bluuebunny/crossref_metadata_2025 huggingface dataset:
Client perspectives on creating supportive sexual health environments for people with persistent anxiety: a qualitative study
Authors: Black Stéphanie , Watt Sarah , Gilbert Mark , Pedersen Heather Nicole , Ablona Aidan , Chang Hsiu-Ju , Salway Travis
Published: July 2024

Objectives

We sought to explore sexual health service clients’ perspectives, preferences and suggestions for how to better address or alleviate anxiety among clients of sexual health services (eg, sexually transmitted infection testing) regarding both online and in-person sexual health services among those who experience persistent anxiety.

Methods

We conducted qualitative interviews with 27 sexual health service clients with persistent experiences of anxiety in British Columbia, Canada. Participants were recruited from respondents to a COVID-19-related sexual health survey who consented to follow up. Interviews were conducted via Zoom, recorded and transcribed. Transcripts were coded and analysed using thematic analysis by searching for themes in order to summarise the experiences and needs of participants.

Results

The median participant age was 34. 16 participants identified as women, 10 as men and 1 each as non-binary and gender fluid. Participants described anxiety related to sexual health service access and experiences due to sexual health-related stigma and privacy concerns; provider judgement and lack of communication or information regarding test results. They suggested that routinely integrating discussions with providers about mental health in sexually transmitted and bloodborne infection (STBBI) testing appointments may help clients feel safer and could connect them to support. They highlighted the need for personal and genuine interactions with providers (eg, making appointments feel less perfunctory, asking clients how they are feeling about why they are there) and sufficient time with providers (eg, not feeling rushed through the appointment, time to discuss resources, testing and advice).

Conclusions

Disease-specialised health services may not adequately address the multifaceted and inter-related mental health needs of people accessing services. In STBBI testing service settings, more personalised appointments, additional communication with providers and easier access to results can help improve both the service experiences of people experiencing persistent anxiety and their connections to appropriate mental health support.
Understanding experiences and perspectives in addressing unmet social needs of children and families in a paediatric weight management program: a qualitative descriptive study
Authors: Kwan Celia , Davis Sarah , Marjerrison Stacey , Wahi Gita
Published: July 2024

Objective

The objective is to describe the experiences and perceptions of caregivers who participated in a community systems navigator intervention that addressed unmet social needs.

Design, setting and patients

A qualitative descriptive study with caregivers of children enrolled in a clinical trial addressing unmet social needs of families with children cared for in a tertiary pediatric weight management clinic, through community systems navigation. Participants were asked open-ended questions related to perceptions of social needs screening in clinical settings. Interviews were recorded and analysed using Braun and Clarke’s six-phase approach to thematic analysis.

Results

Ten parent participants were interviewed. Social needs screening perception and acceptability varied between participants. Social needs screening was comfortable for most but stressful for others. Participants noted that trusting relationships promote comfort with sharing social needs information, and this data should be shared on the electronic health record if accurate and purposeful. They found the online screening tool convenient but thought it could also limit opportunities to elaborate. Some participants noted the intervention of community systems navigation helpful; however, others described the need for more tailored resources.

Conclusions

Screening for unmet social needs in clinical settings is complex and should be family centred, including the consideration of the mode of screening, data sharing in the electronic health record and ensuing interventions. Perspectives of families should drive the design of future larger scale community navigation interventions to address unmet social needs in clinical settings.
Work-related slip, trip and fall injuries reported by National Health Service staff in Great Britain: how many are due to slipping?
Authors: Liddle Mark , Nicholls Gillian , Leigh David , Kinder Jennifer , Curran Alison , Zand Michael
Published: July 2024

Background

Workplace injuries due to a slip, trip or fall on the level (STF) are often reported together, making the potential impact of targeted interventions, such as slip-resistant footwear, difficult to assess. The objective of this research was to review workplace non-fatal injuries reported as STFs under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 to determine what proportion of staff STF injuries reported by the National Health Service (NHS) in Great Britain were caused specifically by a slip.

Methods

The free text descriptions of all 1004 STF injuries reported by NHS staff in summer 2018 and winter 2018/2019 were independently reviewed by two researchers to determine whether a slip was the primary cause or not. Where agreement could not be reached or the cause was unclear, an STF specialist reviewed the reports to establish the likely cause. The kappa statistic was used to measure inter-reviewer agreement, and the χ2test was used to compare proportions across seasons.

Results

The reviewers agreed on the initiating event, slip or non-slip, for 917 (91.3%) of the incidents. The kappa statistic was 0.842 (95% CI 0.785 to 0.898) indicating strong agreement between reviewers. In total, 431 or 42.9% (95% CI 39.8% to 46.1%) of the STF incidents were slips. This percentage was greater in winter compared with summer (49.0% and 36.0%, respectively, p<0.001).

Conclusion

The high proportion of slips among reported STF injuries implies that an effective intervention targeting workplace slips in the NHS could have a substantial impact on the number of injuries reported.
Medical and work loss costs of violence, self-harm, unintentional and traumatic brain injuries per injured person in the USA
Authors: Peterson Cora , Xu Likang , Zhu Sha , Dunphy Christopher , Florence Curtis
Published: July 2024

Objective

Injuries and poisoning are leading causes of US morbidity and mortality. This study aimed to update medical and work loss cost estimates per injured person.

