bluuebunny/crossref_metadata_2025 huggingface dataset:
Choosing not to help: The ethical challenge of beneficence for clinicians conducting ethnographic research
Authors: Brookfield Samuel
Published: April 2024

For clinicians conducting ethnographic research, conflict can arise between the clinical understanding of beneficence, meaning to apply skills and knowledge for people towards whom there is a duty of care, and enacting beneficence through research, which can sometimes allow researchers to withhold assistance in the interests of generating data which may have a broader beneficent effect when applied. As a nurse and ethnographic researcher, I present three reflections on my own fieldwork with people engaging in recovery from harmful methamphetamine use, to explore how beneficence can be enacted in constrained and complex circumstances. These reflections provide the basis for a discussion of how relational ethics can reveal the fabric of microethical actions and decisions which comprise clinical and research interactions, allowing practitioners to demonstrate a continuity between how they enact principles like beneficence both in the context of clinical work and in the field.
A disturbing intimacy: Robert Smithson and the end of ecology
Authors: Maimon Vered
Published: April 2024

This essay offers an interdisciplinary approach to the critical writings and artistic works of Robert Smithson in light of current discussions on the Anthropocene, and calls for what Timothy Morton defines as an ‘ecology without nature’. By mobilizing scholarly fields such as art history, aesthetics, anthropology, philosophy, and psychology, it propose new perspectives on Smithson’s embrace of entropy as a specific form of artistic practice; and his dialectic of Site and Nonsite through which he ‘reclaimed’ polluted industrial sites for his art works. In particular, it focuses on Smithson’s interest in scale as manifested most clearly in the Spiral Jetty (1970). This concern is often analyzed through phenomenological theories of perception that focus on the human subject. Yet, scale can be disorienting in ways that move beyond the category of the human subject, by suggesting the possibility of contact with and an imposition from unseen distant entities that nonetheless feel very close. This disturbing intimacy challenges the divisions between subject and object, human and inhuman, organic and inorganic and offers new insights into Smithson’s practice.
Nesting Ferality
Authors: Uskakovych Karolina
Published: April 2024

This paper presents Nesting Ferality, a performative installation that examines how feral rose-ringed parakeets are represented online and governed in Dutch cities. Expanding existing research at the interconnection of artistic practice and cultural geography, the installation incorporates and performs quantitative and qualitative data in an exhibition space. The project deploys everyday digital technologies in novel ways to reshape people’s perception and to explore how artists and geographers can collaborate to foster new environmental politics and mobilise new publics.
The effects of velocity loss thresholds during resistance training on lower-limb performance enhancement: A systematic review with meta-analysis
Authors: Chen Bo-Ying , Chen Wei-Han , Liu Yu , Fiolo Nicholas J , Fuchs Philip X , Huang Chen-Fu , Shiang Tzyy-Yuang
Published: April 2024

This study assessed the effects of squat training with different velocity loss (VL) thresholds on squat strength, heavy-load squat velocity (HLSV), light-load squat velocity (LLSV), countermovement jump (CMJ) height, and sprint time (ST). A systematic search of electronic databases was conducted. Meta-analysis was used to examine effects of trainings with different VL thresholds and used meta-regression to examine the interaction effects (correlation) between training effects and VL in different performance-based outcomes. Our systematic search yielded 1017 articles, 13 of which were included in the present study. Meta-analysis revealed that resistance training with both low (0%–20%) and high (30%–45%) VL thresholds improved squat strength, HLSV, LLSV, and CMJ height, but only low VL improved ST ( p < 0.05). Training gains for HLSV, LLSV, CMJ ( p = 0.088), and ST with low VL were superior to those with high VL ( p < 0.05). Meta-regression revealed that CMJ ( p = 0.076) and ST ( p = 0.010) demonstrated improvements as VL decreased in the range of 0% to 45%. In conclusion, squat resistance training with low (≤20%) VL provides relatively more effective training stimuli, improving performance in power and speed tasks. Optimal VL ranges may be in the range 10% to 20%, ≤20%, and ≤10% for the HLSV and LLSV, CMJ, and ST, respectively.
Orbital Floor Fractures: Treatment and Diagnostics – A Survey Among Swiss, German and Austrian Maxillofacial Units
Authors: Burger Thomas , Fan Kathleen , Brokmeier Johannes , Thieringer Florian M. , Berg Britt-Isabelle
Published: April 2024

Study Design

N/A.

