bluuebunny/crossref_metadata_2025 huggingface dataset:
First-Line Lenvatinib Plus Pembrolizumab for Hepatocellular Carcinoma: Post Hoc Analysis of Japanese Patients From the Phase 3 LEAP-002 Trial
Authors: Kudo Masatoshi , Ikeda Masafumi , Aikata Hiroshi , Numata Kazushi , Marusawa Hiroyuki , Hosaka Tetsuya , Kato Naoya , Kurosaki Masayuki , Morimoto Manabu , Yamashita Tatsuya , Koga Hironori , Masaki Tsutomu , Yatsuzuka Naoyoshi , Suzuki Masato , Nagao Satoshi , Kaneko Shuichi , Kumada Hiromitsu
Published: November 2024

Introduction: The phase 3 LEAP-002 study (NCT03713593) of advanced hepatocellular carcinoma (HCC) suggested improved antitumor activity of lenvatinib plus pembrolizumab versus lenvatinib alone with manageable safety, although overall survival (OS) and progression-free survival (PFS) did not reach prespecified statistical significance. This post hoc analysis assessed efficacy and safety in Japanese patients.
Methods: Patients with advanced HCC without prior systemic treatment were randomly assigned 1:1 to receive 8 mg (body weight <60 kg) or 12 mg (body weight ≥60 kg) oral lenvatinib once daily plus 200 mg intravenous pembrolizumab or placebo every 3 weeks for up to 35 cycles. Dual primary end points were OS and PFS per RECIST v1.1 by blinded independent central review (BICR). Secondary end points were objective response rate, disease control rate, duration of response, and time to progression per RECIST v1.1 by BICR and safety.
Results: Overall, 80 patients were enrolled in Japan (lenvatinib plus pembrolizumab, n = 39; lenvatinib plus placebo, n = 41). Median time from randomization to database cutoff (June 21, 2022) was 34.1 months (range, 26.9–39.6). Median OS was 31.4 months (95% CI: 21.2–not reached) for lenvatinib plus pembrolizumab and 21.4 months (95% CI: 14.4–25.4) for lenvatinib plus placebo (hazard ratio [HR] = 0.55 [95% CI: 0.31–0.96]). Median PFS for lenvatinib plus pembrolizumab was 10.4 months (95% CI: 6.2–18.5) and 6.5 months (95% CI: 6.0–8.3) for lenvatinib plus placebo (HR = 0.54 [95% CI: 0.32–0.90]). Grade 3 or 4 treatment-related adverse events occurred in 26 patients (67%) in the lenvatinib plus pembrolizumab group and 24 patients (59%) in the lenvatinib plus placebo group.
Conclusion: In Japanese patients enrolled in LEAP-002, findings were consistent with the global population where OS and PFS trended toward improvement; a similar safety profile was observed.
A Secretaria da Agricultura no Plano de Ação do Governo do Estado de São Paulo (1959-1963)
Authors: Aguiar Gabriel Deller de , Camargo Monica Junqueira de
Published: November 2024

Logo após assumir o Governo do Estado de São Paulo em 1959, Carlos Alberto de Carvalho Pinto começa a delinear o que seria uma das mais emblemáticas experiências de planejamento no Brasil, o Plano de Ação do Estado de São Paulo. Ao lado dos investimentos setoriais em justiça, educação e saúde, que viabilizaram obras paradigmáticas da arquitetura paulista, a Secretaria da Agricultura atuou durante essa experiência de planejamento com a proposição de um programa específico para o setor agrícola, o que rendeu um importante acervo documental de mais de 450 obras, que compõem redes infraestruturais para o avanço produtivo. Esse acervo inédito lança luz sobre a trajetória de personagens desconhecidos pela historiografia e atuantes nos quadros técnicos do Estado, além de contribuir para ampliar o debate sobre os horizontes do desenho moderno, apresentando arquiteturas de viéses pragmático e econômico, bem como de caráter certamente pioneiro, ao marcar uma fase de inflexão na arquitetura pública promovida pelo estado de São Paulo.
Desumanização: afinal o que isso tem a ver com a Universidade?
Authors: Battistella Linamara Rizzo
Published: November 2024

Universities have long been considered institutions that promote intellectual growth, critical thinking, and personal development. Nonetheless, beneath the surface, there is a worrying issue of dehumanization that can profoundly impact the well-being of this ecosystem that binds professors, students, and the immense and necessary aggregate of administration staff. Dehumanization refers to the process by which individuals are treated as objects or stripped of their human qualities, leading to a feeling of alienation and disconnection. Exploring the various manifestations of dehumanization in universities and shedding light on their consequences for society is not a new topic. Dehumanization in universities is a pressing issue that requires attention and action. By recognizing the various manifestations of dehumanization and setting up strategies to mitigate their impact, universities can create a more humane and supportive environment for students. Institutions must prioritize the well-being and personal growth of students and professors, ensuring they are not reduced to mere statistics but valued as individuals with unique strengths and aspirations.
Influência da prática de atividade física no desempenho cognitivo de adultos de meia-idade e pessoas idosas: um estudo longitudinal realizado antes e durante a pandemia
Authors: Kwiatkoski Marcelo , Kajiyama Mariana Tiemi , Martins Tatiana Carvalho Reis , Luchesi Bruna Moretti
Published: November 2024

