bluuebunny/crossref_metadata_2025 huggingface dataset:
Does psychopathy mediate the relationship between exposure to intimate partner violence in childhood and the perpetration of intimate partner violence in adulthood?
Authors: Cunha Olga , Cruz Ana Rita , Rodrigues Andreia de Castro , Gonçalves Rui Abrunhosa , Peixoto Maria Manuela
Published: August 2024

Exposure to intimate partner violence during childhood has been linked to both intimate partner violence perpetration in adulthood and psychopathy. However, the role of psychopathy in the connection between exposure to intimate partner violence during childhood and later intimate partner violence perpetration is less understood. This study aimed to analyze the relationship between exposure to intimate partner violence during childhood, psychopathy, and the frequency of intimate partner violence perpetration while examining the mediating role of psychopathy. A sample of 245 men convicted of intimate partner violence in Portugal was recruited from prison and the community. Exposure to intimate partner violence was significantly associated with both the frequency of intimate partner violence perpetration in adulthood and psychopathy, and psychopathy was correlated with the frequency of intimate partner violence perpetration. Psychopathy did not act as a mediator in the relationship between exposure to intimate partner violence and the frequency of intimate partner violence perpetration. These findings underscore the significance of exposure to intimate partner violence during childhood and emphasize the necessity for increased attention to early adverse experiences that precede the development of maladaptive traits and behaviors.
Acacia ehrenbergiana (Hayne) and Prosopis juliflora Extracts Promote the Survival of Caenorhabditis elegans Infected with Methicillin-Resistant Staphylococcus aureus
Authors: Zarroug Samah H O , Nammor Talah , Eisa Shatha , Hamoor Reela , Ibrahim Linda , Shata Yousef , Alqhtani Meshal , Bashir Omnia , Garaween Ghada , Hamza Fatheia N , Bakheet Dana , Khalid Assad , Abdalla Hana K
Published: August 2024

Background: Staphylococcus aureus (S. aureus) is a leading cause of skin and soft tissue infections, with antibiotic-resistant strains causing potentially life-threatening diseases. This study explored the antimicrobial potential of Acacia ehrenbergiana (Hayne) and Prosopis juliflora using a Caenorhabditis elegans (C. elegans) in vivo model infected with methicillin-susceptible (MSSA) and methicillin-resistant (MRSA) S. aureus strains. Methods: Wild-type C. elegans were exposed to MSSA strain ATCC 25923 and MRSA strains ATCC BF195 and ATCC BC 3820 using an agar-based killing assay. The impact of ethanol extracts from A. ehrenbergiana and P. juliflora on the survival of infected C. elegans was assessed by analyzing the survival rates of infected and non-infected worms. The effects of the plant extracts on C. elegans feeding rate and colonization of MSSA and MRSA in the worm's gut were also examined. Additionally, in vitro assays were conducted to assess the bactericidal and/or bacteriostatic effects of the plant extracts. Results: Exposure to MSSA and MRSA strains significantly reduced C. elegans lifespan, with a mean time to death (TDmean) of 72 ± 1.3 h. Treatment with 100–500 μg/ml of either plant extract increased C. elegans survival by 65–70%. The extracts did not affect C. elegans pharyngeal pumping. Colony-forming Unit (CFU) assays showed a significant reduction in MSSA and MRSA colonization in the worm intestine with P. juliflora, but not A. ehrenbergiana extracts. In vitro Minimum Inhibitory Concentration (MIC) assays indicated that neither extract had direct bactericidal activity, suggesting the observed reduction in bacterial infection in worms was likely due to enhanced host immune response rather than direct antibacterial effects. Conclusion: These findings suggest that A. ehrenbergiana and P. juliflora extracts enhance C. elegans survival upon infection through indirect mechanisms, possibly involving immune system activation. This study highlights the potential of these extracts as antibacterial agents against MSSA and MRSA strains.
Technical debt, a double-edged sword that can damage moral responsibility
Authors: Ghanbari Hadi
Published: August 2024

This teaching case provides a simple yet comprehensive overview of Technical Debt (TD) and its associated terminology to the readers. TD, which has received an increasing amount of attention from information systems (IS) development research and practice, is mainly used to communicate the consequences of sub-optimal design decisions and trade-offs made during software development with non-technical project stakeholders. We reviewed the extant literature and interviewed five software professionals from a European company to examine this costly phenomenon. As such, we provide a comprehensive understanding of TD, its relevant terminology, and concrete examples that can help information systems and business students better understand the topic. In addition, the teaching case demonstrates antecedents, benefits and challenges, and the responsibilities associated with the accumulation of TD. We argue that, unfortunately, the moral responsibility associated with TD tends to get diffused leading to the invisibility of consequences and de-individuation issues in software teams. To this end, considering the critical role of software-intensive systems in modern societies, we argue that practitioners should look beyond the financial or technical costs and benefits of TD and consider the ethical and societal responsibilities associated with its accumulation carefully.
Integrating telemedicine in routine heart failure management: Experiences of healthcare professionals – A qualitative study
Authors: van Eijk Jorna , Trappenburg Jaap , Asselbergs Folkert W , Jaarsma Tiny
Published: August 2024

Objective

To describe the experiences of healthcare professionals with integrating telemedicine in routine heart failure (HF) care.