Objective

This study investigated the different ways of orbital floor reconstruction with special focus on reconstruction materials, imaging modalities (intra-/ post-operative), 3D printing and navigation.

Methods

The heads of all governmental-run or associated cranio-maxillofacial surgery units in Switzerland, Austria and Germany were asked in person or received an email link for an online survey with 12 questions.

Results

The return rate was 57%. The most often selected number of reconstructions was between 10 and 50 per year. Resorbable polydioxanone (PDS) foils (41%) and titanium mesh (18 %) were most often used to reconstruct the orbital floor. 31% use 3D Navigation intraoperative. Post-operative imaging was most often performed with CBCT (34.5%) in patients without complications, whereas CT scans were most often performed (63.3%) in patients with persisting complications. In total, 27% stated that they never use preformed orbital plates, and the remaining units use them more or less regularly. 48% have access to a 3D printer and 75% of the respondents use patient specific implants.

Conclusions

The majority of the participating units prefer to use resorbable material for the reconstruction of the orbital floor defects. 3D printing facilities are not available in the majority of units, but it can be expected that the number of units with 3D printing facilities will rise in the near future.
Cruising through the crisis: How Amazon became the biggest gainer in the pandemic
Authors: Jyani Nancy
Published: April 2024

The coronavirus pandemic brought multitude of problems for business firms across the world. Shut businesses led to huge losses and mass layoffs. In the times of economic tumult, the e-commerce sector boosted unimaginably. Amazon being the market leader set breakthrough records during this period and emerged as the biggest gainer with huge profits and record sales. The case study focuses on challenges faced by Amazon during this period such as price gouging, employee safety, supply chain disruption and warehouse workers’ agitation. The case unveils how vertical integration in Amazon emerged as a saviour during the global supply chain disruption. It emphasizes the pro decision-making involved in safeguarding the company from the impact of pandemic as well as the robust actions taken by it to secure maximum profits without compromising the health of its customers as well as employees. The case study exhibits two important dimensions of Amazon’s success in the pandemic, its farsighted approach in controlling the supply chain and crucial management in times of crisis.
Gender Roles and Translation in the Book of Proverbs
Authors: Bellis Alice Ogden
Published: April 2024

The editors of Proverbs structured the book to counter traditional negative sentiments about women. Proverbs such as 19.13, “a stupid child is a ruin to a father, and a wife’s quarreling is a continual dripping of rain” (NRSVue), are misogynistic, presenting problems for the contemporary reader and arguably for the ancient editor as well. Their strategy to combat these old sayings included beginning and ending the book with positive feminine figures, Wisdom in the prologue (Prov 1–9) and the Strong Woman in Prov 31.10-31, and using negative masculine stereotypes as a foil for the negative feminine ones. Recent translations that use gender-neutral language mask these tropes about men’s behavior.
Assessing illness-related uncertainty in relapsing-remitting multiple sclerosis: A psychometric analysis of the Mishel Uncertainty of Illness Scale
Authors: Sabin Julia , Salas Elisa , Martín-Martínez Jesús , Candeliere-Merlicco Antonio , Barrero Francisco Javier , Alonso Ana , Sánchez-Menoyo José Luis , Borrega Laura , Rodríguez-Rodríguez María , Gómez-Gutiérrez Montserrat , Eichau Sara , Hernández-Pérez Miguel Ángel , Calles Carmen , Fernández-Díaz Eva , Carmona Olga , Orvíz Aida , López-Real Ana , López-Muñoz Pablo , Mendoza Amelia , Agüera Eduardo , Maurino Jorge , Ballesteros Javier
Published: April 2024

