bluuebunny/crossref_metadata_2025 huggingface dataset:
Absent or Hidden? Hyperactivity in Females With ADHD
Authors: Wettstein Ravian , Navarro Ovando Valentina , Pirgon Esra , Kroesen Jeroen , Wettstein Karl , Kroesen Hans , Mathôt Ron , Dumont Glenn
Published: August 2024

Objective:

This study aimed to objectively assess signs of hyperactivity in adults suspected of having ADHD, addressing potential sex bias in diagnosis.

Methods:

About 13,179 (49% female) adults with an average age of 33 years with ADHD and 1,910 (41% female) adults with an average age of 36 years without ADHD were included. Motor activity was measured using the Quantified Behavioral Test, analyzing “provoked,” and “basal” activity. Sex by group differences were analyzed using analysis of variance.

Results:

Results showed significant ADHD effects on the basal and provoked activity measures, while sex effects were only notable for provoked activity. Males, irrespective of diagnosis, exhibited higher provoked activity than females, while both sexes with ADHD displayed approximately twice the basal activity and about three times the provoked activity compared to their respective sex controls.

Conclusion:

These findings suggest that females with ADHD suffer equally from hyperactivity compared to males, challenging the notion of a sex-dependent presentation of hyperactivity. This may lead to more accurate and timely diagnoses, reducing ADHD-related burdens and comorbidities in females.
Survey of veterinarians in the USA to evaluate trends in the treatment approach for non-obstructive feline idiopathic cystitis
Authors: Krause Laurel R , Li Emma , Lilly M Leanne , Byron Julie , Cooper Edward , Quimby Jessica
Published: August 2024

Objectives

The goal of this study was to gather information on treatment approaches and trends for the treatment of non-obstructive feline idiopathic cystitis (FIC).

Methods

An internet-based survey of veterinarians was conducted focusing on outpatient treatment approaches for cats that are stable, not obstructed and that exhibit lower urinary signs suspected to be due to FIC, where other causes (eg, urolithiasis, urinary tract infection, other) have been ruled out.

Results

A total of 606 veterinarians submitted complete surveys for inclusion. Respondents reported that when obtaining patient histories, in ⩾75% of client interactions they gathered information about feline stressors (542/606, 89%), resource set-up (eg, number of litter boxes; 466/606, 77%) and diet (552/606, 91%). Only 31% (187/606) of respondents reported that they gathered information about daily human/cat interaction in ⩾75% of client interactions, with 69% (419/606) of veterinarians inquiring about this information 50% of the time or less. Top treatments selected for acute presentations of FIC were analgesics (537/606, 89%), modified litter box management (435/606, 72%) and synthetic feline pheromones (422/606, 70%). Top treatments selected for chronic FIC management were prescription diets (519/606, 86%), modified litter box management (508/606, 84%) and environmental enhancements (493/606, 81%). Challenges with owner compliance and expectations were selected as barriers to achieving a positive treatment outcome by 81% (486/599) and 62% (372/599) of respondents, respectively. Rehoming or euthanasia were recommended by 37% (224/606) and 10% (59/606) of veterinarians, respectively, due to difficulties managing FIC.

Conclusions and relevance

The treatment approach for non-obstructive FIC appears to be multimodal and recommendations vary between acute and chronic presentations. An area of opportunity is client communication and education, which may improve owner compliance and help set appropriate expectations. The importance of human/cat interaction as a management strategy appears under-emphasized.
Using telepractice for language sampling during COVID-19 pandemic: A scoping review
Authors: Voniati Louiza , Armostis Spyros , Georgiou Rafaella , Tafiadis Dionysios
Published: August 2024

Introduction

Language sampling is a widely used means of language assessment; it is based on the collection and transcription of a child's language production in various communicative contexts. The need for social distancing due to the COVID-19 pandemic impacted language sampling and speech and language therapy services in general. The in-person assessment became extremely challenging leading to the immediate increased use of telepractice in speech and language therapy. This scoping review aimed to identify the use of telepractice for language sampling in speech and language therapy during the COVID-19 pandemic.

Methods

A scoping review of existing literature was performed to collect evidence on using language sample collection via telepractice. A database search was conducted in PubMed, PsycINFO, Cochrane Library, Mendeley, Electronic, and grey bibliography in 2022. Articles were included if they met the inclusion criteria. The quality of each selected study was assessed using the modified critical appraisal skills program (CASP) checklist.

Results

Systematic searches identified 51 studies with six studies in total meeting the inclusion criteria. The results showed that telepractice was a necessary tool during the pandemic of COVID-19 to conduct language sampling in speech and language assessment.

