bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review and meta-analysis of operative versus non-operative management for first time traumatic anterior shoulder dislocation in young adults
Authors: Cutteridge Joseph , Dixon Joe , Garrido Pierre , Peckham Nicholas , Smith Carolyn , Woods Alex , Gwilym Stephen
Published: May 2024

Background

The most appropriate management following primary traumatic anterior shoulder dislocation in young adults is unclear. This systematic review and meta-analysis evaluated operative versus non-operative management. The primary outcome measure was re-dislocation rate, in contrast to the often reported ‘recurrent instability’, which includes subjective instability.

Methods

Our review was prospectively registered with PROSPERO (CRD42022322600) and reported as per PRISMA guidelines. Selection criteria included mean age of participants between 15 and 25 and minimum follow-up of 1 year.

Results

21 studies meet the inclusion criteria with 5142 patients included. The mean age of patients was 23, with 87% male. There was a median of 54 patients per study and a mean follow up of 46 months per study. The mean re-dislocation rate was 16.08% in the operative group and 24.84% in the non-operative group. In the subgroup meta-analysis, including only RCTs, comparing arthroscopic stabilisation vs non-operative there was an odds ratio of 0.09, strongly favouring intervention.

Discussion

This systematic review found the literature available supports surgical intervention in patients under the age of 25, in order to reduce re-dislocation. However, there is a lack of cost-effectiveness data to support these findings, and this should be an area of future research.
Unvaccinated employees during Covid-19 emergency: Debating the Italian labour court referral
Authors: Sonnati Silvio
Published: May 2024

This contribution examines the inadmissibility of a preliminary reference order submitted by the Court of Padua, Italy to the Court of Justice of the European Union (CJEU). The case involved the suspension of a worker, who, while legally obliged, declined to have the Covid-19 vaccine. The Italian court temporarily halted proceedings initiated by the worker's appeal. The author provides a comprehensive analysis facts of the case, the applicable national legislation, and the content of the preliminary reference order. The order scrutinised the compatibility of the conditional authorisation issued by the European Commission for the release of vaccines in circulation at that time. Additionally, it explored potential discrimination against workers who, by refusing vaccination, faced suspension from work without pay, as per explicit legal provisions. The contribution concludes by addressing the specific details of the inadmissibility ruling from the CJEU.

Case: Judgment of the Court (Second Chamber) of 13 July 2023. D. M. v Azienda Ospedale-Università di Padova. Request for a preliminary ruling from the Tribunale Ordinario di Padova. Reference for a preliminary ruling – Public health – National legislation imposing a vaccination obligation on health professionals – Suspension from duty without pay for personnel refusing the vaccine – Regulation (EC) No 726/2004 – Medicinal products for human use – Vaccines against Covid-19 – Regulation (EC) No 507/2006 – Validity of conditional marketing authorisations – Regulation (EU) 2021/953 – Prohibition of discrimination between vaccinated and unvaccinated persons – Inadmissibility.
Self-determination and intention to adopt massive open online courses (MOOC) for professional development
Authors: Al Oraini Badrea
Published: May 2024

Motivations have shown great influences in people’s acceptance of technologies, this can be concluded from previous research in the field of technology acceptance. This study investigates the relationship between the Self-Determination Theory of Motivation and the Technology Acceptance Model (TAM) and confirms a significant relationship across most of the variables in the theories. The study offered an expanded Technology acceptance model (TAM) in the context of a massive open online course (MOOC), based on self-determination theory (SDT). By investigating the effect of autonomy, competence and relatedness on perceived usefulness, perceived ease of use and attitudes. The findings show a statistically significant positive relationship between perceived ease of use, perceived usefulness and attitudes. Results indicate that autonomy and relatedness have a statistically significant positive influence on attuited but the influence of competence was not statistically significant. Moreover, results show a statistically significant influence of autonomy and relatedness influence on perceived ease of use but the influence of competence was not statistically significant. Also, results show a statistically significant relationship between autonomy, and competence but not statistically significant for relatedness.
Prevalence of priformis syndrome in sciatica patients: Predictability of specific tests and radiological findings for diagnosis
Authors: Yürük Damla , Can Ezgi , Genç Perdecioglu Gevher Rabia , Yıldız Gökhan , Akkaya Ömer Taylan
Published: May 2024

Background

The traditional approach for diagnosing piriformis syndrome (PS) is to rule out other causes of sciatica. This approach may lead to unnecessary radiological examinations and a waste of time. In contrast to the traditional approach, we aimed to first exclude PS and determine its prevalence by injecting patients with priformis tenderness.

Methods

This observational cross-sectional study included patients diagnosed with PS who had sciatica and tenderness on palpation of the priformis muscle and whose pain was reduced by at least 50% with local injection. Age, sex, pain duration, presence of tenderness in the piriformis muscle, Freiberg test, PACE sign, FADIR, Visual Analog Scale (VAS) score, Douleur Neuropathique 4 Questions (DN4) score, and radiological findings were compared between patients who responded and those who did not respond to the priformis injection.

