bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic 6E analysis of a novel power and freshwater production based on integration of combined cycle power plant-MED-TVC-RO-STC-ORC systems
Authors: Movasaghi Gilani Mahdi , Torabi Azad Masoud , Khoshgoftar manesh Mohammad Hassan , Lary Kamran , Salehi Gholamreza
Published: December 2023

In this study, a novel power and potable aqua creation system has been proposed based on a combination of the gas cycle, steam cycle, multieffect desalination (MED), reverse osmosis (RO) desalination units, organic Rankine cycle (ORC), and the solar thermal collector (STC). In this regard, the Energy, Exergy, Exergoeconomic, Exergoenvironmental, Emergoeconomice, and EmergoEnvironment (6E) assessments and further dynamic analysis are executed on the novel suggested system. Dynamic analysis helps us to understand the system performance at different times. The validation has been performed based on THERMOFLEX simulation and base references with high accuracy. The results show that the proposed system produces 60 and 73.61 kg/s of freshwaters, respectively. The gas cycle generates 25 MW of power standing alone, and adding ORC as the bottom cycle can generate 4.89 MW extra power using the excess energy of the gas cycle, which elevates the system's thermal efficiency from 36.51 to 43.27%. Using a thermal vapor compressor (TVC) in the MED unit reduces the demand for motive steam from 12.59 to 5.38 kg/s, increasing this unit's performance ratio (PR) from 4.76 to 11.15. Integrating the system with the STC improves the system's thermal efficiency from 42.82 to 43.27 percent.
Impact of changes to invite methodology on equality of access to the National Breast Screening Programme in the South of England
Authors: Westrop Samantha J , Thomas Ashley , Williams Alun , Johnson Fiona , Liao Hui , Edlin Kirsty , Burgess Karen , Kearins Olive , Maclean Rebecca
Published: December 2023

In response to the COVID-19 pandemic, a temporary change in policy was implemented in 2020. Breast screening services in England were advised to change from timed appointments to an open invitation for invitees to contact the service and arrange an appointment. This change to invitation methodology had potential benefits and risks including impacting inequalities in uptake. Qualitative data were collected by online questionnaire from 23 service providers and routinely collected quantitative uptake data were analysed to investigate the impact of open invitations on the National Programme in the South of England. Office for National Statistics and general practitioner (GP) practice profile data enabled the modelling of sociodemographic characteristics of breast screening invitees at each GP practice. Most services changed to open invitations (17/23), 82% of which altered administrative capacity and/or procedures to accommodate this change. Logistic benefits were reported including a more consistent flow of participants, fewer long gaps and fewer wasted slots. The change to open invitations was associated with a 7.2% reduction in the percentage of participants screened, accounting for participant sociodemographics and historical screening provider uptake. The inequality in screening uptake experienced by participants of minority ethnic background was exacerbated by the change to open invitations. Open invitations, whilst affording logistic benefits in an unprecedented pandemic era, were associated with reduced overall uptake and exacerbation of existing health inequality experienced by women of minority ethnic background. The broader impact on services highlighted the need for sustainability of measures taken to accommodate such operational changes.
A file audit of gym usage in an Australian private inpatient psychiatric hospital
Authors: Lakeman Richard , Moloney Andrew , Emeleus Mary
Published: December 2023

Objective

This study aimed to determine the extent to which people admitted to a private psychiatric inpatient unit access and utilise the gymnasium and individualised coaching with an exercise physiologist (EP).

Methods

An audit of the medical record of 100 consecutive discharges and 60 individuals referred to an EP during the audit period was undertaken. Selected demographic information, physical health status, psychiatric diagnosis and routinely collected outcome data were extracted from files.

Results

Twenty-four percent of people discharged from the hospital had documentary evidence of having attended the gym. These people were noted to have used the gym regularly and had an exercise prescription documented on discharge. Those with substance use disorder were more likely to use the gym than those diagnosed with an affective disorder. There were no significant differences in outcomes between those who were noted to exercise and those who did not.

