bluuebunny/crossref_metadata_2025 huggingface dataset:
Burden, risk factors, and maternal postpartum and birth outcomes of hypertensive disorder of pregnancy in Ethiopia, 2024: A systematic review and meta-analysis
Authors: Alemayehu Astawus , Demissie Abebaw , Ibrahim Ibsa , Geremew Addisalem , Mohammed Feysal , Gudeta Mogos , Oljira Lamessa , Dessie Yadeta , Assefa Nega
Published: October 2024

Objectives:

This review aimed to report the estimated pooled level of prevalence, risk factors, and birth outcome of hypertensive disorder of pregnancy in Ethiopia, in 2024.

Design:

A systematic review and meta-analysis approach was utilized.

Data Sources and Methods:

PubMed/MEDLINE, Google Scholar, African Index Medicus, Web of Science, and CINHAL (EBSCO) search was carried out. The result was written according to the PRISMA-updated guidelines. To estimate the pooled prevalence and effect sizes, a random-effect model was used. Heterogeneity was assessed and investigated using I2 test statistics and meta-regression, respectively. Publication bias was assessed using funnel plot and Egger’s test statistics. Statistical tests result at p-value < 0.05 were declared as having significance.

Result:

From a total of 52 primary studies with a total sample size of 269, 158 were included in this systematic review and meta-analysis. The pooled prevalence of hypertensive disorder in pregnancy was 8%. Egger’s test statistics ( p = 0.8013) showed there is no publication bias. Having a history of kidney disease (AOR: 3.47), being rural resident (AOR: 2.5), having fruit intake during pregnancy (AOR: 0.39), being overweight (AOR: 2.24), and having multiple pregnancy (AOR: 2.1) were found to have a significant association with hypertensive disorder of pregnancy.

Conclusion:

Overall, the level of prevalence of hypertensive disorders of pregnancy in Ethiopia was significantly increasing. Having a history of kidney disease was found to have a strong association with hypertensive disorders of pregnancy among factors. The most common or dominant adverse maternal and childbirth outcomes were low birth weight, preterm birth, fifth minute low APGAR score; and eclampsia, hemolysis, elevated liver enzymes, and low platelets syndrome, and acute kidney injury. The governments and other stakeholders should work to broaden and strengthen the existing maternal and c﻿hild h﻿ealth (MCH) practice by incorporating all possible risk factors of hypertensive disorders of pregnancy in MCH guidelines. In addition, a large-scale study is required that considers those important missed variables, especially, in the eastern part of Ethiopia.
The Listening Public in Public Diplomacy: How Did the Public Respond to President Zelensky on Twitter?
Authors: Rikkonen Lassi , Isotalus Pekka
Published: October 2024

This exploratory study focuses on the public as a listening ensemble that takes part in public diplomacy on Twitter. Here, listening is considered as the receiving component of communication, and responsive behavior as its visible product. The focus is on public communication that followed Russia’s 2022 invasion of Ukraine. A total of 4,392 quote tweets (citing the President of Ukraine Volodymyr Zelensky’s tweets mentioning Ukraine’s possible membership in the European Union) were analyzed using the taxonomy of verbal response modes. Two major modes were identified: responses to the situation by sharing information and persuasion, and responses to Zelensky, Ukrainians, and the public by disclosing feelings and opinions. Interestingly, the different social roles of the public were associated with how much interaction was elicited. The listening public contributes to global deliberativeness; not strictly from an issue-oriented problem-solving perspective, but in the sense that they weave together analytical and social aspects of deliberative reflection.
Rates of Reporting and Analyzing Race and Ethnicity in Athlete-Specific Sports Medicine Research: A Systematic Review
Authors: Sonnier John Hayden , Coladonato Carlo , Khan Irfan A. , Connors Gregory , Paul Ryan W. , Hall Anya T. , Johnson Emma E. , Bishop Meghan E. , Tjoumakaris Fotios P. , Freedman Kevin B.
Published: October 2024

Background:

Race- and ethnicity-based differences in treatment access and outcomes have been reported in the orthopaedic sports medicine literature. However, the rate at which race and ethnicity are reported and incorporated into the statistical analysis of sports medicine studies remains unclear.

Purpose:

To determine the rate at which race and ethnicity are reported and analyzed in athlete-specific sports medicine literature.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles published by the 3 journals of the American Orthopaedic Society for Sports Medicine between 2017 and 2021 were considered for inclusion. Original sports medicine research studies that focused on athletes were included. Outcome measures included reporting and analysis of patient demographics (age, sex, race, ethnicity). Studies that included demographic variables in a multivariate analysis or that performed a race-/ethnicity-based stratified analyses were considered to have analyzed that variable. Studies that reported and/or analyzed patient demographics were examined. Chi-square tests were performed to determine statistical significance.