Results

A total of 110 patients with sciatica were evaluated, of whom 66 with tenderness on palpation of the primiformis muscle underwent local injection. In 27 of the 66 patients (40.9%), a decrease in the NRS score of >50% was observed after injection, and PS was diagnosed. There were no statistically significant differences in age, sex, pain duration, Pace, FADIR test positivity, radiological findings, NRS, and DN4 scores, but Freiberg test positivity was statistically higher in patients diagnosed with PS.

Conclusion

PS is more common than is thought to be a cause of sciatica. A positive Freiberg test is predictive for the diagnosis of PS, but it should be confirmed by tenderness of the priformis muscle and local injection. Many pathologies can be detected incidentally radiographically in PS; however, they are not predictive of the diagnosis.
Planetary health and its relevance in the modern era: A topical review
Authors: Mago Arpit , Dhali Arkadeep , Kumar Harendra , Maity Rick , Kumar Bharat
Published: May 2024

Planetary health is a relatively new concept that has gained traction in recent years due to the urgent need to address the health of our planet and its inhabitants. It refers to the interdependent health of both humans and the environment, recognizing that the two are inseparable and that the health of one is intricately linked to the health of the other. This article aims to advocate changes in how health care for both the environment and humans is envisaged, and aligned with sustainable development goals using ethically sound, solution-oriented, and practical approaches to education. Rapid industrialization, urbanization, and population growth led to environmental degradation and climate change in this era. These factors have profound implications for human health, with the World Health Organization estimating that 23% of global deaths are linked to environmental factors. Climate change and extreme weather events are exacerbating existing health problems. Air pollution, water pollution, and toxic chemicals are additional environmental factors that add to it and lead to health issues, including non-communicable diseases and death. A collaborative and interdisciplinary approach is needed to address planetary health challenges, including working across sectors and investing in research to understand better the complex interactions between human health and the environment. By promoting sustainable development and protecting the planet’s health and inhabitants, we can ensure a healthy future for generations.
Disrupting MMORPGs gaming: Exploring and renegotiating end-user license agreements in the Metaverse
Authors: Lau Pin Lean
Published: May 2024

This paper explores key legal issues surrounding gaming platforms that provide/host Massive Multiplayer Online Role-Playing Games. Since we are entering the next epoch of the Internet, Web3.0 – and the emergence of Metaverses that operate within this space, this paper conducts an inquiry into the key facets of end-user license agreements (EULAs) used in the platforms that may likely need to be renegotiated. Firstly, how do we reconcile the legal regulatory status of gaming platforms in a decentralized Web3.0 Metaverse? Secondly, how can the rights of end users of gaming platforms be protected vis-à-vis the EULAs in this space? And thirdly, what specific aspects in existing EULAs are likely needed to be renegotiated in light of a decentralized Web3.0 Metaverse? This paper will utilize a case study using the EULAs of Blizzard Entertainment Inc. and provide a possible reformulation of specific terms and conditions of EULAs.
Evaluation of delays in technical approval of UK Highways Act Section 278 projects
Authors: Bagheri Meghdad , Bate Edward
Published: May 2024

This paper attempts to address the causes of delays to the legal and technical approval processes involved in the creation of agreements authorising works to public highways under s.278 Highways Act (1980) specific to Warwickshire County Council, UK, and whether the type of contract (JCT or NEC) or s.278 agreement (minor or major) has any tangible influence. A series of questionnaires and interviews were carried out on a sample group of individuals including designers, developers, construction lawyers and council engineers with extensive industry experience in relation to s.278 legal, technical, construction and adoption processes. The results revealed the key causes of delays, and therefore, the barriers to prompt and efficient approval processes, as the lack of communication between developer and local authority, inexperienced developers’ engineers, poor quality drawings and insufficient information in the local authority's design guide. These key factors are discussed and recommendations are provided to tackle these issues.
Surgical Management of Norwood Procedure for Atypical Aortic Arch
Authors: Masaki Shota , Ando Yusuke , Nakano Toshihide
Published: May 2024

Background: Postoperative restenosis of the aortic arch after the Norwood procedure is still an important complication that significantly affects surgical outcomes. The rarity of the Norwood procedure for atypical aortic morphology means appropriate arch reconstruction methods and postoperative complications are still unknown. This study aimed to assess the rate of arch reintervention and clinical outcomes after the Norwood procedure for atypical aortic arch. Methods: This retrospective single-center study was conducted between 2001 and 2022. Sixteen patients were identified, eight with a right aortic arch, five with transposition of the great arteries, one with a right aortic arch and transposition of the great arteries, and two with a large tortuous patent ductus arteriosus connected to the opposite side of the descending aorta. We selected and performed four different surgical techniques depending on each aortic arch morphology. Results: Except for one case, autologous tissue-only arch reconstruction was possible. There was one operative death and four late deaths. Overall, no patients required any surgical or catheter-based reintervention for the aortic arch. On the other hand, left pulmonary artery stenosis due to a narrow subaortic space was found in two patients. Conclusions: The Norwood procedure for atypical aortic arch was performed with good results by choosing the appropriate technique for each morphology. On the other hand, pulmonary artery stenosis is likely to occur especially in the transposition of the great arteries group. Therefore, careful surgical method selection or further improvement of the technique that allows retroaortic space should be considered.
The Vaccine-Education Paradox in a Cross-Country Analysis: Education Predicts Higher and Lower Vaccination Rates
Authors: Trepanowski Radosław , Drążkowski Dariusz
Published: May 2024

