bluuebunny/crossref_metadata_2025 huggingface dataset:
Capturing cognitive load management during authentic virtual reality flight training with behavioural and physiological indicators
Authors: Lämsä Joni , Mannonen Joonas , Tuhkala Ari , Heilala Ville , Helovuo Arto , Tynkkynen Ilkka , Lampi Emilia , Sipiläinen Katriina , Kärkkäinen Tommi , Hämäläinen Raija
Published: April 2023

Background

Cognitive load (CL) management is essential in safety‐critical fields so that professionals can monitor and control their cognitive resources efficiently to perform and solve scenarios in a timely and safe manner, even in complex and unexpected circumstances. Thus, cognitive load theory (CLT) can be used to design virtual reality (VR) training programmes for professional learning in these fields.

Objectives

We studied CL management performance through behavioural indicators in authentic VR flight training and explored if and to what extent physiological data was associated with CL management performance.

Methods

The expert (n = 8) and novice pilots (n = 6) performed three approach and landing scenarios with increasing element interactivity. We used video recordings of the training to assess CL management performance based on the behavioural indicators. Then, we used the heart rate (HR) and heart rate variability (HRV) data to study the associations between the physiological data and CL management performance.

Results and Conclusions

The pilots performed effectively in CL management. The experience of the pilots did not remarkably explain the variation in CL management performance. The scenario with the highest element interactivity and an increase in the very low‐frequency band of HRV were associated with decreased performance in CL management.

Takeaways

Our study sheds light on the association between physiological indicators and CL management performance, which has traditionally been assessed with behavioural indicators in professional learning in safety‐critical fields. Thus, physiological measurements can be used to supplement the assessment of CL management performance, as relying solely on behavioural indicators can be time consuming.
Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: A randomized controlled trial
Authors: Magnolo Nina , Jaenicke Thomas , Tsianakas Athanasios , Czech Wolfgang , Thaçi Diamant , Pinter Andreas , Kerob Delphine , Salah Samir , Luger Thomas A.
Published: April 2023

Background

Moderate to severe AD can be successfully managed by systemic treatments. Current guidelines also recommend emollients or emollients ‘plus’ and eudermic cleansers for all AD patients to improve the skin barrier and provide anti‐irritant and anti‐pruritic effects.

Objectives

To investigate the efficacy of skin care (in addition to systemic treatment) with an Emollient ‘plus’ balm designed to improve the skin barrier and skin microbiome plus a corresponding syndet compared to usual commercial emollients and cleansers.

Methods

In a randomized controlled multicenter study, patients with moderate to severe AD (Severity scoring of atopic dermatitis [SCORAD] score ≥ 40) receiving systemic treatment (cyclosporin A, dupilumab or a Janus kinase inhibitor) were randomized 1:1 to apply twice daily for 10 weeks Emollient ‘plus’ after pre‐cleaning with the syndet (Emollient ‘plus’ group) or to continue with their usual emollient and cleanser (Control group). Assessments included SCORAD, pruritus on a Visual Analog Scale, Dermatology quality of life questionnaire (DLQI), efficacy and tolerance questionnaires.

Results

Included were 57 patients with mean age of 38 years (range 19–70 years). The mean amount of emollient used after 10 weeks was 447.3 g (range 29–1099 g) and 613.2 g (range 97–2565 g) for the Emollient ‘plus’ versus the Control, respectively (p = 0.0277). After 10 weeks, subjects in the Emollient ‘plus’ had a significantly greater reduction in current pruritus (p = 0.0277) and a greater reduction in some DLQI items compared to the Control group.

Conclusions

In patients with moderate to severe AD receiving systemic treatment, the Emollient ‘plus’ regimen significantly improved pruritus and quality of life items compared to the control, while using 23% less product over a 10‐week period. These results stress the importance of daily use of emollients, especially emollients ‘plus’ to improve signs, symptoms and quality of life in patients with AD.
Effectiveness of a marital relationship skills training intervention on marital adjustment among individuals in Hosanna Town, Southwest Ethiopia: A randomized‐controlled trial
Authors: Asfaw Likawunt S. , Alene Getu D.
Published: April 2023

Marital distress increases the risk of morbidity and mortality by altering psychological and biological health, including cardiovascular and endocrine function. Numerous interventions have been developed to mitigate marital distress. However, most of these interventions had very specific content and were limited to certain segments of the population. This study was conducted to evaluate the effectiveness of a marital relationship skills training intervention on the marital adjustment of married people in Ethiopia. We conducted a randomized‐controlled trial study on 80 married people with low marital satisfaction. We used STATA 14 statistical software to process the data. The results of an Independent sample's t test analysis showed that marital relationship skills training had a significant impact on the marital adjustment of distressed couples (p = 0.001, 95% confidence interval: 0.79–1.10). A marital relationship skills training intervention can effectively improve marital adjustment and can be used as a treatment for marital distress.
Rents and Intangible Capital: A Q+ Framework
Authors: CROUZET NICOLAS , EBERLY JANICE
Published: April 2023

In recent years, U.S. investment has been lackluster, despite rising valuations. Key explanations include growing rents and growing intangibles. We propose and estimate a framework to quantify their roles. The gap between valuations—reflected in average Q—and investment—reflected in marginal q—can be decomposed into three terms: the value of installed intangibles; rents generated by physical capital; and an interaction term, measuring rents generated by intangibles. The intangible related terms contribute significantly to the gap, particularly in fast‐growing sectors. Our findings suggest care in a pure‐rents interpretation, given the rising role of intangibles.
Extreme drought alters plant community structure by changing dominant species growth in desert grassland
Authors: Wang Junfeng , Zhang Lihua , Xu Xuexuan , Zhao Ruifeng , Liu Beibei , Gao Jiangping
Published: April 2023

Questions

Interannual precipitation changes, both in amount and frequency, are expected to increase due to climate change, and these changes could dramatically affect the structure and function of ecosystems. However, how plant life‐forms and dominant species regulate the plant community structure after precipitation changes remains unclear.

