bluuebunny/crossref_metadata_2025 huggingface dataset:
Pop‐up screening nested within routine community activities unmasks an addressed cardiovascular risk: A pilot study (Gippsland Healthy Heart Study)
Authors: Fujino Masashi , Butters Julie , Boyes Mark , Duncan Noel , Streets Fleur , Sabatini Amy , Herschtal Alan , Nelson Adam J. , Nicholls Stephen J.
Published: September 2023

Objective

To evaluate the benefits of a pop‐up health screening for cardiovascular risk factors (CVRF) in the Gippsland region, and to assess the acceptability of the screening and to determine whether such a process results in attendance at a general practitioner (GP).

Participants

Overall, 454 participants over the age of 18 who were residents of the Gippsland region were enrolled.

Methods

This is a community‐based, observational, prospective cohort study using pop‐up screening sites at six retail locations or workplaces, where participants' blood pressure, body weight and lipid profile were measured. The primary outcome was to assess the proportion of participants with at least one unaddressed CVRF (hypertension [blood pressure >140/90 mmHg], overweight and obesity [body mass index >25 kg/m2] or hypercholesterolaemia [low‐density lipoprotein cholesterol >2.5 mmol/L]). Email surveys were performed after 4 weeks of follow‐up.

Results

Overall, 85.8% (95% confidence interval [CI], 82.1%–88.8%) of participants had at least one unaddressed CVRF. Among the 54 participants who responded to the email survey, 50 participants (92.6% [95% CI, 81.3%–97.6%]) found the screening approach acceptable, and 31 (57.4% [95% CI, 43.3%–70.5%]) considered a discussion with the GP.

Conclusions

This study supported the feasibility and effectiveness of pop‐up screening to detect CVRF in rural communities.
Universal cervical length screening for preterm birth is not useful after 24 weeks of gestation
Authors: Seravalli Viola , Abati Isabella , Strambi Noemi , Tofani Lorenzo , Tucci Claudia , Tartarotti Enrico , Di Tommaso Mariarosaria
Published: September 2023

Introduction

Cervical length measurement using transvaginal sonography at 18+0–24+0 weeks of gestation is used to identify women at risk of preterm delivery, who may benefit from treatment with progesterone to prevent premature birth. Few and conflicting data exist regarding the predictive value of cervical length measurement performed at later gestational ages. The primary objective of this study was to evaluate the predictive accuracy for spontaneous preterm birth of a single cervical length measurement performed between 24 and 32 weeks of gestation in asymptomatic singleton pregnancies at low risk for spontaneous preterm birth. The secondary objective was to test the predictive accuracy of different cervical length thresholds in the same population.

Material and methods

This was a historical cohort study conducted in a tertiary referral hospital. A total of 2728 asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth were recruited. Of these women, 1548 had cervical length measured at 24+0–27+6 weeks of gestation and 2191 women at 28+0–32+0 weeks. In all, 1010 women were present in both gestational age windows. Maternal demographics, medical and obstetrical history, and pregnancy outcome were reviewed. The predictive value of cervical length for spontaneous preterm birth was evaluated through logistic regression analysis. Results were adjusted for confounding factors.

Results

Overall, spontaneous preterm birth occurred in 53/2728 women (1.9%). In both the 24+0–27+6 and 28+0–32+0 weeks groups, a shorter cervical length was significantly associated with spontaneous preterm birth (p < 0.01), but it had a low predictive value, as shown by the receiver operating characteristics curve analysis (areas under the curve 0.62, 95% CI 0.50–0.74 for the 24+0–27+6 weeks group, and 0.61, 95% CI 0.52–0.70 in the 28+0–32+0 weeks group). When the predictive accuracy for preterm delivery of different cervical length cut‐offs was evaluated, the sensitivity and positive predictive value were low in both gestational age windows, irrespective of the threshold used.

Conclusions

In asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth, the predictive value of cervical length after 24+0 weeks of gestation is low. Therefore, cervical length screening in these women should be discouraged.
Complement in immune thrombocytopenia (ITP): The role of complement in refractory ITP
Authors: Weitz Ilene Ceil , Liebman Howard Allen
Published: September 2023

Immune thrombocytopenia (ITP) is a disorder characterized by low platelets due to increased clearance and decreased platelet production. While ITP has been characterized as an acquired disorder of the adaptive immune system, the resulting platelet autoantibodies provide ancillary links to the innate immune system via antibody interaction with the complement system. Most autoantibodies in patients with ITP are of the IgG1 subclass, which can be potent activators of the classical complement pathway. Antibody‐coated platelets can initiate complement activation via the classical pathway leading to both direct platelet destruction and enhanced clearance of C3b‐coated platelets by complement receptors. Similar autoantibody interactions with bone marrow megakaryocytes can also result in complement injury and ineffective thrombopoiesis. The development of novel therapeutic complement inhibitors has revived interest in the role of complement in autoantibody‐mediated disorders, such as ITP. A recent early‐phase clinical trial of a classical complement pathway inhibitor has demonstrated efficacy in a subset of ITP patients refractory to conventional immune modulation. In this review, we will analyse the role of complement in refractory ITP.
Immunomodulation with romiplostim as a second‐line strategy in primary immune thrombocytopenia: The iROM study
Authors: Schifferli Alexandra , Rüfer Axel , Rovo Alicia , Nimmerjahn Falk , Cantoni Nathan , Holbro Andreas , Favre Geneviève , Dirks Jan , Wieland Anna , Faeth Heike , Pereira Renata , Kühne Thomas
Published: September 2023