Research has shown a mixed relationship between education and vaccination rates. In the current analysis, we aimed to determine the relationship between educational level and coronavirus disease 2019 (COVID-19) vaccination rates. We performed a cross-country analysis on data from 133 countries. Correlation analyses showed that higher and better education was associated with higher COVID-19 vaccination rates. When we performed the regression analysis including the education, health system, and economic development variables, education-COVID-19 vaccination relationships were mostly reversed. In particular, in wealthy countries, as the mean years of schooling decreased and the pupil-teacher ratio increased, COVID-19 vaccination rates increased. In less affluent countries, with greater education expenditures, COVID-19 vaccination rates decreased. We explain these contradictions by describing links between vaccination rates, life expectancy, and education-related variables. Our findings may aid in promoting more effective uptake of COVID-19 vaccination.
Clinical Features of Cutaneous Paraneoplastic Syndromes in Hodgkin Lymphoma
Authors: McCormick Benjamin J. , Zieman Daniel , Sluzevich Jason C. , Alhaj Moustafa Muhamad
Published: May 2024

Cutaneous paraneoplastic syndromes due to Hodgkin lymphoma present with a wide spectrum of clinical manifestations from generalized pruritus to exfoliative erythroderma. We summarize the clinical findings and outcomes of 14 patients with Hodgkin lymphoma and associated cutaneous paraneoplastic syndromes treated at Mayo Clinic over the past 3 decades. Cutaneous paraneoplastic syndromes may be present at the time of lymphoma diagnosis, whereas in other patients, it may appear at the time of relapse, including patients with initial absence of cutaneous manifestations during the initial lymphoma presentation. Our results indicate that complete resolution of the paraneoplastic syndrome is associated with significantly improved overall survival. Recognition of cutaneous paraneoplastic syndromes is a crucial surrogate of relapsed malignancy and treatment requires targeting the underlying malignancy.
Emergency Scenario-Based Training Curriculum Development: Enhancement of Caregivers for the Elderly’ Emergency Assistance Competency in a Rural Thai Community
Authors: Pongtriang Praditporn , Soontorn Thassanee , Sumleepun Jaruwat , Chuson Noawarat
Published: May 2024

Background

Caregivers for the elderly are a critical component of the health care system, especially in rural communities. They play a crucial role, assisting older people in confronting emergency illnesses.

Objective

The study describes the process of developing an emergency scenario-based training curriculum (ESBTC) for caregivers of the elderly, focusing on geriatric life-threatening surveillance and emergency assistance (GLTSEA) in rural communities.

Methods

The descriptive qualitative research utilized for developing the ESBTC followed Karn's six steps of curriculum development: (1) needs assessment, (2) targeted needs assessment, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback. The research sample comprised community representatives engaged in providing care during emergency illnesses, emergency experts, and health care providers. A group discussion and focus group were conducted along with semi-structured interviews. The data were analyzed by content analysis following Creswell's six steps.

Results

The results revealed problems and needs related to the care and management of emergency illnesses in rural communities. Five main themes emerged, including insufficient knowledge, difficulties in communication, mindfulness and self-confidence, Unable to assess the initial symptoms, and a need for skills development. In the development step, the curriculum focused on skill development and continued follow-up to ensure necessary skills, such as providing basic life support, using automated external defibrillators, through training scenarios. In the evaluation step, the participants indicated that their emergency assistance skills had improved. The six main themes that emerged regarding the training continuity, courses, and competencies needed to support the emergency system for caregivers were benefits and value, competence enhancements, upstreaming confidence, sustainable development, challenges in curriculum development, and effective strategies.

Conclusions

The ESBTC combines community-based and realistic scenarios, involving the participation of community stakeholders. It is crucial to gather community feedback and needs assessments to formulate potential strategies as part of the curriculum.
Impact of On-the-Job Training on Nurses’ Performance in Creating a Healing Environment and Clustered Nursing Care for Premature
Authors: Hendy Abdelaziz , Alsharkawy Sabah Saad , Al-Kurdi Zeinab , El-Nagger Nahed Saied , Hendy Ahmed , Sayed Salwa , Al-Mugheed Khalid , Alsenany Samira Ahmed , Farghaly Abdelaliem Sally Mohammed
Published: May 2024

Introduction

Premature infants require specialized care, and nurses need to have specific skills and knowledge to provide this care effectively.

Objective

To evaluate the impact of an on-the-job training program on the improvement of nurses’ knowledge and practice related to creation of a healing environment and clustering nursing procedures.

Methods

From January to April 2022, a study utilizing a one-group pre- and post-test design was conducted at NICUs in governmental hospitals. The study participants involved 80 nurses working in these NICUs. Researchers used predesigned questionnaire and checklist practice to collect the data pre and post the intervention.