Location

Gaolan Experiment Station for Ecology and Agriculture Research of the Northwest Eco‐Environment and Resources Research Institute of the Chinese Academy of Sciences, located in the desert grassland of the western Loess Plateau, China.

Methods

To investigate the effect of precipitation changes on the growth of communities, life‐forms, and species, we used rain shelters and irrigation to create a variety of precipitation gradients (i.e., −40%, −20%, 0% [= CK, i.e., control treatment], +20%, +40% of ambient precipitation) in desert grasslands from 2014 to 2015.

Results

The plant community density, coverage, and height were significantly decreased in the −40% treatment compared to CK. In contrast, species richness, Shannon–Wiener index, and Pielous' evenness did not respond significantly to the precipitation treatment. In addition, at the level of life‐forms, the density of perennial herbaceous plants was significantly increased by the +40% treatment in 2015, while the richness and density of annual herb were significantly inhibited by extreme drought. The effect on the shrub growth index of increasing and decreasing precipitation compared to the CK was insignificant. Furthermore, at the level of species, the growth of dominant species was obviously suppressed by the −40% and +40% treatment in 2015. However, the positive effect of the +40% treatment on the growth of rare species reached significant levels in 2015. Also, the change in precipitation did not have a significant effect on the growth of companion species. Dominant species primarily drove the response of community‐level plant growth to precipitation changes over the three‐year study period.

Conclusion

The response of plant community composition to changes in precipitation in desert grassland is largely regulated by changes in the composition of the dominant species. This finding could also provide a better prediction of the effects of extreme drought on desert grassland plant communities in the scenarios of future global climate change.
The Government and Lake Governance Criteria for the Seven Crater Lakes of San Pablo City, Laguna, Philippines
Authors: Brillo Bing Baltazar C.
Published: April 2023

The Local Government and the Government Agency shape the Seven Crater Lakes. The present study focused on understanding the predominant Governments and Lake Governance's concept vis‐a‐vis the small lakes and their basin communities. These foremost authorities are intertwined, and Lake Governance's essential criteria interplayed and continuous to the responsibility. Although the City Government of San Pablo City and the Laguna Lake Development Authority (LLDA) have improved the small lake's situations and they are satisfactorily functioning, serious issues still remain at present and into the future. Focusing on the criteria's lessons, Pandin Lake, Yambo Lake, Mohicap Lake and Sampaloc Lake have been ameliorated to varying degrees. In contrast, Bunot Lake, Palakpakin Lake and Calibato Lake continue to struggle with deficiencies. Thus, over the dual governments need to exhibit greater commitment, decisiveness and effectiveness if the Seven Crater Lakes are to flourish in development and conservation. Furthermore, while the Structuring Government and Administering Water criteria are adequate, completing the Developing Tourism, accomplishing the Regulating Fishery and substantially subsidizing the Supporting Finance in the City Government and the LLDA remain deficient. Accordingly, the main target of the paired Governments' over time is to address the remaining challenges facing the Seven Crater Lakes.
Bureaucratic Responsiveness under Dynamic Political Settings: Experimental Evidence from Local Governments
Authors: Lee Don S. , Park Soonae
Published: April 2023

How do bureaucrats respond to legislators' demands for change in policy implementation? We distinguish between unified and divided government, where the degree of legislative oversight over bureaucratic autonomy is likely to differ, and we argue that how bureaucrats actually respond in varying executive‐legislative relations depends on their incentives shaped by greater autonomy in implementation (unified government) versus closer monitoring by legislators (divided government). Analyzing two sets of original data from list and endorsement experiments with local bureaucrats in Korea (n = 4064)—one from the period of legislative auditing and the other from the nonauditing period—we find that bureaucrats are more likely to incorporate legislators' views into their decision‐making under unified than under divided government. Furthermore, bureaucrats are more responsive to legislatures when their political ideology is congruent with that of a legislative majority than when it is incongruent, regardless of unified or divided government. Our findings have a clear implication: the importance of bureaucratic autonomy and preferences rather than monitoring as an effective tool to increase bureaucratic responsiveness.
Environmental stress during larval development induces DNA methylation shifts in the migratory painted lady butterfly (Vanessa cardui)
Authors: Boman Jesper , Zhu Yishu , Höök Lars , Vila Roger , Talavera Gerard , Backström Niclas
Published: April 2023

