bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Time and Power Requirement Trade-Offs in an Additive Manufacturing-Disrupted Production Cell
Authors: Jones Chad , Montoya Matthew , Strawser Larry , Patterson Albert E.
Published: December 2024

The introduction of additive manufacturing (AM) into modern production environments has provided new capabilities; however, these capabilities have disrupted manufacturing cells. The disruption of manufacturing through the addition of AM processes provides an opportunity to model a manufacturing cell, quantify the cells performance with respect to primary concerns, disrupt the cell, and lastly provide a qualitative analysis of the trade space between primary concerns. Using a previously developed cell model and convex optimization approach, the qualitative trade-offs between power and manufacturing time were explored. This trade-off analysis was then demonstrated using a realistic case study in which an existing cell was disrupted via the introduction of an additive manufacturing process with the requirement that the cell was not able to be re-designed or re-configured. The optimal machine settings for the original cell were used as the starting point for an adaptive optimization to recover as much performance as possible from the cell without changing the order, number, or types of machines other than the introduction of the AM process. The results offer a large number of important lessons related to the design of manufacturing cells, the design of products, and the possible decision variables for integrating AM into end-user manufacturing systems.
Application of an Equivalent Temperature Field for Emulating Thermal Autofrettage-Induced Residual Stresses in Thick-Walled Cylinder
Authors: Roy A. K. , Sharma Indranuj , Kamal S. M. , Patil R. U. , Rao V. V.
Published: December 2024

The equivalent temperature field of residual stresses induced by autofrettage of thick-walled cylinders and spheres have been successfully implemented in a finite element method framework to study the crack growth in autofrettaged components. Thermal autofrettage is a potential alternative method for strengthening hollow cylinders against internal pressurization. The assessment of service life of thermally autofrettaged cylinders containing cracks is imperative when they are subjected to high pressure static or cyclic in-service loading. There the equivalent temperature field replicating the thermal autofrettage-induced residual stresses will serve as the input to the finite element method analysis to evaluate the important fracture parameters such as static fracture endurance and the rate of crack growth for predicting service life. This work presents evaluation of an equivalent temperature field by establishing an equivalence between the thermoelastic stress field and thermal autofrettage-induced residual stress field in a cylinder obtained from either an analytical or a numerical model. The evaluated equivalent temperature field is then used in a finite element method analysis to exemplify the replication of the original residual stresses generated by thermal autofrettage in SS304, aluminum cylinders and electroslag refined (ESR) steel gun barrel. It is found that the finite element stress solution due to the application of equivalent temperature field and the original analytical or numerical thermal autofrettage residual stress solution are in good agreement with less than 5% deviation in the case of SS304 and aluminum cylinders, and that in ESR steel barrel with less than 1% deviation.
Analytical solutions for acoustic vortex beam radiation from planar and spherically focused circular pistons
Authors: Gokani Chirag A. , Haberman Michael R. , Hamilton Mark F.
Published: December 2024

Analytical solutions for acoustic vortex beams radiated by sources with uniform circular amplitude distributions are derived in the paraxial approximation. Evaluation of the Fresnel diffraction integral in the far field of an unfocused source and in the focal plane of a focused source leads to solutions in terms of an infinite series of Bessel functions for orbital numbers ℓ>−2. These solutions are reduced to closed forms for 0≤ℓ≤4, which correspond to orbital numbers commonly used in experiments. A scaling law for the vortex ring radius is derived, and its relevance is characterized using ray theory.
Multimodal Rehabilitation Including Strengthening Exercise Is Effective in Improving Fear-Avoidance Beliefs in Individuals With Patellofemoral Pain: A Critically Appraised Topic
Authors: Meade Sarah , Kim Sungwan , Glaviano Neal R.
Published: December 2024

Clinical Scenario: Individuals with patellofemoral pain (PFP) present with a variety of neuromuscular and psychological deficits, with the “gold-standard” for treatment being rehabilitation programs with strengthening-based exercises. While such interventions primarily target pain and function measures, it is unknown whether psychological measures such as fear-avoidance beliefs (FABs) are also affected. Clinical Question: Is rehabilitation including strengthening exercises effective in improving FABs in individuals with PFP? Summary of Key Findings: Three studies met the inclusion criteria and were included in the appraisal. All studies found that rehabilitation including strengthening exercises was effective in improving FABs for physical activity, though such improvements were modest. One study found that supplementing a one-time psychological intervention to rehabilitation including strengthening exercises resulted in greater improvements in FABs than with rehabilitation including strengthening exercises alone. Two studies found associations between changes in FABs and changes in pain and/or function outcomes. Clinical Bottom Line: There is consistent evidence that the incorporation of rehabilitation with strengthening exercises is effective in improving FABs in individuals with PFP, though such improvements are modest. Furthermore, supplementation with psychological interventions to rehabilitation including strengthening exercises may produce larger improvements in FABs, particularly in patients with an elevated FABs phenotype. As a result of improving FABs, patient outcomes of pain and function may be improved, though future research is needed. Therefore, at this time, we recommend that rehabilitation, including strengthening exercises with supplemental psychological interventions be prescribed for the treatment of PFP particularly in subgroups with elevated FABs, to improve patient outcomes. Strength of Recommendation: Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A based on the Strength of Recommendation Taxonomy.
Exploring Perceived Mattering in Physical Education Teacher Education Doctoral Students
Authors: Schulz Denis , Gaudreault Karen Lux , Richards Kevin Andrew , Shiver Victoria N. , Simonton Kelly L.
Published: December 2024