Conclusion

Speech and language therapists (SLTs) effectively collected language samples through telepractice during the COVID-19 pandemic. Although, to date, the literature on language sampling via telepractice is limited. The need for SLTs to rely on telepractice for language sampling warrants further investigation.
Advancing structural efficacy and resonance performance of battery enclosures through multi-objective optimization
Authors: Naresh Gnanasekar , Praveenkumar Thangavelu , Madheswaran Dinesh Kumar , Solomon Jenoris Muthiya , Goud Kureli Shivakumar , Kolhe Yash Kiran , Lalvani J Isaac Joshua Ramesh
Published: August 2024

Pursuing electric mobility has led to a growing demand for efficient battery enclosures that can withstand dynamic forces and vibrations. This study focuses on advancing the structural integrity and vibrational resilience of battery enclosures through a holistic optimization approach. This research identifies optimal design parameters that minimize deformation and stress while maximizing resonance frequency by leveraging finite element analysis, modal analysis, and multi-objective optimization techniques. The study unveils three candidate designs that showcase remarkable improvements, including a 49.41% reduction in deformation, a 35.79% reduction in stress, and a 19.92% increase in resonance frequency. These findings underscore the potential of integrated design strategies to drive innovation in sustainable electric vehicle technologies.
Post-COVID-19 European Country-Specific Recommendations on adult education, training, and skills: Content, focus, shifts, and patterns
Authors: Boeren Ellen
Published: August 2024

The COVID-19 pandemic significantly disrupted economic and social life across Europe and the wider world. Currently, the European Commission is heavily investing in recovery and resilience facilities to encourage economic and social reforms in Member States. As part of the European Semester, the Commission formulates annual Country-Specific Recommendations (CSRs) to steer and advice Member States on their policy directions. This paper aims to investigate to what extent the European Commission’s recommendations include advice on education, training, and skills development to boost economic and social progress. Four specific aims were to investigate (1) the content of CSRs that mention the need for actions relevant to adult education, training, and skills development, (2) the extent to which these CSRs focus on economic versus social goals, or both, (3) the extent to which the content and focus of these CSRs shifts over years, and (4) the extent to which there are visible patterns within the content and focus of CSRs across the 27 EU Member States. Results indicate that CSRs in the first year of the COVID-19 lockdowns – 2020 – heavily focussed on the need for digital skills development. CSRs in 2022 were not dominated by advice on education, training, and skills development apart from the focus on skills mismatches in some countries. The 2023 CSRs were strongly targeted towards the need for green skills development. In line with previous academic debates around education and training, CSRs contained text on economic and social goals, although social aspects tend to lead back to the integration of vulnerable adults in the labour market for economic purposes, instead of treating education holistically. While CSRs are country-specific, it is clear from the analyses that core recommendations feature across Member States, linked to broad European agendas such as the Twin transition to a green and digital economy.
Police Violence Exposure and Associated Health Outcomes Among Latinx Adults in the United States: An Integrative Review
Authors: Motley Robert O. , Patel Priti , Roh HeeJoo , Walker Danielle T.
Published: August 2024

Police violence exposure among Latinx adults in the United States is increasingly concerning due to its prevalence and associated risks for adverse mental, behavioral, and physical health outcomes. This integrative review appraised studies published from 2003 to 2023 that examine the relationship between police violence exposure and negative health outcomes in Latinx adults. Using structured search terms, articles were identified in APA PsycInfo and PubMed databases, supplemented by a gray literature search and citation mining. Eleven studies met the inclusion criteria. Findings indicate a significant positive association between police violence exposure and adverse mental ( n = 9), behavioral ( n = 2), and physical ( n = 1) health outcomes. The results underscore the mental, behavioral, and physical health consequences of police violence exposure for Latinx adults. Given the increasing Latinx population in the United States, further research is needed to better understand this relationship and inform interventions.
Effects of acupuncture versus placebo on clinical status and potential specific effects in Fibromyalgia: an umbrella review of 11 meta-analyses
Authors: Araya-Quintanilla Felipe , Ramirez-Vélez Robinson , Mendez-Rebolledo Guillermo , Cuyul-Vásquez Iván , Arce-Álvarez Alexis , Ezzatvar Yasmin , Gutiérrez-Espinoza Héctor
Published: August 2024

Background:

The use of acupuncture is related to patients’ expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM).

Objective:

To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM.

Design:

Umbrella review of systematic reviews (SRs) and meta-analyses.

Data sources and methods:

An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results:

Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = −1.13 cm, 95% CI −2.09 to −0.17, p < 0.001), physical function (SMD = −0.63, 95% CI −1.67 to 0.41, p = 0.06), sleep quality (SMD = −0.25, 95% CI −1.39 to 0.88, p = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, p < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI −0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21).

Conclusion:

Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture.

