bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a center for automated equipment processing to transform the research enterprise configuration
Authors: Richter Philip J , LeClair Albert , Lim Harry
Published: October 2024

The strategy of centralizing equipment sanitation and processing was developed by a top-tier public university to address the growing physical infrastructure and human resource challenges of its expanding in-vivo research enterprise. Subsequently, a center for automated equipment processing physically separate from all animal research facilities was developed and has operated consistently since 2016. The facility incorporates systems such as process automation to sanitize and sterilize equipment as efficiently as possible. Analysis of the differences between the new centralized and old distributed research enterprise configurations shows a total estimated fiscal benefit of almost US$54 m to date projected out to US$124 m through 2028. Utility consumption of operations over nine years in the new configuration was estimated to be decreased by over 125 million gallons of water, 14 million gallons of chilled water, 121 million pounds of steam, and almost 3.6 million kilowatts of electricity, with consumption savings significantly increased projected out to 2028. Additional operational and organizational benefits as well as direct research benefits were identified. The new configuration has functioned for nine years without detectable cross contamination within the research enterprise thus providing evidence that the location of equipment processing can be less of a “microbial” risk factor than previously attributed.
Does Meaning-Making Mediate COVID-19 Restrictions’ Impact on Grief and Psychological Symptoms?
Authors: Batista João , Albuquerque Sara , Delalibera Mayra , Oliveira João T. , Coelho Alexandra
Published: October 2024

The COVID-19 pandemic imposed substantial restrictions on funeral ceremonies, profoundly affecting grief experiences. This study investigated the mediating role of meaning-making in the relationship between these restrictions and prolonged grief disorder (PGD) symptoms, anxiety, depression, and trauma. A longitudinal study involving 141 bereaved individuals was conducted, with assessments at two time points: 3–6 months (T1) and 9–12 months (T2) post-loss. Structural equation modeling revealed that the psychological impact of restrictions on death and funeral ceremonies had indirect effects on anxiety and prolonged grief symptoms through meaning-making, particularly the footing in the world subscale. These findings underscore the importance of understanding the complex interplay between pandemic-related restrictions and grief experiences, emphasizing the pivotal role of meaning-making in adapting to loss during those challenging times.
Associations between executive functions at age 3 and children’s learning behaviors at age 6
Authors: Guedes Carolina , Ferreira Tiago , de Lemos Marina Serra , Cadima Joana
Published: October 2024

This longitudinal study explores the associations between children’s executive functions at the beginning of preschool and their learning behaviors, namely competence motivation and attentional persistence, at the end of preschool. Participants were 218 Portuguese children ( Mage = 40.4 months, SD = 4.2; 52% boys) and their preschool teachers ( n = 29). The children’s executive functions (specifically attention shifting, working memory, and response inhibition) were individually assessed when they were 3 years of age. Teachers’ perceptions about the children’s competence motivation and attentional persistence were assessed with the Preschool Learning Behaviors Scale (PLBS) when the children were 6 years old. Results showed positive associations between children’s executive functions and attentional persistence, but not competence motivation, after controlling for covariates (age, gender, and expressive vocabulary). These findings contribute to current evidence about the links between early executive functions and later behavioral indicators of child persistence in learning tasks.
The War Routes in the European Tourist Market During the Spanish Civil War
Authors: Larrinaga Carlos
Published: October 2024

During the Spanish Civil War, War Routes with tourist itineraries were organized in the area controlled by General Francisco Franco. They began to operate on 1 July 1938 and ran throughout the whole of the following year. The objective was, on the one hand, to create a new tourism product essentially aimed at the European market in order to attract tourists and obtain foreign currency. On the other hand, these itineraries formed part of a propaganda campaign which sought to spread the virtues of the new regime that was under construction in order to counteract the campaign being carried out against it abroad by the legitimate regime of the Republic. This new tourism product was promoted among the principal European travel agencies, although it generated poor economic results. This article studies the promotion of these itineraries, the travel agencies that were interested in them, the banks that acted as intermediaries and the results of the initiative.
Trends in intergenerational class mobility and education in Argentina, Chile, and Uruguay, over common birth cohorts
Authors: Jorrat Jorge Raúl , Boado Marcelo , Espinoza Vicente
Published: October 2024

