bluuebunny/crossref_metadata_2025 huggingface dataset:
Teacher Caring and Perceptions of In-School Play
Authors: Burson Sheri L. , Castelli Darla M. , Erwin Heather
Published: August 2024

Purpose: The purpose of this study was to elicit salient information from K–5 teachers regarding their perceptions of in-school play. Play is not goal-focused and can be structured or unstructured, includes high or low physical activity, or utilizes gross or fine motor skills, and children participate in play for enjoyment. Method: K–5 teachers (n = 27) were asked questions based on the Theory of Planned Behavior during focus groups. Theory of Planned Behavior and Caring Theory themes were identified within and across groups with 34 codes across nine themes identified. Results: Teachers thought positively about in-school play. Play supported caring teaching, as relationships could develop and strengthen during playtime. The lack of administrative support and time was discussed as play barriers. Discussion/Conclusion: Perceptions of and desires to provide play conflict with the current educational models. An issue impacting the provision of effective, caring education has been identified. Studies on factors influencing teacher play practices are needed.
Effects of Jump Rope Lessons on Physical Skills, Inhibitory Control, and Perceived Enjoyment of Elementary Students
Authors: Woodard Kaylee F. , Chen YuChun
Published: August 2024

Purpose: This research examined the effects of a freestyle jump rope unit on students’ jump rope proficiency, agility, balance, inhibitory control, physical activity level, and perceived enjoyment. Method: One hundred and nine third and fourth graders were randomly assigned to the video-led (VID), teacher-led (TEA), or control group. A 30-s jump test, crisscross test, shuttle run, balance test, and Stroop test were conducted before and after the intervention. Physical activity level and perceived enjoyment were also assessed. Results: Repeated-measures analysis of covariance revealed that all groups showed significant improvement on the 30-s jump test, the VID and TEA groups improved on the crisscross test, and the TEA group ran significantly faster on the shuttle run following the intervention. The VID and TEA groups showed significantly greater inhibitory control after the intervention. Students in all groups were less active in the last two lessons compared with previous lessons. Perceived enjoyment was higher after Lesson 2 than Lesson 8. Discussion/Conclusion: This research indicated that implementing a freestyle jump rope unit in PE can elicit various benefits for children aged 8–9 years. Additionally, using a teacher-led instructional method may yield advantages beyond video-based instruction.
Reprogramming
Yarrowia lipolytica
metabolism for efficient synthesis of itaconic acid from flask to semipilot scale
Authors: Fu Jing , Zaghen Simone , Lu Hongzhong , Konzock Oliver , Poorinmohammad Naghmeh , Kornberg Alexander , Ledesma-Amaro Rodrigo , Koseto Deni , Wentzel Alexander , Di Bartolomeo Francesca , Kerkhoven Eduard J.
Published: August 2024

Itaconic acid is an emerging platform chemical with extensive applications. Itaconic acid is currently produced by
Aspergillus terreus
through biological fermentation. However,
A. terreus
is a fungal pathogen that needs additional morphology controls, making itaconic acid production on industrial scale problematic. Here, we reprogrammed the Generally Recognized As Safe (GRAS) yeast
Yarrowia lipolytica
for competitive itaconic acid production. After preventing carbon sink into lipid accumulation, we evaluated itaconic acid production both inside and outside the mitochondria while fine-tuning its biosynthetic pathway. We then mimicked the regulation of nitrogen limitation in nitrogen-replete conditions by down-regulating NAD
+
–dependent isocitrate dehydrogenase through weak promoters, RNA interference, or CRISPR interference. Ultimately, we optimized fermentation parameters for fed-batch cultivations and produced itaconic acid titers of 130.1 grams per liter in 1-liter bioreactors and 94.8 grams per liter in a 50-liter bioreactor on semipilot scale. Our findings provide effective approaches to harness the GRAS microorganism
Y. lipolytica
for competitive industrial-scale production of itaconic acid.
Distinguishing surface and bulk electromagnetism via their dynamics in an intrinsic magnetic topological insulator
Authors: Nguyen Khanh Duy , Lee Woojoo , Dang Jianchen , Wu Tongyao , Berruto Gabriele , Yan Chenhui , Ip Chi Ian Jess , Lin Haoran , Gao Qiang , Lee Seng Huat , Yan Binghai , Liu Chaoxing , Mao Zhiqiang , Zhang Xiao-Xiao , Yang Shuolong
Published: August 2024

The indirect exchange interaction between local magnetic moments via surface electrons has been long predicted to bolster the surface ferromagnetism in magnetic topological insulators (MTIs), which facilitates the quantum anomalous Hall effect. This unconventional effect is critical to determining the operating temperatures of future topotronic devices. However, the experimental confirmation of this mechanism remains elusive, especially in intrinsic MTIs. Here, we combine time-resolved photoemission spectroscopy with time-resolved magneto-optical Kerr effect measurements to elucidate the unique electromagnetism at the surface of an intrinsic MTI MnBi
2
Te
4
. Theoretical modeling based on 2D Ruderman-Kittel-Kasuya-Yosida interactions captures the initial quenching of a surface-rooted exchange gap within a factor of two but overestimates the bulk demagnetization by one order of magnitude. This mechanism directly explains the sizable gap in the quasi-2D electronic state and the nonzero residual magnetization in even-layer MnBi
2
Te
4
. Furthermore, it leads to efficient light-induced demagnetization comparable to state-of-the-art magnetophotonic crystals, promising an effective manipulation of magnetism and topological orders for future topotronics.
Microporous polyarylate membranes based on 3D phenolphthalein for molecular sieving
Authors: Yao Ayan , Hou Junjun , Dou Pengjia , Du Jingcheng , Sun Qian , Song Ziye , Liu Linghao , Guan Jian , Liu Jiangtao
Published: August 2024