Thrombopoietin receptor agonists (TPO‐RAs) stimulate platelet production, which might restore immunological tolerance in primary immune thrombocytopenia (ITP). The iROM study investigated romiplostim's immunomodulatory effects. Thirteen patients (median age, 31 years) who previously received first‐line treatment received romiplostim for 22 weeks, followed by monitoring until week 52. In addition to immunological data, secondary end‐points included the sustained remission off‐treatment (SROT) rate at 1 year, romiplostim dose, platelet count and bleedings. Scheduled discontinuation of romiplostim and SROT were achieved in six patients with newly diagnosed ITP, whereas the remaining seven patients relapsed. Romiplostim dose titration was lower and platelet count response was stronger in patients with SROT than in relapsed patients. In all patients, regulatory T lymphocyte (Treg) counts increased until study completion and the counts were higher in patients with SROT. Interleukin (IL)‐4, IL‐9 and IL‐17F levels decreased significantly in all patients. FOXP3 (Treg), GATA3 (Th2) mRNA expression and transforming growth factor‐β levels increased in patients with SROT. Treatment with romiplostim modulates the immune system and possibly influences ITP prognosis. A rapid increase in platelet counts is likely important for inducing immune tolerance. Better outcomes might be achieved at an early stage of autoimmunity, but clinical studies are needed for confirmation.
Novel therapeutics and future directions for refractory immune thrombocytopenia
Authors: Al‐Samkari Hanny , Neufeld Ellis J.
Published: September 2023

Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder affecting approximately 1 in 20 000 people. While most patients with ITP are successfully managed with the current set of standard and approved therapeutics, patients who cannot be adequately managed with these therapies, considered to have refractory ITP, are not uncommon. Therefore, there remains an ongoing need for novel therapeutics and drug development in ITP. Several agents exploiting novel targets and mechanisms in ITP are presently under clinical development, with trials primarily recruiting heavily pretreated patients and those with otherwise refractory disease. Such agents include the neonatal Fc receptor antagonist efgartigimod, the Bruton tyrosine kinase inhibitor rilzabrutinib, the complement inhibitors sutimlimab and iptacopan and anti‐CD38 monoclonal antibodies such as daratumumab and mezagitamab, among others. Each of these agents exploits therapeutic targets or other aspects of ITP pathophysiology currently not targeted by the existing approved agents (thrombopoietin receptor agonists and fostamatinib). This manuscript offers an in‐depth review of the current available data for novel therapeutics in ITP presently undergoing phase 2 or 3 studies in patients with heavily pretreated or refractory ITP. It additionally highlights the future directions for drug development in refractory ITP, including discussion of innovative clinical trial designs, health‐related quality of life as an indispensable clinical trial end‐point and balancing potential toxicities of drugs with their potential benefits in a bleeding disorder in which few patients suffer life‐threatening bleeding.
Chronic refractory immune thrombocytopenia in adolescents and young adults
Authors: Schifferli Alexandra , Le Gavrian Gautier , Aladjidi Nathalie , Moulis Guillaume , Godeau Bertrand , Kühne Thomas
Published: September 2023

Defining immune thrombocytopenia (ITP) in two age groups—children and adults—overlooks the specific clinical features and needs of adolescents and young adults (AYAS). We previously reported a high risk of chronic disease at 12 months (50%); however, data on the course of chronic ITP, the risk of refractoriness and treatment strategies in AYAS are limited. Data from patients aged 12–25 years with chronic primary ITP at 12 months were extracted from three large registries between 2004 and 2021. Clinical and laboratory data were evaluated until 48 months of follow‐up (FU). Refractory ITP was defined as the administration of ≥3 different lines of therapy. A total of 427 AYAS (64% female) with chronic ITP were included. Overall, 7% and 14% were classified as ‘refractory’ at 12 and 48 months of FU respectively. The proportion of males was greater in the refractory group than in the non‐refractory group (43% vs. 35%). AYAS with refractory disease displayed lower median platelet counts, more bleeding and a higher need for treatment at initial diagnosis and FU than non‐refractory patients. This study reveals that refractory ITP is uncommon in AYAS; however, AYAS with refractory ITP display a high disease burden at all time points, including at initial diagnosis.
Early child development and its determinants: Findings from a large cohort of healthy children growing up in a low‐risk environment
Authors: Kappelt Jonas , Meigen Christof , Schild Clara Elise , Kiess Wieland , Poulain Tanja
Published: September 2023

Background

Despite numerous studies on early child development, there is still much to be discovered about the significance of possible risk factors. This study examines cognitive, motor, and language development of healthy children growing up in a low‐risk environment and how various individual and environmental factors are associated with it. The study also considers whether the importance of particular parameters changes depending on child age.