Conclusion

Those who may most benefit from coaching around exercise in the context of hospital admission are not presently the individuals most likely to be referred to an EP. Standardised procedures for assessment, referral, exercise prescription and ongoing monitoring of activity and outcomes are recommended across the care continuum.
A Retrospective Comparison of Electrocardiographic Parameters in Ketamine and Tiletamine-Zolazepam Anesthetized Indian Rhesus Monkeys (Macaca mulatta)
Authors: Bhatt Laxit K. , Shah Chitrang R. , Patel Shital D. , Patel Sudhir R. , Patel Vipul A. , Patel Rajesh J. , Joshi Nikita M. , Shah Niraj A , Patel Jitendra H. , Dwivedi Pankaj , Sundar Rajesh , Jain Mukul R.
Published: December 2023

Electrocardiographic evaluation is performed in rhesus monkeys to establish the cardiovascular safety of candidate molecules before progressing to clinical trials. These animals are usually immobilized chemically by ketamine (KTM) and tiletamine-zolazepam (TZ) to obtain a steady-state heart rate and to ensure adequate human safety. The present study aimed to evaluate the effect of these anesthetic regimens on different electrocardiographic parameters. Statistically significant lower HR and higher P-wave duration, RR, QRS, and QT intervals were observed in the KTM-anesthetized group in comparison to TZ-anesthetized animals. No significant changes were noticed in the PR interval and p-wave amplitude. Sex-based significance amongst these parameters was observed in male and female animals of TZ- and KTM-anesthetized groups. Regression analysis of four QTc formulas in TZ-anesthetized rhesus monkeys revealed that QTcNAK (Nakayama) better corrected the QT interval than QTcHAS (Hassimoto), QTcBZT (Bazett), and QTcFRD (Fridericia) formulas. QTcNAK exhibited the least correlation with the RR interval (slope closest to zero and r = .01) and displayed no statistical significance between male and female animals. These data will prove useful in the selection of anesthetic regimens for chemical restraint of rhesus monkeys in nonclinical safety evaluation studies.
Surgical Repair for Rhomboid Major Tear: A Case Report
Authors: Furuhata Ryogo , Yamaguchi Sakura , Tanji Atsushi
Published: December 2023

Rhomboid tears are a rare type of tendon injury. Although rhomboid tears can present with periscapular pain and scapular dyskinesis, their clinical presentations and diagnostic procedures remain largely unknown. In addition, few reports are available on the surgical treatment of rhomboid tears. We report a rhomboid repair case for a complete rhomboid major tear diagnosed based on physical findings and magnetic resonance imaging (MRI). A 28-year-old man presented with right medial scapular pain that appeared after carrying a heavy box. He had right medial scapular tenderness, with worsening pain during shoulder joint elevation. The inferior pole of the right scapula was lateral compared with the left scapula, and a dent was observed on the medial scapula. Magnetic resonance imaging revealed a tear in the right rhomboid major at its insertion, with muscle retraction. Two months of conservative treatment failed to improve his symptoms; therefore, we performed a surgical repair. We created the bone holes on the medial border of the scapula and repaired the torn rhomboid major muscle to its insertion using the Krackow stitch technique. He had a satisfactory functional outcome without postoperative retearing. This case report provides new information on the clinical presentation and surgical procedure of rhomboid major tears and the first MRI finding that depicts a rhomboid tear clearly. In cases of rhomboid tears, persistent medial scapular pain and winging scapula can be clinically problematic, requiring surgery. In addition to physical findings, a periscapular MRI is useful in diagnosing rhomboid tears. The results of this case study suggest that surgical repair using locking sutures is an option for treating complete rhomboid tears with muscle retraction.
Experiences of Introduction to and Participation in Quad Rugby: A Grounded Theory Approach
Authors: Ali Darkhishan , Rider John V.
Published: December 2023

Individuals with spinal cord injuries (SCI) report low physical activity participation levels. A lack of physical activity can lead to increased secondary health concerns, such as cardiovascular, psychological, genitourinary, and musculoskeletal complications. Adaptive sports, such as quad rugby, allow individuals with SCI to maintain appropriate physical activity levels. This grounded theory study aimed to explore the experiences of individuals learning about and participating in quad rugby after SCI in the United States. Twelve participants from seven states across the United States completed semistructured interviews. Four themes emerged: benefits of quad rugby participation, enabling quad rugby participation, barriers to quad rugby participation, and motivation for continued participation in quad rugby. This study highlights the importance of an early introduction to quad rugby after SCI and the biopsychosocial benefits of participation. Occupational therapy practitioners can address barriers identified in this study through innovative approaches and advocacy efforts.
Pediatric Complex Regional Pain Syndrome and Occupational Therapy Intervention: A Scoping Review
Authors: Tay Monica C. , Rider John V.
Published: December 2023