Thin-film composite (TFC) membranes have gradually replaced some traditional technologies in the extraction, separation, and concentration of high value-added pharmaceutical ingredients due to their controllable microstructure. Nevertheless, devising solvent-stable, scalable TFC membranes with high permeance and efficient molecule selectivity is urgently needed to improve the separation efficiency in the separation process. Here, we propose phenolphthalein, a commercial acid-base indicator, as an economical monomer for optimizing the micropore structure of selective layers with thickness down to 30 nanometers formed by in situ interfacial reactions. Molecular dynamics simulations indicate that the polyarylate membranes prepared using three-dimensional phenolphthalein monomers exhibit tunable microporosity and higher pore interconnectivity. Moreover, the TFC membranes show a high methanol permeance (9.9 ± 0.1 liters per square meter per hour per bar) and small molecular weight cutoff (≈289 daltons) for organic micropollutants in organic solvent systems. The polyarylate membranes exhibit higher mechanical strength (2.4 versus 0.8 gigapascals) compared to the traditional polyamide membrane.
Pluralizing actuation behavior of 3D printable liquid crystal elastomers via polymerization sequence control
Authors: Peng Wenjun , Zhao Pengxin , Zhou Xiaorui , Liang Xin , Zhang Xianming , Jin Binjie , Chen Guancong , Zhao Qian , Xie Tao
Published: August 2024

Mechanical stretching is commonly used for mesogen alignment which is essential for the muscle-like actuations of liquid crystal elastomers (LCEs). Despite the simplicity of the method, the mesogens are typically aligned in the stretching direction, limiting exclusively the LCE to an actuation mode of cooling-induced elongation. Here, we design an interpenetrating double network consisting of an LCE network and an elastomer network, with one polymerized network stretched before the polymerization of the other network. Depending on the polymerization sequence of the two networks, the double network shows two opposite actuation modes, namely, the conventional cooling-induced elongation or an unusual cooling-induced contraction. Strategic integration of the two opposite behaviors into the same LCE leads to sophisticated actuation difficult to achieve with a conventional LCE design. Coupled with 3D printing, geometrically complexed LCEs with diverse multimodal four-dimensional actuation behaviors are illustrated. Our work expands the design scope of LCE actuators and their potential device applications.
Blocking HXA
3
-mediated neutrophil elastase release during
S. pneumoniae
lung infection limits pulmonary epithelial barrier disruption and bacteremia
Authors: Xu Shuying , Tan Shumin , Romanos Patricia , Reedy Jennifer L. , Zhang Yihan , Mansour Michael K. , Vyas Jatin M. , Mecsas Joan , Mou Hongmei , Leong John M.
Published: August 2024

Streptococcus pneumoniae
(
Sp
), a leading cause of community-acquired pneumonia, can spread from the lung into the bloodstream to cause septicemia and meningitis, with a concomitant threefold increase in mortality. Limitations in vaccine efficacy and a rise in antimicrobial resistance have spurred searches for host-directed therapies that target pathogenic immune processes. Polymorphonuclear leukocytes (PMNs) are essential for infection control but can also promote tissue damage and pathogen spread. The major
Sp
virulence factor, pneumolysin, triggers acute inflammation by stimulating the 12-lipoxygenase (12-LOX) eicosanoid synthesis pathway in epithelial cells. This pathway is required for systemic spread in a mouse pneumonia model and produces a number of bioactive lipids, including hepoxilin A3 (HXA
3
), a hydroxy epoxide PMN chemoattractant that has been hypothesized to facilitate breach of mucosal barriers. To understand how 12-LOX-dependent inflammation promotes dissemination during
Sp
lung infection and dissemination, we utilized bronchial stem cell-derived air–liquid interface cultures that lack this enzyme to show that HXA
3
methyl ester (HXA
3
-ME) is sufficient to promote basolateral-to-apical PMN transmigration, monolayer disruption, and concomitant
Sp
barrier breach. In contrast, PMN transmigration in response to the non-eicosanoid chemoattractant N-formyl-L-methionyl-L-leucyl-phenylalanine (fMLP) did not lead to epithelial disruption or bacterial translocation. Correspondingly, HXA
3
-ME but not fMLP increased the release of neutrophil elastase (NE) from
Sp
-infected PMNs. Pharmacologic blockade of NE secretion or activity diminished epithelial barrier disruption and bacteremia after pulmonary challenge of mice. Thus, HXA
3
promotes barrier-disrupting PMN transmigration and NE release, pathological events that can be targeted to curtail systemic disease following pneumococcal pneumonia.