Methods

Within the framework of the LIFE Child study in Leipzig, Germany, 481 children participated in a total of 832 visits between 1 and 36 months of age. Developmental status was assessed using the Third Edition of the Bayley Scales of Infant and Toddler Development. Linear regression analyses were applied to examine the associations between child development and sex, gestational age, birth weight, birth mode, overweight, height, and parental education.

Results

Mean Bayley composite scores for cognitive, language, and motor development were close to the standard value of 100. Poorer developmental outcomes were significantly associated with lower gestational age, vacuum cup/forceps birth, being overweight, small height, and lower parental education, although some of the associations became insignificant after applying multivariate models. While the association between gestational age and language development became weaker with advancing age, our interaction models found disparities related to parental education to become more apparent in older children across all three domains of early child development.

Conclusions

Several factors were identified to be associated with early child development. As children grow older, obstetric parameters, for example, gestational age, might become less relevant compared with sociodemographic factors, for example, parental education.
Associations between socio‐demographic characteristics of pregnant women and birth outcome: The Nutritional status of Expectant Mothers and their newborn Infants study
Authors: Jordaan Elizabeth Margaretha , Joubert Gina , Robb Liska , Ngounda Jennifer , Walsh Corinna May
Published: September 2023

Background

Low socio‐economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio‐demographic variables of pregnant women and birth outcome in their offspring.

Methods

This study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio‐demographic information were completed on 682 pregnant women in a structured interview. Post‐delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio‐demographic variables and birth outcome (defined as premature delivery or low length‐for‐age or low weight‐for‐length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p‐value of <0.15 on bivariate analysis were considered for inclusion in the model.

Results

Poor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02–0.67), and higher for women with grade 8–10 (OR 5.84, 95% CI: 1.90–17.91) or grade 10–12 (OR 4.33, 95% CI: 1.50–12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part‐time (OR 2.55, 95% CI: 1.10–5.93) versus full‐time and/or self‐employed.

Conclusion

Our findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio‐demographic risk factors that may impact on birth outcome is recommended.
Veridiction and juridiction in Confessions of the Flesh
Authors: Clements Niki Kasumi
Published: September 2023

In an archived draft at the Bibliothèque nationale de France, Foucault describes two questions haunting him since 1963: “Why are we obliged to tell the truth about ourselves? Which truth?” Foucault poses these two questions in 1980 in drafts for his lectures at the University of California, Berkeley, and I see in these two questions two argumentative threads that weave through Foucault's changing History of Sexuality series over his last decade. These two threads correspond to the dimorphism Foucault frames in Part III of Confessions of the Flesh between confessing monks and married men, that correlates with the distinction between “veridiction” and “juridiction” as two forms relating subjectivity and sexuality. To help tease out these threads, I make two recommendations for how to read Confessions of the Flesh in this following review essay: (1) situate Confessions of the Flesh in relation to Foucault's History of Sexuality series which spans his last decade from 1974 to 1984 and (2) untangle two major threads of Confessions of the Flesh in Foucault's treatment of Cassian and Augustine, as progenitors of veridiction and juridiction respectively, which together produce the conditions for modern disciplinary subjects.
Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity
Authors: Nikles Florence , Kerkeni Hassen , Zamaro Ewa , Korda Athanasia , Wagner Franca , Sauter Thomas C. , Kalla Roger , Morrison Miranda , Mantokoudis Georgios
Published: September 2023

Background and purpose

Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross‐sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes.

Methods

As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms.

Results

Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory.

Conclusions

A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
Frailty is associated with the clinical expression of neuropsychological deficits in older adults
Authors: Canevelli Marco , Wallace Lindsay M. K. , Bruno Giuseppe , Cesari Matteo , Rockwood Kenneth , Ward David D.
Published: September 2023

Background and purpose

The aim was to determine whether frailty is associated with the relationship between neuropsychological markers and global cognition in older adults.

Methods

Cross‐sectional analyzes were conducted of baseline data from three large cohort studies: National Alzheimer's Coordinating Center (NACC), Rush Memory and Aging Project (MAP) and Alzheimer's Disease Neuroimaging Initiative (ADNI). Studies recruited North American participants along the spectrum of cognitive functioning (44% no cognitive impairment at baseline). A frailty index was computed in each dataset. Frailty indices, neuropsychological tests (including measures of processing speed, episodic, semantic and working memory) and Mini‐Mental State Examination (MMSE) scores were the variables of interest, with age, sex, education and apolipoprotein E ε4 evaluated as confounders.

