bluuebunny/crossref_metadata_2025 huggingface dataset:
Dialectical Emotional Labour in Digital Person-branding: The case of digital influencers
Authors: Heeris Christensen Anna-Bertha , Gyrd-Jones Richard , Beverland Michael B.
Published: October 2023

This article examines the emotional labour of digital influencers to extend our understanding of the processes of transmutation of workers’ emotional systems. According to Arlie Hochschild, transmutation occurs when workers’ emotional systems are engineered into commercial and organizational settings for economic profit. To date much work has been carried out within formal organizational settings on ‘surface acting’, which often leads to self-abuse, burnout and depersonalization, and ‘deep acting’, which is associated with feelings of personal freedom. We use a multi-sited ethnography of digital influencers’ emotional work practices to show how so-called ‘person-brands’ labour on the self through dialectical process between emancipating one’s person-brand and exploiting oneself. We suggest a new mode of emotional labour in which transmutation happens in practices where influencers display their private actions to the public and where they transfer commercial agendas into their private realm and exploit their selves. Consequently, digital influencers work under the condition that they must self-exploit to succeed, and we demonstrate how they do this in seven distinct work practices. While we suggest self-exploitation to be a condition of digital influencers’ work, we question whether this is a boundary condition in the transformation to become more powerful person-brands where work becomes more individualized and subjectified.
Self-Efficacy, Burnout, and Intent to Leave for Teachers of Students With Emotional and Behavioral Disorders
Authors: Brunsting Nelson C. , Stark Kristabel , Bettini Elizabeth , Lane Kathleen Lynne , Royer David James , Common Eric Alan , L. Rock Marcia
Published: October 2023

Due to ongoing and severe teacher shortages, preparing and sustaining a skilled special education teacher (SET) workforce is a top policy priority. Understanding predictors of SETs’ intent to leave is crucial for policy makers and school leaders alike, as they seek to develop interventions to support retention efforts. In this study, we examined attrition intentions among SETs serving students with emotional and behavioral disorders (EBDs), using longitudinal survey data from a U.S. nationally representative sample of teachers in the 2019–2020 school year (fall-winter-spring). We measured teachers’ self-efficacy and burnout in fall, winter, and spring as well as teachers’ intent to leave in spring. We found all three dimensions of fall burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) had an indirect effect on spring intent to leave. All three dimensions of burnout in the spring predicted intent to leave, as did winter scores on depersonalization. Cross-time relationships between of dimensions of self-efficacy and burnout were revealed; however, at no timepoint was self-efficacy a significant predictor of intent to leave in spring, whether directly or indirectly. We discuss implications for both practitioners and researchers.
Our validity looks like justice. Does yours?
Authors: Randall Jennifer , Poe Mya , Slomp David , Oliveri Maria Elena
Published: October 2023

Educational assessments, from kindergarden to 12th grade (K-12) to licensure, have a long, well-documented history of oppression and marginalization. In this paper, we (the authors) ask the field of educational assessment/measurement to actively disrupt the White supremacist and racist logics that fuel this marginalization and re-orient itself toward assessment justice. We describe how a justice-oriented, antiracist validity (JAV) approach to validation processes can support assessment justice efforts, specifically with respect to language assessment. Relying on antiracist principles and critical quantitative methodologies, a JAV approach proposes a set of critical questions to consider when gathering validity evidence, with potential utility for language testers.
Coping with inflation: Social perceptions and ordinary measures of price increases in contemporary Argentina
Authors: Hernández María Clara , Luzzi Mariana
Published: October 2023

Since the COVID-19 pandemic, in a significant part of the world, the cost of living has once again become a central issue in the agenda of both governments and populations. However, in some countries, inflation has been a distinctive feature of the economy for more than a decade, which the pandemic has only exacerbated. Argentina is one of these countries. Based on a 4-year qualitative investigation carried out among low- and middle-income households in a mid-sized city in Buenos Aires province and complemented by observations made among senior households in the same province during the pandemic, this article seeks two purposes: on one hand, to analyze how price rise appears in people’s concerns when we focus on domestic economies and, on the other, to account for the ways of measuring inflation and evaluating its impacts on such economies. The document intends to contribute to the construction of a perspective on inflation that is attentive to how people act and think about the economy in their everyday lives.
Inhibition of IKKβ via a DNA-Based In Situ Delivery System Improves Achilles Tendinopathy Healing in a Rat Model
Authors: Ge Zilu , Yang Mingyu , Wei Danfeng , Wang Dong , Zhao Renliang , Deng Xiangtian , Tang Yunfeng , Fang Qian , Xiong Zhencheng , Wang Chengshi , Wang Guanglin , Li Wei , Tang Kanglai
Published: October 2023

Background:

The inhibition of IKKβ by the inhibitor 2-amino-6-[2-(cyclopropylmethoxy)-6-hydroxyphenyl]-4-(4-piperidinyl)-3-pyridine carbonitrile (ACHP) is a promising strategy for the treatment of Achilles tendinopathy. However, the poor water solubility of ACHP severely hinders its in vivo application. Moreover, the effective local delivery of ACHP to the tendon and its therapeutic effects have not been reported.

