bluuebunny/crossref_metadata_2025 huggingface dataset:
The Meaning of Being a ‘Good Nurse’ in the ICU During the COVID‐19 Pandemic
Authors: Haddad Ali Al , Arber Anne , Cox Anna , Gallagher Ann
Published: December 2024

Intensive care unit (ICU) nurses were at the forefront of patient care during the coronavirus (COVID‐19) pandemic. To date, no studies have explored what it meant to be a ‘good nurse’ in this unique and challenging context. As such, the aim of this study was to construct the meaning of the ‘good nurse’ in ICUs during a pandemic. Semi‐structured interviews were conducted with 25 ICU nurses from three ICUs in Kuwait, who had worked during the COVID‐19 pandemic. The data were analysed using Charmaz's grounded theory methodology. The analysis showed that the good ICU nurse was defined by their sense of duty, which motivated compassionate and dedicated patient care. However, the nurses' attempts to demonstrate virtue also had negative consequences for them. Selflessness led to unsustainable self‐sacrifice, empathy led to emotional labour, and efforts to remain patient and respectful led to exhaustion as the nurses found themselves under increasing pressure. Attempts to remain mentally strong may have partially protected them from stress, but also deprived them of an outlet for authentic emotional expression and support. Ultimately, their efforts to preserve their quality of patient care despite the numerous challenges of the pandemic came at an increasing cost, and resulted in moral distress and impaired well‐being.
Leaf warming in the canopy of mature tropical trees reduced photosynthesis due to downregulation of photosynthetic capacity and reduced stomatal conductance
Authors: Crous Kristine Y. , Middleby Kali B. , Cheesman Alexander W. , Bouet Angelina Y. M. , Schiffer Michele , Liddell Michael J. , Barton Craig V. M. , Cernusak Lucas A.
Published: December 2024

Tropical forests play a large role in the global carbon cycle by annually absorbing 30% of our annual carbon emissions. However, these forests have evolved under relatively stable temperature conditions and may be sensitive to current climate warming. Few experiments have investigated the effects of warming on large, mature trees to better understand how higher temperatures affect these forests in situ.

We targeted four tree species (Endiandra microneura, Castanospermum australe, Cleistanthus myrianthus and Myristica globosa) of the Australian tropical rainforest and warmed leaves in the canopy by 4°C for 8 months. We measured temperature response curves of photosynthesis and respiration, and determined the critical temperatures for chloroplast function based on Chl fluorescence.

Both stomatal conductance and photosynthesis were strongly reduced by 48 and 35%, respectively, with warming. While reduced stomatal conductance was likely in response to higher vapour pressure deficit, the biochemistry of photosynthesis responded to higher temperatures via reduced Vcmax25 (−28%) and Jmax25 (−29%). There was no shift of the Topt of photosynthesis. Concurrently, respiration rates at a common temperature did not change in response to warming, suggesting limited respiratory thermal acclimation.

This combination of physiological responses to leaf warming in mature tropical trees may suggest a reduced carbon sink with future warming in tropical forests.
Understanding Pediatric Anesthesiology Fellowship Interest: A National Survey of the Resident Experience
Authors: Carullo Philip , Khan Sabina , Nause‐Osthoff Rebecca , Gupta Ruchika , Xie James , Azamfirei Razvan , Tran Lieu , Wang Tammy
Published: December 2024

Background

The field of pediatric anesthesiology faces an impending shortage of fellowship‐trained physicians. Despite this projection, fewer anesthesiology residents are opting to pursue a fellowship. To better understand the current perspective and motivation of trainees to pursue a career in pediatric anesthesiology, we surveyed anesthesiology residents across the United States.

Aims

Our primary aims were to assess the understanding of the current workforce shortage as well as explore the impact of both exposure and characteristics of the anesthesia resident rotation on the decision to pursue pediatric anesthesiology fellowship.

Methods

A 25‐question Qualtrics survey was distributed to members of the Pediatric Anesthesia Leadership Council and Education Committee within the Society for Pediatric Anesthesia and to anesthesiology residency program directors based in the United States.

Results

The survey received 201 responses. Of the respondents, 29% were in Clinical Anesthesia Year 3, 25% in Year 2, 19% in Year 1, and 10% in their intern year. The analysis revealed that self‐reported adequate exposure to high‐acuity cases and advanced procedures (arterial lines, central lines, and nerve blocks) significantly increased the likelihood of planning to pursue pediatric anesthesiology fellowship (adjusted Odd Ratio 8.47, 95% Confidence Interval, 1.65–43.4). Perceptions of faculty teaching, mentor availability, planned practice environment, and the presence of fellowship programs at the institution were not significantly associated with intentions to pursue pediatric anesthesiology fellowship.

