bluuebunny/crossref_metadata_2025 huggingface dataset:
Yönetim Kurulu Yapısı ve Banka Performansı Arasındaki İlişki: Gelişmekte Olan Ülkelerin Borsalarında İşlem Gören Ticari Bankalar Üzerine Dinamik Panel Veri Analizi
Authors: Hokka Cengiz , Biber Ahmet Emre
Published: March 2024

Bu çalışmanın amacı, yönetim kurulu yapısı ile banka performansı arasındaki ilişkiyi ortaya koymaktır. Bu amaç doğrultusunda 2011-2021 döneminde gelişmekte olan ülkelerin borsalarında işlem gören bankaların yönetim kurulu yapısı ile finansal performansı arasındaki ilişki dinamik panel veri analiz yöntemi kullanılarak incelenmiştir. Bağımlı değişken olarak aktif kârlılığı (ROA)’nın kullanıldığı çalışmada, yönetim kurulu büyüklüğü, sektör tecrübesine sahip yönetici oranı, icracı olmayan yönetici oranı ve liderlik yapısı ise yönetim kurulu değişkenleri olarak kullanılmıştır. Analizden elde edilen bulgulara göre, hem yönetim kurulu büyüklüğü değişkeni hem de genel müdürlük ve yönetim kurulu başkanlığı görevlerinin aynı kişi tarafından icra edilmesi durumunu ifade eden liderlik yapısı değişkeni ile banka performansı arasında negatif yönlü bir ilişki olduğu görülmüştür. Diğer taraftan, bankaya özgü kontrol değişkenlerinden banka sermayesinin performans üzerindeki etkisinin pozitif ve istatistiki olarak anlamlı olduğu tespit edilmiştir.
Ortaçağ’da Bir Seyyahın Gözünden İskenderiye Şehri
Authors: Akyazıcı Sefa , Genç Özlem
Published: March 2024

Endülüslü seyyah İbn Cübeyr, 1183 yılında hac amacıyla gerçekleştirdiği seyahatinde günlük benzeri notlar tutarak deneyimlerini "Rıhlet el-Kinani" adlı eserinde belgelemiştir. Bu eser, 12. yüzyıl Akdeniz ve Yakın Doğu'suyla ilgili sosyal, antropolojik, etnolojik, tarihî, hukuki, sosyolojik, coğrafi ve folklorik bilgiler sunmaktadır. İbn Cübeyr'in eseri, ilk kez William Wright tarafından tercüme edilip basılmıştır. İngilizceye çevrildiğinde araştırmacılar arasında büyük ilgi uyandırmıştır. Seyyah, gezdiği şehirlerin yapılarına ve kültürlerine büyük bir merak ve ilgi beslemiştir; özellikle İskenderiye şehri ilgisini en çok çeken şehirlerden biri olmuştur. İskenderiye şehri Orta Çağ'ın önemli liman şehirlerinden biri olarak güzelliğiyle İbn Cübeyr'in takdirini kazanmıştır. İbn Cübeyr, İskenderiye'nin yapısal ve kültürel özellikleri hakkında önemli bilgiler sunarak, 1183 yılındaki hac yolculuğu sırasında bu şehre dair detaylı bir bakış sunmuştur. Bu çalışma, İbn Cübeyr'in 1183 yılındaki İskenderiye ziyaretini ayrıntılı bir şekilde ele almaktadır.
“Bilimin İnsanileştirilmesi”nden Bilim Sosyolojisine: George Sarton
Authors: Koçhan Metin
Published: March 2024

Sarton, bilimi sistematize edilmiş pozitif bilgi olarak tanımlarken bilim tarihini de elde edilen bu bilginin gelişimini betimleme ve açıklama çabası olarak tarif etmiştir. Sarton, bilimin gelişimini betimleme girişiminin başarıya ulaşması açısından, bilim tarihi araştırmalarında izlenmesi gereken çeşitli yöntemler belirlemiştir. Bu yöntemler arasında göz önünde bulundurulması gerektiğini önemle vurguladığı husus bilimsel etkinliğe, insanî bir hüviyetin kazandırılması düşüncesidir. Zira Sarton açısından bilim tarihi, sadece bilim insanlarının ortaya koymuş oldukları bilgileri tarif etmekle sınırlandırılamaz, bilimsel bilginin elde ediliş sürecindeki tüm insani özellikler de olabildiğince aydınlatılmalı, bilim insanlarının sosyal bir boşluk içinde yaşamadıkları gösterilmelidir. Sarton’un bu tutumu, bilim sosyolojisi alanına da kapı aralayan bir muhtevaya sahiptir. Bu açıdan bu çalışmada Sarton’un bilim tarihi araştırmalarında yöntem analizinde bilimin insani yönüne ayırdığı yer ele alınacak, bu yaklaşımın bilim sosyolojisi açısından nasıl bir muhtevaya sahip olduğu gösterilmeye çalışılacaktır.
Creolization as Decolonial Theory
Authors: Drabinski John E.
Published: March 2024