Methods

Injuries treated in emergency departments (ED) during 2019–2020 were analysed in terms of mechanism (eg, fall) and intent (eg, unintentional), as well as traumatic brain injury (TBI) (multiple mechanisms and intents). Fatal injury medical spending was based on the Nationwide Emergency Department Sample and National Inpatient Sample. Non-fatal injury medical spending and workplace absences (general, short-term disability and workers’ compensation) were analysed among injury patients with commercial insurance or Medicaid and matched controls during the year following an injury ED visit using MarketScan databases.

Results

Medical spending for injury deaths in hospital EDs and inpatient settings averaged US$4777 (n=57 296) and US$45 678 per fatality (n=89 175) (2020 USD). Estimates for fatal TBI were US$5052 (n=5363) and US$47 952 (n=37 184). People with ED treat and release visits for non-fatal injuries had on average US$5798 (n=895 918) in attributable medical spending and US$1686 (11 missed days) (n=116 836) in work loss costs during the following year, while people with non-fatal injuries who required hospitalisation after an ED injury visit had US$52 246 (n=32 976) in medical spending and US$7815 (51 days) (n=4473) in work loss costs. Estimates for non-fatal TBI were US$4529 (n=25 792), US$1503 (10 days) (n=1631), US$51 241 (n=3030) and US$6110 (40 days) (n=246).

Conclusions and relevance

Per person costs of injuries and violence are important to monitor the economic burden of injuries and assess the value of prevention strategies.
Frailty or frailties: exploring frailty index subdimensions in the English Longitudinal Study of Ageing
Authors: Johnson Lara , Guthrie Bruce , Kelly Paul A T , Anand Atul , Marshall Alan , Seth Sohan
Published: July 2024

Background

Frailty, a state of increased vulnerability to adverse health outcomes, has garnered significant attention in research and clinical practice. Existing constructs aggregate clinical features or health deficits into a single score. While simple and interpretable, this approach may overlook the complexity of frailty and not capture the full range of variation between individuals.

Methods

Exploratory factor analysis was used to infer latent dimensions of a frailty index constructed using survey data from the English Longitudinal Study of Ageing, wave 9. The dataset included 58 self-reported health deficits in a representative sample of community-dwelling adults aged 65+ (N=4971). Deficits encompassed chronic disease, general health status, mobility, independence with activities of daily living, psychological well-being, memory and cognition. Multiple linear regression examined associations with CASP-19 quality of life scores.

Results

Factor analysis revealed four frailty subdimensions. Based on the component deficits with the highest loading values, these factors were labelled ‘mobility impairment and physical morbidity’, ‘difficulties in daily activities’, ‘mental health’ and ‘disorientation in time’. The four subdimensions were a better predictor of quality of life than frailty index scores.

Conclusions

Distinct subdimensions of frailty can be identified from standard index scores. A decomposed approach to understanding frailty has a potential to provide a more nuanced understanding of an individual’s state of health across multiple deficits.
Racial and economic segregation and diabetes mortality in the USA, 2016–2020
Authors: Saelee Ryan , Alexander Dayna S , Wittman Jacob T , Pavkov Meda E , Hudson Darrell L , Bullard Kai McKeever
Published: July 2024

Background

The purpose of this study was to examine the association between racial and economic segregation and diabetes mortality among US counties from 2016 to 2020.

Methods

We conducted a cross-sectional ecological study that combined county-level diabetes mortality data from the National Vital Statistics System and sociodemographic information drawn from the 2016–2020 American Community Survey (n=2380 counties in the USA). Racialized economic segregation was measured using the Index Concentration at the Extremes (ICE) for income (ICEincome), race (ICErace) and combined income and race (ICEcombined). ICE measures were categorised into quintiles, Q1 representing the highest concentration and Q5 the lowest concentration of low-income, non-Hispanic (NH) black and low-income NH black households, respectively. Diabetes was ascertained as the underlying cause of death. County-level covariates included the percentage of people aged ≥65 years, metropolitan designation and population size. Multilevel Poisson regression was used to estimate the adjusted mean mortality rate and adjusted risk ratios (aRR) comparing Q1 and Q5.

Results

Adjusted mean diabetes mortality rate was consistently greater in counties with higher concentrations of low-income (ICEincome) and low-income NH black households (ICEcombined). Compared with counties with the lowest concentration (Q1), counties with the highest concentration (Q5) of low-income (aRR 1.96; 95% CI 1.81 to 2.11 for ICEincome), NH black (aRR 1.32; 95% CI 1.18 to 1.47 for ICErace) and low-income NH black households (aRR 1.70; 95% CI 1.56 to 1.84 for ICEcombined) had greater diabetes mortality.

