bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the concordance of recommendations across guidelines on chest imaging for the diagnosis and management of COVID-19: A proposed methodological approach based on a case study
Authors: Yaacoub Sally , Chamseddine Fatimah , Jaber Farah , Blazic Ivana , Frija Guy , Akl Elie A.
Published: July 2023

Objective

To describe a methodological approach to explore the concordance of recommendations across guidelines and its application to the case of the WHO recommendations on chest imaging for the diagnosis and management of COVID-19.

Study design and setting

We followed a methodological approach applied to a case study that included: defining the ‘reference guideline’ (i.e., the WHO guidance) and the ‘reference recommendations’; searching for ‘related guidelines’ and identifying ‘related recommendations’; constructing the PICO for the recommendations; assessing the matching of the PICO of each related recommendation to the PICO corresponding reference recommendation; and assessing the concordance between the PICO-matching recommendations.

Results

We identified a total of 89 related recommendations from 22 related guidelines. Out of the 89 related recommendations, 43 partly matched and 1 entirely matched one of the reference recommendations, and out of these, 8 were concordant with one of the reference recommendations. When considering the seven reference recommendations, they had a median of 12 related recommendations (range 3–17), a median of 7 PICO-matching recommendations (range 0–13), and a median of 1 concordant recommendation (range 0–4).

Conclusion

Following a detailed methodological approach, we were able to explore the concordance between our reference recommendations and related recommendations from other guidelines. A relatively low percentage of recommendations was concordant.
Simulation and evaluation of increased imaging service capacity at the MRI department using reduced coil-setting times
Authors: Sun Ying-Chou , Wu Hsiu-Mei , Guo Wan-You , Ou Yang-Yu , Yao Ming-Jong , Lee Li-Hui
Published: July 2023

The wait times for patients from their appointments to receiving magnetic resonance imaging (MRI) are usually long. To reduce this wait time, the present study proposed that service time wastage could be reduced by adjusting MRI examination scheduling by prioritizing patients who require examinations involving the same type of coil. This approach can reduce patient wait times and thereby maximize MRI departments’ service times. To simulate an MRI department’s action workflow, 2,447 MRI examination logs containing the deidentified information of patients and radiation technologists from the MRI department of a medical center were used, and a hybrid simulation model that combined discrete-event and agent-based simulations was developed. The experiment was conducted in two stages. In the first stage, the service time was increased by adjusting the examination schedule and thereby reducing the number of coil changes. In the second stage, the maximum number of additional patients that could be examined daily was determined. The average number of coil changes per day for the four MRI scanners of the aforementioned medical center was reduced by approximately 27. Thus, the MRI department gained 97.17 min/d, which enabled them to examine three additional patients per month. Consequently, the net monthly income of the hospital increased from US$17,067 to US$30,196, and the patient wait times for MRI examinations requiring the use of flexible torso and head, shoulder, 8-inch head, and torso MRI coils were shortened by 6 d and 23 h, 2 d and 15 h, 2 d and 9 h, and 16 h, respectively. Adjusting MRI examination scheduling by prioritizing patients that require the use of the same coil could reduce the coil-setting time, increase the daily number of patients who are examined, increase the net income of the MRI department, and shorten patient wait times for MRI examinations. Minimizing the operating times of specific examinations to maximize the number of services provided per day does not require additional personnel or resources. The results of the experimental simulations can be used as a reference by radiology department managers designing scheduling rules for examination appointments.
Lifestyle interventions for patients with non-alcoholic steato-hepatitis–Design, rationale and protocol of the study “target group-specific optimisation of lifestyle interventions for behavior change in non-alcoholic steato-hepatitis (OPTI-NASH)”
Authors: Krüger Kathrin , Oedingen Carina , Kautz Achim , Langenbacher Diane , Rossol Siegbert , Stahmeyer Jona T. , Krauth Christian
Published: July 2023

Background

Non-alcoholic steato-hepatitis (NASH) is the inflammatory, progressive form of non-alcoholic fatty liver disease (NAFLD). A delayed diagnose interval is typical for the majority of the patients because of the asymptomatic natural course. However, serious sequelae may develop such as cirrhosis or hepatocellular carcinoma. NASH is also associated with an increased risk of metabolic diseases. Obesity developed due to a lack of exercise or a disadvantageous diet often leads to NAFLD or NASH, thereby interventions including enhanced physical activity and calorie reduction form the actual gold standard of treatment. To date, patients rarely use these. The project aims to model lifestyle interventions based on the preferences of the NASH patients.

Methods

Based on a systematic review and focus group discussions, two discrete choice experiments (DCE) will be designed, one on aspects influencing successful uptake of lifestyle interventions and one to analyses parameters contributing to long-term participation. An online survey will be used to elicit patient’s preferences on program design and on motivational aspects in a cross-sectional design. The recruitment will take place in nine certified specialist practices and hospital outpatient clinics aiming to reach a sample size of n = 500 which is also required for the DCE design.