Methods

Semi-structured interviews were conducted with healthcare professionals ( n = 19) in the Netherlands who were involved in decision-making, implementation or routine use of telemedicine in HF management. Using purposive sampling, nurses, cardiologists and managers were selected to be interviewed. Interviews were performed in-person, recorded and transcribed verbatim. Interview data were analysed using a reflexive thematic analysis.

Results

This study identified four themes: (1) Responsibility – the lack of a clear delineation of roles and responsibilities among healthcare professionals, patients and suppliers in telemedicine. (2) Confidence and safety – telemedicine is seen by healthcare professionals as capable of enhancing safety, yet also introduces the risk of fostering a false sense of security among patients. (3) Collaboration – actively involving end-users in the development and implementation of telemedicine promotes the adoption. (4) Processes and mutual agreements – rather than replacing traditional care, telemedicine is perceived as an adjunct to it. Structured care pathways support telemedicine implementation, and personalised telemedicine can empower patients in self-care.

Conclusions

Telemedicine is a promising intervention in the management of HF. However, existing systems and care pathways have resulted in limited adoption. Improvements in the collaboration and establishing clear agreements on responsibilities between professional, patient and supplier can lead to more confidence in adopting telemedicine. Structured care pathways can be supportive. A personalised telemedicine approach can ensure that telemedicine remains manageable for patient and professional.
Wearables are a viable digital health tool for older Indigenous adults living remotely in Australia (research)
Authors: Henson Connie , Freedman Ben , Rambaldini Boe , Carlson Bronwyn , Parter Carmen , Nalliah Chrishan J , Chapman Felicity , Shepherd Gina , Orchard Jessica , Skinner John , Gwynn Josephine , Macniven Rona , Ramsden Robyn , Speier Sophia Nala ‘Ḵixsisa̱'las , Nahdi Suud Mohamed , Christie Vita , Huang Yansong (Harry) , Ward Katrina D , Gwynne Kylie
Published: August 2024

Objective

Health programs for Indigenous people are most effective, acceptable, and sustainable when Indigenous perspectives are prioritized. Codesign builds on Indigenous people's creativity and propensity to experiment with new technologies and ensures research is designed and implemented in a culturally safe and respectful manner. Limited research has focused on older Indigenous people as partners in digital health. No research has focused on the acceptability and feasibility of older Indigenous people using wearables for heart health monitoring. This study provides insights into the acceptability and feasibility for ≥55-year-old Indigenous people living in remote locations to use wearables (watches and patches) to detect atrial fibrillation (AF) and high blood pressure.

Methods

This mixed methods study was codesigned and coimplemented with the local Aboriginal Controlled Health Service in a remote area of New South Wales, Australia. It included active involvement and codesign with the participants. The devices used in this study included a Withings Scan watch and a Biobeat patch.

Results

Despite challenging conditions (>36°C) and variable internet connectivity, 11 Indigenous older adults participated in a five-day wearables program in a remote location. Participants indicated that using digital health devices was acceptable and feasible for older Indigenous users. They described high levels of comfort, safety and convenience when using wearables (patches and watches) to detect AF. They were active participants in codesigning the program.

Conclusion

Older Indigenous Australians are motivated to use wearable health devices. They are keen to participate in codesign innovative health tech programs to ensure new health technologies are acceptable to Indigenous people and feasible for remote locations.
Developing a Sustainable Finance Index and Its Implications on Inter-Intra Banking Sector
Authors: Malik Muhammad Shaukat , Irfan Muhammad , Munir Samavia
Published: August 2024

In the contemporary landscape of corporate governance, where organizations are increasingly recognizing the importance of not only generating profits but also contributing to societal progress and environmental preservation, there arises a pressing requirement for a comprehensive financial index that accurately captures these multifaceted commitments. In this study, we introduce a novel sustainable finance index that utilizes the Grey Relational Analysis (GRA) method to comprehensively capture the three fundamental dimensions of sustainability: economic, social, and environmental aspects. The GRA methodology ensures a comprehensive and balanced consideration of each dimension, thereby providing a holistic perspective. The deployment of this index, which encompasses a wide range of criteria, on an extensive 11-year financial dataset (2010–2021) obtained from 21 prominent commercial banks, reveals fascinating and thought-provoking findings. Banks frequently demonstrate intermittent commitments, wherein their pursuit of short-term gains often takes precedence over the imperative of economic sustainability. While some banks have been notable champions of social endeavors, it is concerning to observe that environmental sustainability has unfortunately taken a backseat in the overall banking landscape. This index provides a meticulous assessment of sustainable financial paradigms, ensuring accuracy and reliability. It serves as a valuable resource, enhancing the quality of research and providing corporations with a sophisticated framework to evaluate and enhance their sustainable financial paths.
Factors Affecting Cultural Transmission in Museum Tourism: An Empirical Study with Mediation Analysis
Authors: Chen Jiyun
Published: August 2024