Objective: To analyze the influence of physical activity on the cognitive performance of middle-aged and older adults before and during the pandemic. Methods: Longitudinal and quantitative study, carried out with 200 individuals aged 45 years or older enrolled in Family Health Units in Três Lagoas/MS. The data collection took place in two moments, before the pandemic (2018/19) and during the pandemic (2021). Socio-demographic data, physical activity practice (International Physical Activity Questionnaire - IPAQ) and cognitive performance (Mini-Mental State Examination - MMSE) were evaluated. Data were analyzed using McNemar, chi-square, t-test and Wilcoxon test for paired samples. Results: Regarding the practice of physical activities, 28% of the sample became inactive during the period evaluated, and 12% became active, with a significant difference. There was no difference between participants who became active, became inactive, remained active and remained inactive with regard to sociodemographic characteristics, indicating that the groups are similar. Cognitive performance significantly worsened when comparing the two assessments. When analyzing the groups separately, it was found that the group that became inactive was the only one that had a significantly worse cognitive performance, in the comparison before and during the pandemic. Conclusion: The reduction in the practice of physical activity due to the pandemic in middle-aged and older adults negatively influenced cognitive performance. Individuals who stop practicing physical activities should be the main target for tracking and cognitive monitoring, especially in pandemic periods.
Adesão aos guias e consensos para pessoas com atrofia muscular espinhal tipo 1: prática clínica da fisioterapia motora
Authors: Nascimento Bruna Oliveira do , Barbosa Bruno Amaral , Medeiros Natalia Mariano , Moriyama Cristina Hamamura , Leite Isabela Pessa Anequini , Lima Ana Angélica Ribeiro de
Published: November 2024

Objective: To investigate adherence in the clinical practice of motor physiotherapy to consensuses and guides for people with SMA type 1. Method: This is a quantitative cross-sectional exploratory study carried out with 59 Brazilian physiotherapists with experience in caring for patients with SMA type 1, from the application of a quantitative questionnaire prepared by the authors. Sample characterization data and responses to care are presented using absolute and relative frequency. Percentage adherence was obtained by calculating the number of adherence responses, divided by the total number of physiotherapists and multiplied by 100. Subsequently, stratification was carried out into weak, moderate, strong and very strong adherence. Results: The responses about assessment, objectives and conduct indicated strong or very strong adherence, from more than 69.49% of professionals, but regarding the use of some types of scales, orthoses and equipment, adherence was lower. Conclusion: Physiotherapists strongly adhere to consensus recommendations and guides specifically for assessment, goal development and therapeutic approaches. However, it is still necessary to understand why there was less adherence to recommendations related to the choice of motor scales, types of orthoses and equipment.
A new and a known species of the Taeniacanthidae (Copepoda, Cyclopoida), recovered from Japanese fishes (Actinopterygii)
Authors: Izawa Kunihiko
Published: November 2024

Anchistrotos kojimensis Do & Ho, 1983 is redescribed on the basis of a single female recovered from the original host, Acanthogobius flavimanus (Temminck & Schlegel, 1845) (Perciformes, Gobiidae), and Taeniacanthus uranoscopi sp. nov. is described based on specimens of both sexes recovered from Uranoscopus japonicus Houttuyn, 1782 (Perciformes, Uranoscopidae). The family Uranoscopidae is a new host group for the Taeniacanthidae.
Doubts about Normative Skepticism
Authors: Schueler G. F.
Published: November 2024

The ‘error theory’ holds that all normative claims are false. Of course, if there is any reason to believe the error theory then, since it would be a reason to believe something, that would show the error theory itself to be false. A recent book (Streumer, 2017) tries to block this argument by arguing on the basis of the claim that the error theory itself can’t be believed that there can be no reason to believe it. This is a paradoxical conclusion since it leaves the possibility that the error theory is true even though it is impossible to believe it and we can have no reason to believe it.

In this paper I argue for a different paradox. Even if we can believe the error theory, we are committed to rejecting it, but this still leaves normative skepticism unanswered.
Rural Boy Groups: Awkward (Ga) Dance, Reflexive Gimmick, and the Livestreaming Craze in China
Authors: Wang Huanruo
Published: November 2024

This article examines the recent emergence on Chinese livestreaming platforms of what I call ‘rural boy groups’. Mostly self-employed and self-trained, the members of rural boy groups capitalize on the most accessible resources that they have – their own bodies – to become digital entrepreneurs, instead of following the conventional path as migrant workers or manual laborers in urban cities. Engaging with Sianne Ngai’s concept of the gimmick, the article investigates what makes their performance gimmicky: namely, ‘earthy taste’ (tuwei) aesthetic, ‘awkwardness’ (ga), and atmospheric interaction. It shows that this gimmicky entertainment by rural boy groups simultaneously exposes and exploits the underlying conditions of their labor, such as class divides and platform exploitation, which ends up perpetuating their precarious situation.
Vita Communis Taking a More Secular Shape: Samuel Pufendorf’s Concept of Community Applied by Ernst König to Civic Education in West (Royal) Prussia
Authors: Oseka Matthew
Published: November 2024