What does Édouard Glissant have to contribute to theorizing decolonization and a philosophy of difference? And how is this contribution tied to rethinking place (from Caribbean to Caribbeanness) and world (comprised of creolized culture and identity)? This essay takes up Glissant’s work in the context of questions of history and memory, with particular focus on how historical experience grounds philosophical work on place and world through articulations of identity, language, cultural production, and thinking after catastrophe. Drawing from a contrast with Martin Heidegger and Walter Benjamin, this essay shows how Glissant’s critical concept “creolization” works as an expression of what I call “the afropostmodern,” and also as an important contribution to decolonial theories of world, culture, memory, language, and subjectivity after the Middle Passage.
The International Maritime Organization’s Revised Greenhouse Gas Strategy: A Political Signal of Shipping’s Regulatory Future
Authors: Friedman Andrew
Published: March 2024

The International Maritime Organization (IMO) 2023 Strategy on Reduction of GHG Emission from Ships offers few specifics from a legal perspective, but is an important political signal. IMO Member States have committed to adopt binding rules to incentivise greenhouse gas emission reductions in 2025 which will enter into force by 2027. Moreover, the Strategy calls for the elimination of shipping emissions by or around 2050 and sets checkpoints to track progress. IMO now faces key decisions to implement the Strategy, including how to structure a goal-based fuel standard, how to integrate an economic element (e.g., an emission levy) into its regulatory framework, its methods for assessing upstream emissions and effects of fuel production, and specific reduction pathways. These measures will likely be effectuated as amendments to Annex VI of the International Convention for the Prevention of Pollution from Ships, leveraging its existing compliance and enforcement tools, including port State controls.
The Turbulence of Postcolonial Displacement, Exclusion and Racism in Tahar Ben Jelloun’s Les Yeux Baissés
Authors: Baba Nouzha
Published: March 2024

This article examines the Moroccan-French author, Tahar Ben Jelloun’s novel Les Yeux Baissés, translated as With Downcast Eyes. A winner of the Prix Goncourt, the author narrates the challenges of postcolonial displacement, exclusion and racism in a French multicultural neighbourhood. The novel explores the theme of displacement as one that is two-fold: firstly, it refers to the migration process, while secondly, it foregrounds the socio-cultural dimension of being “out of place” in the diaspora. I delve into the way migrants’ children experience the turbulence of displacement, exclusion, and racism. While engaging with postcolonial theoretical debates, this study considers the representation of migrants’ alienation in the narrative resulting from a lack of French hospitality and acute hostility. As such, this article demonstrates that postcolonial displacement does not enable the homogenization of cultures, but rather reinforces boundaries, at the social and cultural level, in the diaspora.
Toward Building a Virtual Laboratory to Investigate Rainfall Microphysics at Process Scales
Authors: Ji Lihui , Barros Ana P.
Published: March 2024

A 3D numerical model was built to serve as a virtual microphysics laboratory (VML) to investigate rainfall microphysical processes. One key goal for the VML is to elucidate the physical basis of warm precipitation processes toward improving existing parameterizations beyond the constraints of past physical experiments. This manuscript presents results from VML simulations of classical tower experiments of raindrop collisional collection and breakup. The simulations capture large raindrop oscillations in shape and velocity in both horizontal and vertical planes and reveal that drop instability increases with diameter due to the weakening of the surface tension compared with the body force. A detailed evaluation against reference experimental datasets of binary collisions over a wide range of drop sizes shows that the VML reproduces collision outcomes well including coalescence, and disk, sheet, and filament breakups. Furthermore, the VML simulations captured spontaneous breakup, and secondary coalescence and breakup. The breakup type, fragment number, and size distribution are analyzed in the context of collision kinetic energy, diameter ratio, and relative position, with a view to capture the dynamic evolution of the vertical microstructure of rainfall in models and to interpret remote sensing measurements.

Significance Statement

Presently, uncertainty in precipitation estimation and prediction remains one of the grand challenges in water cycle studies. This work presents a detailed 3D simulator to characterize the evolution of drop size distributions (DSDs), without the space and functional constraints of laboratory experiments. The virtual microphysics laboratory (VML) is applied to replicate classical tower experiments from which parameterizations of precipitation processes used presently in weather and climate models and remote sensing algorithms were derived. The results presented demonstrate that the VML is a robust tool to capture DSD dynamics at the scale of individual raindrops (precipitation microphysics). VML will be used to characterize DSD dynamics across scales for environmental conditions and weather regimes for which no measurements are available.
Clinical and treatment characteristics of infants and toddlers less than 2 years of age with hemophilia
Authors: Han Jennifer H. , Dupervil Brandi , Mahajerin Arash , Kulkarni Roshni , Manco-Johnson Marilyn , Thornburg Courtney
Published: March 2024