Discussion

The results will provide an overview of the NASH patient’s preferences regarding the successful uptake and long-term implementation of lifestyle interventions. Recommendations for optimized lifestyle change programs will be derived and an intervention manual will be developed to facilitate target group-specific inclusion in programs in practice.
Genetic and environmental contributions to individual differences in sustainable working life—A Swedish twin cohort study
Authors: Ropponen Annina , Narusyte Jurgita , Wang Mo , Silventoinen Karri , Böckerman Petri , Svedberg Pia
Published: July 2023

Although genetics is known to have a role in sickness absences (SA), disability pensions (DP) and in their mutual associations, the empirical knowledge is scarce on not having these interruptions, i.e., sustainable working life. Hence, we aimed to investigate how genetic and environmental factors affect individual variation in sustainable working life in short-term (two consecutive years) and in long-term (22 years of follow-up) using the classical twin modeling based on different genetic relatedness of mono- and dizygotic twins. The final sample (n = 51 071) included Swedish same-sex twins with known zygosity born between 1930 and 1990 (53% women) with complete national register data of employment, SA, DP, unemployment, old-age pension, emigration, and death. For the short-term sustainable working life, genetic factors explained 36% (95% confidence intervals (CI) 31–41%), environmental factors shared by co-twins such as family background 8% (95% CI 5–14%) and environmental factors unique to each twin individual 56% (95% CI 56–56%) on the individual differences. For the long-term sustainable working life, the largest proportions on individual differences were explained by environmental factors shared by co-twins (46%, 95% CI 44–48%) and unique to each twin individual (37% 95% CI 36–38%) whereas a small proportion was explained by genetic factors (18%, 95%CI 14–22%). To conclude, short-term sustainable working life was explained to a large extent by unique environment and to lesser extent by genetic factors whereas long-term (22 years) sustainable working life had both moderate unique and common environmental effect, and to lower extent genetic effects contributing to individual differences. These findings suggest that sustainable working life have different short- and long-term predictors.
Ambition or comparison? Socioeconomic status and wellbeing differences between local and migrant workers
Authors: Li Dan , Yang Xiaocong , Zou Guanyang
Published: July 2023

Pursuing wellbeing is an essential part of human life and plays a determining role in public health and social sustainability. Prior research identified objective socioeconomic status (O-SES), such as real income and homeownership, as facilitators of human subjective wellbeing (SWB). However, not all humans with better SES reported high SWB. This paper expects that subjective socioeconomic status (S-SES) is the key path through which O-SES shapes SWB and that this indirect relationship varies by household registration status, length of residentship, and type of migrant status. Based on a national representative survey dataset-China General Social Survey 2010 (CGSS), the results of generalized structural equation modeling (GSEM) show that household income and homeownership as O-SES are positively related to SWB. Self-evaluated household SES as an important indicator of S-SES not only has a positive relationship with SWB but also significantly mediates the relationship between O-SES and SWB, especially for the new-local residents (NLRs), urban-to-urban migrants (UUMs) and rural-to-urban migrants (RUMs). This study has substantial implications for targeting the comparative psychology and sustainable productivity of Chinese migrants and the local labor force since it is currently facing a growing aging society.
Intersections of informal work status, gender and tuberculosis diagnosis: Insights from a qualitative study from an Indian setting
Authors: George Sobin , Syamala T. S. , Paranjpe Aditi , Saalim Mohamed
Published: July 2023

Background

There is evidence that more than one third of tuberculosis (TB) cases in India go undiagnosed each year and it is more pronounced among female patients. While there are studies available on the socioeconomic, cultural and gender-related dimensions of TB diagnosis delays among female patients in India, intersections of gender, informal work and diagnosis delays are not sufficiently studied. The present study aims to fill this gap by examining the TB diagnosis delay that are linked to the contingencies of working in informal arrangements for women from lower socio economic background.

Methods

The study draws on 80 qualitative in-depth interviews conducted among female patients from lower socio-economic background, who were working or recently stopped working in informal arrangements and undergoing Directly Observed Therapy, Short-course (DOTS) treatment in Bengaluru (India) city and 60 willing significant others of the patients. The participants were identified through a scoping survey that covered 188 female patients from 18 DOTS centres in the city.

Findings

Other than the already known reasons for the delay in TB diagnosis for women such as normalisation of symptoms, stigma and the gender-related discrimination leading to low prioritisation of women’s illness, the present study identifies reasons related to work informality. These are normalisation of symptoms as workplace health problems; work related concerns that restricted formal help seeking; non TB specific narratives of symptoms, often incorrectly assumed to be work related health issues or comorbidities and thus confounding the early accurate diagnosis by the medical personnel and shifting between formal and informal systems of help-seeking. Further, the study found that mere knowledge of TB symptoms did not always translate to early diagnosis for patients from the lower socioeconomic groups working in informal arrangements due to the fear of losing work and wages owing to hospital visits.

Conclusions

The workplace focus, especially the informal sector where a huge majority of India’s workforce is employed, is notably absent in the TB elimination programme. The study indicates the need to adopt a comprehensive approach in the ongoing TB elimination programme in India in which family, living environment and workplace should be integral parts.
Indoor aeroallergens from American cockroaches and mites initiate atopic march via cutaneous contact in a murine model
Authors: Lee Mey-Fann , Chu Yu-Wen , Wu Chi-Sheng , Lee Ming-Hao , Chen Yi-Hsing , Wang Nancy M.
Published: July 2023

The progression of allergic diseases from atopic dermatitis in childhood to other allergic conditions such as asthma in later life is often referred to as the atopic march. In order to study the relationship between cutaneous sensitization by aeroallergen and atopic march, we established a mouse model to test the hypothesis using American cockroaches and house dust mites as the model allergens. Mice were sensitized via skin with native cockroach extract (CraA) or recombinant Per a 2 and Der p 2 proteins without adjuvant. Each mouse was subjected to a total of three 1-week patching sensitizations with a 2-week interval in between each application. The resulting immunological variables in sera, scratching behavior, airway hyperresponsiveness (AHR), and pathology of skin lesions and nasal mucosa were evaluated. In mice, application of CraA, rPer a 2, and rDer p 2 aeroallergens through skin patching induced significantly high levels of both total IgE and specific IgEs. The epicutaneous sensitization after a subsequent allergen challenge showed a significant increase in scratch bouts, AHR, epidermal thickness, and eosinophil counts in the skin compared with the control mice. In addition, stimulation of murine splenocytes with allergens increased higher levels of Th2 cytokines, anti-inflammatory cytokines, and chemokines excretion. Our study provides evidence supporting that epicutaneous sensitization to aeroallergens also led to nasal and airway symptoms comparable to atopic march as described in humans. We hope this new allergy model will be useful in the development of new preventive and therapeutic strategies aimed at stopping the atopic march.
Secondary traumatic stress and work ability in death care workers: The moderating role of vicarious posttraumatic growth
Authors: Grandi Annalisa , Rizzo Marco , Colombo Lara
Published: July 2023