Conclusion

Racial and economic segregation is associated with diabetes mortality across US counties.
An unequal health policy landscape? Examining socioeconomic differences in acceptability and preferences for policies that aim to reduce socioeconomic inequalities in health
Authors: Verra Sanne E , Poelman Maartje P , de Wit John , Kamphuis Carlijn B M
Published: July 2024

Background

This study explores socioeconomic differences in acceptability and preferences for policies that aim to reduce socioeconomic health inequalities. The investigated policies range from structural policies, requiring no individual agency, to agentic policies, which depend on the individual agency for behaviour change.

Methods

An online, cross-sectional survey was conducted among 1182 participants, stratified by education and representative of Dutch adults (aged 25–65) for age and gender. Across 31 policies, including structural socioeconomic policies, structural housing and neighbourhood policies, structural and agento-structural behavioural policies (facilitating behaviour) and agentic policies (focusing on information provision for behaviour change), acceptability was measured on a 7-point scale, preferences were measured using participants’ top-5 policy choices. Regression analyses examined socioeconomic differences in acceptability and preferences based on education and income, controlling for age, gender, receiving welfare, and employment.

Results

People in lower socioeconomic positions were more likely to accept and favour structural socioeconomic policies, whereas those in higher socioeconomic positions were more likely to accept and favour structural housing and neighbourhood, structural and agento-structural behavioural, and agentic policies. Socioeconomic differences were the largest for agentic policies. Overall, 83.3% preferred at least one structural socioeconomic policy, while only 32% preferred an agentic policy. Most preferred was eliminating taxes on fruits and vegetables, (preferred by 41.4%), and least preferred was a campaign promoting healthy nutrition (preferred by 3.9%).

Conclusions

These socioeconomic differences in policy support underscore the need for inclusive policymaking processes. Including the perspectives of people in lower socioeconomic positions helps to ensure that their needs are met.
Peptide-based PET tracer targeting LAG-3 for evaluating the efficacy of immunotherapy in melanoma
Authors: Yuan Peizhe , Long Yu , Wei Nannan , Wang Yan , Zhu Ziyang , Han Jinquan , Jiang Dawei , Lan Xiaoli , Gai Yongkang
Published: July 2024

Background

Lymphocyte activation gene 3 (LAG-3) is expressed on activated immune cells and has emerged as a promising target for immune checkpoints blockade. However, conflicting findings have been reported regarding the association between LAG-3 expression in tumors and patient prognosis, indicating the need for further investigation into the significance of LAG-3 expression levels in tumor therapies. In this study,68Ga-NOTA-XH05, a novel peptide-based positron emission tomography (PET) tracer targeting LAG-3, was constructed to non-invasively detect LAG-3 expression in melanoma after CpG oligonucleotide (CpG) treatment and explore the relationship between LAG-3 expression and therapeutic effect.

Methods

The tracer68Ga-NOTA-XH05 was identified by high-performance liquid chromatography after being prepared and purified. Cell uptake and blocking essays were performed to verify the specificity of the tracer in vitro. The expression of LAG-3 in B16-F10 subcutaneous tumors was monitored by flow cytometry, and its correlation with the tracer uptake was analyzed to evaluate the tracer specificity. PET imaging and biodistribution studies were conducted after CpG treatment of unilateral or bilateral B16-F10 subcutaneous tumor models to assess the ability of68Ga-NOTA-XH05 in monitoring immunotherapy efficacy and the abscopal effect of CpG.

Results

Following purification,68Ga-NOTA-XH05 exhibited high radiochemical purity and specificity. Flow cytometry analysis revealed a positive correlation between LAG-3 expression in tumors and the uptake of68Ga-NOTA-XH05. In B16-F10 bearing mice treated with CpG, PET imaging using68Ga-NOTA-XH05 demonstrated a higher tumor to blood ratio (TBR) compared with the control group. Furthermore, TBR values obtained from CpG-treated mice allowed for differentiation between responders and non-responders. In a bilateral subcutaneous tumor model where only right-sided tumors were treated with intratumoral injection of CpG, TBR values of left-sided tumors were significantly higher than those in the control group, indicating that68Ga-NOTA-XH05 could effectively monitor the systemic effect of local CpG injection.

Conclusion

Our findings highlight the detection capability of68Ga-NOTA-XH05 in assessing LAG-3 expression levels within tumors and evaluating response to immunotherapy, thereby suggesting promising clinical translational prospects.
Dynamic consent: a royal road to research consent?
Authors: Bruns Andreas , Winkler Eva C
Published: July 2024

In recent years, the principle of informed consent has come under significant pressure with the rise of biobanks and data infrastructures for medical research. Study-specific consent is unfeasible in the context of biobank and data infrastructure research; and while broad consent facilitates research, it has been criticised as being insufficient to secure a truly informed consent. Dynamic consent has been promoted as a promising alternative approach that could help patients and research participants regain control over the use of their biospecimen and health data in medical research. Critical voices have focused mainly on concerns around its implementation; but little has been said about the argument that dynamic consent is morally superior to broad consent as a way to respect people’s individual autonomy. In this paper, we identify two versions of this argument—an information-focused version and a control-focused version—and then argue that both fail to establish the moral superiority of dynamic over broad consent. In particular, we argue that since autonomous choices are a certain species of choices, it is neither obvious that dynamic consent would meaningfully enhance people’s autonomy, nor that it is morally justifiable to act on every kind of consent choice enabled by dynamic consent.
The benefit of favorable venous outflow profiles is mediated through the reduced risk of intracranial hemorrhage in acute ischemic stroke patients undergoing endovascular treatment
Authors: Jiang Shuyu , Gong Chen , Huang Liping , Wang You , Wang Zhiyuan , Chen Yankun , Yuan Jinxian , Wang Li , Gong Siyin , Tan Dandan , Zhang Peng , Huang Yunyi , Wen Yuetao , Hu Yang , Li Zhipeng , Li Wenze , Liu Jin , Guo Jing , Chen Shengli , Chen Yangmei , Xu Tao
Published: July 2024

