bluuebunny/crossref_metadata_2025 huggingface dataset:
Capturing Nursing Students’ Cognitive Challenges and Efforts in EHR-related Tasks: Findings from a Thematic Analysis
Authors: Vaughn Austin , Son Changwon , Caballero Sandra
Published: September 2024

Electronic health record (EHR) systems are medical databases designed to standardize patient and medical information as well as aid care providers in clinical decisions. Despite such useful intentions, the combination of rapid incorporation and lack of user testing of the EHR systems resulted in increased medical errors, user stress and burnout. This prompted broad investigations into the issues related to the usability of the EHR applications. However, limited research has studied user’s cognitive challenges and efforts, which are a more fundamental aspect than the usability of technical interface. Especially, there has been lack of attention to a novice user group, that is a nursing student. The current paper provides findings from interviews with nursing students with respect to their challenges and efforts while conducting critical nursing tasks. Findings from the thematic analysis include nursing students’ challenges with interpreting patient data in different modalities (e.g., audio, visual, tactile), recalling numerical values of patient data, and correcting discovered errors in a timely manner. These findings broaden the current understanding of the EHR-related issues into the underlying cognitive mechanism under specific nursing task contexts. Future efforts are needed to address the nursing students’ cognitive challenges with human-centered technical solutions and work design.
Interruption Management: Education and Practice using Simulations with Embedded Interruptions
Authors: Schroers Ginger
Published: September 2024

Research demonstrates that interruptions increase risks for errors and decrease task efficiency. Interruptions to nurses in healthcare settings are prevalent, particularly during medication administration. Experts recommend that nurses and nursing students learn strategies to mitigate the negative effects of interruptions. However, among the nursing population, there is sparse evidence of methods used to teach interruption management skills. The purpose of this paper is to describe the development and implementation of an education bundle that was used to teach nursing students an interruption management strategy. The bundle included simulated medication administration scenarios with embedded interruptions and distractions.
Lessons Learned Using Rapid Human Factors Methods at Multiple Health Care Facilities
Authors: Maddox Kyle , Chumbler Neale R.
Published: September 2024

This paper describes how the Veterans Health Administration (VHA), Office of Health Informatics (OHI) Human Systems Integration (HSI) team of human factors practitioners led a broad, multidisciplinary team to conduct a series of contextual inquiries at sites newly transitioned to Oracle Health Millennium, VHA’s new electronic health record (EHR)a at the request of VHA leadership. The team utilized contextual inquiry methods and principles of discount usability to identify system performance, workflow, and usability barriers for end users at live sites post-implementation of the new EHR. The VHA OHI and the VHA Electronic Health Record Modernization Integration Office (OEHRM IO) formed a team known as the Technical Get-Well Workstream to conduct rapid, semi-structured interviews and observations of clinical end users at several post-implementation VHA facilities to gather system performance and qualitative data documenting the end user’s experiences with the EHR. After each visit to the facilities, the team analyzed the data to identify core findings and make recommendations for remediation. The team produced user experience maps with collected data to visualize experienced system performance concerns. A key contributor to these efforts continued success is the application of discount usability methods to refine the scope and techniques of onsite data collection. This novel method ensures a carefully targeted scope, focusing on a small number of end user participants by asking targeted questions developed in advance, while at the same time capturing data during short interview and observation windows. The team continuously refined its method via after action reviews, lessons learned journals, and a strong practice committee, including study planning, logistics, onsite data collection, analysis, and reporting to reduce burden on hosting facilities and clinical participants.
The Power of Digital and Promotional Instructional Resources: An Industry & Consultancy Perspective
Authors: Poker Rachel , Pisa Andrea , Grant Thomas
Published: September 2024