IMPORTANCE

Streptococcus pneumoniae
(
Sp
), a leading cause of pneumonia, can spread from the lung into the bloodstream to cause systemic disease. Limitations in vaccine efficacy and a rise in antimicrobial resistance have spurred searches for host-directed therapies that limit pathologic host immune responses to
Sp
. Excessive polymorphonuclear leukocyte (PMN) infiltration into
Sp
-infected airways promotes systemic disease. Using stem cell-derived respiratory cultures that reflect bona fide lung epithelium, we identified eicosanoid hepoxilin A3 as a critical pulmonary PMN chemoattractant that is sufficient to drive PMN-mediated epithelial damage by inducing the release of neutrophil elastase. Inhibition of the release or activity of this protease in mice limited epithelial barrier disruption and bacterial dissemination, suggesting a new host-directed treatment for
Sp
lung infection.
Two cyanobacterial species exhibit stress responses when grown together in visible light or far-red light
Authors: Nien Ting-Shuo , Chan Ting-Hsuan , Li Ying-Yang , Liu Ting-So , Shiau Yo-Jin , Ho Ming-Yang
Published: August 2024

Although most cyanobacteria grow in visible light (VL;
λ
= 400–700 nm), some cyanobacteria can also use far-red light (FRL;
λ
= 700–800 nm) for oxygenic photosynthesis by performing far-red light photoacclimation. These two types of cyanobacteria can be found in the same environment. However, how they respond to each other remains unknown. Here, we reveal that coculture stresses FRL-using
Chlorogloeopsis fritschii
PCC 9212 and VL-using
Synechocystis
sp. PCC 6803. No significant growth difference was found in
Synechocystis
sp. PCC 6803 between the coculture and the monoculture. Conversely, the growth of
Chlorogloeopsis fritschii
PCC 9212 was suppressed in VL under coculture. According to transcriptomic analysis,
Chlorogloeopsis fritschii
PCC 9212 in coculture shows low transcript levels of metabolic activities and high transcript levels of ion transporters, with the differences being more noticeable in VL than in FRL. The transcript levels of stress responses in coculture were likewise higher than in monoculture in
Synechocystis
sp. PCC 6803 under FRL. The low transcript level of metabolic activities in coculture or the inhibition of cyanobacterial growth indicates a possible negative interaction between these two cyanobacterial strains.

IMPORTANCE

The interaction between two cyanobacterial species is the primary focus of this study. One species harvests visible light, while the other can harvest far-red and visible light. Prior research on cyanobacteria interaction concentrated on its interactions with algal, coral, and fungal species. Interactions between cyanobacterial species were, nevertheless, rarely discussed. Thus, we characterized the interaction between two cyanobacterial species, one capable of photosynthesis using far-red light and the other not. Through experimental and bioinformatic approaches, we demonstrate that when one cyanobacterium thrives under optimal light conditions, it stresses the remaining cyanobacterial species. We contribute to an ecological understanding of these two kinds of cyanobacteria distribution patterns. Cyanobacteria that utilize far-red light probably disperse in environments with limited visible light to avoid competition with other cyanobacteria. From a biotechnological standpoint, this study suggests that the simultaneous cultivation of two cyanobacterial species in large-scale cultivation facilities may reduce the overall biomass yield.
Human papillomavirus molecular prevalence in south China and the impact on vaginal microbiome of unvaccinated women
Authors: Wang Tingting , Li Weili , Cai Mingya , Ji Shushen , Wang Yufang , Huang Nan , Jiang Yancheng , Zhang Zhishan
Published: August 2024

The vaginal microbiome (VM) is associated with human papillomavirus (HPV) infection and progression, but a thorough understanding of the relation between HPV infection, and VM needs to be elucidated. From August to December 2022, women who underwent routine gynecological examinations were screened for HPV infection. The distribution of HPV variants and clinical characteristics were collected. Then, a total of 185 participants were enrolled and divided into HPV-negative (HC), high-risk HPV (H), low-risk HPV (L), multiple high-risk HPV (HH), and mixed high-low risk HPV (HL) groups. Samples were collected from the mid-vagina of these 185 participants and sent for 16S rDNA sequencing (V3–V4 region). Among 712 HPV-positive women, the top 3 most frequently detected genotypes were HPV52, HPV58, and HPV16. Among 185 participants in the microbiology study, the β diversity of the HC group was significantly different from HPV-positive groups (
P
< 0.001). LEfSe analysis showed that
Lactobacillus iners
was a potential biomarker for H group, while
Lactobacillus crispatus
was for L group. Regarding HPV-positive patients, the α diversity of cervical lesion patients was remarkably lower than those with normal cervix (
P
< 0.05). Differential abundance analysis showed that
Lactobacillus jensenii
significantly reduced in cervical lesion patients (
P
< 0.001). Further community state type (CST) clustering displayed that CST IV was more common than other types in HC group (
P
< 0.05), while CST I was higher than CST IV in H group (
P
< 0.05). Different HPV infections had distinct vaginal microbiome features. HPV infection might lead to the imbalance of
Lactobacillus
spp. and cause cervical lesions.