A multicenter study involving 204 adults with relapsing-remitting multiple sclerosis (RRMS) assessed the dimensionality and item characteristics of the Mishel-Uncertainty of Illness Scale (MUIS), a generic self-assessment tool. Mokken analysis identified two dimensions in the MUIS with an appropriate item and overall scale scalability after excluding nonclassifiable items. A refined 12-item MUIS, employing a grade response model, effectively discriminated uncertainty levels among RRMS patients (likelihood ratio test p-value = .03). These findings suggest the potential value of the 12-item MUIS as a reliable measure for assessing uncertainty associated with the course of illness in RRMS.
Early rectal cancer: The diagnostic performance of MRI supplemented with a rectal micro-enema and a modified staging system to identify tumors eligible for local excision
Authors: Viktil Ellen , Hanekamp Bettina Andrea , Nesbakken Arild , Løberg Else Marit , Sjo Ole Helmer , Negård Anne , Dormagen Johann Baptist , Schulz Anselm
Published: April 2024

Background

In staging early rectal cancers (ERC), submucosal tumor depth is one of the most important features determining the possibility of local excision (LE). The micro-enema (Bisacodyl) induces submucosal edema and may hypothetically improve the visualization of tumor depth.

Purpose

To test the diagnostic performance of MRI to identify ERC suitable for LE when adding a pre-procedural micro-enema and concurrent use of a modified classification system.

Material and Methods

In this prospective study, we consecutively included 73 patients with newly diagnosed rectal tumors. Two experienced radiologists independently interpreted the MRI examinations, and diagnostic performance was calculated for local tumors eligible for LE (Tis-T1sm2, n = 43) and non-local tumors too advanced for LE (T1sm3-T3b, n = 30). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were registered for each reader. Inter- and intra-reader agreements were assessed by kappa statistics. Lymph node status was derived from the clinical MRI reports.

Results

Reader1/reader2 achieved sensitivities of 93%/86%, specificities of 90%/83%, PPV of 93%/88%, and NPV of 90%/81%, respectively, for identifying tumors eligible for LE. Rates of overstaging of local tumors were 7% and 14% for the two readers, and kappa values for the inter- and intra-reader agreement were 0.69 and 0.80, respectively. For tumors ≤T2, all metastatic lymph nodes were smaller than 3 mm on histopathology.

Conclusion

MRI after a rectal micro-enema and concurrent use of a modified staging system achieved good diagnostic performance to identify tumors suitable for LE. The rate of overstaging of local tumors was comparable to results reported in previous endorectal ultrasound (ERUS) studies.
High-Risk Anomalous Aortic Origin of the Left Coronary Artery: Consecutive Admissions Presenting With Sudden Cardiac Arrest
Authors: Burns Joseph , Emeruwa Ezinne , Connell Patrick , Borges Nirica , Reaves-O’Neal Dana , Molossi Silvana
Published: April 2024

Anomalous aortic origin of the left coronary artery (AAOLCA) confers high risk for sudden cardiac arrest (SCA). This series aims to describe consecutive admissions with interarterial AAOLCA presenting with SCA and distinct clinical trajectories. An eight-year-old boy collapsed at school and received 10-min of cardiopulmonary resuscitation (CPR) and defibrillation prior to return of spontaneous circulation. He had no end-organ dysfunction and underwent uneventful coronary unroofing. In contrast, a 14-year-old boy presented with collapse while jogging. He received 40-min of CPR prior to extracorporeal membranous oxygenation cannulation with multisystem dysfunction and persistent severely depressed left ventricular function. He is now rehabilitating following uneventful orthotropic heart transplantation. These cases illustrate the diverse outcomes of AAOLCA with SCA following exertional syncope.
How Automotive 3D Interactive Display Marketing Affects Consumers’ Intention to Buy Cars
Authors: Gao Chao , Wang Feng , Zhang Ming
Published: April 2024