Currently digital instructions for medical devices are primarily developed for digital products or as promotional instructional labeling and tend to be available in addition to the paper-based Instructions for Use (IFU). In many markets, digital instructions are limited to Healthcare Professional (HCP) use only and the potential benefits to patients are not being realized. This narrative review discusses some of the realities of patient onboarding and the potential to offer additional support to patients learning to inject through the provision of digital instructions. The review explores the current regulatory landscape for digital instructions across different markets and discusses some of the key differences between regulatory required labeling and promotional labeling. The review concludes with a range of digital instructional concepts to illustrate how evidence-based design principles can be incorporated into digital instructions to create meaningful, engaging content that could enhance the patient experience of instructional content.
How Has the Knowledge of Human Factors and Safety Science Changed My World as a Physician?
Authors: Yale Sarah , Jacobson Nancy , Ladell Meagan , Scanlon Matt , Papautsky Elizabeth Lerner
Published: September 2024

This paper investigates the creation of a multi-disciplinary team and their journey to integrate human factors science into academic medicine. This work explores the many areas in which implementation of human factors thinking has changed their world as physicians – through direct clinical care, medical education, physician research, and leadership/operational roles.
Applying Human Factors Methods to Improve Workflow Safety in Transitioning to a New Special Care Nursery Unit
Authors: Bañez Carleene , Hall Sandra , Gelmi Stefano , Yee Anthony Soung , Farshait Nataly , Hall Trevor
Published: September 2024

The physical healthcare environment plays a pivotal role in shaping work processes, including workflow, equipment usage, human resources management, patient experience, and the ability of healthcare workers to provide safe care. Transitioning to a new space provides an opportunity to proactively identify and enhance safety measures for critical tasks and workflows. This paper presents a collaborative project between the Healthcare Insurance Reciprocal of Canada (HIROC) and Guelph General Hospital (GGH), aimed at improving workflow and workspace in GGH’s Special Care Nursery Unit (SCN) during its transition to a new space. The project was executed in two phases. Phase 1 involved contextual inquiry and observations over three days in the existing unit, which informed simulation scenarios of critical workflows and tasks. Phase 2 comprised simulation walkthroughs with 14 nurses in the new unit, conducted individually or in groups of up to four, to gather feedback. The data collected were used to identify opportunities to build resilience in the SCN, including considerations for improving communication and situation awareness. Survey results also indicated that participants found the simulations helpful for identifying areas to improve safety in the SCN.
Clinical Trial Care, Everywhere: Leveraging Mobile, Digital Technology for Effective Communication of Clinical Research: Safety Information to Rural Clinical Providers
Authors: Molnar Lea Lisa , Benner Kaitlyn , Ma Jiahui , McCrory Bernadette , Johnson Elizabeth A.
Published: September 2024

Background: Clinical trials are traditionally complex in their designs and objectives. To heighten research participant safety, communication between research and clinical teams is necessary to ensure clinical treatment is aligned with the boundaries of the research protocol and anticipated safety of the investigational product (i.e., patient medical alert information). Methods: Secondary analysis of clinical nurse patient simulation and interview transcripts via Linguistic Inquiry Word Count (LIWC-22) examined sentiments and overall nurses’ perceptions of a prototype, wearable medical device designed for mobile information exchange of research safety details needed at point of clinical care. Audio recorded transcriptions of patient simulation interaction and post-interviews were assessed to assess a novel prototype device worn on the patient’s left wrist, which was not identified to nurses (primed) prior to the patient simulation. Results: Registered Nurses (RNs, n=13) and Advanced Practice Registered Nurses (APRNs, n=5) working in direct patient clinical care settings and specialties (e.g., emergency care, urgent care, primary care) from the micropolitan Rocky Mountain West were included in the study. Undergraduate nursing students (n=17) from a College of Nursing also participated in this study. Post-simulation transcription files analyzed using LIWC-22 established summary measures of four sentiments (i.e., analytic, clout, authenticity, tone) for each participant. Practicing nurses were more analytic, yet student nurses conveyed more social understanding (clout). Using LIWC-22, it was observed RNs balanced their analytic, authentic, clout and tone better when conveying information compared to student nurses and APRNs. Conclusion: LIWC-22 is a valid use of natural language processing to examine covert sentiments and perspectives which may not be evident in traditional qualitative analysis of design-related end-user interviews. LIWC-22 may enable design teams to explore another plane of technological acceptance with clinician feedback. Future research is needed to better understand nursing behavior and wearable medical device interaction by coupling sentiment analysis results with objective analysis such as eye-tracking.
Counterfeit Awareness Warnings (CAW) for Over-the-Counter Medications
Authors: Hoffman Haley , Peterson Doug
Published: September 2024