IMPORTANCE

In this study, we first investigated the prevalence of different HPV genotypes in south China, which could provide more information for HPV vaccinations. Then, a total of 185 subjects were selected from HPV-negative, high-risk, low-risk, multiple hr-hr HPV infection, and mixed hr-lr HPV infection populations to explore the vaginal microbiome changes. This study displayed that HPV52, HPV58, and HPV16 were the most prevalent high-risk variants in south China. In addition, high-risk HPV infection was featured by
Lactobacillus iners
, while low-risk HPV infection was by
Lactobacillus crispatus
. Further sub-group analysis showed that
Lactobacillus jensenii
was significantly reduced in patients with cervical lesions. Finally, CST clustering showed that CST IV was the most common type in HC group, while CST I accounted the most in H group. In a word, this study for the first time systemically profiled vaginal microbiome of different HPV infections, which may add bricks to current knowledge on HPV infection and lay the foundation for novel treatment/prevention development.
Early hypophosphataemia and refeeding syndrome in extremely low birthweight babies and outcomes to 2 years of age: secondary cohort analysis from the ProVIDe trial
Authors: Ford Nadia , Bloomfield Frank Harry , Jiang Yannan , Cormack Barbara Elizabeth
Published: August 2024

Objective

To investigate in extremely low birthweight (ELBW; <1000 g) babies the associations between refeeding syndrome (serum phosphate <1.4 mmol·L
-1
and serum total calcium>2.8 mmol·L
-1
) and hypophosphataemia in the first week and death or neurodisability at 2 years’ corrected age (CA).

Design

Secondary cohort analysis of the ProVIDe trial participants with serum biochemistry within 7 days of birth. At 2 years’ CA, neurodisability was assessed by Bayley Scales of Infant Development Edition III and neurological examination. Associations between neurodisability and other variables were analysed using t-tests and logistic regression adjusted for sex and smallness-for-gestational age.

Setting

Six tertiary neonatal intensive care units (NICUs) in New Zealand.

Participants

352 ELBW babies born between 29 April 2014 and 30 October 2018.

Main outcome measure

Death or neurodisability at 2 years’ CA.

Results

Fifty-nine babies died, two after discharge from the NICU. Of the 336 babies who survived to 2 years’ CA, 277 had neurodevelopmental assessment and 107 (39%) had a neurodisability. Death or neurodisability was more likely in babies who had refeeding syndrome (aOR 1.96 (95% CI 1.09 to 3.53), p=0.02) and in babies who had hypophosphataemia (aOR 1.74 (95% CI 1.09 to 2.79), p=0.02). Hypophosphataemia was associated with increased risk of death (aOR 2.07 (95% CI 1.09 to 3.95), p=0.03)) and severe hypophosphataemia (<0.9 mmol·L
-1
) with increased risk of death (aOR 2.67 (95% CI 1.41 to 5.00), p=0.002) and neurodisability (aOR 2.31 (95% CI 1.22 to 4.35), p=0.01).

Conclusions

In ELBW babies, refeeding syndrome and hypophosphataemia in the first week are associated with death or neurodisability. Until optimal phosphate requirements are determined through further research, monitoring for hypophosphataemia and mitigation strategies are indicated.

Trial registration number

ACTRN12612001084875
Lower indoor spatial frequency increases the risk of myopia in children
Authors: Li Dan-Lin , Dong Xing-Xuan , Yang Jin-Liu-Xing , Lanca Carla , Grzybowski Andrzej , Pan Chen-Wei
Published: August 2024

Background/aims

Animal models have shown that the absence of high-frequency visual information can precipitate the onset of myopia, but this relationship remains unclear in humans. This study aims to explore the association between the spatial frequency content of the visual environment and myopia in children.

Methods

Images from the rooms of children and their frequently visited outdoor areas were taken by their parents and collected by the researcher through questionnaires. The spatial frequency was quantified using Matlab. Cycloplegic refraction was used to measure the spherical equivalent (SE), and IOL Master was used to measure axial length (AL) and corneal radius (CR). AL/CR ratio was calculated.

Results

The study included 566 children with an average age of (8.04±1.47) years, of which 270 were girls (47.7%), and the average SE was (0.70±1.21) D. Image analysis revealed that indoor spatial frequency slope was lower than that of the outdoor environment (−1.43±0.18 vs −1.11±0.23, p<0.001). There were 79 myopic individuals (14.0%). Images from indoor content of myopic children had a lower spatial frequency slope than non-myopic children (−1.47±0.16 vs 1.43±0.18, p=0.03) while there was no significant difference in outdoor spatial frequency slope. Regression analysis indicated that the indoor spatial frequency slope was positively associated with SE value (β=0.60, p=0.02) and inversely related to myopia (OR=0.24, p<0.05).

Conclusion

The spatial frequency of the outdoor environment is significantly higher than that of the indoor environment. Indoor spatial frequency is related to children’s refractive status, with lower indoor spatial frequency being associated with a higher degree of myopia.
Mental health and well-being of elite youth athletes: a scoping review
Authors: Gwyther Kate , Pilkington Vita , Bailey Alan P , Mountjoy Margo , Bergeron Michael F , Rice Simon M , Purcell Rosemary
Published: August 2024

Background

There is increasing recognition of the prevalence and risk factors for mental health symptoms and disorders among adult elite athletes, with less research involving elite youth athletes. This scoping review aimed to characterise the mental health and well-being of elite youth athletes who travel internationally and compete for their sport.

Method

Four databases were searched in March 2023. Inclusion criteria were studies with elite youth athlete populations (mean age 12–17 years) reporting mental health and well-being outcomes. Data from included studies were charted by outcome, and risk/protective factors identified.