We compare intergenerational class mobility trends in Argentina, Chile, and Uruguay, exploring the effects of education over birth cohorts. After presenting descriptive measures of absolute mobility, we use log-linear models to study relative mobility and the mediating role of education. Then, we examine trends in intergenerational class mobility linked to educational levels over cohorts. Finally, counterfactual simulations show the net effects of education on mobility. Results show that intergenerational class mobility across cohorts occurred only for men in Argentina and Chile. Inequality trends in educational opportunities were only present for women. Class returns to education occurred among men in Chile and Uruguay, and women in Argentina. Social fluidity under the mediating effects of education did not show a clear pattern. The claim that educational expansion created more opportunities for intergenerational mobility does not find support in our data.
Small-scale experimental study on EPS ETICS and flame-retardant coating reaction-to-fire performance
Authors: Tang Mingwei , Rogaume Thomas , Batiot Benjamin , Bensabath Tsilla , Bourbigot Serge
Published: October 2024

External thermal insulation composite systems (ETICS) are a common and energy-efficient cladding system. Thermoplastic expanded polystyrene (EPS) is widely used as an insulation core. However, such combustible material has aggravated fire incidents in recent years, thus it is essential to improve its fire behavior. To evaluate the performance of EPS ETICS, a series of specimens with different flame-retardant (FR) coatings were tested using a small-scale bench and a mass loss calorimeter with a maximum heat flux of 40 kW/m2. When untreated EPS ETICS are exposed to heat, the EPS foam degrades, releases a large volume of combustible gases, and ignites. Applying FR agents such as FR surface paint and expandable graphite blended coating can stop flame propagation, reduce total heat release by approximately 50%, and preserve about 50% of the EPS foam during heat exposure. This enhances significantly the fire safety of EPS ETICS.
A Typology of Psychological Mechanisms Underlying Prosocial Decisions
Authors: Erlandsson Arvid , Dickert Stephan
Published: October 2024

This theoretical article summarizes the various psychological and motivational processes that underlie prosocial decision-making. To this aim, we propose a novel way to organize and synthesize research related to emotions, thoughts, and beliefs (i.e., psychological mechanisms) that motivate or demotivate human prosociality. This is done with a new typology including four overarching interrelated categories, each encompassing multiple subcategories: (a) emotions; (b) moral principles; (c) anticipated impact; and (d) anticipated personal consequences. We highlight differences and commonalities to other influential frameworks and showcase how the proposed typology can help researchers and practitioners better differentiate and understand the diverse psychological mechanisms that underlie human prosociality.
Multi-objective optimization design of automobile seat backrest considering coupling effect
Authors: Chen Haifeng , Yu Ping , Long Jiangqi
Published: October 2024

To investigate the impact of the coupling effects of carbon fiber reinforced polymer in the seat back layer on the performance of car seats, this paper presents a comprehensive optimization design method for composite materials. In detail, the finite element models firstly established and validated through five typical working conditions of automotive seats based on experimental data. Then, the optimized variables are divided and determined through backrest stress nephograms for each working conditions of the automotive seats, in which the various perspective are taken into account, such as the total mass of seat backrest, safety performance, and comfort index. Subsequently, an optimization strategy for unequal thickness layers lay-up design is constructed, which combines strength factors, optimal Latin hypercube sampling, best-worst method, gray relational analysis, and Visekriterijumsko KOmpromisno Rangiranje method for the optimal design of the automotive CFRP seat backrest. Additionally, the impact of layer coupling effects on different performance indices of the seat is examined through simulating and analyzing the seat backrest with various layer coupling types, while incorporating the classical laminate theory. The study reveals that by minimizing the laminate coupling effect, the comfort of the seat can be enhanced. Finally, a comprehensive comparative analysis of the optimal trade-off solution is carried out in terms of optimization strategies. The results show that ensuring the safety performance, the total mass of the seat backrest decreased by 21.3%, as a result of the optimization strategy proposed in this paper, and the comfort performance is also improved to some extent. Therefore, the multi-objective optimization strategy proposed in this paper performs well in terms of effectiveness and provides a reliable reference for related composite material multi-objective optimization.
Thermal hydraulic analysis of a high-temperature gas reactor steam generator after loss of feed water accidents
Authors: Rahmani Bouzina Salheddine , Merrouche Djemai , Kerboua Ziari Yasmina
Published: October 2024

The helical coil steam generator is widely employed in the energy conversion process of high-temperature gas-cooled reactors for its high thermal efficiency in producing superheated steam within the helical tubes. These tubes necessitate materials specifically designed to endure high temperatures, prevent ruptures, and ensure durability under various operational conditions. This study aims to identify the maximum temperatures arising from potential transients in the secondary system and to propose immediate safety measures for minimizing associated risks. The RELAP5/MOD3.4 code was used to simulate the behavior of the next generation nuclear plant steam generator's conceptual design using steady-state conditions. Following the validation of the model, the established steady-state conditions were utilized to simulate accident scenarios, including the feed water line break and the loss of feed water flow to the steam generator. The transient scenarios assumptions include closed flap valves and retained hot helium in the shell side. The simulation tasks were conducted both with and without activating the depressurization system, in order to assess its effect on the temperature of tubes on the wall side. The analysis results indicate that tube wall temperatures can reach 720 °C at the steam generator outlet region and 620 °C at the weld region. The immediate activation of the depressurization system with a controlled relief valve can effectively reduce these temperatures by 239 °C in the steam generator outlet and by 133 °C in the weld region. This also lowers the steam generator's secondary side pressure. As a result, an upgrade and enhancement of operational procedures is straightforward.
Gender Differences in Climbing up the Ladder: Why Experience Closes the Ambition Gender Gap
Authors: Wald Kristina A. , Abraham Mabel , Pike Brian , Galinsky Adam D.
Published: October 2024