Complex regional pain syndrome (CRPS) is an increasingly recognized pain condition in the pediatric population. Occupational therapy (OT) is a crucial component of a multidisciplinary approach to treating pediatric CRPS. Yet, there is limited evidence detailing these OT interventions. This review aimed to explore the existing literature on OT interventions and delivery methods for pediatric CRPS. We performed a scoping review of peer-reviewed articles that included pediatric participants with CRPS with no limitation on publication date. Most of the 11 included studies described OT interventions that addressed pain, functional disability, motor and sensory function, social participation, and psychological well-being. Interventions included sensory reeducation programs, exercises, functional use of affected extremities, psychoeducation, and client and family education. To facilitate engagement in meaningful occupations, OT practitioners treating pediatric CRPS should provide evidence-based interventions and age-appropriate client education and include caregivers in the care plan.
The “3 Ps” of EmPowerment, Partnership and Protection - Stakeholder Perceptions of Beneficial Outcomes of Engagement in HIV Prevention Trials
Authors: Wilkinson Abigail , Thabethe Siyabonga , Salzwedel Jessica , Slack Catherine
Published: December 2023

Background: Stakeholder engagement is increasingly recognized as a key component of ethical research in leading ethics guidelines. Ethics commentators have also argued that engagement has several beneficial outcomes for the field. Aim: This paper reports on the beneficial outcomes of stakeholder engagement in HIV prevention trials as perceived by stakeholders in the field. Method: We conducted 28 interviews between 2019 and 2021 with interviewees from various stakeholder groups in 12 countries and used thematic analysis to analyze the transcripts. Findings: We found three major themes - namely emPowerment where engagement is perceived to empower stakeholders, Partnerships where engagement is perceived to build equitable relationships and Protections where engagement is perceived to strengthen protections for participants and community stakeholders and to improve science. Conclusions: These findings map closely onto beneficial outcomes envisaged by ethics guidelines, however, the relationship between outcomes seen as beneficial deserves further exploration.
Fighting against ‘Apology of Fascism’: Origins and Contradictions of the Italian Approach to Militant Democracy
Authors: Martini Andrea
Published: December 2023

Although Italy was one of the first European countries to tolerate the existence of a fascist party, the democratic governments of its immediate postwar engaged in a genuine and important reflection on the means to counter the re-emergence of fascism. Thus Italy too, like its European counterparts, sought to conceive of itself as a militant democracy. This article aims to illuminate its efforts and its approach, and also to cast light on the evident limits and contradictions. Looking at the Italian case while observing how other European countries tackled the re-emergence of fascism in the same period will make clear the intrinsic difficulties of turning a democracy into a militant one only a short time after the fall of an authoritarian regime and in the aftermath of an inevitably problematic transition.
From Bitter Enemies to Political Partners: Shifting Viewpoints of Slovenian Clericals and Liberals during World War I
Authors: Ivašković Igor
Published: December 2023

The article examines Slovenian liberal and clerical magazines to analyse the adaptations of the political narratives of the two main Slovenian political parties from the assassination in Sarajevo in 1914 until early in the final stage of World War I in March 1918. Slovenian clericals, who gathered together in the Slovenian People's Party, reacted to the killings in Sarajevo by adopting a strong pro-Habsburg and anti-Serbian position. Their magazines even called for a military invasion of Serbia. In comparison, their primary political competitors on Slovenian soil, the Slovenian liberals congregated in the National Progressive Party and condemned the act of assassination, yet they were critical of the Austrian anti-Serbian policy for having escalated the war. These two Slovenian political parties were also divided on the issue of the future envisioned for the Slovenian nation within South Slavic state formations. The clericals pressed for realization of the trialist idea, which forecast a Croatian–Slovenian state unit within the Habsburg Monarchy with its centre in Zagreb. The liberals, in contrast, dreamed of a larger South Slavic state that would bring all South Slavs together and have its centre in Serbia. The development of the war, chiefly the Entente's foreseeable victory, the threat of implementation of the London Pact, and the fact that Austrian Germans characterized all emancipatory Slovenian political movements as an anti-state element, all worked to force Slovenian clericals to cooperate with their pre-war enemies. The overriding aim was for them to retain their leading position among Slovenians by formally cooperating with the liberal stream, including taking over part of the liberal political strategy, in order to ensure that it was in the best possible position in the South Slavic state at end of the war.
Enhancing knowledge and practices toward Vitamin D deficiency through implementing awareness programs among medical science female students
Authors: Alhuthali Hayaa M. , Alzahrani Hind A. , Ataya Eman F. , Almehmadi Mazen , Alsaiari Ahad Amer , Alrehaili Amani A. , Bakhuraysah Maha M. , Alsaeedi Fouzeyyah Ali , Alsalmi Ohud , Altalhi Wafaa , Gharib Amal F. , Ramadan Eman N.
Published: December 2023

Objectives

Vitamin D (VD) deficiency has widespread prevalence worldwide. In Saudi Arabia, it is the most common form of public health problem with regard to malnutrition. This is because there is insufficient knowledge about negative VD practices. The current study aimed to evaluate VD deficiency knowledge and practices before and after the implementation of an awareness programme.

