bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumor Bed Margins Versus Specimen Margins in Oral Cavity Cancer: Too Close to Call?
Authors: Villemure-Poliquin Noémie , Roy Ève-Marie , Nguyen Sally , Beauchemin Michel , Audet Nathalie
Published: September 2024

Introduction

The routine assessment of intraoperative margins has long been the standard of care for oral cavity cancers. However, there is a controversy surrounding the best method for sampling surgical margins. The aim of our study is to determine the precision of a new technique for sampling tumor bed margins (TBMs), to evaluate the impact on survival and the rate of free flap reconstructions.

Methods

This retrospective cohort study involved 156 patients with primary cancer of the tongue or floor of the mouth who underwent surgery as initial curative treatment. Patients were separated into 2 groups: one using an oriented TBM derived from Mohs’ technique, where the margins are taken from the tumor bed and identified with Vicryl sutures on both the specimen and the tumor bed, and the other using a specimen margins (SMs) driven technique, where the margins are taken from the specimen after the initial resection. Clinicopathologic features, including margin status, were compared for both groups and correlated with locoregional control. Precision of per-operative TBM sampling method was obtained.

Results

A total of 156 patients were included in the study, of which 80 were in TBM group and 76 were in SM group. Precision analysis showed that the oriented TBM technique pertained a 50% sensitivity, 96.6% specificity, 80% positive predictive value, and an 87.5% negative predictive value. Survival analysis revealed nonstatistically significant differences in both local control (86.88% vs 83.50%; P = .81) as well as local-regional control (82.57% vs 72.32%; P = .21). There was a significant difference in the rate of free flap-surgeries between the 2 groups (30% vs 64.5%; P < .001).

Conclusion

Our described oriented TBM technique has demonstrated reduced risk of free flap reconstructive surgery, increased precision, and similar prognostic in terms of local control, locoregional control, and disease-free survival when compared to the SM method.
Pinus mugo Turra and its Therapeutic Potential: A Narrative Review
Authors: Manzione Maria Giulia , Vitalini Sara , Sharopov Farukh , Capó Xavier , Iriti Marcello , Martorell Miquel , Pezzani Raffaele
Published: September 2024

Pinus mugo Turra is a coniferous species of shrub or small tree typical of central and south-eastern Europe. It is commonly called mugo pine, mountain pine, or dwarf mountain pine referring to its habit and small size. Indeed, this plant lives at higher altitude above 1400 m above the see level where it deals with harsh conditions typical of high mountain. From an ethnotraditional point of view, P. mugo is mainly used for respiratory disorders and wound healing. In particular, its essential oils have been shown to possess interesting antimicrobial and antioxidant activities, which can substantiate its potential therapeutic effect in pulmonary and urinary tract diseases, as well as antinflammatory and antitumor effects. This review also offers a summary on the chemical constituents of P. mugo that contribute to its therapeutic potential.
Labour as a component of carceral circuitry: The case of asylum seekers
Authors: Bales Katie
Published: September 2024

Building upon insights from carceral geography, this article conceptualises the ‘carceral’ as permeating beyond the prison walls to other areas of life through law and policymaking that confines and incarcerates without necessarily ‘imprisoning’. 1 Utilising the case study of asylum applicants in the UK, this article traces the role of ‘work’ as a component of carceral circuitry which enmeshes asylum seekers’ lives. Outside of immigration detention, this includes work exclusions which hinder mobility, life choices and economic independence, as well as fuelling engagement in both ‘voluntary’ unpaid work arrangements, and/or unregulated ‘criminal’ labour practices which arise as a result of exclusionary laws intent on creating a hostile environment. Inside of immigration detention analysis extends to the practice of ‘paid activities’ in which immigration detainees undertake millions of hours of work at a rate of £1.00 per hour, ostensibly ‘for their own benefit’. Labour law and its explicit exclusions, as well as the social welfare framework, thereby intersect with immigration control and the criminal law to construct, shape and reproduce this carceral sphere which seeks to control and govern asylum seekers’ lives as well as entrenching their vulnerability as an easily exploitable workforce from which value can be extracted.
Prison labour as punishment
Authors: Kelly Rory
Published: September 2024

Mandatory prison labour is not classed as part of the offender's punishment. The sentence is the years to be served in prison and on licence in the community. I argue that there is reason for reclassifying or reforming the current regime of prison labour in England and Wales. The argument for reclassification draws analogy to the place of labour in community orders and suspended sentences. If there is reason to reclassify prison labour, consideration of proportionality would require significantly reduced time in prison. However, there are important difficulties with establishing what reduction should be offered and operationalising any such reduction in a fair way. If prison labour is instead to be reformed so as to be non-punitive, this may require an overhaul, giving the offender a choice of whether to work and wider labour protections. Prison labour is lost when classed as neither punishment nor as employment.
Six and twelve-month respiratory outcomes in a cohort of severe and critical COVID-19 survivors: A prospective monocentric study in Latin America
Authors: Fernández-Trujillo Liliana , Galindo-Sánchez Juan Sebastián , Cediel Angie , García Carlos A , Morales Eliana I , Largo Jessica , Amezquita-Dussan María A
Published: September 2024

Introduction:

Severe COVID-19 can result in long-term sequelae known as “chronic COVID,” characterized by a wide range of persistent physical and mental symptoms. Chest imaging and pulmonary function test alterations have been observed in recovered patients. Most studies focus on up to a 3-month follow-up after symptom onset or hospital discharge, with few reports on long-term follow-up and limited evidence regarding disease progression in Latin America.