Consistent with global trends in cultural tourism, museum tourism has emerged as a popular form of cultural tourism that has increasingly drawn the significant attention of scholars as the target of academic research. The tourists’ cultural experience can affect their evaluation of the specific visit and subsequent behavior. While previous researchers have paid more attention to the mechanism of visitors’ post-visit behaviors, cultural transmission as a dependent variable has received scarce attention. This study examines factors influencing college students’ behavior in communicating specific museum cultural content after a visit. It also identifies the mediating mechanism underlying the relationships between cultural transmission and its antecedents. The purposive questionnaire in a highly structured survey was distributed online among college students. A total of 195 usable responses were drawn. A quantitative survey methodology was employed, including Chi-square analysis, Confirmatory Factor Analysis, and Structural Equation Modeling. The results show that: (1) the determinants of college students’ cultural transmission behavior are cultural experience, cultural identity, and satisfaction, which explains 59% of the variance of cultural transmission; (2) the impact of cultural experience on cultural transmission was mediated by cultural identity and satisfaction (it includes a serial mediation effect as the effect of cultural experience on satisfaction flowed through cultural identity, where student satisfaction mediated the impact of cultural identity on cultural transmission); and (3) college students pursuing the liberal arts present statistically different preferences in visiting museums when compared with science and engineering students. The discussion and implications present theoretical advancements in elucidating the mechanism of visitors’ cultural communication processes and recommend the use of technology-driven innovations for improvements in post-visit activities for cultural transmission.
Getting Around the Community: Qualitatively Exploring the Transportation Experiences of Adults With Intellectual and Developmental Disabilities
Authors: Carey Gwendolyn C. , Kearney Kelly B. , Downey Angelica R. , Miller Brianna J.
Published: August 2024

Transportation is a necessity in adult life. Qualitative literature regarding the usability of transportation to travel freely within the community (e.g., school, work, leisure activities) is widely circulated; however, information regarding transportation needs and barriers specifically faced by individuals with an intellectual and developmental disabilities (IDD) is limited. This study discusses the accessibility and usability of transportation avenues for individuals with IDD. Young adults with IDD ( n = 9) explored their transportation experiences of accessing specialized public transportation (paratransit), ride-share, and personal vehicles independently. Researchers used a multiple-case study design to analyze interviews, observations, and document reviews. Results indicated the importance of teaching, maintaining, and generalizing transportation skills. Limitations and implications for research and practice are discussed.
I Felt Like I Was Getting to Be My Own Person: Exploring the Impact of Cultural Master Narratives on Identity Development During Student Exchange
Authors: McKay Samuel , Thomas Virginia , Lyons Claire W. , Eguiluz Itzel
Published: August 2024

International mobility experiences such as student exchange can promote identity development and cultural awareness. However, little research has assessed such processes using a master narrative framework. This study explored undergraduate student perspectives on how changing cultural contexts and the associated cultural master narratives influence identity development during university exchange experiences. Twenty interviews were conducted with Australian and U.S. exchange students aged 21-22 years. Thematic analysis identified a process model of master narrative awareness and associated responses incorporating three key elements: contexts of awareness, identity responses, and experiences of self-transformation. A fourth theme highlighted the influence of individual identities as interaction effects in these processes. The findings show that exposure to diverse master narratives during student exchange enhances students’ awareness of their own and other master narratives, which supports identity development. The study provides new insights into the ways intercultural experiences shape master narrative awareness and identity in emerging adults.
Overview and Feasibility of a Novel Transdisciplinary Integrative Approach to High Impact Chronic Pain in Vermont
Authors: Plavin Joshua , Landau Jerry , Rose Gail L. , Ziller Erika , Nowak Sarah , Finley Heather , Audy Laurel , Porter Jon
Published: August 2024

Background/Objective

Pain is one of the most common chronic conditions in the US, estimated to affect 20.9% of the population (51.6 million people). We evaluated the Partners Aligned in Transformative Healing (PATH) program at University Medical Center’s Comprehensive Pain Program clinic. Feasibility, initial clinical and financial results were assessed to inform payers’ support for PATH, an integrative transdisciplinary program within a bundled payment format.

Methods

Participants completed a multi-week program including integrative therapies, with empirically validated assessment surveys administered at the beginning and end of the program. Insurance claims data were analyzed 12 months pre- and post-program. Statistical significance of pre-post differences was assessed by paired T-tests with P < 0.05.

