bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of abnormal liver function tests and associated factors among COVID-19-infected patients in Addis Ababa, Ethiopia, 2022: a facility-based comparative cross-sectional study
Authors: Mekuanint Amare , Ambachew Sintayehu , Worede Abebaw , Asrie Fikir , Sinishaw Mulusew Alemneh , Gelaw Yemataw , Dagnew Mulat , Gelaw Aschalew , Negash Markos , Kassa Eyuel , Bizuneh Segenet , Wudineh Dessalew , Dimah Belayneh , Abebe Wagaw , Chane Elias , Fetene Getnet
Published: September 2024

Objective

Liver function test (LFT) abnormalities are higher in patients with severe COVID-19. Most of the studies on this theme were conducted in foreign nations, and the association with LFT abnormalities was not sufficiently addressed in the study areas. Therefore, the current study aimed to investigate the effects of COVID-19 infection on liver function of patients.

Setting

A facility-based comparative cross-sectional study was carried out from 10 April to 15 June 2022, among COVID-19 infected individuals admitted in Eka Kotebe General Hospital and Saint Petrous Specialized Hospitals, Addis Ababa, 2022.

Participants

A total of 284 confirmed COVID-19-positive and COVID-19-negative controls matched by gender and age were included in the present study.

Results

Among SARS-COV-2 positive groups, 63 (44.4%) had one or more LFT abnormalities. The most common elevated level of the LFTs among patients with COVID-19 were gamma-glutamyl transferase (GGT) 50 (35.2%), while the most common lowered level was albumin 58 (40.8%). The mean values of aspartate aminotransferase (AST) (35.4±26.9 vs 22.9±12.6, p<0.001) were significantly different between patients with COVID-19 and the COVID-19-free groups. Being COVID-19-positive was significantly associated with an elevated level of AST (AOR=3.0, 95% CI 1.2 to 7.4) and GGT (AOR=4.55, 95% CI 2.02 to 10.3). Being male was significantly associated with an elevated level of total bilirubin (BILT, AOR=2.41, 95% CI 1.2 to 4.9) and direct bilirubin (BILD, AOR=3.7, 95% CI 1.72 to 8.2), and also severe stage of COVID-19 was associated with hypoalbuminaemia (AOR=3.3, 95% CI 1.4 to 7.9). SARS-COV-2 infection was independently associated with LFT abnormality.

Conclusion

Patients with COVID-19 had decreased albumin levels, and elevated AST, GGT, BILT and BILD levels.
Effect of ketogenic diets on lipid metabolism in adults: protocol for a systematic review
Authors: Hilary Serene , Östlundh Linda , Platat Carine , Al-Rifai Rami H , Almehairbi Osha , Alshamsi Fayeza , Ali Habiba I , Al Dhaheri Ayesha S , Cheikh Ismail Leila , Stojanovska Lily
Published: September 2024

Introduction

The ketogenic diet is a very low carbohydrate diet known for its ability to reduce weight and counteract hyperglycaemia. However, ketogenic diets recommend an increased intake of fats, raising concerns about cardiometabolic risk in adults. Due to the higher intake of fats in the ketogenic diet, there is significant variability in outcomes of lipid metabolism in the population. Interventions have reported improvements in lipid profile while other studies did not find changes, and there are reports of increased low density lipoprotein (LDL) and triglyceride values. Hence, this is a protocol for a systematic review of the published literature and a summary of the effect of ketogenic diets on lipid metabolism in adults.

Methods and analysis

Five databases (PubMed, Embase, Scopus, Cochrane Library and Web of Science) will be searched for studies on ketogenic diets in adult populations. Studies will be included if they report results from ketogenic diet interventions among adults. Exclusion is populations with diagnosed neurological disorders. Two reviewers will independently screen retrieved citations, extract data and appraise the risk of bias. Quantitative estimates (eg, standardised mean difference) measuring the change in the total cholesterol, LDL and triglyceride concentration will be pooled using random effects meta-analysis to produce one summarised weighted estimate. Sources of heterogeneity will be explored using subgroup analysis. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols (PRISMA), and the final review will be reported following the PRISMA 2020 guidelines.

Ethics and dissemination

The present protocol and the systematic review to be carried out do not require ethics clearance. The data source will be published studies. This review will provide estimates to inform the public about the effect of ketogenic diets on lipid metabolism and the possible peril of increasing cardiometabolic risk. The results will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42022309665.
Examining attitudes to uptake and sustainment of technology among care aides in the delivery of care: a scoping review protocol
Authors: Omotunde Muyibat , Hunter Kathleen , Wagg Adrian
Published: September 2024

Introduction

Care aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides’ attitudes may either facilitate or hinder the adoption of healthcare technologies is lacking.

The aim of the proposed scoping review is to examine available evidence regarding care aides’ attitudes towards the adoption of innovation and factors that may influence the sustainable use of technology in healthcare delivery. Published studies, grey literature and review articles that identify a method for the review, conference abstracts and website publications regarding the attitude, uptake and sustainable use of technology in care delivery by care aides will be included. For abstracts that have resulted in publications, the full publications will be included. The search for evidence commenced in June 2023 and will end in March 2024.