Results

Across all studies, 23,819 participants aged 55–104 (57% female) were included in analyzes. Frailty index scores were significantly and inversely associated with MMSE scores and significantly moderated relationships between neuropsychological test scores and MMSE scores. In participants with higher frailty index scores, lower neuropsychological test scores were more strongly associated with lower MMSE scores (standardized interaction coefficients ranged from −0.19 to −1.17 in NACC, −0.03 to −2.27 in MAP and −0.04 to −0.38 in ADNI, depending on the neuropsychological test). These associations were consistent across the different databases and were mostly independent of the composition of frailty indices (i.e., after excluding possible symptoms of dementia).

Conclusions

Amongst older Americans, frailty is associated with the cognitive expression of neuropsychological deficits. Implementation of frailty assessment in routine neurological and neuropsychological practice should be considered to optimize care outcomes for older adults.
Predicting mild cognitive impairment in older adults: A machine learning analysis of the Alzheimer's Disease Neuroimaging Initiative
Authors: Wu Yafei , Wang Xing , Fang Ya
Published: September 2023

Aim

Mild cognitive impairment (MCI) in older adults is potentially devastating, but an accurate prediction model is still lacking. We hypothesized that neuropsychological tests and MRI‐related markers could predict the onset of MCI early.

Methods

We analyzed data from 306 older adults who were cognitive normal (CN) attending the Alzheimer's Disease Neuroimaging Initiative sequentially (474 pairs of visits) within 3 years. There were 231 pairs of MCI conversion (CN to MCI), and 242 pairs of CN maintenance (CN to CN). Variables on demographic, neuropsychological tests, genetic, and MRI‐related markers were collected. Machine learning was used to construct MCI prediction models, comparing the area under the receiver operating characteristic curve (AUC) as the primary metric of performance. Important predictors were ranked for the optimal model.

Results

The baseline age of the study sample was 74.8 years old. The best‐performing model (gradient boosting decision tree) with 13 variables predicted MCI with an AUC of 0.819, and the rank of variable importance showed that intracranial volume, hippocampal volume, and score from task 4 (word recognition) of the Alzheimer's Disease Assessment Scale were important predictors of MCI.

Conclusions

With the help of machine learning, fewer neuropsychological tests and MRI‐related markers are required to accurately predict MCI within 3 years, thereby facilitating targeted intervention. Geriatr Gerontol Int 2024; 24: 96–101.
Invasive stratified mucin‐producing carcinoma (ISMC) of the cervix: a clinicopathological and molecular analysis of 59 cases with special emphasis on histogenesis and potential therapeutic targets
Authors: Yao Yeli , Wang Yan , Ye Lei , Lu Bingjian , Lu Weiguo
Published: September 2023

Aims

This study aimed to better characterize the clinical and molecular features in invasive stratified mucin‐producing carcinoma (ISMC), an uncommon aggressive subtype of endocervical adenocarcinoma (EAC).

Methods and Results

We recruited 59 ISMC for clinicopathological analysis, immunohistochemistry (n = 56), and targeted next‐generation sequencing (n = 17). Our cases contained 29 pure and 30 mixed‐type ISMC. Five patients developed local recurrence at 6–32 months (median: 13 months), and died of disease at 16–55 months (median: 16 months). Pure and mixed‐type ISMC showed no significant difference in overall survival and tumour relapse (P > 0.05) except larger tumour size in the pure‐type (P = 0.009). Compared to the usual‐type EAC (n = 217), ISMsC were more frequently associated with large tumour size (P = 0.003), advanced FIGO stage (P = 0.017), lymph node metastasis (P = 0.022), Silva pattern C (P < 0.001), and poor overall survival and short tumour recurrence. SOX2 expression was observed in 82.1% (46/56) ISMC, substantially higher than p63 expression (P < 0.001), while positive SOX17 was present in 3.6% (2/56) cases. PD‐L1 was positive in 41/56 ISMC (73.21%) (combined positive score: range: 1–92, median: 22). Three ISMC patients (17.65%) had PIK3CA mutations, while one each (5.88%) patient harboured an ERBB2, TP53, STK11, and PTEN mutation, respectively.

Conclusion

We conclude that ISMC is clinically more aggressive than the usual‐type EAC. ISMC may originate from cervical reserve cells with bidirectional differentiation. PD‐L1 overexpression and the molecular profiles raise the possibility that a subset of ISMC patients may benefit from anti‐PD‐L1 immunotherapy and other targeted therapy, such as mTOR inhibitor and T‐DM1.
Effect of ZrSnO4 solid solution on the crystallization behavior of Li2O–Al2O3–SiO2 glasses
Authors: Kajihara Takato , Hijiya Hiroyuki , Yoshida Satoshi , Ninomiya Kakeru , Nishibori Maiko , Saito Hikaru , Fujino Shigeru , Hata Satoshi
Published: September 2023