Results

Between June 2019 and August 2022, 170 individuals enrolled in PATH, 151 (88.8%) completed the program, and 121 participants completed outcome surveys. Participants were predominately White, non-Hispanic (98%), female (76%), with an average age of 49.8. All participant-reported clinical outcomes (PROs) showed statistically significant improvement from baseline to final assessment, and some but not all were clinically significant. PEG subscale of average pain interference, enjoyment of life, and interference with general activity each decreased. The T-scores for the following domains of PROMIS-29 decreased: Pain interference; fatigue; sleep disturbance; anxiety, and depression. The PROMIS-29 domains of overall physical function and social roles and activities mean T-scores increased. Per Member Per Month (PMPM) total cost of care decreased by $462 (18%). Emergency room utilization for all diagnoses decreased by 457 visits/1000 patients (65%), and for pain-related diagnoses by 194 visits/1000 patients (67%) during the observation period.

Conclusions

Results suggest that the PATH Program is a feasible and acceptable model that shows initial effectiveness relative to short-term patient-reported clinical outcomes and shows signs of durability in both utilization and financial outcomes at 1 year. The results support continued study including a multi-site RCT.
NFAT5 counters long-term IFN-1 responses in hematopoietic stem cells to preserve reconstitution potential
Authors: Traveset Laia , Cerdán Porqueras Víctor , Huerga Encabo Hector , Avalle Silvia , Esteve-Codina Anna , Fornas Oscar , Aramburu Jose , Lopez-Rodriguez Cristina
Published: August 2024

Hematopoietic stem cells (HSCs) readily recover from acute stress, but persistent stress can reduce their viability and long-term potential. Here, we show that the nuclear factor of activated T cells 5 (NFAT5), a transcription modulator of inflammatory responses, protects the HSC pool under stress. NFAT5 restrains HSC differentiation to multipotent progenitors after bone marrow transplantation and bone marrow ablation with ionizing radiation or chemotherapy. Correspondingly, NFAT5-deficient HSCs fail to support long-term reconstitution of hematopoietic progenitors and mature blood cells after serial transplant. Evidence from competitive transplant assays shows that these defects are HSC intrinsic. NFAT5-deficient HSCs exhibit enhanced expression of type 1 interferon (IFN-1) response genes after transplant, and suppressing IFN-1 receptor prevents their exacerbated differentiation and cell death after reconstitution and improves long-term regeneration potential. Blockade of IFN-1 receptor also prevented the overdifferentiation of NFAT5-deficient HSCs after bone marrow ablation. These findings show that long-term IFN-1 responses to different hematopoietic stressors drive HSCs toward more differentiated progenitors, and that NFAT5 has an HSC-intrinsic role, limiting IFN-1 responses to preserve reconstitution potential. Our identification of cell-intrinsic mechanisms that strengthen the resistance of HSCs to stress could help to devise approaches to protect long-term stemness during the treatment of hematopoietic malignancies.
Definition, classification and diagnosis of pulmonary hypertension
Authors: Kovacs Gabor , Bartolome Sonja , Denton Christopher P. , Gatzoulis Michael A. , Gu Sue , Khanna Dinesh , Badesch David , Montani David
Published: August 2024

Pulmonary hypertension (PH) is a haemodynamic condition characterised by elevation of mean pulmonary arterial pressure (mPAP) >20 mmHg, assessed by right heart catheterisation. Pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) distinguish pre-capillary PH (PAWP ≤15 mmHg, PVR >2 Wood Units (WU)), isolated post-capillary PH (PAWP >15 mmHg, PVR ≤2 WU) and combined post- and pre-capillary PH (PAWP >15 mmHg, PVR >2 WU). Exercise PH is a haemodynamic condition describing a normal mPAP at rest with an abnormal increase of mPAP during exercise, defined as a mPAP/cardiac output slope >3 mmHg/L/min between rest and exercise. The core structure of the clinical classification of PH has been retained, including the five major groups. However, some changes are presented herewith, such as the re-introduction of “long-term responders to calcium channel blockers” as a subgroup of idiopathic pulmonary arterial hypertension, the addition of subgroups in group 2 PH and the differentiation of group 3 PH subgroups based on pulmonary diseases instead of functional abnormalities. Mitomycin-C and carfilzomib have been added to the list of drugs with “definite association” with PAH. For diagnosis of PH, we propose a stepwise approach with the main aim of discerning those patients who need to be referred to a PH centre and who should undergo invasive haemodynamic assessment. In case of high probability of severe pulmonary vascular disease, especially if there are signs of right heart failure, a fast-track referral to a PH centre is recommended at any point during the clinical workup.
Treatment algorithm for pulmonary arterial hypertension
Authors: Chin Kelly M. , Gaine Sean P. , Gerges Christian , Jing Zhi-Cheng , Mathai Stephen C. , Tamura Yuichi , McLaughlin Vallerie V. , Sitbon Olivier
Published: August 2024

Pulmonary arterial hypertension leads to significant impairment in haemodynamics, right heart function, exercise capacity, quality of life and survival. Current therapies have mechanisms of action involving signallingviaone of four pathways: endothelin-1, nitric oxide, prostacyclin and bone morphogenetic protein/activin signalling. Efficacy has generally been greater with therapeutic combinations and with parenteral therapy compared with monotherapy or nonparenteral therapies, and maximal medical therapy is now four-drug therapy. Lung transplantation remains an option for selected patients with an inadequate response to therapies.
Genetics and precision genomics approaches to pulmonary hypertension
Authors: Austin Eric D. , Aldred Micheala A. , Alotaibi Mona , Gräf Stefan , Nichols William C. , Trembath Richard C. , Chung Wendy K.
Published: August 2024