Death care work consists of dealing with traumatic events frequently, if not daily. This type of exposure is considered characteristic of the profession and can lead to significant negative consequences such as secondary traumatic stress. However, sometimes positive changes can occur as a result of experiencing trauma, which is referred to as vicarious posttraumatic growth. The aim of the present study is to investigate the role of vicarious posttraumatic growth (VPTG) in the relationship between secondary traumatic stress (STS) and work ability (WA) in a sample of 231 death care workers in northern Italy. Regression analysis with interaction was performed using PROCESS. The results showed a negative association between STS and WA and a positive association between VPTG and WA. The interaction between STS and VPTG was also statistically significant. The moderating role of VPTG was partially confirmed by the analysis: at low and moderate VPTG levels, the conditional effect was negative and statistically significant, while at high VPTG, STS exposure had no significant and negative effect on WA, as if VPTG had some kind of protective role against STS. These results provide new insights into the role of VPTG in work environments with daily trauma exposure, such as death care.
Bi-frequency operation in a membrane external-cavity surface-emitting laser
Authors: Daykin Jake , Woods Jonathan R. C. , Bek Roman , Jetter Michael , Michler Peter , Mills Ben , Horak Peter , Wilkinson James S. , Apostolopoulos Vasilis
Published: July 2023

We report on the achievement of continuous wave bi-frequency operation in a membrane external-cavity surface-emitting laser (MECSEL), which is optically pumped with up to 4 W of 808 nm pump light. The presence of spatially specific loss of the intra-cavity high reflectivity mirror allows loss to be controlled on certain transverse cavity modes. The regions of spatially specific loss are defined through the removal of Bragg layers from the surface of the cavity high reflectivity mirror in the form of crosshair patterns with undamaged central regions, which are created using a laser ablation system incorporating a digital micromirror device (DMD). By aligning the laser cavity mode with the geometric centre of the loss patterns, the laser simultaneously operated on two Hermite-Gaussian spatial modes: the fundamental HG00 and the higher order HG11 mode. We demonstrate bi-frequency operation over a range of pump powers and sizes of spatial loss features, with a wavelength separation of approximately 5 nm centred at 1005 nm.
Longitudinal multiplexity and structural constraints of online emergency collaborative networks: A tale of two Chinese societies
Authors: Wang Xiao
Published: July 2023

Drawing upon the concept of longitudinal multiplexity and the Institutional Collection Action (ICA) framework, this article conducts a longitudinal observation of online emergency collaborative networks (ECNs) built and sustained among organizational actors within Shenzhen and Hong Kong in response to Typhoon Mangkhut. In addition to investigating the multiplex relationships among three types of online ECNs (i.e., preparedness networks, response networks, recovery networks), this article takes a comparative approach to examining how the structural constraints imposed by distinct emergency management systems (EMSs) influence the network formation and evolution as the disaster evolves over time. Findings obtained from a series of inferential network analyses reveal that preexisting online collaborative ties formed at the disaster preparedness stage are important for increasing organizations’ tendency to build and sustain online collaborations during disaster response and recovery. Moreover, the decentralized EMS in Hong Kong exhibits more effectiveness in facilitating online network changes during both transitional periods. These findings demonstrate a pressing need for emergency researchers and frontline communication managers to understand the dynamic relationships among online ECNs across different disaster phases and further explore potential opportunities to facilitate online emergency collaboration on a broader scale.
Continuous speech with pauses inserted between words increases cortical tracking of speech envelope
Authors: Deoisres Suwijak , Lu Yuhan , Vanheusden Frederique J. , Bell Steven L. , Simpson David M.
Published: July 2023

The decoding multivariate Temporal Response Function (decoder) or speech envelope reconstruction approach is a well-known tool for assessing the cortical tracking of speech envelope. It is used to analyse the correlation between the speech stimulus and the neural response. It is known that auditory late responses are enhanced with longer gaps between stimuli, but it is not clear if this applies to the decoder, and whether the addition of gaps/pauses in continuous speech could be used to increase the envelope reconstruction accuracy. We investigated this in normal hearing participants who listened to continuous speech with no added pauses (natural speech), and then with short (250 ms) or long (500 ms) silent pauses inserted between each word. The total duration for continuous speech stimulus with no, short, and long pauses were approximately, 10 minutes, 16 minutes, and 21 minutes, respectively. EEG and speech envelope were simultaneously acquired and then filtered into delta (1–4 Hz) and theta (4–8 Hz) frequency bands. In addition to analysing responses to the whole speech envelope, speech envelope was also segmented to focus response analysis on onset and non-onset regions of speech separately. Our results show that continuous speech with additional pauses inserted between words significantly increases the speech envelope reconstruction correlations compared to using natural speech, in both the delta and theta frequency bands. It also appears that these increase in speech envelope reconstruction are dominated by the onset regions in the speech envelope. Introducing pauses in speech stimuli has potential clinical benefit for increasing auditory evoked response detectability, though with the disadvantage of speech sounding less natural. The strong effect of pauses and onsets on the decoder should be considered when comparing results from different speech corpora. Whether the increased cortical response, when longer pauses are introduced, reflect improved intelligibility requires further investigation.
Qualitative research concerning physiotherapy approaches to encourage physical activity in older adults with dementia
Authors: Yokogawa Masami , Taniguchi Yoshimi , Yoneda Yumi
Published: July 2023

Background

Physical exercise is known to improve the level of activities of daily living and physical function in people with dementia; however, symptoms of dementia often pose challenges when implementing physical therapy. This study aimed to elucidate how physiotherapists (PTs) engage with older adults with dementia to encourage exercise and participation in physical activity.

