bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence‐Based Practice and Its Associated Factors among Health Professionals Working at Public Hospitals in Southwest Ethiopia
Authors: Shibabaw Adamu Ambachew , Chereka Alex Ayenew , Walle Agmasie Damtew , Demsash Addisalem Workie , Kebede Shimels Derso , Gebeyehu Ayenew Sisay , Tizie Sefefe Birhanu , Mamo Daniel Niguse , Kassie Sisay Yitayh
Published: December 2023

Introduction. “Evidence‐based practice” (EBP) is the process of incorporating clinical expertise and taking patient values and preferences into consideration when making clinical decisions. It is used to describe the provision of high‐quality patient care. Objective. This study is aimed at assessing evidence‐based practice and associated factors among health professionals working at public hospitals in Illu Aba Bora and Buno Bedele Zones, Oromia Region, Southwest Ethiopia, in 2022. Methods. An institution‐based cross‐sectional study design was conducted from May 8 to June 20 at public hospitals in Illu Aba Bora and Buno Bedele Zones, Oromia Region, Southwest Ethiopia. A total of 423 health professionals were included, using proportional allocation and simple random sampling. The data were collected using a self‐administered questionnaire. Data was entered using EpiData version 4.6, and the collected data was cleared, arranged, coded, and then analyzed using Statistical Package for the Social Sciences version 26. Descriptive statistics and bivariable and multivariable analyses of logistic regression with AOR (95% CI) were performed at p < 0.05. Result. The study revealed that 36.2% of health professionals had good evidence‐based practice. The factors found to be significantly associated with good EBP include having training in EBP (AOR = 5.43; 95% CI: 4.323, 9.532), good knowledge (AOR = 1.91; 95% CI: 1.065, 3.541), a favorable attitude (AOR = 1.91; 95% CI: 1.884, 2.342), and work experience greater than 5 years (AOR = 1.58; 95% CI: 1.482, 2.437). Conclusion. The evidence‐based practice of health professionals was poor. Evidence‐based practice should included in the curriculum, and also planned trainings need to be delivered to all health professionals, inorder to enhancing their knowledge as well as their attitudes by motivating them to increase evidence‐based practice.
Multiscale Hjorth Descriptor on Epileptic EEG Classification
Authors: Rizal Achmad , Hadiyoso Sugondo , Aulia Suci , Wijayanto Inung , Triwiyanto  , Said Ziani
Published: December 2023

The electroencephalogram (EEG) examination provides information on the brain’s electricity, especially in cases of epilepsy. Since the characteristics of EEG signals are nonlinear and nonstationary, visual inspection becomes very difficult. To overcome this problem, digital EEG signal processing was developed. Automatic epileptic EEG recognition is an area of interest on which much research focuses. The complexity approach to EEG signal analysis is interesting to be used as feature extraction, referring to the nonlinear characteristics of the signal. This study proposed an automatic epileptic EEG classification method based on the multiscale Hjorth descriptor measurement. EEG signals consisting of normal, interictal, and seizure (ictal) were simulated. The signal is scaled into new signals using the coarse-grained procedure on a scale of 1–20. Then, the Hjorth parameter which consists of activity, mobility, and complexity is calculated on the new signal. This process produces a feature vector that is used in the classification stage. Support vector machine (SVM) is used to evaluate the proposed feature extraction method. Simulation results showed that the Hjorth parameter on a scale of 1–15 yields 99.5% accuracy. The proposed method is expected to be applied to digital EEG for seizure detection and prediction.
Relationship between β1-AA and AT1-AA and Cardiac Function in Patients with Hypertension Complicated with Left Ventricular Diastolic Function Limitation
Authors: Wang Liang , Lv Xue-Bai , Yuan Yu-Ting , Wang Ning , Yao Hong-Ying , Zhang Wen-Chao , Yin Peng-Fei , Liu Xiao-Hui
Published: December 2023

Objective. To investigate the association between β1 adrenergic receptor autoantibodies (β1-AA) and angiotensin II type-1 receptor autoantibodies (AT1-AA) and cardiac function in patients with hypertension complicated with left ventricular diastolic function limitation. Methods. A total of 120 patients with essential hypertension who were not taking drug treatment and were hospitalised in the Department of Cardiology at the authors’ hospital from April 2018 to December 2018 were enrolled in this study and divided into a diastolic dysfunction group (65 cases) and a normal diastolic group (55 cases) according to their left ventricular diastolic function. The levels of cardiac parameters, β1-AA, AT1-AA, and other indicators were compared. Logistic regression analysis was used to analyse the related factors affecting left ventricular diastolic dysfunction (LVDD). The diagnostic efficacy of related factors in the diagnosis of diastolic dysfunction was evaluated. Results. Univariate analysis demonstrated that the left ventricular posterior wall diameter (

10.29
±
1.23

vs.

9.12
±
1.53

), left ventricular systolic dysfunction (

10.56
±
1.37

vs.

9.43
±
1.44

), systolic blood pressure (

152.37
±
10.24

vs.

140.33
±
5.99

), diastolic blood pressure (

95.66
±
6.34

vs.