Methods and analysis

The Joanna Briggs Institute (JBI) method will be used to conduct the review. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years to examine trends in health technology and attitudes of care aides towards innovation over the last two decades. A search of grey literature and websites will be conducted. The reference list of the retrieved articles will be used to identify additional literature. The search results will be exported into a literature management tool for screening and analysis. Article screening will be performed by two authors and if a third is needed to resolve any differences. Data analysis will be guided by two theoretical frameworks.

Ethics and dissemination

No ethics approval is required. The findings will be disseminated in a peer-reviewed journal and presented in conferences.

Registration details

https://doi.org/10.17605/OSF.IO/CZQUP
Arterial stiffness after 6 weeks postdelivery in women with a history of hypertensive disorders of pregnancy: a systematic review protocol
Authors: Mbongozi Xolani , Galloway Stuart , Hunter Angus , Businge Charles Bitamazire
Published: September 2024

Introduction

Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal morbidity and mortality. The risk of developing cardiovascular diseases following HDP is high. Arterial stiffness is a prognostic indicator for cardiovascular disease in the general population, and it is elevated during pregnancy in women with HDP. No systematic reviews have been conducted to determine if arterial stiffness remains elevated beyond puerperium in these women with HDP.

Methods and analysis

We will conduct a systematic literature search in the following electronic databases: Medline, PubMed, Embase, Cochrane Library, Google Scholar, Web of Science and CINAHL. The review will consider studies that investigate arterial stiffness in women who had HPD and are between 43 days and 10 years postdelivery and under 60 years of age. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. Estimates of mean ± SD for arterial stiffness indices (cfPWV, AIx and AIx@75) for the women in the included studies will be obtained. For studies where the estimates were reported as the median and IQR, approximate estimates of mean ± SD will be calculated by using the low and high end of the range, median and sample size. Data from the individual studies will be pooled by use of a random-effects model. The risk of bias assessment will be assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Quality Assessment Scale as appropriate. Sources of heterogeneity will be explored by sensitivity and subgroup analyses.

Ethics and dissemination

No ethics approval is required as only published data will be used in this study. The research study’s outcomes will be shared through scientific conferences and peer-reviewed publications.

PROSPERO registration number

CRD42023461867.
Establishing national hospital costing systems: insights from the qualitative assessment of cost surveillance pilot in Indian hospitals
Authors: Chugh Yashika , Sharma Shuchita , Guinness Lorna , Sharma Deepshikha , Garg Basant , Mehndiratta Abha , Prinja Shankar
Published: September 2024

Objective

The Indian Government launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), the world’s largest health insurance scheme, in 2018. To reform pricing and gather evidence on healthcare costs, a hospital cost-surveillance pilot was initiated among PM-JAY empanelled hospitals. We analysed the process and challenges from both healthcare providers and payer agency’s perspectives and offer recommendations for implementing similar systems in lower- and middle-income countries.

Design

We employed an open-ended, descriptive and qualitative study design using in-depth interviews (IDI) as the data collection strategy.

Settings

The interviews were conducted in both virtual and face-to-face modes depending on the convenience of the participants. The IDIs for the National Health Authority (NHA) officials and all providers in Kerala were conducted virtually, while face-to-face interviews were conducted and in Haryana and Chhattisgarh.

Participants

Staff from 21 hospitals in three states (Haryana, Chhattisgarh and Kerala), including officials from State Health Agency (n=5) and NHA (n=3) were interviewed.

Results

The findings highlight significant challenges in reporting cost data at the hospital level. These include a shortage of trained staff, leading to difficulties in collecting comprehensive and high-quality data. Additionally, the data collection process is resource-intensive and time-consuming, putting strain on limited capacity. Operational issues with transaction management system, such as speed, user-friendliness and frequent page expirations, also pose obstacles. Finally, current patient records data has gaps, in terms of quantity and quality, to be directly put to use for pricing.

Conclusion

Accurate cost data is vital for health policy decisions. Capacity building across healthcare levels is needed for precise cost collection. Integration into digital infrastructure is key to avoid burdening providers and ensure quality data capture.
Development of a core outcome set of clinical research on the integration of traditional Chinese and Western medicine for spinal metastases:a study protocol
Authors: Fang Guozheng , Yu Wenlong , Chen Dingbang , Ding Xing , Qiao Liang , Zhang Luosheng , Gao Xin , Yan Yinjie , Huang Quan , Ma Junming , Yin Mengchen
Published: September 2024

Background

In recent years, the incidence of spinal metastasis (SM) has been increasing steadily. In response to this serious public health problem, researchers have made progress by using the integration of traditional Chinese and Western medicine. However, considerable heterogeneity in the definition and measurement of outcomes across clinical research studies, along with the lack of uniform measurement standards for study data, makes it difficult for researchers to compare different treatments. Therefore, it is crucial to accurately evaluate clinical research on the integration of traditional Chinese and Western medicine for SM.

Methods

This study protocol outlines a comprehensive research programme based on the Core Outcome Set Standards Protocol Items. The study consists of four phases: a literature review, semistructured interviews, a two-round modified Delphi survey, a consensus meeting. Phase 1 involves a comprehensive literature review to extract outcomes used in current clinical studies of integrated traditional Chinese and Western medicine or Western medicine for the treatment of SM. A semistructured interview format will be used to survey patients and caregivers in phase 2 to collect suggestions from the patient perspective. Phase 3 involves a two-round modified Delphi survey to complete a prioritisation evaluation of outcomes to generate a candidate list for core outcome set (COS). Finally, phase 4 involves a face-to-face consensus meeting to review and establish the COS.