Background

Favorable venous outflow (VO) has been recognized as an independent predictor of excellent clinical outcomes in acute ischemic stroke caused by anterior circulation large vessel occlusion (AIS-LVO) patients who received endovascular treatment (EVT). However, the reasons why VO affects clinical outcomes have not been fully explained. In this study, we aimed to identify the potential mediators of VO affecting prognosis.

Methods

We conducted a multicenter retrospective cohort study of consecutive patients with AIS-LVO who underwent EVT. Baseline computed tomographic angiography (CTA) was applied to assess VO by the Cortical Vein Opacification Score (COVES). The primary outcome was functional independence at 90 days (modified Rankin Scale (mRS) score of 0–2). Classifying subtypes of intracranial hemorrhage (ICH) to explore the relationship between ICH subtypes and VO. Multivariate logistic regression and causal mediation analyses were used to evaluate the relationship among VO, functional independence, and potential mediators.

Results

Among 860 AIS-LVO patients undergoing EVT, a total of 515 patients were included in the present study after strict screening. In multivariate logistic regression analysis, favorable VO profiles (defined as COVES 3–6) were significantly associated with a lower incidence of ICH (24.2% vs 46.9%, adjusted odds ratio (aOR) 0.48, 95% confidence interval (CI) 0.30 to 0.77, P=0.002) and a higher proportion of functional independence (58.9% vs 15.0%, aOR 4.07, 95% CI 2.41 to 6.88, P<0.001). Mediation analysis showed that favorable VO profiles significantly reduced the incidence of parencuymal hematoma (PH) 2 accounting for 8.0% (95% CI 0.9% to 19.0%) of its beneficial effect on functional independence.

Conclusion

This study demonstrated the potential mediating effects of severe ICH for the beneficial effect of favorable VO on clinical prognosis among patients with AIS-LVO who underwent EVT.
Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study
Authors: Salim Hamza Adel , Yedavalli Vivek , Musmar Basel , Adeeb Nimer , E l Naamani Kareem , Henninger Nils , Sundararajan Sri Hari , Kühn Anna Luisa , Khalife Jane , Ghozy Sherief , Scarcia Luca , Tan Benjamin Yong Qiang , Heit Jeremy J , Regenhardt Robert W , Cancelliere Nicole M , Bernstock Joshua D , Rouchaud Aymeric , Fiehler Jens , Essibayi Muhammed Amir , Sheth Sunil A , Puri Ajit S , Barreau Xavier , Colasurdo Marco , Renieri Leonardo , Dyzmann Christian , Marotta Thomas , Spears Julian , Mowla Askan , Jabbour Pascal , Filipe João Pedro , Biswas Arundhati , Harker Pablo , Clarençon Frédéric , Radu Răzvan Alexandru , Siegler James E , Nguyen Thanh N , Varela Ricardo , Ota Takahiro , Gonzalez Nestor , Moehlenbruch Markus A , Altschul David , Gory Benjamin , Costalat Vincent , Stracke Christian Paul , Aziz-Sultan Mohammad Ali , Hecker Constantin , Shaikh Hamza , Liebeskind David S , Baker Amanda , Pedicelli Alessandro , Alexandre Andrea , Faizy Tobias D , Tancredi Illario , Kalsoum Erwah , Lubicz Boris , Patel Aman B , Mendes Pereira Vitor , Guenego Adrien , Dmytriw Adam A
Published: July 2024

Background

The efficacy of endovascular treatment (EVT) in acute ischaemic stroke due to distal medium vessel occlusion (DMVO) remains uncertain. Our study aimed to evaluate the safety and efficacy of EVT compared with the best medical management (BMM) in DMVO.

Methods

In this prospectively collected, retrospectively reviewed, multicentre cohort study, we analysed data from the Multicentre Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy registry. Patients with acute ischaemic stroke due to DMVO in the M2, M3 and M4 segments who underwent EVT or received BMM were included. Primary outcome measures comprised 10 co-primary endpoints, including functional independence (mRS 0–2), excellent outcome (mRS 0–1), mortality (mRS 6) and haemorrhagic complications. Propensity score matching was employed to balance the cohorts.