Infants and toddlers (ITs) with hemophilia have unique bleeding features. Factor prophylaxis has been shown to decrease the risk of intracranial hemorrhage (ICH), which supports recommendations to begin at a young age. Clinical and demographic characteristics were analyzed for 883 ITs ≤2 years old with hemophilia A and B, seen at US Hemophilia Treatment Centers and enrolled in the Community Counts Registry, a surveillance program of the Centers for Disease Control and Prevention. ICH in the first 2 years of life was seen in 68 of 883 (7.7%) ITs, of whom 8 of 68 (11.8%) were on continuous prophylaxis at the time of ICH. ITs in this study usually started prophylaxis within the first year of life (mean, 10.3 months), with earlier ages of prophylaxis initiation in later birth cohorts in ITs with hemophilia A. Compared with those without a family history (FH) of hemophilia, known positive FH of hemophilia was associated with earlier age of diagnosis (P ≤ .0001) and decreased rates of vaginal delivery (P = .0006). The use of factor VIII mimetics and extended half-life clotting factor prophylaxis increased with later birth cohorts for ITs with hemophilia A and B. The study highlights that ICH rates in ITs with hemophilia remains substantial and underscores the need for further research to identify modifiable risk factors to prevent ICH by earlier diagnosis and initiating prophylaxis early, even within the first month of life.
Fibrinogen levels and clot properties identify patients who benefit from catheter-directed thrombolysis after DVT
Authors: Iding Aaron F. J. , Alkarithi Ghadir , Cate Hugo ten , Ariëns Robert A. S. , ten Cate-Hoek Arina J.
Published: March 2024

Ultrasound-accelerated catheter–directed thrombolysis (UA-CDT) to improve patency after deep vein thrombosis (DVT) has not conclusively been shown to prevent postthrombotic syndrome (PTS) but might benefit patients who are unlikely to obtain patency with standard treatment. We hypothesized that these patients could be selected based on their fibrin clot properties. To study this, patients with acute iliofemoral DVT from the CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-thrombotic Syndrome) trial had blood samples taken at inclusion. Fibrin clot properties in plasma were determined by turbidimetric clotting (lag time and maximal turbidity) and lysis assays (time to 50% lysis and lysis rate), permeation assay, and confocal microscopy (fiber density), as well as levels of fibrin clot modifiers fibrinogen and C-reactive protein (CRP). Patency was defined as >90% iliofemoral vein compressibility at 12-month ultrasound. PTS was defined as ≥5 Villalta score at 6 or 12 months. In total, 91 of 152 patients were included, including 43 with additional UA-CDT and 48 with standard treatment. Patients with additional UA-CDT more often obtained patency (55.8 vs 27.1%) Patients who obtained patency had longer lag times and lower maximal turbidity, fibrinogen, and CRP; only maximal turbidity and fibrinogen remained associated when adjusting for treatment, thrombus load, and body mass index. Fibrinogen levels had an optimal cutoff at 4.85 g/L. Low fibrinogen levels best predicted patency. Additional UA-CDT decreased the risk of PTS only in patients with high fibrinogen. Therefore, additional UA-CDT might prevent PTS in selected patients based on routinely measured fibrinogen levels. This study was registered at www.ClinicalTrials.gov as #NCT00970619.
Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy
Authors: Op de Beeck Sara , Vena Daniel , Mann Dwayne , Azarbarzin Ali , Huyett Phillip , Van de Perck Eli , Gell Laura K. , Alex Raichel M. , Dieltjens Marijke , Willemen Marc , Verbraecken Johan , Wellman Andrew , Vanderveken Olivier M. , Sands Scott A.
Published: March 2024

Background

Differences in the pharyngeal site of collapse influence efficacy of non-continuous positive airway pressure therapies for obstructive sleep apnoea (OSA). Notably, complete concentric collapse at the level of the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated with reduced efficacy of hypoglossal nerve stimulation, but CCCp is currently not recognisable using polysomnography. Here we develop a means to estimate DISE-based site of collapse using overnight polysomnography.

Methods

182 OSA patients provided DISE and polysomnography data. Six polysomnographic flow shape characteristics (mean during hypopnoeas) were identified as candidate predictors of CCCp (primary outcome variable, n=44/182), including inspiratory skewness and inspiratory scoopiness. Multivariable logistic regression combined the six characteristics to predict clear presence (n=22)versusabsence (n=128) of CCCp (partial collapse and concurrent tongue base collapse excluded). Odds ratios for actual CCCp between predicted subgroups were quantified after cross-validation. Secondary analyses examined complete lateral wall, tongue base or epiglottis collapse. External validation was performed on a separate dataset (ntotal=466).

Results

CCCp was characterised by greater scoopiness (β=1.5±0.6 per 2sd, multivariable estimate±se) and skewness (β=11.4±2.4) compared with non-CCCp. The odds ratio for CCCp in predicted positiveversusnegative subgroups was 5.0 (95% CI 1.9–13.1). The same characteristics provided significant cross-validated prediction of lateral wall (OR 6.3, 95% CI 2.4–16.5), tongue base (OR 3.2, 95% CI 1.4–7.3) and epiglottis (OR 4.4, 95% CI 1.5–12.4) collapse. CCCp and lateral wall collapse shared similar characteristics (skewed, scoopy), diametrically opposed to tongue base and epiglottis collapse characteristics. External validation confirmed model prediction.

Conclusions

The current study provides a means to recognise patients with likely CCCp or other DISE-based site of collapse categories using routine polysomnography. Since site of collapse influences therapeutic responses, polysomnographic airflow shape analysis could facilitate precision site-specific OSA interventions.
Physical capacity and inactivity in obstructive airway diseases: a “can do, do do” analysis
Authors: Urroz Guerrero Paola D. , Lewthwaite Hayley , Gibson Peter G. , Clark Vanessa L. , Cordova-Rivera Laura , McDonald Vanessa M.
Published: March 2024

Introduction

Physical capacity is an important determinant of physical activity in people with obstructive airway disease (OAD). This study aimed to extend the “can do, do do” concept in people with OAD, to identify if people categorised into quadrants based on physical capacity and activity differ by clinical and movement behaviour characteristics.