Seasonal environmental fluctuations provide formidable challenges for living organisms, especially small ectotherms such as butterflies. A common strategy to cope with harsh environments is to enter diapause, but some species avoid unsuitable conditions by migrating. Despite a growing understanding of migration in the life cycles of some butterfly species, it remains unknown how individuals register and store environmental cues to determine whether and where to migrate. Here, we explored how competition and host plant availability during larval development affect patterns of DNA methylation in the migratory painted lady (Vanessa cardui) butterfly. We identify a set of potentially functional methylome shifts associated with differences in the environment, indicating that DNA methylation is involved in the response to different conditions during larval development. By analysing the transcriptome for the same samples used for methylation profiling, we also uncovered a non‐monotonic relationship between gene body methylation and gene expression. Our results provide a starting point for understanding the interplay between DNA methylation and gene expression in butterflies in general and how differences in environmental conditions during development can trigger unique epigenetic marks that might be important for behavioural decisions in the adult stage.
Characteristics of disorders of gut–brain interaction in the Japanese population in the Rome Foundation Global Epidemiological Study
Authors: Fukudo Shin , Nakaya Kumi , Muratsubaki Tomohiko , Nakaya Naoki , Hozawa Atsushi , Bangdiwala Shrikant I. , Palsson Olafur S. , Sperber Ami D. , Kanazawa Motoyori
Published: April 2023

Background

The aims were to use Japanese data from the Rome Foundation Global Epidemiological Study (RFGES) to test the hypotheses that severity of gastrointestinal (GI) symptoms and psychosocial disturbance are ordered as Rome IV irritable bowel syndrome (IBS) > Rome III IBS > DGBI, not IBS > others.

Methods

Subjects were 2504 Japanese in the RFGES. We assessed DGBI/IBS diagnoses with Rome IV/III, IBS Symptom Severity Scale (IBS‐SSS), Patient Health Questionnaire (PHQ) for anxiety/depression and non‐GI somatic symptoms, PROMIS‐10 for quality of life (QOL), Work Productivity and Activity Impairment (WPAI) Questionnaire, parts of Self‐reported IBS Questionnaire (SIBSQ) for meal effect and stress effect, Food Frequency Questionnaire, and medication questions.

Key Results

The prevalence of Rome IV DGBI was as follows; IBS‐C 0.5%, IBS‐D 0.8%, IBS‐M 0.8%, IBS‐U 0.1%, unspecified functional bowel disorder 10.7%, postprandial distress syndrome 2.2%, and epigastric pain syndrome 0.3%. Rome III IBS prevalence; IBS‐C 3.0%, IBS‐D 3.1%, IBS‐M 2.7%, and IBS‐U 0.6%. Comparison among Rome IV IBS (n = 54), Rome III IBS (n = 197), other DGBI (n = 746), others (n = 1389) revealed significant order as Rome IV IBS > Rome III IBS > other DGBI > others in IBS‐SSS, anxiety/depression, activity impairment, non‐GI symptoms, physical QOL, mental QOL, exacerbated symptoms by meals and perceived stress (all p < 0.001).

Conclusions & Inferences

These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut–brain psychobehavioral involvement than Rome III IBS.
Searching for inclusive artificial intelligence for social good: Participatory governance and policy recommendations for making AI more inclusive and benign for society
Authors: Moon M. Jae
Published: April 2023

While artificial intelligence (AI) has begun to transform individual lives, business operations, and public services, there has been a lack of discussion concerning its role in contributing to social good. Both academic research and practical evidence have often compellingly predicted and suggested AI's potential impact on the labor market, industry, and services, as well as the risks and benefits of disruptive technologies. With an emphasis on understanding the complex and uncertain nature of AI as well as the disparities in its benefits, in this article, the logic of participatory governance is examined, and it is posited that this governance is an appropriate governing mechanism for an inclusive AI that contributes to social good. This study also offers a set of policy recommendations by reviewing selected cases and the challenges that policy‐makers face at the national and global levels.
Guests or pests? Eirenid hydroids living on the soft tissue of bivalves
Authors: Di Camillo Cristina , Roveta Camilla , Mantas Torcuato Pulido , Gravili Cinzia , Cerrano Carlo , Calcinai Barbara , Coppari Martina , Gregorin Chiara , Marrocco Teo , Riccardi Agnese , Puce Stefania
Published: April 2023

Both wild and reared bivalves can host hydroids from the Eirenidae family which settle on the soft body parts of their host. Thousands of hydroids have been observed on a single bivalve, and often have severe detrimental effects on the host. However, this relationship has received little attention in aquaculture research, which is probably due to a lack of baseline data. An extensive review was conducted (i) to show the current level of knowledge on the association between eirenids and bivalves, providing a benchmark for future research; (ii) to detect a critical combination of biotic/abiotic factors that could switch the relationship from commensalism to infestation and (iii) to identify research priorities for future studies. Seventy scientific papers were screened to provide ecological information useful in understanding the hydroid‐host‐environment interactions and to show the global spatial and bathymetric distribution of the relationship. Although the main parameters influencing the hydroid abundance were identified, it was challenging to collate information from such heterogeneous data sources. A standardized method for data collection is proposed to obtain more robust and comparable data on the association. The most relevant and unstudied issue is the potential physiological and qualitative changes that could occur in infested bivalves. Monitoring the association could provide data needed to prevent or to control hyper‐proliferation of the symbionts and to detect eventual synergistic effects with climate change. This could be fundamental for species living in areas particularly prone to climate regime shifts, such as semi‐enclosed basins and estuarine habitats.
Revealing indirect risks in complex socioeconomic systems: A highly detailed multi‐model analysis of flood events in Austria
Authors: Bachner Gabriel , Knittel Nina , Poledna Sebastian , Hochrainer‐Stigler Stefan , Reiter Karina
Published: April 2023