Results

Among 2125 patients included in the primary analysis, 1713 received EVT and 412 received BMM. After propensity score matching, each group comprised 391 patients. At 90 days, no significant difference was observed in achieving mRS 0–2 between EVT and BMM (adjusted OR 1.00, 95% CI 0.67 to 1.50, p>0.99). However, EVT was associated with higher rates of symptomatic intracerebral haemorrhage (8.4% vs 3.0%, adjusted OR 3.56, 95% CI 1.69 to 7.48, p<0.001) and any intracranial haemorrhage (37% vs 19%, adjusted OR 2.61, 95% CI 1.81 to 3.78, p<0.001). Mortality rates were similar between groups (13% in both, adjusted OR 1.48, 95% CI 0.87 to 2.51, p=0.15).

Conclusion

Our findings suggest that while EVT does not significantly improve functional outcomes compared with BMM in DMVO, it is associated with higher risks of haemorrhagic complications. These results support a cautious approach to the use of EVT in DMVO and highlight the need for further prospective randomised trials to refine treatment strategies.
Estimates of unintended pregnancy among US active-duty service women and the impact on Women Peace and Security objectives as measured by potential readiness days lost
Authors: Janvrin Miranda Lynn , Banaag A , Lawry L L , Scott R , Koehlmoos T
Published: July 2024

Introduction

The prevalence of unintended pregnancy (UIP) in the United States is high among active-duty service women (ADSW).

Objective

To estimate the number of UIPs and the impact these pregnancies have on the ability to meet Women, Peace and Security objectives as measured by maximum potential readiness days lost (mRDL).

Methods

Using data from the Military Health System Data Repository, ADSW aged 18 to 44 years, were identified from fiscal year (FY) 2019 data. Deliveries were identified using Medicare Severity Diagnosis-Related Group codes. The estimated number of UIPs was calculated by multiplying both the number of ADSW and the number of deliveries by age-adjusted rates of UIP. Post partum women do not have to meet height and weight standards or complete a physical fitness test for up to 365 days after a full-term delivery. Lost readiness days were calculated by multiplying the number of UIPs by 365 days. Data were stratified by age, race, rank and branch of service.

Results

A total of 230 596 ADSW were identified in FY2019. Using the number of ADSW, an estimated 12 683 ADSW experienced an unintended pregnancy, resulting in an estimated 4 629 215 mRDL. Using the number of deliveries, an estimated 6785 deliveries were a result of UIPs, resulting in an estimated 2 476 364 mRDL. The highest estimates of UIPs were among ADSW aged 18 to 24 years, of White race, in a Junior Enlisted rank and in the Army.

Conclusion

Estimates of UIPs among ADSW would result in considerable impact on their military career. Dealng with UIPs proactively, by encouraging comprehensive family planning and instituting additional reproductive health policies for service members by ensuring that service members can make informed decisions about their reproductive health while maintaining operational effectiveness, is important for meeting United States Department of Defense Women, Peace and Security objectives.
Is inflammatory change associated with psychological risk and resilience in high-risk military personnel?
Authors: Bennett Neanne , Lawrence-Wood E , McFarlane A
Published: July 2024

Introduction

In military populations, the potential for under-reporting of Post-traumatic Stress Disorder (PTSD) symptoms and challenges in recognising early changes can make it difficult to detect an emerging disorder. However, early identification of PTSD symptoms would improve opportunities for intervention, and potentially reduce the likelihood of chronic mental health problems.

Method

This study explored if changes in levels of inflammation, measured by C reactive protein (CRP) and interleukin 6 (IL-6), were associated with the onset of psychological symptoms associated with PTSD. It also examined if changes in inflammation over time contributed to psychological risk and resilience, which was defined by psychological reactivity to deployment-related combat exposures. Participants were special forces personnel who completed psychological self-report questionnaires and had measures of CRP and IL-6 taken pre and post deployment. Regression analysis was used to examine how psychological symptoms predicted change in inflammation, and Analysis of Variance (ANOVA) were used to examine differences between identified subgroups.

Results

Results identify this population as having high levels of combat and trauma exposures, with low-level psychological symptoms. The results also identified a decrease in CRP and an increase in IL-6 over time. A significant difference in inflammation was identified between subgroups (p<0.05). An association between inflammatory markers and subthreshold symptoms related to anger (p<0.01) and sleep (p<0.05) was also identified.

Conclusion

These preliminary findings suggest inflammatory markers may help to identify adaptive responses post deployment. In addition, low-level increases in inflammatory markers may be associated with subthreshold PTSD symptoms. These findings offer potential insights for prevention, early identification and treatment in military and veteran populations.
Sex-specific aspects on prognosis after aortic valve replacement for aortic stenosis: a SWEDEHEART registry study
Authors: Johnston Nina , James Stefan K , Lindhagen Lars , Ståhle Elisabeth , Christersson Christina
Published: July 2024

Objective

To compare long-term cardiovascular (CV) outcomes between men and women with aortic stenosis (AS) undergoing aortic valve replacement (AVR) by the type of valve implant.

Methods

The study population consisted of 14 123 non-selected patients with AS undergoing first-time AVR and included in the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry during 2008–2016. Comparisons were made between men and women and type of valve implant (ie, surgical implantation with a mechanical (mSAVR) (n=1 966) or biological valve (bioSAVR) (n=9 801)) or by a transcatheter approach (TAVR) (n=2 356). Outcomes included all-cause mortality, ischaemic stroke, major bleeding, thromboembolic events, heart failure and myocardial infarction, continuously adjusted for significant comorbidities and medical treatment.