Purpose:

To investigate the therapeutic effects of IKKβ inhibition via injection of ACHP incorporated into a DNA supramolecular hydrogel in a collagenase-induced tendinopathy rat model.

Study Design:

Controlled laboratory study.

Methods:

Dendritic DNA, a Y-shaped monomer, and a crosslinking monomer were mixed with ACHP and self-assembled into an ACHP-DNA supramolecular hydrogel (ACHP-Gel). The effects of ACHP-Gel in tendon stem/progenitor cells were investigated via RNA sequencing and validated using quantitative reverse transcription polymerase chain reaction (qRT-PCR). A total of 120 collagenase-induced rats were randomly assigned to 5 groups: blank, phosphate-buffered saline (PBS), DNA-Gel, ACHP, and ACHP-Gel. Healing outcomes were evaluated using biomechanic and histologic evaluations at 4 and 8 weeks.

Results:

ACHP-Gel enhanced the solubility of ACHP and sustained its release for ≥21 days in vivo, which significantly increased the retention time of ACHP and markedly reduced the frequency of administration. RNA sequencing and qRT-PCR showed that ACHP effectively downregulated genes related to inflammation and extracellular matrix remodeling and upregulated genes related to tenogenic differentiation. The cross-sectional area ( P = .024), load to failure ( P = .002), stiffness ( P = .039), and elastic modulus ( P = .048) significantly differed between the ACHP-Gel and PBS groups at 8 weeks. The ACHP-Gel group had better histologic scores than the ACHP group at 4 ( P = .042) and 8 weeks ( P = .009). Type I collagen expression (COL-I; P = .034) and the COL-I/collagen type III ratio ( P = .015) increased while interleukin 6 expression decreased ( P < .001) in the ACHP-Gel group compared with the ACHP group at 8 weeks.

Conclusion:

DNA supramolecular hydrogel significantly enhanced the aqueous solubility of ACHP and increased its release-retention time. Injection frequency was markedly reduced. ACHP-Gel suppressed inflammation in Achilles tendinopathy and promoted tendon healing in a rat model.

Clinical Relevance:

ACHP-Gel injection is a promising strategy for the treatment of Achilles tendinopathy in clinical practice.
Methodology to quantify single-use plastic products in municipal solid waste Part 2: Quantification of tobacco products with filters in Germany
Authors: Spies Alena Maria , Geldmacher Jonathan , García López Cristina , Pretz Thomas , Raulf Karoline
Published: October 2023

Discharge from unrestricted tobacco products with filters (TPF) causes environmental damage. To reduce TPF litter quantities, Directive (EU) 2019/904 requires TPF producers to proportionally contribute to the costs of discarding their products in public waste collection systems, including litter waste ones. An appropriate output-based cost model requires assessing TPF quantities in relevant waste streams. Currently, there is no comprehensive data available on TPF quantities in municipal solid waste (MSW). Therefore, a case study was conducted to quantify TPF in MSW. This study aimed to determine TPF quantities (1) in residual waste from four German district types and (2) in waste from public collection systems for three settlement structures within Trier City. Relevant waste streams from public collection systems, namely waste from public waste receptacles, street-cleaning waste and sinkhole residues, were identified. For both sampling campaigns, consideration was given to extrapolating the results to a larger scale. The results showed that the average specific TPF quantities in residual waste were 277.7, 271.8, 193.3 and 204.5 gi− 1a− 1 in the selected city district, urban district, densely populated rural district and sparsely populated rural district, respectively. Extrapolation of these results to Germany yielded a specific TPF quantity in residual waste of 250.3 gi-1a-1. The average specific TPF quantities in waste from public waste receptacles, street-cleaning waste and sinkhole residues were 12.2, 47.4 and 9.9 gi−1a− 1, respectively. The results could contribute to cost model development based on Directive (EU) 2019/904.
Reaction of Indian Stock Market to Outbreak of COVID-19: An Empirical Analysis of Extreme Inter-day Movements
Authors: Sharma Dhanraj , Verma Ruchita , Sam Shiney , Sharma Shubham
Published: October 2023