Conclusions

The journey toward specializing in pediatric anesthesiology is influenced by a complex interplay of factors. Among these, enhanced exposure to challenging cases and advanced procedures during the residency phase is emerging as a critical element. Such exposure not only equips residents with the necessary skills and confidence to handle complex pediatric anesthesia cases but also plays a pivotal role in attracting more trainees to this essential subspecialty.
Mosaic KRAS Mutation in Schimmelpenning–Feuerstein–Mims Syndrome With Overlapping Oculoectodermal Syndrome and Encephalocraniocutaneous Lipomatosis Features
Authors: Hanna Hyvönen , Kaisa Kettunen , Kristiina Avela , Sirpa Kivirikko , Leila Jeskanen , Sinikka Suominen , Päivi Salminen , Katariina Hannula‐Jouppi
Published: December 2024

We report a patient with clinically confirmed Schimmelpenning–Feuerstein–Mims (SFM) syndrome but many overlapping features with oculoectodermal syndrome (OES) and encephalocraniocutaneous lipomatosis (ECCL). Whole exome sequencing revealed a mosaic KRAS c.436G>A, p.(Ala146Thr) mutation, previously identified in three OES and ECCL patients. These findings corroborate the evidence of SFM syndrome being a mosaic RASopathy, broaden the phenotypic spectrum of oculocutaneous mosaic RASopathies, and indicate SFM syndrome as a continuum of the OES–ECCL disorder spectrum.
Executive Functioning Across the Transition to Kindergarten: Links With Social and Academic Outcomes in Early Childhood
Authors: Memba Gabriela V. , Ostrov Jamie M.
Published: December 2024

The current project investigates the longitudinal relations of executive functioning (EF) at the beginning of pre‐kindergarten, and outcomes of (mal)adjustment both at the end of pre‐kindergarten and beginning of the kindergarten. To examine this aim, a secondary analysis was conducted using a large, primarily low‐income and under‐represented early childhood sample (N = 476, M = 52.8 months old, 47.3% female, 60.8% Black and Hispanic/Latinx). Data were analyzed using confirmatory factor analyses and longitudinal structural equation modelling. Results demonstrated that an affective conceptualization of EF predicted increases in social competence across the pre‐kindergarten year. When examining effects from the beginning of pre‐kindergarten to kindergarten, a traditional, non‐affective, conceptualization of EF predicted increases in academic achievement whereas affective EF skills predicted decreases in aggression. Importantly, conclusions are interpreted with caution given measurement limitations. Results from the current study provide insight regarding the development of EF during early childhood and the transition from preschool to kindergarten for a marginalized and under‐resourced population.
Effects of Solid-to-Fluid Conductivity Ratio on Thermal Convection in Fluid-Saturated Porous Media at Low Darcy Number
Authors: Bavandla K. C. , Srinivasan V.
Published: December 2024

This study presents experimental data on the effects of the solid-to-fluid thermal conductivity ratio on natural convective heat transfer in a fluid-saturated porous medium heated from below. Argon is used as the saturating fluid, while a bed of glass, steel, or aluminum spheres constitutes the solid porous matrix. Emphasis is placed on attaining high Rayleigh numbers while maintaining low Darcy numbers (5.68×10−8≤Da≤5.22×10−7). At low modified Rayleigh numbers (Ra*) corresponding to the Darcy regime, the Nusselt number is independent of the medium conductivity. As Ra* increases and the system transitions into the Forchheimer regime, the data diverge, with Nusselt numbers decreasing with increased thermal conductivity ratio at a fixed Ra*. This nonintuitive result is shown to be the result of the traditional choice of Ra* and Da as the controlling parameter since the heat transfer coefficient appears independent of the conductivity ratio. Scaling arguments are used to identify transition points between the regimes, which yield the transition criterion Ra* ∼ Prp, where Prp is the modified Prandtl number. When the data are expressed by scaling with Prp, it is shown that the data for multiple parameter combinations collapse onto a single curve, which also agrees well with some theoretical predictions. In light of this finding, the data from available literature are assessed, and it is proposed that deviations from theory are likely the result of the strong porous medium condition (low Da) not being satisfied.
Physics-Assisted Machine Learning Models for Predicting Pool Boiling Critical Heat Flux for Cryogenic Fluids
Authors: Li Jiayuan , Kharangate Chirag R.
Published: December 2024

Cryogenic fluid management is highly crucial for NASAs space missions and one challenge identified by NASA is the tank fill process for pure cryogenic fluids. To date, no predictive tool can accurately estimate the pool boiling curve during this process. We aim to address this gap by first accurately predicting critical heat flux. We use both traditional machine learning and physics-assisted machine learning methods to predict critical heat flux on a large dataset of 1322 datapoints from 53 published studies with a wide range of operational conditions and surface properties. While the traditional machine learning approach used no prior knowledge in modeling, the physics-assisted machine learning approach assumes the correlation form of the Zuber instability model (Zuber, N., 1958, “On the stability of boiling heat transfer,” ASME Trans. ASME., 80(3), pp. 711–714) and predicts the multiplier for the hydrodynamic instability term to estimate the critical heat flux. Two groups of input features are compared including one with fluid-only properties and another with both fluid and solid surface properties. Various feature selection methods are employed to reduce the redundant features, and multiple machine learning models are used for modeling the dataset. Physics-assisted machine learning methods predict much better than traditional machine learning methods. The inclusion of solid properties further improves the predictions of critical heat flux across all models using physics-assisted method. Machine learning models are more stable when using physics-assisted methods compared to traditional methods. The best predictions are obtained using the extreme gradient boosting model based on the physics-assisted machine learning method resulting in a mean absolute percentage error of 8.88% which is far better than the semi-empirical correlations.
Entropic Analysis of the Maximum Output Power of Thermoradiative Cells
Authors: Zhang Zhuomin M. , Bohm Preston , Menon Akanksha K.
Published: December 2024