Background: Physical Education Teacher Education (PETE) doctoral programs lay the foundation for training PETE doctoral students to become PETE faculty members. Limited knowledge is available on how PETE doctoral students experience and navigate their educational doctoral programs. Purpose: This study explored PETE doctoral students’ perceptions of mattering within their doctoral programs. Methods: Data were collected through an online questionnaire and semistructured interviews with 16 doctoral students nationwide. Findings: Qualitative data analysis revealed four distinct themes: (a) faculty members can induce feelings of mattering, (b) importance grows over time, (c) peer support matters, and (d) gender and race influence perceptions of mattering. Discussion: As time passes, doctoral students’ feelings of importance grow as they take on more responsibilities. The level of support provided by faculty members and peers can strongly impact doctoral students’ perceptions of mattering. Celebrating achievements with peers can serve as a way for students to extend their self-worth. Females and historically marginalized groups may experience increased feelings of self-doubt and marginalization. Conclusion: Intentionally cultivating perceptions of mattering and acknowledging the diverse backgrounds of each student can improve the quality of a doctoral program.
Stories of Governance: Examining “Consensus” in the International Olympic Committee’s Consensus Statements on Relative Energy Deficiency in Sport
Authors: Posbergh Anna , Jette Shannon L.
Published: December 2024

Policies to “protect” athletes, particularly women, are derived from contextual and unstable entanglements between sociocultural and biological considerations. This is especially demonstrated in relative energy deficiency in sport (REDs): a syndrome that occurs due to low energy availability and is influenced by environmental and societal factors. While sport organizations such as the International Olympic Committee have generated consensus statements to help with prevention, identification, and treatment of REDs, developing “consensus” remains a contentious issue given the syndrome’s multifactorial nature. Using a governmentality framework alongside Star and Griesemer’s concept of a “boundary object,” we analyze three International Olympic Committee consensus statements on REDs and interviews with five relevant experts to understand how “consensus” is developed. We identify three stories of governance (messy, flexible, and simplified) which, we argue, illustrate how multiple REDs-related epistemologies and ontologies are accommodated in the consensus statements, albeit with a push toward standardization and, ultimately, simplified governance.
Cranial nerve III palsy induced by adjuvant capecitabine for cholangiocarcinoma
Authors: Dungey Maurice , Ashmore Norene , Dulloo Sean
Published: December 2024

A man in his 70s with completely resected cholangiocarcinoma started adjuvant treatment with capecitabine chemotherapy. Within 3 weeks he developed complete left-sided ptosis with loss of ocular adduction, elevation and depression. There were no other neurological features; CT and MRI scans of the brain were normal. He had no history of diabetes and blood pressure was reasonably controlled. A diagnosis of capecitabine-induced cranial nerve III palsy was made and no further capecitabine was given. The patient’s ptosis improved within a month and there was full resolution within 2 months. He continued with follow-up surveillance CT scans for cholangiocarcinoma. This is the first reported cranial nerve III palsy due to capecitabine, the aetiology of which is uncertain. It is important that clinicians are able to recognise this as a potential complication as capecitabine is commonly given in combination with other agents for various cancer types.
A rare homozygousINSvariant causes adult-onset diabetes
Authors: Tans Roel , Glendorf Tine , van Herwaarden Antonius E , Venselaar Hanka , van Rijswijck Danique M H , Wevers Ron A , Gloerich Jolein , van Gool Alain , Tack Cees J
Published: December 2024

Introduction

Maturity-onset diabetes of the young (MODY) and neonatal diabetes mellitus (NDM) are the most prevalent causes of monogenic diabetes. MODY is an autosomal dominant condition with onset in childhood and young adulthood, while NDM is defined with diabetes onset within 6 months of age and can be caused by dominant, recessive, X-linked genes or by chromosomal abnormalities. Here, we describe a rare case of monogenic diabetes in a patient who is homozygous for anINSgene variant.

Research design and methods

The index patient, a male diagnosed with type 2 diabetes, was treated with low-dose insulin and metformin. Blood plasma was collected under fasting conditions for analysis. MODY screening was performed using a next-generation sequencing panel. In silico analysis of the insulin variant’s three-dimensional structure and its interaction with the insulin receptor was conducted. Insulin receptor affinity and downstream signaling potency were evaluated in vitro.