Results

In the mSAVR cohort, there were no significant sex differences in any CV events. In the bioSAVR cohort, a higher risk of death (HR: 1.14; 95% CI: 1.04 to 1.26, p=0.007) and major bleeding (HR: 1.41; 95% CI: 1.18 to 1.69, p<0.001) was observed in men. In the TAVR cohort, men suffered a higher risk of death (HR: 1.24; 95% CI: 1.07 to 1.45, p=0.005), major bleeding (HR: 1.35; 95% CI: 1.00 to 1.82, p=0.022) and thromboembolism (HR: 1.35, 95% CI: 1.00 to 1.82, p=0.047).

Conclusion

No significant long-term difference in CV events was noted between men and women undergoing AVR with a mechanical aortic valve. In both the bioSAVR and TAVR cohort, mortality was higher in men who also had an increased incidence of several other CV events.
No difference in clinical parameters and drug retention in PsA patients receiving b/tsDMARD monotherapy versus combination with methotrexate: data from the RABBIT-SpA registry
Authors: Regierer Anne Constanze , Kiefer David , Schett Georg , Krause Andreas , Weiß Anja , Sewerin Philipp , Strangfeld Anja
Published: July 2024

Background

The potential benefit of methotrexate (MTX) in combination with biologic (b) and targeted synthetic (ts) disease modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA) is still a matter of debate.

Objectives

To compare clinical and patient reported characteristics as well as drug retention rates in PsA patients receiving b/tsDMARD monotherapy or in combination with MTX.

Methods

RABBIT-SpA is a prospective longitudinal cohort study including axSpA and PsA patients. In this analysis, PsA patients were stratified into two groups: starting b/tsDMARD as monotherapy or in combination with MTX. Treatment retention was compared by drug survival analysis.

Results

69% of the patients (n=900) started b/tsDMARD as monotherapy while 31% were treated in combination with MTX (n=405). At baseline, clinical domains like skin, nail and joint affection, dactylitis, enthesitis and axial involvement were similar between the groups. Only the patients’ satisfaction concerning tolerability of the previous treatment was significantly better in the combination group at treatment start. Drug retention rates did not differ between the groups (p=0.4). At 6/12 months, 66%/48% of patients in monotherapy and 67%/48% in the combination group were still on their original treatment.

Conclusions

We did not identify any clinical parameters with notable influence on the choice of b/tsDMARD mono or MTX-combination therapy in PsA. Drug retention rates are similar between mono and combination therapy. It seems that the decision to continue MTX at initiation of b/tsDMARDs is mostly based on the subjective tolerability of MTX treatment.
Impact of inflammation on cognitive function in patients with highly inflammatory rheumatoid arthritis
Authors: Mena-Vázquez Natalia , Ortiz-Márquez Fernando , Ramírez-García Teresa , Cabezudo-García Pablo , García-Studer Aimara , Mucientes-Ruiz Arkaitz , Lisbona-Montañez Jose Manuel , Borregón-Garrido Paula , Ruiz-Limón Patricia , Redondo-Rodríguez Rocío , Manrique-Arija Sara , Cano-García Laura , Serrano-Castro Pedro J. , Fernández-Nebro Antonio
Published: July 2024

Objective

To evaluate cognitive function in patients with rheumatoid arthritis (RA) and inflammatory activity.

Patients and methods

We performed a cross-sectional study of a cohort of patients with RA initiating their first biological treatment due to moderate-to-high inflammation and a healthy control group (no inflammatory diseases) matched for age, sex and educational level. All participants underwent a comprehensive neuropsychological assessment, with cognitive impairment defined as a Montreal Cognitive Assessment (MoCA) score<26. Additional assessments included various cognitive tests (STROOP, forward and backward digit spans), anxiety and depression scales (Hospital Anxiety and Depression Scale), quality of life measures (Quality of Life-Rheumatoid Arthritis) and average inflammatory activity according to the 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) into high activity (DAS28≥3.2) and low activity (DAS28<3.2) groups, also CRP levels and interleukin 6 (IL-6) levels were measured using an ELISA.

Results

The study population comprised 140 participants, 70 patients with RA and 70 controls. Patients more frequently experienced cognitive impairment than controls (60% vs 40%; p=0.019) and had lower mean (SD) values in the MoCA (23.6 (3.9) vs 25.1 (3.4); p=0.019. As for subtests of the MoCA, involvement was more marked in patients than in controls for the visuospatial-executive (p=0.030), memory (p=0.026) and abstraction (p=0.039) domains. Additionally, patients scored lower on executive function, as assessed by the backward digit span test (4.0 (1.7) vs 4.7 (1.9); p=0.039). Cognitive impairment is associated with age and a lower educational level in the general population, and among patients with RA with educational level, obesity and average inflammatory activity (DAS28, CRP, and IL-6).