The concept of community formulated by Samuel Pufendorf, Protestant philosopher and civil servant, in the 17th century, on the one hand, drew upon the Reformation legacy, and on the other hand, explored a more secular and less confessional approach to this issue. The present paper examines how Ernst König, Protestant scholar and President of the Academic Gymnasia in Thorn and in Elbing, applied Pufendorf’s concept of community to civic education in West Prussia (Royal Prussia). König was diligent in applying Pufendorf’s concept of community to civic education (philosophia / doctrina civilis) as cultivated at the Academic Gymnasia in Thorn and in Elbing where he served as President. He also promoted the idea of civic education in all his ethical writings and made use of Pufendorf’s De officio hominis et civis, working with his students. Likewise, supervising works submitted by his students, König made them familiar with Pufendorf’s thought.
Effect of low velocity impact at different temperatures on hybrid adhesives in aluminium-composite single lap joints
Authors: Yilmaz Musa , Ekrem Mürsel
Published: November 2024

This study aims to investigate the effect of a small stone impact on aluminum composite adhesive joints used in aircraft after exposure to various temperature conditions. In this context, single lap adhesive joints were prepared using 2024-T3 aluminium alloy sheets and 8-layer carbon fiber-reinforced epoxy hybrid composite sheets, with epoxy adhesive applied to the bonding surfaces. In addition, different types of hybrid adhesives were developed by reinforcing pure epoxy adhesive with various ratios (1%, 3% and 5% by weight) of graphene doped and undoped Nylon 6.6 (N6.6) nanofibers produced by electrospinning method to reduce brittleness. Low-velocity impact tests of 1.04 m/s under five different temperatures (−50, −20, 0, 23 and 50°C) were applied to all single lap adhesion joints produced and tensile tests were applied to the non-failed specimens to examine the loading conditions after low-speed impact. It was determined that approximately 1.5 J of the 3 J energy given by the low- velocity impact was absorbed in common in all samples, while the remaining part was returned and some separation occurred within the adhesion area due to the effect of this impact. While the low- velocity post-impact tensile strength of pure epoxy resin was measured as 2230.3 N at 23°C and 585.15 N at −50°C, the highest values were obtained in N6.6 reinforced epoxy adhesive with 1%GNP additive, which was measured as 3206.39 N at 23°C and 641.82 N at −50°C, and increased by 43.7% and 9.6% for 23°C and −50°C, respectively. In addition, the rupture surfaces of the specimens destroyed by the tensile test were examined by scanning electron microscopy (SEM) for damage analysis.
Spanish Translation, Adaptation and Psychometric Analysis of a Short Version of the Intercultural Sensitivity Scale in Chilean Public Workers
Authors: Martínez-Zelaya Gonzalo , Chavez-Herting David , Guglielmetti-Serrano Florencia
Published: November 2024

Chile has been facing socio-cognitive, affective and cultural tensions and changes due to the constant increase of the migrant population in Chile over the last two decades. This means that local public policy workers must interact and achieve effective communication with migrant users living in their territories. Intercultural sensitivity is understood as the affective dimension of intercultural communication. This dimension facilitates the awareness that people differ in their behaviors, perceptions and feelings during intercultural communication processes, promoting acceptance and respect towards these differences. The aim of this paper was to analyze the factor structure, psychometric properties and invariance of the Intercultural Sensitivity scale (Chen & Starosta, 2000) in a sample of Chilean workers. The sample consists of 337 workers from five municipalities in two regions of Chile. The sample has a mean age of 42.8 years (SD = 10.4), and 62.9% report being female. To determine the factor structure, an unweighted least squares (ULS) parameter estimation method was used, which is recommended for relatively small sample sizes, as is the case in this study. The overall structure of the original scale, although showing adequate indicators in a confirmatory factor analysis, presented serious conflicts in the covariance matrix used. Therefore, the 5-factor structure seen in other studies is disconfirmed. Because of this, it was decided to construct an abbreviated version, but reducing the limitations encountered during the validation process. The final result is a 4-dimensional structure, corresponding to four of the original dimensions, with a total of 13 items. The goodness-of-fit indices (CFI, TLI, RMSEA and SRMR) had optimal levels. The Manifest and Subtle Prejudice scale was used for its divergent validity, presenting all the dimensions of the instrument, and its total score, inverse and significant correlations with manifest prejudice, subtle prejudice, and total prejudice, as expected.
Book review: Subhadeep Ray and Gautam Karmakar, Modernist Transitions: Cultural Encounters between British and Bangla Modernist fiction from 1910s to 1950s
Authors: Chaudhuri Rudrani Dasgupta
Published: November 2024

Subhadeep Ray and Gautam Karmakar, Modernist Transitions: Cultural Encounters between British and Bangla Modernist fiction from 1910s to 1950s (New Delhi: Bloomsbury India, 2024), xx + 237pp.
Innovative Game-Based Teaching Methods for Promoting Nursing Students’ Cultural Competence and Attitudes Toward Refugees: An Explanatory Sequential Mixed Study
Authors: Baysal Ebru , Rodriguez-Arrastia Miguel , Roman Pablo
Published: November 2024

Introduction:

Nursing cultural competence is crucial for enhancing the quality of care for refugees. While innovative game-based teaching methods have been used to foster in a wide range of clinical competences, little is known about its use on refugees’ care. This study aims to evaluate the effect of these methods on nursing students’ cultural competence and attitudes toward refugees.