Results

Searches retrieved 3088 records, of which 33 studies met inclusion criteria, encapsulating data from 5826 athletes (2538 males, 3288 females). The most frequently studied issue was disordered eating (k=16), followed by anxiety (k=7), depression (k=5) and mixed anxiety/depression (k=2). Caseness estimates (a symptom level where mental health treatment is typically indicated) for disordered eating were wide ranging (0%–14% for males; 11%–41% for females), whereas only two studies estimated caseness for depression (7% in a mixed-sex sample; 14% for males, 40% for females) and one for anxiety (8% for males, 28% for females). Common risk factors for mental ill-health included sex, athlete status (compared with non-athletes) and social/relationship factors (with coaches/parents/peers). Contradictory evidence was observed for elite/competition level, which was associated with higher and lower rates of disordered eating.

Conclusion

Further representative research into the mental health and well-being of elite youth athletes is needed to enhance understanding and guide prevention and intervention measures.
Resuscitation on the field of play: a best-practice guideline from Resuscitation Council UK
Authors: Smith Christopher M , Moore Fionna , Drezner Jonathan A , Aird Ryan , Benson Clarke Adam , Cant James , Hamilton-Bower Isabelle , Hampshire Sue , Hodgson Lisa , Johnston Christopher , O’Sullivan Judy , Patterson Michael , Pitcher David , Smith Andrew , Soar Jasmeet , Thomas Lynn , Zideman David Anthony , Perkins Gavin D
Published: August 2024

Sudden cardiac arrest (SCA) is the leading cause of sudden death in athletes during high-level, organised sport. Patient-related and event-related factors provide an opportunity for rapid intervention and the potential for high survival rates. The aim of this consensus was to develop a best-practice guideline for dedicated field-of-play medical teams responding to SCA during an organised sporting event. A task-and-finish group from Resuscitation Council UK identified a stakeholder group of relevant experts and cardiac arrest survivors in March and April 2022. Together, they developed a best-practice guideline using the best available evidence. A public consultation period further refined the guideline before it was finalised in December 2023. Any sudden collapse, without rapid recovery during sporting activity, should be considered an SCA until proven otherwise. Field-of-play medical teams should be empowered to access the collapsed athlete as soon as possible and perform initial essential interventions in situ. This includes a suggested minimum of three cycles of cardiopulmonary resuscitation and defibrillation in persistent shockable rhythms while other aspects of advanced life support are initiated. There should be careful organisation and practice of the medical response, including plans to transport athletes to dedicated facilities for definitive medical care. This best-practice guideline complements, rather than supersedes, existing resuscitation guidelines. It provides a clear approach to how to best treat an athlete with SCA and how to organise the medical response so treatments are delivered effectively and optimise outcomes.
Measuring availability of and facility readiness to deliver comprehensive abortion care: experiences and lessons learnt from integrating abortion into WHO’s health facility assessments
Authors: Johnston Heidi Bart , Footman Katy , Ali Mohamed Mahmoud , Aly Eman Abdelkreem , Asmani Chilanga , Asrat Sofonias Getachew , Atweam Dominic Kwabena , Awais Sayema , Ayiasi Richard Mangwi , Boamah Martin Owusu , Chooye Ovost , Doe Roseline , Droti Benson , Elamin Hayfa , Fofie Chris , Gholbzouri Karima , Hadush Azmach , Hemachandra Nilmini , Hien Yelmali , Kasolo Francis Chisaka , Kipruto Hillary , Lainez Yolanda Barbera , Natseri Nasan , Onyiah Pamela Amaka , Orach Christopher Garimoi , Ouangare Assane , Ouedraogo Leopold , Sentumbwe-Mugisa Olive , Sheffel Ashley , Siyam Amani , Ssendyona Martin , Thom Ellen , Tingueri Rose Koirine , Traoré Soumaïla , Uzma Qudsia , Venter Wendy , Ganatra Bela
Published: August 2024

Routine assessment of health facility capacity to provide abortion and post-abortion care can inform policy and programmes to expand access and improve quality. Since 2018, abortion and/or post-abortion care have been integrated into two WHO health facility assessment tools: the Service Availability and Readiness Assessment and the Harmonised Health Facility Assessment. We discuss lessons learnt through experiences integrating abortion into these standardised tools. Our experiences highlight the feasibility of including abortion in health facility assessments across a range of legal contexts. Factors facilitating the integration of abortion include cross-country collaboration and experience sharing, timely inputs into tool adaptations, clear leadership, close relationships among key stakeholders as in assessment coordination groups, use of locally appropriate terminology to refer to abortion and reference to national policies and guidelines. To facilitate high-quality data collection, we identify considerations around question sequencing in tool design, appropriate terminology and the need to balance the normalisation of abortion with adequate sensitisation and education of data collectors. To facilitate appropriate and consistent analysis, future work must ensure adequate disaggregation of recommended and non-recommended abortion methods, alignment with national guidelines and development of a standardised approach for measuring abortion service readiness. Measurement of abortion service availability and readiness should be a routine practice and a standardised component of health facility assessment tools. Evidence generated by health facility assessments that include abortion monitoring can guide efforts to expand access to timely and effective care and help normalise abortion as a core component of sexual and reproductive healthcare.
Design and architecture of the CARA infrastructure for visualising and benchmarking patient data from general practice
Authors: Garzón-Orjuela Nathaly , Garcia Pereira Agustin , Vornhagen Heike , Stasiewicz Katarzyna , Parveen Sana , Amin Doaa , Porwol Lukasz , d’Aquin Mathieu , Collins Claire , Stanley Fintan , O’Callaghan Mike , Vellinga Akke
Published: August 2024

Objective

Collaborate, Analyse, Research and Audit (CARA) project set out to provide an infrastructure to enable Irish general practitioners (GPs) to use their routinely collected patient management software (PMS) data to better understand their patient population, disease management and prescribing through data dashboards. This paper explains the design and development of the CARA infrastructure.