Conclusions

Patients with RA with high inflammatory activity are more susceptible to cognitive impairment, which specifically affects the domains of visuospatial, memory, abstraction and executive function.
Diagnosis challenges in inception cohorts in axial spondyloarthritis: the case of the French national DESIR cohort
Authors: Molto Anna , Serrand Chris , Alonso Sandrine , Berenbaum Francis , Claudepierre Pascal , Combe Bernard , Gossec Laure , Ruyssen-Witrand Adeline , Saraux Alain , Wendling Daniel , Lequerre Thierry , Dougados Maxime
Published: July 2024

Background

Inception cohorts aim to describe chronic diseases from diagnosis and over years of follow-up. Axial spondyloarthritis (axSpA) diagnosis might be challenging during the first years of the disease. Thus, identifying the features that will be associated with a confirmed diagnosis over time is key.

Objectives

To assess the frequency and the predisposing factors for a change of an initial diagnosis in an inception axSpA cohort.

Methods

DESIR is an ongoing national multicentre inception axSpA cohort with currently 12.5 years of follow-up. At the entry visit and confirmed at each visit, the diagnosis of axSpA was based on the opinion of the treating rheumatologist. Follow-up was interrupted in case of a change in this initial diagnosis. Multiple imputation was used to estimate the probability of a change in the initial diagnosis of axSpA for each patient lost to follow-up. Factors predisposing to an unchanged diagnosis of axSpA were then assessed using a multivariate logistic regression model on the imputed data sets.

Results

Of the 708 patients included, over 10 years of follow-up, 45 (6.4%) were excluded due to a diagnosis change and 300 (42.4%) patients were lost to follow-up. Based on the imputation of these 300 patients, a change in their initial axSpA diagnosis was estimated in 42 (14.0%). Factors predisposing to an unchanged initial axSpA diagnosis during follow-up were (ORs (95% CIs)): radiographic sacroiliitis: 17.0 (4.1 to 71.0); psoriasis: 5.3 (2.0 to 14.3); CRP≥6 mg/L: 2.7 (1.3 to 5.3); good NSAID response: 2.5 (1.5 to 4.2); HLA B27+: 2.0 (1.3 to 3.3); anterior chest wall pain: 2.0 (1.2 to 3.3) and female sex: 1.9 (1.2 to 3.0).

Conclusion

These data suggest that a change in diagnosis in recent onset axSpA exists, but is not frequent, and is less likely to occur in the presence of objective features at baseline.
Biological use influences the impact of inflammation on risk of major adverse cardiovascular events in rheumatoid arthritis
Authors: Karpouzas George Athanasios , Ormseth Sarah R , van Riel Piet Leonardus Cornelis Maria , Gonzalez-Gay Miguel A , Corrales Alfonso , Rantapää-Dahlqvist Solbritt , Sfikakis Petros P , Dessein Patrick , Tsang Linda , Hitchon Carol , El-Gabalawy Hani , Pascual-Ramos Virginia , Contreras-Yáñez Irazú , Colunga-Pedraza Iris J , Galarza-Delgado Dionicio Angel , Azpiri-Lopez Jose Ramon , Semb Anne Grete , Misra Durga Prasanna , Hauge Ellen-Margrethe , Kitas George
Published: July 2024

Objectives

Chronic inflammation promotes cardiovascular risk in rheumatoid arthritis (RA). Biological disease-modifying antirheumatic drugs (bDMARDs) improve disease activity and cardiovascular disease outcomes. We explored whether bDMARDs influence the impact of disease activity and inflammatory markers on long-term cardiovascular risk in RA.

Methods

We studied 4370 participants without cardiovascular disease in a 10-country observational cohort of patients with RA. Endpoints were (1) major adverse cardiovascular events (MACE) encompassing myocardial infarction, stroke and cardiovascular death; and (2) any ischaemic cardiovascular events (iCVE) including MACE plus revascularisation, angina, transient ischaemic attack and peripheral arterial disease.

Results

Over 26 534 patient-years, 239 MACE and 362 iCVE occurred. The interaction between 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and bDMARD use was significant for MACE (p=0.017), suggesting the effect of DAS28-CRP on MACE risk differed among bDMARD users (n=515) and non-users (n=3855). DAS28-CRP (per unit increase) is associated with MACE risk in bDMARD non-users (HR 1.21 (95% CI 1.07 to 1.37)) but not users (HR 0.69 (95% CI 0.40 to 1.20)). The interaction between CRP (per log unit increase) and bDMARD use was also significant for MACE (p=0.011). CRP associated with MACE risk in bDMARD non-users (HR 1.16 (95% CI 1.04 to 1.30)), but not users (HR 0.65 (95% CI 0.36 to 1.17)). No interaction was observed between bDMARD use and DAS28-CRP (p=0.167) or CRP (p=0.237) for iCVE risk.

Conclusions

RA activity and inflammatory markers associated with risk of MACE in bDMARD non-users but not users suggesting the possibility of biological-specific benefits locally on arterial wall independently of effects on systemic inflammation.
DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease (DR. BEYOND): the protocol of a multicentre randomised trial
Authors: Mo Dapeng , Tong Xu , Li Xiaoqing , Qin Chuan , Pan Yuesong , Guan Sheng , Miao Zhongrong
Published: July 2024

Background

Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease (sICAD), an elevated rate of restenosis remains an important issue for the conventional bare-metal stent (BMS). Recent evidence from observational studies suggests that applying drug-coated balloons (DCB) in sICAD may decrease restenosis occurrence. Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB.