Methods

A total of 281 participants (bronchiectasis n=60, severe asthma n=93, COPD n=70 and control n=58) completed assessments to characterise physical capacity as “can do”versus“can't do” (6-min walk distance < or ≥70% pred) and physical activity as “do do”versus“don't do” (accelerometer-derived moderate to vigorous intensity physical activity (MVPA) < or ≥150 min·week−1).

Results

The control group had a greater proportion of people in the “can do, do do” quadrant compared with the OAD groups (76%versus10–33%). People with OAD in the “can't do, don‘t do” quadrant had worse clinical characteristics (airflow limitation, comorbidities, quality of life and functional dyspnoea) and spent less time doing light-intensity physical activity (LPA) and more time being sedentary compared with the “can do, do do” quadrant.

Discussion

This study highlights that many people with OAD may be inactive because they do not have the physical capacity to participate in MVPA, which is further impacted by greater disease severity. It is important to consider the potential benefits of addressing LPA and sedentary behaviour due to suboptimal levels of these movement behaviours across different quadrants. Future research is needed to investigate if tailoring intervention approaches based on quadrant allocation is effective in people with OAD.
Modified blood cell GAP model as a prognostic biomarker in idiopathic pulmonary fibrosis
Authors: Kreuter Michael , Lee Joyce S. , Tzouvelekis Argyrios , Oldham Justin M. , Molyneaux Philip L. , Weycker Derek , Atwood Mark , Samara Katerina , Kirchgässler Klaus-Uwe , Maher Toby M.
Published: March 2024

Background

The Gender, Age and Physiology (GAP) model is a simple mortality prediction tool in patients with idiopathic pulmonary fibrosis that uses demographic and physiological variables available at initial evaluation. White blood cell variables may have associations with idiopathic pulmonary fibrosis outcomes. We evaluated whether incorporating blood cell counts in modified GAP (cGAP) models would improve outcome prediction in patients with idiopathic pulmonary fibrosis.

Patients and methods

This retrospective analysis included pooled data from phase 3 randomised trials of pirfenidone in idiopathic pulmonary fibrosis (ASCEND, CAPACITY 004, CAPACITY 006). Study outcomes (disease progression, all-cause mortality, all-cause hospitalisation, respiratory-related hospitalisation) were evaluated during the initial 1-year period. Shared frailty models were used to evaluate associations between continuous and categorical baseline white and red blood cell parameters and study outcomes in a bivariate context, and to evaluate the impact of adding continuous monocyte count (cGAP1) or white and red blood cell parameters (cGAP2) to traditional GAP variables in a multivariable context based on C-statistics changes.

Results

Data were pooled from 1247 patients (pirfenidone, n=623; placebo, n=624). Significant associations (bivariate analyses) were idiopathic pulmonary fibrosis progression with neutrophil and eosinophil counts; all-cause mortality with monocyte and neutrophil counts; all-cause hospitalisation with monocyte count, neutrophil count and haemoglobin level; and respiratory-related hospitalisation with monocyte count, neutrophil count and haemoglobin level. In multivariate analyses, C-statistics were highest for the cGAP2 model for each of the outcomes.

Conclusion

Modified GAP models incorporating monocyte counts alone or plus other white and red blood cell variables may be useful to improve prediction of outcomes in patients with idiopathic pulmonary fibrosis.
Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study – PHOSP-COVID
Authors: Elneima Omer , Hurst John R. , Echevarria Carlos , Quint Jennifer K. , Walker Samantha , Siddiqui Salman , Novotny Petr , Pfeffer Paul E. , Brown Jeremy S. , Shankar-Hari Manu , McAuley Hamish J.C. , Leavy Olivia C. , Shikotra Aarti , Singapuri Amisha , Sereno Marco , Richardson Matthew , Saunders Ruth M. , Harris Victoria C. , Houchen-Wolloff Linzy , Greening Neil J. , Harrison Ewen M. , Docherty Annemarie B. , Lone Nazir I. , Chalmers James D. , Ho Ling-Pei , Horsley Alex , Marks Michael , Poinasamy Krisnah , Raman Betty , Evans Rachael A. , Wain Louise V. , Sheikh Aziz , Brightling Chris E. , De Soyza Anthony , Heaney Liam G.
Published: March 2024

Background

The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown.

Methods

Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group.

Results

A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4%versus33.2%, p<0.001), had higher burden of anxiety (29.1%versus22.0%, p=0.002), depression (31.2%versus24.7%, p=0.006), higher percentage of impaired mobility using short physical performance battery ≤10 (57.4%versus45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning)versus16.6%, p=0.014. HRQoL assessed using EQ-5D-5L Utility Index was lower in the airways group (mean±SD 0.64±0.27versus0.73±0.25, p<0.001). Burden of breathlessness, fatigue and cough measured using a study-specific tool was higher in the airways group.