Women are unequally represented in the highest positions in society. Beyond discrimination and bias, women are missing from the top because they are less likely to pursue high-ranking opportunities. We propose that experience is a critical moderator of gender differences in pursuing leadership opportunities, with low-experience women being particularly unlikely to seek higher level positions. We used field analyses of 96 years of U.S. senator and governor elections to examine male and female politicians’ propensity to run for higher political offices. As predicted, among those with little political experience, women were less likely than men to run for higher office, but experience closed this gender gap. A preregistered experiment among U.S.-based adults replicated the field findings and revealed that it was the increased self-confidence of experienced women that reduced the gender gap. The findings suggest experience, and the self-confidence that comes with it, is one lever for closing the gender gap in seeking to climb professional hierarchies.
Aucubin Induces Apoptotic Cell Death Through Caspase-dependent Pathways in Human Osteosarcoma MG-63 Cells
Authors: Cui Mengfan , Chen Pengyu
Published: October 2024

Background

Osteosarcomas (OSs) are predominantly generated by mesenchymal cells, which commonly develop in the distal and upper regions of the bones. OS has high mortality rates and treatment failures, mostly due to the presence of lung metastases.

Objectives

The present work aimed to scrutinize the anticancer potentials of aucubin against OS human osteosarcoma (MG-63) cells.

Materials and Methods

The proliferation of the control and aucubin-treated MG-63 cells was studied by an XTT assay. Various fluorescent staining assays were done to assess the endogenous reactive oxygen species (ROS) accumulation and apoptosis in the aucubin-treated MG-63 cells. The caspase-3, -8, and -9 activities were investigated using the assay kits.

Results

The XTT assay results confirmed that the aucubin treatment considerably reduced the MG-63 cells. The findings of the various fluorescent staining assays evidenced that the aucubin treatment remarkably promoted endogenous ROS accumulation and apoptosis in the OS cells. The caspase activities were also improved in the OS cells after the aucubin treatment.

Conclusion

The results of this work show that aucubin treatments inhibit cell proliferation and trigger apoptosis in MG-63 cells, suggesting its potential as a promising anticancer agent. These findings will facilitate the future development of aucubin as a talented anticancer agent to treat OS.
Diabetes Glycemic Control in Adults With Type 2 Diabetes Mellitus and ADHD
Authors: Leshno Dahlia , Lev Shalem Liat , Perlov Gavze Revital , Leshno Moshe
Published: October 2024

Introduction:

Persistence in treatment is important in balancing diabetes and preventing complications. ADHD impairs quality of life and functioning in many areas of life. The aim of this study is to evaluate the possible association of ADHD and diabetes glycemic control among adults with type 2 diabetes mellitus (T2DM).

Methods:

All data were obtained from Maccabi Healthcare Services (MHS) automated databases. This retrospective cross-sectional study uses electronic medical records from the Maccabi Healthcare Services database during the years 2010 to 2020. Using a propensity score with the variables of age, gender, and duration of diabetes, we compared a group of 1,582 patients with T2DM and ADHD to 1,582 patients with T2DM and without ADHD. We used a t-test to compare continuous variables and a Mann-Whitney U test for non-parametric testing. In addition, we used multivariate logistic regression with a cutoff of several HbA1c values in T2DM patients with and without ADHD during 2019 to 2020. The proportion of patients with HbA1c values above 10%, 9%, and 8% in the group of patients with ADHD was 4.7 to 5.9 times higher than in patients without ADHD. In addition, the OR in the multivariate logistic regression was 4.2 (95% CI [2.5, 6.8]), 4.3 (95% CI [3.1, 6.1]), and 2.7 (95% CI [2.2, 3.4]) for cutoff of HbA1c of 10%, 9%, and 8%, respectively.