The contagious COVID-19 pandemic has been considered a massive global crisis since World War II and has disturbed business and economic activities across the globe. The current study examined the reaction of the stock market’s to the outbreak of COVID-19, considering the extreme inter-day movements in the Indian stock market. The extreme inter-day movements in S&P CNX Nifty-50 have been identified during the study period from January 2020 to December 2021 and further classified into decline and gain events based on positive and negative announcements related to COVID-19. The study utilized an event study approach and panel regression for empirical investigation. The results of the event study analysis illustrate that the significant abnormal loss ranges from 12.86% to 2.47% for the major decline events and significant abnormal return from 8.43% to 3.23% for the gain events. The regression analysis results showed that real return and Central Bank Policy rate have a considerable impact on the abnormal returns during COVID-19. The study’s findings are helpful to policy implications that identified the need to focus on financial education and strengthen the health and finance-related policies to deal with such pandemics in the future.
The Influence of Flooding Imagery and Party Cues on Perceived Threat, Collective Efficacy, and Intentions for Political Action to Address Climate Change
Authors: Hart P. Sol , Feldman Lauren , Choi Soobin , Zhang Annie Li , Hegland Austin
Published: October 2023

This study investigates how episodic and thematic flooding imagery and political party cues in climate change news stories influence risk perceptions, collective efficacy perceptions, and intended political action. We found that imagery and party cues had significant total effects on perceived flooding threat but not on perceived climate change threat. Specifically, episodic imagery (but not thematic imagery) increased perceived flooding threat, and party cues lowered perceived threat. Perceived threat was positively associated with collective efficacy, which, in turn, was positively associated with intended political action. Both imagery and party cues had significant indirect effects on perceived efficacy and intended action.
A Mile in Their Shoes: Poetic Inquiry for Qualitative Caregiver Research
Authors: Duplantier Sally , Lester Jessica Nina
Published: October 2023

Poetic inquiry as a form of arts-based research can penetrate the complexity, ambiguity, and multidimensional nature of representing participant emotions. This methodological approach allows researchers to explore the sensitive intersection of competing emotions without flattening the layered and often conflicting experience of participants’ embodied experiences. In this article, we share participant-voiced poems generated from interviews with family caregivers of Alzheimer’s patients and invite readers to sit with how these poems transcend mere descriptions and instead offer an emotive experience that defies words alone.
Integrin α2 promotes immune escape in non-small-cell lung cancer by enhancing PD-L1 expression in exosomes to inhibit CD8 + T-cell activity
Authors: Jing Hui , Meng Meng , Ye Mengjie , Liu Shuan , Cao Xubo , Li Ke , Liu Yuanyuan , Zhang Jinghao , Wu Yanmin
Published: October 2023

This study intended to delineate the mechanism and functional role of integrin α2 (ITGA2) in non-small-cell lung cancer (NSCLC) cell immune escape. Bioinformatics analysis was utilized to analyze ITGA2 expression in NSCLC tissues, and correlations between ITGA2 expression and patient survival time, ITGA2 expression and programmed cell death ligand 1 (PD-L1; CD274) expression, and ITGA2 expression and CD8+ T-cell infiltration. Quantitative real-time polymerase chain reaction detected ITGA2 expression. Transmission electron microscopy was applied to examine the morphology of exosomes, and western blot measured CD9, CD63, and PD-L1 levels. CCK-8 measured cell viability. Cell toxicity experiment measured the killing effect of CD8+ T cells on cancer cells. Enzyme-linked immunosorbent assay assessed secretion levels of interleukin-2, interferon-gamma, tumor necrosis factor-alpha, and PD-L1 expression in exosomes. Immunohistochemistry detected ITGA2, CD8, and PD-L1 expression in patient tissue samples. ITGA2 was highly expressed in NSCLC, and Pearson correlation analysis showed a negative correlation of ITGA2 with CD8+ T-cell infiltration and a positive correlation of ITGA2 with PD-L1 expression. Cell experiments showed that silencing ITGA2 hindered NSCLC cell progression and increased levels of CD8+ T-cell secretory factors. Further mechanism studies found that ITGA2 reduced CD8+ T-cell-mediated antitumor immunity via the increase in PD-L1 expression. Clinical sample testing unveiled that ITGA2 was upregulated in NSCLC tissues. PD-L1 upregulation was seen in exosomes separated from patient blood, and correlation analysis showed a positive correlation of exosomal PD-L1 expression in blood with ITGA2 expression in tissues. This study displays a novel mechanism and role of ITGA2 in NSCLC immune escape, providing directions for the clinical therapy of NSCLC patients.
The implications of generative artificial intelligence in academic research and higher education in tourism and hospitality
Authors: Dogru Tarik , Line Nathana , Hanks Lydia , Acikgoz Fulya , Abbott Je’Anna , Bakir Selim , Berbekova Adiyukh , Bilgihan Anil , Iskender Ali , Kizildag Murat , Lee Minwoo , Lee Woojin , McGinley Sean , Mody Makarand , Onder Irem , Ozdemir Ozgur , Suess Courtney
Published: October 2023

