bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological and pathological characterization of acute respiratory infections
Authors: Xu Mengyun , He Wenying , Xie Songsong , Ren Zhongye , Chen Jie , Nuerbolati Bahejianati
Published: October 2024

This research comprehensively investigates the epidemiological features and pathogen profile of acute respiratory infections (ARI) in Shihezi City, Xinjiang. A pivotal aspect of this study is the construction of a Bayes discriminant function for principal pathogen infections. This innovative methodology aims to furnish a robust scientific basis for the prevention and clinical management of ARI, potentially guiding more effective strategies in both public health and clinical settings. We compiled and examined data from January 2020 to June 2023, pertaining to patients admitted with acute respiratory infections at the First Affiliated Hospital of Shihezi University. This investigation focused on discerning patterns in epidemiology and pathogen etiology. Among 2110 cases of acute respiratory infections (ARI), 1736 underwent pathogenetic testing. Of these, 595 cases tested positive for at least one pathogen, marking a positivity rate of 34.27%. Viral detections, at a rate of 27.47%, were notably higher than bacterial detections, which stood at 6.51%. The most prevalent viruses identified were Human respiratory syncytial virus (hRSV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2), and Human adenovirus (HAdV), while the dominant bacterial pathogens included Klebsiella pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Co‐infections were observed in 76 cases, accounting for 12.77% of positive diagnoses, predominantly involving hRSV in conjunction with other pathogens. In cases of acute bronchiolitis, hRSV was the most frequent pathogen, contributing to 23.10% of such cases. Similarly, in severe pneumonia cases, SARS‐CoV‐2 was predominant, accounting for 25.4% of these infections. The group with bacterial positivity exhibited elevated levels of C‐reactive protein (CRP, 19.17 mg/L) and neutrophilic granulocyte percentage (NE%, 54.7%). The Bayes discriminant function demonstrated an initial validation accuracy of 74.9% and a cross‐validation accuracy of 63.7%. The study underscores that hRSV, SARS‐CoV‐2, and HAdV are the primary pathogens in acute respiratory infections in the Shihezi region. Pathogen susceptibility exhibits variation across different age groups, with a higher pathogen detection rate in children compared to adults. The Bayes discriminant function shows significant promise in the classification and diagnosis of major pathogenic infections.
Efficacy of Gonadotropin Treatment for Induction of Spermatogenesis in Men With Pathologic Gonadotropin Deficiency: A Meta‐Analysis
Authors: Muir Christopher A. , Zhang Ting , Jayadev Veena , Conway Ann J. , Handelsman David J.
Published: October 2024

Introduction

Hypogonadotropic hypogonadism (HH) is a treatable cause of nonobstructive azoospermic male infertility. Gonadotropin treatment can successfully induce spermatogenesis in most patients, although comprehensive quantitative summary data on spermatogenic outcomes like those required to induce pregnancy is lacking in the literature.

Materials and Methods

Systematic review and meta‐analysis of outcomes related to male reproductive function following gonadotropin treatment.

Results

Our search strategy identified 41 studies encompassing 1673 patients with a mean age of 25 (± 5) years. Average sperm concentration achieved after a median of 18 months of gonadotropin treatment was 11.6 M/mL of ejaculate (95% CI 8.4–14.9). Sperm concentrations > 0, > 1, > 5, > 10 and > 20 M/mL were achieved by 78%, 55%, 36%, 24% and 15% of patients, respectively. Mean sperm output and the proportion of patients achieving all sperm thresholds were significantly greater following combined hCG/FSH treatment compared with hCG monotherapy. When compared by diagnosis, patients with congenital HH (CHH) had significantly lower mean sperm output compared with patients with hypopituitarism or mixed patient cohorts that did not differentiate between CHH and hypopituitarism. Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.

Conclusions

Gonadotropin treatment successfully induced spermatogenesis in most men with pathological gonadotropin deficiency. Sperm outputs more consistent with those typically needed to induce a natural pregnancy were less commonly achieved. Despite similar effects on serum testosterone and TV, combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis.
Rethinking concepts of special educational needs and disability in the primary classroom
Authors: Hamilton Paula , Matthews Sarah
Published: October 2024

This paper examines the outcomes of a disability awareness programme aimed at rethinking concepts of special educational needs and disability (SEND) with children aged 8–9 years old. Designed specifically for this research study, the work was undertaken in a mainstream primary classroom in England. Although research has been undertaken in this area, it is limited and often focused on children's friendships. Drawing upon a disability studies in education lens, the study contributes to the literature through its use of interactive methods to elicit and deconstruct children's thinking. The findings suggest that many children continue to hold deficit perceptions about SEND, rooted in medical model perspectives. However, carefully designed programmes which enable children to consider first‐person experiences, and encourage the deconstruction of ableist discourses, can promote more flexible understanding and progressive attitudes towards SEND in childhood.
Hurricane‐induced changes in mayfly assemblage structure, production and emergence in a tropical island stream
Authors: Ramírez Alonso , Meza‐Salazar Ana M. , Gómez Jesús E. , Gutiérrez‐Fonseca Pablo E. , Sánchez‐Ruiz José
Published: October 2024

Hurricanes are major disturbances with important consequences to stream ecosystems as they create major floods and remove riparian vegetation. Understanding their impacts is a priority, as hurricane intensity is expected to increase due to global climate change.