Results

37.5% of the participants were aged between 25 and less than 30 years, with a mean age of 28.99 ± 7.43 years. Additionally, 73.7% of the nurses were female, with a mean experience of 9.45 ± 3.87 years. Prior to the intervention, the study found that a majority of the nurses (62.4%) demonstrated poor knowledge. However, after the intervention, a significant improvement was observed, with 60.0% of the nurses demonstrated good knowledge. Likewise, prior to the intervention, the study revealed that the majority of the nurses (83.8%) exhibited incompetent practice. However, post-intervention, a substantial improvement was observed, with 81.3% of the nurses demonstrated competent practice.

Conclusion

On-the-job training had significant improvements in nurses’ knowledge and practices regarding applying healing environments and clustering nursing care. On-the-job training is suggested as an adaptable, effective and low-cost technique to train nurses. To maintain the improvement achieved, ongoing instruction, feedback, assessment/reassessment, and monitoring are encouraged.
Zomato’s Quest for Survival
Authors: Bhattacharjee Animesh
Published: May 2024

The case of ‘Zomato’s Quest for Survival’ focuses on the concept of value relevance of accounting information. The case deals with financial ratio analysis, comparative financial statement analysis, cost–volume–profit analysis and DuPont analysis. The case also deals with the effect of acquisition on the acquiring firm’s fundamentals, post-acquisition. The case explores the potential growth of India’s food delivery market and goes on to explore Zomato’s business strategy and source of income. The case starts with Mr. Arghadip considering purchasing Zomato Ltd. Shares. He, therefore, gathered information from various sources to assess the company’s fundamentals and prospects for the future. A lot of questions worth discussing were brought up by the case. The ideal students for the case would be students of B.Com, M.Com, BBA and MBA. The case can also be discussed in Chartered Accountant and Cost and Management Accountant courses.
Paramedicine research with family and bystanders: A methodological review
Authors: Satchell Eillish , Anderson Natalie , Gott Merryn
Published: May 2024

The evolving nature of paramedic care has resulted in a growing body of evidence considering service user experience, including the experiences of patients, family members and bystanders. As new areas of research enquiry emerge in paramedicine, it is important to review the methods, methodologies, and quality of evidence in these topic areas. A methodological review was conducted of peer-reviewed empirical studies reporting on family and bystander experiences where emergency ambulance services responded. Descriptive statistics were calculated to describe select study characteristics. Study quality was appraised using the Johanna Briggs Institute Checklist for Qualitative Research and the Mixed Method Appraisal Tool. Service user engagement was evaluated using a newly adapted tool, the Service User Engagement Ladder. After searching five databases, 37 studies of varying research designs were included in this review. While overall study quality was high, there was a notable absence of theoretical discussion, particularly regarding qualitative methodologies. In assessing service user engagement, family and bystanders had very low levels of engagement in the research process. Only one study in this review utilised methods where co-construction of research occurred. Current research is dominated by Western study locations and biomedical paradigms that privilege Westernised populations and ways of considering experience, ignoring the preferences and experiences of Indigenous people and people from minoritised ethnic groups. To further develop paramedicine research involving family and bystanders, transparent reporting around the theoretical underpinnings of research must be strengthened. There is a significant opportunity to increase service user engagement in the research process. Greater attention to cultural and ethnic diversity is needed in researching family and bystander experiences.
A Post-Humanist Perspective of Singapore's Ecomodernist Leadership
Authors: Maher Sasha , Lloyd Rhiannon , Martin Lydia
Published: May 2024

Green growth has become doxa in the political economic governance of climate change. This is despite the lack of empirical evidence of its success and concerns that it reifies a business-as-usual dynamic. The question arises: why have practices of ‘green leadership’ maintained a hegemonic hold on how nation states respond to climate change? This provocation examines this question through an analysis of Singapore's policy ambition to become Asia's climate services leader. It draws on post-humanism to suggest that the form of ecomodernist leadership exhibited by Singapore not only perpetuates the status quo but (re)affirms the problematic anthropocentrism underpinning their approach. We demonstrate this through analysis of recent policy, media and private sector documents. Finally, we argue that a focus on Singapore matters because of its influence in the region and networked position globally.
ABCD4 is associated with mammary gland development in mammals
Authors: Guo Xiaoli , Zhao Chengcheng , Yang Ruifei , Wang Yuzhe , Hu Xiaoxiang
Published: May 2024

Background

Mammary gland development is a critical process in mammals, crucial for their reproductive success and offspring nourishment. However, the functional roles of key candidate genes associated with teat number, including ABCD4, VRTN, PROX2, and DLST, in this developmental process remain elusive. To address this gap in knowledge, we conducted an in-depth investigation into the dynamic expression patterns, functional implications, and regulatory networks of these candidate genes during mouse mammary gland development.