Conclusion

Individuals with pre-existing airway diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to 1 year post-hospital discharge.
Comparison of structural variant callers for massive whole-genome sequence data
Authors: Joe Soobok , Park Jong-Lyul , Kim Jun , Kim Sangok , Park Ji-Hwan , Yeo Min-Kyung , Lee Dongyoon , Yang Jin Ok , Kim Seon-Young
Published: March 2024

Background

Detecting structural variations (SVs) at the population level using next-generation sequencing (NGS) requires substantial computational resources and processing time. Here, we compared the performances of 11 SV callers: Delly, Manta, GridSS, Wham, Sniffles, Lumpy, SvABA, Canvas, CNVnator, MELT, and INSurVeyor. These SV callers have been recently published and have been widely employed for processing massive whole-genome sequencing datasets. We evaluated the accuracy, sequence depth, running time, and memory usage of the SV callers.

Results

Notably, several callers exhibited better calling performance for deletions than for duplications, inversions, and insertions. Among the SV callers, Manta identified deletion SVs with better performance and efficient computing resources, and both Manta and MELT demonstrated relatively good precision regarding calling insertions. We confirmed that the copy number variation callers, Canvas and CNVnator, exhibited better performance in identifying long duplications as they employ the read-depth approach. Finally, we also verified the genotypes inferred from each SV caller using a phased long-read assembly dataset, and Manta showed the highest concordance in terms of the deletions and insertions.

Conclusions

Our findings provide a comprehensive understanding of the accuracy and computational efficiency of SV callers, thereby facilitating integrative analysis of SV profiles in diverse large-scale genomic datasets.
Metabolomics analysis reveals the metabolite profiles of Rheum tanguticum grown under different altitudinal gradients
Authors: Wang Lingling , Zhao Shuo , Li Jianan , Zhou Guoying
Published: March 2024

Background

Plant growth and quality are often affected by environmental factors, including geographical location, climate, and soil. In this study, we describe the effect of altitudinal differences on the growth and active ingredients in Rheum tanguticum Maxim. ex Balf. (R. tanguticum), a traditional Chinese medicinal herb known for its laxative properties.

Results

The results showed that plants grown at lower altitudes had better growth performances than those in higher altitude areas. The yield varied by 2.45–23.68 times with altitude, reaching a maximum of 102.01 t/ha. In addition, total anthraquinone and total sennoside contents decreased with increasing altitude, whereas total tannins increased with increasing altitude. The total anthraquinone content of the indicator compound reached 5.15% at five experimental sites, which exceeded the Chinese Pharmacopoeia standard by 70.87%. The content of the other two categories of active ingredients reached a maximum value of 0.94% (total sennosides) and 2.65% (total tannins). Redundancy analysis revealed that annual rainfall, annual average temperature, annual sunshine hours, and pH significantly affected growth and active ingredients. Moreover, key metabolites, such as flavonoids, amino acids and their derivatives, phenolic acids, lipids, and terpenes, were differentially expressed between samples from low- and high-altitude cultivation areas. These metabolites were enriched in the flavonoid and flavonol biosynthetic pathway and the monoterpene biosynthetic pathway.

Conclusions

These results suggest that high anthraquinone content was observed in the lowest-latitude cultivation area due to low rainfall and alkaline soil pH. Key metabolites were significantly upregulated in high-latitude cultivation areas. These results provide a scientific basis for quality control and the systematic cultivation of R. tanguticum.
The impact of preoperative biliary drainage on postoperative healthcare-associated infections and clinical outcomes following pancreaticoduodenectomy: a ten-year retrospective analysis
Authors: Yu Zheng-Hao , Du Ming-Mei , Zhang Xuan , Suo Ji-Jiang , Zeng Tao , Xie Xiao-Lian , Xiao Wei , Lu Qing-Bin , Liu Yun-Xi , Yao Hong-Wu
Published: March 2024

Background

Pancreaticoduodenectomy (PD) is a complex procedure and easily accompanied by healthcare-associated infections (HAIs). This study aimed to assess the impact of PBD on postoperative infections and clinical outcomes in PD patients.

Methods

The retrospective cohort study were conducted in a tertiary hospital from January 2013 to December 2022. Clinical and epidemiological data were collected from HAIs surveillance system and analyzed.

Results

Among 2842 patients who underwent PD, 247 (8.7%) were diagnosed with HAIs, with surgical site infection being the most frequent type (n = 177, 71.7%). A total of 369 pathogenic strains were detected, with Klebsiella pneumoniae having the highest proportion, followed by Enterococcu and Escherichia coli. Although no significant association were observed generally between PBD and postoperative HAIs, subgroup analysis revealed that PBD was associated with postoperative HAIs in patients undergoing robotic PD (aRR = 2.174; 95% CI:1.011–4.674; P = 0.047). Prolonging the interval between PBD and PD could reduce postoperative HAIs in patients with cholangiocarcinoma (≥4 week: aRR = 0.292, 95% CI 0.100–0.853; P = 0.024) and robotic PD (≤2 week: aRR = 3.058, 95% CI 1.178–7.940; P = 0.022). PBD was also found to increase transfer of patients to ICU (aRR = 1.351; 95% CI 1.119–1.632; P = 0.002), extended length of stay (P < 0.001) and postoperative length of stay (P = 0.004).