Mayfly assemblages in streams fill a diversity of ecological roles and functions. They are important consumers of algae by scraping benthic biofilms and detritivores associated with fine particles and leaf litter. Other taxa are filterers and even predators. Mayflies are also important prey items in aquatic and terrestrial food webs.

Here, we assessed the effects of two consecutive hurricanes that impacted Puerto Rico in 2017 to understand how hurricane‐induced changes in the environment alter mayfly composition, secondary production and emergence.

The study was conducted in the Luquillo Experimental Forest, Puerto Rico. Mayflies were sampled as nymphs and emerging adults for 6 months before and 17 months after hurricanes Irma and María hit the island in September 2017. Leaf litter inputs, canopy cover and chlorophyll a concentrations were monitored along with mayflies.

Mayfly assemblages were dominated by two genera of Leptophlebiidae before the hurricane, Neohagenulus (two species: N. julio Traver, 1938, N. luteolus Traver, 1938) and Borinquena (one species: B. carmencita Traver, 1938). Both genera decreased in density after the hurricanes and were replaced with the Baetidae Cloeodes maculipes Traver, 1938 as the dominant taxon. This pattern was observed in both nymph and emerging adult densities.

The secondary production of Leptophlebiidae species was highest before hurricane disturbance, with the Baetidae C. maculipes showing the opposite pattern. Neohagenulus had an annual production of 445 mg m−2 year−1, C. maculipes of 153 mg m−2 year−1 and B. carmencita of 68 mg m−2 year−1.

Overall, the mayfly assemblages in our studied stream are vulnerable to hurricane disturbances. Expected increases in hurricane impacts might result in assemblage shifts that could change assemblage composition and alter energy flows within the ecosystem.
Distance to CAR‐T Treatment Center Does Not Impede Delivery
Authors: Tan Xiu Xia Sherry , Maltez Melissa T. , Mallick Ranjeeta , Hamelin Linda , McDiarmid Sheryl , Cieniak Carolina , Granger Matthew , Bredeson Christopher , Kennah Michael , Atkins Harold L. , Kekre Natasha
Published: October 2024

Background

Chimeric antigen receptor T‐cell (CAR‐T) therapy has demonstrated remarkable efficacy in relapsed or refractory large B cell lymphoma, but real‐world evidence is needed to confirm safety and efficacy when facing the unique challenges of a wide geographical catchment area.

Methods

We reviewed patients treated with commercially available CAR‐T at a medium‐sized single center in Canada (The Ottawa Hospital) between December 2020 and July 2022 (Canadian implementation started in 2020).

Results

Fifty‐one patients (59% male, median age 62) traveled a median distance of 655 km (range 3–3659) for treatment. Median time from apheresis to CAR‐T infusion was 36 days (range 26–81). With a median follow‐up of 383 days (95% CI: 333–480), median progression‐free survival (PFS) and overall survival (OS) were 257 days (95% CI: 92‐NE) and 422 days (95% CI: 106‐NE), respectively. The median PFS for out‐of‐province patients was 115 days (95% CI: 91‐NE) versus 280 days for in‐province patients (95% CI: 142‐NE), p = 0.12. Multivariate analysis demonstrated that distance from treatment center (p = 0.05) and refractory disease status (p = 0.003) were independently associated with shorter PFS. The time from the last disease progression to CAR‐T referral was longer for out‐of‐province patients, but there was no difference in the time of referral to CAR‐T consult, apheresis, or CAR‐T infusion between in‐province and out‐of‐province patients.

Conclusion

Our results confirm that despite the complexity of CAR‐T therapy administration, Ottawa can effectively provide commercial CAR‐T therapy in a timely fashion for patients from across the country.
Optimal organic fertilization enhances the phytoavailability of phosphorus in the root zone of rice
Authors: Zhu Wenbin , Zhao Hongmeng , Wang Yu , Butterly Clayton R. , Chen Hao , Yuan Jiahui , Liu Mingqing , Chen Qiuhui , Zhang Longjiang , Wang Lei
Published: October 2024