Results

In this study, the spatial and temporal patterns of key genes were characterized in mammary gland development. Using time-series single-cell data, we uncovered differences in the expression of A bcd4, Vrtn, Prox2, and Dlst in cell population of the mammary gland during embryonic and adult stages, while Vrtn was not detected in any cells. We found that only overexpression and knockdown of Abcd4 could inhibit proliferation and promote apoptosis of HC11 mammary epithelial cells, whereas Prox2 and Dlst had no significant effect on these cells. Using RNA-seq and qPCR, further analysis revealed that Abcd4 can induce widespread changes in the expression levels of genes involved in mammary gland development, such as Igfbp3, Ccl5, Tlr2, and Prlr, which were primarily associated with the MAPK, JAK-STAT, and PI3K-AKT pathways by functional enrichment.

Conclusions

These findings revealed ABCD4 as a candidate gene pivotal for regulating mammary gland development and lactation during pregnancy by influencing PRLR expression.
Are physical activity and/or adherence to the Mediterranean diet determinants of the changes found in kinanthropometric variables, body composition and physical fitness in adolescents?
Authors: Mateo-Orcajada Adrián , Vaquero-Cristóbal Raquel , del Mar Sánchez-Serrano María , Abenza-Cano Lucía
Published: May 2024

The practice of physical activity and adherence to the Mediterranean diet (AMD) have been extensively studied for their relationship with kinanthropometric, body composition and physical fitness variables. However, no previous study has analyzed whether these healthy habits are equally determinant for the differences found in kinanthropometric, body composition and physical fitness variables or, on the contrary, if one of them is more relevant. For this reason, the objectives of the present study were: (1) to analyze the differences in kinanthropometric, body composition, and physical fitness variables between adolescents with different levels of physical activity and AMD, and (2) to determine whether physical activity and/or AMD are predictors of differences in kinanthropometric variables, body composition or physical fitness in adolescents. The sample consisted of 791 adolescents (404 males and 387 females; mean age: 14.39±1.26 year-old) whose physical activity level, AMD, kinanthropometric variables, body composition and physical fitness, were measured. The results showed differences when considering the level of physical activity in kinanthropometric variables, body composition and physical fitness, but not the level of AMD, which was relevant only when it was poor, and the adolescents were inactive. Nevertheless, the AMD did not seem to exert such a determining effect as to produce significant differences on its own. On the other hand, the practice of physical activity did act as a predictor mainly of changes in the fitness variables. Therefore, the main novelty of the present study is the establishment of an order of importance of the healthy habits acquired by adolescents, concluding that the practice of physical activity is more determinant for the differences found in the study variables.
An acute gastric volvulus in a child with congenital left diaphragmatic hernia: a case report
Authors: Yang Zesheng , Xie Xiaoying , Wang Shicheng , Pei Guanghua , Zhan Jianghua
Published: May 2024

Background

Acute complete gastric volvulus is a rare and life-threatening disease, which is prone to gastric wall ischemia, perforation, and necrosis. If it is not treated by surgery in time, the mortality rate can range from 30 to 50%. Clinical presentations of acute gastric volvulus are atypical and often mimic other abdominal conditions such as gastritis, gastroesophageal reflux, gastric dilation, and pancreatitis. Imaging studies are crucial for diagnosis, with barium meal fluoroscopy being the primary modality for diagnosing gastric volvulus. Cases of acute gastric volvulus diagnosed by ultrasound are rarely reported.

Case presentation

We reported a rare case of acute gastric volvulus in a 4-year-old Chinese girl who presented with vomiting and abdominal pain. Ultrasound examination revealed the “whirlpool sign” in the cardia region, raising suspicion of gastric volvulus. Diagnosis was confirmed by X-ray barium meal fluoroscopy, which indicated left-sided diaphragmatic hernia and obstruction at the cardia region. Surgical intervention confirmed our suspicion of acute complete gastric volvulus combined with diaphragmatic hernia.

Conclusion

In this case, we reported an instance of acute complete gastric volvulus. Ultrasound revealed a “whirlpool sign” in the cardia, which is likely to be a key sign for the diagnosis of complete gastric volvulus.
Air pollution, life’s essential 8, and risk of severe non-alcoholic fatty liver disease among individuals with type 2 diabetes
Authors: Aimuzi Ruxianguli , Xie Zhilan , Qu Yimin , Jiang Yu
Published: May 2024

Background

The impacts of long-term exposure to air pollution on the risk of subsequent non-alcoholic fatty liver disease (NAFLD) among participants with type 2 diabetes (T2D) is ambiguous. The modifying role of Life’s Essential 8 (LE8) remains unknown.

Methods

This study included 23,129 participants with T2D at baseline from the UK Biobank. Annual means of nitrogen dioxide (NO2), nitrogen oxides (NOX), and particulate matter (PM2.5, PM2.5–10, PM10) were estimated using the land-use regression model for each participant. The associations between exposure to air pollution and the risk of severe NAFLD were evaluated using Cox proportional hazard models. The effect modification of LE8 was assessed through stratified analyses.