Methods

In this qualitative study, four PTs working with older adults with dementia in long-term care facilities in Japan were recruited and interviewed. We used a modified grounded theory approach to assess how PTs engaged with older adults with dementia during physiotherapy sessions.

Results

Based on PT responses, five categories of engagement were identified: “make structured preparations for clients to begin physical activity,” “link exercise therapy to a client’s daily life,” “discover changes in daily life,” “ascertain cognitive function,” and “accommodate client differences.” Concepts were derived under each category. The category “make structured preparations for clients to begin physical activity” served as a preceding stage for PTs to engage with older adults with dementia. PTs linked exercise therapy to each client’s daily life activities to encourage voluntary participation in daily physical activity. PTs ensured the performance of routine patterns of movement and modified these movement patterns per clients’ differing paces.

Conclusion

PTs provided exercise and movement training based on various degrees of client involvement and made structured preparations for clients to begin physical activity that were linked to exercise therapy. Our findings may prompt PTs to encourage older people with dementia to participate in physical therapy and benefit from exercise.
Initial functional disability as a 1-year prognostic factor in geriatric patients hospitalized with SARS-CoV-2 infection
Authors: Brière Olivier , Otekpo Marie , Asfar Marine , Gautier Jennifer , Sacco Guillaume , Annweiler Cédric ,   on behalf of the GERIA-COVID study group
Published: July 2023

Background

SARS-CoV2 infection has affected many older people and has required us to adapt our practices to this new pathology. Initial functional capacity is already considered an important prognostic marker in older patients particularly during infections.

Aim

The objective of this longitudinal study was to determine whether baseline functional disability was associated with mortality risk after 1 year in older patients hospitalized for COVID-19.

Methods

All COVID-19 patients admitted to the geriatric acute care unit of Angers University Hospital, France, between March-June 2020 received a group iso-ressource (GIR) assessment upon admission. Disability was defined as a GIR score≤3. All-cause mortality was collected after 1 year of follow-up. Covariables were age, sex, history of malignancies, hypertension, cardiomyopathy, number of acute diseases at baseline, and use of antibiotics or respiratory treatments during COVID-19 acute phase.

Results

In total, 97 participants (mean±SD 88.0+5.4 years; 49.5% women; 46.4% GIR score≤3) were included. 24 of the 36 patients who did not survive 1 year had a GIR score ≤ 3 (66.7%; P = 0.003). GIR score≤3 was directly associated with 1-year mortality (fully adjusted HR = 2.27 95% CI: 1.07–4.89). Those with GIR≤3 at baseline had shorter survival time than the others (log-rank P = 0.0029).

Conclusions

Initial functional disability was associated with poorer survival in hospitalized frail elderly COVID-19 patients.

Clinical trial registration

ClinicalTrials.gov: NCT04560608 registered on September 23, 2022
Deregulation of exosomal miRNAs in rheumatoid arthritis patients
Authors: Hussain Muhammad Zahid , Haris Muhammad Shahbaz , Rizwan Muhammad , Ashraf Nida Sarosh , Arshad Maryam , Mahjabeen Ishrat
Published: July 2023

Exosomes are small-diameter endosomal vesicles secreted in all biological fluids and play biological/pathological roles in the cell. These pathological roles are played by exosome’s cargo molecules through inter-cellular communication. Exosomal cargo molecules contain proteins and miRNAs. miRNAs are small non-coding RNA fragments involved in the reduction of final protein output by destabilizing or suppressing the translation of target messenger RNA (mRNA). This deregulation of the protein due to miRNAs ultimately accelerates the process of disease pathogenesis. The role of exosomal miRNAs has been investigated in different diseases and the limited number of studies have been published concerning exosomal miRNAs and rheumatoid arthritis (RA). The current study is designed to investigate the role of exosomal miRNAs (miRNA-103a-3p, miRNA-10a-5p, miRNA-204-3p, miRNA-330-3p, and miRNA-19b) in the pathogenesis of RA. Furthermore, the role of selected exosomal miRNAs in RA pathogenesis was further explored by estimating oxidative stress and histone deacetylation in RA patients. In the current study, 306 RA patients and equal numbers of age/gender-matched controls were used. The level of expression of above-mentioned exosomal miRNAs was assessed by performing qRT PCR. Deacetylation and oxidative stress assays were performed to estimate the 8-hydroxydeoxyguanosine (8-OHdG level) and histone deacetylation levels using the Enzyme-linked immunosorbent assay (ELISA). Statistical analysis indicated a significantly downregulated expression of miRNA-103a-3p (p<0.0001), miR-10a-5p (p<0.0001), miR-204-3p (p<0.0001), miR-330-3p (p<0.0001) and miR-19b (p<0.0001) in RA patients compared to controls. Significantly increased levels of 8-OHdG(p<0.0001) and histone deacetylation (p<0.0001) were observed among RA patients compared to controls. Spearman correlation showed a negative correlation between the deregulated exosomal miRNAs and increased oxidative stress and histone deacetylation in RA patients. Receiver operating characteristics (ROC) curve analysis showed a good diagnostic specificity/sensitivity of the above-mentioned exosomal miRNAs among RA patients. These analyses indicated the potential role of deregulated exosomal miRNAs in the initiation of RA by targeting oxidative stress and histone deacetylation processes.
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: A cohort study
Authors: Brown Tiffany , Lee Ji Young , Guzman Adriana , Fischer Michael A. , Friedberg Mark W. , Chua Kao-Ping , Linder Jeffrey A.
Published: July 2023

Objectives

Ambulatory antibiotic stewardship generally aims to address the appropriateness of antibiotics prescribed at in-person visits. The prevalence and appropriateness of antibiotics prescribed outside of in-person visits is poorly studied.