87.33
±
7.28

), β1-AA (33 vs. 9 cases), and AT1-AA (35 cases vs. 12 cases) were higher in the dysfunction group than in the control group (all

P
<
0.05

). Multivariate regression analysis showed that β1-AA (odds ratio

OR

=
1.96

, 95% confidence interval

CI

:
1.369
–
4.345

) and AT1-AA (

OR
=
2.02

, 95% CI: 1.332–6.720) were independent risk factors for cardiac diastolic dysfunction (

P
<
0.05

). Both autoimmune antibodies had a certain predictive value, and the combined prediction value of the two was the highest, with an area under the curve of 0.942 (95% CI: 0.881~0.985). Conclusion. The positive rate of β1-AA and AT1-AA in essential hypertension patients with LVDD was higher than that in the normal group. Both β1-AA and AT1-AA could be used as early markers of LVDD in essential hypertension patients.
Ginkgolide B Blocks Vascular Remodeling after Vascular Injury via Regulating Tgfβ1/Smad Signaling Pathway
Authors: Wang Quan , Ni Shuai , Ling Li , Wang Siqi , Xie Hanbin , Ren Zhanhong
Published: December 2023

Coronary artery disease (CAD) is the most prevalent cardiovascular disease worldwide, resulting in myocardial infarction (MI) and even sudden death. Following percutaneous coronary intervention (PCI), restenosis caused by vascular remodeling is always formed at the stent implantation site. Here, we show that Ginkgolide B (GB), a naturally occurring terpene lactone, effectively suppresses vascular remodeling and subsequent restenosis in wild-type mice following left carotid artery (LCA) injury. Additional experiments reveal that GB exerts a protective effect on vascular remodeling and further restenosis through modulation of the Tgfβ1/Smad signaling pathway in vivo and in human vascular smooth muscle cells (HVSMAs) but not in human umbilical vein endothelial cells (HUVECs) in vitro. Moreover, the beneficial effect of GB is abolished after incubated with pirfenidone (PFD, a drug for idiopathic pulmonary fibrosis, IPF), which can inhibit Tgfβ1. In Tgfβ1-/- mice, treatment with pirfenidone capsules and Yinxingneizhi Zhusheye (including Ginkgolide B) fails to improve vascular remodeling and restenosis. In conclusion, our data identify that GB could be a potential novel therapeutic agent to block vessel injury-associated vascular remodeling and further restenosis and show significant repression of Tgfβ1/Smad signaling pathway.
A Dysfunctional T-cell Gene Signature for Predicting Nonresponse to PD-1 Blockade in Non–small Cell Lung Cancer That Is Suitable for Routine Clinical Diagnostics
Authors: Hummelink Karlijn , Tissier Renaud , Bosch Linda J.W. , Krijgsman Oscar , van den Heuvel Michel M. , Theelen Willemijn S.M.E. , Damotte Diane , Goldwasser François , Leroy Karen , Smit Egbert F. , Meijer Gerrit A. , Thommen Daniela S. , Monkhorst Kim
Published: December 2023

Purpose:

Because PD-1 blockade is only effective in a minority of patients with advanced-stage non–small cell lung cancer (NSCLC), biomarkers are needed to guide treatment decisions. Tumor infiltration by PD-1T tumor-infiltrating lymphocytes (TIL), a dysfunctional TIL pool with tumor-reactive capacity, can be detected by digital quantitative IHC and has been established as a novel predictive biomarker in NSCLC. To facilitate translation of this biomarker to the clinic, we aimed to develop a robust RNA signature reflecting a tumor's PD-1T TIL status.

Experimental Design:

mRNA expression analysis using the NanoString nCounter platform was performed in baseline tumor samples from 41 patients with advanced-stage NSCLC treated with nivolumab that were selected on the basis of PD-1T TIL infiltration by IHC. Samples were included as a training cohort (n = 41) to develop a predictive gene signature. This signature was independently validated in a second cohort (n = 42). Primary outcome was disease control at 12 months (DC 12 m), and secondary outcome was progression-free and overall survival.

Results:

Regularized regression analysis yielded a signature using 12 out of 56 differentially expressed genes between PD-1T IHC-high tumors from patients with DC 12 m and PD-1T IHC-low tumors from patients with progressive disease (PD). In the validation cohort, 6/6 (100%) patients with DC 12 m and 23/36 (64%) with PD were correctly classified with a negative predictive value (NPV) of 100% and a positive predictive value of 32%.

