bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality
Authors: Liu Ruiying , Qiu Qing , Ye Baojuan
Published: April 2024

Background

The global spread of COVID-19 has brought immense physiological and psychological distress to students, such as test anxiety and poor sleep quality. This study aims to explore the relationship between COVID-19 stress and test anxiety and the mediating roles of intolerance of uncertainty and sleep quality between them.

Methods

A study was conducted in China during the late stage of the pandemic. A total of 936 Chinese art students (age M = 18.51, SD = 2.11, 46.6% female) completed the Coronavirus Stress Measure (CSM), the 12-item Intolerance of Uncertainty (IUS-12), the Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI), and the Test Anxiety Inventory (TAI). A chain mediation model analysis was conducted to examine the mediating effects of intolerance of uncertainty and sleep quality on the association with COVID-19 stress and test anxiety.

Results

COVID-19 stress was positively associated with test anxiety (β = 0.50, p < 0.001). The intolerance of uncertainty and sleep quality partially and serially mediated the relationship between COVID-19 stress and test anxiety (β = 0.01, 95% CI = 0.01 to 0.02).

Conclusion

These findings suggest that art students’ intolerance of uncertainty and sleep quality partially and serially mediate the relation between COVID-19 stress and test anxiety. The results have significant implications for the intervention and prevention of test anxiety, providing additional evidence for the relationship between COVID-19 stress and test anxiety.
Risk factors for smoking in adolescence: evidence from a cross-sectional survey in Switzerland
Authors: Altwicker-Hámori Szilvia , Ackermann Kurt Alexander , Furchheim Pia , Dratva Julia , Truninger Dominique , Müller Steffen , Wieber Frank
Published: April 2024

Background

Cigarette smoking during adolescence is a major public health concern with far-reaching health implications. Adolescents who smoke are at an increased risk of developing long-term health problems and are more likely to continue smoking into adulthood. Therefore, it is vital to identify and understand the risk factors that contribute to adolescent smoking – which in turn facilitate the development of targeted prevention and intervention programs.

Methods

Data was drawn from a cross-sectional survey conducted between October and December 2021, encompassing adolescents of adolescents aged 14 to 19 residing in Switzerland (n = 2,683). Multiple logistic regression analysis was employed to explore which demographic, household, behavioural and psychographic factors are associated with current smoking status.

Results

The regression results showed higher odds of smoking for female respondents (OR 1.39; p-value 0.007); older adolescents (OR 1.30; p-value < 0.001); those living in the French-speaking part of Switzerland (OR 1.39; p-value 0.021), in suburban areas (OR 1.35; p-value 0.023) and with a smoker in the same household (OR 2.41; p-value < 0.001); adolescents consuming alcohol (OR 4.10; p-value < 0.001), cannabis products (OR 6.72; p-value < 0.001) and hookah (OR 5.07; p-value < 0.001) at least once a month; respondents not engaging in sports (OR 1.90; p-value < 0.001) or music (OR 1.42; p-value 0.031) as top five leisure activities and those experiencing high stress levels at home (OR 1.74; p-value < 0.001). Adolescents with high scores in health awareness (OR 0.33; p-value < 0.001), on the relational self-esteem scale (OR 0.78; p-value 0.054) and on the general well-being scale (OR 0.52; p-value 0.022) were less likely to smoke than their counterparts with lower scores. High risk-seeking was associated with higher odds of smoking (OR 2.15; p-value < 0.001).

Conclusions

Our results suggest the importance of a comprehensive approach at both individual and institutional levels to reduce smoking rates in adolescents. More specifically, a holistic strategy that encompasses adolescents, families, schools and policymakers ranging from strengthening adolescents’ self-esteem, smoking cessation support for parents, to increasing engagement in musical and physical activities, and enhancing health awareness in the school curriculum.
Does the coronoid fracture in terrible triad injury always need to be fixed?
Authors: Ahn Yeong-Seub , Woo Seong-Hwan , Kim Sungmin , Lim Jun-Hyuk , An Tae-Hoon , Kim Myung-Sun
Published: April 2024

Background

The ideal treatment of terrble triad injuries and whether fixation of coronoid process fractures is needed or not are still debated. Therefore, we aimed to investigate if terrible triad injuries necessitate coronoid fracture fixation and evaluate if non-fixation treatments have similar efficacies and outcomes as fixation-treatments in cases of terrible triad injuries.

Methods

From August 2011 to July 2020, 23 patients with acute terrible triad injuries without involvement of the anteromedial facet of the coronoid process were included to evaluate the postoperative clinical and radiological outcomes (minimum follow-up of 20 months). According to the preoperative height loss evaluation of the coronoid process and an intraoperative elbow stability test, seven patients underwent coronoid fracture fixation, and the other eight patients were treated conservatively. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and modified Broberg-Morrey score were evaluated at the last follow-up. In addition, plain radiographs were reviewed to evaluate joint congruency, fracture union, heterotopic ossification, and the development of arthritic changes.