Ethics and dissemination

Conducted in response to the current dilemma of SM, the study was endorsed by the Spine Oncology Group of the Orthopaedic Surgeons Branch of the Chinese Physicians’ Association. It will be developed and reported through a rigorous process, with the results of the study to be published in a peer-reviewed journal.

Registration:COMET Registry: COMET 2938;https://www.comet-initiative.org/Studies/Details/2938.
Development of an interprofessional diagnostic toolkit to enhance outside walking gait-related participation of people after stroke in Germany: study protocol of an ongoing multi-methods study
Authors: Pott Claudia , Dreischulte Tobias , Koller Daniela , Fegl Marlene , Langemeyer Jürgen , Bauer Petra
Published: September 2024

Introduction

Persons after stroke experience limitations in activities of daily living even in the chronic phase. Many patients who had a stroke report mobility limitations with loss of social roles such as reduced gait-related participation. International best-practice recommendations for patients who had a stroke include interprofessional diagnostics as a core element for goal setting and intervention planning to improve social participation. Interprofessional diagnostics has not yet been implemented in Germany.

Methods and analysis

The aim is to develop an interprofessional diagnostic toolkit. This will be done in a multi-step process: first, an integrative review is conducted to synthesise the literature. Second, the experiences regarding diagnostics and walking outside is captured in focus groups with persons after stroke, relatives and health professionals. Third, a toolkit for the interprofessional diagnostic process of gait-related-participation will be developed based on the results of the previous steps in a future workshop. Fourth, the results of each work package will be integrated into the iterative development process for evaluation and implementation. All steps will be performed in accordance with the respective reporting guidelines.

Ethics and dissemination

This study has been approved by the ethics committee at the Ludwig Maximilians University (LMU), Germany and is overseen by LMU-Medical Institutional Review Board. Written informed consent will be obtained from all participants. Results will be disseminated through knowledge exchange with stakeholders and in peer-reviewed journal publications, scientific conferences, formal and informal reports. Stakeholders, patients and providers will be involved in most steps of the development from the beginning, which will facilitate later implementation at a larger scale.

Trial registration number

German Register Clinical Trials/Deutsches Register Klinischer Studien DRKS00032389.
Barriers and facilitators to implementing imaging-based diagnostic artificial intelligence-assisted decision-making software in hospitals in China: a qualitative study using the updated Consolidated Framework for Implementation Research
Authors: Liao Xiwen , Yao Chen , Jin Feifei , Zhang Jun , Liu Larry
Published: September 2024

Objectives

To identify the barriers and facilitators to the successful implementation of imaging-based diagnostic artificial intelligence (AI)-assisted decision-making software in China, using the updated Consolidated Framework for Implementation Research (CFIR) as a theoretical basis to develop strategies that promote effective implementation.

Design

This qualitative study involved semistructured interviews with key stakeholders from both clinical settings and industry. Interview guide development, coding, analysis and reporting of findings were thoroughly informed by the updated CFIR.

Setting

Four healthcare institutions in Beijing and Shanghai and two vendors of AI-assisted decision-making software for lung nodules detection and diabetic retinopathy screening were selected based on purposive sampling.

Participants

A total of 23 healthcare practitioners, 6 hospital informatics specialists, 4 hospital administrators and 7 vendors of the selected AI-assisted decision-making software were included in the study.

Results

Within the 5 CFIR domains, 10 constructs were identified as barriers, 8 as facilitators and 3 as both barriers and facilitators. Major barriers included unsatisfactory clinical performance (Innovation); lack of collaborative network between primary and tertiary hospitals, lack of information security measures and certification (outer setting); suboptimal data quality, misalignment between software functions and goals of healthcare institutions (inner setting); unmet clinical needs (individuals). Key facilitators were strong empirical evidence of effectiveness, improved clinical efficiency (innovation); national guidelines related to AI, deployment of AI software in peer hospitals (outer setting); integration of AI software into existing hospital systems (inner setting) and involvement of clinicians (implementation process).

Conclusions

The study findings contributed to the ongoing exploration of AI integration in healthcare from the perspective of China, emphasising the need for a comprehensive approach considering both innovation-specific factors and the broader organisational and contextual dynamics. As China and other developing countries continue to advance in adopting AI technologies, the derived insights could further inform healthcare practitioners, industry stakeholders and policy-makers, guiding policies and practices that promote the successful implementation of imaging-based diagnostic AI-assisted decision-making software in healthcare for optimal patient care.
Data collection methods for patient-reported outcome measures in cancer randomised controlled trials: a protocol for a rapid scoping review
Authors: Lehmann Jens , Krepper Daniela , Pe Madeline , Kuliś Dagmara , Giesinger Johannes M , Sztankay Monika , Kern Scottie , Fitzsimmons Deborah , Holzner Bernhard
Published: September 2024

Background

There are different modes and ways to assess patient-reported outcomes (PROs) in clinical trials. However, there is little systematic information on how often different modes of assessment (MOA) are used in cancer clinical trials and how exactly assessments are conducted. The goal of this scoping review is to gain an understanding of the MOA and data management of PROs in cancer randomised controlled trials (RCTs) and the reporting quality thereof.