Methods

The first exemplar dashboard was developed with GPs and focused on antibiotic prescribing to develop and showcase the proposed infrastructure. The data integration process involved extracting, loading and transforming de-identified patient data into data models which connect to the interactive dashboards for GPs to visualise, compare and audit their data.

Results

The architecture of the CARA infrastructure includes two main sections: extract, load and transform process (ELT, de-identified patient data into data models) and a Representational State Transfer Application Programming Interface (REST API) (which provides the security barrier between the data models and their visualisation on the CARA dashboard). CARAconnect was created to facilitate the extraction and de-identification of patient data from the practice database.

Discussion

The CARA infrastructure allows seamless connectivity with and compatibility with the main PMS in Irish general practice and provides a reproducible template to access and visualise patient data. CARA includes two dashboards, a practice overview and a topic-specific dashboard (example focused on antibiotic prescribing), which includes an audit tool, filters (within practice) and between-practice comparisons.

Conclusion

CARA supports evidence-based decision-making by providing GPs with valuable insights through interactive data dashboards to optimise patient care, identify potential areas for improvement and benchmark their performance against other practices.

Supplementary file 1. Graphical abstract
Suicide deaths associated with climate change-induced heat anomalies in Australia: a time series regression analysis
Authors: Hertzog Lucas , Charlson Fiona , Tschakert Petra , Morgan Geoffrey G , Norman Richard , Pereira Gavin , Hanigan Ivan C
Published: August 2024

Background

Although environmental determinants play an important role in suicide mortality, the quantitative influence of climate change-induced heat anomalies on suicide deaths remains relatively underexamined.

Objective

The objective is to quantify the impact of climate change-induced heat anomalies on suicide deaths in Australia from 2000 to 2019.

Methods

A time series regression analysis using a generalised additive model was employed to explore the potentially non-linear relationship between temperature anomalies and suicide, incorporating structural variables such as sex, age, season and geographic region. Suicide deaths data were obtained from the Australian National Mortality Database, and gridded climate data of gridded surface temperatures were sourced from the Australian Gridded Climate Dataset.

Findings

Heat anomalies in the study period were between 0.02°C and 2.2°C hotter than the historical period due to climate change. Our analysis revealed that approximately 0.5% (264 suicides, 95% CI 257 to 271) of the total 50 733 suicides within the study period were attributable to climate change-induced heat anomalies. Death counts associated with heat anomalies were statistically significant (p value 0.03) among men aged 55+ years old. Seasonality was a significant factor, with increased deaths during spring and summer. The relationship between high heat anomalies and suicide deaths varied across different demographic segments.

Conclusions and implications

This study highlights the measurable impact of climate change-induced heat anomalies on suicide deaths in Australia, emphasising the need for increased climate change mitigation and adaptation strategies in public health planning and suicide prevention efforts focusing on older adult men. The findings underscore the importance of considering environmental factors in addition to individual-level factors in understanding and reducing suicide mortality.
Reduction of head and neck cancer risk following smoking cessation: a systematic review and meta-analysis
Authors: Khalifeh Malak , Ginex Pamela , Boffetta Paolo
Published: August 2024

Objective

Head and neck (HN) cancer comprises the neoplasms originating from the oral cavity, pharynx and larynx. We aimed at reviewing the available literature on the effect of smoking cessation on HN cancer risk.

Method

We conducted a systematic search in Medline, PubMed and Embase to June 2022. We abstracted or calculated relative risks (RR) and 95% CIs of HN cancer after cessation of tobacco smoking (both former smoking status and duration of quitting) and combined them using random effects meta-analyses. Papers included were case–control or cohort studies available in the English language. Studies investigating smoking cessation after cancer diagnosis, case reports, intervention studies or animal studies were excluded. Quality and susceptibility to bias of each included study were evaluated using the Newcastle-Ottawa Scale. Publication bias was assessed using funnel plot and Egger’s test.

Results

A total of 65 studies were included in the review, including 5 cohort and 60 case–control studies. The RR of HN cancer for former smokers compared with current smokers was 0.40 (95% CI 0.35 to 0.46). In an analysis by cancer site, the RR of oral cancer was 0.44 (95% CI 0.35 to 0.55), that of pharyngeal cancer 0.44 (95% CI 0.32 to 0.60) and that of laryngeal cancer 0.38 (95% CI 0.29 to 0.50). The dose-response meta-analysis was based on 37 studies. The RR per 10-year increase in smoking cessation was 0.47 (95% CI 0.43 to 0.52).

Conclusions

The risk of HN cancer declines within the first 5 years of quitting smoking. Quitting smoking is an essential element of HN cancer prevention.

Trial registration number

The protocol has been deposited in the PROSPERO repository (CRD42022338262).
Specialist intellectual disability liaison nurses in general hospitals in England: cohort study using a large mortality dataset
Authors: Sheehan Rory , Ding Jonathon , White Adam , Magill Nicholas , Chauhan Umesh , Marshall-Tate Karina , Strydom André
Published: August 2024

Objective

Intellectual disability liaison nurses in general hospitals could enhance access to high-quality, adapted healthcare and improve outcomes. We aimed to explore associations between the input of intellectual disability liaison nurses and the quality of care in people with intellectual disability who are admitted to hospital.