Organic fertilization is considered an effective approach in promoting agricultural green development, dramatically affecting soil phosphorus (P) availability. Nonetheless, limited information is available on the comprehensive impact of full substitution of organic fertilizer for chemical fertilizer on P speciation, phytoavailability, and apparent balance throughout different rice‐growth stages. To address this gap, a 5‐year field experiment was conducted, implementing five organic P gradients ranging from 0 (P0), 70 (P70), 140 (P140), 210 (P210) to 280 (P280) kg P2O5 ha−1 of organic fertilizer. To assess P phytoavailability in the root zone with submillimetre spatial resolutions, this study employed techniques such as the one‐ and two‐dimensional diffusive gradients in thin films (DGT) technique and the high‐resolution soil solution sampling technology (HR‐Peeper). The findings revealed that increasing P rates enhanced soil Olsen‐P and biological‐based P fractions across rice‐growth stages, primarily driven by variation in mineral‐associated P. Notably, the P140 treatment demonstrated the highest P uptake efficiency among the different rice‐growth stages, with a significant increase in soil DGT‐P, particularly in the 0–60 mm soil layer (p <0.05), providing tangible evidence for enhanced P uptake. Moreover, compared with higher P treatments (P210 and P280), the P140 treatment markedly increased P use efficiency by 31.7% and 99.0%, respectively (p <0.05). Further, with a high ratio of DGT‐P to Peeper‐P and a low apparent balance of P, organic fertilization at the rate of 140 kg P2O5 ha−1 effectively struck a balance between ensuring adequate P supply for yield stability and mitigating potential P loss risks. These results underscore the significance of optimal organic fertilization in enhancing agronomic benefits while reducing environmental risks. They offer valuable insights to support field P management strategies and government decision‐making processes.
A Parasite Plant Promotes the Coexistence of Two Annual Plants
Authors: Shinohara Naoto , Nomiya Riku , Yamawo Akira
Published: October 2024

Consumers can influence the competitive outcomes of prey species in various ways. Modern coexistence theory predicts that consumers can promote prey coexistence by preferably targeting a competitively superior one, thereby reducing fitness differences. However, previous studies yielded mixed conclusions. In this study, we tested the hypothesis that a parasitic annual plant, Cuscuta campestris, facilitates the coexistence of two common annual plants. We performed field surveys and parasitism experiments to parameterize a plant competition dynamics model. The model suggested a competition–defence tradeoff: the legume Lespedeza striata was a better competitor than the grass Setaria faberi, while it was more susceptible to the parasite. Moreover, an empirical host–parasite dynamics model, extended from the plant competition model, predicted their coexistence within broad, biologically reasonable ranges of parameters. This work provides field evidence of the coexisting–promoting role of a parasitic plant, as caused by stabilising feedback between host and parasite densities.
Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN‐RND)
Authors: Wittebrood Casper , Boban Marina , Cagnin Annchiara , Capellari Sabina , De Winter François‐Laurent , Djamshidian Atbin , González Manuel Menéndez , Hjermind Lena E. , Krajcovicova Lenka , Krüger Johanna , Levin Johannes , Reetz Kathrin , Rodriguez Eloy Rodriguez , Rohrer Jonathan , Van Langenhove Tim , Reinhard Carola , Graessner Holm , Rusina Robert , Saracino Dario , Houot Marion , Seelar Harro , Vandenberghe Rik
Published: October 2024

Background and Purpose

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial‐based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers.

Method

The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN‐RND).

Results

The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self‐injury and self‐harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases.

Conclusions

The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.
Treating to target in multiple sclerosis: Do we know how to measure whether we hit it?
Authors: Bsteh Gabriel , Krajnc Nik , Altmann Patrick , Hendin Barry , Bharadia Trishna , Jaruszowic Sonja , Lublin Fred , Oh Jiwon , Parow Detlev , Ribbens Annemie , Shields Aoife , Smeets Dirk , Thouvenot Eric , Chan Andrew , Berger Thomas
Published: October 2024

Background and purpose

The rapidly evolving landscape of effective treatment options in multiple sclerosis has led to a shift of treatment objectives towards a treat‐to‐target approach aiming to suppress disease activity below the level of detectability early during the disease. To enable treat‐to‐target, a thorough reappraisal of available outcome measures with respect to their ability in this regard is required.

Methods

To that end, we conducted a comprehensive systematic literature review of more than 1000 studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) 2020 methodology focusing on underlying evidence as well as utility and implementability in clinical practice.

Results

From there, we propose a set of measurable outcomes for everyday routine clinical practice as well as advanced/aspirational measurables requiring additional resources. We also outline remaining knowledge/technology gaps that need to be overcome to enable a treat‐to‐target approach.

Conclusions

This work provides the basis for an evidence‐based definition of outcome targets for relevant stakeholders and regulatory authorities.
Performance of instrumental activities of daily living in patients with haemophilic arthropathy. A cross‐sectional cohort study
Authors: Seoane‐Martín Marta Elisa , Cuesta‐Barriuso Rubén , Rodríguez‐Martínez María Carmen
Published: October 2024

Background

The development of haemophilic arthropathy causes joint damage that leads to functional impairment that limits the performance of activities in patients with haemophilia. The aim was to identify the best predictive model for performing instrumental activities of daily living in adult patients with haemophilia arthropathy.

Methods

Cross‐sectional cohort study. 102 patients were recruited. The dependent variable was the performance of instrumental activities of daily living (Lawton and Brody scale). The dependence on the performance of activities of daily living was the dependent endpoint (Barthel scale). The secondary variables were joint damage (Hemophilia Joint Health Score), pain intensity, and clinical, anthropometric, and sociodemographic variables.

Results

The degree of dependence, joint damage, pain intensity, and marital status (Cp = 5.60) were the variables that best explain the variability in the performance of instrumental activities of daily living (R2adj = 0.51). Loss of predictive capacity is acceptable with good mean internal (R2 mean = 0.40) and external (R2‐r2 = 0.09) validation. According to the predictive pattern obtained, patients with haemophilia, who were married, without joint pain or damage, and independent in their day‐to‐day lives, had a score of 7.91 points (95% CI: 7.42; 8.39) in the performance of instrumental activities of daily living.