Conclusion:

Patients with co-morbid ADHD and T2DM have a higher incidence of poor glycemic control. The findings extend the knowledge on the relationship between ADHD and diabetes and highlight the need for further research to improve treatment.
“We didn’t even have time to worry about our mental health.” Long-term impact of the pandemic on nursing professionals’ experiences
Authors: Peres Tyele Goulart , Springer Paul , Ucar Sezercan , Seibel Bruna Larissa , Ramis Ivy Bastos
Published: October 2024

Explore the experiences of nursing professionals during the COVID-19 pandemic and the impact these experiences continue to have on their personal and professional lives. This qualitative study utilized interpretative phenomenological analysis with nine nursing professionals from southern Brazil. Two main themes and five subthemes were developed. The first theme, “Ongoing trauma response,” had three subthemes: (a) Fear of dying and family dying, (b) Loneliness and isolation, and (c) My emotions don’t matter. The second theme highlights the “Continued problems with the larger healthcare system” and is made up of two subthemes: (a) We are humans, not superheroes, and (b) We are still invisible. Symptoms of trauma response continued to be a significant challenge among nursing professionals even after the end of the pandemic. Recommendations for improving working conditions and making mental health services more readily available are discussed.
Buffeting analysis of long-span twin-box cable-stayed bridge during construction
Authors: Li Qinfeng , Shen Dawei , Ma Cunming , Chen Xin , Feng Yuxiang
Published: October 2024

During the cantilever construction stage, long-span sea-crossing twin-box cable-stayed bridges exhibit low stiffness, low natural frequency, and low damping ratio compared to the completed bridge state, making them susceptible to large buffeting responses under the high design wind speeds typical of coastal areas. Accurate calculation of the buffeting response during the bridge construction period is essential for enhancing construction safety. In this study, China’s Huangmaohai Bridge is used as a case study to introduce the three-dimensional aerodynamic admittance function (3D-AAF) of a twin-box into the buffeting analysis theory for long-span sea-crossing twin-box cable-stayed bridges. The 3D-AAF and the spanwise coherence function, key parameters of the buffeting force, were obtained through large-scale section model tests. These parameters describe the unsteady and spanwise distribution characteristics of the buffeting force. The self-excited force was calculated using the Scanlan model. Subsequently, the buffeting response of the bridge was calculated and compared with the results from the full bridge aeroelastic model test. The results demonstrate that the theoretical calculations are in reasonable agreement with experimental values, proving that the frequency domain buffeting analysis method based on 3D-AAF for long-span twin-box cable-stayed bridges is reliably accurate.
Do we need a high level of detail in health information animations? An experimental study investigating the association between level of detail and information recall
Authors: Pedersen Pernille Blom , Høybye Mette T , Borreskov Dahl Line , Rud Budtz Cecilie
Published: October 2024

Objective: This study examined the potential of simple animations with a low level of detail and their impact on patient’s ability to recall information. Also, we examined how the patients’ digital health literacy influenced the association.

Methods: Over 900 Danish adults were continuously included in this experimental study, and they were allocated to either an animation with a low or high level of detail. Participants answered questionnaires about demographics, digital health literacy, and the ability to recall information. The association between level of detail and information recall was examined by OR (95% CI).

Results: The results showed no association between the level of detail and information recall.

Conclusion: This novel study supports the potential of simple animations, and future research could advantageously investigate animations with more significant differences in level of detail. The results should be cautiously interpreted, as selection and information problems may have caused bias.
Perceived benefits and challenges of using an electronic cancer prediction system for safety netting in primary care: An exploratory study of C the signs
Authors: Spear Sara , Knight-Davidson Pamela
Published: October 2024

Objectives

This paper reports on an exploratory study into the perceived benefits and challenges of using an electronic cancer prediction system, C the Signs, for safety netting within a Primary Care Network (PCN) in the East of England.

Methods

The study involved semi-structured interviews and a qualitative questionnaire with a sample of 15 clinicians and practice administrators within four GP practices in the PCN.

Results

Participants generally perceived benefits of C the Signs for managing and monitoring referrals as part of post-consultation safety netting. Clinicians made little use of the decision support function though, as part of safety netting during the consultation, and referrals were still sent by administrators, rather than directly by clinicians through C the Signs.

Conclusion

Emphasising the benefits of C the Signs for post-consultation safety netting is most likely to gain buy-in to the system from clinicians, and can also be used by administrators for shared visibility of referrals. More evidence is needed on the value of C the Signs for safety netting during the consultation, through better diagnosis of cancer, before this is seen as a valued benefit by clinicians and provides motivation to use the system.
Barriers to mobile personal health assistant in patients living with diabetes
Authors: Kuo Mei-Chen , Liou Chiou-Fang , Lin Jyh-Horng , Huang Ching-Feng , Weng Li-Chueh
Published: October 2024