Results

Auto-immune diabetes was excluded. A homozygous missense variant of theINSgene (c.130G>A, p.Gly44Arg) was identified in the patient. The combination of three different insulin assays showed that the biosynthesis of proinsulin into insulin was intact. In silico analysis of the mutant insulin 3D structure revealed that theINSvariant is likely to affect insulin receptor binding and subsequent in vitro analysis suggested reduced potency in downstream signaling.

Conclusions

The homozygous c.130G>A variant in theINSgene results in reduced insulin receptor binding and signaling potency. This, combined with pancreatic β-cell apoptosis or dedifferentiation supposedly, has contributed in the late-onset of monogenic diabetes in the index patient.
Assessing progress on the coverage of interventions in the first 1000 days in India: role of national programs
Authors: Avula Rasmi , Nguyen Phuong Hong , Christopher Anita , Gune Soyra , Bhatia Neena , Chauhan Alka , Dwivedi L K , Kapur Avani , Pedgaonkar Sarang , Shukla Ritwik , Chakrabarti Suman , Singh Shri Kant , Menon Purnima
Published: December 2024

Background

High coverage of nutrition-specific interventions is critical to meet global nutrition targets, and it is imperative to understand how to attain it. We examined trends and inequalities in the coverage of interventions in India and the role of the National Nutrition Mission (NNM) in achieving improvements.

Methods

We conducted trends and equity analysis of 30 interventions using two rounds of National Family Health Survey data (2015–2016, n=1 78 874, and 2019–2021, n=1 70 697). We also compared coverage between states that received incentives and monitoring under NNM and those that did not. We reviewed programme documents and grey literature to construct a policy timeline to trace pathways to coverage improvement and consulted with stakeholders to confirm interpretation of findings.

Findings

Between 2016 and 2021, coverage improved significantly for nearly all interventions (~1–22 percentage points (pp) during pregnancy, ~7–20 pp during delivery/postpartum and~5–17 pp during early childhood). Improvements in coverage were higher among the poor and in rural areas compared with the rich and in urban areas, respectively; wealth and residence gaps narrowed for most interventions. These improvements could be traced to community mobilisation, technology and monitoring under NNM. Improvements in coverage of growth monitoring and counselling were higher in states that received additional incentives and monitoring under NNM. Stakeholders concurred that the improvements in coverage were likely driven by NNM.

Interpretation

Focused policy attention and programmatic efforts improved coverage and reduced inequities indicating an inclusive approach. Persistent coverage gaps for certain interventions require further inquiry.
Work-related temporary hearing loss and associated factors among textile industry workers in Amhara region, Ethiopia: a cross-sectional study
Authors: Yirdaw Atalay Tadele , Abere Giziew , Belay Azanaw Asega , Kinfe Beletu , Worede Eshetu Abera
Published: December 2024

Objectives

This study was designed to assess occupational noise exposure levels, prevalence of temporary hearing loss and associated factors among textile industry workers in Amhara region, Ethiopia.

Design

An institution-based, cross-sectional study was conducted between June and July 2022. Participants were selected via a simple random sampling technique.

Setting

Textile industry workers in Bahir Dar and Kombolcha.

Participants

A total of 413 study participants were included in the data analysis.

Procedures and analysis

The data were collected using a structured questionnaire. Area noise exposure levels in different work sections were measured using a sound level meter. Data analysis was done using Stata Version 14.0 software. Bivariate and multivariable logistic regression analysis were used to identify factors associated with temporary hearing loss. Adjusted OR with 95% CI and p-value<0.05 were used to determine statistical significance.

Results

A total of 413 workers participated in the study with a response rate of 97.9%. The age of respondents ranged from 22 to 59 years (median age 32 years). The prevalence of work-related temporary hearing loss was 38.7% (95% CI 34.14% to 43.6%). Weaving department (AOR=6.6, 95% CI 3.06 to 14.3) and higher sound pressure level (>90 dBA) (AOR=7.9; 95% CI 2.6 to 23.7) were significantly associated with work-related temporary hearing loss among textile workers.

Conclusions

The prevalence of work-related temporary hearing loss among textile industry workers was high. Weaving department and higher sound pressure level were significantly associated with work-related temporary hearing loss. Implementation of noise reduction measures, particularly in the weaving department, should be prioritised. Provision and enforcement of the use of hearing protection devices and establishment of regular hearing screening programmes to monitor workers' auditory health are advisable.
AI-assisted detection for chest X-rays (AID-CXR): a multi-reader multi-case study protocol
Authors: Khan Farhaan , Das Indrajeet , Kotnik Marusa , Wing Louise , Van Beek Edwin , Murchison John , Ahn Jong Seok , Lee Sang Hyup , Seth Ambika , Espinosa Morgado Abdala Trinidad , Fu Howell , Novak Alex , Salik Nabeeha , Campbell Alan , Shah Ruchir , Gleeson Fergus , Ather Sarim
Published: December 2024

Introduction

A chest X-ray (CXR) is the most common imaging investigation performed worldwide. Advances in machine learning and computer vision technologies have led to the development of several artificial intelligence (AI) tools to detect abnormalities on CXRs, which may expand diagnostic support to a wider field of health professionals. There is a paucity of evidence on the impact of AI algorithms in assisting healthcare professionals (other than radiologists) who regularly review CXR images in their daily practice.