Methods:

This study aims to describe the clinical characteristics and changes in pulmonary function, imaging, and quality of life in severe and critical COVID-19 patients requiring ICU admission in a high-complexity hospital in Latin America. A prospective cohort of survivors underwent clinical, radiological, pulmonary function, and quality of life assessments 6 and 12 months post-discharge.

Results:

One hundred twelve patients were included, all of whom attended the 6-month follow-up, and 99 returned for the 12-month follow-up. Most subjects had no previous respiratory symptoms or significant medical history. At the end of the follow-up period, 74% of the patients showed interstitial infiltrates in chest tomography and a higher frequency of fibroatelectatic tracts and parenchymal bands. Pulmonary function tests returned to normal ranges, except for carbon monoxide diffusion, but no altered scores were reported in the questionnaires.

Conclusion:

Despite residual radiological findings, most parameters studied in severe and critical COVID-19 survivors improved over the 12-month follow-up period. Regardless of the imaging abnormalities, the improvement in variables such as symptomatic relief and normal pulmonary function suggests that these alterations are transient. Carbon monoxide diffusion did not normalize by the end of the follow-up, which is consistent with the abnormalities reported in multiple studies, indicating a potential disease-related pattern.
Exploring the thoughts, emotions, and behaviours related to the self-management practices of adults with type 2 diabetes
Authors: Visagie Elné , Deacon Elmari , Kok Rümando
Published: September 2024

This qualitative research study explored the thoughts, emotions, and behaviours of adults aged between 35 and 45 who managed their type 2 diabetes effectively and adults who struggled with diabetes self-management in a South African setting. Semi-structured interviews were conducted with 17 adults who engaged in either successful self-management or who struggled with self-management. Effective management was characterised by an HbA1c level of 8% or lower. This group comprised of nine individuals. The participants who faced challenges with self-management had HbA1c levels ranging between 10% and 14%. This group consisted of eight participants. The data were analysed using inductive thematic analysis, and four main themes were identified: the emotional experience, prominent cognitions, practising acceptance and the mechanisms of behavioural change. These themes identified key determinants of individuals’ self-management practices and can contribute to providing information for future cognitive behaviour therapy interventions to be developed that target specific components to improve self-management practices.
Live Free and Die: How Social Media Amplify Populist Vaccine Resistance
Authors: Rojecki Andrew , Conner Viki Askounis , Royal Peter
Published: September 2024

The COVID-19 pandemic led to over one million American deaths, disproportionately suffered by those who resisted vaccination by championing individual autonomy over the collective good. The article takes as its point of departure that vaccine resistance is a recurring phenomenon in U.S. history with multiple origins. Among these are the absence of a consistent approach to public health policy—the combined result of the absence of federal police power—and tensions between the public good and libertarian values. The latest instance of populist resistance was assisted by changes in the information system. Relying on several lines of research, we specify a model of group identification that highlights social media’s role in this latest eruption of opposition. A key element is an attentive public that selectively shares information based on reputational concerns. We test our model by applying frame analysis on a body of data drawn from U.S.-based news content and audience reactions on Facebook.
How to Spark Joy: Strategies of Depoliticization in Platform’s Corporate Social Initiatives
Authors: Scharlach Rebecca
Published: September 2024

Despite social media companies’ public commitments to do good, they regularly face international criticism. This article explores how platforms engage in corporate public relations campaigns to negotiate social and political responsibilities. Through a qualitative analysis of the values promoted in the social initiative TikTok for Good, I show how TikTok promotes messages that amplify positivity, minimize negativity, and focus on individual well-being, while consistently assigning responsibility to other actors. Together, these strategies allow TikTok to symbolically empower users while maintaining control. I conceptualize these strategies that downplay and distance a company from conflicts associated with struggles over power as depoliticization by platforms. This study highlights platform companies’ soft forms of governance and demonstrates how the analysis of platform values allows researchers to cut through the strategic vagueness of claims to do good.
Refugees’ Storytelling Strategies on Digital Media Platforms: How the Russia–Ukraine War Unfolded on TikTok
Authors: Marino Sara
Published: September 2024