Results

During a median 13.6 years of follow-up, a total of 1,123 severe NAFLD cases occurred. After fully adjusting for potential covariates, higher levels of PM2.5 (hazard ratio [HR] = 1.12, 95%CI:1.02, 1.23 per interquartile range [IQR] increment), NO2 (HR = 1.15, 95%CI:1.04, 1.27), and NOX (HR = 1.08, 95%CI:1.01, 1.17) were associated with an elevated risk of severe NAFLD. In addition, LE8 score was negatively associated with the risk of NAFLD (HR = 0.97, 95% CI: 0.97, 0.98 per point increment). Compared with those who had low air pollution and high LE8, participants with a high air pollution exposure and low LE8 had a significantly higher risk of severe NAFLD.

Conclusions

Our findings suggest that long-term exposure to air pollution was associated with an elevated risk of severe NAFLD among participants with T2D. A lower LE8 may increase the adverse impacts of air pollution on NAFLD.
Prediction of adolescent weight status by machine learning: a population-based study
Authors: Liu Hengyan , Wu Yik-Chung , Chau Pui Hing , Chung Thomas Wai Hung , Fong Daniel Yee Tak
Published: May 2024

Background

Adolescent weight problems have become a growing public health concern, making early prediction of non-normal weight status crucial for effective prevention. However, few temporal prediction tools for adolescent four weight status have been developed. This study aimed to predict the short- and long-term weight status of Hong Kong adolescents and assess the importance of predictors.

Methods

A population-based retrospective cohort study of adolescents was conducted using data from a territory-wide voluntary annual health assessment service provided by the Department of Health in Hong Kong. Using diet habits, physical activity, psychological well-being, and demographics, we generated six prediction models for successive weight status (normal, overweight, obese and underweight) using multiclass Decision Tree, Random Forest, k-Nearest Neighbor, eXtreme gradient boosting, support vector machine, logistic regression. Model performance was evaluated by multiple standard classifier metrics and the overall accuracy. Predictors’ importance was assessed using Shapley values.

Results

442,898 Primary 4 (P4, Grade 4 in the US) and 344,186 in Primary 6 (P6, Grade 6 in the US) students, with followed up until their Secondary 6 (Grade 12 in the US) during the academic years 1995/96 to 2014/15 were included. The XG Boosts model consistently outperformed all other model in predicting the long-term weight status at S6 from P4 or P6. It achieved an overall accuracy of 0.72 or 0.74, a micro-averaging AUC of 0.92 or 0.93, and a macro-averaging AUC of 0.83 or 0.86, respectively. XG Boost also demonstrated accurate predictions for each predicted weight status, surpassing the AUC values obtained by other models. Weight, height, sex, age, frequency and hours of aerobic exercise were consistently the most important predictors for both cohorts.

Conclusions

The machine learning approaches accurately predict adolescent weight status in both short- and long-term. The developed multiclass model that utilizing easy-assessed variables enables accurate long-term prediction on weight status, which can be used by adolescents and parents for self-prediction when applied in health care system. The interpretable models may help to provide the early and individualized interventions suggestions for adolescents with weight problems particularly.
COVID-19 vaccine intentions and attitudes in Black American emerging adults with asthma
Authors: Hall Amy Lee , Movva Pranati , Dailey Rhonda , Gibson-Scipio Wanda , Baptist Alan P. , MacDonell Karen Kolmodin
Published: May 2024

Background

Emerging adults (aged 18–29) are less likely to receive the COVID-19 vaccine than any other adult age group. Black Americans are less likely than non-Hispanic white Americans to be fully vaccinated against COVID-19. This study explored factors which affect vaccine intention and attitudes in Black American emerging adults with asthma.

Methods

Participants were recruited from an NHLBI-funded clinical trial to improve asthma control. Fifty-nine Black American emerging adults completed a Qualtrics survey that assessed asthma control, intention to vaccinate, and factors which may affect the decision to vaccinate. Twenty-five participants also completed a semi-structured interview via Zoom. Bivariate correlations and descriptive statistics, including Chi Square analyses, were run using SPSS. Interview thematic analyses were conducted via QDA Miner.

Results

Of the 59 Black American emerging adults with asthma who completed surveys, 32.2% responded that they were highly unlikely to receive the COVID-19 vaccine, while 50.8% responded that they were highly likely to receive it. Increased asthma control was significantly correlated with a higher likelihood to discuss the COVID-19 vaccine with their healthcare provider (ρ = 0.339, α = 0.011). Concerns about immediate (ρ= -0.261, α = 0.050) and long-term (ρ= -0.280, α = 0.035) side effects were inversely correlated with intention to vaccinate. Only 17% of the participants who were unemployed stated that they were highly likely to receive the vaccines compared to 65% of the participants who were employed; however, interview participants who were unemployed stated not needing the vaccine because they were protecting themselves by social distancing. When deciding whether to receive the vaccine, safety, efficacy, and immediate side effects were the top three factors for 91%, 54%, and 49% of the participants, respectively. Beliefs about the vaccines’ safety and efficacy, information gathering, personal factors, and societal factors emerged as important themes from the interviews.