Considerable progress has been made in the genomics of pulmonary arterial hypertension (PAH) since the 6th World Symposium on Pulmonary Hypertension, with the identification of rare variants in several novel genes, as well as common variants that confer a modest increase in PAH risk. Gene and variant curation by an expert panel now provides a robust framework for knowing which genes to test and how to interpret variants in clinical practice. We recommend that genetic testing be offered to specific subgroups of symptomatic patients with PAH, and to children with certain types of group 3 pulmonary hypertension (PH). Testing of asymptomatic family members and the use of genetics in reproductive decision-making require the involvement of genetics experts. Large cohorts of PAH patients with biospecimens now exist and extension to non-group 1 PH has begun. However, these cohorts are largely of European origin; greater diversity will be essential to characterise the full extent of genomic variation contributing to PH risk and treatment responses. Other types of omics data are also being incorporated. Furthermore, to advance gene- and pathway-specific care and targeted therapies, gene-specific registries will be essential to support patients and their families and to lay the foundation for genetically informed clinical trials. This will require international outreach and collaboration between patients/families, clinicians and researchers. Ultimately, harmonisation of patient-derived biospecimens, clinical and omic information, and analytic approaches will advance the field.
Negotiating grey areas: an interview-based analysis of paramedic uncertainty and decision-making in cardiac arrest events
Authors: Gardiner Galina , Eli Karin , Huxley Caroline J. , Fothergill Rachael , Perkins Gavin D. , Smyth Michael A. , Griffiths Frances , Slowther Anne-Marie
Published: August 2024

Background

Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate their decision-making. Within the United Kingdom (UK), there is little evidence on how and why paramedics make their decisions at actual OHCA events.

Methods

We explored the experiences of UK paramedics using individually recalled OHCA events as catalysts for discussion. Pen portraits developed from semi-structured interviews with 31 paramedics across two UK ambulance services were thematically analysed, enabling cross-participant comparisons whilst retaining depth and context.

Results

We identified four themes: uncertainties encountered in resuscitation guidelines, influences on decision-making, holistic perspectives, and indirect moderators. We found that paramedics experienced uncertainty at all stages of the resuscitation process. Uncertainties arose from indeterminate, ambiguous or complex information and were described as having both clinical and ethical dimensions. Whilst guidelines drove paramedics’ decisions, non-clinical personal, practical and relational factors moderated their assessments of survivability and decision-making, with attitudes to interactions between patient age, frailty and quality of life playing a substantial role. Coping strategies such as uncertainty reduction, assumption-based reasoning and weighing pros and cons were evident from interviews.

Conclusions

The complexity of interactions between clinical and non-clinical factors points to an element of variability in paramedics’ responses to uncertainty. Exploring UK paramedics’ uncertainties and decision-making during specific OHCA events can help acknowledge and address uncertainties in resuscitation guidelines and paramedic training, providing paramedics with the tools to manage uncertainty in a consistent and transparent way.
Co-detection of respiratory pathogens among ILI patients: characterization of samples collected during the 2018/19 and 2019/20 pre-pandemic seasons
Authors: Ferrari Allegra , Schiavetti Irene , Ogliastro Matilde , Minet Carola , Sibilio Raffaella , Giberti Irene , Costa Elisabetta , Massaro Elvira , Lai Piero Luigi , Mosca Stefano , Bruzzone Bianca , Orsi Andrea , Panatto Donatella , Icardi Giancarlo
Published: August 2024

Influenza-like illness (ILI) patients co-detected with respiratory pathogens exhibit poorer health outcomes than those with single infections. To address the paucity of knowledge concerning the incidence of concurrent respiratory pathogens, their relationships, and the clinical differences between patients detected with single and multiple pathogens, we performed an in-depth characterization of the oropharyngeal samples of primary care patients collected in Genoa (Northwest Italy), during winter seasons 2018/19–2019/20.

The apriori algorithm was employed to evaluate the incidence of viral, bacterial, and viral-bacterial pairs during the study period. The grade of correlation between pathogens was investigated using the Phi coefficient. Factors associated with viral, bacterial or viral-bacterial co-detection were assessed using logistic regression.

The most frequently identified pathogens included influenza A, rhinovirus, Haemophilus influenzae and Streptococcus pneumoniae. The highest correlations were found between bacterial-bacterial and viral-bacterial pairs, such as Haemophilus influenzae-Streptococcus pneumoniae, adenovirus-Haemophilus influenzae, adenovirus-Streptococcus pneumoniae, RSV-A-Bordetella pertussis, and influenza B Victoria-Bordetella parapertussis. Viruses were detected together at significantly lower rates. Notably, rhinovirus, influenza, and RSV exhibited significant negative correlations with each other. Co-detection was more prevalent in children aged < 4, and cough was shown to be a reliable indicator of viral co-detection.