Results:

A total of 5140 publications were screened, and 842 met the inclusion criteria. Age and sex were well reported (84.1% and 87.0%, respectively), while race (3.8%) and ethnicity (2.0%) were poorly reported. There was no difference in rates of reporting age, sex, race, or ethnicity between the American Journal of Sports Medicine ( AJSM), the Orthopaedic Journal of Sports Medicine ( OJSM), or Sports Health: A Multidisciplinary Approach ( Sports Health). The rate of analysis was also calculated as a percentage of the studies that reported that variable. Of the studies that reported age, 38.5% analyzed age. Using this method, 26.2% of studies analyzed sex, 40.6% analyzed race, and 17.6% analyzed ethnicity. Although there was no difference in the overall rate at which studies from the 3 journals analyzed ethnicity, Sports Health studies analyzed age ( P = .044), sex ( P = .001), and race ( P = .027) more frequently than studies published in AJSM and OJSM. Of the studies that analyzed race, most of those studies (8/13, 61.5%) found significant race-based differences in reported outcomes.

Conclusion:

This systematic review demonstrated that race and ethnicity are poorly reported and analyzed in athlete-specific sports medicine literature, despite the fact that a majority of studies analyzing race found significant differences between racial groups. Improved reporting of race and ethnicity can determine whether race- and ethnicity-based differences exist in patient interventions to ameliorate disparities in patient outcomes.
Marrying across Borders in Latin America: Visualizing Intermarriage Flows
Authors: Robles Adriana , Pesando Luca Maria , Abufhele Alejandra , Bucca Mauricio , Urbina Daniela R.
Published: October 2024

The authors propose an adaptation of the well-known “circular plot,” traditionally used to quantify international migration flows, to visualize patterns of intermarriage within Latin American countries. The authors present data on intermarriage flows between partners’ countries of origin using data from recent household surveys from five Latin American countries. The visualization allows an easy-to-grasp snapshot of marital pairings considering partners born in different countries, as well as the identification of their spatial patterns. In some countries, such as Colombia and Peru, most intermarriage occurs between natives and Venezuelans. Conversely, in Chile, Ecuador, and Uruguay, there is much wider heterogeneity in country-pair combinations. In Chile, no country-pair combination dominates, reflecting the more balanced nature of migration flows from a broader set of countries. Overall, the results aid the interpretation of trends and patterns in marriage across country lines by placing them within a comparative regional context. This is a flexible tool that could be easily adapted to multiple other countries within or outside of the region, to analyses over time, and to a heterogeneous array of couple-level characteristics.
NetAScore: An open and extendible software for segment-scale bikeability and walkability
Authors: Werner Christian , Wendel Robin , Kaziyeva Dana , Stutz Petra , van der Meer Lucas , Effertz Lea , Zagel Bernhard , Loidl Martin
Published: October 2024

Systematic and reproducible analyses of walkability and bikeability are crucial for efficient and effective interventions to promote active mobility. Previous methods for segment-based walkability and bikeability are limited in applicability due to high data requirements, a constrained set of aspects considered, or are not openly available and adjustable. The lack of transparency, limited reproducibility, and the high effort required to re-implement customized and extended variants of such methods inhibit wider application and retard knowledge gain. The open source software NetAScore aims to fill this gap. It is based on open and widely available data, provides default mode profiles for modeling utilitarian bikeability and walkability, and is designed for customization. General applicability and suitability of the software and its underlying models were shown in two evaluation studies. Source code and documentation are available on GitHub and via doi.org/10.5281/zenodo.7695369.
Founder’s Insights: Unveiling HR Challenges in Start-ups
Authors: Deka Debleena
Published: October 2024

This article explores the HR challenges encountered by start-up ventures, focusing on the perspective of founders. Research indicates that human-related factors contribute significantly to start-up failures. By analysing innovative human resource management (HRM) strategies, including the importance of open communication and incentivisation systems, the study intends to find out some crucial challenges, which are faced by founders. Furthermore, it investigates the impact of high-commitment work systems (HCWS) on start-up performance. Through this exploration, the article provides valuable insights for founders and HR practitioners to navigate HR challenges and optimise human capital management in the start-up environment, ultimately fostering sustainable growth.
How social workers are positioned and constructed as contributors within national palliative care policies in Sweden: a policy analysis
Authors: Ågren Axel , Holmberg Bodil
Published: October 2024

Background:

Palliative care is expected to acknowledge physical, psychological, emotional, spiritual, and social needs, to which social workers can contribute with expertise on recognizing the importance of social relations and how social inequalities impact on individuals. The social work profession faces challenges in claiming their contributions in the hierarchies of medical professions. Polices play an important role in constructing and positioning responsibilities of professions.

Objectives:

To analyze how social workers are positioned as contributors to palliative care within national-level policies in Sweden.

Methods and materials:

A policy analysis was conducted through a constructivist lens. Data were collected from 10 Swedish national-level policy documents on palliative care.

Results:

Three themes emerged: “A natural presence conveying special expertise”; “Emotional conversational support before and after death”; and “Practical support.” Overall, social workers’ contribution was vaguely described and in similar ways as registered nurses.