Aims

To assess the utility of an AI-based CXR interpretation tool in assisting the diagnostic accuracy, speed and confidence of a varied group of healthcare professionals.

Methods and analysis

The study will be conducted using 500 retrospectively collected inpatient and emergency department CXRs from two UK hospital trusts. Two fellowship-trained thoracic radiologists with at least 5 years of experience will independently review all studies to establish the ground truth reference standard with arbitration from a third senior radiologist in case of disagreement. The Lunit INSIGHT CXR tool (Seoul, Republic of Korea) will be applied and compared against the reference standard. Area under the receiver operating characteristic curve (AUROC) will be calculated for 10 abnormal findings: pulmonary nodules/mass, consolidation, pneumothorax, atelectasis, calcification, cardiomegaly, fibrosis, mediastinal widening, pleural effusion and pneumoperitoneum. Performance testing will be carried out with readers from various clinical professional groups with and without the assistance of Lunit INSIGHT CXR to evaluate the utility of the algorithm in improving reader accuracy (sensitivity, specificity, AUROC), confidence and speed (paired sample t-test). The study is currently ongoing with a planned end date of 31 December 2024.

Ethics and dissemination

The study has been approved by the UK Healthcare Research Authority. The use of anonymised retrospective CXRs has been authorised by Oxford University Hospital’s information governance teams. The results will be presented at relevant conferences and published in a peer-reviewed journal.

Trial registration number

Protocol ID 310995-B (awaiting approval), ClinicalTrials.gov
Mapping an evidence-based end-of-life care framework for older adults in Chinese nursing homes: protocol for a scoping review
Authors: Zhao Yuanyuan , Tu Yuehua , Chew Boon How , Gacasan Eva Marie
Published: December 2024

Introduction

End-of-life care is essential for older adults aged ≥60, particularly those residing in long-term care facilities, such as nursing homes, which are known for their home-like environments compared with hospitals. Due to potential limitations in medical resources, collaboration with external healthcare providers is crucial to ensure comprehensive services within these settings. Previous studies have primarily focused on team-based models for end-of-life care in hospitals and home-based settings. However, there is a lack of sufficient evidence on practices in such facilities, particularly for Chinese older adults. The aim of this scoping review is to map the existing literature and inform the development of an appropriate care framework for end-of-life care in nursing homes. The focus of this article will be on the scope of services, guidelines for decision making, roles within interdisciplinary teams, and the practical feasibility of care provision.

Methods and analysis

A systematic search will be conducted across nine electronic databases: PubMed, Scopus, EMBASE, Cochrane, PsycINFO, ERIC, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The search will identify literature published in English and Chinese from January 2012 onwards. Articles will be selected based on their relevance to older adults aged ≥60 with disabilities or life-threatening chronic conditions receiving end-of-life care in nursing homes or similar settings. The data extraction process will be guided by the Canadian Hospice Palliative Care Association model (CHPCA) and the Respectful Death model. Qualitative data analysis will be performed using a framework method and thematic analysis, employing both inductive and deductive approaches, with three reviewers participating in the review process.

Ethics and dissemination

Ethical approval is not required because the data for this review is obtained from selected publicly available articles. The results will be disseminated through publications in peer-reviewed journals and presented at relevant conferences. Furthermore, the findings will be shared with policymakers and healthcare professionals engaged in end-of-life care to inform practice and decision making.

Study registration

The review protocol has been registered on osf.io (https://osf.io/3u4mp).
Carer strain in post-stroke emotionalism: a cross-sectional analysis
Authors: Broomfield Niall , Walters Matthew , West Robert M
Published: December 2024

Objectives

Post-stroke emotionalism (PSE) is a common, under-researched neurologic symptom of stroke, characterised by frequent crying episodes not under usual social control. Currently, there are no data on carer strain in the context of emotionalism after stroke. We aimed to explore the degree of carer strain in carers of individuals with diagnosed PSE compared with carers of individuals with stroke but no PSE to examine whether carer strain varies with particular characteristics of the cared for individual (patient age, sex, social deprivation, stroke type, functional status, mood status) and to quantify the impact of PSE on carer strain, after accounting for other factors.

Design

Cross-sectional observation study.

Setting

Nine secondary care stroke units in Scotland, UK.

Participants

102 informants of people with stroke.