Conclusion

Only half of the surveyed Black American emerging adults with asthma were highly likely to receive the COVID-19 vaccine. Safety and efficacy were important for the majority of the participants, regardless of vaccine intention. Greater asthma control, but not access to asthma-related healthcare, was correlated with intention to discuss the vaccine with their healthcare provider.
Impact of COVID-19 on women living with HIV who are survivors of intimate partner violence
Authors: Zhang Xinyi , Price Carolina R. , Pope Alexandrya S. , Sullivan Tami P. , Meyer Jaimie P.
Published: May 2024

Background

Women living with HIV (WLWH) experience higher rates of intimate partner violence (IPV) compared to women without HIV, but there has been minimal research to date on the impact of the COVID-19 pandemic on the lived experiences of WLWH who are IPV survivors.

Methods

This is a secondary analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study of HIV care engagement among WLWH who have experienced lifetime IPV. We measured the impact of COVID-19 along key domains (i.e., physical health, day-to-day life, sexual/relationship behavior, substance use, HIV care, mental health, financial status, and having conflict with partners). Using independent t-tests or Fisher’s exact tests, and Pearson’s chi-squared tests, we compared women with and without ongoing IPV across sociodemographic characteristics, psychiatric disorders, substance use, and COVID-19 impact domains. We then built separate multivariate linear regression models for each of the different COVID-19 impact domains; ongoing IPV exposure was the primary explanatory variable of interest.

Results

Enrolled participants (n = 84) comprised a group of women (mean age 53.6y; SD = 9.9) who were living with HIV for a mean 23.3 years (SD = 10), all of whom had experienced lifetime IPV. Among 49 women who were currently partnered, 79.6% (n = 39) reported ongoing IPV. There were no statistically significant differences between those experiencing ongoing IPV and those who were not (or not partnered) in terms of demographic characteristics, substance use, or mental health. In multivariate models, ongoing IPV exposure was not associated with any COVID-19 impact domain. Anxiety and depression, however, were associated with COVID-19-related physical health, HIV care, and relationship conflict. Hispanic ethnicity was significantly associated with COVID-19-related physical health. More severe cocaine and opioid use were also significantly associated with COVID-19-related impact on day-to-day life.

Conclusions

Among this sample of WLWH who are all lifetime IPV-survivors, nearly half had ongoing IPV exposure. The COVID-19 public health emergency period affected WLWH in varied ways, but impacts were most profound for women experiencing concurrent mental health and substance use problems. Findings have important implications for future interventions to improve women’s health and social outcomes.
A novel perineal exposure method in laparoscopic abdominal perineal resection of rectal cancer: a case series study
Authors: Ma Jun , Tang Daibin , Tang Yuquan , Wang Datian , Jiang Peng , Zhang Yaming
Published: May 2024

Background

Abdominal perineal resection (APR) of rectal cancer, also known as Mile’s procedure, is a classic procedure for the treatment of rectal cancer. Through the improvement of surgical skills and neoadjuvant therapy, the sphincter-preserving rate in rectal cancer patients has improved, even in patients with ultralow rectal cancer who underwent APR in the past. However, APR cannot be completely replaced by low anterior resection (LAR) in reality. APR still has its indications, when the tumor affects the external sphincter, etc. Good perineal exposure in APR is difficult and can seriously affect surgical safety and the long-term prognosis.

Methods

We reviewed the records of 16 consecutive patients with rectal cancer who underwent APR at Anqing Municipal Hospital from January 2022 to April 2023, including 11 males and 5 females, with an average age of 64.8 ± 10.3 years. The perineal operation was completed with the Lone-Star® retractor-assisted (LSRA) exposure method. After incising the skin and subcutaneous tissue, a Lone-Star® retractor was placed, and the incision was retracted in surrounding directions with 8 small retractors, which facilitated the freeing of deep tissues. We dynamically adjusted the retractor according to the plane to fully expose the surgical field.

Results

All 16 patients underwent laparoscopic-assisted APR successfully. Thirteen procedures were performed independently by a single person, and the others were completed by two persons due to intraoperative arterial hemostasis. All specimens were free of perforation and had a negative circumferential resection margin (CRM). Postoperative complications occurred in 4 patients, including urinary retention in 1 patient, pulmonary infection in 1 patient, intestinal adhesion in 1 patient and peristomal dermatitis in 1 patient, and were graded as ClavienDindo grade 3 or lower and cured. No distant metastasis or local recurrence was found for any of the patients in the postoperative follow-up.

Conclusions

The application of the LSRA exposure method might be helpful for perineal exposure during APR for rectal cancer, which could improve intraoperative safety and surgical efficiency, achieve one-person operation, and increase the comfort of operators.
Hypopituitarism with secondary adrenocortical insufficiency and arginine vasopressin deficiency due to hypophysitis after COVID-19 vaccination: a case report
Authors: Watanabe So , Tamura Yoshiaki , Oba Kazuhito , Kitayama Saori , Sato Motoya , Kodera Remi , Toyoshima Kenji , Chiba Yuko , Araki Atsushi
Published: May 2024

Background

Although vaccination against coronavirus disease (COVID-19) has several side effects, hypopituitarism due to hypophysitis has rarely been reported.