Methodology:

An explanatory sequential mixed design was conducted from March to May 2023.

Results:

One-hundred forty-one nursing students participated. There were no statistically significant differences in total Outgroup Threat Perception Scale and Cultural Competence Assessment Scale scores between the experimental and control groups, pre- or post-intervention. However, students reported increased awareness and empathy for refugee issues.

Discussion:

The study showed that innovative game-based teaching methods effectively increased nursing students’ awareness of health-related issues faced by refugees. It recommends incorporating transcultural nursing courses into curricula and professional training, with updated content on migration and refugee issues.
Satisfaction With Home Care Services and Its Related Factors for Persons With Spinal Cord Injury: A National Community Survey
Authors: Wagner Aylin , Brach Mirjam , Scheel-Sailer Anke , Friedli Manuela , Hund-Georgiadis Margret , Jordan Xavier , Schubert Martin , Gemperli Armin
Published: November 2024

In order to live independently at home, persons with spinal cord injury (SCI) often require professional home care. The role of the care coordinator remains unclear, as it can be fulfilled by the general practitioner or an SCI specialist, as well as by informal caregivers. We aimed to quantify satisfaction with professional home care among persons with SCI living in Switzerland and the association between first contact for care and having an informal caregiver with satisfaction with home care. Measurements were obtained from the national community survey of the Swiss Spinal Cord Injury Cohort Study. Logistic regression was used to determine the association between first contact for care, having an informal caregiver, and satisfaction with home care, adjusted for sociodemographic factors, SCI characteristics, and functional level. Overall satisfaction with professional home care was high, with 84% of participants reporting being either very satisfied or satisfied. Neither first contact for care nor availability of an informal caregiver was statistically significantly associated with satisfaction. The results showed that women (odds ratio 0.56, 95% CI 0.31-1.00) were statistically significantly less satisfied with home care than men. There was also variation by language region. These findings highlight the importance of providing personalized and culturally sensitive home care that takes into account the diverse preferences and expectations of persons with SCI, especially regarding gender and language region.
Water, Water, Everywhere… but for Whom?
Authors: Purkayastha Bandana , Roy Rianka
Published: November 2024

Bandana Purkayastha and Rianka Roy on scarcity and supply in a thirsty world.
Sequential endoscopic treatment for esophageal and gastric variceal bleeding significantly reduces patient mortality and rebleeding rates
Authors: Tao Kong , Shan Xu , He Binbo , Zeng Qingyu , Wu Meirong , Jie Liu , Yuan Wenfeng , Dan Hu , Tao Zhang
Published: November 2024

Background:

Esophageal-gastric variceal bleeding (EGVB) is a serious complication in patients with liver cirrhosis, characterized by high mortality and rebleeding rates. The effect of sequential endoscopic therapy on patient mortality and rebleeding rates remains unclear.

Objectives:

This study aimed to evaluate the effects of sequential endoscopic therapy on mortality and rebleeding rates in patients with EGVB.

Design:

In this single-center retrospective study, 373 hospitalized cases of EGVB caused by liver cirrhosis, collected between November 2019 and November 2023, were divided into four groups according to different treatment methods: a sequential endoscopy group, emergency endoscopy group, emergency endoscopy plus transjugular intrahepatic portosystemic shunt (TIPS) group and control group.

Methods:

Mortality and rebleeding rates were compared among the four groups using statistical analyses.

Results:

The mortality and rebleeding rates of the sequential endoscopy group (3.7% and 19%, respectively) were significantly lower than those of the emergency endoscopy (22% and 36%, respectively), emergency endoscopy plus TIPS (33% and 28%, respectively), and control groups (33% and 51%, respectively) ( p = 0.013 and p = 0.013, respectively).

Conclusion:

Sequential endoscopic therapy may significantly reduce the mortality and rebleeding rates of patients with EGVB compared to other conventional treatment strategies. The findings of the study could help develop approaches benefiting EGVB treatment.
Analyses of Xenorhabdus griffiniae genomes reveal two distinct sub-species that display intra-species variation due to prophages
Authors: Heppert Jennifer K. , Awori Ryan Musumba , Cao Mengyi , Chen Grischa , McLeish Jemma , Goodrich-Blair Heidi
Published: November 2024

Background

Nematodes of the genus Steinernema and their Xenorhabdus bacterial symbionts are lethal entomopathogens that are useful in the biocontrol of insect pests, as sources of diverse natural products, and as research models for mutualism and parasitism. Xenorhabdus play a central role in all aspects of the Steinernema lifecycle, and a deeper understanding of their genomes therefore has the potential to spur advances in each of these applications.