Herein, the crystallization behavior of a Li2O–Al2O3–SiO2 (LAS) glass system with the addition of ZrO2 and SnO2 as nucleating agents was investigated using X‐ray diffraction, differential scanning calorimetry, four‐dimensional scanning transmission electron microscopy, and X‐ray absorption fine‐structure measurements. At lower heat‐treatment temperatures, the addition of ZrO2 and SnO2 afforded a ZrSnO4 solid solution (SS), whereas at higher heat‐treatment temperatures, the ZrSnO4 SS decomposed, affording tetragonal ZrO2 and tetragonal SnO2. LAS‐based crystalline phases, such as β‐quartz and β‐spodumene phases SS, were formed after the formation of the ZrSnO4 SS. ZrSnO4 SS particles a few nanometers in size were present in contact with the β‐quartz SS particles a few dozen nanometers in size. This suggests that the ZrSnO4 SS served as a crystal nucleus for the β‐quartz SS, promoting its growth.
Knockout of nuclear receptor HR38 gene impairs pupal–adult development in silkworm Bombyx mori
Authors: Xu Xinyue , Pu Shangkun , Jiang Mouzhen , Hu Xiaoxuan , Wang Qing , Yu Jun , Chu Jianghong , Wei Guoqing , Wang Lei
Published: September 2023

Nuclear receptors are ligand‐regulated transcription factors that play important role in regulating insect metamorphosis through the ecdysone signalling pathway. In this study, we investigated the nuclear receptor HR38 gene in Bombyx mori (BmHR38), belonging to the NR4A subfamily. BmHR38 mRNA was highly expressed in the head and epidermis at the pupal stage. The expression of the BmHR38 gene was influenced by different doses of 20E at different times. A BmHR38 deletion mutant silkworm was generated using the clustered regularly interspaced short palindromic repeat (CRISPR)/Cas9 system. Compared with the wild‐type B. mori, the BmHR38 deletion mutant resulted in abnormal development during the pupal stage, leading to either failed eclosion or the formation of abnormal adult wings. After silencing of BmHR38 in the pupal stage, the phenotype of pupa or moth had no significant change, but it did result in reduced egg production. The mRNA levels of USP, E75 and E74 were significantly increased, while the transcript levels of FTZ‐F1 were suppressed after RNA interference. Furthermore, interference with BmHR38 also inhibited the expressions of chitin metabolism genes, including Chs1, Chs2, Chi, Chi‐h and CDA. Our results suggest that BmHR38 is essential for pupal development and pupa–adult metamorphosis in B. mori by regulating the expression of NRs and chitin metabolism genes.
Approaches for improving sexuality and sexual health care in mental health settings: A qualitative study exploring clinicians' own perspectives
Authors: Urry Kristi , Breakey Georgia R. , Scholz Brett , Chur‐Hansen Anna
Published: September 2023

There is an acknowledged professional practice gap regarding sexuality and sexual health related needs within mental health settings in Australia and internationally. Yet little is known about how clinicians can be best supported or enabled to improve sexuality‐related practice, from their own perspective. This is important, given the sensitive and complex nature of sexuality and sexual health within the context of mental distress and service provision. This article reports a follow‐up study, where mental health clinicians who participated in an initial study were invited to reflect on and discuss the (finalized) results and recommendations generated. The aim was to generate insights into the tools, strategies, and approaches participants felt would best equip and support clinicians to better incorporate sexuality and sexual health into their work. Six clinicians from three disciplines (mental health nursing, psychology, and psychiatry) participated in in‐depth interviews to reflect on a plain language summary of the initial study. Three interconnected themes were generated via reflexive thematic analysis: (1) access to knowledge and information; (2) support from peers, senior colleagues, and workplaces; and (3) enacting a focus on sexuality‐related care. These findings provide valuable insights into how clinicians may want to be supported in relation to (improving) their sexuality‐related practice. The analysis also demonstrates the importance of a multifaceted approach to improving sexuality‐related care in mental health and other health settings. This knowledge will contribute to directing future research and development of interventions, tools, strategies, or other approaches to this end.
The limits of parametric reforms in sustaining the Algerian retirement system in a context of population ageing
Authors: Flici Farid
Published: September 2023

Accelerated population ageing in Algeria threatens the financial sustainability of its pay‐as‐you‐go retirement system. Reform is a necessity, with options ranging from simple parametric reforms to important systemic changes. Prior to undertaking systemic reforms, it is worthwhile to investigate whether parametric reforms can place the system on a financially sustainable footing. In this article, we used a multi‐scenario analysis that crosses the possible reform actions with possible socioeconomic scenarios. The results show that when using the most favourable scenarios, the financial balance of the Algerian system will remain negative in the short and long term. Implementing major parametric reforms can only help reduce the deficit and make it stable over time. Thereafter, systemic reforms will have to be implemented.
Effect of fast‐track surgery on postoperative wound pain in patients with prostate cancer: A meta‐analysis
Authors: Fan Shicheng , Liu Haolin , Zhu Yuanquan , Zheng Zhiqiang , Cui Qingpeng
Published: September 2023