Cascading risks that can spread through complex systems have recently gained attention. As it is crucial for decision‐makers to put figures on such risks and their interactions, models that explicitly capture such interactions in a realistic manner are needed. Climate related hazards often cascade through different systems, from physical to economic and social systems, causing direct but also indirect risks and losses. Despite their growing importance in the light of ongoing climate change and increasing global connections, such indirect risks are not well understood. Applying two fundamentally different economic models—a computable general equilibrium model and an agent‐based model—we reveal indirect risks of flood events. The models are fed with sector‐specific capital stock damages, which constitutes a major methodological improvement. We apply these models for Austria, a highly flood exposed country with strong economic linkages. A key finding is that flood damages pose very different indirect risks to different sectors and household groups (distributional effects) in the short and long‐term. Our results imply that risk management should focus on specific societal subgroups and sectors. We provide a simple metric for indirect risk, showing how direct and indirect losses are related. This can provide new ways forward in risk management, for example, focusing on interconnectedness of sectors and agents within different risk‐layers of indirect risk. Although we offer highly relevant leverage points for indirect risk management in Austria, the methodology of analyzing indirect risks can be transferred to other regions.
Psychosocial safety climate: Measurement and relationship with well‐being in a four‐wave longitudinal study during remote work
Authors: Juutinen Soile , Sjöblom Kirsi , Dollard Maureen F. , Mäkikangas Anne
Published: April 2023

To create healthy workplaces, organizations need tools for assessing factors contributing to employee well‐being. Psychosocial safety climate (PSC) refers to shared perceptions regarding the extent to which psychological health and safety are prioritized in organizations; it is operationalized in the PSC scale. We evaluated the factor structure of the Finnish version of the PSC‐4 scale, its invariance across time and concurrent and predictive relationships with perceived stress, job exhaustion, and work engagement. Moreover, the mean‐level changes in PSC and well‐being during enforced remote work were studied. Participants were 442 higher education employees who completed a well‐being survey four times between April 2020 and February 2021. The longitudinal factor structure of the PSC‐4 and well‐being indicators were investigated using confirmatory factor analysis and structural equation modeling. The statistical analyses supported the one‐factor structure of the PSC‐4 and its measurement invariance across time. PSC was negatively associated with concurrent stress and job exhaustion and positively associated with concurrent work engagement at each measurement. Moreover, PSC predicted subsequent stress between each time point. Cross‐lagged effects were also evident for job exhaustion at T2–T3 and T3–T4 and for work engagement at T1–T2. The mean level of PSC decreased during enforced remote work. To conclude, the Finnish PSC‐4 is a valid tool for evaluating perceived psychosocial safety climate in organizations. PSC predicted well‐being over time and showed subsequent relationships with job exhaustion and work engagement, which is a new contribution to PSC theory and literature. Organizations need to design interventions to improve it, especially during stressful times.
Non-linear Effects of Trade Openness on Economic Growth
Authors: ONDAYE William Geslin
Published: April 2023

This paper analyzes the effects of trade openness on economic growth in a panel of thirty developed and developing countries. The fixed effects model was estimated using the PSTR technique on data covering the period 1980-2019. The results show that the relationship between trade openness and economic growth is non-linear, and that the effects of external openness on growth depend on the thresholds of national income per capita. Below the estimated national income threshold of 35 118 USD per capita, trade openness has no significant effect on economic growth. Above this threshold, trade openness contributes positively to economic growth. It is suggested that the political authorities implement policies that contribute to increasing national income and improving purchasing power
The Family Role in Adolescents Protection: Evidence from Pre and Amid Covid-19 in Qatar
Authors: Al-Emadi Sharifa , Aref Ahmed , AlFara Heba
Published: April 2023

Evidence from different regions confirms that parents are playing a larger role in protecting their children from behavioral deviations. The family unit, when functioning well, represents a responsible and healthy environment for child development. Despite the importance given to this relational nexus, evidence from the MENA region remains limited in this regard, especially among the adolescent age group. Through quantitative evidence collected from adolescents themselves, this article explores the role that parents play in adolescent protection, investigating the risk and protective factors before and during Covid-19 in Qatar. Periodical comparative analysis is meant to provide scientific measurement on how Covid-19 positively and negatively impacted parental functions and adolescents’ attitudes. Results confirm enhanced quality parenting, reduced domestic violence, better relational ties and parental emotional support, yet evidence raises concern on digital addiction and fatherhood engagement.
Analytical Investigation of Surface Temperatures for Different Sized CubeSats at Varying Low Earth Orbits
Authors: Atar Cihan , Aktaş Metin , Sözbir Nedim , Bulut Murat
Published: April 2023