Design and setting

Retrospective cohort study of all ambulatory antibiotic prescribing in an integrated health delivery system in the United States.

Participants

Antibiotic prescribers and patients receiving oral antibiotic prescriptions between January 2016 and December 2019.

Main outcome measures

Proportion of antibiotics prescribed with in-person visits or not-in-person encounters (e.g., telephone, refills). Proportion of prescriptions in in 5 mutually exclusive appropriateness groups: 1) chronic antibiotic use; 2) antibiotic-appropriate; 3) potentially antibiotic-appropriate; 4) non-antibiotic-appropriate; and 5) not associated with a diagnosis.

Results

Over the 4-year study period, there were 714,057 antibiotic prescriptions ordered for 348,739 unique patients by 2,391 clinicians in 467 clinics. Patients had a mean age of 41 years old, were 61% female, and 78% White. Clinicians were 58% women; 78% physicians; and were 42% primary care, 39% medical specialists, and 12% surgical specialists. Overall, 81% of antibiotics were prescribed with in-person visits and 19% without in-person visits. The most common not-in-person encounter types were telephone (10%), orders only (5%), and refill encounters (3%). Of all antibiotic prescriptions, 16% were for chronic use, 15% were antibiotic-appropriate, 39% were potentially antibiotic-appropriate, 22% were non-antibiotic-appropriate, and 8% were not associated with a diagnosis. Antibiotics prescribed in not-in-person encounters were more likely to be chronic (20% versus 15%); less likely to be associated with appropriate or potentially appropriate diagnoses (30% versus 59%) or non-antibiotic-appropriate diagnoses (8% versus 25%); and more likely to be associated with no diagnosis (42% versus <1%).

Conclusions

Ambulatory stewardship interventions that focus only on in-person visits may miss a large proportion of antibiotic prescribing, inappropriate prescribing, and antibiotics prescribed in the absence of any diagnosis.
Transação de Créditos REDD em Mercados Internacionais de Carbono
Authors: Rosa Renato , Parrado Ramiro , Bosello Francesco
Published: July 2023

While several economic studies have looked into the role of REDD in climate policy, the interlinks between climate policy, international trade and agricultural markets have been only marginally considered. This paper adds to that discussion by developing a policy simulation exercise in which REDD credits can be traded in an international carbon market using a recursive dynamic computable general equilibrium model. The model was extended to incorporate abatement cost curves of avoided deforestation from a partial equilibrium study, and to account for the corresponding induced effects on land and timber markets. We conclude that REDD may significantly reduce policy costs. A large number of REDD credits entering the carbon market would allow regions pertaining to the climate policy agreement to systematically emit above their targets. These results confirm that policy design may require limits to the use of REDD credits along with the creation of long-term incentives to promote a greener economy. Finally, when international competitiveness effects are taken into account, we show that the use of REDD as a means to foster developing countries’ participation in climate policy may not be sufficient.
Os Determinantes do Crédito Comercial Durante e Após a Crise Financeira Internacional de 2008
Authors: Carreira Carlos , Silva Pedro
Published: July 2023

This work analyses the determinants of trade credit granted and received and the effect of the 2008 financial crisis on it. Using a sample of 96,417 Portuguese SMEs from the non-financial sector for the period 2010–2019, we found that trade credit plays an important role in firms' financing policies. Firms with better access to the credit market act as financial intermediaries and grant financing to firms that have difficulty accessing credit. Moreover, the use of trade credit seems to be a substitute for bank financing. We also found that firms use trade credit as a marketing tool to increase their sales. Finally, we found a slump in credit granted to customers after the 2008 financial crisis, which seems to mimic the contraction in aggregate bank credit.
BUDGETING AS A TOOL FOR PLANNING, CONTROL AND DECISION MAKING IN NIGERIAN NATIONAL ASSEMBLY
Authors: OKOYE Kingsley Onu , ARINZE Ikechukwu
Published: July 2023

This study titled “Budgeting as a tool for planning, control and decision making; A case study of the Nigerian National Assembly”, covers the budget preparation as well as implementation process. The study explored the concept of budgeting as a tool for effective planning for the purpose of enhanced implementation and budgetary control. For the purpose of this study, both primary and secondary data were collected. Pre-tested questionnaires numbering 120 were administered, interviews were also conducted among legislators and staff of the National Assembly. Also certain vital unit’s related documents of the National Assembly were carefully studied. Results from the study reveals that the National Assembly prepare budget annually. Furthermore, about 70% of respondents agreed that the budget mechanism used by the National Assembly is ineffective and inefficient. However, 87% of respondents concurred with the position that budgeting is indeed a tool for planning, control and decision-making. Going forward, the National Assembly should set its own organized budget office to implement efficiency and set timelines in budgeting process as well as budgeting implementation.
ПРОФИЛАКТИКА РАЗВИТИЯ ДИАБЕТИЧЕСКОГО КЕТОАЦИДОЗА С ПОМОЩЬЮ
ТЕХНОЛОГИИ ДИСТАНЦИОННОГО МЕДИЦИНСКОГО КОНТРОЛЯ У ДЕТЕЙ,
ИСПОЛЬЗУЮЩИХ СИСТЕМЫ НЕПРЕРЫВНОГО МОНИТОРИРОВАНИЯ УРОВНЯ ГЛЮКОЗЫ
Authors: Кияев А. В. , Промин И. А. , Кобаидзе Е. В. , Асташова Е. С. , Вянцловайте К. В. , Карандашова Т. А. , Корнева И. В. , Словак М. А.
Published: July 2023

ЦЕЛЬ: оценить эффективность технологии дистанционного медицинского контроля в профилактике

развития диабетического кетоацидоза (ДКА) у детей, использующих системы непрерывного мониториро-

вания глюкозы (НМГ).