Conclusion

PBD does not exhibit a significant association with postoperative HAIs or other outcomes. However, the implementation of robotic PD, along with a suitable extension of the interval between PBD and PD, appear to confer advantages concerning patients’ physiological recuperation. These observations suggest potential strategies that may contribute to enhanced patient outcomes.
Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa
Authors: Slekiene Jurgita , Swan Nick , Kalina Marc
Published: March 2024

Background

Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system.

Methods

The cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model.

Results

Our findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver.

Conclusions

Our findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.
Chronic diseases and determinants of community health services utilization among adult residents in southern China: a community-based cross-sectional study
Authors: Gu Junwang , Wang Qi , Qiu Wei , Wu Chunmei , Qiu Xiaoqiang
Published: March 2024

Background

The burden of chronic diseases has become a major public health concern, and high-efficiency use of community health services is essential in combating chronic diseases. This study described the status of chronic diseases in southern China and explored the determinants of health service utilization among adult residents.

Methods

Data were obtained from one part of community survey data from four counties in Ganzhou City, southern China. A multistage, stratified random sampling method was used to conduct a cross-sectional survey between 2018 and 2020. Overall, 7430 valid questionnaires were collected. A lasso-linear regression analysis was performed to explore the determinants of community health service utilization.

Results

According to the study, most participants (44.6%) reported having relatively good health, while 42.1% reported having moderate health. Chronic diseases were reported by 66.9% of the respondents. The three most prevalent self-reported chronic diseases were hypertension (22.6%), hyperlipidemia (5.9%), and diabetes (5.9%). Among residents with chronic diseases, 72.1% had one chronic disease, while the rest had multiple. Only 13.9% of residents frequently utilized community health services, while 18.9% never used them. Additionally, among residents who reported having chronic diseases, 14.1% had never attended community health services. Four categories of factors were the key determinants of community health service utilization: (1) personal characteristics, age, and sex; (2) health-related factors, such as family history, self-reported health conditions, and the number of chronic diseases; (3) community health service characteristics, such as satisfaction with and accessibility to community health services; and (4) knowledge of chronic diseases. Specifically, women tend to utilize healthcare services more frequently than men. Additionally, residents who are advanced in age, have a family history of chronic diseases, suffer from multiple chronic conditions, rate their self-reported health condition as poor, have a better knowledge about chronic diseases, have better accessibility to community health services, and have higher the satisfaction with community health services, tend to utilize them more frequently.

Conclusions

Given the limited healthcare resources, the government should promote the effective utilization of community health facilities as a critical community-based strategy to combat the growing threat of chronic diseases in southern China. The priority measures involve enhancing residents’ access to and satisfaction with community health services and raising awareness of chronic illnesses among older individuals with poor health status.
A novel generative adversarial networks modelling for the class imbalance problem in high dimensional omics data
Authors: Cusworth Samuel , Gkoutos Georgios V. , Acharjee Animesh
Published: March 2024

Class imbalance remains a large problem in high-throughput omics analyses, causing bias towards the over-represented class when training machine learning-based classifiers. Oversampling is a common method used to balance classes, allowing for better generalization of the training data. More naive approaches can introduce other biases into the data, being especially sensitive to inaccuracies in the training data, a problem considering the characteristically noisy data obtained in healthcare. This is especially a problem with high-dimensional data. A generative adversarial network-based method is proposed for creating synthetic samples from small, high-dimensional data, to improve upon other more naive generative approaches. The method was compared with ‘synthetic minority over-sampling technique’ (SMOTE) and ‘random oversampling’ (RO). Generative methods were validated by training classifiers on the balanced data.
Dual mediating effects of anxiety to use and acceptance attitude of artificial intelligence technology on the relationship between nursing students’ perception of and intention to use them: a descriptive study
Authors: Cho Kyong Ah , Seo Yon Hee
Published: March 2024

Background

Artificial intelligence (AI)-based healthcare technologies are changing nurses’ roles and enhancing patient care. However, nursing students may not be aware of the benefits, may not be trained to use AI-based technologies in their practice, and could have ethical concerns about using them. This study was conducted to identify the dual mediating effects of anxiety to use and acceptance attitude toward AI on the relationship between perception of and intentions to use AI among nursing students in South Korea.

Methods

The research model followed the PROCESS Macro model 6 proposed by Hayes. The participants were 180 nursing students in Gyeonggi-do. Data were collected from January 5–16, 2023, using self-reported questionnaires. Data were analyzed using the SPSS/WIN 25.0 program, with independent t-tests, one-way analysis of variance, Pearson’s correlations, and Hayes’s PROCESS macro method for mediation.

Results

AI perception positively correlated with acceptance attitude (r =.44, p <.001), intention to use AI (r =.38, p <.001) and negatively correlated with anxiety (r = −.27, p <.001). Anxiety about AI negatively correlated with an acceptance attitude toward AI (r = −.36, p <.001) and intentions to use AI (r = −.28, p <.001). Acceptance attitude toward AI positively correlated with intentions to use AI (r =.43, p <.001). Anxiety about AI and acceptance attitude toward AI had a dual mediating effect on the relationship between AI perception and intentions to use AI.