Results

At the last follow-up, the mean arcs of flexion-extension and supination-pronation values were 118.2° and 146.8° in the fixation group and 122.5° and 151.3° in the non-fixation group, respectively. The mean MEPSs were 96.4 in the fixation group (excellent, nine cases; good, tow cases) and 96.7 in the non-fixation group (excellent, ten cases; good, two cases). The mean modified Broberg-Morrey scores were 94.0 in the fixation group (excellent, sevev cases; good, four cases) and 94.0 in the non-fixation group (excellent, ten cases; good, tow cases). No statistically significant differences in clinical scores and ROM were identified between the two groups. However, the non-fixation group showed a significantly lower height loss of the coronoid process than the fixation group (36.3% versus 54.5%).

Conclusions

There were no significant differences in clinical outcomes between the fixation and non-fixation groups in terrible triad injuries.
Efficacy and safety of solifenacin combined with biofeedback in children with overactive bladder
Authors: Hu Yan , Zhang Hui
Published: April 2024

Background

Overactive bladder is a common chronic urological disorder in children, liable to impact normal social activities, disrupt sleep and even impair self-esteem. We aimed to evaluate the efficacy and safety of solifenacin combined with biofeedback for paediatric overactive bladder.

Method

Forty-five children with overactive bladder were enrolled and divided into three groups: 15 patients in Group A were treated with solifenacin, 15 cases in Group B with biofeedback, and the other 15 patients in Group C with the combination of solifenacin plus biofeedback. Each group was subdivided into the non-urge incontinence (non-UI) and urge incontinence (UI) groups. The remission rates were compared among the three groups at 2, 4, 8 and 12 weeks from the beginning of treatment. The side effects of solifenacin were recorded and followed up.

Result

After 2 weeks since initial treatment, the complete response rates were 33.3% (5/15), 20.0% (3/15), and 53.3% (8/15) in the three groups. At 4 weeks, the complete remission rates were 46.7% (7/15), 33.3% (5/15), and 60.0% (9/15) respectively. Moreover, the complete remission rates of the UI groups were higher than the non-UI groups (p < 0.05). At 8 weeks, the complete response rates were 53.3% (8/15), 40.0% (6/15), and 67.7% (10/15). At 12 weeks, the complete response rates were 67.8% (10/15), 60.0% (9/15), and 86.7% (13/15). The complete response rates were higher and urodynamic parameters were improved obviously in group C than the other two groups (p < 0.05) during the follow-ups. The median voiding frequency decreased and median functional bladder capacity increased obviously in Group C after 4 weeks (p < 0.05). Dry mouth was observed in 2 patients (4.4%). 2 patients experienced constipation (4.4%), and neither case was severe. The symptoms of these four patients had relieved by reducing the dose of solifenacin.

Conclusion

Solifenacin combined with biofeedback had good efficacy and compliance for children experiencing overactive bladder. It took only 2 weeks to achieve the complete response rate over 50%, especially for the improvement of UI symptoms.
Characteristics, management and outcomes of primary hyperparathyroidism from 2009 to 2021: a single centre report from South Africa
Authors: Govind Kamal , Paruk Imran M. , Motala Ayesha A.
Published: April 2024

Background

There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003–2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH.

Methods

A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded.

Results

Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008).

Conclusions

The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.
Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study
Authors: Lyng Hilda Bø , Ree Eline , Strømme Torunn , Johannessen Terese , Aase Ingunn , Ullebust Berit , Thomsen Line Hurup , Holen-Rabbersvik Elisabeth , Schibevaag Lene , Bates David W. , Wiig Siri
Published: April 2024

Background

Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes.

Methods

This study is based on an exploratory qualitative methodology. The empirical data was collected through the ‘Improving Quality and Safety in Primary Care – Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory.

Results

Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing.

Conclusion

This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
TFEB regulates dendritic cell antigen presentation to modulate immune balance in asthma
Authors: Xiang JinYing , Liu Bo , Li Yan , Ren Yinying , Li Yuehan , Zhou Mi , Yu Jinyue , Luo Zhengxiu , Liu Enmei , Fu Zhou , Ding Fengxia
Published: April 2024

Objective

Asthma stands as one of the most prevalent chronic respiratory conditions in children, with its pathogenesis tied to the actived antigen presentation by dendritic cells (DCs) and the imbalance within T cell subgroups. This study seeks to investigate the role of the transcription factor EB (TFEB) in modulating the antigen presentation process of DCs and its impact on the differentiation of T cell subgroups.

Methods

Bone marrow dendritic cells (BMDCs) were activated using house dust mites (HDM) and underwent RNA sequencing (RNA-seq) to pinpoint differentially expressed genes. TFEB mRNA expression levels were assessed in the peripheral blood mononuclear cells (PBMCs) of both healthy children and those diagnosed with asthma. In an asthma mouse model induced by HDM, the TFEB expression in lung tissue DCs was evaluated. Further experiments involved LV-shTFEB BMDCs co-cultured with T cells to explore the influence of TFEB on DCs’ antigen presentation, T cell subset differentiation, and cytokine production.