Counterfeit medications pose serious public health risks, ranging from lack of active pharmaceutical ingredients to contamination, and in extreme cases, even death. To combat this problem, pharmaceutical companies employ anti-counterfeiting technologies, including covert and overt authenticity indicators. This study focuses on overt warning labels on consumer perceptions and awareness. The research investigates the effects of warning label types, colors, and symbol usage on consumer awareness and education. Consumer viewed over-the-counter (OTC) medication packaging with and without counterfeit awareness warning indicators (CAWs) and selected packaging properties they noticed first. While CAWs were selected less than one-quarter of time when present, there was a significant advantage when the CAW was red, employed a stop sign icon and appears prominently on the main package area. Further findings note that consumers are largely unaware of the presence or dangers of counterfeit medication and rely primarily on trust in the point of purchase to ensure safely.
Alleviating Poverty Through ‘Women of Will’ Interest-Free Microcredit and Mentoring Model in Malaysia
Authors: Lee Grace H. Y. , Koh Sharon G. M. , Chen Vivien , Charwat Nicola
Published: September 2024

Microenterprise development has been lauded for its capacity to empower socially marginalised women and alleviate poverty. However, the high cost of microcredit due to the relatively high-interest rate charged by institutions poses a debt trap to microenterprises. The study presents a successful case of a private sector-non-governmental organisation partnership to provide interest-free microcredit embedded in a flexible training and mentoring program by Women of Will. The study uses quantitative and qualitative methods to measure the impact of such microcredit and mentoring models on women’s empowerment and entrepreneurial growth, analysing what works and why. The growing importance of environmental, social and governance (ESG) suggests that corporate support for these initiatives has become increasingly sustainable, challenging neoliberal assumptions concerning the inevitable cost of microcredit. The case study draws on a realist approach to inform evidence-based policy by shedding light on the interactions and processes that influence the outcomes.
Reliable Anatomic Femoral Tunnel Positioning for Anterior Cruciate Ligament Reconstruction Using a Novel Femoral Aiming Guide
Authors: Khan Shehzaad A. , Spalding Tim
Published: September 2024

Background:

Anterior cruciate ligament (ACL) tunnel placement has been long debated for many years. Femoral tunnel mal-position is the commonest technical error resulting in early ACL laxity and failure. There are many different methods to achieve accurate femoral tunnel position. In this video, we describe use of a novel femoral jig aiming device to drill a reliably and easily reproducible femoral tunnel for primary ACL reconstruction (ACLR).

Indications:

This femoral jig aiming device is indicated for all patients undergoing primary ACLR with any graft chosen by the surgeon. This jig is particularly useful for the inexperienced and low volume ACLR surgeon.

Technique Description:

An appropriate graft is harvested and prepared according to preferred techniques and the diameter of the graft to be inserted in the femoral tunnel is measured. The femoral notch is prepared, ensuring appropriate tissue is cleared to view the apex of the deep cartilage (ADC). The Infinity anteromedial (AM) femoral guide (Conmed), is inserted through the AM portal and hooked onto the notch just proximal to the ADC. In deep flexion, the guide wire is advanced and the tunnel reamed, aiming to preserve 2.0 to 2.5 mm of bone.

Results:

19 consecutive patients were operated on. There were no complications during the intra- and postoperative period. There have been no reported failures or graft ruptures. All tunnels (100%) were centered in the footprint. The mean tunnel position was 25:20 on the superimposed Bernard-Hertel grid with tight grouping.

Discussion/Conclusion:

We have shown that this new femoral guide accurately locates the femoral tunnel close to the AM bundle position and gives a reliable and reproducible femoral tunnel position, thereby reducing the risk of intra-operative error. This may assist accuracy of tunnel position for surgeons starting out performing ACLR or for low-volume surgeons.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Adherence-enhancing interventions for pharmacological and oxygen therapy in patients with COPD: a systematic review and component network meta-analyses
Authors: Ammous Omar , Kampo Regina , Wollsching-Strobel Maximilian , Zimmermann Maximilian , Andreas Stefan , Friede Tim , Kroppen Doreen , Stanzel Sarah , Salem Susanna , Windisch Wolfram , Mathes Tim
Published: September 2024

Introduction

Adherence to COPD management strategies is complex, and it is unclear which intervention may enhance it.