Conclusion:

In Swedish policies analyzed, social workers’ contributions were difficult to differentiate from that of registered nurses, which may complicate their mutual collaborations and cause confusion for individuals at the end of life and their next of kin. Future research on how different professions are positioned within palliative care is needed to reduce risks of role blurring between professions with similar aims. Moreover, given social workers long history of psychosocial knowledge, meanings of this concept need to be further acknowledged.
Influence of parboiling conditions on rice grain quality characters and insect infestation with rice weevil (Sitophilus oryzae. L) of some rice cultivars
Authors: Salam Khaled M. H. Abd El , El-Soud Germine M. Abou , Marei Abd El Salam M. , Abdel-Rheim Khaled H. M. , Abdel‑Megeed Ahmed , Lamlom Sobhi F.
Published: October 2024

Parboiling improves rice grain hardness and reduces susceptibility to Sitophilus oryzae infestation by gelatinizing the starch and enhancing resistance.A newly designed electric machine was used to parboil four Egyptian rice cultivars—Sakha 108, Giza 178, Super 300, and Egyptian Yasmin—at 70, 75, and 80 °C and determine their susceptibility to Sitophilus oryzae L. (Coleoptera: Curculionidae) infestation. Results indicated that heating affected most traits in all four rice cultivars during both study seasons 2021 and 2022. Super 300 rice cultivar exhibited the highest hulling values (81.23 and 81.42%) when heated to 80 °C, while the Yasmin rice cultivar showed the lowest values for hulling (77.66 and 77.45%) at 70 °C. while Giza 178 cultivar showed a significant decrease in broken percentage (90.85 and 94.02%) compared to control when heated to 80 °C. The results also indicated that the Yasmin rice cultivar had the highest values for white belly, hardness, and gel consistency at 80 °C, while the Sakha 108 cultivar showed the lowest values for these traits at 70 °C. Furthermore, the protein, elongation, and water uptake characters significantly responded to the different investigated treatments. Yasmin cultivar at 80 °C showed the highest significant values for protein (9.26 and 9.47%), elongation (65.02 and 65.44%), and water uptake (453.2 and 455.1 ml water/100 g milled grains) in both seasons. Sakha 108 cultivar had the lowest values for these traits at 70 °C. The S. oryzae insects responded differently to the rice cultivars. Using Dobie’s Index of Susceptibility, all cultivars were classified as resistant to S. oryzae infestation. Super 300 was moderately resistant before parboiling but resistant after heat treatment. In conclusion, the study underscores the influence of pre-storage parboiling on rice weevil infestation, suggesting that heat treatment could serve as an effective control measure. These findings emphasize the importance of parboiling conditions in enhancing rice grain quality and bolstering resistance to insect infestation.
Single nucleotide polymorphism (SNP) analysis reveals ancestry and genetic diversity of cultivated and wild grapevines in Croatia
Authors: Marinov Luka , Magris Gabriele , Di Gaspero Gabriele , Morgante Michele , Maletić Edi , Bubola Marijan , Pejić Ivan , Zdunić Goran
Published: October 2024

Background

Croatia is a geographically small country with a remarkable diversity of cultivated and spontaneous grapevines. Local germplasm has been characterised by microsatellite markers, but a detailed analysis based on single nucleotide polymorphisms (SNPs) is still lacking. Here we characterize the genetic diversity of 149 accessions from three germplasm repositories and four natural sites using 516,101 SNPs to identify complete parent-offspring trios and their relations with spontaneous populations, offering a proof-of-concept for the use of reduced-representation genome sequencing in population genetics and genome-wide association studies (GWAS).

Results

Principal component analysis revealed a clear discontinuity between cultivated (V. vinifera subsp. sativa) and spontaneous grapevines, supporting the notion that the latter represent local populations of the wild progenitor (V. vinifera subsp. sylvestris). ADMIXTURE identified three ancestry components. Two sativa components are alternatively predominant in cultivars grown either in northern Adriatic Croatia and Continental Croatia or in Dalmatia (i.e. central and southern Adriatic Croatia). A sylvestris component, which is predominant in accessions from spontaneous populations, is a minor ancestry component in cultivated accessions. TREEMIX provided evidence of unidirectional migration from the vineyards to natural sites, suggesting that gene flow has gone preferentially from the introduced domesticated germplasm into local wild populations rather than vice versa. Identity-by-descent analysis indicated an extensive kinship network, including 14 complete parent-offspring trios, involving only cultivated accessions, six full-sibling relationships and invalidated a presumed pedigree of one of the most important varieties in Croatia, ‘Plavac Mali’. Despite this strong population structure, significant association was found between 143 SNPs and berry skin colour and between 2 SNPs and leaf hairiness, across two previously known genomic regions.