Conclusions:

The PD-1T mRNA signature showed a similar high sensitivity and high NPV as the digital IHC quantification of PD-1T TIL. This finding provides a straightforward approach allowing for easy implementation in a routine diagnostic clinical setting.
Research Progress on the Etiology and Treatment of Premature Ovarian Insufficiency
Authors: Wang Yuxian , Jiang Jianqiu , Zhang Jiali , Fan Peiyin , Xu Jian
Published: December 2023

Background: Menopause in women marks the knot of reproductive life, and menopause is defined as the last menstrual period in a woman, but this is caused by the failure of the ovarian reserve. The average age of natural menopause in the general population of women has remained around 50–52 years. Premature ovarian insufficiency (POI) is a debilitating clinical syndrome that manifests as a decline in ovarian function in women under 40. This condition is a prominent cause of female infertility. Summary: POI is a debilitating condition that not only wreaks havoc on patients’ physical and mental well-being but also imposes substantial mental, psychological, and economic burdens, particularly on women. In addition to diminished fertility, individuals afflicted with POI face an elevated risk of developing debilitating conditions such as osteoporosis and cardiovascular disease. The etiologies of POI are highly heterogeneous, and it can be caused by spontaneous genetic defects or induced by autoimmune diseases, infections, and iatrogenic or environmental factors. Alarmingly, idiopathic POI, a subtype characterized by an unknown etiology, accounts for more than half of all POI cases. Currently, clinical interventions for POI primarily consist of hormone replacement therapy. Fertility preservation methods are cryopreservation of embryos, oocytes, and ovarian tissue. Immunological interventions, gene editing techniques, and stem cell-based therapies are being explored to unravel the diverse etiologies and underlying mechanisms of POI, thereby enabling the identification of optimal therapeutic interventions. These innovative approaches offer unprecedented opportunities to advance the field of reproductive medicine. Key Messages: The main aim of this paper was to offer a succinct summary of the latest research breakthroughs concerning the elucidation of the mechanisms governing the origin and management of POI.
Sentiment analysis of imbalanced Arabic data using sampling techniques and classification algorithms
Authors: Al-Khazaleh Maisa J. , Alian Marwah , Jaradat Manar A.
Published: December 2023

Sentiment analysis is a popular natural language processing task that recognizes the opinions or feelings of a piece of text. Microblogging platforms such as Twitter are a valuable resource for finding such people’s opinions. The majority of Arabic sentiment analysis studies indicated that the data utilized to train machine learning algorithms is balanced. In this paper, we investigated the impact of sampling techniques and classification algorithms on an imbalanced Arabic dataset about people’s perceptions of COVID-19, with the majority of opinions reflecting people’s fear and stress about the pandemic, and the minority reflecting the belief that the pandemic was a hoax. The experiments concentrated on analyzing the imbalanced learning of Arabic sentiments using over-sampling and under-sampling techniques on seven single machine learning algorithms and two common ensemble algorithms from the bagging and boosting families, respectively. Results show that resampling-based approaches can overcome the difficulty of an imbalanced dataset, and the use of over-sampled data leads to better performance than that of under-sampled data. The results also reveal that using oversampled data from synthetic minority over-sampling technique (SMOTE), borderline-SMOTE, or adaptive synthetic sampling with random forest classifier is the most effective in addressing this classification problem, with F1-score value of 0.99.
Fermentation profile, chemical composition, and aerobic stability of cassava shoots silages with cactus pear
Authors: Araújo Cleyton de Almeida , Oliveira Getúlio Figueiredo de , Pinto Marcelo de Siqueira , Cunha Diego de Sousa , Lima Raquel da Silva , Costa Claudenilde de Jesus Pinheiro , Melo Daniel Anderson de Souza , Campos Fleming Sena , Magalhães André Luiz Rodrigues , Gois Glayciane Costa
Published: December 2023

The aim was to evaluate the effect of the cactus pear levels (0, 15, 30, and 45%) in cassava shoot silages on the fermentation profile, chemical composition, and aerobic stability. Four treatments were tested with five repetitions, totaling 20 silos. The inclusion of cactus pear in cassava shoots silages promoted an increase in gas losses (P < 0.001), buffering capacity (P < 0.001), pH (P = 0.033), mineral matter (P < 0.001), total carbohydrates (P < 0.001), non-fiber carbohydrates (P < 0.001) and a decreasing in dry matter (P < 0.001), organic matter (P < 0.001), ether extract (P = 0.002), and crude protein (P < 0.001) content. A quadratic effect was observed for effluent losses (P < 0.001), with greater effluent losses (94.78 kg/t natural matter) obtained with the inclusion of 30% cactus pear in cassava shoots silages. Cactus pear inclusion in cassava shoots silage promoted a reduction in the pH during oxygen exposure (P = 0.008). Including cactus pear in up to 45% of cassava silage, shoots cause changes in the fermentation and nutritional characteristics. However, values found in the silages are by good quality standards.
O direito ao esquecimento na ótica da Ciência da Informação: uma análise a partir das produções científicas na BRAPCI entre 2018 e 2022
Authors: Mendes Michele da Mota , Moraes Margarete Farias de , Silva Luiz Carlos da
Published: December 2023

Há pouco tempo, estudiosos da área da Ciência da Informação demonstravam-se preocupados com as questões relacionadas à preservação da informação e da memória diante dos avanços tecnológicos e do crescimento da internet. Hoje, mais do que preocupar-se com a preservação, estão atentos, também, ao oposto, ou seja, ao apagamento da informação e da memória. Esta pesquisa buscou analisar as produções científicas sobre direito ao esquecimento na base de dados BRAPCI, entre os anos de 2018 e 2022, a fim de observar o que vem sendo discutido sobre o tema na área da Ciência da Informação no Brasil. De modo mais específico, verificou os conceitos, temas e discussões abordados nas publicações. Desta forma, caracterizou-se como pesquisa de revisão de literatura, do tipo bibliográfica e de natureza qualitativa. Concluiu-se que ainda são escassos os estudos sobre o direito ao esquecimento na área da Ciência da Informação. Existe a necessidade de se realizarem mais discussões e pesquisas sobre o direito ao esquecimento no âmbito da Ciência da Informação, especialmente por se tratar de um tema cada vez mais atual e relevante ante às novas tecnologias de informação e comunicação que despontam no ambiente digital.
Cem anos do Instituto de Pesquisa Social. Entrevista com Martin Jay
Authors: Torre Bruna Della , Altheman Eduardo
Published: December 2023