Results

Here, we report a comparative genomics analysis of Xenorhabdus griffiniae, including the symbiont of Steinernema hermaphroditum nematodes, for which genetic and genomic tools are being developed. We sequenced and assembled circularized genomes for three Xenorhabdus strains: HGB2511, ID10 and TH1. We then determined their relationships to other Xenorhabdus and delineated their species via phylogenomic analyses, concluding that HGB2511 and ID10 are Xenorhabdus griffiniae while TH1 is a novel species. These additions to the existing X. griffiniae landscape further allowed for the identification of two subspecies within the clade. Consistent with other Xenorhabdus, the analysed X. griffiniae genomes each encode a wide array of antimicrobials and virulence-related proteins. Comparative genomic analyses, including the creation of a pangenome, revealed that a large amount of the intraspecies variation in X. griffiniae is contained within the mobilome and attributable to prophage loci. In addition, CRISPR arrays, secondary metabolite potential and toxin genes all varied among strains within the X. griffiniae species.

Conclusions

Our findings suggest that phage-related genes drive the genomic diversity in closely related Xenorhabdus symbionts, and that these may underlie some of the traits most associated with the lifestyle and survival of entomopathogenic nematodes and their bacteria: virulence and competition. This study establishes a broad knowledge base for further exploration of not only the relationships between X. griffiniae species and their nematode hosts but also the molecular mechanisms that underlie their entomopathogenic lifestyle.
Correlation between intestinal microbiota and urolithin metabolism in a human walnut dietary intervention
Authors: Liu Huijia , Birk John W. , Provatas Anthony A. , Vaziri Haleh , Fan Nuoxi , Rosenberg Daniel W. , Gharaibeh Raad Z. , Jobin Christian
Published: November 2024

This study is to investigate the relationship between the intestinal microbiota and urine levels of the ellagic acid-derived polyphenols, the urolithins, in a cohort of subjects following a three-week walnut dietary intervention. We longitudinally collected fecal and urine samples from 39 subjects before and after walnut consumption (2 oz per day for 21 days). 16S RNA gene sequencing was performed on fecal DNA to study the association between microbiota composition and the levels of nine urolithin metabolites, which were measured using UHPLC/Q-TOF–MS/MS. Fecal microbial composition was found to be significantly different between pre- and post-walnut intervention (beta diversity, FDR-p = 0.018; alpha diversity, p = 0.018). Roseburia, Rothia, Parasutterella, Lachnospiraceae UCG-004, Butyricicoccus, Bilophila, Eubacterium eligens, Lachnospiraceae UCG-001, Gordonibacter, Paraprevotella, Lachnospira, Ruminococcus torques, and Sutterella were identified as the 13 most significantly enriched genera after daily intake of walnuts. We observed 26 genera that were significantly associated with 7 urolithin metabolites, with 22 genera positively correlating after walnut supplementation (FDR-p ≤ 0.05). PICRUSt analysis showed that several inferred KEGG orthologs were associated with 4 urolithin metabolites after walnut intake. In this study, we found that walnut supplementation altered urolithin metabolites, which associates with specific changes in bacterial taxa and inferred functional contents.
Factors affecting emergency medical dispatchers decision making in stroke calls – a qualitative study
Authors: Jamtli Bjørn , Svendsen Edel Jannecke , Jørgensen Trine Møgster , Kramer-Johansen Jo , Hov Maren Ranhoff , Hardeland Camilla
Published: November 2024

Objectives

Emergency Medical Communication Centers (EMCC) have a key role in the prehospital chain-of-stroke-survival by recognizing stroke patients and reducing prehospital delay. However, studies on EMCC stroke recognition report both substantial undertriage and overtriage. Since mis-triage at the EMCC challenges the whole chain-of-stroke-survival, by occupying limited resources for non-stroke patients or failing to recognize the true stroke patients, there is a need to achieve a more comprehensive understanding of the dispatchers’ routines and experiences. The aim of this study was to explore factors affecting EMCC dispatcher’s decision-making in stroke calls.

Materials and methods

A qualitative exploratory study, based on individual semi-structured interviews of 15 medical dispatchers from EMCC Oslo, Norway. Interviews were conducted during August and October 2022 and analyzed using the principles of thematic analysis.

Results

We identified four themes: [1] Pronounced stroke symptoms are easy to identify [2]. Non-specific neurological symptoms raise suspicion of acute stroke but are difficult to differentiate from other medical conditions [3]. Consistent use of the Criteria Based Dispatch (CBD) protocol may increase EMCC overtriage [4]. Contextual conditions at EMCC can affect dispatchers’ decision-making process and the ability for experiential learning.