Methods

A quasi-experimental design was used for the study, which was conducted at the College of Applied Medical Science at Al-Baha University. A convenience sample encompassing all the female students in the Public Health Department was used ( n = 83 students). Two tools were used for data collection; the first was an intervention questionnaire to assess the students’ knowledge, and the second was a questionnaire concerned with students’ practices in preventing VD deficiency.

Results

The mean age of the students was 20.75 ± 7.85 years. Of the study’s subjects, 45.8% suffered from VD deficiency and 72.3% had a family history of VD deficiency. The study showed that there had been significant progress in students’ VD knowledge and behaviours following the programme. While 59% of the students had poor knowledge and 95.2% had unsatisfactory practices pre-intervention, 86.7% and 48.2% showed exemplary knowledge and a positive attitude towards VD, respectively, post-intervention. The scores achieved by the students had significantly changed ( p ≤ .01); compared to the knowledge and practice scores of 24.43 ± 7.21 out of 53 and 24.29 ± 5.23 out of 48, respectively, before the intervention, they were elevated to 46.89 ± 9.93 and 29.39 ± 14.23 following the awareness programme.

Conclusion

This type of health education programme can raise VD deficiency knowledge and improve practices. This study highlights the importance of holding public health awareness campaigns and recommends the creation of specifically designed booklets and leaflets for medical students and patients/visitors to hospital and public places.
ENDOANGEL versus water exchange for the detection of colorectal adenomas
Authors: Liu Pengwei , Wu Jie , He Chiyi , Wang Wei
Published: December 2023

Background:

Recently, the ENDOANGEL (EN) system, a computer-assisted detection technique, and water exchange (WE) assisted colonoscopy have both been shown to increase the colorectal adenoma detection rate (ADR).

Objectives:

The aim of this study was to compare the ADR between EN- and WE-assisted colonoscopy.

Design:

This was a retrospective study.

Methods:

Data from patients who underwent either EN- or WE-assisted colonoscopy between October 2021 and August 2022 were analysed consecutively. The primary outcome measure was the ADR.

Results:

The ADR was found to be similar between the EN and WE groups, with 80 out of 199 (40.2%) patients in the EN group compared to 78 out of 174 (44.8%) patients in the WE group [1.21; 95% confidence interval (CI), 0.80–1.83]. In the analysis using stabilized inverse probability treatment weighting after adjustment for confounding factors, both colonoscopy methods had similar performance in terms of ADR (1.41; 95% CI, 0.88–2.27).

Conclusion:

EN was found to be comparable to WE in terms of ADR during colonoscopy, and both methods may be effectively used in clinical practice.
Educators’ perspectives on the role the early childhood education and care environment plays in supporting children’s social and emotional development
Authors: Tamblyn Andrea , Sun Yihan , North Angela , Godsman Nicci , Boothby Crystal , Skouteris Helen , Blewitt Claire
Published: December 2023

This study explored educators’ perspectives on the role the physical and sensory Early Childhood Education and Care (ECEC) environment plays in supporting children’s social and emotional development. Ten semi-structured interviews were conducted, in August 2022, at two ECEC sites in Victoria, Australia. Data were thematically analysed and key findings suggest children engage and interact with their environment to facilitate opportunities for social interactions and emotional regulation. Environmental stimuli can have a positive and negative influence on children’s social and emotional competence. Educators reported lack of resources, building design, and limited staffing were barriers to using the environment. Reflective practice, collaboration within teams and services, and access to resources strengthened the use of the environment in everyday practice. Optimal environments rely on educator reflections and responsivity to adapt the environment to the needs of the children utilising the space.
Successful minimally invasive simple hepatic cyst ablation via ethanol sclerotherapy in a cat
Authors: Pfahl Madison , Gallaher Hayley M
Published: December 2023

Case summary

A 12-year-old neutered male domestic shorthair cat was evaluated at the Michigan State University Veterinary Medical Center (MSU-VMC) for an abdominal cyst that was initially noted on ultrasound 1 year prior by the referring veterinarian. The cystic mass was causing clinical signs, including vomiting, diarrhea, hyporexia and abdominal pain. Cyst drainage had originally been performed every few months, but by referral, the required frequency of drainage had increased to every 2 weeks for a total of eight drainage events; therefore, a more definitive curative option was sought. CT evaluation revealed a large simple hepatic cyst – largest diameter 7.2 cm – likely associated with the right medial liver lobe. Minimally invasive ethanol sclerotherapy was performed. A locking-loop catheter was placed percutaneously and transhepatically into the cyst using ultrasound guidance. The cyst was drained, and contrast injected under fluoroscopic guidance to ensure no communication between the cyst and liver. Sclerotherapy was performed using a volume of 99.5% ethanol calculated from the volume of cyst fluid removed. The patient was discharged on the same day and had complete resolution of clinical signs. At a 6-month follow-up, the cyst had decreased in volume by an estimated 95%. The patient remains asymptomatic more than 1 year postoperatively.