Given the evolving epidemiological landscape following the COVID-19 pandemic, future research utilizing the methodology described here, while considering the circulation of SARS-CoV-2, could further enrich the understanding of concurrent respiratory pathogens.
Myths about suicide - validating the Hungarian version of the Literacy of Suicide Scale (H-LOSS) on a community sample
Authors: Flach Richard , Fodor Robert , Kettel-Fulop Flora , Osvath Peter , Lang Andras
Published: August 2024

Background

Suicide was exceptionally high in Hungary in the last century. According to Eurostat, Hungary ranks second in the EU in death by suicide and was among the few countries where the suicidal tendencies increased in 2020. Primary tasks of suicide prevention programs are to develop suicide literacy and dispel myths and misconceptions about suicide. Therefore, the goal of our research was the Hungarian validation of the 26-item Literacy of Suicide Scale (LOSS). Methods: 749 people (382 female (51.0%), 364 male (48.6%), 3 identify as non-binary or other (0.4%); 4 identifying as transgender (0.5%)) participated in our online cross-sectional survey with a mean age of 32.4 years (SD = 14.5 years). The H-LOSS questionnaire was adapted using the 2PL (two-parameter logistic) model with WLSE (weighted least squares) estimation in item response theory method, similarly to the original English version.

Results

Scale unidimensionality was confirmed. Model fit indices and internal reliability indicators were acceptable. Item infit and outfit values were adequate, item discrimination values were within range, but one item had extremely high and three items had extremely low item difficulty parameters. Few items had differential item functioning by age, gender and own suidice attempt.

Conclusions

The H-LOSS scale deemed to be appropriate for assessing suicide literacy in Hungarian speaking samples.
Prediction models for postoperative pulmonary complications in intensive care unit patients after noncardiac thoracic surgery
Authors: He Xiangjun , Dong Meiling , Xiong Huaiyu , Zhu Yukun , Ping Feng , Wang Bo , Kang Yan
Published: August 2024

Background

Postoperative pulmonary complication (PPC) is a leading cause of mortality and poor outcomes in postoperative patients. No studies have enrolled intensive care unit (ICU) patients after noncardiac thoracic surgery, and effective prediction models for PPC have not been developed. This study aimed to explore the incidence and risk factors and construct prediction models for PPC in these patients.

Methods

This study retrospectively recruited patients admitted to the ICU after noncardiac thoracic surgery at West China Hospital, Sichuan University, from July 2019 to December 2022. The patients were randomly divided into a development cohort and a validation cohort at a 70% versus 30% ratio. The preoperative, intraoperative and postoperative variables during the ICU stay were compared. Univariate and multivariate logistic regression analyses were applied to identify candidate predictors, establish prediction models, and compare the accuracy of the models with that of reported risk models.

Results

A total of 475 ICU patients were enrolled after noncardiac thoracic surgery (median age, 58; 72% male). At least one PPC occurred in 171 patients (36.0%), and the most common PPC was pneumonia (153/475, 32.21%). PPC significantly increased the duration of mechanical ventilation (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (LOS) (p < 0.001), and rate of reintubation (p = 0.047) in ICU patients. Seven risk factors were identified, and then the prediction nomograms for PPC were constructed. At ICU admission, the area under the curve (AUC) was 0.766, with a sensitivity of 0.71 and specificity of 0.60; after extubation, the AUC was 0.841, with a sensitivity of 0.75 and specificity of 0.83. The models showed robust discrimination in both the development cohort and the validation cohort, and they were well calibrated and more accurate than reported risk models.

Conclusions

ICU patients who underwent noncardiac thoracic surgery were at high risk of developing PPCs. Prediction nomograms were constructed and they were more accurate than reported risk models, with excellent sensitivity and specificity. Moreover, these findings could help assess individual PPC risk and enhance postoperative management of patients.
Phase 0 trials/ Intra-Target-Microdosing (ITM) and the lung: a review
Authors: Quinn Tom M. , Bruce Annya M. , Burt Tal , Dhaliwal Kevin
Published: August 2024