The article discusses how TikTok has emerged as a platform for self-representation and political contestation during the Russia–Ukraine war. Shortly after the beginning of the conflict, journalists and broadcasters have begun to associate the events unfolding in those countries with the widespread use of this platform among young content creators, refugees, soldiers, and civilians. Described as the “first TikTok war” or as “WarTok,” the conflict in Ukraine represents an important example to look at to uncover the increasingly central role of platforms as spaces where conflicts can be witnessed, documented, and shared with global audiences in real time. The research findings illustrate how TikTok becomes a space where material and affective practices of “performed refugeeness” can become visible and viral due to its unique language, formatting style, and highly personalized narratives, while creating a transnational streaming of war-related discourses that not only bypass traditional circuits of news sharing, but also activate a digital care network that crosses borders and connects diverse digital publics. While the study is small scale to account for a more in-depth narrative analysis of TikTok videos, it nevertheless returns significant insights into refugees’ digital storytelling strategies in conflict areas.
The Percentage of Patients Experiencing Financial Strain Depends on the Screening Measure: Evidence From a Cross-Sectional Survey of Adult Members of an Integrated Healthcare Delivery System
Authors: Tucher Emma L. , Grant Richard W. , Gordon Nancy P.
Published: September 2024

Objectives:

Financial strain has important consequences for patients, providers, and health care systems. However, there is currently no gold standard measure to screen for financial strain. This study compared the performance of 3 single-item screeners using a composite measure of financial strain as a “gold standard.”

Methods:

We conducted a secondary analysis of unweighted data from a 2021 survey of Kaiser Permanente Northern California health plan members comparing the percentages of adults who experienced financial strain based on 3 general single-item screeners, a screener specific to medical and dental health care use, and a composite financial strain measure. The study sample was comprised of 2734 non-Medicaid insured adults who answered all financial strain questions. Kappa statistics evaluating agreement of the 3 general screeners with the composite measure were calculated for the sample overall, by age group, and within age group, by 4 levels of income and 4 racial/ethnic subgroups.

Results:

Among 947 adults aged 35 to 65, 30.7% had just enough money or not enough money to make ends meet, 23.3% had a somewhat hard or hard time paying for basics, 18.8% had trouble paying for ≥1 type of expense, 20.5% had delayed/used less medical/dental care, and 41.5% had experienced financial strain based on the composite measure. Among 1787 adults aged 66 to 85, the percentages who screened positive on these measures were 22.7%, 19.4%, 12.9%, 19.8%, and 34.4%, respectively. Across the sample, by income categories and racial/ethnic groups, the making ends meet screener identified higher percentages of adults experiencing financial strain and performed better when compared with the composite measure than the hard to pay for the very basics and trouble paying for expenses screeners. Overall, substantial decreases in the percentages of adults who screened positive on the financial strain measures were seen as level of income increased. Within income categories, middle-aged adults were more likely than older adults to have experienced financial strain based on the composite and general single-item screeners.

Conclusions:

As social risk screening becomes part of the standard of care, it will be important to assess how well different brief screeners for financial strain perform with diverse patient populations.
The Impact of the Digital Economy on Provincial Carbon Productivity: Empirical Evidence from China
Authors: Fan Jianhong , Yan Le , Chen Huaichao
Published: September 2024

With the introduction of the dual carbon goals of “carbon peak” and “carbon neutrality”, low-carbon economic development has become the focus of attention for all sectors in China. Improving carbon productivity (CP) is the key to developing a low-carbon economy and is essential to achieving carbon emission reduction and economic growth. The rapid development of the digital economy (DE) provides a new breakthrough for improving carbon productivity, but there are few studies on the digital economy and carbon productivity in the existing literatures. We empirically investigate the impact mechanism of the digital economy on provincial carbon productivity using China’s provincial panel data from 2010 to 2019. This study finds that the digital economy significantly raises provincial carbon productivity; this result remains valid after a series of robustness tests. The digital economy can impact provincial carbon productivity through both energy consumption structure (ECS) and green technology innovation (GTI) and can contribute to the improvement of provincial carbon productivity by optimizing energy consumption structure and improving green technology innovation. In addition, different environmental regulations have different impacts. Command-and-control environmental regulation (CER) weakens the positive impact of the digital economy on provincial carbon productivity, whereas market-based environmental regulation (MER) enhances the positive impact of the digital economy on provincial carbon productivity. This study extends the research on the digital economy in the field of low-carbon development, providing insights and policy suggestions for relevant departments to promote low-carbon development from the perspective of the digital economy.
Two Decades of Audiovisual Translation Studies: A Bibliometric Literature Review
Authors: Wang Yu , Daghigh Ali Jalalian
Published: September 2024