Objectives

We aim to evaluate the effectiveness of adherence-enhancing interventions, alone or compared to interventions, for patients with COPD.

Methods

This review comprises a component network meta-analysis with a structured narrative synthesis. We searched MEDLINE, Embase, CENTRAL, CINAHL and trial registries on 9 September 2023. We included controlled studies that explored adherence in patients with COPD. Two review authors independently performed the study selection, data extraction and the risk of bias assessment. We involved patients with COPD in developing this systematic review through focus group interviews and displayed the findings in pre-designed logic models.

Results

We included 33 studies with 5775 participants. We included 13 studies in the component network meta-analysis that explored adherence. It was mainly assessed through questionnaires. As a continuous outcome, there was a tendency mainly for education (standardised mean difference 1.26, 95% CI 1.13–1.38, very low certainty of evidence) and motivation (mean difference 1.85, 95% CI 1.19–2.50, very low certainty of evidence) to improve adherence. As a dichotomous outcome (e.g.adherent/non-adherent), we found a possible benefit with education (odds ratio 4.77, 95% CI 2.25–10.14, low certainty of evidence) but not with the other components. We included six studies that reported quality of life in the component network meta-analysis. Again, we found a benefit of education (mean difference −9.70, 95% CI −10.82– −8.57, low certainty of evidence) but not with the other components.

Conclusions

Education may improve adherence and quality of life in COPD patients. Patient focus group interviews indicated that interventions that strengthen patients’ self-efficacy and help them to achieve individual goals are the most helpful.
A systematic literature review of the clinical and socioeconomic burden of bronchiectasis
Authors: Chalmers James D. , Mall Marcus A. , McShane Pamela J. , Nielsen Kim G. , Shteinberg Michal , Sullivan Sean D. , Chotirmall Sanjay H.
Published: September 2024

Background

The overall burden of bronchiectasis on patients and healthcare systems has not been comprehensively described. Here, we present the findings of a systematic literature review that assessed the clinical and socioeconomic burden of bronchiectasis with subanalyses by aetiology (PROSPERO registration: CRD42023404162).

Methods

Embase, MEDLINE and the Cochrane Library were searched for publications relating to bronchiectasis disease burden (December 2017–December 2022). Journal articles and congress abstracts reporting on observational studies, randomised controlled trials and registry studies were included. Editorials, narrative reviews and systematic literature reviews were included to identify primary studies. PRISMA guidelines were followed.

Results

1585 unique publications were identified, of which 587 full texts were screened and 149 were included. A further 189 citations were included from reference lists of editorials and reviews, resulting in 338 total publications. Commonly reported symptoms and complications included dyspnoea, cough, wheezing, sputum production, haemoptysis and exacerbations. Disease severity across several indices and increased mortality compared with the general population was reported. Bronchiectasis impacted quality of life across several patient-reported outcomes, with patients experiencing fatigue, anxiety and depression. Healthcare resource utilisation was considerable and substantial medical costs related to hospitalisations, treatments and emergency department and outpatient visits were accrued. Indirect costs included sick pay and lost income.

Conclusions

Bronchiectasis causes significant clinical and socioeconomic burden. Disease-modifying therapies that reduce symptoms, improve quality of life and reduce both healthcare resource utilisation and overall costs are needed. Further systematic analyses of specific aetiologies and paediatric disease may provide more insight into unmet therapeutic needs.
The effect of computerized cognitive training and transcranial direct current stimulation on working memory among post-stroke individuals: a systematic review with meta-analysis and meta-regression
Authors: Kazinczi Csaba , Kocsis Krisztián , Boross Katalin , Racsmány Mihály , Klivényi Péter , Vécsei László , Must Anita
Published: September 2024

Background

Working memory (WM) impairment is a common phenomenon after stroke; however, its management in rehabilitation is less researched. This systematic review and meta-analysis aimed to provide a quantitative synthesis of the impact of computerised cognitive training (CCT) and transcranial direct current stimulation (tDCS) on WM span in post-stroke individuals.