Results

Transcriptomic sequencing identified TFEB as a significantly differentially expressed gene associated with immune system pathways and antigen presentation. Notably, TFEB expression showed a significant increase in the PBMCs of children diagnosed with asthma compared to healthy counterparts. Moreover, TFEB exhibited heightened expression in lung tissue DCs of HDM-induced asthmatic mice and HDM-stimulated BMDCs. Silencing TFEB resulted in the downregulation of MHC II, CD80, CD86, and CD40 on DCs. This action reinstated the equilibrium among Th1/Th2 and Th17/Treg cell subgroups, suppressed the expression of pro-inflammatory cytokines like IL-4, IL-5, IL-13, and IL-17, while augmenting the expression of the anti-inflammatory cytokine IL-10.

Conclusion

TFEB might have a vital role in asthma’s development by impacting the antigen presentation of DCs, regulating T cell subgroup differentiation, and influencing cytokine secretion. Its involvement could be pivotal in rebalancing the immune system in asthma. These research findings could potentially unveil novel therapeutic avenues for treating asthma.
Inequities in access to palliative and end-of-life care in the black population in Canada: a scoping review
Authors: Bassah Nahyeni , Beranek Julia , Kennedy Megan , Onabadejo Juliet , Santos Salas Anna
Published: April 2024

Background

Improving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population.

Methods

We undertook a scoping review using the framework by Arksey and O’Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers.

Results

The search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 − 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings.

Conclusion

Findings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada.
Clinical outcomes and treatment necessity in patients with toxin-negative Clostridioides difficile stool samples
Authors: Cho Dae Hyeon , Kim Si-Ho , Jeon Cheon Hoo , Kim Hyoung Tae , Park Kyoung-Jin , Kim Junyoung , Kwak Jiyeong , Kwan Byung Soo , Kong Sungmin , Lee Jung Won , Kim Kwang Min , Wi Yu Mi
Published: April 2024

Purpose

The clinical significance of negative toxin enzyme immunoassays (EIA) for Clostridioides difficile infections (CDIs) is unclear. Our study aimed to investigate the significance of toxin EIA-negative in the diagnosis and prognosis of CDI.

Methods

All stool specimens submitted for C. difficile toxin EIA testing were cultured to isolate C. difficile. In-house PCR for tcdA, tcdB, cdtA, and cdtB genes were performed using C. difficile isolates. Stool specimens were tested with C. difficile toxins A and B using EIA kit (RIDASCREEN Clostridium difficile toxin A/B, R-Biopharm AG, Darmstadt, Germany). Characteristics and subsequent CDI episodes of toxin EIA-negative and -positive patients were compared.

Results

Among 190 C. difficile PCR-positive patients, 83 (43.7%) were toxin EIA-negative. Multivariate analysis revealed independent associations toxin EIA-negative results and shorter hospital stays (OR = 0.98, 95% CI 0.96–0.99, p = 0.013) and less high-risk antibiotic exposure in the preceding month (OR = 0.38, 95% CI 0.16–0.94, p = 0.035). Toxin EIA-negative patients displayed a significantly lower white blood cell count rate (11.0 vs. 35.4%, p < 0.001). Among the 54 patients who were toxin EIA-negative and did not receive CDI treatment, three (5.6%) were diagnosed with CDI after 7–21 days without complication.

Conclusion

Our study demonstrates that toxin EIA-negative patients had milder laboratory findings and no complications, despite not receiving treatment. Prolonged hospitalisation and exposure to high-risk antibiotics could potentially serve as markers for the development of toxin EIA-positive CDI.
Investigating the impact of cartilaginous endplate herniation on recovery from percutaneous endoscopic lumbar discectomy
Authors: Zhao Zenghui , Qi Hao , Wang Chenchen , Zhao Anqi , Zu Feiyu , Zhang Jianzhou , He Mengzi , Yuan Hongru , Yang Ao , Wang Chenxi , Zhang Di
Published: April 2024

Objective

This study aimed to evaluate the influence of herniation of cartilaginous endplates on postoperative pain and functional recovery in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH).

Methods

A retrospective analysis was conducted on 126 patients with LDH treated with PELD at the Third Hospital of Hebei Medical University from January 2021 to January 2022. Whether cartilaginous endplates had herniated was identified by analyzing these specific findings from MRI scans: posterior marginal nodes, posterior osteophytes, mid endplate irregularities, heterogeneous low signal intensity of extruded material, and Modic changes in posterior corners and mid endplates. Patients were assessed for postoperative pain using the Visual Analogue Scale (VAS) and functional recovery using the Oswestry Disability Index (ODI) and Modified MacNab criteria. Statistical analyses compared outcomes based on the presence of herniation of cartilaginous endplates.