Conclusions

The clear genetic separation between Croatian cultivars and sylvestris ruled out the hypothesis that those cultivars originated from local domestication events. On the other hand, the evidence of a crop-to-wild gene flow signals the need for an urgent adoption of conservation strategies that preserve the residual genetic integrity of wild relatives. The use of this reduced-representation genome sequencing protocol in grapevine enables an accurate pedigree reconstruction and can be recommended for GWAS experiments.
Effects of mineral fertilization (NPK) on combined high temperature and ozone damage in rice
Authors: Jo So-Hye , Kim Ju-Hee , Moon Ji-Hyeon , Yang Seo-Yeong , Baek Jae-Kyeong , Song Yeong-Seo , Shon Ji-Young , Chung Nam-Jin , Lee Hyeon-Seok
Published: October 2024

Background

Increasing concern has recently been highlighted regarding crop damage due to extreme weather events caused by global warming and the increased production of ground-level ozone. Several studies have investigated rice growth in response to fertilization conditions under various environmental stress conditions; however, studies on growth development in response to fertilization conditions under combined high-temperature/ozone treatment conditions are scarce. In this study, we aimed investigate the growth and physiological development of rice under combined high temperature and ozone treatment conditions and to reveal the damage-mitigation effects of NPK fertilization treatments.

Results

The plants were treated with varying levels of NPK [N2 (N-P-K: 9.0-4.5-4.0 kg/a), P2 (4.5-9.0-4.0 kg/a), K2 (4.5-4.5-8.0 kg/a), and control (4.5-4.5-4.0 kg/10a).] under combined high-temperature (35 ℃) and ozone (150 pb) treatment conditions. Analysis of the growth metrics, including plant height, leaf age, dry weight, and the plant height/leaf age (PH/L) ratio were revealed that combined high-temperature/ozone treatment promoted the phenological development indicated by increasing leaf age but decreased the plant height and dry weight indicating its negative effect on quantitative growth. The effects of this combined high-temperature/ozone treatment on growth were alleviated by NPK fertilization, particularly in K2 treatment but worsened in N2 treatment. Visible damage symptoms in rice leaves induced by exposure to the combined stressors was also alleviated by the K2 treatment. At the physiological level, K2 treatment reduced the expression of OsF3H2, which is associated with antioxidant activity, suggesting that potassium improved stress tolerance. Additionally, expression of genes related to abscisic acid (ABA) metabolism showed increased OsNECD (ABA synthesis) and decreased OsCYP707A3 (ABA degradation) in the K2 treatment, promoting a stronger adaptive stress response. Stomatal conductance measurements indicated a slight increase under K2 treatment, reflecting enhanced regulation of stomatal function during stress.

Conclusion

The study highlights the potential of potassium fertilization to mitigate combined high-temperature and ozone stress in rice, suggesting it as a strategy to improve crop resilience and optimize fertilization. The findings offer insights into fertilization treatments and can guide future research on stress tolerance in crops.
Two-stage group-sequential designs with delayed responses – what is the point of applying corresponding methods?
Authors: Schüürhuis Stephen , Wassmer Gernot , Kieser Meinhard , Pahlke Friedrich , Kunz Cornelia Ursula , Herrmann Carolin
Published: October 2024

Background

In group-sequential designs, it is typically assumed that there is no time gap between patient enrollment and outcome measurement in clinical trials. However, in practice, there is usually a lag between the two time points. This can affect the statistical analysis of the data, especially in trials with interim analyses. One approach to address delayed responses has been introduced by Hampson and Jennison (J R Stat Soc Ser B Stat Methodol 75:3-54, 2013), who proposed the use of error-spending stopping boundaries for patient enrollment, followed by critical values to reject the null hypothesis if the stopping boundaries are crossed beforehand. Regarding the choice of a trial design, it is important to consider the efficiency of trial designs, e.g. in terms of the probability of trial success (power) and required resources (sample size and time).

Methods

This article aims to shed more light on the performance comparison of group sequential clinical trial designs that account for delayed responses and designs that do not. Suitable performance measures are described and designs are evaluated using the R package . By doing so, we provide insight into global performance measures, discuss the applicability of conditional performance characteristics, and finally whether performance gain justifies the use of complex trial designs that incorporate delayed responses.

Results

We investigated how the delayed response group sequential test (DR-GSD) design proposed by Hampson and Jennison (J R Stat Soc Ser B Stat Methodol 75:3-54, 2013) can be extended to include nonbinding lower recruitment stopping boundaries, illustrating that their original design framework can accommodate both binding and nonbinding rules when additional constraints are imposed. Our findings indicate that the performance enhancements from methods incorporating delayed responses heavily rely on the sample size at interim and the volume of data in the pipeline, with overall performance gains being limited.