Thermal management is a challenging engineering problem for CubeSats due to the limited available volumes restricting the thermal control applications. Therefore, performing thermal modeling and analyses of these small satellites is very crucial for applying proper thermal control measures to maintain safe operating conditions in space. Despite the growing interest in this field, there are still a limited number of studies investigating the thermal behavior of CubeSats. In this paper, surface temperature profiles of 1U, 2U, 3U, 5U, 6U, and 12U sized CubeSats are simulated for varying low earth orbits. The effects of altitudes changing from 400 km to 2000 km and the beta angles changing from 0 to 75 deg are analytically investigated. Not only the coatings with different absorptance and emissivity values but also different amounts of internal heat dissipations are examined to reveal their impact on the thermal balance of satellites. Results demonstrate surface temperatures are highly dependent on those variables. The amount of heat absorbed by satellite panels is affected by the different sizes of CubeSats, different coating properties of panels, and different orbital configurations. The outcomes of this research may be beneficial especially in the early design phase for designing small satellites and selecting proper orbital configurations.
Resistance to Fluconazole of Candida albicans in Vaginal Isolates: a 10-Year Study in a Clinical Referral Center
Authors: Sobel J. D.
Published: April 2023

Review of vaginal isolates of
Candida albicans
that caused clinical failure in a 10-year collection of vaginal
C. albicans
specimens obtained in a university vaginitis referral clinic indicated an increase in fluconazole resistance. Factors contributing to azole resistance are discussed, including treatment choice associated with fluconazole-resistant
C. albicans
vaginal infection.
Prospective Performance Evaluation of the miDiagnostics COVID-19 PCR Test for Rapid SARS-CoV-2 Detection on Nasopharyngeal Swabs
Authors: Bos David A. G. , Lagrou Katrien , Verbakel Jan Y.
Published: April 2023

Rapid diagnosis or exclusion of SARS-CoV-2 infection is essential for correct medical management decisions regarding COVID-19. High-throughput laboratory-based reverse transcriptase (RT)-PCR testing is accurate with longer turnaround times, while rapid antigen tests show moderate sensitivity.
Characterization of Lung and Oral Microbiomes in Lung Cancer Patients Using Culturomics and 16S rRNA Gene Sequencing
Authors: Sun Yifan , Liu Yuejiao , Li Jianjie , Tan Yafang , An Tongtong , Zhuo Minglei , Pan Zhiyuan , Ma Menglei , Jia Bo , Zhang Hongwei , Wang Ziping , Yang Ruifu , Bi Yujing
Published: April 2023

The relationship between lung microbiota and cancer has been explored based on DNA sequencing; however, culture-dependent approaches are indispensable for further studies on the lung microbiota. In this study, we applied a comprehensive approach combining culturomics and 16S rRNA gene amplicon sequencing to detect members of the microbiotas in saliva and BALF samples from patients with unilateral lobar masses.
Exosome-Based Multivalent Vaccine: Achieving Potent Immunization, Broadened Reactivity, and Strong T-Cell Responses with Nanograms of Proteins
Authors: Cacciottolo Mafalda , Nice Justin B , Li Yujia , LeClaire Michael J. , Twaddle Ryan , Mora Ciana L. , Adachi Stephanie Y. , Chin Esther R. , Young Meredith , Angeles Jenna , Elliott Kristi , Sun Minghao
Published: April 2023

The pandemic emergency has brought to light the need for a new generation of rapidly developed vaccines that induce longer-lasting, potent, and broader immune responses. While the mRNA vaccines played a critical role during the emergency in reducing SARS-CoV-2 hospitalization rates and deaths, more efficient approaches are needed.
Penicillin-Binding Protein Occupancy Dataset for 18 β-Lactams and 4 β-Lactamase Inhibitors in Neisseria gonorrhoeae
Authors: López-Argüello Silvia , Montaner Maria , Mármol-Salvador Amanda , Velázquez-Escudero Ana , Docobo-Pérez Fernando , Oliver Antonio , Moya Bartolome
Published: April 2023

The manuscript represents the first
N. gonorrhoeae
PBP-binding data set for 22 chemically different drugs in two type strains with different genetic background. We have identified three clusters of drugs according to their PBP binding IC
50
s and highlighted the binding differences across the two strains studied.
Azithromycin Exposure Induces Transient Microbial Composition Shifts and Decreases the Airway Microbiota Resilience from Outdoor PM
2.5
Stress in Healthy Adults: a Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Du Sisi , Shang Lianhan , Zou Xiaohui , Deng Xiaoyan , Sun Aihua , Mu Shengrui , Zhao Jiankang , Wang Yimin , Feng Xiaoxuan , Li Binbin , Wang Chunlei , Liu Shuai , Lu Binghuai , Liu Yingmei , Zhang Rongrong , Tong Yigang , Cao Bin
Published: April 2023

The influence of antibiotic administration on the airway microbiota of healthy adults remains unknown. This study is a randomized, double-blind, placebo-controlled trial aiming to investigate the microbial shifts in airways after exposure to azithromycin among heathy adults.
Time-varying association between cigarette and ENDS use on incident hypertension among US adults: a prospective longitudinal study
Authors: Cook Steven , Hirschtick Jana L , Barnes Geoffrey , Arenberg Douglas , Bondarenko Irina , Patel Akash , Jiminez Mendoza Evelyn , Jeon Jihyoun , Levy David , Meza Rafael , Fleischer Nancy L
Published: April 2023

Objective

Electronic nicotine delivery systems (ENDS) products have emerged as the most popular alternative to combustible cigarettes. However, ENDS products contain potentially dangerous toxicants and chemical compounds, and little is known about their health effects. The aim of the present study was to examine the prospective association between cigarette and ENDS use on self-reported incident hypertension.