Objectives: Continued use of a digital health assistant that helps patients living with diabetes to self-manage and deal with complex problems in order to enhance their health status is a healthcare priority. The objective was to explore the barriers related to the use of a mobile personal health assistant for patients with type 2 diabetes. Methods: Eighty-one participants were offered a personal health assistant through a smartphone application. They completed a questionnaire after initial training (T0) and after 1 month’s experience (T1). Results and Conclusion: Most had a positive behavioral intention before using it, but the opposite was found after 1 month. There were positive correlations between behavioral intention and the eight related factors. The strongest correlations were with satisfaction and perceived usefulness at T0 and T1, respectively. The factors’ mean values decreased after 1 month. The best predictors of behavioral intention were satisfaction and performance expectancy at T0 and T1, respectively, which predicted the status of 88.4% and 82.7% of the sample. Our findings will help health experts to build better tools that satisfy patients and meet their expectations.
Prevalence and Effect of Cannabinoids in Pain Management for Hand Pathologies
Authors: Sleiman Marc G. , Straszewski Andrew , Stepan Jeffrey G. , Conti Mica Megan
Published: October 2024

Background:

Cannabinoids are a diverse group of compounds under investigation for various medical purposes, including analgesia. Given the evolving landscape of cannabinoid use, we aimed to analyze their prevalence and effect in pain management among urban orthopedic hand patients.

Methods:

An electronic survey was administered to 122 new patients presenting to the orthopedic hand clinic of a major urban academic hospital. Demographic data, numerical rating scale pain scores, cannabinoid usage, and other concomitant pain regimens were recorded.

Results:

Approximately half of the new patients were dissatisfied with current pain management for their hand pathology. Prescription (Rx) and over-the-counter (OTC) pain medications were used by 58% (71/122) of patients, while cannabinoids were used by 15% (18/122) of patients. Compared with pre-usage pain scores, both cannabinoids and Rx/OTC medications induced significant reductions in pain associated with patients’ hand pathologies (Cannabinoid: Δ4.4, P = .002; Rx/OTC: Δ3.0, P < .001). Cannabinoids induced a larger analgesic effect, but this difference was not statistically or clinically significant ( P = .06). Subjectively, cannabinoid users either preferred their cannabinoid over Rx/OTC medications or liked both equally. Opioid use was higher among cannabinoid users (22.2% vs 12.5%), although this was not statistically significant ( P = .28).

Conclusion:

Approximately 15% of new urban hand patients use cannabinoids for pain control, and these compounds have similar analgesic efficacy in hand pathologies as Rx/OTC medications. Cannabinoids are equally liked or preferred relative to traditional medications in this cohort, and they may play an important role in pain management for hand patients.
Flexural property of damaged steel-concrete composite girders strengthened with CFRP sheet
Authors: Hou Wenyu , Gong Xiaolong , Li Yanfeng , Huang Fulong , Wang Jiaqi
Published: October 2024

This paper presents the flexural property of damaged steel-concrete composite girders strengthened with CFRP sheet or prestressed CFRP sheet. Test and numerical analysis were used in the girders. The test findings indicated that the damage level had a substantial impact on the stiffness, yield strength, and ultimate load. And because of the CFRP sheet or prestressed CFRP sheet, the ultimate bearing capability could increase. The findings of the numerical analysis indicated that the increase of concrete strength would improve the stiffness and bearing capability. Increasing the web’s thickness and the steel beam’s flange by 1 mm would result in an approximate increase in the carrying capacity of roughly 4% and 3.8%, respectively. The damage level had a substantial impact on the stiffness and ultimate bearing capability. The bearing capacity would increase by about 2.8% with each additional 0.05 mm of thickness in the CFRP sheet. When the prestressed degree increased by per 5%, the bearing capacity would experience a 1.4% rise and the CFRP sheet’s stress would increase.
Clinical Features and Treatment Outcomes of Influenza-Associated Encephalitis and Encephalopathy: A Study on 16 Children in Vietnam
Authors: Nguyen Lam Van , Nguyen Duc Sy , Pham Que Thi , Do Hai Thien , Tran Dien Minh , Cao Tung Viet , Phan Hai Thanh , Pham Thai Quang
Published: October 2024