Entrevista com Martin Jay (Universidade de Berkeley, Califórnia),  por Bruna Della Torre e Eduardo Altheman.
Mediaciones de teoría y praxis: Adorno, Kluge y el movimiento estudiantil alemán
Authors: Molina Manuel , Roldán Eugenia
Published: December 2023

El presente trabajo replantea la clásica dicotomía de teoría y praxis situada en el centro de la disputa entre el movimiento estudiantil alemán de protesta y Theodor W. Adorno. En un primer momento, se presenta una reconstrucción histórica enfocada en algunos episodios que caracterizan el clima de finales de la década del sesenta alemana, resaltando la figura mediadora del cineasta y escritor alemán Alexander Kluge. A partir de allí, se iluminan los cruces y las asociaciones antes que las posiciones dicotómicas frente al hacer/no hacer: teoría, política y arte se plantean como mediaciones diferentes e interrelacionadas de la noción de crítica de las tres las posiciones.
O ver e o dizer em “As palavras e as coisas”: ecos de Nietzsche na arqueologia foucaultiana
Authors: Noto Carolina de Souza
Published: December 2023

O presente artigo parte de um possível estranhamento que o livro de Foucault “As palavras e as coisas: uma arqueologia das ciências humanas” pode nos causar. Retomando principalmente o prefácio do livro, procuraremos, contudo, desfazer o estranhamento inicial, ao apontar para certa familiaridade que a obra parece ter com alguns temas já presentes na história da filosofia. A hipótese é a de que os problemas filosóficos mais gerais enfrentados pelo livro dizem respeito à tese do conhecimento como interpretação e ao problema da relação entre as palavras e as coisas, entre o ver e o dizer. Tese e problemas que não são estranhos a Nietzsche, por exemplo, que, portanto, parece ter influenciado o pensamento de Foucault para além do tema do poder e da genealogia.
A crítica de Arendt ao conceito de secularização
Authors: Villaça Theo Magalhães
Published: December 2023

O presente artigo busca expor a crítica que Hannah Arendt faz ao teorema da secularização, como apresentado por autores contemporâneos. Em primeiro lugar, será distinguido o teorema do processo de secularização que ocorreu na modernidade, tal como é feito em Hans Blumenberg e na própria Arendt. Em um segundo momento, serão comentadas as teorias de Karl Löwith e Eric Voegelin, que exemplificam o teorema da secularização criticado por Hannah Arendt. Por fim, vamos expor as críticas da autora a esse teorema e mostrar como a rejeição à ideia de secularização está intimamente relacionada com sua interpretação da história.
Comunidade impossível, exumação das formas e “presença corrosiva”
Authors: Aita Virginia H. A.
Published: December 2023

Um excurso no romance de John Updike torna tangível a face sombria da abstração americana, expondo um ethos predatório que consagra e, ipso facto, aniquila seu artista emblemático. Empresta virulência política à crítica de Danto à estética formalista de Greenberg, exumando a “forma pura” que insula a arte. Contudo, essa “pureza” remonta a crenças obscuras da formação colonial, reiteradas pela supremacia branca e protestante. Minando bases da sociabilidade, do “ser-com”, reencena a conflagração da comunidade, a “comunidade impossível”, que faz Nancy repensar sua negatividade como “inoperante”, espaço negativo da relação ao outro. A contrapelo da racionalidade da forma, Sonia Gomes revoga uma ordem excludente e ilegítima que confiscou o espaço da diferença, das memórias e histórias afrodescendentes, para configurar uma imageria do gesto, antes háptica que visual, implodindo a unidade insidiosa do design.
Poética das ruínas e modernidade: acerca de alguns fragmentos da crítica de arte de Denis Diderot sobre Hubert Robert
Authors: Falleiros Flávia
Published: December 2023

Esse artigo apresenta algumas reflexões sobre a crítica de arte de Denis Diderot relativa ao pintor Hubert Robert (1733-1808). Partindo de algumas considerações quanto ao sentido da emergência do motivo pictórico da ruína no século XVIII, a autora propõe uma análise de alguns excertos sobre o pintor, contidos no Salão de 1767; ao mesmo tempo, apresenta a tradução de um florilégio dos fragmentos sobre Robert, analisando-os. Ao cabo da reflexão, a autora conclui que a “poética das ruínas” de Diderot se inscreve na ruptura com alguns dos mais importantes preceitos da estética clássica, na medida em que questiona o ideal iluminista que, confiante no progresso, via, na arte, um meio para instruir e elevar moralmente. Nesse sentido, a crítica de Diderot a Robert pode ser considerada moderna.
Theodor W. Adorno e a elaboração do passado na sociedade ad-ministrada
Authors: Fernandes Rafaela Alves
Published: December 2023