Conclusions

Medical dispatchers at the EMCC perceive vague and non-specific stroke symptoms, such as dizziness, confusion or altered behaviour, challenging to differentiate from symptoms of other less time-critical medical conditions. They also perceive the current CBD protocol in use as less supportive in assessing such symptoms. High workload and strict EMCC response time interval requirements hinder the gathering of essential patient information and the ability to seek guidance in cases of doubt, potentially exacerbating both EMCC undertriage and overtriage. The absence of feedback loops and other strategies for experiential learning in the EMCC hampers the medical dispatcher’s ability to evaluate their own assessments and improve dispatch accuracy.
The relationship and heterogeneity of family participation and social participation among older adults: from an intersectionality perspective
Authors: Liu Yan
Published: November 2024

Participation in late life has been studied as a component of active aging. To effectively promote late-life participation, the study explored the relationship and heterogeneity between two forms of participation among older adults—familial participation and societal participation. This paper utilizes data from the 2020 China Longitudinal Aging Society Survey (CLASS) to examine the relationship between familial participation and societal participation among older Chinese adults. Linear regression results indicate that familial participation can facilitate societal participation among older adults. The MAIHDA model results suggest variations in familial and societal participation among older adults in different social positions. Specifically, older women with higher socioeconomic status and better health have higher levels of familial and societal participation, whereas older men with lower socioeconomic status and health have the lowest levels of participation. Socioeconomic status is the most significant factor contributing to participation disparities among different groups, and older adults with disadvantaged health status experience a compounding effect of multiple disadvantages. The research findings hold significant implications for formulating policies aimed at enhancing the participation of marginalized older adults, ultimately contributing to the realization of active aging.
“There’s no us vs. them, it’s just us”: a creative approach to centring lived experience within the AVATAR2 trial
Authors: Owrid Oliver , Richardson Leonie , Allan Stephanie , Grant Amy , Gogan Sarah , Hamilton Nicholas , Yanga Francis , Sirey Nicola , Syrett Suzy , Garety Philippa , Craig Tom , Clancy Moya , Pinfold Vanessa , Miller Lucy , Ward Thomas , Edwards Clementine
Published: November 2024

This article describes a Patient and Public Involvement (PPI) led creative workshop space held within a clinical trial of a talking therapy for distressing voices (AVATAR2). PPI adds significant value to clinical research and ensures the work is meaningful to patients and their supporters. However, known issues include tokenism, a common power imbalance between PPI colleagues and researchers and a lack of opportunity for PPI to shape the research. PPI has played a key role at all stages of the AVATAR2 trial, including design, recruitment of staff and participants, data collection, analysis, and dissemination. An active and creative group of people was established, with over 30 members flexibly involved across all four sites. PPI group members were from diverse backgrounds, with lived experience of mental health conditions and recovery, and including carers. During this work, PPI colleagues identified that they would value a creative space which would help to promote the study but extend beyond an exclusive focus on trial deliverables. A regular creative workshop was established to support PPI colleagues in their creative work, including material such as poetry, blogs, art and podcasts. PPI colleagues and trial staff have cowritten a reflective piece to share their experiences on the impact of the creative workshops, organised into four themes. We found the workshops to be a powerful tool for forging relationships among trial staff and PPI colleagues, while also fostering personal development. We reflected on how the workshops built up the confidence of attendees and supported demanding trial activities such as public speaking. Finally, we discussed the impact of the workshops on wider trial culture, by upholding the values of the team and challenging the status quo.
Socioeconomic deprivation and perinatal anxiety: an observational cohort study
Authors: Best Catherine , Ayers Susan , Sinesi Andrea , Meades Rose , Cheyne Helen , Maxwell Margaret , McNicol Stacey , Williams Louise R , Alderdice Fiona , Jomeen Julie , Shakespeare Judy ,   MAP Study Team, Constantinou Georgina , Gilbody Simon , Hann Agnes , Holly Jennifer , Howard Grace , Hutton Una , Leonard Rachael , Salmon Debra , Uddin Nazihah , Walker James , White Anna , Yuill Cassandra
Published: November 2024

Background

Women from areas of social deprivation and minority ethnic groups are more likely to experience poor physical health and have higher rates of mental health problems relative to women from less socially disadvantaged groups. However, very little research has examined this in relation to perinatal anxiety. The current study aims to determine prevalence, risk factors and desire for treatment for perinatal anxiety in three regions of the UK with diverse regional characteristics.

Methods

Women completed measures of anxiety in early, mid-, late-pregnancy and postpartum. Participants were included from three regions of the UK: Region 1 = North East England & North Cumbria n = 512; Region 2 = London North Thames n = 665; Region 3 = West Midlands n = 705.

Results

Prevalence of perinatal anxiety was lower in Region 1 (OR 0.63 95% CI 0.45 to 0.89) and Region 2 (OR 0.72 95% CI 0.52 to 0.98) relative to Region 3. Analysis showed the effect of neighbourhood socioeconomic deprivation on perinatal anxiety differed by region. In more affluent regions, living in a deprived neighbourhood had a greater impact on perinatal anxiety than living in a deprived neighbourhood in a deprived region. Other factors associated with risk of anxiety in the perinatal period included physical health problems and identifying as being from ‘mixed or multiple’ ethnic groups.