Audiovisual Translation (AVT) studies have been among the burgeoning disciplines in translation studies. Although much progress has been made in AVT, there has been little scholarship heretofore to sketch a comprehensive understanding of the domain mapping using bibliometric analysis. Based on a total of 1,424 journal articles collected from the Web of Science Core Collection (SSCI, A&HCI, and ESCI) and Scopus from 2002 to 2022, the publication trends, research progress, research hotspots, and research frontiers were analyzed and visualized using CiteSpace and VOSviewer. The results of this study show that research on AVT has experienced exponential growth in the last two decades and is likely to follow an upward trend in the future. Topics including subtitling, dubbing, audio description, reception, and media accessibility have been frequently explored; and active researchers from Europe and Iran, as well as productive institutes in Europe, the USA, and China, with publications in influential journals, have contributed greatly to AVT studies. The historical development of AVT studies also implies an interdisciplinary trend. These findings provide insights into AVT studies, with a comprehensive overview, which is of great reference significance for researchers in understanding the past achievements of the discipline and carrying out their future research.
The Effects of COVID-19 Pandemic on HIV Service Provision in Ukraine
Authors: Neduzhko Oleksandr , Kiriazova Tetiana , Zeziulin Oleksandr , Legkostup Liudmyla , Riabokon Serhii , DeHovitz Jack A , Dumchev Kostyantyn
Published: September 2024

Ukraine faced significant fluctuations in COVID-19 morbidity and mortality, alongside an escalating HIV epidemic. This mixed-methods study, conducted between February and August 2022, employed a sequential explanatory design combining a quantitative analysis of national data and qualitative interviews to investigate the pandemic's effects on HIV services in Ukraine. The observed trends confirmed that the pandemic significantly disrupted facility-based HIV testing due to logistical challenges, an increased burden on healthcare workers, and supply shortages. Meanwhile, community-based testing showed resilience, largely attributed to programmatic adjustments rather than the pandemic itself. The initiation of antiretroviral therapy declined, especially during initial lockdowns, reflecting diminished treatment capacities. Despite these challenges, telemedicine and home medication delivery innovations supported antiretroviral therapy adherence. Furthermore, improvements in viral load testing and suppression rates showed healthcare resilience. The study highlights the critical need for adaptable, sustainable healthcare strategies in crises, emphasized during the war with Russia.
Association of the Inlay Structure Used in the Modified Bristow Procedure With Accelerated Bone Union: Comparing the Cuistow and Modified Bristow Procedures
Authors: Zhang Shuhan , Song Qingfa , Zhang Min , Liu Qiang , Wang Hangle , Li Haoyue , Cheng Xu , Shao Zhenxing , Cui Guoqing
Published: September 2024

Background:

The Chinese unique inlay Bristow (Cuistow) procedure is a modified Bristow surgery in which an inlay (mortise-and-tenon) structure is added to the contact surface between the coracoid tip and the glenoid. Patients who have undergone the Cuistow procedure have had satisfying clinical performance and excellent postoperative bone healing rates (96.1%).

Purpose:

To compare the clinical and radiographic outcomes after the arthroscopic Cuistow procedure and the arthroscopic Bristow procedure.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 91 patients who underwent either the Cuistow or Bristow procedure between January 2017 and March 2018 were selected, and 69 patients (70 shoulders; 35 in the Cuistow group and 35 in the Bristow group) were included. Clinical assessment at minimum 24 months postoperatively, including the visual analog scale for pain and instability, American Shoulder and Elbow Surgeons score, Rowe score, subjective shoulder value score, and active range of motion, was completed by independent observers and compared with values collected preoperatively. Assessment with 3-dimensional computed tomography scans was performed preoperatively; immediately after the operation; at 3, 6, and 12 months postoperatively; and at the final follow-up.

Results:

A total of 69 patients (70 shoulders) were included, with a mean follow-up duration of 34.41 ± 5.99 months (range, 24-50 months). Both groups saw significant improvement in visual analog scale for pain and instability, American Shoulder and Elbow Surgeons, Rowe, and subjective shoulder value scores at the final follow-up compared with the preoperative values ( P < .001 for all), with no significant between-group differences on any clinical outcomes at the final follow-up. The 3-month postoperative graft union rate on computed tomography was significantly higher in the Cuistow group compared with the Bristow group (82.9% vs 51.4%, respectively, P = .003), although the graft union rate at the final follow-up was not significantly different (94.3% vs 85.7%, respectively; P = .449).

Conclusion:

Patients receiving the Cuistow procedure had equivalent clinical outcomes and a significantly higher bone union rate at 3 months postoperatively than those in the Bristow group. The inlay structure used in the Cuistow procedure was found to be associated with accelerated bone union.
What Does Men's Health Education Look Like in Australian University Health Curricula? A Formative Evaluation and Future Enhancement Opportunities
Authors: Seidler Zac E. , Sheldrake Michelle , Benakovic Ruben , Wilson Michael J. , Hall Neil , Wittert Gary A. , McGee Margaret A.
Published: September 2024

OBJECTIVES

Developing the capacity of the health system, and the practitioners within it, to provide quality gender responsive care to men and boys remains critical to advancing men's health, and reducing health inequities amongst men. The aim for this study was to undertake a formative evaluation of Australian university health curricula for men's health content and scope the opportunities for future enhancement.