Fast track surgery (FTS) is widely used in many procedures and has been shown to reduce complications and accelerate recovery. However, no studies have been conducted to assess their effectiveness in treating wounds after radical prostatectomy (RP). The objective of this study was to evaluate the impact of FTS on RP. We went through 4 major databases. A study was conducted by PubMed, the Cochrane Library, Embase, and the Web of Science to determine the effect of comparison of FTS versus conventional surgery in RP on postoperative wound complications as of 1 July 2023. Based on the review of literature, data extraction and literature quality assessment, we conducted meta‐analyses with RevMan 5.3. In the course of the study, the researchers selected 6 of the 404 studies to be analysed according to exclusion criteria. Data analysis showed that the FTS method reduced the postoperative pain associated with VAS and also decreased the rate of postoperative complications in post‐surgical patients. However, there was no significant difference between FTS and conventional surgery in terms of blood loss, operation time, and postoperative infection rate. Therefore, generally speaking, FTS has less impact on postoperative complications in patients with minimal invasive prostatic cancer, but it does reduce postoperative pain and total postoperative complications.
The extended case method in nursing research: Unpacking the ‘what’, ‘why’ and ‘how’
Authors: Bayuo Jonathan , Kuug Anthony Kolsabilik
Published: September 2023

Background

The extended case method approach has been in existence for decades, albeit remains poorly utilized in nursing, though there are several phenomena of interest to the discipline that may potentially benefit from this unique approach. This provides an avenue to examine the extended case method approach and how to employ it to examine phenomena of interest to the discipline of nursing.

Objectives

To examine what the extended case method is, why it should be employed to examine phenomena of interest to nursing, highlight some studies that have employed the approach in nursing, and offer methodological guidance to support its conduct and uptake in nursing research.

Design

Discussion paper.

Findings

The extended case method emphasizes the use of a theory and focuses on discovering how underlying structures at the micro level are affected by broader social forces. This makes it a useful approach to examine how macro level theories affect vulnerable, marginalized persons, which makes it particularly useful to the discipline of nursing. The approach is flexible, and there are no strict steps to be followed, albeit three important stages are highlighted.

Discussion

The extended case method offers a unique approach to examining how policies, rules and structures come into play in phenomena of interest to the discipline of nursing. This notwithstanding, the use of this approach is resource intensive.

What does this paper contribute to the wider global clinical community?

The extended case method is a unique qualitative design applicable to examining understudied, emerging and established phenomena relevant to nursing.

The focus of the extended case method is to examine ‘what is’ and ‘what ought to be’.

Patient and public contribution

No patient or public contribution.
Assessing the reliability and validity of a health‐related quality of life instrument, CPADULT, in a Dutch sample of adults with severe disabilities who are non‐ambulatory
Authors: Zalmstra Trees A. L. , Reinders‐Messelink Heleen A. , Elema Agnes , van Gils Willemijn , van der Sluis Corry K. , van der Putten Annette A. J.
Published: September 2023

Background

A measure to provide insight regarding health‐related quality of life of adults with severe motor and intellectual disabilities was lacking. For this reason, the CPADULT was developed. This measure includes domains relating to an individual's physical, mental, and social functioning. The purpose of this study was to assess the psychometric characteristics of the CPADULT.

Method

Caregivers (n = 47; 77% female, 23% male) of individuals with severe disabilities who are non‐ambulatory completed the questionnaire. Internal consistency, test–retest reliability and construct validity were analysed.

Results

Internal consistency was adequate with Cronbach's alpha values from 0.75 to 0.95. Test–retest reliability was good, as intraclass correlation coefficient of the total score was 0.84 (domains: 0.61–0.89). Construct validity was confirmed with significant differences between subgroups of motor or intellectual abilities.

Conclusion

The CPADULT has sufficient reliability and validity as a proxy measure of health‐related quality of life for adults with severe disabilities who are non‐ambulatory.
Biases in legal decision‐making: Comparing prosecutors, defense attorneys, law students, and laypersons
Authors: Teichman Doron , Zamir Eyal , Ritov Ilana
Published: September 2023

Previous studies of judgment and decision‐making in adjudication have largely focused on juries and judges. This body of work demonstrated that legal training and professional experience sometimes affect attitudes and mitigate the susceptibility to cognitive biases, but often they do not. Relatively few experimental studies examined the decisions of prosecutors and defense lawyers, although they play a major role, especially in legal systems where prosecutors have a broad discretion in charging decisions, courts' discretion regarding sentencing is constrained, and plea bargains abound. This study directly compares laypersons, law students, and legal practitioners—including prosecutors and defense lawyers—in terms of their attitudes about the criminal justice system and their cognitive biases. It was found that the outcome bias and the anti‐inference bias influenced all groups similarly, but an irrelevant anchor only impacted the decisions of laypersons and law students, and not those of legal professionals. Prosecutors were significantly more inclined to judge a behavior as negligent and reach factual conclusions supporting a conviction. However, the hypothesis that the susceptibility of prosecutors and defense lawyers to cognitive biases would be affected by their role was not borne out. The article considers possible explanations for the reported findings, and discusses their policy implications.
The importance of assessing the safe and effective use of oral anticoagulants in older adults
Authors: Creixell Mar , Harxhi Ante
Published: September 2023