Design

Longitudinal cohort study.

Setting

Nationally representative sample of the civilian, non-institutionalised population in the USA.

Participants

17 539 adults aged 18 or older who participated at follow-up and had no self-reported heart condition or previous diagnosis of hypertension or high cholesterol at baseline.

Measures

We constructed a time-varying tobacco exposure, lagged by one wave, defined as no use, exclusive established use (every day or some days) of ENDS or cigarettes, and dual use. We controlled for demographics (age, sex, race/ethnicity and household income), clinical risk factors (family history of heart attack, obesity, diabetes and binge drinking) and smoking history (cigarette pack-years).

Outcomes

Self-reported incident hypertension diagnosis.

Results

The self-reported incidence of hypertension was 3.7% between wave 2 and wave 5. At baseline, 18.0% (n=5570) of respondents exclusively smoked cigarettes; 1.1% (n=336) exclusively used ENDS; and 1.7% (n=570) were dual users. In adjusted models, exclusive cigarette use was associated with an increased risk of self-reported incident hypertension compared with non-use (adjusted HR (aHR) 1.21, 95% CI 1.06 to 1.38), while exclusive ENDS use (aHR 1.00, 95% CI 0.68 to 1.47) and dual use (aHR 1.15, 95% CI 0.87 to 1.52) were not.

Conclusions

We found that smoking increased the risk of self-reported hypertension, but ENDS use did not. These results highlight the importance of using prospective longitudinal data to examine the health effects of ENDS use.
Acupuncture for protracted amphetamine abstinence syndrome: study protocol for a systematic review and meta-analysis
Authors: Zhang Su , Luo Jun , Zeng YiWei , Ren Huan , Chen Zhihan , Ren Yulan
Published: April 2023

Introduction

Amphetamine-type stimulants (ATSs) are presenting a great challenge to global public health along with its worldwide abuse in recent years. Protracted amphetamine abstinence syndrome (PAAS) is one of the primary causes of relapse for ATS abusers during withdrawal. However, different conclusions are reached by previous trials. This study is designed to evaluate the efficacy and safety of acupuncture in treating PAAS.

Methods and analysis

Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Dissertation and Theses, Allied and Complementary Medicine Database (AMED), ClinicalTrials.gov and who.int/trialsearch will be searched from the inception to February 2023 and language will be restricted to English and Chinese. Eligible randomised controlled trials will be included. The primary outcome is the intensity of withdrawal syndrome. The secondary outcomes include: (1) intensity of pain, anxiety, depression and other associated symptoms; (2) number of participants with relapse; (3) retention of treatment and (4) nature and rate of adverse effects. Data synthesis will be performed by using RevMan (V.5.4). The quality of evidence will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluation approach. This study will strictly adhere to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Ethics and dissemination

Ethical approval is not required as this is a systematic review and meta-analysis based on previously published studies that do not involve patients’ privacy. The results of this study will be disseminated in a peer-reviewed journal.

PROSPERO registration number

CRD42022297761.
Understanding potential participation barriers to improve trial design and outcomes: clinical trial simulation in palmoplantar pustulosis as a case study
Authors: Boisvert-Huneault Christian , Trigos Herraez David , Pinter Andreas , Kobayashi Satomi , Bell Stacie , Kallsen Kimberley , Gloede Tristan , Yagi Nobutaka , Brunette Steven , Datsenko Yakov , Baehner Frank , Clerisme-Beaty Emmanuelle , Van de Kerkhof Peter
Published: April 2023

Objectives

Evaluate the experiences and perceptions of patients participating in a simulated clinical trial and identify ways to enhance future patient-centric trial designs.

Design

International, multicentre, non-interventional, virtual clinical trial visits with patient debriefs and advisory boards.

Setting

Virtual clinic visits and accompanying advisory boards.

Participants

Nine patients with palmoplantar pustulosis for simulated trial visits; 14 patients and patient representatives for advisory boards.

Main outcome measures

Qualitative responses to trial documentation, visit schedule and logistics, and trial design were collected during patient debriefs. Results were discussed at two virtual advisory board meetings.

Results

Patients identified key barriers to participation and potential difficulties encountered when attending trial visits and completing assessments. They also proposed recommendations to overcome these challenges. Patients recognised the need for comprehensive informed consent forms, but recommended use of non-technical language, brevity and additional support to aid understanding. Other trial documentations should be relevant to the disease and include known efficacy and safety of the study drug. Patients were concerned about receiving placebo, stopping existing medications and being unable to receive the study drug after trial completion; therefore, patients and physicians recommended an open-label extension following trial completion. Trial visits were too numerous (n=20) and too long (3–4 hours each); patients recommended improvements to the design to make best use of their time and reduce unnecessary waiting. They also requested financial and logistical support. Patients expressed a desire for study outcomes that matter to them, related to their ability to undertake normal daily activities and not be a burden to others.