Results

Patients with herniation of cartilaginous endplates experienced higher pain scores early postoperatively but showed significant improvement in pain and functional status over the long term. The back pain VAS scores showed significant differences between the groups with and without herniation of cartilaginous endplates on postoperative day 1 and 1 month (P < 0.05). Leg pain VAS scores showed significant differences on postoperative day 1 (P < 0.05). Modic changes were significantly associated with variations in postoperative recovery, highlighting their importance in predicting patient outcomes. In patients with herniation of cartilaginous endplates, there were statistically significant differences in the back pain VAS scores at 1 month postoperatively and the ODI functional scores on postoperative day 1 between the groups with and without Modic changes (P < 0.05). There were no significant differences in the surgical outcomes between patients with and without these conditions regarding the Modified MacNab criteria (P > 0.05).

Conclusion

Herniation of cartilaginous endplates significantly affect early postoperative pain and functional recovery in LDH patients undergoing PELD. These findings emphasize the need for clinical consideration of these imaging features in the preoperative planning and postoperative management to enhance patient outcomes and satisfaction.
Cardiovascular mortality risk in patients with ovarian cancer: a population-based study
Authors: Hu Ze-Lin , Yuan Ying-Xue , Xia Meng-Yi , Li Ying , Yang Ying , Wang Sheng-Nan , Meng Xuan-Zhu , Sun Mo-Ying , Wang Ning
Published: April 2024

Objectives

Ovarian cancer (OC) can occur at different ages and is affected by a variety of factors. In order to evaluate the risk of cardiovascular mortality in patients with ovarian cancer, we included influencing factors including age, histological type, surgical method, chemotherapy, whether distant metastasis, race and developed a nomogram to evaluate the ability to predict occurrence. At present, we have not found any correlation studies on cardiovascular death events in patients with ovarian cancer. This study was designed to provide targeted measures for effective prevention of cardiovascular death in patients with ovarian cancer.

Methods

Kaplan–Meier analysis and multivariable Cox proportional model were performed to evaluate the effectiveness of cardiovascular diseases on overall survival (OS) and ovarian cancer‐specific survival (OCSS). We compared multiple groups including clinical, demographic, therapeutic characteristics and histological types. Cox risk regression analysis, Kaplan–Meier survival curves, and propensity score matching were employed for analyzing the data.

Results

A total of 88,653 ovarian cancer patients were collected, of which 2,282 (2.57%) patients died due to cardiovascular-related diseases. Age, chemotherapy and whether satisfactory cytoreduction surgery is still the most important factors affecting the prognosis of ovarian cancer patients, while different histological types, diagnosis time, and race also have a certain impact on the prognosis. The newly developed nomogram model showed excellent predictive performance, with a C-index of 0.759 (95%CI: 0.757–0.761) for the group. Elderly patients with ovarian cancer are still a high-risk group for cardiovascular death [HR: 21.07 (95%CI: 5.21–85.30), p < 0.001]. The calibration curve showed good agreement from predicted survival probabilities to actual observations.

Conclusion

This study found that age, histology, surgery, race, chemotherapy, and tumor metastasis are independent prognostic factors for cardiovascular death in patients with ovarian cancer. The nomogram-based model can accurately predict the OS of ovarian cancer patients. It is expected to inform clinical decision-making and help develop targeted treatment strategies for this population.
The effectiveness of pharmacist-led educational model in adult patients with allergic rhinitis: a single-center randomized control trial protocol (AR-PRISE RCT)
Authors: Chew Chii-Chii , Lim Xin-Jie , Letchumanan Pathma , George Doris , Rajan Philip , Chong Chee Ping
Published: April 2024

Background

Allergic rhinitis is a chronic respiratory disorder that significantly impacts patients’ quality of life (QoL) and work performance. Pharmacists are recognized as suitable professionals to provide patient education and pharmaceutical care for managing allergic rhinitis patients. However, local clinical practice guidelines, particularly regarding pharmaceutical care in public healthcare institutions, are lacking. This study protocol outlines a randomized controlled trial (RCT) designed to evaluate the effectiveness of a pharmacist-led educational model (AR-PRISE Model) in managing allergic rhinitis in adult patients compared to standard pharmaceutical care. The AR-PRISE model delivers patient educational material and a pharmaceutical care algorithm.