Conclusions

The predictive model for the functional capacity of instrumental activities of daily living in haemophilia patients encompasses factors such as level of autonomy, joint impairment, pain severity, and marital status. Notably, despite the presence of joint damage, individuals with haemophilia exhibit a significant level of independence in carrying out both basic daily tasks and instrumental activities of daily living.

International registration number

Id NCT04715100.
Four Years in, What Are the Research Priorities for Long COVID? A Research Priority‐Setting Partnership Between People With Lived Experience, Carers, Clinicians and Researchers
Authors: Grant Aileen , Stage Emma , Blane David , Goss Helen , Ormerod Jane , McIver Stuart , Duncan Edward , Patel Gail , Campbell Abi , Manson Paul , Subramanian Ganesh , Cooper Kay
Published: October 2024

Introduction

Long COVID is a life‐limiting condition that affects 65 million people worldwide. It devastates lives with uncertain illness trajectories, and yet, there are many research uncertainties as there is a lack of understanding of its causes, effective treatments and management plans. We set out to identify current research priorities for people with Long COVID, carers, healthcare professionals and researchers.

Methods

A systematic literature review and previous Long COVID priority‐setting exercises identified three broad under‐researched areas of Long COVID research within the fields of Public Health and Health Services Research: symptoms; managing day‐to‐day life; and the emotional impact of Long COVID. We disseminated an elicitation survey that asked for research questions in these areas; responses were analysed and summarised into 42 research questions. A survey was then disseminated, asking respondents to prioritise these 42 questions. Workshops were held with people with Long COVID, carers, healthcare professionals and researchers to analyse responses and agree the top 10 priorities.

Results

The top priorities in order were pharmacological treatment of Long COVID; understanding the pathophysiology; nonpharmacological symptom management; improving public and professional understanding of Long COVID; understanding of the long‐term risks of Long COVID; improving financial and social supports; improving understanding of postviral syndromes; diagnostics; service redesign/pathways; and the well‐being of children with Long COVID.

Conclusion

Four years into the pandemic, there is an emphasis on the need for research on treatment, understanding and support for people living with Long COVID.

Patient and Public Contribution

People with Long COVID and carers were involved in the study design, survey design, dissemination, data analysis, interpretation and reviewing and editing the manuscript.
Implementing a Hospital‐Wide Programme Using iPARiHS to Prevent and Manage Incontinence‐Associated Dermatitis and Improve Hospital‐Acquired Pressure Injuries
Authors: Geering Samara , Wilson Valerie , Jacob Leena , Macpherson Amanda , Melbourne Gregory , Kohler Friedbert , Chow Josephine S. F.
Published: October 2024

Incontinence‐associated dermatitis poses a significant risk for sacral pressure injuries, infection and morbidity in healthcare settings. Despite the availability of best practice guidelines, implementation remains a challenge.

Aim

To outline the implementation of a hospital‐wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence‐associated dermatitis and improve hospital‐acquired pressure injuries.

Design

This is an empirical research study using mixed methods.

Method

The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys.

Results

Findings indicate a reduction in hospital‐acquired incontinence‐associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long‐term success.

Conclusion

This study underscores the importance of evidence‐based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks.

Implications for the Profession and/or Patient Care

Analysing a hospital‐wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence‐associated dermatitis and improve hospital‐acquired pressure injuries, could help identify the challenges for delivering patient‐centred care.

Patient or Public Contribution

No patient or public involvement.

Reporting Method

To describe the implementation study, we referred to the StaRI Guideline.

Trial Registration: This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved
Phylogenetic and Biogeographic History of the Snooks (Centropomidae: Carangiformes) Spanning the Closure of the Isthmus of Panama
Authors: Ossa‐Hernández Natalia , Ballen Gustavo A. , P Arturo Acero , Tavera Jose
Published: October 2024

Aim

Amphiamerican New World fishes provide a unique opportunity to explore the impact of geological processes and the formation of geographic barriers on biological diversification across both spatial and temporal dimensions. We employed phylogenetic and biogeographic methods to assess the impact of the emergence of the Isthmus of Panama on the evolutionary history of snooks.

Location

Eastern tropical Pacific and western Atlantic Oceans.

Methods

Bayesian methods were used for phylogenetic inference and divergence time estimation, incorporating the fossil record of Carangidae, Centropomidae, Istiophoriformes, Latidae and Sphyraenidae to establish a timeline using the methods of stratigraphic intervals for node calibration density specification. Biogeographic models were fitted to test the hypothesis that transisthmian vicariant events are coeval with the Isthmus closure. To estimate ancestral range probability and perform stochastic mapping, we utilised BioGeoBears and the parameters from the best‐fitting model. This allowed us to estimate the quantity and kind of biogeographical events.