In this study, entropic analysis is combined with the detailed balance model to determine the maximum output power of thermoradiative (TR) cells, which are semiconductor devices that generate electric power from a heat source that emits photons to a cold reservoir. Previous studies used different models without addressing their interconnections and inherent assumptions. This work unifies these models by considering the modified Bose–Einstein distribution of photons and reveals the underlying relationship between different models. The findings provide useful insights on the application and optimization of emissive power generation devices for harvesting low-grade heat and space power generation.
Cost-Effective Clinical Methods to Evaluate the Efficacy of Gait Training Devices: A Systematic Review of Randomized Controlled Trials
Authors: B. V. Clinton Wilson , D. S. Mohan Varma
Published: December 2024

This systematic review was aimed at identifying cost-effective outcome assessment metrics to perform clinical trials for assessing the efficacy of novel, low-cost gait training devices. The search was conducted by the investigators through electronic databases, namely, SCOPUS (91), Web of Science (93), PubMed (141), and Cochrane Library (164), from origination to Mar. 31, 2024. The study design was a preferred reporting items for systematic reviews and meta-analyses (PRISMA) style systematic review of randomized controlled trials (RCTs) of robotic gait training devices (RGTDs) that treated stroke patients. Based on our inclusion and exclusion criteria, 17 randomized controlled trials were studied to identify suitable outcome assessment measures. This involved 705 patients at different stages of stroke, who were treated with different intervention durations, devices, randomization, and blinding methods. It was observed from the extensive clinical trials with the RGTDs that it was tested with a variety of assessment methods. Cost-effective outcome assessment measures that require commonly available materials are chosen and discussed in this review. It is identified that the most extensively used measures possess concurrent validity, sufficient inter-rater, intra-rater, and test-retest reliability. Clinical trials with a sophisticated setup cannot be afforded by clinics in low-income countries. It is vital to identify assessment methods that require commonly available materials that do not incur huge material costs. The methods discussed in this review can be administered without special training. This can facilitate quantifying and comparing the efficacy of these devices through clinical trials and multicentric investigations.
Robotic Hand Exoskeletons for Rehabilitation and Assistance: A State-of-the-Art
Authors: Chen Bing , Wu Yadong , Ni Xiang , Qin Laiyin , Li Eric
Published: December 2024

The number of patients with hand dysfunction is increasing worldwide, and their activities of daily living (ADLs) are seriously affected. Robotic medical devices such as robotic hand exoskeletons have been investigated to help restore and improve the hand functions of these patients. In comparison with the traditional therapies, robotic hand exoskeletons have the advantages of providing a controllable assistive force/torque, recording the wearer's motion data, and improving the wearer's voluntary participation and motivation in the rehabilitation, which can improve the hand rehabilitation efficiency. Currently, there is a lack of systematic reviews of robotic hand exoskeletons. This paper presents a systematic review of robotic hand exoskeletons. Six electronic databases are searched using the same keywords, and a total of 86 papers that meet the inclusion criteria are selected for this review. The biomechanics of a human hand is introduced. The design concepts of robotic hand exoskeletons are also proposed, which include the actuator design and configuration, human-machine kinematic compatibility, and design of degrees-of-freedom (DOFs). Additionally, the control strategies of robotic hand exoskeletons are described. Finally, the limitations of the currently available robotic hand exoskeletons and their possible future research and development directions are discussed. The significance of this review is to provide useful information for the engineers and researchers to develop robotic hand exoskeletons with practical and plausible applications.
On the Efficacy of Sparse Representation Approaches for Determining Nonlinear Structural System Equations of Motion
Authors: Pasparakis George D. , Fragkoulis Vasileios C. , Kougioumtzoglou Ioannis A.
Published: December 2024

A sparsity-based optimization approach is presented for determining the equations of motion of stochastically excited nonlinear structural systems. This is done by utilizing measured excitation-response realizations in the formulation of the related optimization problem, and by considering a library of candidate functions for representing the system governing dynamics. Note that a novel aspect of the approach relates to treating, also, systems endowed with fractional derivative elements. Clearly, this is of significant importance to a multitude of diverse applications in engineering mechanics taking into account the enhanced modeling capabilities of fractional calculus. Further, the fundamental theoretical and computational aspects of various representative, state-of-the-art, numerical schemes for solving the derived sparsity-based optimization problem are reviewed and discussed. A Bayesian compressive sampling approach that exhibits the additional advantage of quantifying the uncertainty of the estimates is considered as well. Furthermore, comparisons and a critical assessment of the employed numerical schemes are provided with respect to their efficacy in determining the nonlinear structural system equations of motion. In this regard, two illustrative numerical examples are considered pertaining to a nonlinear tuned mass-damper–inerter vibration control system and to a nonlinear electromechanical energy harvester, both endowed with fractional derivative elements.
Relationship Between Group Activities and Social Anxiety Among College Students and the Intervention Effect of Group Activities
Authors: Yang Xiaoyu , Ye Chunhan
Published: December 2024