Conclusions

It is necessary to develop systematic educational programs to improve the perception of AI. Thus, the competency and professionalism of nursing students regarding the use of AI in healthcare can be improved.
Group Health & Wellness Coaching: development and validation of the required competencies
Authors: Wolever Ruth Q , Cline Timothy R , Weiss Jocelyn M , Carmack Suzie , Schultz Cindy , Arloski Michael , Lawson Karen
Published: March 2024

Background

As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC) continue to grow to address chronic disease prevalence worldwide, delivery of this approach in a group format is gaining traction, particularly in healthcare. Nonetheless, very little empirical work exists on group coaching and there are currently no published competencies for Group Health and Wellness Coaching (GHWC).

Methods

We used a well-established two-phase (Development and Judgment) process to create and validate GHWC competencies with strong content validity.

Results

Seven highly qualified Subject Matter Experts systematically identified and proposed the GHWC competencies, which were then validated by 78 National Board Certified Health and Wellness Coaches (NBC-HWCs) currently practicing GHWC who rated the importance and use frequency of each one. The validation study led to 72 competencies which are organized into the structure and process of GHWC.

Conclusions

GHWC requires not only coaching skills, but significant group facilitation skills to guide the group process to best support members in maximizing health and well-being through self-directed behavioral change. As the presence of HWC continues to grow, it is imperative that GHWC skill standards be accepted and implemented for the safety of the public, the effectiveness of the intervention, and the value analysis of the field. Such standards will guide curriculum development, allow for a more robust research agenda, and give practical guidance for health and wellness coaches to responsibly run groups. High quality standards for GHWC are particularly needed in health care, where a Level III Current Procedural Terminology (CPT®) code for GHWC has been approved in the United States since 2019 and reimbursement of such has been approved by the Centers for Medicare and Medicaid for 2024.
Minocycline-loaded nHAP/PLGA microspheres for prevention of injury-related corneal angiogenesis
Authors: Li Zitong , Huang Wenpeng , Zhang Ming , Huo Yan , Li Feifei , Song Lele , Wu Sitong , Yang Qi , Li Xiaoming , Zhang Jianjun , Yang Liu , Hao Jianchen , Kang Lei
Published: March 2024

Background

Corneal neovascularization (CoNV) threatens vision by disrupting corneal avascularity, however, current treatments, including pharmacotherapy and surgery, are hindered by limitations in efficacy and adverse effects. Minocycline, known for its anti-inflammatory properties, could suppress CoNV but faces challenges in effective delivery due to the cornea's unique structure. Therefore, in this study a novel drug delivery system using minocycline-loaded nano-hydroxyapatite/poly (lactic-co-glycolic acid) (nHAP/PLGA) nanoparticles was developed to improve treatment outcomes for CoNV.

Results

Ultra-small nHAP was synthesized using high gravity technology, then encapsulated in PLGA by a double emulsion method to form nHAP/PLGA microspheres, attenuating the acidic by-products of PLGA degradation. The MINO@PLGA nanocomplex, featuring sustained release and permeation properties, demonstrated an efficient delivery system for minocycline that significantly inhibited the CoNV area in an alkali-burn model without exhibiting apparent cytotoxicity. On day 14, the in vivo microscope examination and ex vivo CD31 staining corroborated the inhibition of neovascularization, with the significantly smaller CoNV area (29.40% ± 6.55%) in the MINO@PLGA Tid group (three times daily) than that of the control group (86.81% ± 15.71%), the MINO group (72.42% ± 30.15%), and the PLGA group (86.87% ± 14.94%) (p < 0.05). Fluorescein sodium staining show MINO@PLGA treatments, administered once daily (Qd) and three times daily (Tid) demonstrated rapid corneal epithelial healing while the Alkali injury group and the DEX group showed longer healing times (p < 0.05). Additionally, compared to the control group, treatments with dexamethasone, MINO, and MINO@PLGA were associated with an increased expression of TGF-β as evidenced by immunofluorescence, while the levels of pro-inflammatory cytokines IL-1β and TNF-α demonstrated a significant decrease following alkali burn. Safety evaluations, including assessments of renal and hepatic biomarkers, along with H&E staining of major organs, revealed no significant cytotoxicity of the MINO@PLGA nanocomplex in vivo.

Conclusions

The novel MINO@PLGA nanocomplex, comprising minocycline-loaded nHAP/PLGA microspheres, has shown a substantial capacity for preventing CoNV. This study confirms the complex's ability to downregulate inflammatory pathways, significantly reducing CoNV with minimal cytotoxicity and high biosafety in vivo. Given these findings, MINO@PLGA stands as a highly promising candidate for ocular conditions characterized by CoNV.

Graphical Abstract
External validation and update of the International Medical Prevention Registry on Venous Thromboembolism bleeding risk score for predicting bleeding in acutely ill hospitalized medical patients: a retrospective single-center cohort study in Japan
Authors: Arakaki Daichi , Iwata Mitsunaga , Terasawa Teruhiko
Published: March 2024

Background

The International Medical Prevention Registry for Venous Thromboembolism (IMPROVE) Bleeding Risk Score is the recommended risk assessment model (RAM) for predicting bleeding risk in acutely ill medical inpatients in Western countries. However, few studies have assessed its predictive performance in local Asian settings.