Conclusions

Simulated trials are an innovative method for assessing trial design and acceptance from a patient-centric perspective, enabling specific improvements to be made prior to trial initiation. Incorporation of recommendations from simulated trials could enhance trial recruitment and retention, and optimise trial outcomes and data quality.
Frequency and clinical features of radiographic head injury caused by inpatient falls: a single-centre retrospective cohort study
Authors: Tokioka Fumiaki , Okamoto Hiroshi , Shiotsu Akiko , Hashimoto Toru
Published: April 2023

Objectives

The lack of clear criteria makes it difficult for clinicians to determine which patients should be imaged after an inpatient fall. This study identified the clinical characteristics of patients who required a head CT scan following an inpatient fall.

Design

This was a retrospective cohort study conducted from January 2016 to December 2018. We obtained the data from our safety surveillance database, which record all cases of inpatient falls in our hospital.

Setting

Single-centre, tertiary, secondary care hospital.

Participants

We included all consecutive patients who claimed to have fallen and bruised their heads as well as patients who were confirmed to have a bruise on the head but were unavailable to be interviewed about the fall.

Primary and secondary outcome measures

The primary outcome was radiographic head injury revealed on head CT after a fall.

Results

Overall, 834 adult patients (662 confirmed and 172 suspected cases) were included. The median age was 76 years, and 62% were men. Patients with radiographic head injury were more likely to have a lower platelet count, consciousness disturbance and new vomiting episodes compared with those without radiographic head injury (all p<0.05). The use of anticoagulants or antiplatelets was not different between patients with and without radiographic head injury. Among the 15 (1.8%) patients with a radiographic head injury, 13 with intracranial haemorrhage had at least one of the following characteristics: received anticoagulant or antiplatelet agents, platelet count of <2.0×109/L, consciousness disturbance or new vomiting episodes. There were no deaths among patients with radiographic head injuries.

Conclusions

The incidence of radiographic head injury due to falls in adult inpatients with suspected or confirmed head injuries was 1.8%. Only patients with risk factors had radiographic head injuries, which might help reduce the number of unnecessary CT scans in inpatient falls.

Trial registration number

Study protocol (Kurashiki Central Hospital, Medical ethical committee. IRB no. 3750).
Safe shortening of antibiotic treatment duration for complicatedStaphylococcus aureusbacteraemia (SAFE trial): protocol for a randomised, controlled, open-label, non-inferiority trial comparing 4 and 6 weeks of antibiotic treatment
Authors: Buis DTP , van Werkhoven CH , van Agtmael MA , Bax HI , Berrevoets M , de Boer MGJ , Bonten MJM , Bosmans JE , Branger J , Douiyeb S , Gelinck LBS , Jong E , Lammers AJJ , Van der Meer JTM , Oosterheert JJ , Sieswerda E , Soetekouw R , Stalenhoef JE , Van der Vaart TW , Bij de Vaate EA , Verkaik NJ , Van Vonderen MGA , De Vries PJ , Prins JM , Sigaloff KCE
Published: April 2023

Introduction

A major knowledge gap in the treatment of complicatedStaphylococcus aureusbacteraemia (SAB) is the optimal duration of antibiotic therapy. Safe shortening of antibiotic therapy has the potential to reduce adverse drug events, length of hospital stay and costs. The objective of the SAFE trial is to evaluate whether 4 weeks of antibiotic therapy is non-inferior to 6 weeks in patients with complicated SAB.

Methods and analysis

The SAFE-trial is a multicentre, non-inferiority, open-label, parallel group, randomised controlled trial evaluating 4 versus 6 weeks of antibiotic therapy for complicated SAB. The study is performed in 15 university hospitals and general hospitals in the Netherlands. Eligible patients are adults with methicillin-susceptible SAB with evidence of deep-seated or metastatic infection and/or predictors of complicated SAB. Only patients with a satisfactory clinical response to initial antibiotic treatment are included. Patients with infected prosthetic material or an undrained abscess of 5 cm or more at day 14 of adequate antibiotic treatment are excluded. Primary outcome is success of therapy after 180 days, a combined endpoint of survival without evidence of microbiologically confirmed disease relapse. Assuming a primary endpoint occurrence of 90% in the 6 weeks group, a non-inferiority margin of 7.5% is used. Enrolment of 396 patients in total is required to demonstrate non-inferiority of shorter antibiotic therapy with a power of 80%. Currently, 152 patients are enrolled in the study.

Ethics and dissemination

This is the first randomised controlled trial evaluating duration of antibiotic therapy for complicated SAB. Non-inferiority of 4 weeks of treatment would allow shortening of treatment duration in selected patients with complicated SAB. This study is approved by the Medical Ethics Committee VUmc (Amsterdam, the Netherlands) and registered under NL8347 (the Netherlands Trial Register). Results of the study will be published in a peer-reviewed journal.