Due to environmental changes, personal pressure, and other reasons, college students' social anxiety is severe, which is not conducive to the healthy development of individuals. Therefore, intervention is needed. This paper aims to understand the relationship between group activities combined with mindfulness technology and college students' social anxiety and the intervention of group activities to explore whether mindfulness group activities can alleviate college students' social anxiety. Using social avoidance and distress scale (SAD), interaction anxiousness scale (IAS), and five facet mindfulness questionnaire (FFMQ) as tools, 110 college students with social anxiety from Enshi Polytechnic were randomly divided into an experimental group and a control group. The former group underwent mindfulness activity intervention for 8 weeks, and the pre- and post-test levels of social anxiety and mindfulness of the two groups were compared. Significant differences were not observed in pretest IAS, SAD, and FFMQ scores between the two groups (p > 0.05). In the post-test, the experimental group exhibited significantly lower IAS scores (43.28 ± 8.36) and SAD scores (11.45 ± 2.07) compared to both their pretest scores and those of the control group (p < 0.05). The experimental group showed a significantly higher FFMQ score of 118.78 ± 12.87 points compared to both the pretest and control group (p < 0.05). No obvious changes were observed in the IAS, SAD, and FFMQ scores of the experimental group during the follow-up period (p > 0.05).
Thermal Protection Analysis of Hypersonic Reentry Nose Cone With Multirow Disk Spike Using Lateral Single/Multijets: A Computational Investigation
Authors: Gao Huiliang , Zhu Dan
Published: December 2024

This research examines the efficacy of employing lateral multijets to decrease thermal effects on the blunt body featuring a multirow disk (MRD) spike, which holds significant importance in the design of high-speed vehicles. The main novelty of the model is the combination of the spike with multiple row disk along with the injection of the coolant jet. The study thoroughly analyzes the cooling mechanism of lateral jets and assesses the influence of coolant jet positioning on heat reduction of the nose and mechanical spike. This study employed Reynolds-averaged Navier-Stokes equations with shear stress transport turbulence model for the simulation of the high-speed flow around the nose cone with multirow disk spike. A comparison is made between the effectiveness of CO2 and helium jets, both as single and multiple injectors. The results display that a single CO2 jet released near the tip of the spike is the most effective, and placing the lateral coolant injector away from the main body effectively manages aerodynamic heating. Additionally, the research compares the heat load reduction achieved by triple lateral jets and concludes that the CO2 jet is the most efficient option for thermal protection of the main body. The role of the spike in reduction of the heat load is reduced 20% when CO2 jet is released from all lateral injectors.
The Influence of Vortex Flow in the Dispersed Phase on Droplet Formation Dynamics
Authors: Maurya Tara Chand Kumar , Dutta Sushanta
Published: December 2024

This work explores the characteristics of a two-phase system's dispersed phase flow that interacts inside the microfluidic channel at the junction. Direct visualization and μ-particle image velocimetry measurements are performed on the interaction of two immiscible fluids in different stepped flow-focusing (SFF) channels for droplet formation. The capillary instabilities produce the counter-rotating vortex flow in dispersed phase fluid at the interface, which plays a significant role in droplet formation. The vortex flow has been analyzed using various data processing techniques. The effect of flowrate and step channel dimensions on the evolution of the vortices generated during droplet thread propagation is studied. The strength of the vortex and momentum flux led to the development of more bulging shapes in the droplet thread. Also, this study exhibits transient flow characteristics during the detachment stage and contributes to understanding its influences on mass transfer at the microlevel dimensions.
Performance Analysis of a Brazed Plate Heat Exchanger During Condensation of R1233zd(E)
Authors: Khalid R. , McMullen M. , Amalfi R. L. , Ortega A. , Wemhoff A. P.
Published: December 2024

This paper focuses on the validation of a brazed plate heat exchanger (BPHE) model that acts as the condenser of a novel in-rack cooling loop. In the proposed system, the primary fluid enters as a saturated vapor, while the secondary fluid enters as a subcooled liquid flowing in a counterflow configuration. The model augments an existing general technique for simplicity and computational efficiency and is applied to the condensation of a low-pressure, environmentally friendly refrigerant, i.e., R1233zd(E). The model analyzes the heat transfer and pressure drop values of both fluids in the heat exchanger and uses these results to predict the heat exchanger duty and exit temperature and pressure of both fluids. The model predicts the values of fluid output properties along with heat exchanger duty to within 20% of experimental measurements. The validated model is then used to assess the magnitude of the heat transfer coefficient and friction factor attained on both fluid sides of the heat exchanger, including relatively uniform water-side heat transfer coefficient, a substantial (30%–80% of overall flow length) region of two-phase condensation, and a minimum refrigerant-side friction factor in the subcooled regime.
Effects of Lattice Orientation Angle on TPMS-Based Transpiration Cooling
Authors: Son Juchan , Brouman Mohsen , Pyo Yeongmin , Richer Patrick , Jodoin Bertrand , Hong Zekai
Published: December 2024