3D interactive display marketing is a marketing method that uses 3D interactive technology and three-dimensional display scenes to facilitate interaction between people and display content. This approach has been widely used in online retail and is very popular in China’s automotive industry. The automobile industry tries to solve the severe issue of potential client loss in the automotive sector by using 3D interactive display marketing to persuade consumers to buy cars. However, it’s still unclear whether and how 3D interactive display marketing in the automobile sector might alter consumers’ inclination to buy cars. To address this issue, this study collected data through experiments and questionnaires and used a structural equation model to explore how automotive 3D interactive display marketing affected consumers’ willingness to purchase cars. The study established a model consisting of seven dimensions: information richness, information quality, interaction quality, esthetic experience, action experience, emotional experience, and willingness to purchase. The findings of this study can provide reference for producers and sellers in the automotive industry, promote the better application of automotive 3D interactive display marketing in the sector, and reduce potential loss of automotive customer.
Pregnancy exercise effectiveness on anxiety level among pregnant women
Authors: Susanti  , Hassan Hafizah Che , Aljaberi Musheer Abdulwahid
Published: April 2024

Background:

Changes in one’s mental state are possible during pregnancy because it is a phase. Anxiety is one of these mental changes that is common during pregnancy and has a tendency to have a detrimental impact on both the mother and the fetus. This study aims to examine the effectiveness of pregnancy exercise on pregnancy anxiety levels.

Design and methods:

The method used in this study was quasi-experimental with a purposive sampling technique. The Hamilton Anxiety Rating Scale (HARS) is the instrument that is employed in this study, and it will be given to the sample group of 15 pregnant women without complications to determine their levels of anxiety. This research was conducted at one of the Health Centers in Batam City, Indonesia. The sample is instructed to perform pregnancy exercise for a total of 4 weeks, with each week’s instruction consisting of pregnancy exercise being performed twice for a total of 1 h.

Result:

The findings of the data analysis performed with the t-test, which assessed the differences in sample anxiety levels before and after taking out pregnant exercise, showed a value of p = 0.000. This indicates that the value of p is less than 0.05, which is the threshold at which the significance level of the test is considered to be significant.

Conclusions:

Therefore, childbirth of complementary care in the form of exercise during pregnancy can have the impact of lowering levels of anxiety.
Updating Eindhoven: Clarifying the features of a patient safety near miss
Authors: Woodier Nick , Burnett Charlotte , Sampson Paul , Moppett Iain
Published: April 2024

Background

There are benefits to healthcare from reporting and learning from near misses in patient care. However, there have been longstanding issues with identifying near misses, with variation in definitions. Learning is being lost, unlike in other industries that have harnessed their learning potential. The features of a healthcare near miss have never been described nor modelled. This study aimed to identify those features to support near-miss identification, reporting and learning.

Methods

This study took a mixed-methods approach with participants from healthcare and four high-reliability industries – aviation, maritime, nuclear and rail. Qualitative exploration helped identify the features of a near miss, while quantitative supported assessment of agreement on features between participants through the use of a scenario.

Results

Participants from 17 healthcare and 35 industry organisations took part. Quantitative findings demonstrated variation in agreement of the features of a near miss using Fleiss Kappa. Qualitative findings identified the following themes in relation to the features of a near miss – context dependent, involve control, are complex and represent vulnerabilities. In particular, several industries have lists of specific situations that constitute near misses that support reporting and focus.

Conclusion

Without clear agreement of the features of a healthcare near miss, definitions will continue to vary. This study has, for the first time, provided exploration and clarification of the features of a near miss with the offer of a healthcare model for future validation. Without addressing the fundamentals, such as agreeing what a near miss is, healthcare cannot hope to learn from them.
Arthroscopic Remplissage Using a Double-Pulley Technique
Authors: Ashy Cody , Pottanat Paul , Slone Harris , Pullen W. Michael
Published: April 2024

Background:

Anterior shoulder instability is associated with Hill-Sachs lesions (HSLs) in 40% to 90% of cases. When addressing anterior shoulder instability, unaddressed engaging or “off-track” HSL have a recurrence rate of 75%. Remplissage is a known technique to address recurrent instability in the setting of an engaging HSL. In this video, we demonstrate that a double-anchor-pulley technique may be used to address recurrent instability in the setting of engaging HSL.