The purpose of this study is to critically review the effect of generative artificial intelligence (GAI) tools on higher education and research in the tourism and hospitality (TH) field. This manuscript identifies capabilities and implications of these GAI applications through a theoretical lens. GAI adoption in TH education can facilitate personalized learning experiences, enhance the technological competence of students, and foster a more diverse and inclusive learning environment. For academic research, GAI-enabled technologies may revolutionize data collection, analysis, and writing in a myriad of ways. However, there are multiple ethical and legal concerns associated with adoption that must be considered. At the end of this paper, we propose ten discussion questions aimed at stimulating conversation about adoption of GAI tools in TH education and research.
“Public pedagogy, autotheory, and Egyptian female podcasters”
Authors: Ebada Yasmeen , Fox Kim
Published: October 2023

This research examines six Egyptian female podcasters whose work sits at the theoretical intersection of public pedagogy and autotheory, loosely defined as a first-person narrative form of feminist expression used to challenge hegemonic discourses as a means of activism. The two theories supplement each other, especially since feminism aims to abolish sexism, and public pedagogy is a means to obtain that result. The researchers adopted American-Canadian cultural critic Henry Giroux’s (2004) theory of public pedagogy because it allows for critical dialogue to address discrimination and push for egalitarian transfiguration. Autotheory was chosen for its relation to the podcasters' life experiences and their perceived desire to disrupt traditional social and cultural norms in Egypt. A qualitative critical analysis of the podcast episodes investigated the utilization of public pedagogy highlighting societal issues, advocating for decolonization through social change and responsibility, and critical learning through personal experience. The results confirmed that public pedagogy and autotheory were prevalent in the podcasts and established that this medium could have a meaningful impact on the Egyptian digital public sphere.
Biomechanical Performance of Total Wrist Arthrodesis Plates With and Without Arthrodesis of the Carpometacarpal Joint
Authors: Owen David H. , Wang Dongyang , Cong Xu , Mowbray Cameron , Perriman Diana M. , Roberts Chris J. , Smith Paul N. , Drobetz Herwig , Ackland David
Published: October 2023

Background:

It is unknown whether total wrist arthrodesis (TWA) should be performed with or without arthrodesis of the carpometacarpal joint (CMCJ). The aim of this study is to compare CMCJ-spanning TWA plates using 3D printed wrist arthrodesis model with and without arthrodesis of the CMCJ.

Methods:

Total wrist arthrodesis plates mounted to 3D printed models were tested under a 4-N bending load at 4 Hz for 50 000 cycles, increased by 15% every 10 000 cycles until failure.

Results:

Plates with arthrodesis CMCJ were stiffer and failed at a significantly greater load and number of cycles than plates mounted to models without CMCJ arthrodesis. The Synthes stainless steel locking TWA plate performed better than the Trimed plate applied to the model without CMCJ arthrodesis and the Acumed plate applied to the model with CMCJ arthrodesis. Based on these findings, we recommend arthrodesis of the CMCJ in TWA.

Conclusions:

Incorporation of the CMCJ in TWA may protect against plate failure. If arthrodesis of the CMCJ is not performed, plate removal should be considered before breakage occurs.

Level of Evidence:

IV
A Domain-Function Analysis of ni zhidao (你知道, “You Know”) in Chinese Simultaneous Speech
Authors: Shan Yi
Published: October 2023

Most theoretical and empirical studies of discourse marker multifunctionality do not approach it using a formal, systematic annotation model. Drawing on a domain-function taxonomy, this study examines 270 tokens of the discourse marker ni zhidao in Chinese media interviews. All values of the two-dimensional model designed for the whole category of discourse markers apply to ni zhidao, demonstrating its equally potent affordance on a particular discourse marker case cross-linguistically. By putting this model to the test, we found that “emphasis” needs to be added to the original 15 functions in the model, and that domains and functions need to be treated as dependent layers of pragmatic meaning. Functions determine domains, and domains need to be regarded as macro-functions to which specific functions are attributed. As such, we tentatively put forth an updated version that provides finer granularity and greater affordance, shedding new light on the pragmatic meaning of ni zhidao and the speaker’s underlying communicative intent. We propose that the sample be divided into uni-functional and multi-functional categories before being analyzed within the updated model to capture the multifunctional discourse markers in the same context-specific utterances. This study has implications for the need of more exhaustive, speech-friendly annotation models of DM multifunctionality and the cross-linguistic adaptation or refinement of established DM annotation models to cater to the unique traits of spoken DMs in different languages.
Excruciating Journey of Sanitation Workers: Evidence of Mobility and Change from Field
Authors: Awasthi Ruchi
Published: October 2023