O que significa elaborar o passado enuncia uma pergunta que como o próprio autor adverte, requer esclarecimentos. Porém, mais que isso, a questão requer uma leitura a posteriori dos fenômenos sociais que a sucederam, assim como o seu enquadramento num contexto histórico e intelectual mais amplo, inclusive no interior da própria obra de Theodor. W. Adorno. Sem a pretensão de esgotar o assunto ou apresentar uma síntese conciliadora das ideias presentes nos escritos de Adorno, visto que muitas delas variam no desenvolvimento de sua obra, o artigo tece considerações sobre a arte e a literatura como meios privilegiados de elaboração do passado, capazes de evidenciar o processo de desumanização do sujeito na sociedade administrada. A exigência adorniana de não esquecimento das catástrofes cometidas no século XX, por fim, adquire outros contornos na contemporaneidade, acrescida de problemas tal como a saturação de memórias traumáticas.
Daily Physical Activity Measured by Wearable Smartwatch for Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the SMART TAVR Study
Authors: Fan Jiaqi , Liu Qiong , Dai Hanyi , Zhou Dao , Guo Yuchao , Xu Jianguo , Wang Lihan , Hu Po , Jiang Jubo , Lin Xinping , Li Cheng , Liu Xianbao , Wang Jian’an
Published: December 2023

BACKGROUND:

This study aims to evaluate limited data about daily physical activity patterns, influential factors, and their association with 1-year mortality or rehospitalization after transcatheter aortic valve replacement (TAVR) through smartwatches.

METHODS:

Consecutive severe aortic stenosis patients undergoing elective transfemoral TAVR in a Chinese tertiary hospital were enrolled from July 2021 to May 2022 and received a Huawei smartwatch at least 1 day before TAVR. The primary outcome was a composite of all-cause mortality or hospital readmission within 1 year. Linear mixed-effects models were applied to determine influential factors of daily step counts, and Cox proportional hazard regression models were to estimate the association between baseline step counts within 1 month since discharge and composite outcome from months 2 to 12. The dose-response association was assessed using restricted cubic spline curves.

RESULTS:

A total of 222 participants and 59 469 valid monitoring person-day records were included (mean age, 72.7 years; 61% women). Step counts increased rapidly within the first 2 months (
P
<0.001), followed by a slower increase for those without composite outcomes (
P
=0.029) and a gradual decrease for those who developed composite outcomes (
P
<0.001). In multivariate linear mixed models, a 1-m increase in baseline 6-minute walk test and a 1-month delay after discharge were associated with 4 (95% CI, 1–7) and 170 (95% CI, 145–194) additional step counts, respectively. In restricted cubic spline analysis, the hazard ratio declined progressively until ≈5000 steps per day, after which they leveled. Below 5000 steps, the adjusted hazard ratio of composite outcome associated with each 1000-step count increase was 0.67 (0.50–0.89;
P
=0.007). However, above 5000 steps, step counts were not significantly associated with the composite outcome (
P
=0.645), with a hazard ratio of 1.12 (0.70–1.79).

CONCLUSIONS:

Daily step counts rapidly increased within the first 2 months post-TAVR. Increased physical activity was associated with a lower risk of 1-year mortality or rehospitalization after TAVR for patients with daily step counts below 5000.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04454177.
Health equity, care access and quality in headache – part 2
Authors: Raffaelli Bianca , Rubio-Beltrán Eloísa , Cho Soo-Jin , De Icco Roberto , Labastida-Ramirez Alejandro , Onan Dilara , Ornello Raffaele , Ruscheweyh Ruth , Waliszewska-Prosół Marta , Messina Roberta , Puledda Francesca
Published: December 2023

Background

Headache disorders are a global public health concern affecting diverse populations. This review examines headache service organizations in low-, middle-, and high-income countries. It addresses global challenges in pharmacological headache treatment, with a focus on safety, tolerability, reproductive and child health, and outlines disparities in accessing innovative treatments worldwide.

Main body

Organized headache services are essential due to the wide prevalence and varying severity of headache disorders. The tiered headache service model is globally recognized, although its implementation varies based on financial and workforce considerations. Headache burden affects well-being, causing disability, economic challenges, and work limitations, irrespective of location or income. All nations still require improved diagnosis and treatment, and the majority of countries face obstacles including limited access, awareness, economic barriers, and inadequate health policies. Provided adequate internet availability, telemedicine could help improve health equity by expanding access to headache care, since it can offer patients access to services without lengthy waiting times or extensive travel and can provide healthcare unavailable in underserved areas due to staff shortages.

Numerous health disparities restrict global access to many headache medications, especially impacting individuals historically excluded from randomized controlled trials, such as those with cardiovascular and cerebrovascular conditions, as well as pregnant women. Furthermore, despite advancements in researching migraine treatments for young patients, the options for treatment remain limited.