Conclusions

Neighbourhood deprivation relative to regional deprivation is a better predictor of perinatal anxiety than either regional deprivation or neighbourhood deprivation alone. Women of mixed ethnic backgrounds and women with physical health problems may warrant more attention in terms of screening and support for perinatal anxiety. Self-reported desire for treatment was found to be low.
Why are organisational approvals needed for low-risk staff studies in the UK? Procedures, barriers, and burdens
Authors: Dunleavy Lesley , Board Ruth , Coyle Seamus , Dickman Andrew , Ellershaw John , Gadoud Amy , Halvorsen Jaime , Hulbert-Williams Nick , Lightbody Liz , Mason Stephen , Nwosu Amara Callistus , Partridge Andrea , Payne Sheila , Preston Nancy , Swash Brooke , Taylor Vanessa , Walshe Catherine
Published: November 2024

Background

Health care staff should be given the opportunity to participate in research, but recruiting clinicians via their employing organisation is not always straightforward or quick in the UK. Unlike many countries outside the UK, very low-risk survey, interview or focus group studies can be subject to some of the same governance approval procedures as interventional studies. An exemplar study carried out by the NIHR funded Palliative Care Research Partnership North West Coast is used to highlight the challenges still faced by researchers and health care organisations when setting up a low-risk staff study across multiple NHS and non-NHS sites.

Methods

A study database was created and information was collected on the first point of contact with the clinical site, Health Research Authority (HRA) and local organisational approval times, time from trust or hospice agreement to the first survey participant recruited and overall site survey recruitment numbers. Descriptive statistics (median, range) were used to analyse these data.

Results

Across participating NHS trusts, it took a median of 147.5 days (range 99–195) from initial contact with the local collaborator to recruitment of the first survey participant and hospice sites mirrored these lengthy timescales (median 142 days, range 110–202). The lengthiest delays in the HRA approval process were the period between asking NHS trusts to assess whether they had capacity and capability to support the research and them granting local agreement. Local approval times varied between trusts and settings which may indicate organisations are applying national complex guidance differently.

Conclusions

There is the potential for HRA processes to use more NHS resources than the research study itself when recruiting to a low-risk staff study across multiple organisations. There is a need to reduce unnecessary administrative burden and bureaucracy to give clinicians and research staff more opportunities to participate in research, and to free up NHS R&D departments, research nurses and clinicians to focus on more demanding and patient focused research studies. Hospices need standardised guidance on how to assess the risk of being involved in low-risk research without adopting the unnecessarily complex systems that are currently used within the NHS.
Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis
Authors: Baatiema Leonard , Sanuade Olutobi Adekunle , Kretchy Irene Akwo , Okoibhole Lydia , Kushitor Sandra Boatemaa , Haghparast-Bidgoli Hassan , Awuah Raphael Baffour , Amon Samuel , Mensah Sedzro Kojo , Grijalva-Eternod Carlos S. , Adjaye-Gbewonyo Kafui , Antwi Publa , Jennings Hannah Maria , Arhinful Daniel Kojo , Aikins Moses , Koram Kwadwo , Blandford Ann , Fottrell Edward
Published: November 2024

Background

The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana.

Methods

This was explanatory mixed methods research which started with a document review of Ghana’s WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically.

Results

Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana’s implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care.

Conclusion

Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.
Insecticide-impregnated dog collars for the control of visceral leishmaniasis: evaluation of the susceptibility of field Lutzomyia longipalpis populations to deltamethrin
Authors: de Sousa Félix de Lima Mayra , Albuquerque e Silva Rafaella , de Almeida Rocha Douglas , de Oliveira Mosqueira Gabriela , Gurgel-Gonçalves Rodrigo , Takashi Obara Marcos
Published: November 2024

Background

Visceral leishmaniasis (VL) is a zoonotic disease caused by Leishmania infantum and transmitted by the sand fly Lutzomyia longipalpis. Dogs are the major domestic reservoir of L. infantum. To prevent the spread of the disease, dog collars impregnated with 4% deltamethrin have been effectively used in VL endemic areas. However, this approach may contribute to the emergence of insecticide resistance in sand flies. Therefore, it is important to characterize the susceptibility of different populations of Lu. longipalpis to deltamethrin in areas where insecticide-impregnated dog collars are used.

Methods

Six field sand fly populations from Brazil were exposed to deltamethrin in CDC bottle bioassays at the diagnostic doses (DD) of 21.9 μg/bottle and 30 μg/bottle. For the dose–response (DR) experiments, doses of 1, 3, 5, 7, 9 and 11 μg/bottle of deltamethrin were used to impregnate bottles; control group bottles were impregnated with acetone only. Each bottle contained an average of 20 sand flies, both male and female, and they were exposed to either deltamethrin or acetone for 60 min.

Results

Based on the DD of 21.9 μg/bottle, three populations were susceptible to deltamethrin. In contrast, two populations collected from the states of Ceará and Minas Gerais exhibited mortality rates of 94.9% and 95.7%, indicating possible resistance, and one population from the state of Ceará showed resistance, with a mortality rate of 87.1%. At the DD of 30 μg/bottle, two populations from the states of Ceará and Piauí showed possible resistance, while the other four populations were susceptible. The resistance ratio (RR50) ranged from 2.27 to 0.54, and RR95 ranged from 4.18 to 0.33, indicating a low resistance intensity.