PROSPERO registration number:

CRD42023487315.
Pediatric Primary Care Provider Perspectives on Universal Suicide Screening
Authors: Plax Katie , Leshem Edan , Dodd Sherry , Wang Ruoyun , Rook Shannon , Ericson Lauren , Solsrud Andrew
Published: August 2024

Introduction:

Given the increase in youth mental health concerns, the American Academy of Pediatrics (AAP) recommends universal suicide screening for ages 12 and older, with positive screens followed by a brief suicide risk assessment. However, it is unclear how pediatric clinicians incorporate this recommendation into practice. Therefore, the objective of this qualitative study was to identify pediatric clinicians’ current practice, attitudes, and barriers to implement the updated universal suicide screening recommendation in primary care.

Methods:

Community-based pediatric primary care providers (PCPs) in the St. Louis Metropolitan area who by self-report provide mental health care for patients participated. Participants completed a 30-minute semi-structured interview with invitations extended through an electronic listserv in a local Pediatric PCP Learning Collaborative. Interviews were transcribed and analyzed using consensual deductive and inductive approaches until data saturation.

Results:

Eighteen PCPs participated in the interviews. Interviews described themes related to acceptability of the recommendations, PCPs’ current screening practices, and perceived barriers for implementing the recommendations. Overall, PCPs agreed with, but expressed hesitancy about, the recommendation. Frequently mentioned barriers to suicide screening included time, training, and inadequate access to resources for follow-up care for at-risk patients. Yet, PCPs were optimistic they could learn with support and were interested in working in this subject area through quality improvement interventions.

Conclusions:

PCPs agree with the AAP recommendation about suicide screening but need support to implement into practice. Specifically, PCPs need time sensitive strategies, resources, training, and practice change support to assist these efforts.
A Rare Variant of Aorto-Atrial Fistula; Left Sinus of Valsalva Fistula to Superior Vena Cava and Right Atrium in a Neonate
Authors: Srinivasan Naveen
Published: August 2024

Aorta-atrial fistula (AAF) is defined as the communication of blood flow between the aorta and the atrium. Most of the fistula occurs between the ascending aorta and the right atrium. Aorta-atrial fistula occurs mostly due to acquired causes. Congenital causes remain a minority. We report a very rare variant of AAF in a two-day-old neonate in whom the fistula was arising from the left sinus of Valsalva of the aortic root and draining into the superior vena cava and the right atrium. The child underwent successful surgical ligation of the fistula on a beating heart and is doing well on a two-year follow-up.
Patient Perception of Allograft Versus Autograft in ACL Reconstruction Using a Validated Online Survey Marketplace
Authors: Dean Robert S. , Hafen Tanner J. , Braithwaite Collin L. , Farley Kevin X. , LaPrade Robert F. , Guettler Joseph H. , Bicos James
Published: August 2024

Background:

Little is known regarding the opinions of the general population on anterior cruciate ligament (ACL) graft options.

Purpose:

To evaluate the general population's perception of the use of allografts versus autografts in ACL reconstruction using a previously validated online marketplace platform.

Methods:

A prospective 34-question survey was distributed via the online marketplace. After collecting baseline demographics, participant preferences for ACL reconstruction with an allograft or autograft were established. All respondents completed a preeducation survey, reviewed an evidence-based education sheet, and completed a posteducation survey to assess their understanding. Upon completion, participants were asked which graft they would prefer. Participants were then asked if they would be willing to change their preference based on surgeon recommendation. Finally, participants were asked to rank the factors from the education sheet that were most influential.

Study Design:

Cross-sectional study.

Results:

There were 491 participants that completed the survey (mean age, 39.9 years [range, 19-72 years]; 244 male, 241 female, and 6 nonbinary/third-gender participants). Before reading the education sheet, 276 (56%) reported no graft preferences, 146 (30%) preferred autograft, and 69 (14%) preferred allograft. After reading the provided sheet, 226 (46%) participants preferred autograft, 185 (38%) preferred allograft, and 80 (16%) had no preference. The mean score on the preeducation test was 45%, and the mean score on the posteducation test was significantly greater (61%; P < .01). Overall, 345 participants (83.9%) stated they would change their preference for autograft or allograft if their surgeon recommended it. Surgeon preference (n = 330; 67%), educational information provided (n = 117; 24%), and previous knowledge (n = 44; 9%) were the most important factors for making graft selections. The mean ages of the participants selecting each graft type before and after education were as follows: allograft (37.8 ± 10.1 vs 40.6 ± 11.8 years; P = .05), autograft (38 ± 11.5 vs 39.5 ± 10.1 years; P = .21), and no preference (41.5 ± 11.2 vs 39.4 ± 11.8 years; P = .16).