МАТЕРИАЛЫ И МЕТОДЫ: на 01.02.2023 72,2% (1268 из 1758) детей до 18 лет с СД1, проживающих

в Свердловской области, были первично обеспечены датчиками для НМГ «FreeStyle Libre» из средств реги-

онального бюджета, а у 897 детей, подключенных к аккаунту Областного центра детской эндокринологии

в облачной платформе «LibreView», имеется информация по данным НМГ, как минимум за последние 2 неде-

ли. Координатором Центра, в режиме 1 раз в 2 недели выгружаются данные по пациентам в файл формата

«Excel» с последовательным анализом установленных «сигнальных» параметров: основное условие – актив-

ность датчика ≥70% за предшествующие 2 недели; «пороговое значение уровня глюкозы >17,0 ммоль/л».

При нахождении пациента более 10 % времени в течение последних 2 недель в указанном диапазоне, за-

конные представители ребенка информируется о высоком риске развития острой декомпенсации диабета

(кетоза/ДКА) и им предлагается внеплановая очная или телемедицинская консультация врачами Центра.

РЕЗУЛЬТАТЫ: по данным регулярной аналитики информационной сигнальной панели «LibreView»

высокий риск развития кетоза/ДКА фиксируется от 9,5 до 18,1% детей с СД1. Это пациенты, которые регу-

лярно используют датчик НМГ (активность датчика ≥70%), но при этом находятся в состоянии хронической

декомпенсации диабета: от 10 до 60% времени уровень глюкозы находится выше 17,0 ммоль/л. Всего

за 11 месяцев с момента практического внедрения модели дистанционного медицинского контроля прове-

дено 305 внеплановых консультаций детей из группы риска. Ни у одного из пациентов, попавших в анализ

по принятым критериям, не произошло развития ДКА и не зафиксировано неотложных госпитализаций.

ВЫВОДЫ: технология дистанционного медицинского контроля СД1 у детей, использующих НМГ, явля-

ется эффективной в профилактике ДКА у детей со стажем диабета.
НЕПРЕРЫВНОЕ FLASH-МОНИТОРИРОВАНИЕ ГЛЮКОЗЫ У ДЕТЕЙ С САХАРНЫМ
ДИАБЕТОМ 1 ТИПА И АУТОИММУННЫМ ТИРЕОИДИТОМ
Authors: Макина О. В. , Туз В. В. , Щедрова Е. В. , Марьина О. И.
Published: July 2023

ЦЕЛЬ: провести сравнительный анализ результатов непрерывного flash-мониторирования глюкозы

(НМГ) крови у детей и подростков с сахарным диабетом 1 типа (СД1) и группой пациентов с СД1 и ауто-

иммунным тиреоидитом (АИТ).

МАТЕРИАЛЫ И МЕТОДЫ: обследовано 79 пациентов. Основная группа: 57 детей и подростков с СД1

от 3 до 17 лет, из них 25 девочек (43,9 %) и 32 мальчика (56,1%). Группа сравнения: 22 пациента с сочетанной

аутоиммунной патологией (СД1 и АИТ) в возрасте от 4 до 17 лет; 12 девочек (54,5%) и 10 мальчиков (45,5%).

Анализируемые параметры по данным НМГ: время нахождения в целевом диапазоне (3,9-10,0 ммоль/л,

TIR>70%); выше целевого диапазона (TAR<25%); ниже целевого диапазона 1 уровня (3,0–3,8 ммоль/л)

и 2 уровня (<3,0 ммоль/л) TВR, %; коэффициент вариации гликемии (CV,%). Статистическая обработка дан-

ных выполнена в программе StatTech v.2.8.2.

РЕЗУЛЬТАТЫ: медиана (Ме) длительности заболевания СД1 в основной группе составляет 2 года, в груп-

пе детей с сочетанной патологией – 3,5 года. В основной группе средний уровень HbA1c - 9,3 % (min – 5,9%;

мах – 14,9 %); в группе сравнения средний HbA1c – 10,5 % (min – 6,7 %; мах – 18,0 %), что свидетельствует

о более декомпенсированном течении СД1 на фоне АИТ. В основной группе детей TIR>70% зарегистриро-

ван у 40,4% (n=23); в группе сравнения 40,9 % (n=9), (р>0,05). В основной группе нетяжелые гипогликемии

(3,0-3,8 ммоль/л) фиксировались у 61,4 % (n=35) против группы сравнения 86,4 % (n=19) (р<0,05) и тяжелые

(<3,0 ммоль/л) у 40,4% (n=23) и 59,1% (n=13), соответственно (р>0,05). Гипергликемия была зафиксирована

у всех пациентов в обеих группах. По данным анализа коэффициента вариации гликемии нестабильная

гликемия (CV≥36%) зарегистрирована у 49,1 % (n=28) и у 54,5 % (n=12) пациентов в обоих группах (р>0,05).

ВЫВОДЫ: по данным анализа flash-мониторирования глюкозы у пациентов с СД1 и АИТ достоверно

чаще зарегистрирована гликемия ниже целевого диапазона 1 уровня и более высокая вариабельность

гликемии, чем у пациентов с изолированным СД1, что свидетельствует об угнетении процесса глюконе-

огенеза, а также изменению периферической утилизации глюкозы, в результате чего возникают более

частые гипогликемии.
НЕПРЕРЫВНЫЙ МОНИТОРИНГ ГЛЮКОЗЫ КРОВИ У ДЕТЕЙ С САХАРНЫМ ДИАБЕТОМ
1 ТИПА: ЭФФЕКТИВНОСТЬ ИСПОЛЬЗОВАНИЯ
Authors: Бурлуцкая А. в. , Статова А. А.
Published: July 2023

ЦЕЛЬ: оценить эффективность использования непрерывного мониторинга глюкозы (НМГ) крови у детей

с сахарным диабетом 1 типа (СД 1 типа).