The COVID-19 pandemic has highlighted the importance of efficient drug discovery in respiratory disease. The traditional set up of clinical trials is expensive and allows for significant attrition of new drugs, many of which undergo extensive safety testing before being abandoned for lack of efficacy. Phase 0 trials, named as they sit between pre-clinical research and phase I, allow for the testing of sub-clinical microdoses in humans to gather early pharmacokinetic (PK), pharmacodynamic (PD) and mechanistic data, before deciding on which drugs to advance further. This early data can improve the efficiency and cost effectiveness of drug development and reduce the extent of animal testing. Phase 0 trials traditionally have utilised sub-therapeutic microdoses of compounds administered intravenously with readouts focusing on PK - measured using highly sensitive methods such as accelerator mass spectrometry (AMS) and liquid chromatography tandem mass spectrometry (LC-MS/MS) of peripheral blood, as well as whole-body positron emission tomography (PET). Mathematical models allow for extrapolation of this PK data to support the further testing of larger, systemically effective doses. However, this extrapolation method is limited at providing robust PD or target engagement/ mode of action data. Using an Intra-Target Microdosing (ITM) approach, a small compartment of the body (about 1% or less) is exposed to potentially clinically active local concentrations. This allows for the collection of PD data, evidence of target cell engagement, as well as the opportunity to extrapolate systemic PK and PD data. This approach has the potential within the pulmonary system for the study and rapid and cost-effective development of new and repurposed drugs.
Effects of adaptive scaffolding on performance, cognitive load and engagement in game-based learning: a randomized controlled trial
Authors: Faber Tjitske J. E. , Dankbaar Mary E. W. , van den Broek Walter W. , Bruinink Laura J. , Hogeveen Marije , van Merriënboer Jeroen J. G.
Published: August 2024

Background

While game-based learning has demonstrated positive outcomes for some learners, its efficacy remains variable. Adaptive scaffolding may improve performance and self-regulation during training by optimizing cognitive load. Informed by cognitive load theory, this study investigates whether adaptive scaffolding based on interaction trace data influences learning performance, self-regulation, cognitive load, test performance, and engagement in a medical emergency game.

Methods

Sixty-two medical students from three Dutch universities played six game scenarios. They received either adaptive or nonadaptive scaffolding in a randomized double-blinded matched pairs yoked control design. During gameplay, we measured learning performance (accuracy, speed, systematicity), self-regulation (self-monitoring, help-seeking), and cognitive load. Test performance was assessed in a live scenario assessment at 2- and 6–12-week intervals. Engagement was measured after completing all game scenarios.

Results

Surprisingly, the results unveiled no discernible differences between the groups experiencing adaptive and nonadaptive scaffolding. This finding is attributed to the unexpected alignment between the nonadaptive scaffolding and the needs of the participants in 64.9% of the scenarios, resulting in coincidentally tailored scaffolding. Exploratory analyses suggest that, compared to nontailored scaffolding, tailored scaffolding improved speed, reduced self-regulation, and lowered cognitive load. No differences in test performance or engagement were found.

Discussion

Our results suggest adaptive scaffolding may enhance learning by optimizing cognitive load. These findings underscore the potential of adaptive scaffolding within GBL environments, cultivating a more tailored and effective learning experience. To leverage this potential effectively, researchers, educators, and developers are recommended to collaborate from the outset of designing adaptive GBL or computer-based simulation experiences. This collaborative approach facilitates the establishment of reliable performance indicators and enables the design of suitable, preferably real-time, scaffolding interventions. Future research should confirm the effects of adaptive scaffolding on self-regulation and learning, taking care to avoid unintended tailored scaffolding in the research design.

Trial registration

This study was preregistered with the Center for Open Science prior to data collection. The registry may be found at https://osf.io/7ztws/.
From admission to discharge: a systematic review of clinical natural language processing along the patient journey
Authors: Klug Katrin , Beckh Katharina , Antweiler Dario , Chakraborty Nilesh , Baldini Giulia , Laue Katharina , Hosch René , Nensa Felix , Schuler Martin , Giesselbach Sven
Published: August 2024

Background

Medical text, as part of an electronic health record, is an essential information source in healthcare. Although natural language processing (NLP) techniques for medical text are developing fast, successful transfer into clinical practice has been rare. Especially the hospital domain offers great potential while facing several challenges including many documents per patient, multiple departments and complex interrelated processes.

Methods

In this work, we survey relevant literature to identify and classify approaches which exploit NLP in the clinical context. Our contribution involves a systematic mapping of related research onto a prototypical patient journey in the hospital, along which medical documents are created, processed and consumed by hospital staff and patients themselves. Specifically, we reviewed which dataset types, dataset languages, model architectures and tasks are researched in current clinical NLP research. Additionally, we extract and analyze major obstacles during development and implementation. We discuss options to address them and argue for a focus on bias mitigation and model explainability.

Results

While a patient’s hospital journey produces a significant amount of structured and unstructured documents, certain steps and documents receive more research attention than others. Diagnosis, Admission and Discharge are clinical patient steps that are researched often across the surveyed paper. In contrast, our findings reveal significant under-researched areas such as Treatment, Billing, After Care, and Smart Home. Leveraging NLP in these stages can greatly enhance clinical decision-making and patient outcomes. Additionally, clinical NLP models are mostly based on radiology reports, discharge letters and admission notes, even though we have shown that many other documents are produced throughout the patient journey. There is a significant opportunity in analyzing a wider range of medical documents produced throughout the patient journey to improve the applicability and impact of NLP in healthcare.