Conclusion:

Education resulted in a greater number of individuals’ reporting a preference in graft type (either allograft or autograft) compared with preinformation questioning. In addition, 83.9% of the participants were willing to switch their graft choice if recommended by their surgeon.
Reperfusion treatment in basilar artery occlusion presenting with mild symptoms
Authors: Schwarz Ghil , Cascio Rizzo Angelo , Matusevicius Marius , Moreira Tiago , Vilionskis Aleksandras , Naldi Andrea , Martinez-Majander Nicolas , Bigliardi Guido , Toni Danilo , Roffe Christine , Agostoni Elio Clemente , Ahmed Niaz
Published: August 2024

Introduction:

Endovascular treatment (EVT) improves outcomes for basilar artery occlusion (BAO) with moderate-to-severe symptoms. However, the best treatment for mild symptoms (NIHSS score 0–10 and 0–5) remains unclear. This study compared EVT ± IVT to IVT alone in BAO patients with mild symptoms.

Patients and Methods:

From the SITS-International Stroke Treatment Register, we included BAO patients with available baseline NIHSS score, treated by EVT, IVT, or both within 6 h of symptom onset from 2013 to 2021. Using the Doubly Robust approach (propensity score matching plus multivariable logistic regression), we analyzed efficacy (3-month mRS) and safety (SICH and 3-month death) outcomes for EVT ± IVT versus IVT alone in BAO patients with NIHSS scores 0–10 and 0–5.

Results:

1426 patients were included. For NIHSS scores 0–10 (180 matched, 1:1 ratio), outcomes were similar between EVT ± IVT and IVT alone groups. For NIHSS scores 0–5 (89 matched, 1:1 ratio), EVT ± IVT was associated with worse outcomes compared to IVT alone (mRS 0–2, aOR 0.20 [95% CI 0.06–0.61]; p = 0.005; mRS 0–3, aOR 0.27 [95% CI 0.08–0.89]; p = 0.031), but safety outcomes were similar.

Discussion:

In early-treated BAO patients with mild symptoms, defined as NIHSS 0–10, there were no significant differences in outcomes between EVT ± IVT and IVT alone. However, for very mild symptoms, defined as NIHSS 0–5, IVT alone was associated with better outcomes compared to EVT ± IVT.Conclusion: Randomized trials are crucial to determine the optimal reperfusion therapy for BAO patients with mild symptoms.
Delayed Wound Healing in a Young Patient with TNXB Variants and the Role of WES
Authors: Holmes Kathryne , Shah Pearl , Jones Melanie , Langston Ryan , Asumda Faizal , Yu Jack
Published: August 2024

After decades of quality improvement efforts, surgical site infections and abnormal wound healing remain intermittent complications in surgery. In both cases, the complication and abnormality may be superficial, restricted to the skin, or deeper within the tissue. The synthesis of connective tissue proteins, critical for structural support as part of the extracellular matrix, is under the control of multiple genes, forming a complex adaptive network. We report an unusual case of delayed and abnormal wound healing with chronic infection in a 16-year-old patient following surgery for scoliosis. Skin patch test showed that he is allergic to cobalt, a component of fixation hardware used in his surgery. He underwent evaluation by clinical genetics with whole exome sequencing (WES) which showed two (maternally and paternally inherited) variants in the TNXB ( Tenasin XB) gene. These two variants are variants of uncertain significance (VUS). TNXB encodes tenascin-XB which is an extracellular matrix glycoprotein located primarily in the basement membrane. Autosomal recessive pathogenic and likely pathogenic variants in TNXB cause TNXB-related classical-like Ehlers-Danlos Syndrome. At present, there are no causal linkages of these VUSs in TNXB to abnormal wound healing. However, as WES becomes more affordable, its use will increase and therefore it is important that we start to document such associations.
Risk factors of undiagnosed and uncontrolled hypertension in primary care patients with hypertension: a cross-sectional study
Authors: Adediran Emmanuel , Owens Robert , Gardner Elena , Curtin Andrew , Stuligross John , Forbes Danielle , Wang Jing , Ose Dominik
Published: August 2024

Background

Hypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings.

Aim

The present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients.

Methods

A cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension.

Results

Among 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18–44 (2.05 [1.90–2.21]), Hispanic/Latino ethnicity (1.13 [1.03–1.23]),  Medicaid (1.43 [1.29-1.58]) or self-pay  (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41–6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08–1.34]), male (1.24 [1.17–1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62])  or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]).

