillary sinusitis
Authors: Zou Caiyun , Ji Hongbo , Cui Jie , Qian Bo , Chen Yu-Chen , Zhang Qingxiang , He Shuangba , Sui Yang , Bai Yang , Zhong Yeming , Zhang Xu , Ni Ting , Che Zigang
Published: June 2024

Objective

To construct the deep learning convolution neural network (CNN) model and machine learning support vector machine (SVM) model of bone remodeling of chronic maxillary sinusitis (CMS) based on CT image data to improve the accuracy of image diagnosis.

Methods

Maxillary sinus CT data of 1000 samples in 500 patients from January 2018 to December 2021 in our hospital was collected. The first part is the establishment and testing of chronic maxillary sinusitis detection model by 461 images. The second part is the establishment and testing of the detection model of chronic maxillary sinusitis with bone remodeling by 802 images. The sensitivity, specificity and accuracy and area under the curve (AUC) value of the test set were recorded, respectively.

Results

Preliminary application results of CT based AI in the diagnosis of chronic maxillary sinusitis and bone remodeling. The sensitivity, specificity and accuracy of the test set of 93 samples of CMS, were 0.9796, 0.8636 and 0.9247, respectively. Simultaneously, the value of AUC was 0.94. And the sensitivity, specificity and accuracy of the test set of 161 samples of CMS with bone remodeling were 0.7353, 0.9685 and 0.9193, respectively. Simultaneously, the value of AUC was 0.89.

Conclusion

It is feasible to use artificial intelligence research methods such as deep learning and machine learning to automatically identify CMS and bone remodeling in MSCT images of paranasal sinuses, which is helpful to standardize imaging diagnosis and meet the needs of clinical application.
Psychiatrists’ perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation
Authors: Schwarz Julian , Hoetger Cosima , Pluschke Lena-Sophie , Muehlensiepen Felix , Schneider Michael , Thoma Samuel , Esch Tobias
Published: June 2024

Objective

In a growing list of countries, patients are granted access to their clinical notes (“open notes”) as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians’ notes. More research is needed to optimize the benefits and mitigate the risks.

Methods

Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis.

Results

We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts.

Conclusion

Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
Does dynamic navigation system preserve more dentine? – A systematic review
Authors: Langaliya Akshayraj , Kritika Selvakumar , Shah Aarshvi , Shah Jinali , Mahalaxmi Sekar
Published: June 2024

Objective

This systematic review aims to comparatively analyse the amount of dentin removal by free hand and static guided endodontics with dynamic navigation system (DNS) in endodontic access cavity preparation.

Methods

The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Based on the structured PICO framework of “Comparative evaluation of dynamic navigation system (I) to freehand (C) and static guided endodontics (C) in endodontic access cavity preparation on the preservation of tooth structure (O) when assessed on permanent human teeth (P)”, the keywords were formulated and the articles were retrieved from three databases namely PubMed, Scopus and Embase, based on the keywords from the time of inception of DNS till June 2023. The risk of bias assessment was done using a modified Joanne Briggs Institute checklist, which evaluated domains such as randomisation, sample size, image acquisition using CBCT, angulation, accuracy and time taken. As the data was heterogenous, a quantitative meta-analysis was not performed.

Results

Initially, 174 articles were retrieved from the three databases, 30 duplicates were removed, after title check 108 articles were excluded and following abstract check only 10 articles qualified for full text analysis. On reviewing the 10 full text articles, 5 articles were excluded and the remaining 5 articles were subjected to the risk of bias analysis which showed that 2 articles displayed low risk of bias and three articles showed high risk of bias. The RoB analysis revealed that only 2 studies evaluated the preservation of dentin in terms of accuracy, angulation and time taken proving the increased precision with minimal loss of tooth structure using DNS. In both the studies, DNS proved to be superior to free hand technique in terms of precision, accuracy and efficiency in locating the canals during access cavity preparation with maximal preservation of tooth structure.

Conclusion

With the minimal literature evidences, the present systematic review highlights maximal preservation of dentin using DNS. However, further invitro and invivo studies comparing the free hand, static guided endodontics to DNS must be carried out for its translation into clinical practice. Clinical Significance: Dynamic navigation system provides maximal preservation of dentin during access cavity preparation.
Ethical regulation of biomedical research in Brazil: a quality improvement initiative
Authors: de Castro Daniel Ribeiro Paes , Castillo Camilo Hernan Manchola , Ferreira João Paulo Dias , Oliveira João Paulo Alves , Kirsten Tassila Fernandes , de França Paulo Henrique Condeixa , Zavalhia Lisiane Silveira , Notti Regina Kuhmmer , Kochhann Renata , Amantéa Sérgio Luís
Published: June 2024

Background

Q-CEP (Qualificação dos Comitês de Ética em Pesquisa que compõem o Sistema CEP/Conep) is a nationwide project resulting from a partnership between the Brazilian National Research Ethics Commission (Conep), the Ministry of Health and Hospital Moinhos de Vento (HMV). It was developed to consolidate policy for ethical review of research with human beings in all members of the CEP/Conep System, Brazil’s national system of institutional review boards. The aim of this study was therefore to report on the experience and results of the Q-CEP project.