Conclusions

Our findings suggest that there is a significant opportunity to leverage NLP approaches to advance clinical decision-making systems, as there remains a considerable understudied potential for the analysis of patient journey data.
Causal associations between insulin and Lp(a) levels in Caucasian population: a Mendelian randomization study
Authors: Lejawa Mateusz , Goławski Marcin , Fronczek Martyna , Osadnik Tadeusz , Paneni Francesco , Ruscica Massimiliano , Pawlas Natalia , Lisik Małgorzata , Banach Maciej
Published: August 2024

Background

Numerous observational studies have demonstrated that circulating lipoprotein(a) [Lp(a)] might be inversely related to the risk of type 2 diabetes (T2D). However, recent Mendelian randomization (MR) studies do not consistently support this association. The results of in vitro research suggest that high insulin concentrations can suppress Lp(a) levels by affecting apolipoprotein(a) [apo(a)] synthesis. This study aimed to identify the relationship between genetically predicted insulin concentrations and Lp(a) levels, which may partly explain the associations between low Lp(a) levels and increased risk of T2D.

Methods

Independent genetic variants strongly associated with fasting insulin levels were identified from meta-analyses of genome-wide association studies in European populations (GWASs) (N = 151,013). Summary level data for Lp(a) in the population of European ancestry were acquired from a GWAS in the UK Biobank (N = 361,194). The inverse-variance weighted (IVW) method approach was applied to perform two-sample summary-level MR. Robust methods for sensitivity analysis were utilized, such as MR‒Egger, the weighted median (WME) method, MR pleiotropy residual sum and outlier (MR-PRESSO), leave-one-out analysis, and MR Steiger.

Results

Genetically predicted fasting insulin levels were negatively associated with Lp(a) levels (β = − 0.15, SE = 0.05, P = 0.003). The sensitivity analysis revealed that WME (β = − 0.26, SE = 0.07, P = 0.0002), but not MR‒Egger (β = − 0.22, SE = 0.13, P = 0.11), supported a causal relationship between genetically predisposed insulin levels and Lp(a).

Conclusion

Our MR study provides robust evidence supporting the association between genetically predicted increased insulin concentrations and decreased concentrations of Lp(a). These findings suggest that hyperinsulinaemia, which typically accompanies T2D, can partially explain the inverse relationship between low Lp(a) concentrations and an increased risk of T2D.
The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods
Authors: Augdal Thomas , Angenete Oskar , Zadig Pia , Lundestad Anette , Nordal Ellen , Shi Xieqi , Rosendahl Karen
Published: August 2024

Background

Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA).

Methods

Data used in the present study was drawn from a large multicentre study including 228 children aged 4–16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested.

Results

One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites.

Categorizing BHI SDS and DXA BMD Z-scores on a 0–5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 – 0.5.

For cone-beam CT, based on a 1–3 scale, 59 out of 94 left TMJ’s were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1).

Conclusions

Categorizing DXA LS and automated radiographic Z-scores on a 0–5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.
Diagnostic challenges and outcome of fatty acid oxidation defects in a tertiary care center in Lebanon
Authors: Daher Rose T. , Taoum Katia El , Samaha Jinane , Karam Pascale E.
Published: August 2024

Background

Fatty acid oxidation defects are rare autosomal recessive disorders with variable clinical manifestations and outcome. Early detection by systematic neonatal screening may improve their prognosis. Long-term outcome studies of these disorders in the Middle East and North Africa region are limited. The purpose of this study is to report the diagnostic challenges and outcome of fatty acid oxidation defects in a major tertiary care center in Lebanon, a resource-constrained country in the Middle East.

Methods

A retrospective review of charts of all fatty acid oxidation defects sequential patients diagnosed and followed at our center was conducted. Collected data included: parental consanguinity, age at diagnosis, clinical presentation, biochemical profile, confirmatory diagnosis, treatment and outcome. A genotype–phenotype correlation was also performed, when available.

Results

Seven types of fatty acid oxidation defects were identified in a total of 34 patients from 21 families. Most families (79%) were consanguineous (first-degree cousins). The majority were diagnosed when clinically symptomatic (78%), at various ages between 10 days and 19 years (average: 2 years). Follow-up duration spanned between 2 months and 15 years (average: 5 years). The remainder of the patients were detected while still asymptomatic by systematic neonatal screening (9%) or due to positive family history (9%). The most common defect was carnitine transporter deficiency (50%) with an exclusive cardiac presentation related to a founder variant c.981C > T, (p.Arg254*) in theSLC22A5gene. Medium chain acyl-CoA dehydrogenase deficiency was found in 13% only, which could be explained by the absence of systematic neonatal screening. Rare gene variants were detected in very long chain and multiple acyl-CoA dehydrogenase deficiency. The worse prognosis was observed in very long chain acyl-CoA dehydrogenase deficiency. The overall survival at last follow-up reached 75% with a complete reversal of symptoms with treatment in most patients (63%), despite their late diagnosis.

Conclusions

Our experience highlights the diagnostic challenges and outcome of fatty acid oxidation defects in a resource-constrained country with high consanguinity rates. Physicians’ awareness and systematic neonatal screening are key for diagnosis. Larger genotype–phenotype studies are still needed to understand the natural history of these rare diseases and possibly improve their outcome.