Indications:

Patients with recurrent anterior shoulder instability with off-track HSL in patients with glenoid bone loss <20% are candidates for arthroscopic Remplissage.

Technique Description:

Patients are placed in the lateral decubitus position. Examination under anesthesia is performed to assess for degree of instability and engagement of HSL. Posterior, anterosuperior, and anteroinferior portals are established. Routine diagnostic arthroscopy is performed with identification of the HSL. While viewing from an anterosuperior portal and working through the posterior portal, the HSL bed is prepared with curettage and a bur. A 5.5-mm accessory Cannula is used through an accessory posterior portal. Two knotless all-suture self-tensioning anchors are placed in the anterior and inferior aspect of the defect, passed through the cannula, and tagged for later identification. Bankart stabilization is performed. The knotless anchors are linked to each other to perform a knotless repair with a broad area of compression.

Results:

Results are excellent with only a 5.6% failure rate, significant patient improvement, low complication rate, and 95.5% return to play.

Discussion:

We demonstrate the technical aspects of an all-arthroscopic Remplissage technique using all-suture knotless anchors to provide a simple and reproducible method of performing a Remplissage.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Primary large B-cell lymphomas of immune-privileged sites
Authors: Roschewski Mark , Phelan James D. , Jaffe Elaine S.
Published: April 2024

Diffuse large B-cell lymphoma (DLBCL) encompasses a diverse spectrum of aggressive B-cell lymphomas with remarkable genetic heterogeneity and myriad clinical presentations. Multiplatform genomic analyses of DLBCL have identified oncogenic drivers within genetic subtypes that allow for pathologic subclassification of tumors into discrete entities with shared immunophenotypic, genetic, and clinical features. Robust classification of lymphoid tumors establishes a foundation for precision medicine and enables the identification of novel therapeutic vulnerabilities within biologically homogeneous entities. Most cases of DLBCL involving the central nervous system (CNS), vitreous, and testis exhibit immunophenotypic features suggesting an activated B-cell (ABC) origin. Shared molecular features include frequent comutations of MYD88 (L265P) and CD79B and frequent genetic alterations promoting immune evasion, which are hallmarks of the MCD/C5/MYD88 genetic subtype of DLBCL. Clinically, these lymphomas primarily arise within anatomic sanctuary sites and have a predilection for remaining confined to extranodal sites and strong CNS tropism. Given the shared clinical and molecular features, the umbrella term primary large B-cell lymphoma of immune-privileged sites (IP-LBCL) was proposed. Other extranodal DLBCL involving the breast, adrenal glands, and skin are often ABC DLBCL but are more heterogeneous in their genomic profile and involve anatomic sites that are not considered immune privileged. In this review, we describe the overlapping clinical, pathologic, and molecular features of IP-LBCL and highlight important considerations for diagnosis, staging, and treatment. We also discuss potential therapeutic vulnerabilities of IP-LBCL including sensitivity to inhibitors of Bruton tyrosine kinase, immunomodulatory agents, and immunotherapy.
Cost-effectiveness of prophylaxis with recombinant vs plasma-derived VWF in severe von Willebrand disease in the United States
Authors: Waldron Christina , Ito Satoko , Wang Daniel , Allen Cecily , Viswanathan Giri , Bona Robert D. , Cuker Adam , Goshua George
Published: April 2024