Method

This is a 6-month, single-center, prospective, randomized, two-arm, and parallel-group controlled trial. The trial recruits patients attending the otorhinolaryngology clinics of a tertiary referral hospital. Participants are randomized into control or intervention groups in a 1:1 ratio using permuted block randomization. The total number of participants estimated is 154, with each group requiring 77 participants. The control group receives standard pharmaceutical care, while the intervention group receives pharmacist-led education according to the AR-PRISE model. Both groups are assessed for middle turbinate endoscopy findings, disease severity, knowledge level, symptom control, medication adherence, and QoL at baseline and the end-of-study follow-up (day 180 ± 7). Depending on feasibility, intermediate follow-ups are conducted on days 60 ± 7 and 120 ± 7, either virtually or face-to-face. During intermediate follow-ups, participants are assessed for symptom control, medication adherence, and QoL. The intention-to-treat analysis includes all participants assigned to each group. An independent T-test compares the mean difference in knowledge level between the two groups. A two-way repeated measures ANOVA analysis is employed to determine between-group differences for scores of symptom control, adherence rate, and QoL. A P-value < 0.05 is considered statistically significant.

Discussion

This study protocol will provide a framework for conducting a randomized controlled trial (RCT) to evaluate the effectiveness of pharmacist-led education intervention in managing allergic rhinitis within public healthcare settings. The parameters measured in this trial will quantify outcomes associated with improvements in symptoms and QoL. By systematically assessing these outcomes, we aim to contribute valuable insights into the role of pharmacist-led interventions in enhancing the management of allergic rhinitis in public healthcare settings.

Trial registration

ClinicalTrials.gov NCT06027736. Registered on 9 July 2023—retrospectively registered.
Idiopathic intracranial hypertension associated with SARS-CoV-2 infection in an adult male patient: a case report and review of the literature
Authors: Solela Gashaw , Tenaw Addis A. , Fisseha Henok , Argaw Abel M. , Petros Tamirat , Mengistu Betelhem
Published: April 2024

Background

Headache is a frequent symptom in coronavirus disease 2019 (COVID-19) patients, and idiopathic intracranial hypertension (pseudotumor cerebri) has been reported among patients who underwent lumbar puncture for persistent headaches.

Case presentation

A 45-year-old black man presented with dyspnea, cough, fever and headache for 05 days followed by blurring of vision associated with worsening of the headache. Physical examination was significant for tachypnea and oxygen desaturation and there were no abnormal neurologic findings. He tested positive for SARS-CoV-2 with nasopharyngeal swab PCR. His CSF opening pressure appeared high with normal CSF analysis and brain magnetic resonance imaging (MRI) revealed prominent subarachnoid space around the optic nerves and bilateral papilledema. He had significant improvement with medical therapy alone.

Conclusion

Idiopathic intracranial hypertension (IIH) may occur in association with SARS-CoV-2 infection and should be considered when making a differential diagnosis for headache and blurring of vision. COVID-19 may play a role in the development of intracranial hypertension, even in the absence of known risk factors. Early diagnosis and treatment of IIH has paramount importance to prevent vision loss and other morbidities.
Event-Triggered confidentiality fusion estimation against eavesdroppers in cyber-physical systems
Authors: Xu Daxing , Chen Zhiqiang , Wang Hailun
Published: April 2024

System state plays an important role in cyber-physical systems (CPSs). Ensuring the security of the CPSs is a key issue that can be widely applied. The confidentiality of system state is a fundamental feature of the CPSs security. This paper studies the distributed fusion estimation problem in the presence of eavesdropper, where local sensors send their estimates to a remote fusion center (FC). To prevent eavesdropping, the event triggered scheduling strategy was adopted on each sensor. Some sufficient conditions on the triggers’ threshold were derived to make the eavesdropping expected covariance unbounded while the expected error covariance for the user remains bounded. Moreover, the distributed confidentiality fusion estimation algorithm is provided to achieve perfect expected secrecy. Finally, simulations of different trigger levels for two local systems are employed to show the effectiveness of the proposed methods.
Lower bounds on the minimum eigenvalue of the Fan product of several M-matrices
Authors: Zhong Qin
Published: April 2024

The concept of the Fan product of several M-matrices is introduced. Furthermore, two new lower bounds of the minimum eigenvalue of the Fan product of several M-matrices are proposed. These obtained new lower bounds generalize and improve some earlier findings. One example is presented to illustrate the precision of the given lower bounds.
A qualitative assessment of provider-perceived barriers to implementing family-based treatment for anorexia nervosa in low-income community settings
Authors: Egbert Amy H. , Irizarry Bailey , Lualdi Elisabeth , Tortolani Christina C. , Donaldson Deidre L. , Goldschmidt Andrea B.
Published: April 2024

Background

Family-based treatment (FBT) is a front-line empirically supported intervention for adolescent anorexia nervosa, but it is often inaccessible to families from lower income backgrounds, as it is most typically available in specialty research and private practice settings. In preparation for a pilot trial of FBT delivered in the home setting, this study qualitatively examined provider perceptions of implementing FBT in lower-income communities.

Methods

Eating disorder clinicians working in community clinics (therapists, medical doctors, dietitians, and social workers; n = 9) were interviewed about their experiences using FBT. Interview transcripts were analyzed both deductively, using an approach consistent with applied thematic analysis, and inductively, using the Replicating Effective Programs implementation framework, to examine barriers to FBT implementation.