Methods

We retrospectively identified acutely ill adolescents and adults (aged ≥ 15 years) who were admitted to our general internal medicine department between July 5, 2016 and July 5, 2021, and extracted data from their electronic medical records. The outcome of interest was the cumulative incidence of major and nonmajor but clinically relevant bleeding 14 days after admission. For the two-risk-group model, we estimated sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively). For the 11-risk-group model, we estimated C statistic, expected and observed event ratio (E/O), calibration-in-the-large (CITL), and calibration slope. In addition, we recalibrated the intercept using local data to update the RAM.

Results

Among the 3,876 included patients, 998 (26%) were aged ≥ 85 years, while 656 (17%) were hospitalized in the intensive care unit. The median length of hospital stay was 14 days. Clinically relevant bleeding occurred in 58 patients (1.5%), 49 (1.3%) of whom experienced major bleeding. Sensitivity, specificity, NPV, and PPV were 26.1% (95% confidence interval [CI]: 15.8–40.0%), 84.8% (83.6–85.9%), 98.7% (98.2–99.0%), and 2.5% (1.5–4.3%) for any bleeding and 30.9% (95% CI: 18.8–46.3%), 84.9% (83.7–86.0%), 99.0% (98.5–99.3%), and 2.5% (1.5–4.3%) for major bleeding, respectively. The C statistic, E/O, CITL, and calibration slope were 0.64 (95% CI: 0.58–0.71), 1.69 (1.45–2.05), − 0.55 (− 0.81 to − 0.29), and 0.58 (0.29–0.87) for any bleeding and 0.67 (95% CI: 0.60–0.74), 0.76 (0.61–0.87), 0.29 (0.00–0.58), and 0.42 (0.19–0.64) for major bleeding, respectively. Updating the model substantially corrected the poor calibration observed.

Conclusions

In our Japanese cohort, the IMPROVE bleeding RAM retained the reported moderate discriminative performance. Model recalibration substantially improved the poor calibration obtained using the original RAM. Before its introduction into clinical practice, the updated RAM needs further validation studies and an optimized threshold.
Getting more bang for their buck: BCL2 inhibitors boost dendritic-cell function to enhance anti-cancer immune surveillance
Authors: Montes-Gómez Alfredo E. , Tait Stephen W. G.
Published: March 2024

The anti-apoptotic BCL-2 protein family regulates cancer cell survival, thus it represents an important therapeutic target. Indeed, a drug class, called BH3-mimetics, have been developed to directly target BCL2 proteins and promote cancer cell death. Conventional wisdom suggests that the primary anti-cancer effect of BCL-2 inhibition is through induction of cancer cell death. However, a recent study by Zhao and colleagues describes that BCL-2 inhibition also enhances the function of classical dendritic cells, unleashing their role in immunosurveillance, promoting T cell immunity and tumour regression. Thus, inhibiting anti-apoptotic BCL-2 function may have a multi-pronged anti-tumour action.
The immunomodulatory effect of oral NaHCO3 is mediated by the splenic nerve: multivariate impact revealed by artificial neural networks
Authors: Alvarez Milena Rodriguez , Alkaissi Hussam , Rieger Aja M. , Esber Guillem R. , Acosta Manuel E. , Stephenson Stacy I. , Maurice Allison V. , Valencia Laura Melissa Rodríguez , Roman Christopher A. , Alarcon Juan Marcos
Published: March 2024

Stimulation of the inflammatory reflex (IR) is a promising strategy for treating systemic inflammatory disorders. Recent studies suggest oral sodium bicarbonate (NaHCO3) as a potential activator of the IR, offering a safe and cost-effective treatment approach. However, the mechanisms underlying NaHCO3-induced anti-inflammatory effects remain unclear. We investigated whether oral NaHCO3’s immunomodulatory effects are mediated by the splenic nerve. Female rats received NaHCO3 or water (H2O) for four days, and splenic immune markers were assessed using flow cytometry. NaHCO3 led to a significant increase (p < 0.05, and/or partial eta squared > 0.06) in anti-inflammatory markers, including CD11bc + CD206 + (M2-like) macrophages, CD3 + CD4 + FoxP3 + cells (Tregs), and Tregs/M1-like ratio. Conversely, proinflammatory markers, such as CD11bc + CD38 + TNFα + (M1-like) macrophages, M1-like/M2-like ratio, and SSChigh/SSClow ratio of FSChighCD11bc + cells, decreased in the spleen following NaHCO3 administration. These effects were abolished in spleen-denervated rats, suggesting the necessity of the splenic nerve in mediating NaHCO3-induced immunomodulation. Artificial neural networks accurately classified NaHCO3 and H2O treatment in sham rats but failed in spleen-denervated rats, highlighting the splenic nerve's critical role. Additionally, spleen denervation independently influenced Tregs, M2-like macrophages, Tregs/M1-like ratio, and CD11bc + CD38 + cells, indicating distinct effects from both surgery and treatment. Principal component analysis (PCA) further supported the separate effects. Our findings suggest that the splenic nerve transmits oral NaHCO3-induced immunomodulatory changes to the spleen, emphasizing NaHCO3’s potential as an IR activator with therapeutic implications for a wide spectrum of systemic inflammatory conditions.

Graphical abstract