Design

Retrospective analysis of a national dataset of mortality reviews.

Setting

General hospitals in England.

Participants

4742 adults with intellectual disability who died in hospital between 2016 and 2021 and whose deaths were reviewed as part of the Learning from Lives and Deaths mortality review programme.

Outcome measures

We used logistic regression to compare the sociodemographic and clinical characteristics of those who did, and did not, receive input from an intellectual disability liaison nurse. We explored associations between liaison nurse input, care processes and overall quality of care.

Results

One-third of people with intellectual disability who died in hospital in England between 2016 and 2021 had input from an intellectual disability liaison nurse. Intellectual disability liaison nurse input was not evenly distributed across England and was more common in those who died of cancer. Having an intellectual disability liaison nurse involved in an individual’s care was associated with increased likelihood of reasonable adjustments being made to care (adjusted OR (aOR) 1.95, 95% CI 1.63 to 2.32) and of best practice being identified (aOR 1.37, 95% CI 1.17 to 1.60) but was not associated with a rating of overall quality of care received (aOR 0.94, 95% CI 0.78 to 1.12).

Conclusions

Intellectual disability liaison nurses see only a minority of people with intellectual disability who are admitted to hospital in England. Increasing the availability of intellectual disability liaison nurses could improve care for this disadvantaged group.
Analysis of the current situation and demand for perinatal education in pregnant women in general grade A tertiary hospitals in China: a cross-sectional survey
Authors: Shen Jie , Zhang Yue , Xu Jinli , Wan Shenxian , Niu Meie , Chen Youguo , Huang Qin , Que Mochun , Jin Aiying
Published: August 2024

Objectives

This study aimed to assess the factors influencing pregnant women’s participation in perinatal education and their demand for educational courses.

Design

A cross-sectional study.

Setting

Tertiary hospital in Suzhou, China, July–September 2022.

Participants

Pregnant women from a general grade A tertiary hospital in Suzhou were recruited via online survey invitations during the specified period.

Measures

A self-designed scale was used to evaluate pregnant women’s demand for perinatal education. Multiple response sets were employed for the assessment of multiple-choice items and analyses included frequency and cross-tabulation. Logistic regression analysis was conducted to assess the factors influencing pregnant women’s participation in perinatal education.

Outcome

The primary outcome measured was the demand for perinatal education among pregnant women.

Results

A majority (53.8%) of pregnant women expressed a preference for a mixed teaching mode combining online and offline formats. Logistic regression analysis showed that education level significantly influenced pregnant women’s participation in online learning. Specifically, women with higher education levels were more likely to participate actively in online courses. Additionally, compared with those with first-born children, pregnant women with second-born children participated less actively in online learning. Pregnant women in their second and third trimesters showed greater engagement in online learning compared with those in their first trimester.

Conclusions

These findings indicate that Chinese pregnant women’s preferences for perinatal education are influenced by their educational background, pregnancy history and the mode of teaching employed. The variability in educational needs underscores the importance of regularly updating course content based on participant feedback.
Perioperative non-pharmaceutical therapies for insomnia in cancer survivors: a systematic review and network meta-analysis protocol
Authors: Liu Lumin , Jin Qi , Chen Yuelai , Yin Ping
Published: August 2024

Introduction

The presence of perioperative insomnia is common but yet often overlooked among cancer survivors. Non-pharmaceutical therapies have shown promise in treating cancer-related insomnia during the perioperative period; however, the existing evidence from various studies remains inconsistent. Therefore, this study aims to systematically review and assess the effectiveness of a wide range of non-pharmaceutical interventions during perioperative period for cancer-related insomnia. Findings from this study will help to make evidence-based treatment decisions.

Methods and analysis

A comprehensive electronic search will be conducted to identify relevant articles from multiple databases, including PubMed, MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Chinese literature databases such as CNKI, VIP, Wanfang from inception to 1 December 2023. Language restrictions will not be imposed to ensure inclusivity. The change of the Pittsburgh Sleep Quality Index or the Insomnia Severity Index from baseline will be used as the primary outcome of the study. Studies using these as secondary outcomes are also acceptable. Pairwise meta-analysis and network meta-analysis will be conducted using Stata V.15.0 software. The Cochrane collaboration tool for assessing the Risk of Bias and Risk of Bias in Non-randomised Studies of Interventions will be used for risk and bias assessment. Additionally, the Grading of Recommendations, Assessment, Development and Evaluation scale will be employed to evaluate the quality of the evidence.

Ethics and dissemination

Ethical approval is not required for this study since it involves the analysis of existing studies. The anticipated results will be disseminated through publication in a peer-reviewed journal.

PROSPERO registration number

CRD42023437356.
Dating violence prevalence and factors associated among undergraduate public health students of Kathmandu metropolitan city, Nepal: a cross-sectional study
Authors: Gaire Manisha , Gautam Laxmi , Karki Prabin , Poudel Lisasha , Khanal Sudip
Published: August 2024

Objective

The objective of this research was to assess the prevalence of dating violence (DV) and factors associated among undergraduate public health students of Kathmandu metropolitan city (KMC), Nepal.

Design

A descriptive cross-sectional study was conducted involving undergraduate public health students in Kathmandu. We recruited the students using probability proportionate sampling techniques. Data collection was carried out using a self-administered questionnaire. The duration of study was from May 2022 to March 2023.