Establishing a continuous cooling film is an effective way to thermally protect hot-gas path components of gas turbines. For aero-engines, effusion cooling is the state-of-the-art method for developing cooling films. However, the cooling film generated by this method is far from ideal, as discrete miniature cooling air jets exiting from effusion cooling holes leave large gaps between cooling holes without adequate cooling film protection. Furthermore, effusion cooling jets can experience strong liftoff from component surfaces and are subsequently diluted due to mixing with the main flow. Recent advances in additive manufacturing (AM) technologies have enabled the fabrication of porous materials with precisely engineered lattice structures, significantly enhancing the film cooling effectiveness of hot-gas path components through transpiration cooling. A prior study has demonstrated highly promising transpiration cooling results by using a family of lattice geometries referred to as triply periodic minimal surface (TPMS) lattices. The present study experimentally investigates the influence of various TPMS lattice orientations on the film cooling effectiveness. Three types of TPMS structures, namely, diamond, Koch, and gyroid, are compared to demonstrate that the TPMS lattice orientation angle affects transpiration cooling performance, with different levels of sensitivity according to the TPMS structure. The TPMS lattice structures studied in this investigation are fabricated by stereolithography (SLA) three-dimensional printing. The adiabatic cooling film effectiveness (AFE) is measured using pressure sensitive paint (PSP).
Use of Results-Oriented Monitoring tools to enhance global health accountability: lessons from the European Commission/WHO ‘Health Systems Strengthening for Universal Health Coverage’ programme
Authors: Roura Maria , Capa Eva , Appelt Bernd , Lecomte Michel , Fernandez Maria , Schmets Gerard , Porignon Denis
Published: December 2024

Governments and organisations must demonstrate accountability and delivery of results. Results-Oriented Monitoring (ROM) is a European Commission mechanism aiming at enhancing internal control and management. The Health System Strengthening (HSS) for Universal Health Coverage (UHC) programme provides support towards achieving UHC through policy dialogue in 115 countries.

Drawing from the ROM review of the HSS for UHC programme, we examine the value of the Commission’s ROM system as a tool to enhance accountability of large Global Health (GH) programmes. We present the lessons learnt and provide specific recommendations about how ROM tools can be employed to strengthen GH accountability.

ROM reviews can provide critical data to inform the design, implementation and evaluation of large-scale GH programmes through a well-integrated mixed-methods approach in which quantitative and qualitative components reinforce each other. Recognising the tremendous power of measures of performance, they track available quantitative indicators from baseline to target along the results chain. Firmly grounded on qualitative tools, they also capture the complex nature of health systems, and the critical influence of contextual factors and stakeholder dynamics.

Poor data quality and insufficient multistakeholder engagement are persisting but not unsurmountable challenges. As increasing support is provided to strengthen health information and management systems, the process of codeveloping Monitoring and Evaluation frameworks at country level could serve as a tool to enhance mutistakeholder engagement in policy dialogue. The political nature of both results-oriented systems and GH programmes suggests that mechanisms to assess power dynamics should be incorporated into policy dialogues and ROM review processes.
Effectiveness of chatbot-based interventions on mental well-being of the general population in Asia: protocol for a systematic review and meta-analysis of randomised controlled trials
Authors: Leung Wilson , Lam Simon Ching , Ng Fowie , Yip Calvin Chi Kong , Chan Chi-Keung
Published: December 2024

Introduction

In Asian countries, stigma against psychiatric disorders and shortage of manpower are the two major challenges that hinder people from receiving treatments. Chatbots can surely help people surpass the stigmatising and manpower shortage challenges. Since a comprehensive review in the Asian context is lacking, this systematic review will evaluate the effects of chatbot interventions on the mental well-being of the general population in Asia.

Methods and analysis

Four electronic databases (PubMed, CINAHL, PsycINFO and MEDLINE) will be searched until December 2024. Randomised controlled trials with English/Chinese full text available will be included. Random-effect models will be used for meta-analyses. The risk of bias (RoB) and certainty of evidence across studies will be assessed using the Cochrane RoB2 and Grading of Recommendation Assessment, Development and Evaluation tools, respectively.

Ethics and dissemination

This study will not require ethical approval. The findings will be disseminated through peer-reviewed publications.

Funding

School Research Grant of the Tung Wah College (2023-04-52-SRG230401)

PROSPERO registration number

CRD42024546316.
Metabolomics-based treatment for chronic diseases: results from a multidisciplinary clinical study
Authors: Tsoukalas Dimitris , Sarandi Evangelia , Fragoulakis Vassilleios , Xenidis Symeon , Mhliopoulou Maria , Charta Maria , Paramera Efstathia , Papakonstantinou Evangelos , Tsatsakis Aristidis
Published: December 2024

Background

Non-communicable diseases (NCDs), known as chronic diseases, significantly impact patients’ quality of life (QoL) and increase medical expenses. The majority of risk factors are modifiable, and metabolomics has been suggested as a promising strategy for their evaluation, though real-world data are scarce. This study evaluated the QoL improvement and cost-effectiveness of a metabolomics-based treatment for NCDs, aiming to restore metabolic dysfunctions and nutritional deficiencies.