Results

Our results suggest a sister relationship between Centropomidae and Sphyraenidae with a common ancestor that originated in the Upper Cretaceous (~78.51 Ma). The biogeographic model BAYAreaLIKE + j indicated speciation in sympatry and dispersal (founder effect) as the primary modes of speciation in the genus Centropomus. The dispersion in the family Centropomidae was estimated from the Tropical Eastern Pacific to the tropical western Atlantic since the Oligocene.

Main Conclusions

The alignment of divergence times with ancestral species distributions suggests a possible synchrony between the current distribution in Centropomus species and the processes of the formation of the Isthmus of Panama during the Miocene. However, the evidence of only two transisthmic pair suggests that this event was not determinant in allopatric interbasin speciation. Furthermore, recent diversification events within each basin imply an influence of post‐closure environmental conditions on the evolution of this group of fishes.
Integrating peer assessment cycle into ChatGPT for STEM education: A randomised controlled trial on knowledge, skills, and attitudes enhancement
Authors: Wu Ting‐Ting , Lee Hsin‐Yu , Chen Pei‐Hua , Lin Chia‐Ju , Huang Yueh‐Min
Published: October 2024

Background

Science, Technology, Engineering, and Mathematics (STEM) education in Asian universities struggles to integrate Knowledge, Skills, and Attitudes (KSA) due to large classes and student reluctance. While ChatGPT offers solutions, its conventional use may hinder independent critical thinking.

Objectives

This study introduces PA‐GPT, using ChatGPT as a “virtual peer” in peer assessments to promote active learning and enhance knowledge, higher‐order thinking skills (HOTS), and attitudes—the core of KSA in STEM.

Methods

A randomised controlled trial involved 61 first‐year engineering students (43 males, 18 females) from a university in Southern Taiwan enrolled in “Network Embedded Systems and Applications.” Participants, all with prior ChatGPT experience but no programming background, were purposively sampled. They were randomly assigned to the experimental group (n = 31) using PA‐GPT or the control group (n = 30) using traditional ChatGPT. Over 8 weeks, data were collected using pre‐ and post‐tests: a knowledge construction test (20 items, α = 0.85); a HOTS scale (α = 0.78–0.83) measuring critical thinking, problem‐solving, and creativity; and the S‐STEM questionnaire (α >0.80) assessing attitudes towards STEM subjects and 21st‐century learning. ANCOVA analysed the data, controlling for pre‐test scores, and Levene's test checked homogeneity of variances.

Results and Conclusions

ANCOVA results showed that PA‐GPT significantly outperformed traditional ChatGPT in enhancing knowledge construction (F = 9.89, p = 0.002), critical thinking (F = 37.00, p < 0.001), problem‐solving (F = 9.40, p = 0.003), creativity (F = 7.22, p = 0.009), and attitudes towards mathematics (F = 25.52, p < 0.001), engineering/technology (F = 16.06, p < 0.001), and 21st‐century learning (F = 26.38, p < 0.001). These findings demonstrate that PA‐GPT effectively addresses challenges in student engagement and HOTS development in STEM education by simulating peer interactions. Peer Assessment with ChatGPT (PA‐GPT) promotes active learning and self‐reflection, potentially revolutionising AI‐assisted education in large class settings. This study provides pioneering evidence for the effectiveness of AI‐driven peer assessment in enhancing comprehensive STEM competencies, offering a promising direction for future educational technology integration.
Prevalence of frequent premature ventricular contractions and left‐ventricular systolic dysfunction in patients receiving Holter monitoring
Authors: Torrado Juan , Sima Adam , Comstuck Connor , Kaszala Karoly , Tan Alex , Koneru Jayanthi , Frankel David S. , Marchlinski Frank , Kowalski Marcin , Sharma Parikshit , Gerstenfeld Edward P. , Vaseghi Marmar , Shivkumar Kalyanam , Malhotra Rohit , Morillo Carlos , Ellenbogen Kenneth A. , Huizar Jose F.
Published: October 2024

Background

Premature ventricular contractions (PVCs) are frequently observed with left ventricular (LV) systolic dysfunction, although the prevalence of these associated conditions in the general population remains unknown.

Objective

We sought to understand the prevalence of frequent PVCs (defined PVCs > 5%) and high burden PVCs (defined PVCs > 10%) and LV systolic dysfunction in patients receiving ambulatory Holter monitors (HM).

Methods

A prospective multicenter (eight US medical centers) cross‐sectional study collected demographic and PVC burden data from consecutive patients undergoing 24‐h, 48‐h, and 14‐day HM (July 2018–June 2020). Left ventricle ejection fraction (LVEF) data was collected if obtained within 6 months of HM. Four PVC burden groups were analyzed (<1%, 1%–5%, 5.1%–10%, and >10% burden) and stratified by normal LVEF (≥50%) or presence LVEF < 50%.

Results

The prevalence of PVC burden of 5.1%–10% and >10% was 4% and 5%, respectively in the population undergoing HM (n = 6529). Age was significantly different between PVC groups (p < .001). In those with LVEF assessment (n = 3713), the prevalence of LVEF < 50% and both LVEF < 50% and PVC > 5% was 16.4% and 4.2%, respectively. The prevalence of PVC > 5% and PVC > 10% in patients with LVEF < 50% was 26% and 16%, respectively. PVC > 5% were more prevalent in older, male, and Caucasians (p < .001). Females had a lower prevalence of PVC > 5% than males (6% vs. 11%; p < .001), but not among those with LVEF < 50% (24% vs. 26%, p = .10).