Access to headache treatment relies on factors like medication availability, approval, financial coverage, and healthcare provider expertise. Inadequate public awareness leads to neglect by policymakers and undertreatment by patients and healthcare providers. Global access discrepancies are exacerbated by the introduction of novel disease-specific medications, particularly impacting Asian, African, and Latin American nations excluded from clinical trials. While North America and Europe experience broad availability of migraine treatments, the majority of countries worldwide lack access to these therapies.

Conclusions

Healthcare disparities, treatment access, and medication availability are concerning issues in headache medicine. Variations in national healthcare systems impact headache management, and costly innovative drugs are widening these gaps. Healthcare practitioners and experts should acknowledge these challenges and work towards minimizing access barriers for equitable global headache care in the future.
WLP3 Encodes the Ribosomal Protein L18 and Regulates Chloroplast Development in Rice
Authors: Lu Tao , Yin Wenjin , Zhang Yinuo , Zhu Chaoyu , Zhong Qianqian , Li Sanfeng , Wang Nuo , Chen Zhengai , Ye Hanfei , Fang Yuan , Mu Dan , Wang Yuexing , Rao Yuchun
Published: December 2023

Plastid ribosomal proteins play a crucial role in the growth and development of plants, mainly in the gene expression and translation of key genes in chloroplasts. While some information is known about the regulatory processes of plastid ribosomal proteins in various plant species, there is limited knowledge about the underlying mechanisms in rice. In this study, ethyl methanesulfonate (EMS) mutagenesis was used to generate a new mutant called wlp3 (white leaf and panicle3), characterized by white or albino leaves and panicles, which exhibited this phenotype from the second leaf stage until tillering. Furthermore, after a certain period, the newly emerging leaves developed the same phenotype as the rice variety ZH11, while the albino leaves of wlp3 showed an incomplete chloroplast structure and significantly low chlorophyll content. A transition mutation (T to C) at position 380 was identified in the coding region of the LOC_Os03g61260 gene, resulting in the substitution of isoleucine by threonine during translation. WLP3 encodes the ribosomal L18 subunit, which is localized in the chloroplast. Complementation experiments confirmed that LOC_Os03g61260 was responsible for the albino phenotype in rice. WLP3 has high expression in the coleoptile, leaves at the three-leaf stage, and panicles at the heading stage. Compared to the wild-type (WT), wlp3 exhibited reduced chlorophyll synthesis and significantly decreased expression levels of genes associated with plastid development. Yeast two-hybrid (Y2H) analysis revealed that WLP3 interacts with other ribosomal subunits, to influence chloroplast development. These results contribute to a better understanding of the underlying molecular mechanisms of chloroplast development and plastid gene translation.
Small Papillae Regulated by SPD25 are Critical for Balancing Photosynthetic CO2 Assimilation and Water Loss in Rice
Authors: Zhu Lin , Zeng Faliang , Liang Yinpei , Wang Qi , Chen Hongwei , Feng Pulin , Fan Mingqian , Cheng Yanshuang , Wang Jiayu
Published: December 2023

Background

The leaf epidermis plays an important role in the transmission of light and the regulation of water and gas exchange, which influences the photosynthesis of mesophyll cells. Small papillae (SP) are one of the important structural elements of the leaf epidermis. The mechanism of the effect that small papillae have on rice leaf photosynthetic performance remains unclear.

Results

In this study, a small papilla deficient 25 (spd25) mutant was isolated from japonica rice Longjin1. Small papillae were absent on the adaxial and abaxial leaf surfaces of the spd25 mutant and the silicon and cuticular wax content in the spd25 mutant leaves decreased. Map-based cloning and functional analysis revealed that SPD25, encoding a guanine nucleotide exchange factor for Rop, is a novel allele of OsRopGEF10. The spd25 mutant showed an increased water loss rate and reduced relative water content. The lower stomatal conductance in the spd25 mutant prevented water loss but decreased the intercellular CO2 concentration and net assimilation rate. The fluorescence parameters showed that the inhibited CO2 assimilation reaction feedback regulated the photochemical electron-transfer reaction, but the performance of Photosystem II was stable. Further analysis indicated that the excess light energy absorbed by the spd25 mutant was dissipated in the form of non-photochemical quenching to avoid photodamage through the optical properties of small papillae.

Conclusions

SPD25 regulates the development of small papillae on the surface of rice leaves, which play an important role in balancing photosynthetic gas exchange and water loss. This study deepens our understanding of the physiological mechanisms by which small papillae affect photosynthetic performance.
Comorbidities in congenital heart disease: different patterns in childhood and adulthood
Authors: Ding Zhibao , Zhu Jingai , Ding Ye , Zhu Chun
Published: December 2023

Background

Existing studies were no exploration of the association between congenital heart disease (CHD) in children and comorbidities. This study was to assess the prevalence and number of comorbidities in CHD among children and adults, and to compare the comorbidity patterns by children and adults using association rule analysis.

Methods

Patients identified by the International Classification of Diseases, Ninth Revision (ICD‐9) code in the Medical Information Mart for Intensive Care III (MIMIC-III) 2001–2012 and MIMIC-IV 2008–2018 were included in this cross-sectional study. Association rule analysis was used to explore associations between CHD and comorbidities in children and adults using values of support (%), confidence (%), and lift.