Methods

An observational, retrospective study includes data from the Q-CEP, obtained from visits to all the institutional research ethics committees (RECs) in the country. The actions implemented by Q-CEP were part of a two-step process: (i) training visits to each REC; (ii) development of distance learning modules on strategic topics pertaining to research ethics evaluation. The data presented herein cover step one (training visits), defined by Q-CEP as the diagnostic stage of the project. For a country with social and economics inequalities such as Brazil, this is a particularly important stage; an accurate picture of reality is needed to inform planning of quality improvement strategies.

Results

In 2019–2021, Q-CEP visited 832 RECs and trained 11,197 people. This sample covered almost all active RECs in the country; only 4 (0.5%) were not evaluated. Of the 94 items evaluated, 62% did not reach the target of at least 80% compliance and around 1/4 (26%) were below 50% compliance. The diagnostic stage of the process revealed inadequacies on the part of the RECs in their ethical reviews. The analysis of informed consent forms showed compliance in only 131 RECs (15.74%). The description of pending issues made by RECs in their reports was compliant in 19.33% (n = 161). Administrative and operational aspects were also considered inadequate by more than half of the RECs.

Conclusions

Overall, Brazilian RECs showed poor compliance in several aspects of their operation, both in ethics evaluation and in other processes, which justifies additional training. The Q-CEP project is part of a quality improvement policy promoted by the Brazilian Ministry of Health. The data obtained in the diagnostic step of the project have contributed to the qualification and consolidation of one of the world’s largest research ethics evaluation systems.
Impact of health spending on hospitalization rates in Baltic countries: a comparative analysis
Authors: Jiang Huan , Tran Alexander , Gobiņa Inese , Petkevičienė Janina , Reile Rainer , Štelemėkas Mindaugas , Radisauskas Ricardas , Lange Shannon , Rehm Jürgen
Published: June 2024

Introduction

This study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020.

Method

We used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status—i.e., gross domestic product (GDP) per capita.

Results

Our findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models.

Conclusions

The relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts.
The role of body mass index in high- and low-velocity trauma causing knee injury associated with popliteal artery lesions
Authors: Ascoli Marchetti Andrea , Naldi Valerio , Potenza Vito , Oddi Fabio Massimo , De Maio Fernando , Ciattaglia Riccardo , Fazzini Stefano , Battistini Martina , Farsetti Pasquale , Ippoliti Arnaldo
Published: June 2024

Background

Among arterial traumas, osteoarticular traumas are particularly dangerous, and those involving the popliteal artery are associated with a high amputation rate. Despite representing a minority of arterial traumas, with an incidence that varies considerably by population and geographic location, traumatic lesions of the popliteal artery are challenging. This study aimed to verify the impact of body mass index (BMI) on arterial trauma damage and patient outcomes.

Methods

Data were retrospectively collected from the electronic medical reports of all patients with osteoarticular and vascular associated lesions treated in the emergency operating room at our institution between 1 January 2005 and 1 May 2022. Forty-one patients presented with lower limb arterial trauma (43.2%); popliteal artery lesions occurred in 11 of these patients (26.8%), who were eligible for inclusion in the study. The lesion mechanism was dislocation by high-velocity trauma in 9 patients and dislocation by low-velocity trauma in 3 patients. All 7 males (63.6%) experienced high-velocity trauma, and 2 of the 3 females experienced low-velocity trauma. Only one patient had an isolated popliteal artery lesion associated with fractures in the leg or the contralateral limb. Patients with low-velocity trauma were older than 54 years, while those with high-velocity trauma were aged 22 to 71 years.

Results

In 10/11 patients (90.9%), revascularization was performed after osteoarticular stabilization and reduction of the dislocation or fracture. Intraoperative angiography was selectively used. Two patients required above-the-knee amputation after the procedure: one due to infection of the surgical access point and the other due to severe soft tissue injury. One patient died during hospitalization due to trauma-related complications and comorbidities.