Methods and analysis

This scoping review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant trials will be identified via their indexed publications. We will search PubMed for RCTs conducted in cancer populations that evaluate a biomedical treatment with a PRO endpoint. Trials with publications published between January 2019 and November 2023 will be included. Two independent reviewers will review the references for both the abstract and full-text screening. We will extract data from the publications from a trial and the trial protocol if a protocol can be traced. Data will be summarised at the trial level. We will focus on a descriptive analysis of the MOA of PROs and on the relative frequencies of the different MOA. We will also evaluate the quality of reporting for the relevant SPIRIT and CONSORT guidelines that refer to the assessment of PROs in trials. Due to the scoping nature of our review, we will not perform a dedicated quality assessment of all trials.

Ethics and dissemination

The proposed review is based on secondary, published data. Hence, no ethics review is necessary. The review is part of an ongoing project on the use of electronic data capture methods in cancer clinical trials. The findings from the review will support the project and contribute to synthesising guidance to ultimately improve the (electronic) measurement of patient-reported outcome measures in clinical trials.
Regional wall motion abnormalities on focused transthoracic echocardiography in patients presenting with acute chest pain: a predefined post hoc analysis of the prospective single-centre observational EPIC-ACS study
Authors: Roggel Anja , Jehn Stefanie , Dykun Iryna , Balcer Bastian , Al-Rashid Fadi , Totzeck Matthias , Risse Joachim , Kill Clemens , Rassaf Tienush , Mahabadi Amir
Published: September 2024

Objectives

We evaluated the ability of the assessment of regional wall motion abnormalities (RWMA) detected via transthoracic echocardiography to predict the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department.

Design

Prospective single-centre observational study.

Setting

Tertiary care university hospital emergency unit.

Participants

Patients presenting to the emergency department with acute chest pain suggestive of obstructive CAD.

Primary outcome measure

The primary endpoint was defined as the presence of obstructive CAD, requiring revascularisation therapy.

Results

Overall, 657 patients (age 58.1±18.0 years, 53% men) were included in our study. RWMA were detected in 76 patients (11.6%). RWMA were significantly more frequent in patients reaching the primary endpoint (26.2% vs 7.6%, p<0.001). In multivariable regression analysis, the presence of RWMA was associated with threefold increased odds of the presence of obstructive CAD (3.41 (95% CI 1.99 to 5.86), p<0.001). Adding RWMA to a multivariable model of the Thrombolysis in Myocardial Infarction (TIMI) risk score, cardiac biomarkers and traditional risk factors significantly improved the area under the curve for prediction of obstructive CAD (95% CI 0.777 to 0.804, p=0.0092).

Conclusion

RWMA strongly and independently predicts the presence of obstructive CAD in patients presenting with acute chest pain to the emergency department.

Trial registration

The study has been registered online (NCT03787797).
Spatiotemporal patterns and socioeconomic determinants of pulmonary tuberculosis in Dongguan city, China, during 2011–2020: an ecological study
Authors: Zhang Jingfeng , Zhong Minghao , Huang Jiayin , Deng Wenjun , Li Pingyuan , Yao ZhenJiang , Ye Xiaohua , Zhong Xinguang
Published: September 2024

Objective

Pulmonary tuberculosis (PTB) is a critical challenge worldwide, particularly in China. This study aimed to explore the spatiotemporal transmission patterns and socioeconomic factors of PTB in Dongguan city, China.

Methods/design

An ecological study based on the reported new PTB cases between 2011 and 2020 was conducted in Dongguan city, China. The spatiotemporal analysis methods were used to explore the long-term trend, spatiotemporal transmission pattern and socioeconomic factors of PTB.

Main outcome measures

The number of new PTB cases.

Participants

We collected 35 756 new PTB cases, including 23 572 males and 12 184 females.

Results

The seasonal–trend decomposition indicated a significant downward trend for PTB with a significant peak in 2017 and 2018, and local spatial autocorrelation showed more and more high–high clusters in the central and north-central towns with high incidence. The multivariate spatial time series analysis revealed that the endemic component had a leading role in driving PTB transmission, with a high total effect value being 189.40 (95% CI: 171.65–207.15). A Bayesian spatiotemporal model revealed that PTB incidence is positively associated with the agricultural population ratio (relative risk (RR) =1.074), gender ratio (RR=1.104) and the number of beds in medical institutions (RR=1.028).

Conclusions

These findings revealed potential spatiotemporal variability and spatial aggregation of PTB, so targeted preventive strategies should be made in different towns based on spatiotemporal transmission patterns and risk factors.
Assessing the effect of anthocyanins through diet and supplementation on cognitive function in older adults at risk for dementia: protocol for a randomised controlled trial
Authors: do Rosario Vinicius , Lorzadeh Elnaz , Brodaty Henry , Anstey Kaarin J , Chan Karina , Roodenrys Steven , Kent Katherine , Bliokas Vida , Phillipson Lyn , Weston-Green Katrina , Francois Monique E , Jiang Xiaotao , George Jenson , Potter Jan , Batterham Marijka J , Charlton Karen
Published: September 2024

Introduction

Promising evidence is emerging for the procognitive, anti-inflammatory and neuroprotective properties of dietary flavonoids, particularly anthocyanins that provide red, purple and blue plant pigments.