Methods

We performed a pre–post intervention analysis using clinical, metabolomics, QoL and economic data obtained from the electronic health records of 765 patients visiting a private practice. The intervention consisted of personalised treatment to restore metabolic dysfunctions and nutritional deficiencies identified by metabolomics alongside the standard treatment for their condition. The mean intervention duration was 401 days.

Results

Significant improvement was identified in energy levels, sleep quality, gastrointestinal function and physical activity (p<0.001). 67.9% of participants reported significant improvement in the overall QoL, and the average quality-adjusted life-years (QALYs) increased by 0.064 (95% uncertainty interval 0.050 to 0.078) post-treatment. The incremental cost-effectiveness ratio was estimated at €49.774/QALY (95% CI €40.110 to €61.433). Metabolic profiling demonstrated that 16/35 organic acids and 11/24 total fatty acids were significantly changed post-treatment (p<0.001), participating in key pathways such as energy metabolism, microbiome and neurotransmitter turnover. Vitamin D and 5-methyltetrahydrofolate insufficiency was significantly restored (p=0.036).

Conclusion

This is the first study providing evidence that the integration of metabolomics in clinical practice can have a clinical benefit for patients’ QoL and may be a cost-effective method.
National cross-sectional survey of US adults to assess the reliability of current and lifetime cannabis smoking
Authors: Lum Emily , Tang Janet , Ryder Annie , Vali Marzieh , Cohen Beth E , Keyhani Salomeh
Published: December 2024

Objective

The objective is to examine the test–retest reliability and internal reliability of six self-report questions assessing both current (past 30 days) and lifetime cannabis smoking in an internet survey in the adult US population.

Design

Cross-sectional national survey.

Participants

Out of 957 US adults who completed a national 2020 survey administered through Ipsos KnowledgePanel, 557 completed a second survey (‘reliability survey’) aimed at assessing the test–retest and internal reliability of questions asking about current and lifetime cannabis smoking. The sample size used in the analysis for the six self-report questions varied and was dependent on respondents answering the questions in both the 2020 survey and the reliability survey.

Primary outcome measure

Test–retest and internal reliability of six self-report questions asking about current and lifetime cannabis smoking.

Results

Among respondents who had smoked cannabis in the past 30 days, 33.8% were aged 18–34, 29.7% were 35–49, 27.7% were 50–64 and 8.8% were 65 or older. Current cannabis smokers were primarily men (59.5%) and white (63.0%). Almost half of current cannabis smokers had a high school diploma or less followed by some college and a bachelor’s degree or higher (45.7%, 30.6%, 23.8%, respectively). The question assessing number of days participants smoked cannabis in the past 30 days demonstrated good test–retest (r=0.87) and excellent internal reliability (α=0.94). The questions assessing the number of years, the most common form of use and the number of times participants smoked cannabis over their lifetime also demonstrated test–retest (r=0.77 (acceptable), r=0.75 (acceptable) and κ=0.65 (substantial), respectively) and excellent-to-good internal reliability (α=0.91, α=0.87 and α=0.88, respectively).

Conclusions

We found simple questions assessing current and lifetime cannabis use to demonstrate both test–retest reliability and internal reliability. These questions can serve as a simple framework for clinicians to evaluate the frequency of cannabis smoking in their patients. Future work should examine if these simple frequency measures of smoking cannabis are associated with adverse health outcomes.
Opportunities for nurses aspiring to or undertaking clinical academic development globally: protocol for a scoping review
Authors: Jennings Claire , Norman Gill , Marshall Marie , Briggs Michelle
Published: December 2024

Introduction

Nurse researchers often lack awareness of how to start a clinical academic research career and often lack clear entry routes. This scoping review aims to identify the range and nature of clinical academic opportunities available for nurses. This will also identify the knowledge gaps and provide the basis for future research.

Methods and analysis

The review will be conducted using scoping review methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses with the Extension for Scoping Reviews guidelines. We will search CINAHL (EBSCO), MEDLINE (Ovid), AMED (Ovid) and ProQuest using a search based on the facet’s ‘nurse’, ‘research’ and ‘clinical academic’. Grey literature and a hand search of the reference lists will be conducted for additional publications meeting the inclusion and exclusion criteria. We will include articles published in English, with a focus on registered nurses interested in undertaking clinical academic development within any healthcare system, with no restrictions regarding the date of publication. Following initial screening of titles and abstracts, relevant full-text papers will be screened for inclusion. Two independent reviewers will participate in an iterative process of screening the literature, paper selection and data extraction. We will use a prespecified form to extract data which will be charted and presented in a tabular form. Samples of data extraction and charting will be checked by a second reviewer. This will support a narrative summary structured around key identified variables agreed on iteratively by the review team.

Ethics and dissemination

No ethical or Health Research Authority approval is required to undertake this scoping review. The findings will inform future research exploring the opportunities supporting nurses aspiring to undertake clinical academic development and be disseminated via presentations at national conferences and publications in peer-reviewed journals.