METHODS

A two-stage evaluation first involved a review of online course information for a sample of medicine ( n = 10), nursing ( n = 10), pharmacy ( n = 10), clinical psychology ( n = 10), social work ( n = 12) and public health ( n = 15) university curricula for men's health and gender content and opportunities for curricula enhancement. Secondly, university staff completed a survey on the coverage of men's health in their course(s), and receptivity, barriers and facilitators to curricula enhancement.

RESULTS

The curricula review found no dedicated men's health courses, and men's health was referenced in the information for 10 of 1246 courses (0.8%) in 8 of 67 curricula. Gender was rarely referenced in course information, particularly for the disciplines of medicine, nursing, pharmacy, and clinical psychology. There was an average of 16 enhancement opportunities per curricula with 40% relating to communicating and engaging with men within healthcare. Seventy staff from 25 universities and all target disciplines validated the curricula review findings of limited dedicated men's health content. Eighty-three percent were receptive to curricula enhancement, facilitated by content integration into existing courses.

CONCLUSION

This review provides clear evidence that there are gaps, opportunities, and educator receptiveness for improving and implementing content regarding men's health education and gender responsive care in Australian university health curricula.
A sidewalk-level urban heat risk assessment framework using pedestrian mobility and urban microclimate modeling
Authors: Colaninno Nicola , Basu Rounaq , Hosseini Maryam , Alhassan Abdulaziz , Liu Liu , Sevtsuk Andres
Published: September 2024

Climate change and the associated increase in heat-related hazards pose a pressing threat to urban residents’ health and well-being. People, when walking in particular, are at risk of experiencing heat stress as they navigate urban environments. This study proposes a novel heat risk assessment framework combining pedestrian mobility modeling with urban microclimate modeling. Using this framework, we assessed pedestrian heat-related exposure and risk in urban areas by integrating the Universal Thermal Climate Index (UTCI) as the hazard and pedestrian trips to critical destinations as exposure. We considered temporal variation, in both hazard and exposure, by examining different time periods during the day—morning peak, midday, and evening peak. In addition to hazard and exposure, we also considered vulnerability by focusing on young children and older adults. We contribute to improving the spatial resolution of heat risk assessment by analyzing the hazard for pedestrian trips between home locations and five critical destinations—bus stops, rail stations, parks, schools, and commercial amenities—at the address-point level and using a pedestrian network comprising sidewalks and crosswalks. Our framework helps identify sidewalks with high heat exposure levels as well as home locations with high cumulative heat risk, accounting for walking trips to critical destinations along feasible routes. We demonstrated the effectiveness of this framework by applying it to a 36-square-kilometer area of central Los Angeles, CA. Our findings offer valuable information to urban planners and policy-makers, supporting evidence-based prioritization of intervention sites, climate adaptation strategies, and policy decisions essential for climate-proof planning. By implementing targeted interventions in areas where heat hazard is expected to affect the most vulnerable pedestrians, planners can create heat-resilient, pedestrian-friendly environments while prioritizing the health and well-being of vulnerable groups. This study contributes to the growing knowledge of robust risk assessment methodologies for climate-proof planning, specifically with regard to addressing outdoor heat-related risks during extreme heat events.
Selective targeting of mutated calreticulin by the monoclonal antibody INCA033989 inhibits oncogenic function of MPN
Authors: Reis Edimara S. , Buonpane Rebecca , Celik Hamza , Marty Caroline , Lei Angela , Jobe Fatoumata , Rupar Mark , Zhang Yue , DiMatteo Darlise , Awdew Rahel , Ferreira Bianca L. , Leffet Lynn , Lu Lu , Rosa Elodie , Evrard Maxime , Trivedi Gaurang , Wass Brittney , Horsey April , He Xin , Covington Maryanne , Volgina Alla , Pasquier Florence , Legros Laurence , Fouquet Guillemette , Vainchenker William , Yang Yan-ou , Barker Breann , Zhou Jing , Stewart Shaun , Hitchcock Ian S. , Dhanak Dashyant , Macarron Ricardo , Plo Isabelle , Nastri Horacio , Mayes Patrick A.
Published: September 2024

Mutations in calreticulin (mutCALR) are the second most common drivers of myeloproliferative neoplasms (MPNs) and yet, the current therapeutic landscape lacks a selective agent for mutCALR-expressing MPNs. Here, we show that the monoclonal antibody INCA033989 selectively targets mutCALR-positive cells. INCA033989 antagonized mutCALR-driven signaling and proliferation in engineered cell lines and primary CD34+ cells from patients with MPN. No antibody binding or functional activity was observed in the cells lacking mutCALR. In a mouse model of mutCALR-driven MPN, treatment with an INCA033989 mouse surrogate antibody effectively prevented the development of thrombocytosis and accumulation of megakaryocytes in the bone marrow. INCA033989 reduced the pathogenic self-renewal of mutCALR-positive disease-initiating cells in both primary and secondary transplantations, illustrating its disease-modifying potential. In summary, we describe a novel mutCALR-targeted therapy for MPNs, a monoclonal antibody that selectively inhibits the oncogenic function of MPN cells without interfering with normal hematopoiesis.
Real-world impact of differences in the WHO and ICC classifications of non-Hodgkin lymphoma: a LEO cohort study analysis
Authors: Abro Brooj , Maurer Matthew J. , Habermann Thomas M. , Burack W. Richard , Chapman Jennifer R. , Cohen Jonathon B. , Friedberg Jonathan W. , Inghirami Giorgio , Kahl Brad S. , Larson Melissa C. , Link Brian K. , Lossos Izidore S. , Martin Peter , McDonnell Timothy J. , Nastoupil Loretta J. , Riska Shaun M. , Syrbu Sergei , Vega Francisco , Vij Kiran R. , Flowers Christopher R. , Cerhan James R. , Jaye David L. , Feldman Andrew L.
Published: September 2024