Results

Prevailing themes included concern about the time and resources required of caregivers to participate in FBT, which may not be feasible for those who work full time, have other caregiving demands, and/or lack family support. Psychosocial problems outside of the eating disorder, such as food insecurity, other untreated mental health concerns (in themselves or other family members), or externalizing behaviors on the part of the adolescent, were also discussed as barriers, and participants noted that the lack of cohesive treatment teams in the community make it difficult to ensure continuity of care.

Conclusion

Findings from this qualitative study indicate the need to address systemic socioeconomic barriers to improve the efficacy of implementation of FBT in the community and to understand how provider perceptions of these barriers influence their uptake of FBT.
Genetic regulation of l-tryptophan metabolism in Psilocybe mexicana supports psilocybin biosynthesis
Authors: Seibold Paula Sophie , Dörner Sebastian , Fricke Janis , Schäfer Tim , Beemelmanns Christine , Hoffmeister Dirk
Published: April 2024

Background

Although Basidiomycota produce pharmaceutically and ecologically relevant natural products, knowledge of how they coordinate their primary and secondary metabolism is virtually non-existent. Upon transition from vegetative mycelium to carpophore formation, mushrooms of the genus Psilocybe use l-tryptophan to supply the biosynthesis of the psychedelic tryptamine alkaloid psilocybin with the scaffold, leading to a strongly increased demand for this particular amino acid as this alkaloid may account for up to 2% of the dry mass. Using Psilocybe mexicana as our model and relying on genetic, transcriptomic, and biochemical methods, this study investigated if l-tryptophan biosynthesis and degradation in P. mexicana correlate with natural product formation.

Results

A comparative transcriptomic approach of gene expression in P. mexicana psilocybin non-producing vegetative mycelium versus producing carpophores identified the upregulation of l-tryptophan biosynthesis genes. The shikimate pathway genes trpE1, trpD, and trpB (encoding anthranilate synthase, anthranilate phosphoribosyltransferase, and l-tryptophan synthase, respectively) were upregulated in carpophores. In contrast, genes idoA and iasA, encoding indole-2,3-dioxygenase and indole-3-acetaldehyde synthase, i.e., gateway enzymes for l-tryptophan-consuming pathways, were massively downregulated. Subsequently, IasA was heterologously produced in Escherichia coli and biochemically characterized in vitro. This enzyme represents the first characterized microbial l-tryptophan-preferring acetaldehyde synthase. A comparison of transcriptomic data collected in this study with prior data of Psilocybe cubensis showed species-specific differences in how l-tryptophan metabolism genes are regulated, despite the close taxonomic relationship.

Conclusions

The upregulated l-tryptophan biosynthesis genes and, oppositely, the concomitant downregulated genes encoding l-tryptophan-consuming enzymes reflect a well-adjusted cellular system to route this amino acid toward psilocybin production. Our study has pilot character beyond the genus Psilocybe and provides, for the first time, insight in the coordination of mushroom primary and secondary metabolism.
Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort
Authors: Ossima Arnaud Nze , Brzustowski Angélique , Paradis Valérie , Van Beers Bernard , Postic Catherine , Laouénan Cédric , Pol Stanislas , Castéra Laurent , Gautier Jean-François , Czernichow Sebastien , Vallet-Pichard Anais , Larger Etienne , Serfaty Lawrence , Zins Marie , Valla Dominique , Zaleski Isabelle Durand
Published: April 2024

Background & aims

Despite its high prevalence in the western world metabolic dysfunction-associated steatotic liver disease (MASLD) does not benefit from targeted pharmacological therapy. We measured healthcare utilisation and identified factors associated with high-cost MASLD patients in France.

Methods

The prevalent population with MASLD (including non-alcoholic steatohepatitis) in the CONSTANCES cohort, a nationally representative sample of 200,000 adults aged between 18 and 69, was linked to the French centralised national claims database (SNDS). Study participants were identified by the fatty liver index (FLI) over the period 2015–2019. MASLD individuals were classified according as “high-cost” (above 90th percentile) or “non-high cost” (below 90th percentile). Factors significantly associated with high costs were identified using a multivariate logistic regression model.

Results

A total of 14,437 predominantly male (69%) participants with an average age of 53 ± SD 12 years were included. They mainly belonged to socially deprived population groups with co-morbidities such as diabetes, high blood pressure, mental health disorders and cardiovascular complications. The average expenditure was €1860 ± SD 4634 per year. High-cost MASLD cost €10,863 ± SD 10,859 per year. Conditions associated with high-cost were mental health disorders OR 1.79 (1.44–2.22), cardiovascular diseases OR 1.54 (1.21–1.95), metabolic comorbidities OR 1.50 (1.25–1.81), and respiratory disease OR 1.50 (1.11–2.00). The 10% high-cost participants accounted for 58% of the total national health care expenditures for MASLD.