Results

Among 60,400 eligible patients, 1.54% of adults had CHD and 0.83% of adults had CHD with at least one comorbidity, 13.79% had CHD and 12.37% had CHD with at least one comorbidity in children. The most common comorbidities were circulatory system diseases (53.78%), endocrine diseases (35.76%), and respiratory system diseases (23.46%) in adults with CHD, and the most common comorbidities were perinatal diseases (87.50%) in children with CHD. The comorbidity rate was 90.19% and 56.68% in children and adults, respectively. In children, perinatal diseases, circulatory system diseases, and endocrine diseases had the highest prevalence. The incidence of circulatory system diseases, perinatal diseases and endocrine diseases in CHD adults was confidence = 31.56%, 36.11%, and 23.23%, respectively. Perinatal diseases were common comorbidities among all CHD severity groups in children and adults.

Conclusion

The prevalence of comorbidities in children with CHD was higher than that in adults with CHD. The most common comorbidities were perinatal diseases and endocrine diseases among children and adults with CHD, respectively. Our study provided insights into comorbidity patterns in children and adults with CHD.
COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study
Authors: Månsson Sandberg Helena , Landstad Bodil J. , Tjulin Åsa , Brulin Emma
Published: December 2023

Introduction

A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors.

Methods

Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors.

Results

The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion.

Conclusions

COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.
Impact of community health workers on improving identification and primary care of hypertension among the urban poor – findings from Chhattisgarh state of India
Authors: Garg Samir , Dewangan Mukesh , Nanda Prabodh , Sahu Ashu , Xalxo Lalita , Bebarta Kirtti Kumar , Gupta Vishnu , Quereishi Mohammad Jawed , Sahu Anand Kumar , Tandan Pradeep
Published: December 2023

Background

Hypertension is a major health problem globally and in India. Around 60% of people with hypertension in India are not aware that they have the condition. Less than 30% of individuals with hypertension are on treatment. Existing studies have indicated that community health workers (CHWs) can play a useful role in expanding the care for hypertension. Evaluations are needed to study the impact when an intervention is implemented by the government in its existing large-scale CHW programme to improve the identification, regular follow-up and medication adherence for hypertension.

Methods

Chhattisgarh state implemented a pilot intervention to improve screening and follow-up for hypertension by equipping Mitanin-CHWs to measure blood pressure (BP). The study design involved an intervention-group and a comparison-group of urban slum population. The survey covered 5974 individuals (30–79 years age) in intervention-group and 5131 in comparison-group. Multivariate analysis was conducted to find out the effect of intervention on the desired outcomes.

Results

In intervention-group, 80.2% of the individuals (30–79 years age) had been screened for hypertension whereas the proportion was 37.9% in comparison-group. For 47.0% of individuals in intervention-group, Mitanin CHW was the provider who measured BP for the first time. Around 16.3% of individuals in intervention-group and 9.5% in comparison-group had been diagnosed with hypertension. Around 85.9% of hypertension cases in intervention-group and 77.0% in comparison-group were on treatment. BP had been measured in preceding 30 days for 81.8% of hypertension-cases in intervention-group and 64.3% in comparison-group. Around 70.3% of hypertension-cases in intervention-group and 55.1% in comparison-group had taken their complete medication for last seven days. Multivariate analysis showed that CHW intervention was associated significantly with improvements in all the desired outcomes.

Conclusion

Equipping the CHWs to measure BP was effective in increasing the screening and identification of hypertension, regular measurement of BP of individuals with hypertension and the adherence to medication. This shows the potential if the one-million strong work-force of Accredited-Social-Health-Activists (ASHA) CHWs in India gets equipped for this role. Governments need to provide a stronger policy push to get this materialised.
“I can’t imagine having to do it on your own”: a qualitative study on postoperative transitions in care from the perspectives of older adults with frailty
Authors: Hladkowicz Emily , Auais Mohammad , Kidd Gurlavine , McIsaac Daniel I. , Miller Jordan
Published: December 2023

Background

Adults aged 65 and older have surgery more often than younger people and often live with frailty. The postoperative transition in care from hospital to home after surgey is a challenging time for older adults with frailty as they often experience negative outcomes. Improving postoperative transitions in care for older adults with frailty is a priority. However, little knowledge from the perspective of older adults with frailty is available to support meaningful improvements in postoperative transitions in care.

Objective

To explore what is important to older adults with frailty during a postoperative transition in care.

Methods

This qualitative study used an interpretive description methodology. Twelve adults aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery and could speak in English participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using thematic analysis.

Results

Five themes were constructed: 1) valuing going home after surgery; 2) feeling empowered through knowledge and resources; 3) focusing on medical and functional recovery; 4) informal caregivers and family members play multiple integral roles; and 5) feeling supported by healthcare providers through continuity of care. Each theme had 3 sub-themes.