Trial registration number

NL8347 (the Netherlands Trial Register).
Efficacy of carbapenems versus alternative antimicrobials for treating complicated urinary tract infections caused by antimicrobial-resistant Gram-negative bacteria: protocol for a systematic review and meta-analysis
Authors: Maeda Masayuki , Hasegawa Takeshi , Noma Hisashi , Ota Erika
Published: April 2023

Introduction

Complicated urinary tract infections (cUTIs) are associated with poor prognosis. The widespread infection of multidrug-resistant Gram-negative uropathogens such as extended-spectrum beta-lactamase-producing bacteria has limited the efficacy of antibiotics used for treating cUTI. Considering the existence of antimicrobial-resistant (AMR) uropathogens, carbapenem is the last-resort antibiotic for cUTI. Given that carbapenem overuse has facilitated the spread of carbapenem-resistant Gram-negative bacteria, carbapenem dependence should be urgently reduced. However, improvement on the clinical outcomes of alternative antibiotics against cUTI caused by AMR uropathogens has not yet been systematically evaluated. Thus, this systematic review and meta-analysis aims to explore and compare the clinical outcomes of cUTI caused by AMR uropathogens between carbapenem and non-carbapenem antibiotics.

Methods and analysis

The study inclusion criteria will be considered based on the PICO model consisting the following elements: population—adult patients with cUTIs caused by Gram-negative uropathogens; intervention—non-carbapenem class of antimicrobial agents with in vitro activities against Gram-negative uropathogens; comparison—treatment of carbapenem class antibiotics; outcome—a clinical and microbiological cure. Relevant articles published until December 2022 will be systematically searched in February 2023, using electronic databases such as PubMed, the Cochrane Library, EMBASE and ClinicalTrials.gov. Two independent reviewers will screen the select literature and then assess the full-text article to meet the inclusion criteria. The risk of bias will be assessed using the Cochrane risk-of-bias assessment tool. The treatment effects of antibiotics will be estimated as a risk ratio with a 95% CI, using the random-effects model.

Ethics and dissemination

This protocol and systematic review will not include direct patient data; thus, informed consent will be waived. The results of this study will be published in an international peer-reviewed journal for wider information dissemination.

PROSPERO registration number

CRD42022356064.
Understanding the experience in the healthcare system of non-migrant and migrant frequent users of the emergency department in French-speaking Switzerland: a comparative qualitative study
Authors: Cariello Carmen , Grazioli Véronique S , Nikles Justin , Schmutz Elodie , Hugli Olivier , Bodenmann Patrick
Published: April 2023

Background

Previous research revealed the vulnerability of frequent users of emergency department (FUED) because of concomitant medical, psychological and social issues. Case management (CM) provides FUED with effective medical and social support, however, the heterogeneity of this population has highlighted the need to explore the specific needs of FUED subpopulations. In response, this study aimed to explore qualitatively the lived experience of migrant and non-migrant FUED in the healthcare system to identify unmet needs.

Methods

Adult migrant and non-migrant FUED (≥ 5 visits in the ED in the past 12 months) were recruited in a Swiss university hospital to collect qualitative data on their experience within the Swiss health system. Participants were selected based on predefined quotas for gender and age. Researchers conducted one-on-one semistructured interviews until reaching data saturation. Inductive conventional content analysis was used to analyse qualitative data.

Results

In total, 23 semistructured interviews were conducted (11 migrant FUED and 12 non-migrant FUED). Four main themes emerged from the qualitative analysis: (1) self-evaluation of the Swiss healthcare system; (2) orientation within the healthcare system; (3) relationship with caregivers and (4) perception of own health. While both groups were overall satisfied with the healthcare system and care provided, migrant FUED reported language and financial barriers to access it. Both groups expressed overall satisfaction over their relationship with healthcare professionals, although migrant FUED reported a feeling of illegitimacy to consult the ED based on social status, whereas non-migrant FUED felt more often the need to justify their use of the ED. Finally, migrant FUED perceived their own health to be affected by their status.

Conclusion

This study highlighted difficulties specific to subpopulations of FUED. For migrant FUED, these included access to care and impact of migrant status on own health. Adapting CM to the specific needs of migrant FUED could help reduce their vulnerability.
Global prevalence of hospital admissions for low back pain: a systematic review with meta-analysis
Authors: Melman Alla , Lord Harrison J , Coombs Danielle , Zadro Joshua , Maher Christopher G , Machado Gustavo C
Published: April 2023

Objectives

To determine the proportion of low back pain presentations that are admitted to hospital from the emergency department (ED), the proportion of hospital admissions due to a primary diagnosis of low back pain and the mean hospital length of stay (LOS), globally.

Methods

We searched MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO and LILACS from inception to July 2022. Secondary data were retrieved from publicly available government agency publications and international databases. Studies investigating admitted patients aged >18 years with a primary diagnosis of musculoskeletal low back pain and/or lumbosacral radicular pain were included.

Results

There was high heterogeneity in admission rates for low back pain from the ED, with a median of 9.6% (IQR 3.3–25.2; 9 countries). The median percentage of all hospital admissions that were due to low back pain was 0.9% (IQR 0.6–1.5; 30 countries). The median hospital LOS across 39 countries was 6.2 days for ‘dorsalgia’ (IQR 4.4–8.6) and 5.4 days for ‘intervertebral disc disorders’ (IQR 4.1–8.4). Low back pain admissions per 100 000 population had a median of 159.1 (IQR 82.6–313.8). The overall quality of the evidence was moderate.

Conclusion

This is the first systematic review with meta-analysis summarising the global prevalence of hospital admissions and hospital LOS for low back pain. There was relatively sparse data from rural and regional regions and low-income countries, as well as high heterogeneity in the results.