Conclusion

The results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.
Process evaluation of a randomised controlled trial intervention designed to improve rehabilitation services for Aboriginal Australians after brain injury: the Healing Right Way Trial
Authors: Katzenellenbogen Judith M. , White Jane , Robinson Melanie , Thompson Sandra C. , Epstein Amy , Stanley Mandy , Klobas Jane , Haynes Emma , Armstrong Elizabeth A. , Coffin Juli , Skoss Rachel
Published: August 2024

Background

Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a stepped-wedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staff and 2.Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service received, and improved hospital experience. Assessments were undertaken at baseline, 12- and 26-weeks post-injury. Only MPCs and hospital experience were found to improve among intervention patients.

We report on the process evaluation aiming to support interpretation and translation of results.

Methods

Using mixed methods, the evaluation design was informed by the Consolidated Framework for Implementation Research. Data sources included minutes, project logs, surveys, semi-structured interviews, and observations.

Four evaluation questions provided a basis for systematic determination of the quality of the trial. Findings from separate sources were combined to synthesise the emerging themes that addressed the evaluation questions. Three components were considered separately: the trial process, CST and ABIC.

Results

The complex HRW trial was implemented to a satisfactory level despite challenging setting factors, particularly rural–urban system dynamics. Patient recruitment constraints could not be overcome. The vulnerability of stepped-wedge designs to time effects influenced recruitment and trial results, due to COVID. Despite relatively high follow-up, including to rural/remote areas, data points were reduced. The lack of culturally appropriate assessment tools influenced the quality/completeness of assessment data. The ABIC role was deemed feasible and well-received. The CST involved complex logistics, but rated highly although online components were often incomplete. Project management was responsive to staff, patients and setting factors.

Conclusions

Despite mostly equivocal results, the ABIC role was feasible within mainstream hospitals and the CST was highly valued. Learnings will help build robust state-wide models of culturally secure rehabilitation for Aboriginal people after brain injury, including MPC, workforce, training and follow-up.
Implementation of a patient reminder system in Haiti in a socio-political crisis context: evaluation of outcomes
Authors: Presume Marcmy , Almazor Charles Patrick , Altmann Mathias
Published: August 2024

Background

In Haiti, patient’s adherence to treatment and compliance with medical appointments are very challenging due to different local factors. We aimed to assess the effectiveness of a reminder system implemented in health facilities in Haiti in a context of socio-political crisis.

Methods

We used appointment data from patients aged 15 years and older between January 2021 and November 2023 from four healthcare centers in the Port-au-Prince metropolitan area. We performed descriptive analysis, crossing covariates with appointment attendance. We performed Pearson’s Chi-squared test, and multivariate regression analysis using a mixed-effect logistic regression model in order to explore the association between sending reminders and appointment attendance, with and without adjustment for other patient-level covariates.

Results

A total of 14 108 appointments were registered on the reminder systems, with 2 479 (17.6%) attendances. Among those to whom reminders were sent, the number of attendances was 167 (17.4%) for email recipients only, 199 (36.7%) for SMS recipients only, and 19 (42.2%) for both SMS and email recipients – versus 2 094 (16.7%) for non-reminders. After adjusting on all other covariates, we found that patients to whom a reminder was sent via email (aOR: 1.45; CI: 1.08, 1.94), SMS (aOR: 2.95; CI: 2.41, 3.60), and both SMS and email (aOR: 2.86, CI: 1.37, 5.96) were more likely to show up on their appointment day compared to those who did not receive any reminder. Other socio-demographic factors such as being 50 years and older (aOR: 1.31; CI: 1.10, 1.56) compared to under 30 years, living as couple (aOR: 1.23; CI: 1.10, 1.37), and not having children (aOR: 1.21; CI: 1.07, 1.37) were significantly associated with appointment attendance.

Conclusions

Our study suggests that patient reminder systems may be used to reduce non-attendance in Haiti, even in a context of socio-political crisis.
Level of patient contact and Impact of Event scores among Canadian healthcare providers during the COVID-19 pandemic
Authors: Gutmanis Iris , Sanni Ayodele , McGeer Allison , Maunder Robert , Robertson Nicole ,   CCS Working Group, Cooper Curtis , Katz Kevin , Loeb Mark , McNeil Shelly , Muller Matthew , Powis Jeff , Harrison Robyn , Langley Joanne , Mubareka Samira , Nadarajah Jeya , Valiquette Louis , Smieja Marek , Coleman Brenda L
Published: August 2024

Background

Healthcare providers (HCP) continue to provide patient care during the COVID-19 pandemic despite the known risks for transmission. Studies conducted early in the pandemic showed that factors associated with higher levels of distress among HCP included being of younger age, female, in close contact with people with COVID-19, and lower levels of education. The goal of this study was to determine if level of patient contact was associated with concern for post-traumatic stress disorder (PTSD) as measured by the Impact of Event Scale-Revised (IES-R).