Methods

The literature search in PubMed, Embase, Scopus, and Cochrane Library focused on randomized controlled trials testing the effect of CCT and tDCS on treated stroke patients as compared to untreated controls. Neuropsychological instruments such as Digit Span Forward/Backward and Visual Span Forward Tests defined the outcome of WM span. After extracting study characteristics and quality assessment using the Cochrane Risk of Bias Tool, we conducted a meta-analysis and meta-regression using standardised mean differences.

Results

The search yielded 4142 articles, nine of which (N = 461) fulfilled the inclusion criteria. In the case of CCT, we found significant improvement in Digit Span Backward Test (Z = 2.65, P = 0.008; 95% CI [0.10, 0.67]) and Visual Span Forward Test performance (Z = 3.05, P = 0.002; 95% CI [0.15, 0.69]), while for tDCS, we could not find a sufficient number of studies for the analysis. Furthermore, no significant moderating factor was found in the meta-regression.

Conclusions

In conclusion, CCT appears to be a suitable choice to enhance WM span performance after stroke. However, further research is needed to investigate the effect of tDCS due to the limited number of studies.

Trial registration

The meta-analysis was conducted according to PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) standards with a PROSPERO registration protocol (ID: CRD42023387182).
Risk of SARS-CoV-2 infection in professional settings, shops, shared transport, and leisure activities in France, 2020–2022
Authors: Galmiche Simon , Charmet Tiffany , Rakover Arthur , Chény Olivia , Omar Faïza , David Christophe , Mailles Alexandra , Carrat Fabrice , Fontanet Arnaud
Published: September 2024

Purpose

The aim of the study was to identify settings associated with SARS-CoV-2 transmission throughout the COVID-19 pandemic in France.

Methods

Cases with recent SARS-CoV-2 infection were matched with controls (4:1 ratio) on age, sex, region, population size, and calendar week. Odds ratios for SARS-CoV-2 infection were estimated for nine periods in models adjusting for socio-demographic characteristics, health status, COVID-19 vaccine, and past infection.

Results

Between October 27, 2020 and October 2, 2022, 175,688 cases were matched with 43,922 controls. An increased risk of infection was documented throughout the study for open-space offices compared to offices without open space (OR range across the nine periods: 1.12 to 1.57) and long-distance trains (1.25 to 1.88), and during most of the study for convenience stores (OR range in the periods with increased risk: 1.15 to 1.44), take-away delivery (1.07 to 1.28), car-pooling with relatives (1.09 to 1.68), taxis (1.08 to 1.89), airplanes (1.20 to 1.78), concerts (1.31 to 2.09) and night-clubs (1.45 to 2.95). No increase in transmission was associated with short-distance shared transport, car-pooling booked over platforms, markets, supermarkets and malls, hairdressers, museums, movie theatres, outdoor sports, and swimming pools. The increased risk of infection in bars and restaurants was no longer present in restaurants after reopening in June 2021. It persisted in bars only among those aged under 40 years.

Conclusion

Closed settings in which people are less likely to wear masks were most affected by SARS-CoV-2 transmission and should be the focus of air quality improvement.

ClinicalTrials.gov (03/09/2022)

NCT04607941.
Effects of a Paleolithic diet compared to a diabetes diet on leptin binding inhibition in secondary analysis of a randomised cross-over study
Authors: Fontes-Villalba Maelán , Granfeldt Yvonne , Sundquist Kristina , Memon Ashfaque A. , Hedelius Anna , Carrera-Bastos Pedro , Jönsson Tommy
Published: September 2024

Background

Beneficial effects from practising a Paleolithic diet as compared to a diabetes diet on weight, waist circumference, satiety, leptin, HbA1c and glucose control in randomised controlled trial participants with type 2 diabetes could be due to lower leptin resistance. Support for this hypothesis comes from an in vitro experiment that showed that digested wheat gluten, which is excluded from a Paleolithic diet, inhibits leptin from binding to its receptor, thus indicating a possible dietary cause of leptin resistance. However, the clinical relevance of the latter finding is unclear since removal of enzyme activity from the gluten digest by heat treatment also abolished leptin binding inhibition. Assessment of leptin binding inhibition in vivo is possible by comparison of total leptin levels with those of ‘biologically active’ leptin bound to its receptor (bioLep).