Recent introduction of 2 different lymphoma classifications has raised concerns about consistency in diagnosis, management, and clinical trial enrollment. Data from a large cohort reflecting real-world clinical practice suggest that differences between the classifications will affect <1% of non-Hodgkin lymphomas.
Ancestry-independent risk of venous thromboembolism in individuals with sickle cell trait vs factor V Leiden
Authors: Lin Keng-Han , Granka Julie M. , Shastri Anjali J. , Bonham Vence L. , Naik Rakhi P.
Published: September 2024

Sickle cell trait (SCT) is a risk factor for venous thromboembolism (VTE). Prior studies investigating the association between SCT and VTE have been performed nearly exclusively in Black populations. However, race-based research can contribute to systemic racism in medicine. We leveraged data from the 23andMe research cohort (4 184 082 participants) to calculate the ancestry-independent risk of VTE associated with SCT as well as comparative risk estimates for heterozygous factor V Leiden (FVL). Odds ratios (ORs) were calculated using a meta-analysis of 3 genetic ancestry groups (European [n = 3 183 142], Latine [n = 597 539], and African [n = 202 281]) and a secondary full-cohort analysis including 2 additional groups (East Asian [n = 159 863] and South Asian [n = 41 257]). Among the full cohort, 94 323 participants (2.25%) reported a history of VTE. On meta-analysis, individuals with SCT had a 1.45-fold (confidence interval [CI], 1.32-1.60) increased risk of VTE compared with SCT noncarriers, which was similar to the full-cohort estimate. The risk of pulmonary embolism (PE) in SCT (OR, 1.95; CI, 1.72-2.20) was higher than that of isolated deep venous thrombosis (DVT; OR, 1.04; CI, 0.90-1.21). FVL carriers had 3.30-fold (CI, 3.24-3.37) increased risk of VTE compared with FVL noncarriers, with a higher risk of isolated DVT (OR, 3.59; CI, 3.51-3.68) than PE (OR, 2.72; CI, 2.64-2.81). In this large, diverse cohort, the risk of VTE was increased among individuals with SCT compared with those without, independent of race or genetic ancestry. The risk of VTE with SCT was lower than that observed in FVL; however, the pattern of VTE in SCT was PE predominant, which is the opposite to that observed in FVL.
Use of in vivo confocal microscopy in suspected Acanthamoeba keratitis: a 12-year real-world data study at a Swedish regional referral center
Authors: Toba Bogdana , Lagali Neil
Published: September 2024

Purpose

To report real-world data (RWD) on the use of in vivo confocal microscopy (IVCM) in handling cases of suspected Acanthamoeba keratitis (AK) cases at a regional referral center during a 12-year period.

Methods

Retrospective study of patients with suspected AK presenting at a regional referral center for IVCM in Sweden from 2010 to 2022. Demographics, symptoms, outcomes, and clinical management were analyzed, and IVCM images were interpreted.

Results

Of 74 included patients with suspected AK, 18 (24%) were IVCM-positive, 33 (44%) were IVCM-negative, 15 had inconclusive IVCM results (20.2%), and 8 (11%) were referred for a second opinion based on IVCM, 4 of which were IVCM-positive (5.5%), yielding an overall IVCM-positive rate of 29.5%. Cultures were taken in 38 cases (51%) with only 2 cases (2.7%) culture-positive for AK. Of IVCM-negative cases, cultures were taken in 22 (67%) of cases and 100% of these were AK-negative. IVCM-positive cases had more clinic visits (median 30, P = 0.018) and longer follow-up time (median 890 days, P = 0.009) than IVCM-negative patients, while visual acuity improvement did not differ (P > 0.05). Of IVCM-positive cases, 10 (56%) underwent surgery despite prior anti-amoebic treatment, and 14 (78%) had 3 or more IVCM examinations during follow-up, with cysts (100%), dendritic cells (89%) and inflammatory infiltrate (67%) as the most prevalent features. Longitudinal IVCM indicated improvement in cysts, dendritic cells and subbasal nerves with treatment, while clinical resolution was not always consistent with complete absence of cysts.