МАТЕРИАЛЫ И МЕТОДЫ: в исследовании приняли участие 49 детей с СД 1 типа. Создан опросник

для оценки эффективности системы НМГ, включающий данные пола, возраста, длительности сахарного

диабета 1 типа, системы мониторинге глюкозы крови, показателей глюкозы крови. В опросе участвовали

родители детей с СД 1 типа. По данным медицинской документации проведен анализ показателей глико-

зилированного гемоглобина, уровня глюкозы крови натощак и в течение дня, оценка результатов осмотра

невролога, окулиста.

РЕЗУЛЬТАТЫ: в исследовании приняли участие 49 детей с СД 1 типа. Средний возраст составил 11,2 лет.

При оценке длительности заболевания СД 1 типа выявлено, что большая часть детей (93%) болеют СД

1 типа более 1 года. По данным опросника 76,6% детей используют шприц-ручки для введения инсулина,

23,3% - помповую терапию. На основании данных медицинской документации у 23,3% больных с СД 1 типа

выявлены хронические осложнения СД, большая часть 76,7% - осложнений не имеют. В исследовательской

группе 93% больных с СД 1 типа используют систему НМГ крови, из которых 70% обучены управлению си-

стемой НМГ. Все дети отметили облегчение в отслеживании гликемии в течение суток, у 12,5% - отмечались

расхождения в показателях гликемии по результатам НМГ и исследования с помощью глюкометра. При

установке системы НМГ 72,5% больных с СД 1 типа не отметили дискомфорта, всего у 12,5% - отмечалась

местная реакция на пластырь для крепления датчика, у 10% - образование кровоподтека, 5% детей- отме-

тили дискомфорт во сне и при движении. Большинство больных с СД 1 типа (97,5%) отметили облегчение

при рассчете дозы инсулина с системой НМГ; 92,5% - снижение эпизодов гипо- и гипергликемии; у 60% - от-

мечено улучшение показателей гликозилированного гемоглобина, у 77,5% - уменьшилась вариабельность

показателей гликемии в течение суток.

ВЫВОДЫ: при использовании НМГ все больные с СД 1 типа отметили облегчение контроля гликемии.

2/3 детей не испытывают дискомфорта при установке системы НМГ. Больше 90% пациентов с СД 1 типа

отметили уменьшение эпизодов гипо- и гипергликемии в течение суток, более 70% - уменьшение вари-

абельности показателей гликемии в течение суток, у 60% - улучшение показателей гликозилированного

гемоглобина.
НЕПРОПОРЦИОНАЛЬНАЯ ФОРМА ФЕТАЛЬНОЙ МАКРОСОМИИ: РОЛЬ САХАРНОГО
ДИАБЕТА И ОЖИРЕНИЯ
Authors: Виктор С. А. , Курлович И. В. , Ващилина Т. П. , Прилуцкая В. А.
Published: July 2023

ЦЕЛЬ: выявить взаимосвязь между наличием нарушений углеводного и/или жирового обмена у бере-

менных женщин и формированием непропорционально развитых макросомных новорожденных.

МАТЕРИАЛЫ И МЕТОДЫ: проведен ретроспективный анализ историй родов 243 родильниц и их

макросомных новорожденных детей (4000 г и более). Для новорожденных была проведена оценка про-

порциональности физического развития с расчетом масса-ростового индекса (МРИ, отношение массы

тела (кг) к длине тела (м)) и его центильной оценкой относительно гестационного возраста и пола ново-

рожденного с использованием онлайн калькулятора INTERGROWTH-21st. Сформировано 2 группы с учетом

пропорциональности развития новорожденного:

-- группа 1 – 119 родильниц и их новорожденные дети с МРИ менее 90 центиля (макросомные пропорци-

онально развитые новорожденные);

-- группа 2 – 124 родильниц и их новорожденные дети с МРИ, соответствующим 90 центилю и более (ма-

кросомные непропорционально развитые новорожденные).

Анализируемые группы были сопоставимы по возрасту матери: в группе 1 возраст матерей составил 31

(27–35) лет, в группе А2 – 31 (27–34) лет (р=0,751). Масса тела новорожденных в группе 1 составила 4090

(4050–4185) г, в группе 2 – 4295 (4200-4430) г (р<0,001); длина тела в группе 1 – 56 (55–57) см, в группе 2 – 55

(54-56) см (р<0,001); центильная оценка МРИ в группе 1 – 96,3 (93,0-98,6) %, в группе 2 – 81,3 (74,4-86,1) %

(р<0,001). Статистическую обработку полученных данных выполнили с использованием статистической

программы «STATISTICA 10». Статистически значимыми принимали различия при p<0,05.

РЕЗУЛЬТАТЫ: наибольшие значения массы тела и индекс массы тела (ИМТ) до беременности отмеча-

лись у матерей в группе 2 (73 (63–83) кг и 26,0 (22,9–30,4) кг/м2 соответственно), по сравнению с группой 1,

где они составили 68 (59–76) кг (р=0,005) и 23,2 (20,9–26,5) кг/м2 (р<0,001) соответственно. При проведении

корреляционного анализа была выявлена прямая корреляционная связь умеренной силы между массой

новорожденного и прегестационной массой тела матери (rs=0,36, p<0,001) и ИМТ до беременности (rs=0,32,

p<0,001). У матерей непропорционально развитых новорожденных избыток массы тела (ИМТ 25,0-29,9) или

ожирение (ИМТ 30,0 и более) (57,3 % случаев) диагностировались статистически значимо чаще по срав-

нению с группой 1 (ОШ 2,46 (1,46-4,12), р=0,007). Сахарный диабет (прегестационный или гестационный)

статистически значимо чаще регистрировался в группе 2 (в 39,5% случаев) по сравнению с группой 1 (7,6 %

случаев, ОШ 7,99 (3,70-17,23), р<0,001).