Relevance and novel information

To our knowledge, this is the first report of a feline hepatic cyst treated via percutaneous transhepatic ethanol ablation. Minimally invasive simple hepatic cyst ablation is a viable treatment option in cats that could avoid the need for a more invasive surgical intervention.
Market Efficiency and Stock Investment Loss Aversion Guide During COVID-19 Pandemic Events: The Case for Applying Data Mining
Authors: Chen Yen-Chang , Liu Ying-Sing
Published: December 2023

This study explores the late coronavirus disease 2019 (COVID-19) pandemic, particularly, 2022Q1 to 2022Q3, to analyze the stock returns of industries expected to have a direct impact. The aim is to identify the factors influencing stock returns and to provide investment strategies, focusing on investment risk control (loss aversion). A total of 193 common stocks listed on the Taiwanese stock market were collected from four major industries: sports, restaurants, biotechnology, and epidemic prevention. Using the past information set (2021Q4): variables in three dimensions—firm characteristics, financial indicators, and corporate governance—are used to construct a stock investment strategy model. Empirical evidence shows the existence of differences in the stock investment advantages of some industries and firm characteristics and the lack of investment advantages of epidemic prevention stocks in 2020. The decision-tree model has a precision of 79.4% and an accuracy of 72.0%. The five most important factors affecting stock returns are market value, cash flow adequacy ratio, return on assets, Tobin’s Q, and price/book value. The scheme inducting three types of losses of return (loser) and one type of profit (winner) is summarized for reference. Second, it confirms the correlation between past information sets and stock returns, suggesting that Taiwan’s stock market was inefficient during the late stage of the COVID-19 pandemic. Finally, this study’s findings can be used as a reference for future fund managers and investors when handling similar events.

JEL Classification: G11, G14, C88, I15
Comparison of Learning Content Representations to Improve L2 Vocabulary Acquisition Using m-learning
Authors: Rodríguez-Arce Jorge , Vázquez-Cano Esteban , Cobá Juárez-Pegueros Juan Pablo , González-García Salvador
Published: December 2023

Previous works reveal that there is potential in the use of mobile devices as a useful tool to help learn new vocabulary and it allows the learning materials can be displayed with different Learning Content Representation (LCR) types. Nevertheless, there are no conclusive results about which LCR type is better to improve L2 vocabulary acquisition using m-learning. The purpose of this study was to explore the effects of improving the students’ academic performance using two LCR types that promote different learning strategies in a vocabulary learning task. A mobile application with two LCR types was implemented and tested: the SRL type based on a self-regulated learning strategy, and the NSRL type based on a non-self-regulated learning strategy. Quantitative analyses indicated that there is a relationship between the LCR types and the word recall on vocabulary learning. The SRL type seems to be effective in improving the students’ learning abilities and students in this experimental group exhibited significantly better academic performance. The results are meant to draw that LCR-SRL types must be used in m-learning to L2 vocabulary acquisition. Future studies should focus on how to integrate these strategies in m-learning and understand their effects on improving students’ vocabulary acquisition.
Extending Kingdon’s Multiple Streams Policy Framework Through an Analysis of How Community Health Workers in India Are Driving Policy Changes
Authors: Santosh Sanjana , Kane Sumit
Published: December 2023

In this paper we develop and provide a novel account of the process through which the Accredited Social Health Activists (ASHAs), a cadre of seemingly powerless community health workers in India, are navigating a complex policy process to incrementally achieve their goals. ASHAs have been demanding better working conditions, better compensation, and regularisation as public service employees through protests and strikes and have managed to gain concessions from both the Central and various State governments. We observed two important aspects that emerged: (a) ASHAs achieved incremental increases in their wages despite being the lowest in the health system hierarchy, and, (b) major gains were made during the 2 years of the pandemic. We examine and analyse ASHAs’ engagement and strategies used, both overt and covert, sometimes with the government, and the role of other actors in determining these policy outcomes. We do so by drawing on academic literature and news media reports; we trace the changes in ASHAs’ wages by tying together key events, ‘windows of opportunity’, and actions of ‘policy entrepreneurs’ involved in the process.