Conclusions

In a real-world setting, IVCM has a high reliability in classifying AK-negative cases, while IVCM detects AK-positive cases more frequently than the gold-standard culture method, leading to its preferential use over the culture method where time or resources are limited. Despite this, a subset of cases are IVCM-inconclusive, the clinical course of referred patients is long requiring many hospital visits, and visual acuity in most cases does not improve with medical treatment alone. Information sharing across centers and standardization of referral and diagnostic routines is needed to exploit the full potential of IVCM in AK patient management.
Promoting salt tolerance, growth, and phytochemical responses in coriander (Coriandrum sativum L. cv. Balady) via eco-friendly Bacillus subtilis and cobalt
Authors: Brengi Sary H. , Moubarak Maneea , El-Naggar Hany M. , Osman Amira R.
Published: September 2024

In plant production, evaluation of salt stress protectants concerning their potential to improve growth and productivity under saline stress is critical. Bacillus subtilis (Bs) and cobalt (Co) have been proposed to optimize salt stress tolerance in coriander (Coriandrum sativum L. cv. Balady) plants by influencing some physiological activities. The main aim of this work is to investigate the response of (Bs) and (Co) as eco-safe salt stress protectants to resist the effect of salinity, on growth, seed, and essential oil yield, and the most important biochemical constituents of coriander produced under salt stress condition. Therefore, in a split-plot factorial experiment design in the RCBD (randomized complete block design), four levels of salinity of NaCl irrigation water (SA) were assigned to the main plots; (0.5, 1.5, 4, and 6 dS m−1); and six salt stress protectants (SP) were randomly assigned to the subplots: distilled water; 15 ppm (Co1); 30 ppm (Co2); (Bs); (Co1 + Bs); (Co2 + Bs). The study concluded that increasing SA significantly reduced coriander growth and yield by 42.6%, which could be attributed to ion toxicity, oxidative stress, or decreased vital element content. From the results, we recommend that applying Bs with Co (30 ppm) was critical for significantly improving overall growth parameters. This was determined by the significant reduction in the activity of reactive oxygen species scavenging enzymes: superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) and non-enzyme: proline by 5, 11.3, 14.7, and 13.8% respectively, while increasing ascorbic acid by 8% and preserving vital nutrient levels and enhancing plant osmotic potential to buffer salt stress, seed yield per plant, and essential oil yield increased by 12.6 and 18.8% respectively. The quality of essential oil was indicated by highly significant quantities of vital biological phytochemicals such as linalool, camphor, and protein which increased by 10.3, 3.6, and 9.39% respectively. Additional research is suggested to determine the precise mechanism of action of Bs and Co's dual impact on medicinal and aromatic plant salt stress tolerance.
Human factors methods in the design of digital decision support systems for population health: a scoping review
Authors: Vasquez Holland M. , Pianarosa Emilie , Sirbu Renee , Diemert Lori M. , Cunningham Heather , Harish Vinyas , Donmez Birsen , Rosella Laura C.
Published: September 2024

Background

While Human Factors (HF) methods have been applied to the design of decision support systems (DSS) to aid clinical decision-making, the role of HF to improve decision-support for population health outcomes is less understood. We sought to comprehensively understand how HF methods have been used in designing digital population health DSS.

Materials and methods

We searched English documents published in health sciences and engineering databases (Medline, Embase, PsychINFO, Scopus, Comendex, Inspec, IEEE Xplore) between January 1990 and September 2023 describing the development, validation or application of HF principles to decision support tools in population health.

Results

We identified 21,581 unique records and included 153 studies for data extraction and synthesis. We included research articles that had a target end-user in population health and that used HF. HF methods were applied throughout the design lifecycle. Users were engaged early in the design lifecycle in the needs assessment and requirements gathering phase and design and prototyping phase with qualitative methods such as interviews. In later stages in the lifecycle, during user testing and evaluation, and post deployment evaluation, quantitative methods were more frequently used. However, only three studies used an experimental framework or conducted A/B testing.

Conclusions

While HF have been applied in a variety of contexts in the design of data-driven DSSs for population health, few have used Human Factors to its full potential. We offer recommendations for how HF can be leveraged throughout the design lifecycle. Most crucially, system designers should engage with users early on and throughout the design process. Our findings can support stakeholders to further empower public health systems.
CUREMA project: a further step towards malaria elimination among hard-to-reach and mobile populations
Authors: Sanna Alice , Lambert Yann , Jimeno Maroto Irene , Galindo Muriel Suzanne , Plessis Lorraine , Bardon Teddy , Carboni Carlotta , Bordalo Jane , Hiwat Helene , Cairo Hedley , Musset Lise , Lazrek Yassamine , Pelleau Stéphane , White Michael , Suárez Mutis Martha , Vreden Stephen , Douine Maylis
Published: September 2024

Background

In most countries engaged on the last mile towards malaria elimination, residual transmission mainly persists among vulnerable populations represented by isolated and mobile (often cross-border) communities. These populations are sometimes involved in informal or even illegal activities. In regions with Plasmodium vivax transmission, the specific biology of this parasite poses additional difficulties related to the need for a radical treatment against hypnozoites to prevent relapses. Among hard-to-reach communities, case management, a pillar of elimination strategy, is deficient: acute malaria attacks often occur in remote areas, where there is limited access to care, and drugs acquired outside formal healthcare are often inadequately used for treatment, which typically does not include radical treatment against P. vivax. For these reasons, P. vivax circulation among these communities represents one of the main challenges for malaria elimination in many non-African countries. The objective of this article is to describe the protocol of the CUREMA study, which aims to meet the challenge of targeting malaria in hard-to-reach populations with a focus on P. vivax.