Conclusions

High-velocity trauma and low-velocity trauma in patients with a body mass index > 35 kg/m2 and knee lesions are associated with popliteal artery lesions. Revascularization success is not associated with high- or low-velocity trauma.
Comparison of operatively and nonoperatively treated isolated Weber B ankle fractures: a systematic review and meta-analysis
Authors: Tian Jinhui , Miao Jie , Jiang Zhongchao , Li Zhiyuan
Published: June 2024

Background

Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures.

Methods

This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate.

Result

Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%).

Conclusion
Primary glomus tumor of the thymus in a 66-year-old patient
Authors: Zang Yibing , Zhao Ruixing , Ma Chengquan , Gao Dejun
Published: June 2024

We report a unique case of a 66-year-old man who was incidentally identified to have a mass in the thymus region by computerized tomography scan. CT revealed a well-defined 1.6 × 1 × 0.9 cm thymus mass with moderate uniform enhancement. Thoracoscopic thymectomy was performed, and the pathological diagnosis was primary glomus tumor of the thymus. There were no atypia or malignant histological features, and no primary tumors in other sites. To our knowledge, this is the first case of primary thymic glomus tumor reported in the literature.
The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of Chinese population
Authors: Li Kun , Yang Longyan , Zhao Dong
Published: June 2024

Background

This study aims to comprehensively explain of glycosylated Hemoglobin (HbA1c) control patterns and help determine the causal relationship between glycemic control patterns and atherosclerosis progression, thereby contributing to the effective management of diabetes complications.

Method

All participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital. The HbA1c pattern was described by HbA1c variability and trajectory groups of HbA1c. Then we examined the associations between the HbA1c pattern and the changes of intima-media thickness (ΔIMT) using covariate-adjusted means (SE) of ΔIMT, which were calculated by multiple linear regression analyses adjusted for the covariates. Finally, a cross-lagged panel model (CLPM) was performed to further verify the bidirectional relationship between IMT and HbA1c.

Results

After data cleaning, a total of 1041 type 2 diabetes patients aged 20–80 years were included in this study. Except for average real variability (ARV), the other variation variables of HbA1c were associated with ΔIMT% (P < 0.05). Four discrete trajectories of HbA1c were identified in trajectory analysis. Comparing with the low-stable trajectory group of HbA1c, the covariate-adjusted means (SE) of ΔIMT% were significantly higher in Moderate-increase, U-shape and relative high trajectory groups, the mean (SE) were 7.03 (0.031), 15.49 (0.185), 14.15 (0.029), respectively. Meanwhile, there were significant bidirectional cross-lagged associations between HbA1c and IMT after adjusting for covariates.

Conclusion

We found four discrete trajectory groups of HbA1c during the long-term follow-up of diabetes. There was a positive association between HbA1c variability and the progression of atherosclerosis. Our study suggested that patients with diabetes should avoid roller coaster changes in glucose over a long period when controlling blood glucose.
The role of increased post-impact ball speed on plantar pressure during open and square stance groundstrokes in female tennis players
Authors: Lambrich Johanna , Muehlbauer Thomas
Published: June 2024

Background

It is firmly established that achieving a high ball speed during the execution of groundstrokes represents a relevant factor for success in tennis. However, little is known about how plantar pressure changes as post-impact ball speed is increased during open and square stance groundstrokes. The objective of the study was to determine how tennis players change the plantar pressure in each foot when they execute open versus square stance forehand groundstrokes in order to increase post-impact ball speed.

Methods

Fifteen healthy female tennis players with ITN 2 or better (mean age: 22.7 ± 7.8 years) participated in this study. The players performed open and square stance longline forehand groundstrokes (topspin) at the following four post-impact ball speed levels: 80 km/h, 90 km/h, 100 km/h, and vmax. Flexible pressure-detecting insoles were used to measure plantar pressure in each foot [i.e., dominant (equals the stroke arm) and nondominant].

Results

The repeated measures ANOVA showed significant stance style × foot dominance interactions and post-hoc analyses revealed larger maximal and mean forces during open compared to square stance for the dominant but not non-dominant foot. Further, the ball speed × stance style × foot dominance interaction reached the level of significance and post-hoc analyses showed increased/decreased mean forces in the dominant/non-dominant foot during the square but not open stance when players increased their post-impact ball speed.

Conclusion

Larger values in the open stance, but post-impact ball speed-adjusted values in square stance indicate different advantages in both styles, suggesting their situation-specific application.
Evaluation of alcohol use behavior among patients cured through HCV elimination program in Georgia
Authors: Butsashvili Maia , Gulbiani Lasha , Kanchelashvili Giorgi , Kamkamidze Tina , Kajaia Maia , Gudavadze Salome , Kamkamidze George
Published: June 2024

Objective

The objective of the study was to understand the role of self-reported drinking behavior on liver health after achieving sustained viral response (SVR) among HCV patients.