Objectives. This study aims to report clinical features and treatment outcomes of 16 cases diagnosed with post-influenza encephalopathy/encephalitis. Methods. We recorded clinical characteristics of 16 pediatric patients diagnosed with post-influenza encephalopathy/encephalitis at the Vietnam National Children’s Hospital from January 2019 to January 2021. Results. There were 87.5% infected with influenza A, with influenza A/H1pdm09 and influenza A/H3 accounting for 88.9% and 11.1% respectively, and 12.5% of participants infected with influenza B. The time from onset to the appearance of neurological symptoms was 3 days, of which perceptual changes (93.8%), hypertonia (75%), and seizures (43.8%) were prevalent neurological symptoms. The majority of cases had normal cerebrospinal fluid. Cranial CT/MRI imaging revealed abnormalities in 87.5% of patients. 56.3% of patients had sequelae, including epilepsy and cerebral palsy; 25% recovered, and 18.8% died after treatment. Conclusions. Influenza-associated encephalitis/encephalopathy is a complication occurring early in children, with high mortality and sequelae rates.
Prevalence and Associated Factors of Jaundice Among Neonates Admitted to Neonatal Intensive Care Units at Public Specialized Hospitals in Bahir Dar City, Northwest Ethiopia
Authors: Zelelew Amare Molla , Tafere Tesfahun Zemene , Jemberie Senetsehuf Melkamu , Belay Getaneh Mulualem
Published: October 2024

Background. Neonatal jaundice is more common and complicated in low and middle-income countries. However, there is no adequate evidences on the prevalence of neonatal jaundice and associated factors in Ethiopia. Methods. An institution-based cross-sectional study was conducted from 15 April to 15 June 2021 among 340 neonates admitted to neonatal intensive care unit at public specialized hospitals in Bahir Dar city. Results. The prevalence of neonatal jaundice was found to be 38.8%. Conclusion. The prevalence of neonatal jaundice was relatively high. Being male, prematurity, maternal Rh negative, neonatal Rh positive, maternal blood type AB, and ABO incompatibility were predictor variables of neonatal jaundice. Therefore, healthcare facilities in Bahir Dar city should provide opportunities for testing blood groups and Rh factors of all women early during antenatal care follow-up. Moreover, the treatment of neonatal jaundice has to be easily accessible in all primary health care units of the district.
Judicious Use of Benzathine Penicillin G in Response to a Medication Alert During a Critical Drug Shortage
Authors: Campillo Terrazas William , Kenney Rachel M. , Argyris Amy , Shallal Anita B. , Veve Michael P.
Published: October 2024

Purpose:

To evaluate judicious antibiotic prescribing of benzathine penicillin G (BPG) after implementation of an electronic health record-based medication shortage alert during a critical drug shortage.

Methods:

This was an institutional review board–approved retrospective cohort study of patients aged ≥3 months who received BPG between May 9, 2023, and February 28, 2024. The study included inpatient and outpatient visits after implementing a BPG medication shortage alert; patients with severe penicillin allergy, neurosyphilis, or congenital syphilis were excluded. Judicious BPG use was defined as use in patients diagnosed with primary, secondary, or latent syphilis or if they were prescribed a BPG alternative in response to the medication shortage alert; nonjudicious use included BPG for alternative diagnoses. Social determinants of health were assessed as exposure variables of interest. A separate cohort of syphilis patients receiving BPG or alternative therapy (i.e., doxycycline) was described.

Results:

A total of 453 patients were included. Most patients were non-Hispanic Black (n = 273, 60%) men (n = 272, 60%) with a median (interquartile range) age of 32 (22–44) years. Of these, 318 (70%) received judicious BPG, whereas 135 (30%) received nonjudicious BPG. The most nonjudicious diagnosis was streptococcal pharyngitis (n = 128, 95%). Variables associated with judicious use included age >32 years (adjusted odds ratio [adjOR], 2.273; 95% CI, 1.488–3.472), male sex (adjOR, 1.835; 95% CI, 1.206–2.792), and black race (adjOR, 1.847; 95% CI, 1.212–2.815). Among a cohort of 128 syphilis patients who received BPG (n = 64, 50%) or doxycycline (n = 64, 50%), those who received doxycycline were more likely be uninsured (35 [54.7%] vs 43 [67.2%]; P = .15) and receive outpatient treatment (3 [4.7%] vs 12 [18.7%]; P = .13).

Conclusion:

Despite implementing an electronic health record drug shortage alert, 30% of BPG use was nonjudicious and mostly for pharyngitis.
Investigating the effects of indoor lighting on measures of brain health in older adults: protocol for a cross-over randomized controlled trial
Authors: Mazurek Kevin A. , Li Linhao , Klein Robert J. , Rong Shengliang , Mullan Aidan F. , Jones David T. , St. Louis Erik K. , Worrell Gregory A. , Chen Christina Y.
Published: October 2024

Background

The worldwide number of adults aged 60 years and older is expected to double from 1 billion in 2019 to 2.1 billion by 2050. As the population lives longer, the rising incidence of chronic diseases, cognitive disorders, and behavioral health issues threaten older adults’ health span. Exercising, getting sufficient sleep, and staying mentally and socially active can improve quality of life, increase independence, and potentially lower the risk for Alzheimer’s disease or other dementias. Nonpharmacological approaches might help promote such behaviors. Indoor lighting may impact sleep quality, physical activity, and cognitive function. Dynamically changing indoor lighting brightness and color throughout the day has positive effects on sleep, cognitive function, and physical activity of its occupants. The aim of this study is to investigate how different indoor lighting conditions affect such health measures to promote healthier aging.