In doing so, we further develop and propose an extension to Kingdon’s multiple streams policy framework through the addition of a ‘narrative stream’.
Ridge regression and deep learning models for genome-wide selection of complex traits in New Mexican Chile peppers
Authors: Lozada Dennis N. , Sandhu Karansher Singh , Bhatta Madhav
Published: December 2023

Background

Genomewide prediction estimates the genomic breeding values of selection candidates which can be utilized for population improvement and cultivar development. Ridge regression and deep learning-based selection models were implemented for yield and agronomic traits of 204 chile pepper genotypes evaluated in multi-environment trials in New Mexico, USA.

Results

Accuracy of prediction differed across different models under ten-fold cross-validations, where high prediction accuracy was observed for highly heritable traits such as plant height and plant width. No model was superior across traits using 14,922 SNP markers for genomewide selection. Bayesian ridge regression had the highest average accuracy for first pod date (0.77) and total yield per plant (0.33). Multilayer perceptron (MLP) was the most superior for flowering time (0.76) and plant height (0.73), whereas the genomic BLUP model had the highest accuracy for plant width (0.62). Using a subset of 7,690 SNP loci resulting from grouping markers based on linkage disequilibrium coefficients resulted in improved accuracy for first pod date, ten pod weight, and total yield per plant, even under a relatively small training population size for MLP and random forest models. Genomic and ridge regression BLUP models were sufficient for optimal prediction accuracies for small training population size. Combining phenotypic selection and genomewide selection resulted in improved selection response for yield-related traits, indicating that integrated approaches can result in improved gains achieved through selection.

Conclusions

Accuracy values for ridge regression and deep learning prediction models demonstrate the potential of implementing genomewide selection for genetic improvement in chile pepper breeding programs. Ultimately, a large training data is relevant for improved genomic selection accuracy for the deep learning models.
Factors influencing the healthcare transition in Chinese adolescents with inflammatory bowel disease: a multi-perspective qualitative study
Authors: Zhou Mi , Xu Youjun , Zhou Yunxian
Published: December 2023

Background

The development and implementation of the transition from pediatric to adult healthcare systems for adolescents with inflammatory bowel disease (IBD) should consider stakeholders’ perceptions. This study aimed to explore the factors influencing the transition of Chinese adolescents with IBD from the perspectives of patients, parents, and healthcare providers.

Methods

A descriptive qualitative research was conducted. Purposive sampling was used to recruit 36 participants, including 13 patients, 13 parents, and 10 providers, from a tertiary pediatric IBD center, a tertiary adult IBD center, and the China Crohn’s & Colitis Foundation in Zhejiang Province, China. Individual semi-structured interviews were used to collect data on facilitators and barriers to the transition process. Conventional content analysis was used to analyze the interview transcripts.

Results

Nine primary themes were identified. Patients with young age, prolonged disease duration, severe disease, academic pressures such as the Gaokao, low level of disease acceptance, limited transition consciousness, low self-efficacy, poor transition communication, and inadequate medical transition system serve as barriers. While patients with the mentality of guilt towards their parents; parents with low education levels and intensive work schedules, high levels of disease acceptance, and situations of parent-child separation; stakeholders with high transition consciousness, high transition self-efficacy, and effective transition communication act as facilitators. Furthermore, community support and hospital guide services were also contributing factors during the transition.

Conclusions

This study offers comprehensive insights into the factors affecting the transition of Chinese adolescent IBD patients. The process is continuously influenced by stakeholders, community, and healthcare environments and policies. Identifying these factors provides healthcare providers with a reference for developing and implementing targeted transition interventions.
Exploration of the causal effects of leukocyte telomere length and four gastrointestinal diseases: a two-sample bidirectional Mendelian randomization study
Authors: Wang Haikuo , Chen Xiaolin , Wang Siming , Zhang Heyun
Published: December 2023

Background

To explore the underlying causality between leukocyte telomere length (LTL) and four gastrointestinal diseases, we designed a two-sample bidirectional Mendelian randomization study.

Methods

Two-sample Mendelian randomization (MR) was used to explore genetic causality between LTL and four gastrointestinal diseases, including irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), gastrointestinal ulcers disease (GUD), and nonalcoholic fatty liver disease (NAFLD). We utilized inverse-variance weighted (IVW) as the primary method for MR analysis. Supplementary analyses were conducted using methods such as MR-Egger regression, weighted-median, Maximum Likelihood (MaxLik), Robust adjusted profile score (MR-RAPS), Contamination mixture (ConMix), and MR-mix. Cochran’s Q was calculated to check for heterogeneity. The MR-Egger regression and MR pleiotropy residual sum and outlier (MR-PRESSO) were detected for pleiotropy.