Conclusion

This research extends existing literature on group-sequential designs by offering insights into differences in performance. We conclude that, given the overall marginal differences, discussions regarding appropriate trial designs can pivot towards practical considerations of operational feasibility.
Prevalence and exploratory factor analysis of long COVID-19 symptoms among experienced infected population in Bangkok, Thailand
Authors: Krongthaeo Suphanna , Partiprajak Suphamas , Piaseu Noppawan , Ckumdee Sineenuch , Taaon Chonthicha , Kongsuwan Anon
Published: October 2024

Background

Patients with long COVID may experience various concomitant symptoms caused by inflammation, which affect their lives and well-being. In this study, we aimed to (1) investigate the prevalence of long COVID; (2) explore the levels of symptom severity and functional disability owing to long COVID, overall health, and their relationship; and (3) conduct exploratory factor analysis of long COVID-19 symptoms among experienced infected population in the capital of Thailand.

Methods

A cross-sectional research design was used and a sample of 337 community members with previously COVID-19 infection in Bangkok, Thailand was recruited for this study. Purposive sampling was used. Data collection was performed using an online and a paper-based questionnaire. Descriptive statistics (number, percentage), odds ratio, exploratory factor analysis, and Spearman’s rank correlation coefficient were used for the data analysis.

Results

The prevalence of long COVID was 32.9%. The main reported symptoms included anxiety (28.5%), fatigue (26.1%), and dyspnea (13.4%). There was a significant relationship between symptom severity and functional disability (rs=0.385, p value < 0.01). Overall health was negatively correlated with symptom severity (rs = − 0.291, p < .01) and functional disability (rs = − 0.108, p < .05). Using principal component analysis with Promax rotation, three clusters were identified, explaining 71.44% of the total variance. The Clusters comprised (1) common symptoms of long COVID and communication, (2) fatigue, functioning, and nutritional concerns, and (3) psychosocial impacts.

Conclusions

The present results might help multidisciplinary care teams understand the concurrent symptoms of patients with long COVID and develop rehabilitation care programs to ease all symptoms simultaneously and improve patients’ quality of life.
Drivers of COVID-19 vaccine uptake among rural populations in Madagascar: a cross-sectional study
Authors: Kislaya Irina , Andrianarimanana Diavolana Koecher , Marchese Valentina , Hosay Lalatiana , Rivomalala Rakotonavalona , Holinirina Ramananjanahary , Rasamoelina Tahinamandranto , Zafinimampera Alexina Olivasoa Tsiky , Ratefiarisoa Sonya , Totofotsy Olivette , Rakotomalala Rivo , Rausche Pia , Doumbia Cheick Oumar , Guth Ariane , Pavoncello Viola , Veilleux Simon , Randriamanantany Zely Arivelo , May Jürgen , Puradiredja Dewi Ismajani , Rakotoarivelo Rivo Andry , Fusco Daniela
Published: October 2024

Background

The WHO set the global immunisation threshold for COVID-19 at 70% to achieve worldwide protection against the disease. To date, global COVID-19 vaccine coverage is still below this threshold, in particular in several sub-Saharan African (SSA) countries, such as Madagascar. While factors influencing COVID-19 vaccine hesitancy have been widely explored in the past few years, research on drivers of COVID-19 vaccine uptake remains scarce. This study aimed at investigating drivers associated with COVID-19 vaccine uptake in the Boeny region of Madagascar.

Methods

The study used a cross-sectional survey design to collect data on drivers of vaccine uptake from a sample of adults recruited from 12 healthcare facilities between November 2022 and February 2023. Relative and absolute frequencies were used to summarize participants’ characteristics. Prevalence ratios were estimated by Poisson regression to identify and compare sociodemographic and motivational drivers of vaccine uptake among those who were willing to get vaccinated against COVID-19 with those who had already been vaccinated.

Results

A total of 928 participants aged between 18 and 76 years were included in the study. Among those recruited, 44.9% (n = 417) had already been vaccinated and 55.1% (n = 511) were willing to receive their first dose of COVID-19 vaccine on the day of the interview. The proportions of those respondents who live in urban areas (56.5% vs. 43.8%) and who have high school or university education (46.6% vs. 35.8%) were higher for the uptake group, whereas the proportion of employed respondents (66.3% vs. 56.5%) was higher among those willing to get vaccinated. Vaccine being free of charge (aPR = 1.77 [CI 95%: 1.45–2.17]) and being able to travel again (aPR = 1.61 [CI 95%: 1.30–1.98]) were the drivers most strongly associated with higher vaccine uptake after adjustment for sociodemographic factors.

Conclusions

This study shows that actual COVID-19 vaccine uptake is influenced by a different set of factors than willingness to get vaccinated. Taking this difference in drivers into account can inform more tailored vaccination strategies to increase worldwide coverage.
A cross-sectional study on advance care planning documentation attitudes during national advance care planning week in a South-East Asian country
Authors: Low Chen Ee , Rana Sounak , Yau Chun En , Tan Sheryl Yen Pin , Ng Jing Ni , Chan Noreen , Lim Mervyn Jun Rui
Published: October 2024

Background

Through advocacy initiatives such as roadshows during “National ACP Week”, the Agency for Integrated Care (AIC) had increased advance care planning (ACP) engagement since 2011. Project Happy Apples (PHA), a community initiative project led by medical students from the National University of Singapore, also conducted a public exhibition to raise ACP awareness during this period. This study aimed to investigate and identify predictors of attitudes towards ACP documentation among ‘ACP Week’ respondents which may be used to formulate strategies to increase ACP documentation in Singapore.