Objectives

To assess the effects of a Paleolithic diet compared to a diabetes diet on leptin binding inhibition and to replicate our in vitro study.

Methods

BioLep and total leptin levels were measured in secondary analysis of fasting plasma samples from our open label random order three plus three-month long cross-over trial performed in 2005–2007, that compared a Paleolithic diet with a diabetes diet in participants with type 2 diabetes without insulin treatment (per protocol). BioLep was also measured in vitro for known recombinant leptin concentrations incubated with a series of concentrations of 10 kDa spin-filtered digested wheat gluten, with or without prior heat treatment, at 100ºC for 30 min and centrifugation.

Results

There was no difference between diets when comparing differences between bioLep and total leptin levels and their ratio in the 13 participants, three women and 10 men, aged 52–74 years with a mean BMI of 30 kg/m2 and a mean diabetes duration of eight years. We found no carry-over or period effect for bioLep and total leptin. In vitro, wheat gluten digest inhibited leptin binding in a dose-dependent manner but not after heat treatment.

Conclusions

We found no leptin binding inhibition after the Paleolithic or diabetes diet, possibly due to its abolishment from cooking-related heat treatment of wheat gluten.

Trial registration

Registered on 14/02/2007 at ClinicalTrials.gov Identifier: NCT00435240.
An open-label, parallel-group, randomized clinical trial of different silver diamine fluoride application intervals to arrest dental caries
Authors: Schroth Robert J. , Bajwa Sukeerat , Lee Victor H. K. , Mittermuller Betty-Anne , Singh Sarbjeet , Cruz de Jesus Vivianne , Bertone Mary , Chelikani Prashen
Published: September 2024

Background

Silver diamine fluoride (SDF) is an antimicrobial agent and alternative treatment option that can be used to arrest dental decay. While there is optimism with SDF with regard to caries management, there is no true consensus on the number and frequency of applications for children. The purpose of this study was to examine the effectiveness of 38% SDF to arrest early childhood caries (ECC) at three different application regimen intervals.

Methods

Children with teeth that met International Caries Detection and Assessment System codes 5 or 6 criteria were recruited from community dental clinics into an open-label, parallel-group, randomized clinical trial from October 2019 to June 2021. Participants were randomized to one of three groups using sealed envelopes that were prepared with one of three regimens inside: visits one month, four months, or six months apart. Participants received applications of 38% SDF, along with 5% sodium fluoride varnish (NaFV), at the first two visits to treat cavitated carious lesions. Lesions were followed and arrest rates were calculated. Lesions were considered arrested if they were hard on probing and black in colour. Statistics included descriptive and bivariate analyses (Kruskal one-way analysis of variance and Pearson’s Chi-squared test). A p-value of ≤ 0.05 was considered significant.

Results

Eighty-four children participated in the study (49 males and 35 females, mean age: 44.4 ± 14.2 months). Treatment groups were well matched with 28 participants per group. A total of 374 teeth and 505 lesions were followed. Posterior lesions represented only 40.6% of affected surfaces. Almost all SDF treated lesions were arrested for the one-month (192/196, 98%) and four-month (159/166, 95.8%) interval groups at the final visit. The six-month group experienced the lowest arrest rates; only 72% (103/143) of lesions were arrested (p < 0.001). The duration of application intervals was inversely associated with improvements in arrest rates for all lesions.

Conclusions

Two applications of 38% SDF and 5% NaFV in one-month and four-month intervals were comparable and very effective in arresting ECC. Applications six months apart were less effective and could be considered inferior treatment.