Results

The IVW analysis suggests that there may be a potential causal relationship between LTL and two diseases (odds ratio (OR): 1.062; 95% confidence interval (CI): 1.003, 1.124; p = 0.038 for IBS and OR: 0.889; 95% CI: 0.798, 0.990; p = 0.032 for GERD). However, other methods do not entirely align with the results of the IVW analysis. In the reverse MR analysis, we did not find statistically significant associations between LTL and these four diseases.

Conclusion

The current evidence does not definitively rule out a causal relationship between LTL and these four gastrointestinal diseases but suggests a potential association between LTL and IBS, or LTL and GERD. Exploring the relationship between gastrointestinal diseases and LTL may offer new insights into the onset, progression, and treatment of these diseases.
Long-term oral ACEI/ARB therapy is associated with disease severity in elderly COVID-19 omicron BA.2 patients with hypertension
Authors: Zhang Zhe , Wu Shengyong , Wang Zhiyong , Wang Yue , Chen Hui , Wu Cheng , Xiong Lize
Published: December 2023

Objective

To explore the effects of long-term oral ACEIs/ARBs on the incidence of exacerbation and in-hospital mortality in elderly COVID-19 Omicron BA.2 patients with hypertension, especially patients aged 80 years or older.

Materials and methods

In this retrospective study, patients suffering mild and rcommon COVID-19 with hypertension who were hospitalized in the Shanghai Fourth People’s Hospital between April 2022 and June 2022 were enrolled. Primary outcomes included the incidence of exacerbation and in-hospital mortality. Secondary outcomes included the incidence of respiratory failure of patients, use of mechanical ventilation, nucleic acid conversion time (NCT), hospitalization costs, and the temporal trend of the incidence of exacerbations and in-hospital mortality in different age groups. The data were analysed using propensity score weighting (PSW).

Results

In the entire cohort, there were 298 ACEI/ARB users and 465 non-ACEI/ARB users. The ACEI/ARB group showed a lower incidence of exacerbation (OR = 0.64, 95% CI for OR: 0.46–0.89, P = 0.0082) and lower in-hospital mortality (OR = 0.49, 95% CI for OR: 0.27–0.89, P = 0.0201) after PSW. Sensitivity analysis obtained the same results. The results of the subgroup of patients aged 80 years and older obtained a similar conclusion as the whole cohort. Most of the study indicators did not differ statistically significantly in the subgroup of patients aged 60 to 79 years except for rates of mechanical ventilation and respiratory failure.

Conclusion

Antihypertensive therapy with ACEIs/ARBs might reduce the incidence of exacerbation and in-hospital mortality. The findings of this study support the use of ACEIs/ARBs in COVID-19 patients infected by Omicron BA.2, especially in patients aged 80 years or older with hypertension.
Prognostic value of tertiary lymphoid structures (TLS) in digestive system cancers: a systematic review and meta-analysis
Authors: Sun Hao , Shi Yuanyu , Ran Hailiang , Peng Junwei , Li Qiongxian , Zheng Guiqing , He Yandie , Liu Shuqing , Chang Wei , Xiao Yuanyuan
Published: December 2023

Background

Existing literature suggests that tertiary lymphatic structure (TLS) is associated with the progression of cancer. However, the prognostic role of TLS in digestive system cancers remains controversial. This meta-analysis aims to synthesize currently available evidence in the association between TLS and the survival of digestive system cancers.

Methods

We systematically searched three digital databases (PubMed, Embase, Web of Science) for articles published from database inception to December 23, 2022. Study selection criteria are based on PECO framework: P (population: patients with digestive system cancers), E (exposure: presence of TLS), C (comparator: absence of TLS), O (outcome: overall survival, OS; recurrence-free survival, RFS; disease-free survival, DFS). The Quality in Prognostic Studies (QUIPS) tool was used to assess risk of bias for included studies. The study protocol was registered with PROSPERO (CRD42023416307).

Results

A total of 25 studies with 6910 patients were included into the final meta-analysis. Random-effects models revealed that the absence of TLS was associated with compromised OS, RFS, and DFS of digestive system cancers, with pooled hazard ratios (HRs) of 1.74 (95% CI: 1.50–2.03), 1.96 (95% CI: 1.58–2.44), and 1.81 (95% CI: 1.49–2.19), respectively. Subgroup analyses disclosed a stronger TLS-survival association for pancreatic cancer, compared with other digestive system cancers.