Methods and analysis

The ‘Food for Thought’ study is a multicentre, 6-month randomised, parallel 3-arm clinical trial. Its primary aim is to investigate whether anthocyanin consumption, either through diet or supplementation, can prevent memory loss progression and improve inflammatory and cardiovascular health in older adults at risk for dementia. Eligible participants will include those aged 60–85 years with a diagnosis of amnestic mild cognitive impairment or with a self-referral of memory concerns and scoring ≤13 on the Memory Index Score within the Telephone Montreal Cognitive Assessment screening test. Participants will be randomised to one of three arms: High anthocyanin (‘purple foods’) diet (aiming for a target of 250 mg anthocyanins/day); freeze-dried product derived from blackcurrants (250 mg anthocyanins/day); or control (coloured maltose powder). The primary outcome is auditory anterograde memory functioning assessed by the Buschke and Grober Free and Cued Selective Reminding Test-Immediate Recall. Secondary outcomes are additional cognitive functions including processing speed, working memory, aspects of executive functioning (attentional shifting and word generativity) and premorbid estimate as well as subjective memory problems and self-reported depression symptoms. Additional secondary outcomes are blood pressure, inflammatory biomarkers, brain-derived neurotrophic factor, fatty acid profile, apolipoprotein E and polyphenol metabolites, gut microbiota composition and function and vascular and microvascular endothelial function tests. Repeated measures analysis of variance and/or mixed linear modelling will evaluate changes over time, with the inclusion of covariates.

Ethics and dissemination

Ethics approval has been obtained from the Greater Western Human Research Ethics Committee (2021/ETH12083). A Consumer Advisory Group was established to guide and review the protocol and dissemination strategy. The results of this trial are intended to be published in a peer-reviewed journal.

Trial sponsor

National Health and Medical Research Centre Dementia Collaborative Research Centre.

Start date of clinical trial: 02 September 2022.

Expected end date: 11 October 2024.

Trial registration number

ACTRN12622000065796.
Protocol for the LIFEH project: a prospective observational study to explore lifestyle among people living with HIV experiencing weight gain, looking beyond antiretroviral therapy
Authors: Zanini Barbara , Salvi Martina , Marconi Silvia , Tiecco Giorgio , Gilberti Giulia , Castellano Maurizio , Quiros-Roldan Eugenia , Collaboration Group LIFEH
Published: September 2024

Introduction

Weight gain, together with the onset of overweight and obesity, is a relevant emerging health issue among people living with HIV (PLWH). A large body of literature recognises this issue as a part of the secondary effects of some antiretroviral therapy (ART), but little is known about the role of lifestyle. In order to assess the role of modifiable aspects of lifestyle in addition to ART on the onset of overweight and obesity, we designed a prospective observational study among PLWH.

Methods and analysis

This is a prospective observational study among PLWH aged 18–65 years attending the Clinic of Infectious Diseases of Spedali Civili, Brescia, Italy, and on ART for at least 24 months. According to the sample size computation, 175 PLWH will be enrolled. PLWH willing to participate in the study are invited to a scheduled clinical visit to collect anthropometric measures, dietary habits and physical activity levels. During the visit, standardised and validated questionnaires are administered regarding emotional distress, food insecurity, use of food supplements, sleep quality, smoking habit and alcohol consumption/risk of addiction. After the interviews, bioimpedance analysis is performed and blood pressure and heart rate are assessed. After 12 months from baseline, each participant will be asked to participate in a further visit, with the same assessments as at baseline. The primary objective of the study is to assess the role of the modifiable factors of lifestyle in the onset of overweight and/or obesity among on-treatment PLWH experiencing weight gain, focusing on diet and physical activity.

Ethics and dissemination

The study research protocol and informed consent procedures were approved by Ethics Committee of Brescia Province (Italy) on 23 May 2023 (NP5892). Informed consent will be obtained from participants. Results will be submitted for publication in international peer-reviewed journals and summaries will be provided annually to the funders.
Prehospital emergency nurses’ experiences of caring for patients with suspected acute myocardial infarction: an interview study
Authors: Bjöhle Sebastian , Vicente Veronica , Eriksson Caroline , Bohm Katarina , Dodd Maja , R. Wahlin Rebecka , Lederman Jakob
Published: September 2024

Objective

Despite the prevalence of emergency medical service assignments related to chest discomfort, limited research delves into nurses’ experiences of caring for such patients. This study aimed to illuminate prehospital emergency nurses’ (PENs’) experiences of caring for patients with suspected acute myocardial infarction (AMI).

Design

A qualitative interview study.

Setting

Two Swedish emergency medical service organisations in two different regions.

Participants

Consecutive inclusion of 12 PENs.

Data analysis

An inductive content analysis according to Elo and Kyngäs.