Methods

This protocol is a randomized, cross-over, single-site trial followed by an exploratory third intervention. Up to 70 older adults in independent living residences at a senior living facility will be recruited. During this 16-week study, participants will experience three lighting conditions. Two cohorts will first experience a static and a dynamic lighting condition in a cluster-randomized cross-over design. The static condition lighting will have fixed brightness and color to match lighting typically provided in the facility. For the dynamic condition, brightness and color will change throughout the day with increased brightness in the morning. After the cross-over, both cohorts will experience another dynamic lighting condition with increased morning brightness to determine if there is a saturation effect between light exposure and health-related measures. Light intake, sleep quality, and physical activity will be measured using wearable devices. Sleep, cognitive function, mood, and social engagement will be assessed using surveys and cognitive assessments.

Discussion

We hypothesize participants will have better sleep quality and greater physical activity during the dynamic lighting compared to the static lighting condition. Additionally, we hypothesize there is a maximal threshold at which health-outcomes improve based on light exposure. Study findings may identify optimal indoor lighting solutions to promote healthy aging for older adults.

Trial registration

ClinicalTrials.gov Identifier: NCT05978934.
Tree-based analysis of longevity predictors and their ten-year changes: a 35-Year mortality follow-up
Authors: Nosraty Lily , Nevalainen Jaakko , Raitanen Jani , Enroth Linda
Published: October 2024

Background

Prior studies on longevity often examine predictors in isolation and rely solely on baseline information, limiting our understanding of the most important predictors and their dynamic nature. In this study, we used an innovative regression tree model to explore the common characteristics of those who lived longer than their age and sex peers in 35-years follow-up. We identified different pathways leading to a long life, and examined to how changes in characteristics over 10 years (from 1979 to 1989) affect the findings on longevity predictors.

Methods

Data was obtained from the “Tampere Longitudinal Study on Ageing” (TamELSA) in Finland. Survey data was collected in 1979 from 1056 participants aged 60–89 years (49.8% men). In 1989, a second survey was conducted among 432 survivors from the 1979 cohort (40.2% men). Dates of death were provided by the Finnish Population Register until 2015. We employed an individual measure of longevity known as the realized probability of dying (RPD), which was calculated based on each participant’s age and sex, utilizing population life tables. RPD is based on a comparison of the survival time of each individual of a specific age and sex with the survival time of his/her peers in the total population. A regression tree analysis was used to examine individual-based longevity with RPD as an outcome.

Results

This relative measure of longevity (RPD) provided a complex regression tree where the most important characteristics were self-rated health, years of education, history of smoking, and functional ability. We identified several pathways leading to a long life such as individuals with (1) good self-rated health (SRH), short smoking history, and higher education, (2) good SRH, short smoking history, lower education, and excellent mobility, and (3) poor SRH but able to perform less demanding functions, aged 75 or older, willing to do things, and sleeping difficulties. Changes in the characteristics over time did not change the main results.

Conclusion

The simultaneous examination of a broad range of potential predictors revealed that longevity can be achieved under very different conditions and is achieved by heterogeneous groups of people.
Association of circulating monocyte number and monocyte–lymphocyte ratio with cardiovascular disease in patients with bipolar disorder
Authors: Chen Pao-Huan , Chang Chi-Kang , Lin Yen-Kuang , Chiang Shuo-Ju , Trang Nguyen Ngoc
Published: October 2024

Background

Cardiovascular disease (CVD) is the leading cause of excessive and premature mortality in patients with bipolar disorder (BD). Despite immune cells participating considerably in the pathogenesis of CVD, limited data are available regarding leukocyte phenotypes in patients with BD and CVD. This study aimed to evaluate associations between circulating leukocyte subset and CVD among patients with BD.

Methods

A total of 109 patients with BD-I and cardiologist-confirmed CVD diagnosis (i.e., case) were matched with 109 BD-I patients without CVD (i.e., control) according to the age (± 2 years), sex, and date of most recent psychiatric admission because of acute mood episode (± 2 years). Leukocyte subset data were retrieved from complete blood count tests performed on the next morning after the most recent acute psychiatric admission.

Results

During the most recent acute psychiatric hospitalization, circulating monocyte counts in the case group were significantly higher than those in the age- and sex-matched controls (p = 0.020). In addition, monocyte–lymphocyte ratios (MLRs) in the case group were significantly higher than those in the control group (p = 0.032). Multiple logistic regression showed that together with serum levels of uric acid and manic symptoms, circulating monocyte counts (95% CI, OR: 1.01–1.05) and MLRs (95% CI, OR: 1.01–1.09) were significantly associated with CVD in patients with BD, respectively.