Methods

This cross-sectional study, embedded within a prospective cohort study, recruited HCP working in hospitals in four Canadian provinces from June 2020 to June 2023. Data were collected at enrolment and annually from baseline surveys with the IES-R scale completed at withdrawal/study completion. Modified Poisson regression was used to determine the association between level of patient contact and concern for PTSD (i.e., IES-R scores ≥24).

Results

The adjusted rate ratio (RR) associated with concern for PTSD among HCP with physical contact/direct patient care was 1.19 (95% confidence interval (CI) 1.03, 1.38) times higher than for HCP with no direct contact. In fully adjusted linear regression models, physical care/contact was associated with higher avoidance and hyperarousal scores, but not intrusion scores.

Conclusions

Administrators and planners need to consider the impact of heightened and ongoing stress among HCP by providing early screening for adverse emotional outcomes and delivery of tailored preventive strategies to ensure immediate and long-term HCP health.
‘Everyone needs to be educated’: pupils’ voices on menstrual education
Authors: Brown Natalie , Forrest Laura J. , Williams Rebekah , Piasecki Jessica , Bruinvels Georgie
Published: August 2024

Background

Physical, affective and behavioural symptoms associated with the menstrual cycle are commonplace. Adolescents with problematic symptoms have reported a negative impact on school attendance, behaviour and participation in physical activity. In the United Kingdom, evidence suggests that menstrual health education delivered by teachers focusses on menstrual cycle biology as opposed to management of menstruation and menstrual cycle related symptoms. Through obtaining the pupil voice, this study aimed to understand young people’s perceptions and experiences of menstrual education in schools and their experiences of menstruating whilst at school, including within Physical Education.

Methods

To address the aims, a qualitative descriptive study was conducted. Nine focus groups with female pupils (n = 48; ages 10–15 years) were completed across six school locations in England and Wales, including primary and secondary schools. A range of elements relating to the menstrual cycle, education at school and PE were discussed by pupils.

Results

Four main themes were developed (a) Education preferences, (b) Period positive environments, (c) Personal experiences and (d) Impact on school. Similarities were reflected across focus groups in terms of current (lacking) education, lesson style and preferences, comfort of conversations, lack of school support and impact on school and PE.

Conclusion

The findings highlight the lack of menstrual education received and subsequent impact of menstruation and menstrual-related symptoms in school and PE. The abundance of information requested by pupils highlights the deficit in understanding about how to manage periods in school and remain engaged in physical activity. Schools can utilise information from the current study to; create period positive environments; consider lesson content and format; and explore how to support girls to stay physically active in PE.
The deubiquitinase USP15 drives malignant progression of gastric cancer through glucose metabolism remodeling
Authors: Huangfu Longtao , Zhu Huanbo , Wang Gangjian , Chen Junbing , Wang Yongqi , Fan Biao , Wang Xiaoyang , Yao Qian , Guo Ting , Han Jing , Hu Ying , Du Hong , Li Xiaomei , Ji Jiafu , Xing Xiaofang
Published: August 2024

Background

Ubiquitin-specific protease 15 (USP15) exhibits amplifications in various tumors, including gastric cancer (GC), yet its biological function and mechanisms in GC progression remain elusive.

Methods

Here, we established stable USP15 knockdown or overexpression GC cell lines and explored the potential mechanism of USP15 in GC. Besides, we also identified interacting targets of USP15.

Results

USP15 knockdown significantly impeded cell proliferation, invasion, epithelial-mesenchymal transition, and distal colonization in xenograft models, while enhancing oxaliplatin's antitumor effect. USP15 was involved in ubiquitination modification of glycolytic regulators. Silencing of USP15 suppressed glycolytic activity and impaired mitochondrial functions. Interference with USP15 expression reversed tumor progression and distal colonization in vivo. HKDC1 and IGF2BP3 were found as core interacting targets of USP15, and HKDC1 was identified as a substrate for ubiquitination modification by USP15, whereby USP15 regulated glucose metabolism activity by inhibiting the ubiquitination degradation of HKDC1.

Conclusions

Our study unveiled aberrantly high expression of USP15 in GC tissues, correlating with malignant progression and nonresponse to neoadjuvant therapy. USP15 inhibitors, if developed, could be effective in promoting chemotherapy through glucose metabolism remodeling.
Equity in the provision of helicopter emergency medical services in the United Kingdom: a geospatial analysis using indices of multiple deprivation
Authors: McHenry Ryan D. , Leech Caroline , Barnard Ed B. G. , Corfield Alasdair R.
Published: August 2024

Background

Helicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) are provided in a mixed funding model, with the majority of services funded by charities alongside a small number of government-funded operations. More socially-deprived communities are known to have greater need for critical care, such as that provided by HEMS in the UK. Equity of access is an important pillar of medical care, describing how resource should be allocated on the basis of need; a concept that is particularly relevant to resource-intensive services such as HEMS. However, the Inverse Care Law describes the tendency of healthcare provision to vary inversely with population need, where healthcare resource does not meet the expected needs in areas of higher deprivation. It is not known to what extent the Inverse Care Law applies to HEMS in the UK.