Primary and secondary outcome measures

The Modified Carer Strain Index was completed at 6 months post-stroke as part of the Testing Emotionalism After Recent Stroke (TEARS) longitudinal cohort study between 1 October 2015 and 30 September 2018. Stroke survivor diagnostic status was determined using TEARS-Diagnostic Interview based on published, widely accepted diagnostic criteria of emotionalism.

Results

There was little evidence of association between carer strain and sex, age, deprivation level or stroke type of the cared for individual. There was strong evidence that carer strain was associated with both increased functional dependence post-stroke (−0.30 to −0.02, p=0.026) and presence of PSE (0.16 to 1.73, p=0.019).

Conclusions

Even after accounting for increased functional dependence, our study data indicates that caring in a PSE context may significantly increase carer strain, comparable to a six-point reduction on the Barthel Index.

Trial registration number

NRS Stroke Research Network ID 18980.
Optimisation of services to prevent dental caries for school-aged children in China: a discrete choice experiment
Authors: Wang Lidan , Chen Zhu , Chen Sixuan , Jin Xinyu , Hu Lu , Jiang Jiacheng , Yu Hong , Xu Jianguang , Xu Wenhua
Published: December 2024

Objectives

The objective of this study is to analyse the preferences of guardians of school-aged children for children’s caries prevention services (CPS) and their willingness to pay (WTP) for different levels of attributes.

Design

Four key attributes were identified through a literature review and expert consultations: preventive service time, preventive effectiveness, distance (driving time to service institution) and service cost (out-of-pocket for CPS). A D-efficient design was used to create a discrete choice experiment questionnaire, and data were collected via face-to-face interviews.

Setting

Data collection was conducted between July 2021 and January 2022 in Anhui, China.

Participants

Guardians (785) of children aged 3–12 years participated.

Main outcome measures

A mixed-logit model was used to estimate preferences and WTP for different attribute levels, and the preference heterogeneity was assessed using a latent class logit model.

Results

Preventive effectiveness was the most important attribute, followed by service cost, preventive service time and distance. Guardians preferred CPS with over 90% preventive effectiveness, a distance of 10–25 min, services offered during vacations and lower service cost. Guardians were willing to pay 409 Chinese yuan (CNY) for higher effectiveness, 84 CNY for shorter distances and 87 CNY for services offered during vacation. Guardians with a college education or higher and females prioritise preventive effectiveness, while guardians who had children with a caries history and who had children with better oral health status preferred CPS during vacation.

Conclusions

All four attributes influenced guardians’ preferences for CPS, with preventive effectiveness being the most important. Guardians were willing to pay extra money for better CPS, and preferences varied according to individual characteristics. These findings provide a reference for policy-makers to provide personalised, demand-based CPS.
VRx@Home protocol: A virtual reality at-home intervention for persons living with dementia and their care partners
Authors: Saryazdi Raheleh , Appel Lora , Lewis-Fung Samantha , Carsault Lou-Anne , Qi Di , Garcia-Giler Eduardo , Campos Jennifer L
Published: December 2024

Introduction

Virtual reality (VR) technology is increasingly used by researchers and healthcare professionals as a therapeutic intervention to improve the quality of life of persons living with dementia (PLwD). However, most VR interventions to date have mainly been explored in long-term or community care settings, with fewer being explored at home. Setting is important, given that the majority of PLwD live at home and are cared for by their family care partners. One of the challenges affecting PLwD and care partner relationships is barriers in communication, which can lead to social isolation and poor quality of life for both parties. Thus, the goal of the proposed project is to explore whether an immersive, multisensory VR intervention can facilitate communication between PLwD and their care partners and, in turn, enhance personal relationships and improve well-being.

Methods and analysis

Thirty dyads comprised of PLwD and their family/friend care partners will participate in this at-home intervention. Their interactions will be recorded as they experience a series of 360° videos together (eg, concert, travel) either using a VR headset (PLwD) with a paired tablet (care partner) or using only a tablet together. The two conditions will allow us to compare immersive VR technology to more common non-immersive tablet-based technology. The study will begin with at-home training and baseline data collection. The intervention will then take place over a 4-week period, with the two conditions (VR vs tablet-only) experienced 2 weeks each. A comprehensive set of measures will be employed to assess the quality and quantity of dyadic interactions, such as verbal/non-verbal language (eg, informativity, gestures) and self-reported measures of well-being and quality of life.

Ethics and dissemination

Ethical approval for the study was granted by the University Health Network (#21–5701). Findings will be shared with all stakeholders through peer-reviewed publications and presentations.