Results

The study was conducted in HCV treatment provider clinics in three cities in Georgia: Tbilisi, Batumi, and Telavi. Face-to-face interviews were conducted using a questionnaire developed specifically for this study. 9.5% considered themselves heavy drinkers, while 94.2% were aware that heavy alcohol consumption can progress liver fibrosis. During treatment, 97.8% abstained from alcohol, while 76.6% reported resuming drinking after achieving SVR. Additionally, 52.1% believed that moderate alcohol intake is normal for individuals with low fibrosis scores. Liver fibrosis improvement was more prevalent among individuals who abstained from alcohol after HCV diagnosis (85.4% vs. 71.4%, p < 0.01) and after achieving SVR (87.5% vs. 74.7% of those who resumed drinking after achieving SVR, p < 0.02). In conclusion, the majority of HCV patients abstain from alcohol during treatment but resume drinking after achieving SVR. Those who abstain from alcohol intake after HCV cure have a higher chance of liver fibrosis improvement.
Treatment of primary epididymal adenocarcinoma: a case report and review of the literature
Authors: Xiao Jianhua , You Yan , Dong Ziqiang , Wu Qi , Yuan Honggang
Published: June 2024

Background

Epididymal tumors, especially malignant tumors, have low incidence and are rare in our clinical work. However, they may progress quickly and have poor prognosis. For such rare clinical cases with extremely low incidence rates, and as they are prone to misdiagnosis and missed diagnosis and have a very poor prognosis, clinical workers need to pay special attention and consider the possibility of primary epididymal malignant tumors.

Case report

A 63-year-old Chinese male patient from Asia was admitted due to scrotal pain. Upon examination, an abnormal lesion was found in the right epididymal region. After thorough evaluation, surgical resection was performed, and the postoperative pathological result confirmed the presence of epididymal adenocarcinoma. After further ruling out secondary lesions, primary epididymal adenocarcinoma was considered. Right retroperitoneal lymph node dissection was performed under laparoscopic for treatment, and 1/11 lymph node metastasis was detected after surgery. The patient is currently under close follow-up.

Conclusions

The number of clinical cases of primary epididymal malignant tumors is very limited, there is currently no standardized diagnosis and treatment process, and there is a lack of systematic evaluation methods regarding the effectiveness of different treatment options such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy. In addition, the outcome is difficult to predict. In this article, we reviewed relevant literature and systematically elaborated on the diagnosis and treatment of epididymal malignant tumors, hoping to provide useful information for relevant experts.
Exploration of tissue fixation methods suitable for digital pathological studies of the testis
Authors: Tian Pengxiang , Yang Zhan , Qu Changbao , Qi Xin , Zhu Linlin , Hao Guimin , Zhang Yong
Published: June 2024

Background

The way of testicular tissue fixation directly affects the correlation and structural integrity between connective tissue and seminiferous tubules, which is essential for the study of male reproductive development. This study aimed to find the optimal fixative and fixation time to produce high-quality testicular histopathological sections, and provided a suitable foundation for in-depth study of male reproductive development with digital pathology technology.

Methods

Testes were removed from both sides of 25 male C57BL/6 mice. Samples were fixed in three different fixatives, 10% neutral buffered formalin (10% NBF), modified Davidson’s fluid (mDF), and Bouin’s Fluid (BF), for 8, 12, and 24 h, respectively. Hematoxylin and eosin (H&E) staining, periodic acid Schiff-hematoxylin (PAS-h) staining, and immunohistochemistry (IHC) were used to evaluate the testicle morphology, staging of mouse seminiferous tubules, and protein preservation. Aperio ScanScope CS2 panoramic scanning was used to perform quantitative analyses.

Results

H&E staining showed 10% NBF resulted in an approximately 15–17% reduction in the thickness of seminiferous epithelium. BF and mDF provided excellent results when staining acrosomes with PAS-h. IHC staining of synaptonemal complexes 3 (Sycp3) was superior in mDF compared to BF-fixed samples. Fixation in mDF and BF improved testis tissue morphology compared to 10% NBF.

Conclusions

Quantitative analysis showed that BF exhibited a very low IHC staining efficiency and revealed that mouse testes fixed for 12 h with mDF, exhibited morphological details, excellent efficiency of PAS-h staining for seminiferous tubule staging, and IHC results. In addition, the morphological damage of testis was prolonged with the duration of fixation time.