Study registration

Open Science Framework, DOI:10.17605/OSF.IO/WVDXH.
Hepatic arterial infusion chemotherapy plus regorafenib compared with regorafenib alone as second-line therapy for advanced hepatocellular carcinoma: a randomised controlled trial protocol
Authors: Zhao He , Zhang Xiaowu , Tian Pengfei , Luo Yingen , Sun Wei , Li Ying , Li Jingui , Gong Tao , Yang Zhengqiang , Song Peng , Li Xiao
Published: December 2024

Introduction

The exact role of hepatic arterial infusion chemotherapy (HAIC) in advanced hepatocellular carcinoma (aHCC) is still unknown. The combination of HAIC and sorafenib has been proven to be more effective than sorafenib alone in the first-line treatment of aHCC. The aim of the study is to evaluate the efficacy and safety of HAIC plus regorafenib in the second-line treatment of aHCC.

Methods and analysis

This is a multicenter, open-label, randomised controlled phase III trial. A total of 294 patients with aHCC, who are unable to tolerate the first-line systemic therapy or progress after the first-line systemic therapy, will be enrolled in the study. The patients will be randomly (2:1) assigned into the combination treatment group (HAIC plus regorafenib, n=196) and the control group (regorafenib alone, n=98). HAIC and regorafenib (160 mg/day) will be given in a 4-week cycle. The primary endpoint is overall survival in the intention-to-treat population. The second endpoints include progression-free survival, overall response rate, time to progression, etc. The radiological assessments will be based on the criteria of Response Evaluation Criteria in Solid Tumors 1.1.

Ethics and dissemination

This study is approved by the ethics committee of Cancer Hospital, Chinese Academy of Medical Sciences. All participants are required to provide written informed consent. The results of this study will be disseminated through peer-reviewed publications and esteemed academic conferences.

Trial registration number

Chinese Clinical Trial Registry (ChiCTR2300073075).
Dental caries prevalence and caries-associated risk factors of students aged 12–15 in Xide County of Liangshan Prefecture, China: a cross-sectional study
Authors: Sun Suzhen , Lou Yiting , Weng Xiaoyan , Xie Chenghui , Ma Haiying , Sun Zheyuan , Wang Qianting , Yang Yong , Ji Kaile , Ying Binbin
Published: December 2024

Objective

About 2 billion people have caries in permanent teeth, and 514 million children have caries in primary teeth worldwide. Regional disparities in caries prevalence are evident in various areas of China. A comprehensive understanding of the status of dental caries and its associated risk factors is essential for developing effective dental health policies in economically disadvantaged regions. Thus, this study aims to examine the prevalence of dental caries and its risk factors among students aged 12–15 in Xide County, a remote mountainous area in China.

Design

In this cross-sectional study, dental health surveys were conducted using self-administered questionnaires and the Decayed-Missing-Filled Tooth (DMFT) Index. An oral clinical examination was carried out by the criteria and guidelines set forth by WHO.

Setting

Xide County, Liangshan prefecture, China in 2022.

Participants

558 students aged 12–15 years completed the survey.

Results

The study conducted in Xide County found a dental caries prevalence of 42.5% among 12–15 year-old students, with a mean DMFT of 1.50 (SD=2.25). Multivariable logistic regression analysis identified several significant risk factors for dental caries (p<0.05), including starting brushing after the age of six (OR 0.34, 95% CI 0.17 to 0.65), brushing teeth less than once a day (OR 9.24, 95% CI 5.53 to 15.33) and consuming carbonated drinks more than once a day (OR 0.28, 95% CI 0.14 to 0.53). Additionally, the use of fluoride (OR 0.61, 95% CI 0.43 to 0.85) and awareness of its protective effect on teeth (OR 0.75, 95% CI 0.59 to 0.98) were found to be associated with a lower risk of dental caries (p<0.05).

Conclusion

The prevalence of dental caries among students aged 12–15 in Xide County was identified as a significant public oral health concern. The oral health behaviours of students were found to be influenced by factors at the family and community levels.
Psychological and pharmacological treatments of intermittent explosive disorder: a meta-analysis protocol
Authors: Liu Fangqing , Yin Xiaoshan
Published: December 2024

Introduction

Intermittent explosive disorder (IED) is characterised by recurrent, sudden episodes of impulsive aggression that are disproportionate to the provocation. The condition’s management remains challenging due to the variability in treatment efficacy and the absence of Food and Drug Administration-approved interventions specifically for IED. This meta-analysis aims to evaluate the effectiveness of existing treatments for IED.

Methods and analysis

Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted in November 2023, yielding 17 randomised controlled trials after screening and eligibility assessments. Studies were included based on participants’ confirmed diagnosis of IED, sufficient statistical power and provision of data for effect size calculation. Interventions analysed included pharmacological treatments, psychotherapies and combination therapies, with an emphasis on cognitive–behavioural therapy and selective serotonin reuptake inhibitors. Quality assessment was performed using the Cochrane Risk of Bias Tool.