Conclusion

PVC > 5% and PVC > 10% and LVEF < 50% are prevalent in patients undergoing HM. PVC > 5% are associated with older age. Females have a lower prevalence of PVC > 5% than males but similar combined PVC > 5% and LVEF < 50%.

ClinicalTrial.gov identifier: NCT03228823.
PLXNB1/SEMA4D signals mediate interactions between malignant epithelial and immune cells to promote colorectal cancer liver metastasis
Authors: Xuan Zixue , Zhang Yuan , Li Dan , Wang Kai , Huang Ping , Shi Jiana
Published: October 2024

Distal metastases result from metastatic microenvironment and tumour epithelial cell interactions, the cellular heterogeneity of primary colorectal cancer (CRC) and liver metastases (LM) was evaluated by integrating single‐cell sequencing data, and the collected gene expression data from metastatic epithelial cell subsets was used to construct a prognostic model and to identify intercellular receptor‐ligand interactions between epithelial and immune cells in CRC and LM. Multiplex immunofluorescence staining, and in vitro wound healing, cell migration and cell apoptosis assays were performed to further explore the biological relevance of identified potential regulatory molecules. In this study, approximately 17 epithelial cell subtypes were detected, with Epi‐11 cells being highly expressed in LM tissues compared with CRC samples. Furthermore, patients with high expression of the metastasis‐related genetic profile of Epi‐11 had a poorer prognosis. By predicting receptor–ligand interactions, Epi‐11 cells were found to interact more with myeloid and T/natural killer cells in LM tissues when compared to primary CRC samples, which was mediated by the PLXNB1/SEMA4D axis. In addition, high SEMA4D expression was correlated with decreased overall survival of patients with CRC, whereas PLXNB1 was not. SEMA4D knockdown prevented the migration and promoted the apoptosis of HCT116 cells in vitro. In summary, Epi‐11 cells, an important subset of epithelial cells, may drive the LM of CRC and act by crosstalk with immune cells through the PLXNB1/SEMA4D signalling axis.
Systematic review and indirect treatment comparisons of ritlecitinib against baricitinib in alopecia areata
Authors: Aceituno D. , Fawsitt C. G. , Power G. M. , Law E. , Vaghela S. , Thom H.
Published: October 2024

Ritlecitinib and baricitinib are recently approved systemic treatments for severe alopecia areata (AA). Both demonstrated superiority over placebo in hair regrowth measured by the Severity of Alopecia Tool (SALT), but they have not been directly compared in randomized controlled trials (RCTs). We conducted a systematic review of RCTs evaluating treatments in AA and estimated the efficacy and safety of ritlecitinib and baricitinib at Week 24 using Bayesian network meta‐analysis. To adjust and explore effect modifiers, population‐adjusted indirect comparison was performed via multilevel network meta‐regression (ML‐NMR) using ritlecitinib individual patient data (IPD). Co‐primary endpoints were SALT ≤20 and SALT ≤10 at Week 24. Unanchored population adjusted ITCs were also computed to evaluate SALT ≤10 and SALT ≤20 endpoints at Week 48/52. Four RCTs (ALLEGRO 2a [NCT02974868], ALLEGRO 2b/3 [NCT03732807], BRAVE‐AA1 [NCT03570749] and BRAVE‐AA2 [NCT03899259]) were included. No evidence of a difference between ritlecitinib 50 mg and baricitinib 4 mg on SALT ≤10 (odds ratio, OR: 0.96, 95% credible interval, CrI: 0.18–7.21) and SALT ≤20 (OR: 2.16, 95% CrI: 0.48–16.46) at Week 24 was found. ML‐NMR using ALLEGRO IPD adjusted for sex, SALT score at baseline, duration of current episode and disease duration found evidence of effect modification, although relative efficacy between ritlecitinib 50 mg and baricitinib 4 mg remained unchanged. Unanchored population‐adjusted ITC at Week 48/52 was consistent with previous results. We found similar efficacy between ritlecitinib 50 mg and baricitinib 4 mg. These ITCs was informed by only four RCTs, uncertainty was considerable, and there was evidence of effect modification, highlighting the need for further quality research in AA.
Native Parasitoids Recruitment as Potential Controllers of Dryocosmus kuriphilus (Hymenoptera; Cynipidae) in Recently Colonised Areas
Authors: Vinagrero‐Conde Juan Carlos , Muñoz‐Adalia E. Jordán , Pujade‐Villar Juli , Fernández‐Fernández M. Mercedes
Published: October 2024