We evaluated the cost-effectiveness of prophylaxis with recombinant von Willebrand factor (rVWF) vs with plasma-derived von Willebrand factor (pdVWF) for patients with severe Von Willebrand disease. We found that rVWF is a cost-saving factor replacement compared with pdVWF across all willingness-to-pay thresholds in the United States.
Deletion of mouse lysyl oxidase in megakaryocytes affects bone properties in a sex-dependent manner
Authors: Karagianni Aikaterini , Karkempetzaki Anastasia Iris , Brooks Daniel , Matsuura Shinobu , Dambal Vrinda , Trackman Philip C. , Ravid Katya
Published: April 2024

Lysyl oxidase (LOX) is a facilitator of extracellular matrix cross-linking. Using newly developed megakaryocyte-specific LOX knockout mice, we show that LOX expressed in these scarce bone marrow cells affects bone volume and collagen architecture in a sex-dependent manner.
QTL mapping for the flag leaf-related traits using RILs derived from Trititrigia germplasm line SN304 and wheat cultivar Yannong15 in multiple environments
Authors: Zhang Xia , Xing Piyi , Lin Caicai , Wang Honggang , Bao Yinguang , Li Xingfeng
Published: April 2024

Background

Developing and enriching genetic resources plays important role in the crop improvement. The flag leaf affects plant architecture and contributes to the grain yield of wheat (Triticum aestivum L.). The genetic improvement of flag leaf traits faces problems such as a limited genetic basis. Among the various genetic resources of wheat, Thinopyrum intermedium has been utilized as a valuable resource in genetic improvement due to its disease resistance, large spikes, large leaves, and multiple flowers. In this study, a recombinant inbred line (RIL) population was derived from common wheat Yannong15 and wheat-Th. intermedium introgression line SN304 was used to identify the quantitative trait loci (QTL) for flag leaf-related traits.

Results

QTL mapping was performed for flag leaf length (FLL), flag leaf width (FLW) and flag leaf area (FLA). A total of 77 QTLs were detected, and among these, 51 QTLs with positive alleles were contributed by SN304. Fourteen major QTLs for flag leaf traits were detected on chromosomes 2B, 3B, 4B, and 2D. Additionally, 28 QTLs and 8 QTLs for flag leaf-related traits were detected in low-phosphorus and drought environments, respectively. Based on major QTLs of positive alleles from SN304, we identified a pair of double-ended anchor primers mapped on chromosome 2B and amplified a specific band of Th. intermedium in SN304. Moreover, there was a major colocated QTL on chromosome 2B, called QFll/Flw/Fla-2B, which was delimited to a physical interval of approximately 2.9 Mb and contained 20 candidate genes. Through gene sequence and expression analysis, four candidate genes associated with flag leaf formation and growth in the QTL interval were identified.

Conclusion

These results promote the fine mapping of QFll/Flw/Fla-2B, which have pleiotropic effects, and will facilitate the identification of candidate genes for flag leaf-related traits. Additionally, this work provides a theoretical basis for the application of Th. intermedium in wheat breeding.
Continuous palliative sedation until death: a qualitative study of palliative care clinicians’ experiences
Authors: Guité-Verret Alexandra , Boivin Jessica , Hanna Andrew M. R. , Downar James , Bush Shirley H. , Marcoux Isabelle , Guay Diane , Tapp Diane , Lapenskie Julie , Gagnon Bruno
Published: April 2024

Background

The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation.

Aim

This study aims to gain a better understanding of palliative care clinicians’ experiences with continuous palliative sedation.

Design

We conducted a qualitative study based on focus group discussions.

Setting/participants

We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized.

Results

An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death.

Conclusions

Interaction with the patient’s family, uncertainty about the patient’s prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.
Integrating training in evidence-based medicine and shared decision-making: a qualitative study of junior doctors and consultants
Authors: Simons Mary , Fisher Georgia , Spanos Samantha , Zurynski Yvonne , Davidson Andrew , Stoodley Marcus , Rapport Frances , Ellis Louise A.
Published: April 2024

Background

In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors’ attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors’ EBM-SDM learning and practice; and to examine how supervising consultants’ attitudes and authority impact on junior doctors’ opportunities for EBM-SDM learning and practice.