Methods

A cross-sectional study on ACP documentation attitudes of 262 respondents during local roadshows were conducted. Multiple logistic regression models were built to investigate the associations between demographic variables and attitudes toward ACP documentation.

Results

The mean age was 43.5 years (SD = 17.4), 79 (30.15%) were males and 49 (18.7%) were healthcare professionals (HCP). 117 (44.66%) respondents had prior experience with serious illness and 116 (44.27%) had heard of ACP. Age was a significant predictor of readiness to sign official papers naming nominated healthcare spokesperson (NHS) (OR = 1.04, 95%CI: 1.02–1.07). Experience with serious illness was a significant predictor of readiness to discuss end-of-life (EOL) care with healthcare professionals (HCP) (OR = 3.65, 95%CI: 1.36–11.61). Being female was a significant predictor for readiness to speak to their nominated healthcare spokesperson about EOL care (OR = 7.33, 95%CI: 2.06–46.73). Subgroup analyses revealed that those aged 20–39 were less likely to speak to their healthcare professional about or sign official papers regarding EOL care. We also found that being a healthcare professional does not necessitate better or worse attitudes.

Conclusion

Advocacy programs tailored to targeting respondents of different age groups and prior experience with serious illness may improve the efficacy of advocacy efforts.
Investigating the support for equitable admissions policies in health professions education: the Formal Consensus method
Authors: Mulder Lianne , Wouters A. , Somra S. , Koster A. S. , Ravesloot J. H. , Croiset G. , Kusurkar R. A.
Published: October 2024

Higher education institutions increasingly aim to implement equity in admissions. However, there is no one-size-fits-all solution to determine which equitable admissions procedures are suitable in a specific context, nor which groups should be its beneficiaries. Therefore, we applied the Formal Consensus Method (FCM) to investigate the support amongst experts and stakeholders for different equitable admissions policies and target groups within the context of Health Professions Education in The Netherlands. We found majority support (median of ratings ≥ 7 on a scale of 1 to 9) in both groups for the target groups ‘applicants with a low or average socio-economic status’ and ‘applicants with an underrepresented migration background’. The majority of participants was also in favor of Contextualized Admissions, especially when used to increase enrolment of applicants with a low or average socio-economic status, with an underrepresented migration background, and asylum status holders. Lastly, both groups supported lottery with extra tickets for applicants with an underrepresented migration background. However, as the range of ratings fell outside the FCM prescribed range of 5-9, no case in which there was majority support could be defined as a ‘consensus’. The expert group proposed the use of Bonded Medical Places for applicants from the Caribbean parts of the Dutch Kingdom. The policies and target groups for which broad support was found, could contribute to equitable admissions, improved student diversity, and enhanced quality of health education and future care. Our application of the FCM in the area of equitable admissions policies may be useful for researchers in other countries where equity principles are not (widely) used in admissions decisions.
Disclosure of true medical information: the case of Bangladesh
Authors: Siraj Sanwar , Hens Kristien , Ali Yousuf
Published: October 2024

Background

Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh.

Methods

This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets.

Results

This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family’s wishes and preferences.

Conclusions

While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient’s active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.
Cost-effectiveness of Procalcitonin (PCT) guidance for antibiotics management of adult sepsis patients in the Egyptian context
Authors: Mosly Mohamed Metwally , Mousli Hesham Metwalli , Ahmed Iman Mohamed Momtaz , Abdou Mohamed Ibrahim Affify
Published: October 2024

Background

Sepsis, which is described as a life-threatening organ malfunction brought on by an unbalanced host response to infection, continues to be a significant healthcare issue that affects millions of individuals each year. It is well-known that sepsis can affect anyone around the world, but the employed survey results showed that there are significant regional variations in sepsis incidence as well as mortality rates. Although there are no definite estimates for Egypt, the highest rates were in Low-Middle-Income Countries (LMICs).

Procalcitonin (PCT) is a host response marker with high specificity for bacterial infections, unlike C-reactive protein (CRP) or white blood cell count (WBC), which represent the traditional methods of detecting inflammation and infection. Its dynamic profile and superior prognostic prediction make it invaluable for assessing response to antibiotic treatment and improving clinical care for sepsis patients.

Our main purpose was to evaluate the cost-effectiveness of PCT guidance compared to no PCT guidance in the antibiotic management of adult sepsis patients according to the Egyptian context.