The article explores approaches adopted by scavengers to protect themselves from stigma and describes how these approaches are temporal and incomplete. It also addresses the perception of scavenger’s son education and social status for their children’s social mobility. Social mobility has been described among scavengers and its relationship with changes that are taking place among the scavengers of Lucknow. A detailed discussion of ‘social mobility’ is carried out in this document supported by empirical data. At the applied level, the present study may help to identify the aspirations and expectations of the scavengers. In other words, it has been provided as an indicator of measuring the desires and efforts of the scavengers for their status in the caste or the class structure or both. In this article, an effort was made at two levels to know the nature of the status identification of the respondents. At one level, they were asked about their interaction with the non-scavenging community of other Scheduled Castes and their interaction pattern with the upper caste. In further analysis, first, this article has discussed occupation followed by mobility, its various forms and its significance in a scavenger’s life and finally focuses on social mobility in the scavengers’ context.
Risk Factors and Angiographic Profile in Young Individuals with Acute ST-Elevation Myocardial Infarction (STEMI)
Authors: Suri Pawan , Arora Ashutosh , Kinra Kanika , Arora Vanita
Published: October 2023

Coronary artery disease (CAD) represents the leading cause of death in adults and Myocardial infarction (MI) is the lethal manifestation of that. Although males and females beyond certain age are prone to CAD, young men and/or women also suffer from MI. Apart from the rare case reports of non-athermatous coronary artery disease including hyper-coagulable states, spontaneous dissections and/or substance abuse in young MI, the prevalence of conventional risk factors are on rise in young adults and children. The protection offered by young age has been overshadowed by the increased prevalence of these risk factors. To evaluate the prevalence of such conventional risk factors and angiographic pattern in young MI, we did an observational, retrospective study at our tertiary care center. It was observed that one-fourth of young MI had no conventional risk factors and among the rest, obesity (48%) was most common, followed by diabetes mellitus (DM) (32%), Hypertension (29.5%), smoking (15.5%), alcoholism (11%), and a family history of premature CAD (3%). Among the participants, 35.5%, 22.5%, 12%, 4%, and 1% of patients had one, two, three, four, and five risk factors, respectively. On angiography, Left Anterior Descending (LAD) was the most commonly diseased coronary artery (77%) followed by Right Coronary Artery (RCA) (30.5%) and Left Circumflex (LCx) (29.5%). Single-vessel disease (SVD) (69.5%) was the most frequent observation on CAG, whereas 24% and 6.5% of patients had double-vessel and triple-vessel disease (DVD, TVD), respectively.
Transcription factor-binding k-mer analysis clarifies the cell type dependency of binding specificities and cis-regulatory SNPs in humans
Authors: Tahara Saeko , Tsuchiya Takaho , Matsumoto Hirotaka , Ozaki Haruka
Published: October 2023

Background

Transcription factors (TFs) exhibit heterogeneous DNA-binding specificities in individual cells and whole organisms under natural conditions, and de novo motif discovery usually provides multiple motifs, even from a single chromatin immunoprecipitation-sequencing (ChIP-seq) sample. Despite the accumulation of ChIP-seq data and ChIP-seq-derived motifs, the diversity of DNA-binding specificities across different TFs and cell types remains largely unexplored.

Results

Here, we applied MOCCS2, our k-mer-based motif discovery method, to a collection of human TF ChIP-seq samples across diverse TFs and cell types, and systematically computed profiles of TF-binding specificity scores for all k-mers. After quality control, we compiled a set of TF-binding specificity score profiles for 2,976 high-quality ChIP-seq samples, comprising 473 TFs and 398 cell types. Using these high-quality samples, we confirmed that the k-mer-based TF-binding specificity profiles reflected TF- or TF-family dependent DNA-binding specificities. We then compared the binding specificity scores of ChIP-seq samples with the same TFs but with different cell type classes and found that half of the analyzed TFs exhibited differences in DNA-binding specificities across cell type classes. Additionally, we devised a method to detect differentially bound k-mers between two ChIP-seq samples and detected k-mers exhibiting statistically significant differences in binding specificity scores. Moreover, we demonstrated that differences in the binding specificity scores between k-mers on the reference and alternative alleles could be used to predict the effect of variants on TF binding, as validated by in vitro and in vivo assay datasets. Finally, we demonstrated that binding specificity score differences can be used to interpret disease-associated non-coding single-nucleotide polymorphisms (SNPs) as TF-affecting SNPs and provide candidates responsible for TFs and cell types.

Conclusions

Our study provides a basis for investigating the regulation of gene expression in a TF-, TF family-, or cell-type-dependent manner. Furthermore, our differential analysis of binding-specificity scores highlights noncoding disease-associated variants in humans.
Semi-automated assessment of the risk of bias due to missing evidence in network meta-analysis: a guidance paper for the ROB-MEN web-application
Authors: Chiocchia Virginia , Holloway Alexander , Salanti Georgia
Published: October 2023