Methods

Modelled service areas were created with each small unit geography locus in the UK assigned to its closest HEMS operational base. The total population, median decile on index of multiple deprivation, and geographic area for each modelled service area was determined from the most recently available national statistics. Linear regression was used to determine the association between social deprivation, geographic area, and total population served for each modelled service area.

Results

The provision of HEMS in the UK varied inversely to expected population need; with HEMS operations in more affluent areas serving smaller populations. The model estimated that population decreases by 18% (95% confidence interval 1–32%) for each more affluent point in median decile of index of multiple deprivation. There was no significant association between geographic area and total population served.

Conclusion

The provision of HEMS in the UK is consistent with the Inverse Care Law. HEMS operations in more deprived areas serve larger populations, thus providing a healthcare resource inversely proportional with the expected needs of these communities. Funding structures may explain this variation as charities are more highly concentrated in more affluent areas.
Lack of basic rationale in epithelial-mesenchymal transition and its related concepts
Authors: Cao Ying
Published: August 2024

Epithelial–mesenchymal transition (EMT) is defined as a cellular process during which epithelial cells acquire mesenchymal phenotypes and behavior following the downregulation of epithelial features. EMT and its reversed process, the mesenchymal-epithelial transition (MET), and the special form of EMT, the endothelial-mesenchymal transition (EndMT), have been considered as mainstream concepts and general rules driving developmental and pathological processes, particularly cancer. However, discrepancies and disputes over EMT and EMT research have also grown over time. EMT is defined as transition between two cellular states, but it is unanimously agreed by EMT researchers that (1) neither the epithelial and mesenchymal states nor their regulatory networks have been clearly defined, (2) no EMT markers or factors can represent universally epithelial and mesenchymal states, and thus (3) EMT cannot be assessed on the basis of one or a few EMT markers. In contrast to definition and proposed roles of EMT, loss of epithelial feature does not cause mesenchymal phenotype, and EMT does not contribute to embryonic mesenchyme and neural crest formation, the key developmental events from which the EMT concept was derived. EMT and MET, represented by change in cell shapes or adhesiveness, or symbolized by EMT factors, are biased interpretation of the overall change in cellular property and regulatory networks during development and cancer progression. Moreover, EMT and MET are consequences rather than driving factors of developmental and pathological processes. The true meaning of EMT in some developmental and pathological processes, such as fibrosis, needs re-evaluation. EMT is believed to endow malignant features, such as migration, stemness, etc., to cancer cells. However, the core property of cancer (tumorigenic) cells is neural stemness, and the core EMT factors are components of the regulatory networks of neural stemness. Thus, EMT in cancer progression is misattribution of the roles of neural stemness to the unknown mesenchymal state. Similarly, neural crest EMT is misattribution of intrinsic property of neural crest cells to the unknown mesenchymal state. Lack of basic rationale in EMT and related concepts urges re-evaluation of their significance as general rules for understanding developmental and pathological processes, and re-evaluation of their significance in scientific research.
Immunomodulators in patients receiving extracorporeal membrane oxygenation for COVID-19: a propensity-score adjusted analysis of the ELSO registry
Authors: Ling Ryan Ruiyang , Ramanathan Kollengode , Shen Liang , Barbaro Ryan P. , Shekar Kiran , Brodie Daniel , MacLaren Graeme
Published: August 2024

Background

Mortality for patients receiving extracorporeal membrane oxygenation (ECMO) for COVID-19 increased over the course of the pandemic. We investigated the association between immunomodulators and mortality for patients receiving ECMO for COVID-19.

Methods

We retrospectively analysed the Extracorporeal Life Support Organisation registry from 1 January, 2020, through 31 December, 2021, to compare the outcomes of patients who received no immunomodulators, only corticosteroids, only other immunomodulators (selective interleukin blockers, janus-kinase inhibitors, convalescent plasma, and intravenous immunoglobulin), and a combination of corticosteroids and other immunomodulators administered either before or during ECMO. We used Cox regression models to estimate survival time until 90 days. We estimated the propensity score of receiving different immunomodulators using multinomial regression, and incorporated these scores into the regression models.