In this work, we investigate the native parasitoid community colonising galls by an invasive pest: the oriental chestnut gall wasp (OCGW), Dryocosmus kuriphilus (Hymenoptera; Cynipidae). We tried to understand how native parasitoids react after the arrival of the pest (two‐year sampling period) in the province of Zamora (Castilla & León region, N‐W Spain). For this purpose, we collected both, chestnut galls from six stands and oak galls from surrounding oak groves. Our results highlight the response to D. kuriphilus provided by the oak gall wasps that naturally inhabit Quercus pyrenaica. The parasitoid community showed a core assemblage composed of Eurytoma brunniventris, Torymus flavipes and T. sinensis in OCGW galls, and Baryscapus diaphantus, Bootanomyia dorsalis, Eupelmus urozonus, E. brunniventris, Mesopolobus lichtensteini, T. affinis, and T. flavipes in oak galls. We identified the torymid T. flavipes as one of the most common parasitoids of OCGW, in addition to the exotic parasitoid T. sinensis, never officially released in the region but present in the study area. In addition, we intend to know its possible incidence on non‐target cynipids. We have found an intense connection in the food web with some chalcids that establish interactions with the gall wasp, both in adult instar (emerging from reared galls) and larval (presence of larvae in OCGW gall chambers, identified by dissection). We also describe the flight phenology of D. kuriphilus in our study area (as far as we know, the first one focused in Castilla & León region) and evaluate the overlap between OCGW and native and exotic parasitoids showing a promising role of native guild as biocontrollers.
Evaluation of the psychometric properties of the Turkish version of the Skin‐to‐Skin Contact Scale for nurses
Authors: Bektas Ilknur , Özalp Gerçeker Gülçin , Bektas Murat
Published: October 2024

Rationale

Skin‐to‐skin contact is the practice with the highest level of evidence that increases the growth, development, and healing rate of the newborn. Neonatal nurses are also the best practitioners of skin‐to‐skin contact.

Aims

This study examined the psychometric properties of the Turkish version of the Skin‐to‐Skin Contact Scale for nurses.

Methods

This descriptive, correlational, and cross‐sectional study was carried out with 226 neonatal and pediatric nurses between July 2022 and July 2023. The data were collected using an online questionnaire, including a descriptive information form and a skin‐to‐skin contact scale for nurses. Data were analyzed by explanatory and confirmatory factor analysis, Cronbach's alpha, and item‐total score analysis.

Results

It was determined that the scale consisted of 20 items and four sub‐dimensions and that those four sub‐dimensions explained 53.01% of the total variance. All factor loads were higher than 0.30 in the explanatory and confirmatory factor analyses. All the fit indices were higher than 0.80, and the Root Mean Square Error of Approximation (RMSEA) was less than 0.080 in the confirmatory factor analysis. Cronbach's alpha was determined to be 0.89 for the total scale and greater than 0.70 for all sub‐dimensions.

Conclusions

The Skin‐to‐Skin Contact Scale for nurses was determined to be a valid and reliable measurement tool for Turkish nurses. It is recommended that the scale be used regularly in clinics to determine nurses' attitudes towards skin‐to‐skin contact.
Use and impact of clinical pathways across various healthcare settings: A protocol for an umbrella review of global evidence
Authors: Chandra Rishita , Unwin Maria , Tran Viet , Neil Amanda
Published: October 2024

Aim

The proposed umbrella review aims to assess the use and impact of clinical pathways on professional practice, patient outcomes, length of hospital stay, hospital costs, patient satisfaction, and hospital staff satisfaction through a synthesis of existing systematic reviews and meta‐analyses.

Methods

Following PRIOR guidelines, a systematic search will be conducted in MEDLINE, Epistemonikos, and the Cochrane Library to identify relevant systematic reviews and meta‐analyses, from inception till March 2024. Two reviewers will independently screen titles and abstracts, with a third resolving any disagreements. Full‐text articles considered potentially relevant will be assessed for eligibility by the same process. The data extraction form will cover information about the review methods, characteristics of the included primary studies, the types of interventions evaluated, and the reported outcomes. This standardized data extraction form will be piloted by the review team on five to ten articles to ensure all relevant information is recorded. The quality of included systematic reviews and meta‐analyses will be evaluated using AMSTAR 2. PROSPERO registration number is CRD42024529371.

Results

The study will present a narrative synthesis of the findings, addressing the clinical and methodological heterogeneity and assessing the impact of clinical pathways on various healthcare outcomes.

Conclusion and Implications

This umbrella review will provide evidence‐based insights into the effectiveness, challenges, and best practices of clinical pathways, guiding healthcare decision‐making and identifying areas for future research. Results will be disseminated widely to inform policy and improve healthcare service delivery.

Patient or Public Contribution

No patient or public contribution, as this paper is a protocol of an umbrella review.
Development and validation of knowledge, attitude, and practice scale regarding antibiotic use for Chinese medical students
Authors: Sun Hui , Xiang Linghui , Zhang Jiajia , Xiong Xin , Sun Xuemei , Gao Yinyan , Song Jinlu , Luo Han , Sun Dingkui , Lin Xiangfeng , Xu Boya , Wu Irene X. Y. , Dai Wenjie
Published: October 2024

Aims and Objectives

This study aimed to develop and validate a knowledge, attitude, and practice scale of antibiotic use for Chinese medical students.