Methods

We developed a decision tree model to compare the PCT-guided antibiotic management duration endpoint versus the conventional laboratory culture-based antibiotic management in adult sepsis patients. We employed the“Delphi technique” to reach a satisfactory consensus regarding the resources attributed to each compared alternative. The primary measure of the study was the additional cost associated with each Quality-Adjusted Life Year (QALY) gained by sepsis survivors over a one-year time horizon.

Base-case, deterministic and probabilistic sensitivity analyses were conducted using TreeAge, Software.

Results

Base-case analysis showed no dominance for either alternative and resulted in an Incremental Cost-Effectiveness Ratio (ICER) value of 297,783.57 Egyptian Pounds per Quality Adjusted Life Year (L.E/QALY) in favor of the PCT guidance alternative, Deterministic sensitivity analysis revealed that the highest impact magnitudes on ICER reside with seven input parameters, the top two parameters that had the most significant influence were the costs of ICU stay with and without PCT guidance. The CEAC showed a slightly higher probability in terms of acceptability in favor of the no PCT guidance choice along the WTP scale till reaching equal probabilities at the willingness-to-pay (WTP) value point of 390,000 (state currency) after which the - probability supports the PCT guidance choice.

Conclusions

In the Egyptian context, PCT guidance has no cost-effectiveness domination over no PCT guidance in Antibiotics management for adult sepsis patients. This may be attributed to the high cost of PCT investigation that shall be resolved by standardization of its cost when applying the approach of DRG cost packages.
Reduced circulating CD63+ extracellular vesicle levels associate with atherosclerosis in hypercholesterolaemic mice and humans
Authors: Kestecher Brachyahu M. , Németh Krisztina , Ghosal Sayam , Sayour Nabil V. , Gergely Tamás G. , Bodnár Bernadett R. , Försönits András I. , Sódar Barbara W. , Oesterreicher Johannes , Holnthoner Wolfgang , Varga Zoltán V. , Giricz Zoltán , Ferdinandy Péter , Buzás Edit I. , Osteikoetxea Xabier
Published: October 2024

Aims

The association and co-isolation of low-density lipoproteins (LDL) and extracellular vesicles (EVs) have been shown in blood plasma. Here we explore this relationship to better understand the role of EVs in atherogenesis.

Methods and results

Wild type (WT), PCSK9−/−, and LDLR−/− C57BL/6 mice were used in this study. Eleven week-old male mice were fed high-fat diet (HFD) for 12 weeks or kept on normal diet until old age (22-months). Cardiac function was assessed by ultrasound, cholesterol was quantified with a colorimetric kit and circulating EVs were measured using flow cytometry. Plaques were analysed post-mortem using Oil-Red-O staining of the aortic arch. EVs were measured from platelet free blood plasma samples of normal and hypercholesterolaemic clinical patients. Based on annexin V and CD63 staining, we found a significant increase in EV levels in LDLR−/− and PCSK9−/− mice after HFD, but CD81 showed no significant change in either group. There was no significant change in plaque formation after HFD. PCSK9−/− mice show a favourable cardiac function after HFD. Blood cholesterol levels progressively increased during HFD, with LDLR−/− mice showing high levels while PCSK9−/− were significantly lowered compared to WT animals. In mice at old age, similar cholesterol levels were observed as in young mice. In old age, LDLR−/− mice showed significantly increased plaques. At old age, ejection fraction was decreased in all groups of mice, as were CD63+ EVs. Similarly to mice, in patients with hypercholesterolaemia, CD63+ EVs were significantly depleted.

Conclusions

This research demonstrates an inverse relationship between circulating EVs and cholesterol, making EVs a potential marker for cardiovascular disease (CVD). HFD causes reduced cardiac function, but atherosclerotic development is slowly progressing in hypercholesterolaemic models and only observed with old animals. These results also bring further evidence for the benefit of using of PCSK9 inhibitors as therapeutic agents in CVD.
Non-alcoholic fatty liver disease risk with GLP-1 receptor agonists and SGLT-2 inhibitors in type 2 diabetes: a nationwide nested case–control study
Authors: Chang Kai-Cheng , Kuo Fan-Chi , Yang Chen-Yi , Yang Chun-Ting , Ou Huang-Tz , Kuo Shihchen
Published: October 2024

Background

Non-alcoholic fatty liver diseases (NAFLDs)/non-alcoholic steatohepatitis (NASH) are the most common liver disorders among patients with type 2 diabetes. Newer classes of glucose-lowering agents (GLAs), such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is), have been shown to improve liver-related biomarkers. However, their effects on the development of NAFLD/NASH remain inconclusive.

Methods

A nested case–control study was conducted using Taiwan’s National Health Insurance Research Database for 2011–2018. Patients aged ≥ 40 years, diagnosed with type 2 diabetes, having stable non-insulin GLA use, and without NAFLD/NASH history were included. Patients with incident NAFLD/NASH were matched up to 10 randomly sampled controls based on individual’s age, gender, cohort entry date, type 2 diabetes diagnosis date, and disease risk score. Conditional logistic regression analyses were employed to estimate the association between liver risk and treatment exposure. Dose-response analysis was also performed.