Results

We included 7181 patients in the final analysis; 6169 patients received immunomodulators either before or during ECMO. The 90-day survival was 58.1% (95%-CI 55.1–61.2%) for patients receiving no immunomodulators, 50.7% (95%-CI 49.0–52.5%) for those receiving only corticosteroids, 62.2% (95%-CI 57.4–67.0%) for those receiving other immunomodulators, and 48.5% (95%-CI 46.7–50.4%) for those receiving corticosteroids and other immunomodulators. Compared to patients without immunomodulators, patients receiving either corticosteroids alone (HR: 1.13, 95%-CI 1.01–1.28) or with other immunomodulators (HR: 1.21, 95%-CI: 1.07–1.54) had significantly shorter survival time, while patients receiving only other immunomodulators had significantly longer survival time (HR: 0.79, 95%-CI: 0.66–0.96). The receipt of immunomodulators (across all three groups) was associated with an increase in secondary infections.

Conclusions

In this cohort study, we found that immunomodulators, in particular corticosteroids, were associated with significantly higher mortality amongst patients receiving ECMO for COVID-19, after adjusting for potential confounding variables and propensity score. In addition, patients receiving corticosteroids with or without other immunomodulators had longer ECMO runs, which has potential implications for resource allocation. While residual confounding likely remains, further studies are required to evaluate the timing of immunomodulators and better understand the possible mechanisms behind this association, including secondary infections.
Views and experiences of eating disorders treatments in East Asia: a meta-synthesis
Authors: Yim See Heng , Schmidt Ulrike
Published: August 2024

Introduction

Although there have been qualitative meta-syntheses on experiences of eating disorders treatments, there is a paucity of syntheses specifically examining the perspectives and experiences of eating disorders treatments (ED) in East Asia (EA). Such synthesis could facilitate a better understanding of culture-specific perspectives and experiences. This review complements a quantitative scoping review published on ED treatments in EA (Yim & Schmidt, 2023), where most interventions reviewed focused on cognitive behavioural therapy (CBT) and internet interventions. The present meta-synthesis summarises stakeholders’ views on treatments and to synthesise clinical and research recommendations.

Method

A systematic search of five databases and a citation search were conducted to identify relevant studies and data were analysed using thematic synthesis. Out of the 301 studies found, a total of 12 papers were included in the analysis.

Results

A diverse range of treatments, such as family therapy, paediatric/psychiatric inpatient care, CBT, and counselling, were discussed. Three overarching themes were identified: Delineating Physical and Psychological Recovery; ‘I am not alone in this battle’; and Barriers to Change. The themes further delve into the various obstacles to recovery, including financial concerns and limited access to professionals and services. Culture-specific factors include family obligations and promoting family harmony. Balancing interdependence and independence from one’s family, as well as understanding family body ideals versus broader societal body ideals, are important considerations in ED interventions.

Discussion

Some themes paralleled other qualitative syntheses, highlighting improved family relationships, perceived authoritarianism in treatments, and financial barriers. The review extends beyond the previous findings, revealing nuanced factors like family roles, cultural values, and norms. Clinical recommendations include incorporating family context in treatment and considering cultural influences on body image ideals. Capacity building through telemedicine and increased training is essential for advancing ED treatment in East Asia. Continued research is needed to better understand and treat people affected by ED in EA.
Teacher-centered analysis with TIMSS and PIRLS data: weighting approaches, accuracy, and precision
Authors: Haberman Shelby J. , Meinck Sabine , Koop Ann-Kristin
Published: August 2024

This paper extends existing work on teacher weighting in student-centered surveys by looking into aspects of practical implementation of deriving and using weights for teacher-centered analysis in the Trends in International Mathematics and Science Study (TIMSS) and the Progress in International Reading Literacy Study (PIRLS). The formal conditions to compute teacher-centered weights are detailed, including mathematical equations. We provide a proposal on how to define the targeted populations as well as how to collect data that is needed to derive teacher-centered weights, yet currently unavailable. We also tackle the issue of teacher nonresponse by proposing a respective adjustment factor, as well as mentioning the challenge of multiple selection probabilities when teachers teach in multiple schools. The core part of the paper focuses on studying the level of accuracy that can be expected when estimating teacher population characteristics. We use TIMSS 2019 data and simulate likely scenarios regarding the variance in weights. The results show that (i) the different weighting scenarios lead to relatively similar estimates; however, the differences between the scenarios are sufficient to justify the recommendation to use correctly derived teacher weights; (ii) differences between estimated standard errors based on complex sampling and corresponding estimates based on simple random sampling are sufficiently consistent to support use of a procedure to estimate standard errors that accounts for both sample weights and the complex sampling design; (iii) sample sizes and variance in weights significantly limit estimate precision, so that total population estimates with sufficient precision are available in the majority of countries but subpopulation features are generally not sufficiently precise. To provide a critical evaluation of our results, we recommend implementation of the proposed method in one or more countries. This recommended study will permit examination of logistical considerations in implementation of required changes in data acquisition and will provide data to replicate the analysis with teacher-centered weights.