See the Reply by Semla and Steinman in this issue.
Nodal properties of the resting‐state brain functional network in childhood and adolescence
Authors: Tian Yu , Xu Gaoqiang , Zhang Jing , Chen Kuntao , Liu Songjiang
Published: September 2023

Background and Purpose

Changes in the topological properties of brain functional network nodes during childhood and adolescence can provide more detailed and intuitive information on the rules of brain development. This study aims to explore the characteristics of nodal attributes in child and adolescent brain functional networks and analyze the correlation between nodal attributes in different brain regions and age.

Methods

Forty‐two healthy volunteers aged 6‐18 years who were right‐handed primary and middle school students were recruited, and the subgroup analysis included children (6‐12 years, n = 19) and adolescents (13‐18 years, n = 23). Resting‐state functional magnetic resonance imaging data were collected using a 3.0 Tesla MRI scanner. The topological properties of the functional brain network were analyzed using graph theory.

Results

Compared with the children group, the degree centrality and nodal efficiency of multiple brain regions in the adolescent group were significantly increased, and the nodal shortest path was reduced (q<0.05, false discovery rate corrected). These brain regions were widely distributed in the whole brain and significantly correlated with age. Compared with the children group, reduced degree centralities were observed in the left dorsolateral fusiform gyrus, left rostral cuneus gyrus, and right medial superior occipital gyrus.

Conclusion

The transmission efficiency of the brain's core network gradually increased, and the subnetwork function gradually improved in children and adolescents with age. The functional development of each brain area in the occipital visual cortex was uneven and there was functional differentiation within the occipital visual cortex.
Routes to momentary self‐esteem in adolescence: Links with interpersonal perceptions of liking and personality metaperceptions within social interactions
Authors: Bleckmann Eva , Nestler Steffen , Wagner Jenny
Published: September 2023

Objective

This study provides insights into the perceptual processes contributing to positive social experiences and momentary self‐esteem in adolescents' initial social interactions.

Background

A person's self‐esteem is shaped by their social experiences. However, little is known about which interpersonal perceptions are linked to momentary self‐esteem within social interactions. Identifying two key interpersonal perceptions, we examined differential associations between an individual's meta‐liking and other‐perceptions of liking by interaction partners with momentary self‐esteem. Further, we investigated how preceding personality metaperceptions (i.e., meta‐accuracy and meta‐positivity) extended these sociometer processes.

Method

The current study used round‐robin data from N = 296 adolescents participating in a virtual group interaction. Social accuracy modeling was used to estimate meta‐accuracy and meta‐positivity of personality metaperceptions, and path models were used to test associations with interpersonal perceptions of liking and momentary self‐esteem.

Results

Two main findings emerged: First, meta‐liking was consistently related to higher momentary self‐esteem, whereas other‐perceptions of liking were not. Second, meta‐positivity of personality metaperceptions was linked to higher meta‐liking and indirectly contributed to higher momentary self‐esteem through meta‐liking.

Conclusion

These findings highlight the importance of considering different interpersonal perceptions to understand social interaction experiences.
Forecasting the long‐term impact of COVID‐19 on hepatitis C elimination plans in Italy: A mathematical modelling approach
Authors: Kondili Loreta A. , Andreoni Massimo , Aghemo Alessio , Mastroianni Claudio Maria , Merolla Rocco , Gallinaro Valentina , D'Offizi Gianpiero , Craxì Antonio
Published: September 2023

Background

Italy has a high HCV prevalence, and despite the approval of a dedicated fund for ‘Experimental screening’ for 2 years, screening has not been fully implemented. We aimed to evaluate the long‐term impact of the persisting delay in HCV elimination after the Coronavirus disease 2019 (COVID‐19) pandemic in Italy.

Methods

We used a mathematical, probabilistic modelling approach evaluating three hypothetical ‘Inefficient’, ‘Efficient experimental’ and ‘WHO Target’ screening scenarios differing by treatment rates over time. A Markov chain for liver disease progression evaluated the number of active infections, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV liver‐related deaths up to the years 2030 and 2050.

Results

The ‘WHO Target’ scenario estimated 3900 patients with DC and 600 with HCC versus 4400 and 600 cases, respectively, similar for both ‘Inefficient’ and ‘Efficient experimental’ screening up to 2030. A sharp (10‐fold) decrease in DC and HCC was estimated by the ‘WHO Target’ scenario compared with the other two scenarios in 2050; the forecasted number of DC was 420 cases versus 4200 and 3800 and of HCC <10 versus 600 and 400 HCC cases by ‘WHO Target,’ ‘Inefficient’ and ‘Efficient experimental’ scenarios, respectively. A significant decrease of the cumulative estimated number of liver‐related deaths was observed up to 2050 by the ‘WHO Target’ scenario (52000) versus ‘Inefficient’ or ‘Efficient experimental’ scenarios (79 000 and 74 000 liver‐related deaths, respectively).