Conclusion

Our results emphasize the need for comprehensive management of the comorbid conditions which were the major cost drivers of MASLD.

Graphical Abstract
Learning in action: embedding the SDGs through the Reach Alliance
Authors: Roll Kate , MacLeod Marin , Agbodjah Sena , Sánchez Siller Iza M.
Published: April 2024

There has been increasing practical and scholarly interest in the engagement of universities with the Sustainable Development Goals (SDGs). However, there has been limited examination of international university collaborations focusing on the SDGs and how they become embedded within universities. Addressing this need, this article explores the experiences of three members of the Reach Alliance a consortium of eight higher education institutions from around the globe. Reach supports students and faculty mentors to study how critical interventions can be made accessible to those who are the hardest to reach. This work aligns with SDG 4 (Quality Education), as well as SDG 17 (Partnership for the Goals) and the Goal’s second universal value of leave no one behind. This commitment to connecting education and societal engagement resonates with Goddard et al.’s work on the civic university as both “globally competitive and locally engaged” (2012: 43). This article focuses on University College London (UK), Ashesi University (Ghana), and Tecnológico de Monterrey (Mexico), selected for their diverse structures and geographies. For each case, we examine how the Reach Alliance initiative has been institutionally embedded, as well as the role of local and global partnerships in making the case for supporting Reach. We find that Reach’s organisation as an international network has encouraged its adoption by host institutions. The initiative’s emphasis on both local concerns as well as the global goal and networks has also resonated with host institutions. This article will be of interest to those working in sustainability and higher education when considering strategies for introducing or increasing SDG-focussed research and teaching.
Radiation Therapy With or Without Cisplatin for Local Recurrences of Endometrial Cancer: Results From an NRG Oncology/GOG Prospective Randomized Multicenter Clinical Trial
Authors: Klopp Ann H. , Enserro Danielle , Powell Matthew , Randall Marcus , Schink Julian C. , Mannel Robert S. , Holman Laura , Bender David , Kushnir Christina L. , Backes Floor , Zweizig Susan L. , Waggoner Steven , Bradley Kristin A. , Lawrence Lana DeSouza , Hanjani Parviz , Darus Christopher J. , Small William , Cardenes Higinia R. , Feddock Jonathan M. , Miller David S.
Published: April 2024

PURPOSE

Pelvic recurrence is a frequent pattern of relapse for women with endometrial cancer. A randomized trial compared progression-free survival (PFS) after treatment with radiation therapy alone as compared with concurrent chemotherapy.

MATERIALS AND METHODS

Between February 2008 and August 2020, 165 patients were randomly assigned 1:1 to receive either radiation treatment alone or a combination of chemotherapy and radiation treatment. The primary objective of this study was to determine whether chemoradiation therapy was more effective than radiation therapy alone at improving PFS.

RESULTS

The majority of patients had low-grade (1 or 2) endometrioid histology (82%) and recurrences confined to the vagina (86%). External beam with either the three-dimensional or intensity modulated radiation treatment technique was followed by a boost delivered with brachytherapy or external beam. Patients randomly assigned to receive chemotherapy were treated with once weekly cisplatin (40 mg/m2). Rates of acute toxicity were higher in patients treated with chemoradiation as compared with radiation treatment alone. Median PFS was longer for patients treated with radiation therapy alone as compared with chemotherapy and radiation (median PFS was not reached for RT v 73 months for chemoradiation, hazard ratio of 1.25 (95% CI, 0.75 to 2.07). At 3 years, 73% of patients treated definitively with radiation and 62% of patients treated with chemoradiation were alive and free of disease progression.

CONCLUSION

Excellent outcomes can be achieved for women with localized recurrences of endometrial cancer when treated with radiation therapy. The addition of chemotherapy does not improve PFS for patients treated with definitive radiation therapy for recurrent endometrial cancer and increases acute toxicity. Patients with low-grade and vaginal recurrences who constituted the majority of those enrolled are best treated with radiation therapy alone.
Εκτίμηση της ωριμότητας του εμβρύου δια της φασματοφωτομετρήσεως του αμνιακού υγρού
Authors: Σκολαρίκος Παναγιώτης
Published: April 2024

Η πρόγνωση του συνδρόμου αναπνευστικής δυσχέρειας των νεογνών βασίζεται αφ’ενός στον προσδιορισμό των φωσφολιπιδίων του αμνιακού υγρού και τον καθορισμό της σχέσης λεκιθίνης /σφιγγομυελίνης και αφ’ετέρου στην φασματοφωτομέτρηση στα 400nm και στα 650nm του αμνιακου καθώς και τον προσδιορισμό της κρεατινινης του αμνιακου υγρού. Από τα αποτελέσματα βρέθηκε σημαντική συσχέτιση των τιμών της Ο.Π του κλάσματος Λ/Σ και της κρεατινίνης καθώς και υψηλά ποσοστά επιτυχίας σε σχέση με τα κλινικά στοιχεία των νεογνών που γεννήθηκαν μετά τις μετρήσεις.
Η επίδραση των θεσμών στην αποτελεσματικότητα της δημοσιονομικής πολιτικής
Authors: Βασίλαρου Ευαγγελία
Published: April 2024