Results

CUREMA is a multi-centre, international public health intervention research project. The study population is represented by persons involved in artisanal and small-scale gold mining who are active and mobile in the Guiana Shield, deep inside the Amazon Forest. The CUREMA project includes a complex intervention composed of a package of actions: (1) health education activities; (2) targeted administration of treatment against P. vivax after screening against G6PD deficiency to asymptomatic persons considered at risk of silently carrying the parasite; (3) distribution of a self-testing and self-treatment kit (malakit) associated with user training for self-management of malaria symptoms occurring while in extreme isolation. These actions are offered by community health workers at settlements and neighbourhoods (often cross-border) that represent transit and logistic bases of gold miners. The study relies on hybrid design, aiming to evaluate both the effectiveness of the intervention on malaria transmission with a pre/post quasi-experimental design, and its implementation with a mixed methods approach.

Conclusions

The purpose of this study is to experiment an intervention that addresses both Plasmodium falciparum and P. vivax malaria elimination in a mobile and isolated population and to produce results that can be transferred to many contexts facing the same challenges around the world.
A realist impact evaluation of a tool to strengthen equity in local government policy-making
Authors: Schultz Sally , Beissmann Felicity , Zorbas Christina , Yoong Serene , Peeters Anna , Backholer Kathryn
Published: September 2024

Background

Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts.

Methods

We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs.

Results

Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA’s related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support.

Conclusion

Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.
Exploration of different statistical approaches in the comparison of dopamine and norepinephrine in the treatment of shock: SOAP II
Authors: Zampieri Fernando G. , Bagshaw Sean M. , Njimi Hassane , Vincent Jean-Louis , DeBacker Daniel ,   SOAP II Investigators, Biston P. , Devriendt J. , Madl C. , Chochrad D. , Aldecoa C. , Brasseur A. , Defrance P. , Gottignies P. , Kitzberger R. , Holzinger U. , Roman A. , De Bels D. , Anane S. , Brimioulle S. , Van Nuffelen M. , VanCutsem M. , Rico J. , Gomez Herreras J. I. , Mélot C.
Published: September 2024

Background

Exploring clinical trial data using alternative methods may enhance original study’s findings and provide new insights. The SOAP II trial has been published more than 10 years ago; but there is still some speculation that some patients may benefit from dopamine administration for shock management. We aimed to reanalyse the trial under different approaches and evaluate for heterogeneity in treatment effect (HTE).

Methods

All patients enrolled in SOAP II were eligible for reanalysis. We used a variety of methods including the win-ratio (WR), a Bayesian reanalysis stratified according to shock type, and both a risk-based and effect-based explorations for HTE. The methods were applied to different endpoints, including a hierarchy of death, new use of renal-replacement therapy (RRT), and new-onset arrhythmia; 28-day mortality; a composite endpoint (mortality, new use of RRT, and new-onset arrhythmia), and days alive and free of ICU at 28-days (DAFICU28).

Results

A total of 1679 patients were included (average age was 64.9 years, 57% male, 62% with septic and 17% with cardiogenic shock). All analysis favoured norepinephrine over dopamine. Under the WR approach, dopamine had fewer wins compared to norepinephrine (WR 0.79; 95% confidence intervals [CI] 0.68–0.92; p = 0.003), evident in both cardiogenic and septic shock subgroups. The Bayesian reanalysis for type of shock showed, for dopamine, a probability of harm of 0.95 for mortality, > 0.99 probability of harm for composite endpoint, and 0.91 probability of harm for DAFICU28. The fewer DAFICU28 with dopamine was more apparent in those with cardiogenic shock (0.92). Under the risk-based HTE, there was a high probability that dopamine resulted fewer DAFICU28 in the highest quartile of predicted mortality risk. The effect-based HTE assessment model did not recommended dopamine over norepinephrine for any combination of possible modifiers including age, type of shock, presence of cardiomyopathy, and SOFA score. Receiving dopamine when the effect-based model recommended norepinephrine was associated with an absolute increase in composite endpoint of 6%.

Conclusion

The harm associated with the use of dopamine for the management of shock appears to be present in both septic and cardiogenic shock patients. There was no suggestion of any subgroup in which dopamine was found to be favourable over norepinephrine.