ВЫВОДЫ: на формирование непропорционального избыточного роста плода оказывает влияние на-

личие у беременной женщины избытка массы тела или ожирения до беременности (ОШ 2,46 (1,46-4,12),

р=0,007) или прегестационного или гестационного сахарного диабет (ОШ 7,99 (3,70-17,23), р<0,001).
ИЗБЫТОЧНАЯ МАССА ТЕЛА И УРОВНИ ОСТЕОКАЛЬЦИНА И АДИПОНЕКТИНА
У БЕРЕМЕННЫХ С САХАРНЫМ ДИАБЕТОМ 1 ТИПА
Authors: Скриплёнок Т. Н. , Мохорт Т. В. , Прилуцкая В. А.
Published: July 2023

ЦЕЛЬ: определить уровни остеокальцина и адипонектина у беременных с сахарным диабетом 1 тип

(СД 1) и различным прегравидарным индексом массы тела (ИМТ).

МАТЕРИАЛЫ И МЕТОДЫ: объектом исследования явились беременные с доношенной беременностью

и СД 1. В зависимости от прегравидарного ИМТ они были разделены на 2 группы: группа 1 (Гр1) (n=38) –

с нормальным ИМТ <25 (22,0 (20,96−23,05)) и группа 2 (Гр2) (n=34) с ИМТ≥25 (28,38 (25,97−33,09)) (р<0,001).

Группы были сопоставимы по уровню гликированного гемоглобина, который составил в Гр1 − 6,6% (6,0−7,4),

в Гр2 – 6,8% (6,3−7,3) (р=0,912). Прибавка массы тела в Гр1 составила 13 кг (13−15), а в Гр 2 – 10 кг (7−13)

(р<0,05). Забор венозной крови из локтевой вены проводился утром, перед родоразрешением.

РЕЗУЛЬТАТЫ: медиана адипонектина в Гр1 составила 20,59 mcg (12,4−27,07), а в Гр2 – 12,99 mcg

(9,328−22,698) и была статистически значимо ниже у беременных с избыточной массой тела (р<0,05).

Уровень остеокальцина в Гр1 составил 1,04 ng/ml (0,58−2,49), а в Гр2 – 0,73 ng/ml (0,41−2,2), без статисти-

чески значимой разницы (р=0,378).

ВЫВОДЫ: наличие избыточной массы тела сопровождается снижением уровня адипонектина у бере-

менных с СД 1 типа, что видимо, связано с влиянием на другие адипоцитокины, например, лептин и про-

воспалительные цитокины. Сопоставимое состояние углеводного обмена определяет отсутствие значимой

разницы в уровнях остеокальцина на фоне различного прегравидарного ИМТ. Полученные результаты

определяют необходимость дальнейших исследований.
СРАВНЕНИЕ ПОМПОВОЙ ИНСУЛИНОТЕРАПИИ С РЕЖИМОМ МНОЖЕСТВЕННЫХ
ИНЪЕКЦИЙ У БЕРЕМЕННЫХ С САХАРНЫМ ДИАБЕТОМ
Authors: Шестакова Т. П. , Давыдкина Т. И.
Published: July 2023

Данные об эффективности помповой инсулинотерапии во время беременности противоречивы.

ЦЕЛЬ: сравнить эффективность помповой инсулинотерапии (ПИ) у беременных женщин с сахарным

диабетом 1 типа (СД1) по сравнению с множественными инъекциями инсулина (МИИ).

МАТЕРИАЛЫ И МЕТОДЫ: ретроспективный анализ данных 129 беременных женщин с СД1, прохо-

дивших лечение в отделении эндокринологии ГБУЗ МО МОНИКИ. Возраст 28,0±5,2лет, длительность СД

16±6,8лет. ПИ применялась у 44(34,1%) беременных, МИИ у 85(65,9%) беременных. Оценивался HbA1c

до наступления и на протяжении беременности, исходы беременности (срок родов, масса плода, к/с).

РЕЗУЛЬТАТЫ: беременные на ПИ не отличались от беременных на МИИ по возрасту, длительности СД1,

срокам госпитализации. Микрососудистые осложнения СД были у 88,2% беременных на МИИ, по сравне-

нию с 72,1% у беременных на ПИ, р=0,02. По частоте пролиферативной ретинопатии группы не различа-

лись (47,8% на МИИ и 50,6% на ПИ), р=0,6. Диабетическая нефропатия ХБПС3а чаще встречалась в группе

беременных на ПИ-18,2% по сравнению с 2,5% на МИИ, р=0,02. HbA1c у беременных на ПИ на протяжении

всей беременности был ниже, чем в группе на МИИ, таблица 1.Сроки родов не различались в группах: при ПИ 37[36;38,2] недель, на МИИ 38[36;38] недель. Роды ранее

37 недели гестации в группе на ПИ у 20,5%, на МИИ 16,5%. Масса плода у беременных на ПИ была несколько

выше, чем на МИИ: 3396,4±822,7г по сравнению 3090,8±609,7г, р=0,06. По частоте макросомии, потреб-

ности в реанимации для новорожденного, выкидышам, частоте кесарева сечения различий в группах

не выявлено.

ВЫВОДЫ: беременные на ПИ вступали в беременность с более низкими показателями HbA1c, чем

на МИИ, различия сохранялись на протяжении всей беременности. Несмотря на лучшую компенсацию

сахарного диабета ПИ не повлияла существенно на исходы беременности, а масса плода была несколько

выше, что встречалось и в других исследованиях. Причины требуют дальнейшего изучения.