Clinical registration

This study has been registered on clinicaltrials.gov (NCT06568211).
Diagnostic accuracy of screening tests for eating disorders in adolescents and adults in primary health care: protocol for systematic review and meta-analysis
Authors: de Oliveira Thiala Santos Duarte , de Santana Mônica Leila Portela , Queiroz Valterlinda Alves de Oliveira , da Silva Karine Brito Beck , Martins Poliana Cardoso , Pereira Emile Miranda , Costa Priscila Ribas de Farias
Published: December 2024

Introduction

Eating disorders can be irreversible and, in many cases, fatal. However, the symptoms full recovery is possible, and early diagnosis is one, of many, important factors for the success of treatment. In this sense, the screening of risk behaviours arises as a relevant alternative to improve the prognosis of patients. This review will analyse the diagnostic accuracy of self-administered screening tests for eating disorders in adolescent and adult users of primary healthcare.

Methods and analysis

A systematic review will be performed by independent reviewers. The databases used will be Medline, Embase, the Latin American and Caribbean Health Sciences Literature, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO, ProQuest Dissertations and Theses Database and Google Scholar without restrictions on the year of publication and language. Studies that compared the results of self-administered screening tests for eating disorders in adolescents and adults in primary care with the results of clinical interviews will be included. Data extraction will consist of the identification of the publication, study and participant characteristics, general information about the tools and data on the diagnostic accuracy properties. The risk of bias in the studies will be assessed via the Quality Assessment of Diagnostic Accuracy Studies. Qualitative data will be presented in narrative form. The meta-analysis will be conducted via the random effects model with the metadata command of Stata. The summary statistics for sensitivity and specificity, as well as their 95% CI, will be generated.

Ethics and dissemination

This systematic review is based on published literature; therefore, submission to an ethics committee is not necessary. The dissemination of the study will be carried out through technical reports, scientific articles, posters, meeting presentations, specific forums, national congresses and international media.

PROSPERO registration number

CRD42023476156.
Mapping evidence on the regulations affecting accessibility, availability and management of snake antivenom globally: a scoping review protocol
Authors: Majeed Ramsha , Bester Janette , Kgarosi Kabelo , Strydom Morné
Published: December 2024

Introduction

Snakebite envenomation has been declared a neglected tropical disease by the WHO since 2017. The disease is endemic in affected areas due to the lack of availability and access to antivenom, despite it being the standard treatment for snakebites. This challenge is perpetuated by the shortcomings of the regulatory systems and policies governing the management of antivenoms. This study aims to map the evidence about regulations of snake antivenom globally and identify gaps in the literature. This protocol provides an overview of the methodology and analysis which will be used to conduct the scoping review.

Method and analysis

The scoping review follows the guidelines from the Arksey and O’Malley framework for scoping reviews and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed with assistance from a health sciences librarian, and the search was done using six relevant databases. The databases used are PubMed, SCOPUS, ProQuest Central, Africa Wide Web, Academic Search Output and Web of Science. Articles in the English language and between 2009 and 2023 were included. The search results were collated, duplicates were removed and results were exported to Rayyan (https://www.rayyan.ai/) for screening. The initial screening for titles and abstracts is currently in progress, and thereafter the second round of screening will be done for full texts. Data extraction will be done using Google Forms. The results of the review will be synthesised using quantitative and qualitative tools.

Ethics and dissemination

This review will provide guidance for studies investigating regulatory gaps globally and inform future policies governing antivenom management. Ethics approval for the complete postgraduate project was obtained from the University of Pretoria Research Ethics Committee. The review will be published in a scientific journal, and findings will also be disseminated using conference presentations.

Trial registration

This review has been registered on Open Science Framework (OSF):https://osf.io/54zja.
Economic burden of acute kidney injury in children and adults: a protocol for a systematic review and meta-analysis
Authors: Ulrich Emma Heydari , Lillywhite Aspen , Alobaidi Rashid , Morgan Catherine , Paulden Michael , Zappitelli Michael , Bagshaw Sean M
Published: December 2024

Introduction

Acute kidney injury (AKI) is common in hospitalised adults and children and is associated with significantly increased mortality and worse short-term and long-term outcomes. This systematic review and meta-analysis will evaluate the cost associated with AKI.

Methods and analysis

This health economic analysis will be performed using systematic search of databases, including MEDLINE, EMBASE, CINAHL, Scopus and Cochrane Library from 2009 to the present (search completed on 27 May 2024). Two reviewers will independently complete study selection, data extraction and bias assessment. Inclusion criteria will be randomised controlled trials (RCTs) and observational studies (cohort or case–control) from all countries of hospitalised adults and children. The exposure will be AKI based on definitions using serum creatinine and/or urine output criteria, relative to patients without AKI. The primary outcome studied will be the cost of index hospitalisation associated with AKI episode. Other secondary outcomes will include the cost of intensive care unit admission during index hospitalisation, direct costs related to inpatient and outpatient care) and indirect (time) costs related to loss of productivity. Pooled random-effect meta-analysis ORs with 95% CIs will be reported.