Network meta-analysis compares multiple interventions and estimates the relative treatment effects between all interventions, combining both direct and indirect evidence. Recently, a framework was developed to assess the Risk Of Bias due to Missing Evidence in Network meta-analysis (ROB-MEN) which is part of the more comprehensive framework to evaluate the Confidence In the evidence for Network Meta-Analysis (CINeMA). To produce an overall risk of bias judgement for each network estimate, ROB-MEN: performs an assessment of the bias due to missing evidence in each possible pairwise comparison; combines the assessment with the contribution from the direct pairwise comparisons; considers the potential for small-study effects. To facilitate and semi-automate this process, ROB-MEN has been implemented in a user-friendly web-application (https://cinema.ispm.unibe.ch/rob-men). Here we provide a tutorial detailing the functionality and use of the application consisting of data upload, analysis configuration, output visualisation, and production of the tool’s output tables for recording the risk of bias assessment. We also illustrate an example application using the demo dataset available for download on the application’s homepage. The ROB-MEN web-application is open-source and freely available (https://github.com/esm-ispm-unibe-ch/rob-men).
Development and validation of a nomogram model for prediction of stroke-associated pneumonia associated with intracerebral hemorrhage
Authors: Wang Ying , Chen Yuting , Chen Roumeng , Xu Yuchen , Zheng Han , Xu Jiajun , Xia Jinyang , Cai Yifan , Xu Huiqin , Wang Xinshi
Published: October 2023

Background

We aimed to establish risk factors for stroke-associated pneumonia (SAP) following intracerebral hemorrhage (ICH) and develop an efficient and convenient model to predict SAP in patients with ICH.

Methods

Our study involved 1333 patients consecutively diagnosed with ICH and admitted to the Neurology Department of the First Affiliated Hospital of Wenzhou Medical University. The 1333 patients were randomly divided (3:1) into the derivation cohort (n = 1000) and validation Cohort (n = 333). Variables were screened from demographics, lifestyle-related factors, comorbidities, clinical symptoms, neuroimaging features, and laboratory tests. In the derivation cohort, we developed a prediction model with multivariable logistic regression analysis. In the validation cohort, we assessed the model performance and compared it to previously reported models. The area under the receiver operating characteristic curve (AUROC), GiViTI calibration belt, net reclassification index (NRI), integrated discrimination index (IDI) and decision curve analysis (DCA) were used to assess the prediction ability and the clinical decision-making ability.

Results

The incidence of SAP was 19.9% and 19.8% in the derivation (n = 1000) and validation (n = 333) cohorts, respectively. We developed a nomogram prediction model including age (Odds Ratio [OR] 1.037, 95% confidence interval [CI] 1.020–1.054), male sex (OR 1.824, 95% CI 1.206–2.757), multilobar involvement (OR 1.851, 95% CI 1.160–2.954), extension into ventricles (OR 2.164, 95% CI 1.456–3.215), dysphagia (OR 3.626, 95% CI 2.297–5.725), disturbance of consciousness (OR 2.113, 95% CI 1.327–3.362) and total muscle strength of the worse side (OR 0.93, 95% CI 0.876–0.987). Compared with previous models, our model was well calibrated and showed significantly higher AUROC, better reclassification ability (improved NRI and IDI) and a positive net benefit for predicted probability thresholds between 10% and 73% in DCA.

Conclusions

We developed a simple, valid, and clinically useful model to predict SAP following ICH, with better predictive performance than previous models. It might be a promising tool to assess the individual risk of developing SAP for patients with ICH and optimize decision-making.
Epidemiologic characteristics of high-risk HPV and the correlation between multiple infections and cervical lesions
Authors: Luo Qinli , Zeng Xianghua , Luo Hanyi , Pan Ling , Huang Ying , Zhang Haiyan , Han Na
Published: October 2023

Background

The aim of this study was to determine the prevalence of high-risk human papillomavirus (HR-HPV) and the correlation between multiple infections and cervical lesions.

Methods

The current study involved population-based sample of 20,059 women who underwent cervical screening for 15 HR-HPV genotypes with ThinPrep cytologic test (TCT) results. The correlation between multiple HPV genotype infections and cervical lesions was also determined. The odds ratios (ORs) were calculated to assess co-infection patterns for each genotype with 15 other genotypes and the additive statistical interactions were evaluated.

Results

There was a bimodal pattern among multiple HPV infections, with a peak in the younger group and a second peak in the elderly group. Indeed, most multiple HPV genotypes exhibited a bimodal pattern. The most common HPV type in patients with high-grade squamous intraepithelial lesions (HSILs) was HPV-16, followed by HPV-52, HPV-58, and HPV-33. The most frequent HPV type in patients with cervical cancer was HPV-16, followed by HPV-58 and HPV-33. Women with multiple infections were at a increased risk of low-grade squamous intraepithelial lesions [LSIL] (OR = 2.01; 95% CI 1.38–2.93) and HSIL (OR 2.28; 95% CI 1.36–3.81) when compared to women with single infections. patients with cervical cancer had the higher percentage of multiple HPV infections. Based on the data herein, we suggest that HPV-33 and HPV-58 may also be high-risk HPV types worthy of increased surveillance and follow-up. Conclusion: Our findings suggested that the association between multiple HPV infections and HSIL and LSIL are stronger compared to single HPV infections. There may be some specific combinations that synergistically affected the risk of HSIL and LSIL.
Causal relationship between blood metabolites and risk of five infections: a Mendelian randomization study
Authors: Wei Zhengxiao , Xiong Qingqing , Huang Dan , Wu Zhangjun , Chen Zhu
Published: October 2023