Results

The results underline the active role of PENs in providing care for patients with AMI in the emergency medical service. They emphasise the ability to identify classic symptoms and the need for an open-minded approach to diffuse presentations. Ensuring patient security, projecting knowledge and composure are decisive for instilling a sense of safety. Healthcare providers feel profound responsibility and a fear of errors, especially in critical situations with potential patient deterioration. Prioritisation in time-sensitive cases leans towards medical interventions and immediate transportation. Continuing education is essential to enhance patient management and safety. Effective communication and trust are vital for urgent patient care, and prompt activation of the ST-elevation myocardial infarction pathway is recognised as imperative. Malfunctions result in frustration, underlining the importance of pathway functionality.

Conclusions

PENs have immense responsibility for the swift and knowledgeable management of patients with suspected AMI. Balancing patient involvement and urgent medical measures is challenging, emphasising the critical role of mental preparedness and comprehensive education. The study underlines the significance of effective communication and trust between healthcare providers, particularly in time-sensitive scenarios. Establishing feedback mechanisms for prehospital staff is important for advancing prehospital emergency care in this patient category.
Multilevel analysis of individual and community factors of awareness of obstetric fistula among women of childbearing age in Nepal: analysis of recent Nepal Demographic and Health Survey 2022 data
Authors: Fente Bezawit Melak , Abrham Asnake Angwach , Negussie Yohannes Mekuria , Asmare Zufan Alamrie , Asebe Hiwot Altaye , Seifu Beminate Lemma , Melkam Mamaru
Published: September 2024

Background

According to the WHO, obstetric fistula (OBF) is an abnormal connection between the genital tract and the urinary tract that occurs as the result of obstetric trauma, typically from prolonged obstructed labour. In 2018, globally, 50 000 and 100 000 cases of OBF are reported each year. The core of activities focused on reducing fistulas depends on a review of the disorder’s knowledge and the features of women at risk of having a lack of understanding. The effect of community-level factors on awareness of OBF was not yet known in Nepal. Therefore, we aimed to investigate the community-level and individual-level factors of awareness of OBF among childbearing-aged women in Nepal.

Methods

The 2022 Nepal Demographic and Health Survey data were used for this study. It included 14 845 childbearing-aged women. Because of the clustering effects of Demographic and Health Survey data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted OR (AOR) with a 95% CI was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.

Results

The overall prevalence of awareness of OBF among childbearing women in Nepal was 35.9% (95% CI 35.1%, 36.7%). Educational status (women who attended secondary education (AOR=1.65; 95% CI 1.41, 3.03) and higher education (AOR=4.29; 95% CI 1.14, 36.70)), currently working status (AOR=1.85; 95% CI 1.04, 3.30), birth history (AOR=2.23; 95% CI 1.48, 4.10), media exposure (AOR=1.54; 95% CI 1.07, 3.09) and women’s age from 30 to 39 (AOR=3.38; 95% CI 1.35, 8.93) and 40 to 49 years old (AOR=4.68; 95% CI 1.60, 13.67) at the individual level, as well as urban residence (AOR=1.53; 95% CI 1.99, 2.87) and high community-level media exposure (AOR=2.05; 95% CI 1.67, 2.64) at the community level were statistically significant factors with awareness of OBF.

Conclusion

Our study revealed that awareness of OBF among childbearing-aged women in Nepal was low (35.9%). The findings of this study will assist policymakers and public health programmers in understanding the magnitude of OBF awareness and the contributory factors. In addition, it will be useful to increasing awareness of OBF in the communities and promoting primary prevention approaches through education and motivation efforts.
MRI-derived abdominal adipose tissue is associated with multisite and widespread chronic pain
Authors: Kifle Zemene Demelash , Tian Jing , Aitken Dawn , Melton Phillip E , Cicuttini Flavia , Jones Graeme , Pan Feng
Published: September 2024

Introduction

Musculoskeletal pain typically occurs in multiple sites; however, no study has examined whether excessive visceral and subcutaneous adipose tissue are associated with musculoskeletal pain. This study therefore aimed to describe the associations between MRI-derived abdominal adipose tissue and multisite and widespread chronic musculoskeletal pain.

Methods

Data from the UK Biobank, a large prospective, population-based cohort study, were used. Abdominal MRI scans were performed at two imaging visits to quantify visceral adipose tissue and subcutaneous adipose tissue. Pain in the neck/shoulder, back, hip, knee or ‘all over the body’ was assessed at the corresponding visits. Mixed-effects ordinal/multinomial/logistic regression models were used for the analyses.

Results

A total of 32 409 participants were included (50.8% women, mean age 55.0±7.4 years). In multivariable analyses, there was a dose–response association of visceral adipose tissue, subcutaneous adipose tissue and their ratio with the number of chronic pain sites in both women (visceral adipose tissue: OR 2.04 per SD (95% CI 1.85 to 2.26); subcutaneous adipose tissue: OR 1.60 (95% CI 1.50 to 1.70); and their ratio: OR 1.60 (95% CI 1.37 to 1.87)) and men (visceral adipose tissue: OR 1.34 (95% CI 1.26 to 1.42); subcutaneous adipose tissue: OR 1.39 (95% CI 1.29 to 1.49); and their ratio: OR 1.13 (95% CI 1.07 to 1.20)). Higher levels of adipose tissue were also associated with greater odds of reporting chronic pain in both sexes. The effect estimates of these adipose measures were relatively larger in women than in men.