Ethics and dissemination

Given that our study is a synthesis of published data, ethical approval from a research ethics committee is not required. Nevertheless, the methodology of this review was designed to ensure full transparency and accountability. All efforts have been made to respect the confidentiality and intellectual property rights of the original data sources. Any ethical issues encountered during the data collection process were addressed in accordance with the guidelines of the Declaration of Helsinki. As this research involves the analysis of existing published data, there are no direct safety concerns related to patient interactions. Our primary focus has been on ensuring the secure handling and processing of data to uphold the ethical standards set by previous original studies. To ensure the findings of our meta-analysis reach both the academic community and the public effectively, we aim to submit our findings to peer-reviewed journals within the fields of psychology to ensure rigorous review and broad academic dissemination.

PROSPEO registration number

CRD42024497587.
Trial to compare mixed-use (multi-use and single-use) intermittent catheter management with single-use management over 12 months (The MultICath Trial): protocol for a non-inferiority randomised controlled trial
Authors: Fader Mandy , Macaulay Margaret , Wilson Nina , Goudie Nicola , Chadwick Thomas J , Abouhajar Alaa , Jones Jeremy , Watson Gillian , Avery Miriam R , Broadbridge Jackie , Buckley Brian S , Clancy Bridget , Cottenden Alan , Dickson Sylvia , Guerrero Karen , Hagen Suzanne , James Catherine P , Khasriya Rajvinder , Little Paul , May Carl R , McClurg Doreen , Moore Michael , Murphy Cathy , Prieto Jacqui , Reading Isabel , Shields Carol , Timoney Anthony , Wilks Sandra A
Published: December 2024

Introduction

Evaluating the safety and acceptability of reusing catheters for intermittent catheterisation (IC) is one of the top 10 continence research priorities identified by the UK James Lind Alliance Priority Setting Partnership in 2008. There are an estimated 50 000 IC users in England and this number is rising. Globally, both single-use catheters (thrown away after use) and multi-use/reusable ones (cleaned between uses) are used. Using multi-use catheters as well as single-use ones (mixed-use) could bring benefits (eg, reducing plastic waste and patients never running out of catheters) and offer more choice to users. Evidence is needed that mixed-use is at least as safe and acceptable as using only single-use catheters.

Methods

The MultICath Trial is a non-inferiority randomised controlled trial involving 578 participants. The aim is to compare mixed-use catheter management with single-use catheter management over 12 months. Participants are randomised on a 1:1 basis to either mixed-use catheter management, which includes an evidence-based cleaning method for the multi-use catheters (intervention) or single-use catheter management (control). Following randomisation, participants are followed up for 12 months. The primary outcome is at least one episode of microbiologically confirmed symptomatic urinary tract infection with help-seeking or self-help behaviour over the 12-month follow-up period. Laboratory analysis of patient-initiated urine samples is blind. Secondary outcomes include antibiotic use, microhaematuria, visible blood on catheter/in urine, quality of life and health economics. A qualitative sub-study to examine participant experiences using mixed-use is included.

Ethics and dissemination

Ethical review was undertaken by South Central-Hampshire A Research Ethics Committee and favourable opinion was granted on 12 July 2019 (reference: 19/SC/0334). Written, informed consent to participate was obtained from all participants. Results will be disseminated in peer-reviewed publications, in the National Institute for Health and Care Research journal library and to participants and the public via a lay summary published on the trial website.

Trial registration number

ISRCTN42028483.
Vaccination status, personal and workplace experiences of early career health professionals in the WiSDOM cohort study during the COVID-19 pandemic in South Africa
Authors: Rispel Laetitia , Ditlopo Prudence , White Janine A , Blaauw Duane
Published: December 2024

Introduction

The knowledge gaps on the experiences of early career health professionals during the COVID-19 pandemic informed this study, which examined their vaccination status, personal and workplace experiences in South Africa.

Methods

Wits longitudinalStudy toDetermine theOperation of the labourMarket among its health professional graduates (WiSDOM), a prospective longitudinal cohort study established in 2017, consists of eight health professional groups of clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. As a part of annual follow-up surveys, we examined the personal and workplace experiences and the vaccination status of cohort members during the COVID-19 pandemic years: 2020 until 2022. We measured workplace experiences using a Likert scale that ranged from 1 (strongly disagree) to 7 (strongly agree). We constructed a composite index of positive workplace COVID-19 support using a principal component analysis.

We compared differences among the professional groups using proportions for categorical variables and means for numerical variables. We used multiple linear regression to investigate factors associated with the workplace COVID-19 support score and Firth’s penalised logistic regression for COVID-19 infection and vaccination.

Results

In 2022, the mean age of the 363 cohort members was 28.9 (± 2.1), and the majority were female (74.2%). In 2020, 22.6% of the cohort reported COVID-19 infections but this increased to 45.3% by 2021. The composite index shows that doctors and nurses reported the lowest COVID-19 workplace support, while oral hygienists and dentists reported the most support. Although 89.5% of cohort members reported full COVID-19 vaccination status, 9.4% indicated non-intention to get vaccinated. The regression analysis showed that doctors (p<0.001) and women (p<0.05) reported significantly lower workplace COVID-19 support scores. Those working in hospitals had 17.1% higher COVID-19 infections (p<0.01). The lack of a COVID-19 supportive workplace resulted in 15.7% higher infections among early career health professionals (p<0.01).

Conclusion

The study findings underscore the need for positive practice environments for early career health professionals in South Africa.