Objective

Infectious diseases continue to pose a significant threat in the field of global public health, and our understanding of their metabolic pathogenesis remains limited. However, the advent of genome-wide association studies (GWAS) offers an unprecedented opportunity to unravel the relationship between metabolites and infections.

Methods

Univariable and multivariable Mendelian randomization (MR) was commandeered to elucidate the causal relationship between blood metabolism and five high-frequency infection phenotypes: sepsis, pneumonia, upper respiratory tract infections (URTI), urinary tract infections (UTI), and skin and subcutaneous tissue infection (SSTI). GWAS data for infections were derived from UK Biobank and the FinnGen consortium. The primary analysis was conducted using the inverse variance weighted method on the UK Biobank data, along with a series of sensitivity analyses. Subsequently, replication and meta-analysis were performed on the FinnGen consortium data.

Results

After primary analysis and a series of sensitivity analyses, 17 metabolites were identified from UK Biobank that have a causal relationship with five infections. Upon joint analysis with the FinGen cohort, 7 of these metabolites demonstrated consistent associations. Subsequently, we conducted a multivariable Mendelian randomization analysis to confirm the independent effects of these metabolites. Among known metabolites, genetically predicted 1-stearoylglycerol (1-SG) (odds ratio [OR] = 0.561, 95% confidence interval [CI]: 0.403–0.780, P < 0.001) and 3-carboxy-4-methyl-5-propyl-2-furanpropanoate (CMPF) (OR = 0.780, 95%CI: 0.689–0.883, P < 0.001) was causatively associated with a lower risk of sepsis, and genetically predicted phenylacetate (PA) (OR = 1.426, 95%CI: 1.152–1.765, P = 0.001) and cysteine (OR = 1.522, 95%CI: 1.170–1.980, P = 0.002) were associated with an increased risk of UTI. Ursodeoxycholate (UDCA) (OR = 0.906, 95%CI: 0.829–0.990, P = 0.029) is a protective factor against pneumonia. Two unknown metabolites, X-12407 (OR = 1.294, 95%CI: 1.131–1.481, P < 0.001), and X-12847 (OR = 1.344, 95%CI: 1.152–1.568, P < 0.001), were also identified as independent risk factors for sepsis.

Conclusions

In this MR study, we demonstrated a causal relationship between blood metabolites and the risk of developing sepsis, pneumonia, and UTI. However, there was no evidence of a causal connection between blood metabolites and the risk of URTI or SSTI, indicating a need for larger-scale studies to further investigate susceptibility to certain infection phenotypes.
Risk factors for postoperative complications following one-stage proximal hypospadias repair involving the disconnection of the urethral plate: a retrospective study
Authors: Hu Jianjun , Zhao Yaowang , He Tianqu , Chen Yifu , Wang Zhaohui , Peng Liucheng
Published: October 2023

Background

Children with hypospadias are at risk of serious physical and mental health problems, including abnormal urination, sexual dysfunction, and infertility. The sole available treatment is the surgical restoration of genital appearance and function. Proximal hypospadias (PH) correction is more challenging and carries a higher risk of complications than does distal hypospadias correction, with a higher likelihood of postoperative complications requiring additional surgery, resulting in considerable economic and psychological strain for families. Herein, we aimed to identify factors associated with complications following one-stage PH repair with urethral plate disconnection.

Methods

We retrospectively analyzed data from 236 children who underwent PH repair at our center between December 2020 and December 2022. We collected information on age, surgical procedure, length of the reconstructed urethra (LRU), glans width (GW), ventral curvature, surgical approach, preoperative androgen use, suture type, presence of prostatic utricle, body mass index, season of surgery, anesthesia type, low birth weight, preterm birth, follow-up period, and complications. Surgical complications included urethral fistulas, urethral diverticula, anastomotic strictures, urethral strictures, glans dehiscence, and penile curvature recurrences. The study population was divided into complication and no-complication groups, and univariate and multivariate analyses were conducted.