Conclusions

Our estimates highlight the need to extensively and efficiently address HCV screening and cure of HCV infection in order to avoid the forecasted long‐term HCV adverse outcomes in Italy.
Health‐related quality of life in patients aged 6–18 years with chronic hepatitis C treated with sofosbuvir/velpatasvir
Authors: Pokorska‐Śpiewak Maria , Talarek Ewa , Aniszewska Małgorzata , Pluta Magdalena , Dobrzeniecka Anna , Marczyńska Magdalena , Indolfi Giuseppe
Published: September 2023

Background & Aims

The aim of this study was to assess the effect of treatment with sofosbuvir/velpatasvir (SOF/VEL) on the health‐related quality of life (HRQL) of children with chronic hepatitis C.

Methods

In the non‐commercial, non‐randomized, open‐label PANDAA‐PED study, 50 children aged 6–18 years with chronic hepatitis C were treated with a fixed dose of SOF/VEL. All patients achieved sustained virologic response 12 weeks after the end of treatment (SVR12). Evaluation of HRQL was performed twice: at baseline (before the treatment) and during the SVR12 analysis using the KIDSCREEN‐27 questionnaires, which included 5 dimensions of HRQL, for child self‐reporting and parent proxy reporting. The normal range for the population was set to T values of 50 ± 10 points. Child–parent agreement was analysed using the intra‐class correlation coefficient (ICC) and Bland–Altman test.

Results

Mean T values were within the normal range for all dimensions, both before and after treatment. There was a significant improvement in physical well‐being based on the children's self‐assessment (from 48.53 to 51.21, p = .03). In addition, a trend towards better scores in the ‘social support & peers’ part of the parent proxy evaluation (from 45.98 to 48.66, p = .06) was noticed. After the treatment, the proportion of children self‐assessing their physical well‐being as below normal significantly decreased from 17% to 5% (p = .007). HRQL scores were not associated with patients' sex, but in most cases, younger age correlated with better HRQL. Evaluation of the ICC for child self‐reports versus parent proxy reports revealed poor to moderate agreement for most single measures. Bland–Altman analysis showed that in all dimensions, both before and after treatment, the limits of agreement (LoAs) exceeded ±5 points (half of the SD and considered a maximum allowed difference).

Conclusions

A significant proportion of children with chronic hepatitis C have decreased HRQL in all dimensions, but effective treatment with SOF/VEL leads to an improvement in some areas of well‐being. As the effect of HCV on HRQL is more pronounced in older patients, treatment of younger children should be indicated to prevent them from experiencing decreased HRQL due to ongoing HCV infection in the future.
Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive
Authors: Flax Valerie L. , Bose Sujata , Escobar‐DeMarco Jessica , Frongillo Edward A.
Published: September 2023

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer‐reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self‐efficacy and shift social norms. The initiative used data for design and evaluation and facilitated scale and sustainability through close collaboration with governments and other stakeholders. A&T's approach increased exclusive breastfeeding, minimum meal frequency of children and use of iron and folic acid tablets by pregnant women, but had mixed impacts on early initiation of breastfeeding and maternal and child dietary diversity. Multiple SBC channels and frequent contacts strengthened the impact of SBC on MIYCN practices. Lessons learned included: using existing large‐scale platforms for interpersonal communication, improving counselling skills of health workers, delivering timely tailored messages, engaging key influencers to take specific actions, using research to address underlying behavioural concerns and maximize mass media reach and frequency, using simple memorable messages and employing additional channels to reach low media coverage areas. A&T developed and implemented at‐scale MIYCN SBC in multiple countries, providing lessons learned about intervention strategies, engagement of influencers and mass media campaign development, which governments and other implementers can adapt and replicate.
Frank Ebersole on Wittgenstein and Pictures in Philosophy
Authors: Tsilipakos Leonidas
Published: September 2023

How do we get into trouble in philosophy, and what do pictures have to do with it? This article addresses Frank Ebersole's thoughts on (Wittgenstein's remarks on) pictures in philosophy. It identifies the puzzlement generated for Ebersole by what Wittgenstein says and also considers some puzzling aspects of Ebersole's own renderings of pictures. It distinguishes between the philosophical picture and the pictorial form in which it may be crystalized and shows how philosophy's reliance on situationally disembedded grammatical stories (pictorial or not) leads us into trouble. Accordingly, responding to such trouble consists not inrecovering thepicture, in the sense of a single “object” or image we had before our mind's eye, but in—what is better described as Ebersole's strategy of—supplying agrammatical example (pictorial or otherwise) to go with our thinking, an example that makes what we think and say clear to ourselves.