Ethics and dissemination

Ethics approval was not required due to study methodology. The authors have no competing interests to report. The results will be disseminated in peer-reviewed publications according to guidelines by the Cochrane and Centre for Reviews and Dissemination.

PROSPERO registration number

CRD42024512658.
Thirty-six-year trends (1986–2022) in cigarette smoking and snus use in northern Sweden: a cross-sectional study
Authors: Sjödin Erica , Andersson Jonas , Nordendahl Maria , Wennberg Maria , Heldorsson Fjellström Lena , Lundholm Carolina , Söderberg Stefan , Oskarsson Viktor
Published: December 2024

Objectives

To examine the 36-year trends in tobacco use in northern Sweden.

Design and outcome measure

Cross-sectional analysis of the eight population-based surveys that constitute the northern Sweden MONICA study (1986, 1990, 1994, 1999, 2004, 2009, 2014 and 2022). Cigarette smoking and snus use were self-reported via questionnaires, and age-adjusted percentages of cigarette smoking (including occasional use) and snus use were calculated via logit models.

Setting

General population of Norrbotten and Västerbotten (the two northernmost counties of Sweden).

Participants

6678 women and 6320 men, aged 25 to 74 years, were included for analysis. A total of 191 participants were excluded due to missing data on either cigarette smoking or snus use.

Results

Cigarette smoking decreased on a survey-to-survey basis, reaching a minimum in 2022 of 4.9% among men and 9.7% among women, corresponding to a percentage point change of 26.3 and 20.8, respectively, compared with 1986 (pwithin-group<0.01). With respect to snus, the use increased steeply up until 1999 among men, after which it persisted around 25% to 30% (26.2% in 2022), with percentage point changes between 6.6 and 13.4 compared with 1986 (pwithin-group<0.01). The percentage of female snus users was extremely low in the first surveys but increased continuously over time, reaching a maximum of 13.0% in 2022 and a percentage point change of 12.5 since 1986 (pwithin-group<0.01). Cigarette smoking—but not snus use—was more common in Norrbotten than in Västerbotten in 2022 (pbetween-group<0.01).

Conclusions

A substantial decline in cigarette smoking has occurred over time in northern Sweden, particularly among men and more notably in Västerbotten. In contrast, snus use has become increasingly common in both sexes and in both counties.
‘It overwhelms the system’: examining EMS provision in a South Texas border community
Authors: Blackburn Christine Crudo , Lee Miryoung , Rico Mayra , Hernandez Jessica , Knight Lauren
Published: December 2024

Objective

Examine how the characteristics of border communities along the US southern land border impact Emergency Medical Services (EMS) personnel in these border communities.

Design

Using phenomenological approach, we conducted face-to-face, one-on-one interviews using a semistructured interview methodology.

Setting

All participants worked as EMS providers in a city fire department along the Texas-Mexico border.

Participants

28 EMS providers participated in the study. 93% of participants were male and 7% were female. 50% of participants had more than 10 years of experience working as an EMS provider.

Findings

We found that local EMS personnel frequently provide medical support for Border Patrol due to the lack of medical capability within the agency. This care provision creates negative impacts for both the community and EMS personnel. These findings were shown through the overarching theme that the presence of federal law enforcement in the community is the primary characteristic that impacts the experiences and perspectives of EMS personnel. Additional primary themes include: (1) Customs and Border Protection (CBP) utilisation of local EMS strains the system, (2) CBP utilisation of local EMS is the result of a lack of medical training and (3) the presence of the international boundary creates a unique work environment.

Conclusion

The lack of medical support within Border Patrol and relevant federal agencies creates a burden on local EMS resources and causes stress among EMS personnel.
Wilson disease in the USA: epidemiology and real-world patient characteristics based on a retrospective observational health claims study
Authors: Fang Shona , Strader Carey , Costantino Halley , Weiss Karl Heinz , Hedera Peter
Published: December 2024

Objectives

To describe the epidemiology, patient characteristics and comorbidities in patients with Wilson disease (WD) in the USA.

Design

Retrospective, population-based study.

Setting

The study used the US Komodo claims database containing records regarding medical claims for over 120 million individuals.

Participants

Patients with WD were identified via ICD-10 (10th revision of the International Classification of Diseases) code during the study period 2016–2019 and no age restriction was applied. A further stratification by disease subtype (‘hepatic’, ‘neurologic’ and ‘psychiatric’) was performed.

Main outcome measures

WD prevalence was reported by age, sex and US census regions/divisions. Adjusted prevalence was calculated using age-specific prevalence standardised to the USA (2010 US census) and to the world (WHO 2000–2025) to enable comparisons across countries, using direct standardisation of prevalence estimates by age group.