Conclusions

This study established a DD for Lu. longipalpis using the CDC bottle bioassay. We found that Lu. longipalpis populations in three Brazilian states where insecticide-impregnated dog collars were used for VL control were susceptible to deltamethrin. However, one population in Ceará State was classified as resistant to deltamethrin. These results contribute to the current knowledge on sand fly resistance and surveillance, and highlight the need for a better understanding of the resistance mechanisms of Lu. longipalpis in areas where insecticide-impregnated dog collars have been widely used.

Graphical Abstract
Endoparasites of peritoneal organs and skeletal muscles of the European wildcat (Felis silvestris) in Germany
Authors: Bisterfeld Katrin , Raulf Marie-Kristin , Waindok Patrick , Springer Andrea , Lang Johannes , Lierz Michael , Siebert Ursula , Strube Christina
Published: November 2024

Background

For several decades, the European wildcat (Felis silvestris) has gradually been returning to the forests of Germany, mainly in the central and southwestern regions. To increase the knowledge about this threatened species, the endoparasite status of dead found specimens from Germany was surveyed.

Methods

A total of 118 wildcats were examined for endoparasites in peritoneal organs and skeletal muscles. Owing to decomposition or incomplete carcasses, 104 gastrointestinal tracts (stomachs and intestines), 101 livers with gallbladders, 99 urinary bladders, as well as kidneys of 95 and skeletal muscles of 112 specimens were available for examination. All detected parasites were identified morphologically to genus or species level, followed by molecular examinations of one to ten specimens of each parasite species.

Results

Overall endoparasite prevalence in peritoneal organs was 99.0% (103/104). Among the 99.0% (103/104) infected gastrointestinal tracts, the most frequent species were Toxocara cati (95.2% [99/104]), Hydatigera kamiyai (84.6% [88/104]), Mesocestoides litteratus (69.2% [72/104]), Strongyloides spp. (58.7% [61/104]), Cylicospirura petrowi (37.5% [39/104]), Ancylostoma tubaeforme (31.7% [33/104]), Capillaria putorii (24.0% [25/104]), and Echinococcus multilocularis (18.3% [19/104]). In 77.8% (77/99) of the urinary bladders, Capillaria plica and/or Capillaria feliscati were detected. Moreover, the liver fluke Metorchis bilis occurred in 2.0% (2/101) of the livers, and roundworm larvae (presumably Toxocara spp.) were detected in 33.0% (37/112) of the muscle samples.

Conclusions

These results show a broad spectrum of endoparasite species infecting European wildcats in Germany. It might be assumed that some of the endoparasites could pose a risk to domestic cats (Felis catus) and humans through spillover events, or may be transmitted from domestic cats to the free-ranging population, posing a potential risk to wildcats.

Graphical Abstract
Predicting life-threatening hemoptysis in traumatic pulmonary parenchymal injury using computed tomography semi-automated lung volume quantification
Authors: Tang Wen-Ruei , Chang Chao-Chun , Wu Chen-Yu , Wang Chih-Jung , Yang Tsung-Han , Hung Kuo-Shu , Liu Yi-Sheng , Lin Chia-Ying , Yen Yi-Ting
Published: November 2024

Objectives

Chest computed tomography (CT) can diagnose and assess the severity of pulmonary contusions. However, in cases of severe lung contusion, the total lung volume ratio may not accurately predict severity. This study investigated the association between life-threatening hemoptysis and chest CT imaging data on arrival at the emergency department in patients with pulmonary contusions or lacerations due to blunt chest injury.

Methods

The records of 277 patients with lung contusions or lacerations treated at a trauma center between 2018 and 2022 were retrospectively reviewed. The ratio of the local lung contusion volume to lobe volume in each lobe was calculated from chest CT images. The maximal ratio in the Hounsfield unit (HU) range was defined as the highest ratio value within the HU range among five lobes.

Results

The median patient age was 41 years, and 68.6% were male. Life-threatening hemoptysis occurred in 39 patients. The area under the receiver operating characteristic curve for the maximal ratio at −500 HU to 100 HU was 96.52%. The cutoff value was 45.49%. Multivariate analysis showed a high maximal chest CT ratio ≥ 45.49% at −500 HU to 100 HU (adjusted odds ratio [aOR]: 104.66, 95% confidence interval [CI]: 21.81–502.16, p < 0.001), hemopneumothorax (aOR: 5.18, 95% CI: 1.25–21.47, p = 0.023), and chest abbreviated injury scale (AIS, aOR: 5.58, 95% CI: 1.68–18.57, p = 0.005) were associated with life-threatening hemoptysis.

Conclusions

Maximal chest CT ratios ≥ 45.49% at −500 HU to 100 HU, hemopneumothorax, and high chest AIS scores are associated with life-threatening hemoptysis in patients with blunt chest trauma.

Critical relevance statement

The present study provides an objective index derived from chest CT images to predict the occurrence of life-threatening hemoptysis. This information helps screen high-risk patients in need of more intensive monitoring for early intervention to improve outcomes.

Key Points

Emergency department CT helps predict life-threatening hemoptysis in patients with lung contusions.

Maximal CT ratios ≥ 45.49% (−500 HU to 100 HU, either lung lobe) are associated with life-threatening hemoptysis.

High chest abbreviated injury scale scores and hemopneumothorax also predict life-threatening hemoptysis.

Graphical Abstract