Trial registration

ClinicalTrials.gov NCT04054635 (first registered 13/08/2019).
Children’s Health in London and Luton (CHILL) cohort: a 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children’s travel to school
Authors: Xiao Christina , Scales James , Chavda Jasmine , Dove Rosamund E. , Tsocheva Ivelina , Wood Helen E. , Kalsi Harpal , Sartori Luke , Colligan Grainne , Moon Jessica , Lie Esther , Petrovic Kristian , Day Bill , Howett Cheryll , Keighley Amanda , Mihaylova Borislava , Toffolutti Veronica , Grigg Jonathan , Randhawa Gurch , Sheikh Aziz , Fletcher Monica , Mudway Ian , Beevers Sean , Gauderman W. James , Griffiths Christopher J. , van Sluijs Esther , Panter Jenna
Published: September 2024

Background

The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school.

Methods

CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6–9 years attending 84 primary schools within or with catchment areas encompassing London’s ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school ‘today’ (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored.

Results

Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21–10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05–0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87–19.68) compared to those living closer (OR 1.43, 0.27–7.54).

Conclusions

Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.
Enhanced cognitive behaviour therapy for adolescents with eating disorders: development, effectiveness, and future challenges
Authors: Dalle Grave Riccardo , Calugi Simona
Published: September 2024

Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly.
The dual role of POSTN in maintaining glioblastoma stem cells and the immunosuppressive phenotype of microglia in glioblastoma
Authors: Wang Hao , Yao Lin , Chen Jinming , Li Yanyan , Su Zuopeng , Liu Yongsheng , Li Wen , Xiong Yun , Gao Heyang , Zhang Xiao , Zhou Youxin
Published: September 2024

Background

Glioblastoma (GBM) is an immunosuppressive, universally lethal cancer driven by glioblastoma stem cells (GSCs). The interplay between GSCs and immunosuppressive microglia plays crucial roles in promoting the malignant growth of GBM; however, the molecular mechanisms underlying this crosstalk are unclear. This study aimed to investigate the role of POSTN in maintaining GSCs and the immunosuppressive phenotype of microglia.

Methods

The expression of POSTN in GBM was identified via immunohistochemistry, quantitative real-time PCR, and immunoblotting. Tumorsphere formation assay, Cell Counting Kit-8 assay and immunofluorescence were used to determine the key role of POSTN in GSC maintenance. ChIP-seq and ChIP-PCR were conducted to confirm the binding sequences of β-catenin in the promoter region of FOSL1. Transwell migration assays, developmental and functional analyses of CD4+ T cells, CFSE staining and analysis, enzyme-linked immunosorbent assays and apoptosis detection tests were used to determine the key role of POSTN in maintaining the immunosuppressive phenotype of microglia and thereby promoting the immunosuppressive tumor microenvironment. Furthermore, the effects of POSTN on GSC maintenance and the immunosuppressive phenotype of microglia were investigated in a patient-derived xenograft model and orthotopic glioma mouse model, respectively.

Results

Our findings revealed that POSTN secreted from GSCs promotes GSC self-renewal and tumor growth via activation of the αVβ3/PI3K/AKT/β-catenin/FOSL1 pathway. In addition to its intrinsic effects on GSCs, POSTN can recruit microglia and upregulate CD70 expression in microglia through the αVβ3/PI3K/AKT/NFκB pathway, which in turn promotes Treg development and functionality and supports the formation of an immunosuppressive tumor microenvironment. In both in vitro models and orthotopic mouse models of GBM, POSTN depletion disrupted GSC maintenance, decreased the recruitment of immunosuppressive microglia and suppressed GBM growth.

Conclusion

Our findings reveal that POSTN plays critical roles in maintaining GSCs and the immunosuppressive phenotype of microglia and provide a new therapeutic target for treating GBM.
Association between systemic lupus erythematosus and autoimmune thyroid dysfunction in pediatric population: a single center experience
Authors: Shamma Radwa Ahmed , Soliman Hend Mehawed , Abdelfattah Walaa , Badawy Marwa Ahmed , Shafie Eman Shafik
Published: September 2024

Background

Systemic Lupus Erythematosus (SLE) patients are more likely than the general population to suffer from thyroid illness. The major goal was to assess the thyroid dysfunctions due to immunological factors in Egyptian SLE children and how they are related to the course and severity of the illness.