Methods

We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors’ EBM-SDM learning and practice.

Results

Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors.

Conclusions

These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice.
Individuals’ attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey
Authors: Nogueira-Leite Diogo , Marques-Cruz Manuel , Cruz-Correia Ricardo
Published: April 2024

Background

The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals’ attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment.

Objective

This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers.

Methods

A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto’s academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence.

Results

Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one’s information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect.

Conclusions

These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one’s conditions, acceptable stress levels, and overall behavior towards mental health.

Trial registration

RR2-10.2196/41040.
Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study
Authors: Conombo Blanchard , Guertin Jason R. , Hoch Jeffrey S. , Grimshaw Jeremy , Bérubé Mélanie , Malo Christian , Berthelot Simon , Lauzier François , Stelfox Henry T. , Turgeon Alexis F. , Archambault Patrick , Belcaid Amina , Moore Lynne
Published: April 2024

Background

Audit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness.

Methods

We conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided.

Results

Results suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered.

Conclusion

A&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers’ willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.
Tea polyphenol-engineered hybrid cellular nanovesicles for cancer immunotherapy and androgen deprivation therapy
Authors: Guo Yiming , Wu Jicheng , Chen Lefan , Liu Lujie , Bi Tianxiang , Pan Yuanwei , Meng Qian-Fang , Wang Chaoliang , Rao Lang , Li Qi
Published: April 2024

Androgen deprivation therapy (ADT) is a crucial and effective strategy for prostate cancer, while systemic administration may cause profound side effects on normal tissues. More importantly, the ADT can easily lead to resistance by involving the activation of NF-κB signaling pathway and high infiltration of M2 macrophages in tumor microenvironment (TME). Herein, we developed a biomimetic nanotherapeutic platform by deriving cell membrane nanovesicles from cancer cells and probiotics to yield the hybrid cellular nanovesicles (hNVs), loading flutamide (Flu) into the resulting hNVs, and finally modifying the hNVs@Flu with Epigallocatechin-3-gallate (EGCG). In this nanotherapeutic platform, the hNVs significantly improved the accumulation of hNVs@Flu-EGCG in tumor sites and reprogramed immunosuppressive M2 macrophages into antitumorigenic M1 macrophages, the Flu acted on androgen receptors and inhibited tumor proliferation, and the EGCG promoted apoptosis of prostate cancer cells by inhibiting the NF-κB pathway, thus synergistically stimulating the antitumor immunity and reducing the side effects and resistance of ADT. In a prostate cancer mouse model, the hNVs@Flu-EGCG significantly extended the lifespan of mice with tumors and led to an 81.78% reduction in tumor growth compared with the untreated group. Overall, the hNVs@Flu-EGCG are safe, modifiable, and effective, thus offering a promising platform for effective therapeutics of prostate cancer.

Graphical Abstract
Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol
Authors: Maghalian Mahsa , Abbasalizadeh Fatemeh , Mohammad-Alizadeh-Charandabi Sakineh , Ghanbari-Homaie Solmaz , Mirghafourvand Mojgan
Published: April 2024

Background

Diabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women’s experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes.

Methods/design

The study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women’s understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data.

Discussion

The implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system.

Trial registration

Iranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206.
Exploring the association between erythema multiforme and HIV infection: some mechanisms and implications
Authors: Manenzhe Shumani Charlotte , Khammissa Razia Abdool Gafaar , Shangase Sindisiwe Londiwe , Beetge Mia Michaela
Published: April 2024

Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.
A bibliometric and visual analysis of cognitive function in bipolar disorder from 2012 to 2022
Authors: Cui Xiaohong , Xue Tailian , Zhang Zhiyong , Yang Hong , Ren Yan
Published: April 2024

Introduction

Bipolar disorder (BD) is a chronic psychiatric disorder that combines hypomania or mania and depression. The study aims to investigate the research areas associated with cognitive function in bipolar disorder and identify current research hotspots and frontier areas in this field.