Τα τελευταία χρόνια έχουν σημειωθεί σημαντικές αλλαγές στη δημοσιονομική και νομισματική πολιτική των Ηνωμένων Πολιτειών και της Ευρωζώνης. Ο κύριος στόχος αυτών των πολιτικών ήταν η επίτευξη μακροοικονομικής σταθερότητας και βιώσιμης οικονομικής ανάπτυξης με ταυτόχρονη μείωση της εισοδηματικής ανισότητας. Σκοπός αυτής της έρευνας είναι να εξετάσει ποιες πολιτικές και μέτρα πρέπει να υιοθετηθούν για την εφαρμογή αποτελεσματικής δημοσιονομικής πολιτικής, προκειμένου να κατανοηθεί ο αντίκτυπος των θεσμών σε παγκόσμιο επίπεδο. Για να εξετάσουμε τη σημασία των θεσμικών παραγόντων, συλλέξαμε δεδομένα από 178 χώρες για την περίοδο 2002-2019, χρησιμοποιώντας τη Μεθοδολογία Δεδομένων Πίνακα και τα Μοντέλα VAR. Η ανάλυση των θεσμών μπορεί να συμβάλει στην κατανόηση της αποτελεσματικότητας της δημοσιονομικής πολιτικής για την επίτευξη κοινωνικής ευημερίας και τον περιορισμό των επιπτώσεων των οικονομικών διακυμάνσεων.
Utilizations Of Various Of Starches For 3D Design Of Femur Bone Replica Manufacture
Authors: Fadli Ahmad , Prabowo Agung , Komalasari Komalasari , Putra Adi Mulyadi , Yuza Bakti
Published: April 2024

One of the bone implant candidate materials that have similarities to the original bone is porous Hydroxyapatite (HA) based 3D bone replica. Most previous studies primarily focused on the manufacture of porous ceramics in a form that is still far from the original appearance of bone. Manufacturing the femur bone with a shape that resembles the original is expected to be closer to the application. The characteristic of the replica produced have a shrinkage range of 34,28–47.46 %, a porosity range of 18,89-37.75 %, a density range of 1.97-2,56 gr/ cm3, a bending strength range of 0.33-6,49 MPa, and pores sizes of 80-230 µm. Based on the findings, HA scaffolds for bone replicas were successfully created and incorporated in physical and chemical features.
Reconceptualization of curriculum studies: A brief history and personal memories
Authors: Ropo Eero
Published: April 2024

Artikkel koosneb dokumentidel põhinevast lühikesest ülevaatest õppekavauuringute rekontseptualiseerimise ajalukku ja minu isiklikest mälestustest. Rekontseptualiseerimine on oluliselt mõjutanud arusaama, et õppekava ei tähenda üksnes eesmärke ja õppetegevusi, mis päädivad hindamisega, vaid keerulisi, mitut valdkonda hõlmavaid mõttevahetusi. Rekontseptualiseerimine sai alguse Ameerika Ühendriikides 1970. aastatel, kui õppekava uurivate teadlaste põlvkond seadis kahtluse alla seni valitsenud, Tyleri ideedel põhineva lähenemisviisi õppekavale. Rekontseptualiseerimise algusaastad olid tormilised. Rekontseptualistid kritiseerisid administreerivaid lähenemisi õppekavateoorias, kuid samas puudus neil selge teooria, millega peavoolu asendada. 1980. ja 1990. aastatel keskendusid rekontseptualistlikku suunda esindavad teadlased õppekava ümbermõtestamisele, koostades ulatuslikke töid, nt Pinari ja tema kolleegide raamat "Õppekava mõistmine" (Understanding curriculum). Ka William Dolli töödel oli suur mõju hariduse ja õppekava postmodernistliku tausta kirjeldamisele. Viimase 20 aasta jooksul on rekontseptualiseerimine liikunud hariduspraktikat mõjutava dialoogi suunas. Ka Soome õppekavauuringud lähtuvad sellest vaatenurgast. Lisaks keerulistele aruteludele peaks haridus keskenduma autobiograafiliste ja identiteediga seotud protsessidega tegelemisele. Kujutlusvõime ja loovuse laiendamise võimalusena pakutakse sageli välja kunsti. Hoolimata üldistest praktilistest vaatenurkadest on rekontseptualiseerimine siiski kriitiline liikumine lihtsustatud, tehnokraatlike mudelite vastu, mille puhul järgitakse kehtestatud õppekava ja milles domineerivad mõõdetavad õpieesmärgid.
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