Conclusion

Abdominal adipose tissue was associated with chronic musculoskeletal pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain. The identified stronger effects in women than men may reflect sex differences in fat distribution and hormones.
Building Community: Community Engagement Models for Violence Prevention
Authors: Williams Ashley , Evans Charity , Nehra Deepika , Stadeli Kathryn M , Bulger Eileen M , Dicker Rochelle
Published: September 2024

In 2023, the American Association for the Surgery of Trauma (AAST) hosted a panel discussion highlighting existing community engagement models for violence prevention and emphasizing the unique position of trauma surgeons to work with community stakeholders to develop these models. Four distinct programs were discussed.
Nutrient digestibility and availability of mealworms (Tenebrio molitor), poultry by-product meal, and poultry viscera in female mink (Neogale vison) diets: insights on the nitrogen-to-protein conversion factor
Authors: Fong Kiran , Collins Stephanie A.
Published: September 2024

This study measured the digestibility of crude protein, crude fat, and dry matter in three protein sources: poultry by-product meal (PBPM), poultry viscera, and crushed mealworms using diatomaceous earth as an indicator. A control diet was made, and test diets were mixed in a 70:30 control diet:test ingredient ratio. Forty-four female mink housed in individual cages were fed experimental diets for 5 days, and fecal samples were collected and analyzed for nutrient residues compared to the diet composition to determine digestible nutrient levels. Mealworms had a greater dry matter digestibility ( P < 0.01; 96.26%) than poultry viscera (77.29%) and PBPM (86.76%). PBPM had a lower fat digestibility ( P < 0.01; 84.64%) than mealworms (94.78%) and poultry viscera (98.15%). There was no significant difference among treatments for protein digestibility. Using a standard nitrogen-to-protein conversion factor of 6.25, the crude protein content of the mealworms was 51.74%, although with an apparent digestibility coefficient of 0.77, this ingredient had an available crude protein composition of 39.70 ± 2.95. A nitrogen-to-protein conversion factor of 4.80 would be more accurate than 6.25 when using mealworms as a feed ingredient for monogastric animals.
The h-Component Diagnosability of Alternating Group Graphs
Authors: Zhuo Nengjin , Zhang Shumin , Li Yalan , Ye Chengfu
Published: September 2024

With the rapid expansion of multiprocessor systems, the fault diagnosis is becoming more and more important. The [Formula: see text]-component diagnosability of a multiprocessor system, is proposed to extend the traditional diagnosability and has been investigated widely. In this paper, we prove that under both the PMC model and MM* model the [Formula: see text]-component and [Formula: see text]-component diagnosability of an [Formula: see text]-dimensional alternating group graph are [Formula: see text] and [Formula: see text] respectively.
Cluster radioactivity of heavy elements within an improved Coulomb and Proximity potential model
Authors: Jithya K. K. , Prathapan K.
Published: September 2024

The Coulomb and Proximity potential Model (CPPM) is improved by introducing an accurate empirical expression for the nuclear surface diffuseness parameter in the expression for the proximity potential. Within the improved CPPM, the decay half-lives of experimentally detected cluster emissions from heavy elements are calculated. The results of the calculations using the Universal Decay Law (UDL) [Qi et al., Phys. Rev. Lett. 103 (2009) 072501], the improved empirical formula of Sahu et al. (ImSahuB) [Wang et al., Chin. Phys. C 45 (2021) 044111], and the empirical formula of Horoi [J. Phys. G. Nucl. Part. Phys. 30 (2004) 945] are compared with the predictions of the improved CPPM. The lowest standard deviation is obtained for the predictions using the improved CPPM. The model’s predictive power increases significantly when the proximity potential is modified by including the diffuseness parameter. Furthermore, improved CPPM is employed to calculate the decay half-lives of undiscovered cluster emissions from heavy elements, a valuable information for upcoming experimental investigations. The calculated values are compared with the predictions of the UDL, Horoi formula and the improved empirical formula of Sahu et al. (ImSahuB). There is a high degree of agreement between the improved CPPM, UDL, and Horoi formula predictions. The ImSahuB formula predict decay half-life one or two order magnitudes lower than the predictions of the other models.
SOME TOPOLOGICAL PROPERTIES AND APPLICATIONS OF EQUILATERAL SIERPIŃSKI RELATIVES
Authors: LI XIAOHAN , LIANG XIANGYU , ZENG CHENG , XUE YUMEI
Published: September 2024

In this paper, we extend the results for connectivity and convex hulls of Sierpiński relatives whose convex hulls have right isosceles triangle boundaries to the relatives corresponding to equilateral triangle version. Furthermore, we use a particular subclass of the relatives called trapezoid-shaped relatives to build new hexagonal fractals, which helps to visualize and distinguish the subgroups of symmetries of the hexagon. These results contribute to identify the topologies of Sierpiński relatives.
On depth of modules in an ideal
Authors: An Tran Nguyen
Published: September 2024