Aim

To design a randomised trial to examine DCB angioplasty (Taijieweiye intracranial paclitaxel-coated balloon catheter) versus BMS stenting (Wingspan intracranial stent system) in patients with sICAD.

Design

This is a multicentre, prospective, randomised, open-label, blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis (≥70%–99%). Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty (intervention group) or BMS stenting (control group).

Outcome

The primary efficacy outcome is restenosis at 6 months post treatment, that is, >50% stenosis in or within 5 mm of the treated segment and >20% absolute luminal loss. The primary safety outcome is stroke or death within 30 days post treatment.

Discussion

The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.
Does acute dehydration affect the neuromuscular function in healthy adults?—a systematic review
Authors: Francisco Rúben , Jesus Filipe , Santos Paulo , Trbovšek Pia , Moreira Alexandre S. , Nunes Catarina L. , Alvim Marta , Sardinha Luís B. , Lukaski Henry , Mendonca Gonçalo V. , Silva Analiza M.
Published: July 2024

The effects of acute dehydration on neuromuscular function have been studied. However, whether the mechanisms underpinning such function are central or peripheral is still being determined, and the results are inconsistent. This systematic review aims to elucidate the influence of acute dehydration on neuromuscular function, including a novel aspect of investigating the central and peripheral neuromuscular mechanisms. Three databases were used for the article search: PubMed, Web of Science, and Scopus. Studies were included if they had objective measurements of dehydration, muscle performance, and electromyography data or transcranial magnetic stimulation or peripheral nerve stimulation measurements with healthy individuals aged 18–65 years. Twenty-three articles met the eligibility criteria. The studies exhibited considerable heterogeneity in the methods used to induce and quantify dehydration. Despite being inconsistent, the literature shows some evidence that acute dehydration does not affect maximal strength during isometric or moderate-speed isokinetic contractions. Conversely, acute dehydration significantly reduces maximal strength during slow-speed isokinetic contractions and fatigue resistance in response to endurance tasks. The studies report that dehydration does not affect the motor cortical output or spinal circuity. The effects occur at the peripheral level within the muscle.
Scalarized hybrid neutron stars in scalar tensor gravity
Authors: Rahimi Fahimeh , Rezaei Zeinab
Published: July 2024

Hybrid neutron stars, the compact objects consisting hadronic matter and strange quark matter, can be considered as the probes for the scalar tensor gravity. In this work, we explore the scalarization of hybrid neutron stars in the scalar tensor gravity. For the hadronic phase, we apply a piecewise polytropic equation of state constrained by the observational data of GW170817 and the data of six low-mass X-ray binaries with thermonuclear burst or the symmetry energy of the nuclear interaction. In addition, to describe the strange quark matter inside the hybrid neutron star, different MIT bag models are employed. We study the effects of the value of bag constant, the mass of s quark, the perturbative quantum chromodynamics correction parameter, and the density jump at the surface of quark-hadronic phase transition on the scalarization of hybrid neutron stars. Our results confirm that the scalarization is more sensitive to the value of bag constant, the mass of s quark, and the density jump compared to the perturbative quantum chromodynamics correction parameter.
Online unsupervised multi-view feature selection with adaptive neighbors
Authors: Ai Yihao , Zhong Guo , Chen Tingjian , Yuan Haoliang , Lai Loi Lei
Published: July 2024

Unsupervised feature selection has emerged as a significant and challenging issue in multi-view learning due to the need to process a large amount of unlabeled and high-dimensional multi-view data. Although numerous methods have been developed to this point, the majority of them are offline and have substantial computational and memory costs. Unlike previous work, we propose an Online Unsupervised Multi-View Feature Selection with Adaptive Neighbors (OUMVFSAN) method by exploring view-specific feature selection matrices and weights to handle the multi-view streaming data. Specifically, the proposed OUMVFSAN method naturally performs information fusion of different views guided through a consensus clustering indicator matrix to make feature selection matrices select more valuable features. Moreover, through processing multi-view streaming data by a buffering technique, OUMVFSAN reduces the computational and storage cost without sacrificing performance. We demonstrate the effectiveness and efficiency of the proposed OUMVFSAN with extensive experiments on eight multi-view datasets. It is worth noting that OUMVFSAN performs better than many state-of-the-art online and offline unsupervised multi-view feature selection methods.
Consciousness Understood as Contrast, Complexity and Emergence
Authors: Stanowski Mariusz
Published: July 2024

Consciousness still remains puzzling and controversial. This paper demonstrates that at general and objective level, for understanding consciousness it is necessary to understand such fundamental concepts as contrast, interaction, complexity and emergence. New definitions of these terms are provided as they are erroneous or incomplete in their current form. The result of these investigations is the explanation that consciousness is the sensation of energy interaction (like the sensation of touch or pain), but in a more complex form. This objective explanation and the resulting conclusions have been applied to the study of artificial intelligence consciousness and creativity. Specific solutions have been proposed here.