Conclusion

Future programs should focus on supporting patients to return home by empowering patients with resources and clear communication, ensuring continuity of care, creating access to homecare and virtual support, focusing on functional and medical recovery, and recognizing the invaluable role of informal caregivers.
Vascular endothelial growth factor induces the migration of human airway smooth muscle cells by activating the RhoA/ROCK pathway
Authors: Lv Chengtian , Huang Yuwen , Yan Ruirong , Gao Yuanmei
Published: December 2023

Background

Airway remodeling due to increased airway smooth muscle cell (ASMC) mass, likely due to enhanced proliferation, hypertrophy, and migration, has been proven to be highly correlated with decreased lung function in asthma patients. Vascular endothelial growth factor (VEGF) mediates vascular and extravascular remodeling and inflammation and has been proven to be involved in the progression of asthma. Previous studies have focused on the effects of VEGF on ASMC proliferation, but few researchers have focused on the effects of VEGF on human ASMC migration. The purpose of this study was to explore the effect of VEGF on the migration of ASMCs and its related signaling pathway mechanism to provide evidence for the treatment of airway remodeling.

Methods

We examined the effects of VEGF induction on ASMC migration and explored the mechanisms involved in ASMC migration.

Results

We found by wound healing and Transwell assays that VEGF promoted ASMC migration. Through the Cell Counting Kit-8 (CCK-8) experiment, we found that VEGF had no significant effect on the proliferation of ASMCs, which excluded the involvement of cell proliferation in the process of wound healing. Moreover, a cellular immunofluorescence assay showed that VEGF promoted F-actin reorganization, and Western blotting showed that VEGF improved RhoA activation and myosin phosphatase targeting subunit-1 (MYPT1) and myosin light chain (MLC) phosphorylation in ASMCs. Treatment with the ROCK inhibitor Y27632 significantly attenuated the effects of VEGF on MYPT1/MLC activation and cell migration.

Conclusion

In conclusion, the results suggest that the promigratory function of VEGF activates the RhoA/ROCK pathway, induces F-actin reorganization, improves the migration of ASMCs, and provides a better rationale for targeting the RhoA/ROCK pathway for therapeutic approaches in airway remodeling.
Barriers and enablers to achieving clinical procedure competency-based outcomes in a national paediatric training/residency program—a multi-centered qualitative study
Authors: Khan Waqas Ullah , Twomey John , Ryan Ethel , Martin Therese , Kamal Myeda , Lok Boris Cheng Pak , O’Gorman Clodagh , Byrne Dara
Published: December 2023

Background

In 2018, the Royal College of Physicians of Ireland revised its paediatric training program to a competency-based medical education (CBME) training/residency curriculum. This included a requirement to achieve competence in a number of core procedural skills to progress within the program. Internationally, simulation-based medical education (SBME) is gaining interest as an effective teaching pedagogy for training procedural skill competency. The objectives of this study were to (1) identify enablers and barriers for paediatric trainees to achieve their required procedural competencies, (2) gain insight on the feasibility of achieving the required procedural skills, and (3) explore what simulation-based resources are used as well as their role in achieving the required procedural skill competencies.

Methods

A multi-centered qualitative study using semi-structured interviews was performed. Twenty-four paediatric consultants and trainees were recruited from two academic tertiary hospitals using purposive and snowball sampling. Interviews were conducted between March and September 2021, audio recorded, transcribed, and analyzed using thematic analysis.

Results

Three main themes regarding enablers for achieving procedural competencies were reported and include having protected training time, routine assessments, and a standardized curriculum. Barriers to achieving procedural competencies focused mainly on limited clinical exposure. The use of SBME was recommended by all participants (n = 24, 100%) to assist in achieving procedural competencies and most (n = 15, 62.5%) reported it is feasible to attain the required procedural skills in the paediatric CBME program.

Conclusion

It is feasible to achieve the required procedural competencies for most paediatric trainees, but this can be improved with protected training time, routine assessments, and a standardized curriculum. Barriers to achieving these skills mainly center on limited clinical exposure, which can be remedied by SBME. Further research is warranted to determine the costs and types of SBME tools available as well as teaching pedagogies to support paediatric trainees achieve their required procedural competencies.
USP13 drives lung squamous cell carcinoma by switching lung club cell lineage plasticity
Authors: Kwon Juntae , Zhang Jinmin , Mok Boram , Allsup Samuel , Kim Chul , Toretsky Jeffrey , Han Cecil
Published: December 2023

Lung squamous cell carcinoma (LUSC) is associated with high mortality and limited targeted therapies. USP13 is one of the most amplified genes in LUSC, yet its role in lung cancer is largely unknown. Here, we established a novel mouse model of LUSC by overexpressing USP13 on KrasG12D/+; Trp53flox/flox background (KPU). KPU-driven lung squamous tumors faithfully recapitulate key pathohistological, molecular features, and cellular pathways of human LUSC. We found that USP13 altered lineage-determining factors such as NKX2-1 and SOX2 in club cells of the airway and reinforced the fate of club cells to squamous carcinoma development. We showed a strong molecular association between USP13 and c-MYC, leading to the upregulation of squamous programs in murine and human lung cancer cells. Collectively, our data demonstrate that USP13 is a molecular driver of lineage plasticity in club cells and provide mechanistic insight that may have potential implications for the treatment of LUSC.

Graphical Abstract