Results

Of the 236 patients with PH who had a median follow-up of 10.0 (8.0, 14.0) months, 79 were included (33.5%) in the complication group and 157 were included (66.5%) in the no-complication group. In the univariate analysis, age (P < 0.001), LRU (P < 0.001), degree of penile curvature (P = 0.049), and PH with prostatic utricle (P = 0.014) were significantly associated with complications after PH repair. In the multivariate logistic regression analysis, LRU (P<0.001, odds ratio [OR] = 3.396, 95% confidence interval [CI]: 2.229–5.174) and GW (P = 0.004, OR = 0.755, 95%CI: 0.625–0.912) were independent factors influencing postoperative complications. The optimal LRU threshold was 4.45 cm (area under the curve, 0.833; sensitivity, 0.873; specificity, 0.873;P<0.001, OR = 3.396, 95% CI: 2.229–5.174).

Conclusions

LRU and GW are independent factors affecting PH complications. An LRU of < 4.45 cm and an increased GW can reduce the risk of complications.
Digital tools to support mental health: a survey study in psychosis
Authors: Eisner Emily , Berry Natalie , Bucci Sandra
Published: October 2023

Background

There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation.

Methods

A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context.

Results

Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership.

Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support.

Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime.

Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood.

Conclusions

Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.
Assessing sex differences in viral load suppression and reported deaths using routinely collected program data from PEPFAR-supported countries in sub-Saharan Africa
Authors: Fernandez Danielle , Ali Hammad , Pals Sherri , Alemnji George , Vasireddy Vamsi , Siberry George K. ,   PEPFAR MER Interagency Participants, Rebello Cardoso Yolanda , Vasquez Caroll , Bruno Emily , Kavungerwa Apollinaire , Kavabushi Franck , Ndayizeye Aime , Eno Laura T. , Akiy Zacheaus Zeh , Clotaire Billong Serge , Mukinda Elie , Ahmed Solomon , Fiseha Daniel , Hika Zerihun , Waruru Anthony , Asiimwe Fred , Luhanga Misheck , Matchere Faustin , McOwen Jordan , Mutandi Gram , Bikinesi Leonard , Ashipala Laimi , Dalhatu Ibrahim T. , Bolo Alex , Katoro Joel Sua , Balinda Mushubira M. , Rosenthal Matthew , Nguhuni Boniface , Magesa Alex S. , Oboho Ikwo , Godfrey Catherine
Published: October 2023

Background

In sub-Saharan Africa, more women than men access HIV testing and treatment and may have better viral load suppression (VLS). We utilized routinely reported aggregated HIV program data from 21 sub-Saharan African countries to examine sex differences in VLS and death rates within antiretroviral therapy (ART) programs supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR).

Methods

We included VLS and reported death data for persons aged 15 + years on ART from October–December 2020 disaggregated by sex and age for each subnational unit (SNU). We used linear mixed-model regression to estimate VLS proportion and negative binomial mixed-model regression to estimate the rates of death and death plus interruptions in treatment (IIT). All models were weighted for SNU-level ART population size and adjusted for sex, age, HIV/tuberculosis coinfection, country, and SNU; models for reported deaths and deaths plus IIT were also adjusted for SNU-level VLS.

Results

Mean VLS proportion was higher among women than men (93.0% vs. 92.0%, p-value < 0.0001) and 50 + than 15–49 age group (93.7% vs. 91.2%, p-value < 0.0001). The mean rate of reported deaths was higher among men than women (2.37 vs. 1.51 per 1000 persons, p-value < 0.0001) and 50 + than 15–49 age group (2.39 vs. 1.50 per 1000, p-value < 0.0001); the mean rate of reported deaths plus IIT was higher among men (30.1 in men vs. 26.0 in women per 1000, p-value < 0.0001) and higher among 15–49 than 50 + age group (34.7 vs. 22.6 per 1000, p-value < 0.0001).

Conclusions

The mean rate of reported deaths was higher among men in most models despite adjusting for VLS. Further exploration into differences in care-seeking behaviors; coverage of screening, prophylaxis, and/or treatment of opportunistic infections; and more extensive testing options for men to include CD4 is recommended.
A cluster randomised controlled trial to assess the effectiveness of a multi-strategy sustainability intervention on teachers’ sustained implementation of classroom physical activity breaks (energisers): study protocol
Authors: Nathan Nicole , Hall Alix , Shoesmith Adam , Bauman Adrian E. , Peden Belinda , Duggan Bernadette , Gardner Carly , Lane Cassandra , Lecathelinais Christophe , Oldmeadow Christopher , Duncan Craig , Groombridge Daniel , Riley-Gibson Edward , Pollock Emma , Boyer James , Wiggers John , Gillham Karen , Pattinson Martina , Mattingly Megan , McCarthy Nicole , Naylor Patti-Jean , Reeves Penny , Budgen Philippa , Sutherland Rachel , Jackson Rebecca , Croft Thomas , Pascoe William , Wolfenden Luke
Published: October 2023

Background

Governments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers’ sustainment of energisers (short 3–5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up.

Methods

A cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods.

Discussion

This study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools’ sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally.

Trial registration

ACTRN12620000372987 version 1 registered 17th March 2020. Version 3 (current version) updated 4th August 2023.