Let [Formula: see text] be a commutative Noetherian ring, [Formula: see text] an ideal of [Formula: see text] and [Formula: see text] a finitely generated R-module with dimR(M) = d. Denote by depth[Formula: see text] the depth of [Formula: see text] in [Formula: see text]. In [C. Huneke and V. Trivedi, The height of ideals and regular sequences, Manuscr. Math. 93 (1997) 137–142], Huneke and Trivedi proved that if [Formula: see text] is a quotient of a regular ring then there exists a finite subset [Formula: see text] of [Formula: see text] such that [Formula: see text] Denote by [Formula: see text] the [Formula: see text]th pseudo support of [Formula: see text] defined by Brodmann and Sharp [On the dimension and multiplicity of local cohomology modules, Nagoya Math. J. 167 (2002) 217–233]. In this paper, we prove that if [Formula: see text] is closed for all [Formula: see text] then the above formula of [Formula: see text] holds true, where [Formula: see text]. In particular, if [Formula: see text] is a quotient of a Cohen–Macaulay local ring then [Formula: see text]. We also give some examples to clarify the results.
Rings with un − 1 nilpotent for each unit u
Authors: Danchev Peter , Javan Arash , Moussavi Ahmad
Published: September 2024

We continue the study in-depth of the so-called [Formula: see text]-UU rings for any [Formula: see text], that were defined by the first-named author in [Danchev, On exchange P-UU unital rings, Toyama Math. J. 39(1) (2017) 1–7] as those rings [Formula: see text] for which [Formula: see text] is always a nilpotent for every unit [Formula: see text]. Specifically, for any [Formula: see text], we prove that a ring is strongly [Formula: see text]-nil-clean if, and only if, it is simultaneously strongly [Formula: see text]-regular and an [Formula: see text]-UU ring. This somewhat extends results due to [Diesl, Nil clean rings, J. Algebra 383 (2013) 197–211; Abyzov, Strongly q-nil-clean rings, Sib. Math. J. 60(2) (2019) 197–208; Cui and Danchev, Some new characterizations of periodic rings, J. Algebra Appl. 19(12) (2020)]. Moreover, our results somewhat improves the ones obtained by Koşan et al. [Rings such that, for each unit [Formula: see text], [Formula: see text] belongs to the Jacobson radical, Hacettepe J. Math. Stat. 49(4) (2020) 1397–1404].
When ideals of a commutative semilocal ring decompose into cyclic modules
Authors: Asgari Shadi
Published: September 2024

A commutative ring whose ideals are direct sums of cyclic modules was determined whenever it is local, that is, it has only one maximal ideal. This motivates one to study such a ring in the non-local case. In this paper, we give a characterization for such a ring if it is semilocal, that is, it has finitely many maximal ideals. This characterization is in terms of determining the structure of maximal ideals. As a consequence, we obtain that for a semilocal Rickart ring [Formula: see text], every ideal is a direct sum of cyclic modules if and only if [Formula: see text] is a finite direct product of principal ideal domains.
How many principal prime ideals are there in a polynomial ring?
Authors: Chang Gyu Whan , Chun Sangmin
Published: September 2024

Let [Formula: see text] be a commutative ring with identity, [Formula: see text] be an indeterminate over [Formula: see text], [Formula: see text] be the polynomial ring over [Formula: see text], [Formula: see text] be the power series ring over [Formula: see text], and [Formula: see text] be a principal prime ideal of [Formula: see text] with [Formula: see text]. It is well known that if [Formula: see text] is an integral domain, then [Formula: see text] is a DVR and [Formula: see text] has infinitely many such principal prime ideals. In this paper, among other things, we show that (i) [Formula: see text] is a field, (ii) [Formula: see text] is a DVR, but (iii) there is a ring [Formula: see text] such that [Formula: see text] has no principal prime ideal. We also study the maximal ideals of [Formula: see text] that are principal.
Homological properties of persistent homology
Authors: Varlı Hani̇fe , Pamuk Mehmetci̇k , Yilmaz Yağmur
Published: September 2024

In this paper, we investigate to what extent persistent homology benefits from the properties of a homology theory. We show that persistent homology benefits from a Mayer–Vietoris sequence and a long exact sequence for a pair if one works with graded persistence modules. We also give concrete examples showing that the same is not the case for persistent homology groups.
Characterization of the convergent multivariate nonnegative cascade algorithm with a dilation matrix
Authors: Cheng Li , Fang Xufa , Shi Weiyi , Xiang Xueyan , Yao Zhigang , Zhao Nan
Published: September 2024

In this paper, we characterize the convergence of the multivariate cascade algorithm with an [Formula: see text] dilation matrix [Formula: see text] and a nonnegative finite mask, which generalizes the result obtained recently. Moreover, we present two examples, which demonstrate the power and applicability of our main result.
Modified preview repetitive control with equivalent-input-disturbance based on two-dimensional model
Authors: Lan Yonghong , Zheng Shikang , Zheng Litao
Published: September 2024

This paper deals with the problem of two-dimensional (2D) system-based modified preview repetitive control (MPRC) with equivalent-input-disturbance (EID) for continuous-time systems. First, an EID-based MPRC law is used to improve the tracking performance and disturbance attenuation. Next, by using a new equality constraint, a continuous-discrete 2D system is established and the design problem of the EID-based MPRC law is transformed into the stability problem of the 2D system. Then, we employ the 2D system theory together with the linear matrix inequality (LMI) approach, a sufficient condition is derived to ensure the stability of the closed-loop system. By solving an LMI, the gains of the controller and state observer can be obtained. Finally, two numerical examples are provided to illustrate the effectiveness and superiority of the developed controller design technique.