Setting

We conducted a quantitative study among undergraduate students of 11 colleges out of 14 public health colleges located within Kathmandu.

Participants

352 public health students including both men and women were involved in the study. College-going students who were willing to give consent were included in the study.

Outcome measure

A significant prevalence of DV was seen among undergraduate public health students of KMC. Both univariate and multivariate logistic regression techniques were applied to assess the relationship of factors associated with DV and reported adjusted ORs (aOR) with 95% CIs. All statistical analyses were executed using the SPSS V.24.

Results

Among 352 respondents, 182 were having current or past dating relationships. The study shows that the majority (78.02%) of respondents had experienced DV during the time of study or any time in the past. DV was more likely among male participants (aOR 3.95, 95% CI 1.14 to 13.58) and whose partners consumed alcohol (aOR 4.58, 95% CI 1.70 to 12.34). Participants who had ever been exposed to violence done by family members were more likely to experience DV (aOR 5.97, 95% CI 1.39 to 25.49).

Conclusions

The study highlights a significant prevalence of DV among undergraduate public health students in Kathmandu, underscoring the urgency for implementing programmes aimed at addressing this issue.
Registry-based cohort study comparing percentages of patients reaching PASS for knee function outcomes after revision ACLR compared to primary ACLR
Authors: Herman Zachary J , Kaarre Janina , Grassi Alberto , Senorski Eric Hamrin , Musahl Volker , Samuelsson Kristian
Published: August 2024

Objectives

Reaching the Patient-Acceptable Symptom State (PASS) threshold for the Knee injury and Osteoarthritis Outcome Score (KOOS) has previously been reported to successfully identify individuals experiencing clinical success after anterior cruciate ligament reconstruction (ACLR). Thus, the objectives of this study were to examine and compare the percentages of patients meeting PASS thresholds for the different KOOS subscales 1 year postoperatively after primary ACLR compared with revision ACLR (rACLR) and multiply revised ACLR (mrACLR), and second, to examine the predictors for reaching PASS for KOOS Quality of Life (QoL) and Function in Sport and Recreation (Sport/Rec) after mrACLR.

Design

Prospective observational registry study.

Setting

The data used in this study was obtained from the Swedish National Ligament Registry and collected between 2005 and 2020.

Participants

The study sample was divided into three different groups: (1) primary ACLR, (2) rACLR and (3) mrACLR. Data on patient demographic, injury and surgical characteristics were obtained as well as mean 1-year postoperative scores for KOOS subscales and the per cent of patients meeting PASS for each subscale. Additionally, the predictors of reaching PASS for KOOS Sport/Rec, and QoL subscales were evaluated in patients undergoing mrACLR.

Results

Of the 22 928 patients included in the study, 1144 underwent rACLR and 36 underwent mrACLR. Across all KOOS subscales, the percentage of patients meeting PASS thresholds was statistically lower for rACLR compared with primary ACLR (KOOS Symptoms 22.5% vs 32.9%, KOOS Pain 84.9% vs 92.9%, KOOS Activities of Daily Living 23.5% vs 31.4%, KOOS Sport/Rec 26.3% vs 45.6%, KOOS QoL 26.9% vs 51.4%). Percentages of patients reaching PASS thresholds for all KOOS subscales were comparable between patients undergoing rACLR versus mrACLR. No predictive factors were found to be associated with reaching PASS for KOOS QoL and KOOS Sport/Rec 1 year postoperatively after mrACLR.

Conclusion

Patients undergoing ACLR in the revision setting had lower rates of reaching acceptable symptom states for functional knee outcomes than those undergoing primary ACLR.

Level of evidence

Prospective observational registry study, level of evidence II.
Palliative care needs and utilisation of specialist services for people diagnosed with motor neuron disease: a national population-based study
Authors: Bai Wenhui , Liu Huiqin , Ding Jinfeng , Zhang Hongmei , Johnson Claire E , Cook Angus
Published: August 2024

Introduction

There is a growing emphasis on the importance of the availability of specialist palliative care for people with motor neuron disease (MND). However, the palliative care needs of this population and the utilisation of different specialist services remain poorly defined.

Objectives

To (1) describe clinical characteristics, symptom burden and functional levels of patients dying with MND on their admission to palliative care services; (2) determine factors associated with receiving inpatient or community palliative care services.

Design

An observational study based on point-of-care assessment data from the Australian Palliative Care Outcomes Collaboration.

Participants

A total of 1308 patients who received palliative care principally because of MND between 1 January 2013 and 31 December 2020.

Measures

Five validated clinical instruments were used to assess each individual’s function, distress from symptoms, symptom severity and urgency and acuity of their condition.

Results

Most patients with MND had no or mild symptom distress, but experienced a high degree of functional impairment. Patients who required ‘two assistants for full care’ relative to those who were ‘independent’ (OR=11.53, 95% CI: 4.87 to 27.26) and those in ‘unstable’ relative to ‘stable’ palliative care phases (OR=16.74, 95% CI: 7.73 to 36.24) were more likely to use inpatient versus community-based palliative care. Associations between the use of different palliative care services and levels of symptom distress were not observed in this study.

Conclusions

Patients with MND were more likely to need assistance for decreased function and activities of daily living, rather than symptom management. This population could have potentially been cared for in the palliative phase in a community setting if greater access to supportive services were available in this context.