Results

Overall, 2115 patients with WD were identified during the study period. Among them, 56.8% had hepatic symptoms, 57.0% neurologic symptoms and 47.4% psychiatric symptoms. The most frequent manifestations in hepatic patients were liver signs and symptoms (90.8%), in neurologic patients cognitive defects (50.7%) and in psychiatric patients mood disorders (86.4%). The mean age in the overall cohort was 39.9 years. Prevalence estimation was based on 1481 patients with WD between 2017 and 2019. The 2017–2019 crude period prevalence was 21.2 patients per million (95% CI: 20.1 to 22.3), with similar prevalence observed for both sexes.

Conclusions

This study provides important real-world data on the diagnosed prevalence of WD in the USA and revealed the comorbidities associated with various disease subtypes, thereby providing a comprehensive basis for guiding physicians and policy makers in the management of this chronic disease.
Risk factors and prediction model of breast cancer-related lymphoedema in a Chinese cancer centre: a prospective cohort study protocol
Authors: Shen Aomei , Ye Jingming , Zhao Hongmei , Qiang Wanmin , Zhao Hongmeng , Huang Yubei , Zhou Yujie , Wang Yue , Li Xin , Zhang Zhongning , Bian Jingru , Zhang Liyuan , Wu Peipei , Wang Ying , Lu Qian
Published: December 2024

Introduction

Lymphoedema is a distressing and long-term complication for breast cancer survivors. However, the reported incidence of lymphoedema varies, and its risk factors remain underexplored. Currently, a well-established risk prediction model is still lacking. This study aims to describe the rationale, objectives, protocol and baseline characteristics of a prospective cohort study focused on examining the incidence and risk factors of breast cancer-related lymphoedema (BCRL), as well as developing a risk prediction model.

Methods and analysis

This study is an ongoing single-centre prospective observational cohort study recruiting 1967 patients with breast cancer scheduled for surgery treatment in northern China between 15 February 2022 and 21 June 2023. Assessments will be conducted presurgery and at 1, 3, 6, 12, 18, 24, 30 and 36 months postsurgery. Bilateral limb circumferences will be measured by patients at home or by researchers at the outpatient clinics during follow-up visits. The diagnosis of lymphoedema is based on a relative limb volume increase of ≥10% from the preoperative assessment. Self-reported symptoms will be assessed to assist in diagnosis. Potential risk factors are classified into innate personal traits, behavioural lifestyle, interpersonal networks, socioeconomic status and macroenvironmental factors, based on health ecology model. Data collection, storage and management were conducted using the online ‘H6WORLD’ data management platform. Survival analysis using the Kaplan-Meier estimate will determine the incidence of BCRL. Risk factors of BCRL will be analysed using log-rank test and COX-LASSO regression. Traditional COX regression analysis and seven common survival analysis machine learning algorithms (COX, CARST, RSF, GBSM, XGBS, SSVM and SANN) will be employed for model construction and validation.

Ethics and dissemination

The study protocol was approved by the Biomedical Ethics Committee of Peking University (IRB00001052-21124) and the Research Ethics Committee of Tianjin Medical University Cancer Institute and Hospital (bc2023013). The results of this study will be published in peer-reviewed journals and will be presented at several research conferences.

Trial registration number

ChiCTR2200057083.
Association between maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden
Authors: Gernaat Sofie A M , Simard Julia F , Altman Maria , Svenungsson Elisabet , Arkema Elizabeth V
Published: December 2024

Objectives

The objectives of the study are to investigate infection risk in offspring born to women with systemic lupus erythematosus (SLE) compared with offspring born to women without SLE and examine the mediating role of preterm birth.

Design

This is a register-based cohort study.

Setting

Liveborn singletons born in Sweden, 2006–2021, were included in the study.

Participants

1248 infants born to mothers with SLE (≥2 International Classification of Diseases-coded visits in the National Patient Register (NPR) and Medical Birth Register, with ≥1 visit before pregnancy) and 34 886 infants born to women without SLE from the general population were included.

Primary and secondary outcome measures

The primary outcome was any visit for infection in the NPR or anti-infectives in the Prescribed Drug Register. The secondary outcome was hospitalised infection. Infection risks within 72 hours, within 1 month and within 1 year were estimated.

Results

SLE offspring had a higher risk of infection in the first 72 hours compared with non-SLE (2.1% vs 1.2%; risk ratios (RR) (95% CI) 1.62 (1.09 to 2.42)), the first month (5.2% vs 4.5%; RR 1.12 (0.88 to 1.43)) and first year of life (38.2% vs 37.2%; RR 1.09 (1.01 to 1.17)). The hospitalised infection risk for SLE offspring was similar to that of non-SLE (5.8% vs 5.5%, first year of life). The percentage of the total effect of maternal SLE on infant infection mediated through preterm birth was 86% for infection in the first 72 hours and 27% in the first year of life.

Conclusions

The risk of infection in SLE offspring is most increased in the first 3 days after birth, and a proportion of this association can be explained by preterm birth. To prevent early neonatal infections, maternal SLE could be considered as a risk factor before allowing early discharge from postnatal care.