Conclusions

Monocyte activation in an acute manic episode may play a critical role in the pathogenesis of CVD among patients with BD. Future research is required to investigate markers of monocyte activation and indices of cardiovascular structure and function across the different mood states of BD.
Global, regional, and national impact of air pollution on stroke burden: changing landscape from 1990 to 2021
Authors: Fan Yu-xiang , Zhang Wen , Li Wei , Ma Yong-jie , Zhang Hong-qi
Published: October 2024

Background

Exposure to air pollution contributes to cardiovascular disease-related deaths and morbidity, including stroke. However, few studies have examined the global stroke burden linked to air pollution. This study aimed to evaluate the global stroke morbidity and mortality associated with air pollution from 1990 to 2021.

Method

With the Global Burden of Disease Study (GBD) 2021, the numbers, and age-standardized rates (ASRs) of deaths and disability-adjusted life years (DALYs) for air pollution-related stroke were reported globally. Further subgroup analyses were conducted by age, sex, region and country, and stroke subtypes. A linear regression model explored global temporal trends and a cluster analysis examined temporal trends across GBD regions. To predict trends until 2040, the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model were applied.

Results

In 2021, there were 1,989,686 (95% uncertainty interval [95% UI], 1,530,479-2,493,238) deaths and 44,962,167 (95% UI, 35,020,339 − 55,467,024) DALYs due to air pollution-related stroke. The ASRs increased with age, peaking generally over 85 years. Males, the Central African region, and Guinea-Bissau showed higher stroke burdens Intracerebral hemorrhage was the most lethal subtype, with an ASR of 11.69 (95% UI 8.94–14.69) for deaths and 276.93 (95% UI 212.21-344.36) for DALYs. From 1990 to 2021, the crude number of deaths and DALYs increased by 13.4% and 6.3%, respectively, for the global stroke burden but showed a declining trend when age-standardized. Most GBD regions in Asia and Africa experienced an increasing stroke burden linked to air pollution, while Europe and America showed a decreasing trend. Predictions indicated a gradual reduction in ASRs, with higher rates in males from 2020 to 2040.

Conclusions

The global stroke burden associated with air pollution remained significant despite a decreasing trend until 2021. Although future predictions suggested a reduction, the crude counts for stroke burden remained substantial, with significant regional disparities. This warranted the implementation of public health policies and ongoing efforts.
Effect of authentic leadership on work readiness: the mediating role of nurses’ agility
Authors: Tawfik Ahmed Farghaly , Mahgoub Shimaa Abd El-fattah
Published: October 2024

Background

The dynamic and demanding nature of healthcare environments necessitates that nurses not only possess clinical proficiency but also exhibit high levels of work readiness to adapt swiftly to changes. Authentic leadership has been recognized as a critical factor influencing various organizational outcomes.

Aim

Investigating the mediating role of nurses’ agility in the relation between authentic leadership and nurses’ work readiness.

Design and method

A correlational analytical research design was utilized following STROBE guidelines, and data were collected from 249 nurses at a hospital affiliated with Beni-Suef University, Egypt. Instruments included authentic leadership Questionnaire, work readiness scale, and workforce agility scale. Data was collected from the beginning of March to the end of April 2024.

Results

The findings indicate that authentic leadership was notably strong regarding morality/ethics dimension (mean score: 15.81), and nurses demonstrated relatively high agility levels, particularly in proactivity (mean score: 29.16). Organizational acumen scored highest in work readiness dimensions (mean score: 53.94). Nurses’ overall scores for study variables ranged from 72 to 80% of the maximum, with agility scoring highest (mean score: 85.77). Significant positive correlations were found between variables, especially between nurses’ agility and authentic leadership (r = 0.362).

Conclusion

Path analysis reveals nurses’ agility as a paramount mediator between authentic leadership and nurses’ work readiness, indicating its vital role in transmitting the positive effects of authentic leadership. Practical implications include establishing authentic leadership programs that foster nurses’ agility especially proactive behaviors. That in turn improve nurses’ readiness for various work responsibilities.
Barriers and facilitators to women’s access to sexual and reproductive health services in rural Australia: a systematic review
Authors: Wood Sarah M , Alston Laura , Chapman Anna , Lenehan Jacinta , Versace Vincent L
Published: October 2024

Background

Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women’s health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women’s access to SRH services in rural Australia, considering both supply and demand dimensions.

Methods

We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the “best fit” approach to framework synthesis using the patient-centred access to healthcare model.

Results

Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women’s health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility.

Conclusion

This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women’s diverse needs.