Methodology

Publications related to cognitive function in BD from 2012 to 2022 were searched on the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace, and Scimago Graphica were used to conduct this bibliometric analysis.

Results

A total of 989 articles on cognitive function in BD were included in this review. These articles were mainly from the United States, China, Canada, Spain and the United Kingdom. Our results showed that the journal “Journal of Affective Disorders” published the most articles. Apart from “Biploar disorder” and “cognitive function”, the terms “Schizophrenia”, “Meta analysis”, “Rating scale” were also the most frequently used keywords. The research on cognitive function in bipolar disorder primarily focused on the following aspects: subgroup, individual, validation and pathophysiology.

Conclusions

The current concerns and hotspots in the filed are: “neurocognitive impairment”, “subgroup”, “1st degree relative”, “mania”, “individual” and “validation”. Future research is likely to focus on the following four themes: “Studies of the bipolar disorder and cognitive subgroups”, “intra-individual variability”, “Validation of cognitive function tool” and “Combined with pathology or other fields”.
Making Big Business Everybody’s Business: Aboriginal leaders’ perspectives on commercial activities influencing Aboriginal health in Victoria, Australia
Authors: Crocetti Alessandro Connor , Walker Troy , Mitchell Fiona , Sherriff Simone , Hill Karen , Paradies Yin , Backholer Kathryn , Browne Jennifer
Published: April 2024

Background

The commercial determinants of health is a rapidly expanding field of research; however Indigenous perspectives remain notably underrepresented. For Indigenous peoples the intersection of globalisation, colonialism and capitalism may amplify commercially-driven health inequities. This study aimed to explore the perspectives of Aboriginal leaders regarding the influence of commercial activities on Aboriginal health and wellbeing in Victoria, Australia.

Methods

Semi-structured interviews with 23 Aboriginal leaders from across five sectors (n = 15 urban,n = 8 rural/regional) were analysed through reflexive thematic analysis.

Results

Three overarching themes were identified encompassing (i) harmful commercial practices and processes, (ii) improving corporate engagement and (iii) opportunities for self-determination through business. Participants expressed concern over aggressive marketing by the gambling industry, commercial exploitation of Aboriginal culture, the privatisation of public services, and lack of oversignt of corporate social responsibility strategies. Simultaneously, Aboriginal-led businesses were viewed as opportunities for cultural connection, and financial empowerment and self-determination.

Conclusion

Numerous commercial entities and activities are perceived to influence Aboriginal health and wellbeing. This study highlights the need for stronger policy and regulation to mitigate harmful industry practices while incentivising the potential positive impacts of the commercial activities on Aboriginal health and wellbeing.
Beyond visual integration: sensitivity of the temporal-parietal junction for objects, places, and faces
Authors: Rennig Johannes , Langenberger Christina , Karnath Hans-Otto
Published: April 2024

One important role of the TPJ is the contribution to perception of the global gist in hierarchically organized stimuli where individual elements create a global visual percept. However, the link between clinical findings in simultanagnosia and neuroimaging in healthy subjects is missing for real-world global stimuli, like visual scenes. It is well-known that hierarchical, global stimuli activate TPJ regions and that simultanagnosia patients show deficits during the recognition of hierarchical stimuli and real-world visual scenes. However, the role of the TPJ in real-world scene processing is entirely unexplored. In the present study, we first localized TPJ regions significantly responding to the global gist of hierarchical stimuli and then investigated the responses to visual scenes, as well as single objects and faces as control stimuli. All three stimulus classes evoked significantly positive univariate responses in the previously localized TPJ regions. In a multivariate analysis, we were able to demonstrate that voxel patterns of the TPJ were classified significantly above chance level for all three stimulus classes. These results demonstrate a significant involvement of the TPJ in processing of complex visual stimuli that is not restricted to visual scenes and that the TPJ is sensitive to different classes of visual stimuli with a specific signature of neuronal activations.