Results

There were 621,438 study patients included for analysis. During 1.8 years of median follow-up, the incidence of NAFLD/NASH was 2.7 per 1000 person-years. After matching, 5,730 incident NAFLD cases (mean age: 57.6 years, male: 53.2%) and 45,070 controls (57.7 years, 52.7%) were identified. Using GLP-1RAs or SGLT2is was associated with an insignificantly lower NAFLD/NASH risk (i.e., odds ratios [95% CIs]: 0.84 [0.46–1.52] and 0.85 [0.63–1.14], respectively) and increased cumulative SGLT2i doses were significantly associated with a reduced NAFLD/NASH risk (0.61 [0.38–0.97]).

Conclusion

GLP-1RA and SGLT2i therapies in type 2 diabetes patients might prevent NAFLD/NASH development, with a significantly lower risk related to greater treatment exposure.
The role of preoperative immunonutrition on morbidity and immune response after cystectomy: protocol of a multicenter randomized controlled trial (INCyst Trial)
Authors: Derré Laurent , Crettenand François , Grilo Nuno , Stritt Kevin , Kiss Bernhard , Tawadros Thomas , Domingos-Pereira Sonia , Roth Beat , Cerantola Yannick , Lucca Ilaria
Published: October 2024

Introduction

Cancer, malnutrition, and surgery negatively impact patient’s immune system. Despite standardized surgical technique and the development of new perioperative care protocols, morbidity after cystectomy remains a serious challenge for urologists. Most common postoperative complications, such as infections and ileus, often lead to longer length of stay and worse survival. The immune system and its interaction with the gut microbiota play a pivotal role in cancer immunosurveillance and in patient’s response to surgical stress. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. Immunonutrition (IN) may improve the nutritional status, immunological function, and clinical outcome of surgical patients. Aims of the study are (1) to evaluate the impact of IN on morbidity and mortality at 30 and 90 days after cystectomy and (2) to determine immune and microbiota signature that would predict IN effect.

Methods

This is a randomized, multicentric, controlled, pragmatic, parallel-group comparative study, supported by the Swiss National Science Foundation. A total of 232 patients is planned to be enrolled between April 2023 and June 2026. Three participating centers (Lausanne, Bern, and Riviera-Chablais) have been selected. All patients undergoing elective radical and simple cystectomy will be randomly assigned to receive 7 days of preoperative IN (Oral Impact®, Nestlé, Switzerland) versus standard of care (control group) and followed for 90 days after surgery. For the exploratory outcomes, blood, serum, urine, and stool samples will be collected in patients treated at Lausanne. In order to determine the impact of IN on immune fitness, patients enrolled at Lausanne will be vaccinated against influenza and the establishment of the vaccine-specific immune response will be followed. Analysis of the microbiota and expression of argininosuccinate synthetase 1 as potential biomarker will also be performed.

Discussion and conclusion

Strengths of the INCyst study include the randomized, multicenter, prospective design, the large number of patients studied, and the translational investigation. This study will challenge the added value of preoperative IN in patients undergoing cystectomy, assessing the clinical effect of IN on the onset of postoperative morbidity and mortality after cystectomy. Furthermore, it will provide invaluable data on the host immune response and microbiota composition.

Trial registration

ClinicalTrials.gov NCT05726786. Registered on March 9, 2023.
Simplification of KDS 14 Design Method for Slab–Column Connections Subjected to Unbalanced Moment
Authors: Dinh Ngoc Hieu , Kim Seung-Hee , Choi Kyoung-Kyu
Published: October 2024

The current KDS 14 design method yields reasonable accuracy with acceptable safety in assessing the unbalanced moment-carrying capacity of slab–column connections. However, the model requires considerable computational effort owing to the effects of various design parameters, particularly the gravity-load effect. This study proposes a method to simplify the KDS 14 model to evaluate the unbalanced moment-carrying capacity of slab–column connections. In the proposed method, the gravity-load effect is decoupled from equations used for evaluating unbalanced moment-carrying capacity components. Subsequently, the total unbalanced moment-carrying capacity is determined by establishing an interaction between the gravity shear ratio and unbalanced moment components without considering the gravity-load effect. For practical design purposes, final simplified design equations are proposed. The reliability of the simplified method is validated based on a comparison with the current KDS 14 design code using a comprehensive database encompassing interior, exterior, and corner slab–column connections. Furthermore, a parametric study based on the proposed simplified approach, current design codes, combined with finite-element (FE) analysis is performed to elucidate the effects of constituents on the unbalanced moment-carrying capacity of corner slab–column connections. The results show that the proposed simplified model and KDS design method are strongly correlated with the experimental and FE results for a range of design parameters. Meanwhile, the ACI 318 model consistently provides a lower limit for strength prediction, thus yielding overly conservative and safe results compared with the test and FE results in most cases.