Conclusion

TLS may be of prognostic significance for digestive system cancers. More original studies are needed to further corroborate this finding.
Correlation between preoperative peripheral blood NLR, PLR, LMR and prognosis of patients with head and neck squamous cell carcinoma
Authors: Zhou Jiao , Wei Sheng , Guo Xiumei , Huang Yanjun , Zhang Yizheng , Hong Yuming , Chen Xiaofang , Lu Ming , Zheng Feng , Zheng Chaohui
Published: December 2023

Background

Markers that can be used to evaluate the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) remain undefined.

Objective

This study aimed to investigate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in patients with HNSCC who underwent surgery-based treatment for the first time.

Methods

This retrospective study included patients HNSCC who underwent surgery-based treatment at our institution between January 2018 and December 2020. Specificity and sensitivity were analyzed using receiver operating characteristic (ROC) curves and the critical value was determined. Patients were divided into low and high groups according to NLR, PLR, and LMR the critical value. Log-rank and Cox proportional hazards models were used to evaluate the associations between preoperative NLR, PLR, LMR, and overall survival (OS).

Results

A total of 304 patients with HNSCC were included, of whom 190 (62.5%) and 114 (37.5%), 203 (66.8%) and 101 (33.2%), 98 (32.2%), and 206 (67.8%) cases were classified as low NLR and high NLR groups, low PLR and high PLR groups, and low LMR and high LMR groups, respectively. Univariate analysis showed that white blood cell count (WBC), neutrophil count (NEU), platelet count (PLT), NLR, pathologic N stage (pN stage), TNM stage and postoperative complications were significantly associated with OS (p < 0.05). Multivariate analysis showed that NEU, NLR, TNM stage and postoperative complications were independent negative prognostic factors for HNSCC (p < 0.05).

Conclusion

Preoperative NLR is an independent negative prognostic factor for HNSCC. Patients with an increased NLR may have a poor OS.
Neutrophil to lymphocyte ratio in pediatric patients with asthmatic exacerbation and community-acquired pneumonia
Authors: Xu Mei , Zhou Lingfang , Zhang Jie , Luo Sha , Zhao Yunfeng , Xiong Wei
Published: December 2023

Background

Compared with a lower neutrophil to lymphocyte ratio(NLR), a higher one denotes severe asthma exacerbation in hospitalized asthmatic children. In addition, NLR is significantly higher in pediatric patients with community-acquired pneumonia (CAP) than those without. Nevertheless, its role in pediatric patients with concomitant asthmatic exacerbation and CAP remains unknown.

Methods

In this retrospective study including 1032 pediatric patients aged 5 to 14 years old, the diagnostic and prognostic value of NLR in children with concomitant asthmatic exacerbation and non-severe CAP were investigated.

Results

The sensitivity and specificity of NLR for a diagnosis of CAP in patients with asthmatic exacerbation were 56.9% and 90.1%, respectively. The cutoff value of NLR for a diagnosis of CAP in patients with asthmatic exacerbation was 4.15 (P < 0.001). The cumulative asthmatic exacerbation during 3-month followup of patients with high NLR were 23 (21.3%) and 58 (42.0%) in the asthma and asthmatic CAP groups, respectively (P < 0.001). The patients with high NLR who had unimproved CAP were 15 (8.3%) and 23 (12.2%) in the CAP and asthmatic CAP groups, respectively (P = 0.006). Multivariate analyses showed that along with the increase of NLR by 1.0 point, the HR for the occurrence of asthmatic exacerbation and unimproved CAP were 2.91 [1.83–3.96] (P = 0.001) and 3.38 [1.66–5.10] (P < 0.001), respectively.

Conclusions

NLR had high and moderate diagnostic value for the exclusion and indication of CAP, respectively, in pediatric patients with asthmatic exacerbation. It also had prognostic value for the outcomes of pediatric patients with concomitant asthmatic exacerbation and CAP.
Health disparities in one of the world’s most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands
Authors: Hughes Tonda L. , Bochicchio Lauren , Drabble Laurie , Muntinga Maaike , Jukema Jan S. , Veldhuis Cindy B. , Bruck Sunčica , Bos Henny
Published: December 2023

Background

Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands—a country with a long-standing reputation as a pioneer in SGM equality.

Methods

Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands.

Results

Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience.

Conclusions

Findings of persistent health disparities—despite the relatively long history of SGM supportive policies in the Netherlands—highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
Australian, Irish, and Swedish women’s comfort levels when breastfeeding in public
Authors: Gallagher Louise , Brady Vivienne , Kuliukas Lesley , Dykes Charlotta , Rubertsson Christine , Hauck Yvonne L.
Published: December 2023

Background

Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women’s decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding.

Methods

A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25.

Results

Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women’s comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women’s comfort levels.

Conclusion

This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women’s perceived comfort levels, the influence of family members’ perceptions of breastfeeding in public and women’s experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.