Method

A five‐phased procedure was adopted: (a) A item pool was constructed after literature review; (b) Delphi method was used to refine the items; (c) A pilot study was conducted to clarify the item; (d) Item analysis and exploratory factor analysis were used to finalize the scale; (e) Content validity, construct validity and reliability of the scale were analysed.

Results

The scale of 32 items, respectively 15, 9, and 8 for knowledge, attitude, and practice, was finalized. The item‐level content validity ranged from 0.80 to 1.00. The scale‐level content validity of the scale was 0.90. Model fit indices of total scale and the three dimensions met the criteria. Cronbach's α and the split‐half coefficient were respectively 0.81 and 0.65 for the total scale. For each dimension, Cronbach's α varied from 0.68 to 0.89 and the split‐half coefficient varied from 0.64 to 0.83.

Conclusion

The scale can be used as a whole or separately, serving as an effective tool to measure medical students' knowledge, attitude, or practice regarding antibiotic use.
Misconceptions about randomisation harm validity of randomised controlled trials
Authors: Mastnak Wolfgang
Published: October 2024

Rationale

The coherence theory of truth, the epistemology of evidence‐based medicine, mathematical statistics, and axiomatic mathematics.

Aims and Objectives

To explore mathematical misconceptions inhering in randomised controlled trial designs, suggest improvements, encourage meta‐methodological discussions and call for further interdisciplinary studies.

Method

Mathematical‐statistical analyses and science‐philosophical considerations.

Results

Randomisation does not (necessarily) generate equal samples, ergo, outcomes of usual RCTs are not as reliable as they claim. Moreover, ignoring initial sample discrepancies may cause inaccuracies similar to type I and type II errors. Insufficient awareness of these flaws harms final RCT statements about significance and evidence levels, hence their loss of trustworthiness. Statistical parameters such as the standard error of the mean may help to estimate the expected distinction between random samples.

Conclusion

Researchers in EBM should be aware of systemic misconceptions in RCT standards. Pre‐measurement can reduce shortcomings, e.g. through calculation how sample differences impact on usual RCT processing, or randomisation is given up in favour of mathematical minimisation of sample differences, i.e. optimising statistical sample equality. Moreover, the promising future of dynamic simulation models is highlighted.
Cirrhosis in primary practice: many patients remain potentially undiagnosed and are not receiving liver cancer surveillance
Authors: Prince David S , Hoque Shakira , Kim Christy , Maher Salim , Miller Jane , Chomley Phoebe , Pritchard‐Jones Janice , Spruce Sally , McGarry Nathan , Baker David , Elix Penelope , Liu Ken , Strasser Simone I , Goodger Brendan , Zekry Amany , McCaughan Geoffrey W
Published: October 2024

Background and Aim

Most patients with cirrhosis have compensated disease and are cared for in primary care; however, the exact epidemiology within Australia remains largely unknown. The aim of this study was to assess cirrhosis care in an Australian primary care setting by evaluating rates of cirrhosis diagnosis, appropriate hepatocellular carcinoma (HCC) surveillance and specialist communication.

Methods

Electronic medical records in consenting general practices were reviewed using the “Liver Toolkit” to identify patients with an existing cirrhosis diagnosis. Individual cases were reviewed to identify outcomes of interest.

Results

One hundred seventy‐one patients with confirmed cirrhosis across nine general practices were identified (74% male, mean age: 61.2 years). There was significant variation in the rate of cirrhosis diagnosis between practices (range 31.7–637.9 per 100 000 patients, P < 0.0001). Patients with cirrhosis had predominately compensated disease (75% Child–Pugh A) and common etiologies of cirrhosis were alcohol (49%), hepatitis C (47%), and metabolic dysfunction‐associated steatotic liver disease (29%). Forty‐two patients (25%) had received appropriate HCC surveillance. Predictors of inadequate HCC surveillance were time from last specialist correspondence (odds ratio [OR] = 1.06 per month increase, 95% confidence interval [CI]: 1.02–1.10, P = 0.002) and hepatitis B (OR = 0.24, 95% CI: 0.06–0.98, P = 0.047). Specialist correspondence with primary care was older than 2 years or absent in 37% of cases.

Conclusions

There was a 20‐fold difference in the rate of cirrhosis diagnosis between general practices within Sydney, suggesting a large proportion of patients remain undiagnosed. Three quarters of patients with diagnosed cirrhosis are not receiving appropriate HCC surveillance.
The Life Cycle of Systemic Risk and Crises
Authors: BERGER ALLEN N. , SEDUNOV JOHN
Published: October 2024

We present a life cycle view of systemic risk and crises that incorporates and synthesizes a number of views and organizes the theoretical and empirical research evidence in a clear fashion. We illustrate how systemic risks build during the boom, are realized during the following crisis, and are well addressed or not in the aftermath, which helps determine how well or poorly the following cycle will likely evolve. We aim to improve current understanding of systemic risk and crises, the roles of the different economic segments of society, highlight key issues of measurement, and provide guidance for future academic research and policy analysis. We address several controversies—the outsized role of the banking sector in creating and resolving systemic risks, its exclusive role in systemic risk measurement, and seemingly irrational behavior in which the same or similar costly mistakes are repeated every cycle.