Case presentation

An 83-year-old healthy woman, who had received her fourth COVID-19 vaccine dose 2 days before admission, presented to the emergency department with difficulty moving. On examination, impaired consciousness (Glasgow Coma Scale: 14) and fever were observed. Computed tomography and magnetic resonance imaging of the head revealed swelling from the sella turcica to the suprasellar region. Her morning serum cortisol level was low (4.4 μg/dL) and adrenocorticotropic hormone level was normal (21.6 pg/mL). Central hypothyroidism was also suspected (thyroid stimulating hormone, 0.46 μIU/mL; free triiodothyronine, 1.86 pg/mL; free thyroxine, 0.48 ng/dL). Secondary adrenocortical insufficiency, growth hormone deficiency, delayed gonadotropin response, and elevated prolactin levels were also observed. After administration of prednisolone and levothyroxine, her consciousness recovered. On the 7th day of admission, the patient developed polyuria, and arginine vasopressin deficiency was diagnosed using a hypertonic saline test. On the 15th day, the posterior pituitary gland showed a loss of high signal intensity and the polyuria resolved spontaneously. On the 134th day, the corticotropin-releasing hormone loading test showed a normal response; however, the thyrotropin-releasing hormone stimulation test showed a low response. The patient’s disease course was stable with continued thyroid and adrenal corticosteroid supplementation.

Conclusions

Herein, we report a rare case of anterior hypopituitarism and arginine vasopressin deficiency secondary to hypophysitis following COVID-19 vaccination.
Factors influencing menstrual regularity among female workers: a cross-sectional analysis study
Authors: Shim Joohee , Han Seungwoo , Baek Jihyun
Published: May 2024

Background

Regularity of menstrual cycles is an important indicator of women’s health and fertility, and female workers are exposed to several factors, such as sleep disorders, stress, and shift work, that affect their menstrual regularity. This makes it necessary to comprehensively identify the determinants of menstrual regularity. Therefore, this study identified the factors affecting menstrual regularity among female workers from physiological, psychological, and situational dimensions based on the theory of unpleasant symptoms.

Methods

This was a secondary analysis of the 2010–2012 Korea National Health and Nutrition Examination Survey and utilized the data of 2418 female workers. Based on the theory of unpleasant symptoms, physiological factors included age, age at menarche, childbirth experience, body mass index, and sleep duration. Psychological factors included stress level, depressive mood, and suicidal ideation. Situational factors included education level, household income, consumption of alcohol, engagement in smoking, and work schedule. The χ²-test and hierarchical logistic regression analysis were performed, reflecting the complex sample design.

Results

Age at menarche, childbirth experience, and body mass index among physiological factors and education level and work schedule among situational factors were found to be related to menstrual regularity. A higher risk of menstrual irregularities was found among those who had given birth (versus those who had not), had a high age at menarche (versus those with a low age at menarche), were obese (versus those who had a normal body mass index), had elementary school-level or lesser educational achievements (versus those with college graduate-level or higher educational achievements), and who had a shift work schedule (versus those with a fixed schedule).

Conclusions

Intervention is needed for female workers who have these risk factors, and special attention must be paid to female workers who have a shift work schedule. Additionally, since body mass index can be controlled, intervention concerning body mass index is necessary to reduce menstrual irregularity.
Drought response revealed by chromatin organization variation and transcriptional regulation in cotton
Authors: Zhang Boyang , Long Yuexuan , Pei Liuling , Huang Xianhui , Li Baoqi , Han Bei , Zhang Mengmeng , Lindsey Keith , Zhang Xianlong , Wang Maojun , Yang Xiyan
Published: May 2024

Background

Cotton is a major world cash crop and an important source of natural fiber, oil, and protein. Drought stress is becoming a restrictive factor affecting cotton production. To facilitate the development of drought-tolerant cotton varieties, it is necessary to study the molecular mechanism of drought stress response by exploring key drought-resistant genes and related regulatory factors.

Results

In this study, two cotton varieties, ZY007 (drought-sensitive) and ZY168 (drought-tolerant), showing obvious phenotypic differences under drought stress, were selected. A total of 25,898 drought-induced genes were identified, exhibiting significant enrichment in pathways related to plant stress responses. Under drought induction, At subgenome expression bias was observed at the whole-genome level, which may be due to stronger inhibition of Dt subgenome expression. A gene co-expression module that was significantly associated with drought resistance was identified. About 90% of topologically associating domain (TAD) boundaries were stable, and 6613 TAD variation events were identified between the two varieties under drought. We identified 92 genes in ZY007 and 98 in ZY168 related to chromatin 3D structural variation and induced by drought stress. These genes are closely linked to the cotton response to drought stress through canonical hormone-responsive pathways, modulation of kinase and phosphatase activities, facilitation of calcium ion transport, and other related molecular mechanisms.

Conclusions

These results lay a foundation for elucidating the molecular mechanism of the cotton drought response and provide important regulatory locus and gene resources for the future molecular breeding of drought-resistant cotton varieties.