Methods

Fifty children and adolescents with SLE are included in this cross-sectional observational study. Every patient underwent a thorough physical examination and a comprehensive history taking. An enzyme-linked immunosorbent assay (ELISA) approach was used to evaluate the thyroid profile, anti-thyroglobulin (Anti-TG), and anti-thyroid peroxidase (anti-TPO) antibodies.

Results

Of the 50 patients, the female: male ratio (F: M = 7:1) was 44 females and 6 males (12%). They were between the ages of 5 and 17. Out of the patients, thirty-two (64%) had thyroid dysfunctions, 19 (38%) had euthyroid sick syndrome, ten (20%) had overt hypothyroidism, three (6%) had subclinical hypothyroidism, and none had hyperthyroidism. Of the 50 patients, one (2%) had increased anti-TPO, whereas all other patients had normal anti-TG levels. A statistically significant negative correlation (p-value 0.007) was seen between the disease duration and free thyroxine (FT4). Furthermore, a significant negative correlation (p-values 0.015 and 0.028) was found when comparing the disease duration with thyroid antibodies (anti-TG and anti-TPO).

Conclusion

In Juvenile Systemic Lupus Erythematosus (JSLE), thyroid dysfunctions can be identified. The disease duration but not its activity was significantly correlated with thyroid antibodies. For children with JSLE, thyroid function testing should be done on a regular basis. It is preferable to carry out additional thyroid antibody tests when necessary.
Anthropometric measurements as a key diagnostic tool for familial partial lipodystrophy in women
Authors: Veras Victor Rezende , da Cruz Paiva Lima Grayce Ellen , da Ponte Melo Ivana , Fernandes Virginia Oliveira , de Moura Lopes Fabia Karine , do Amaral Camila Lopes , Castelo Maria Helane Gurgel , Queiroz Larissa Luna , Araújo Jessica Silveira , Valerio Cynthia Melissa , Montenegro Junior Renan Magalhães
Published: September 2024

Background

Familial Partial Lipodystrophy (FPLD) is a disease with wide clinical and genetic variation, with seven different subtypes described. Until genetic testing becomes feasible in clinical practice, non-invasive tools are used to evaluate body composition in lipodystrophic patients. This study aimed to analyze the different anthropometric parameters used for screening and diagnosis of FPLD, such as thigh skinfold thickness (TS), Köb index (Köbi), leg fat percentage (LFP), fat mass ratio (FMR) and leg-to-total fat mass ratio in grams (LTR), by dual-energy X-ray absorptiometry, focusing on determining cutoff points for TS and LFP within a Brazilian population.

Methods

Thirty-seven patients with FPLD and seventy-four healthy controls matched for body mass index, sex and age were studied. Data were collected through medical record review after signing informed consent. All participants had body fat distribution evaluated by skinfolds and DXA measures. Fasting blood samples were collected to evaluate glycemic and lipid profiles. Genetic studies were carried out on all patients. Two groups were categorized based on genetic testing and/or anthropometric characteristics: FPLD+ (positive genetic test) and FPLD1 (negative genetic testing, but positive clinical/anthropometric criteria for FPLD).

Results

Eighteen (48.6%) patients were classified as FPLD+, and 19 (51.4%) as FPLD1. Unlike what is described in the literature, the LMNA variant in codon 582 was the most common. Among the main diagnostic parameters of FPLD, a statistical difference was observed between the groups for, Köbi, TS, LFP, FMR, and LTR. A cutoff point of 20 mm for TS in FPLD women was found, which is lower than the value classically described in the literature for the diagnosis of FPLD. Additionally, an LFP < 29.6% appears to be a useful tool to aid in the diagnosis of these women.

Conclusion

Combining anthropometric measurements to assess body fat distribution can lead to a more accurate diagnosis of FPLD. This study suggests new cutoff points for thigh skinfold and leg fat percentage in women with suspected FPLD in Brazil. Further studies are needed to confirm these findings.
Complete response and long-term survival to endocrine monotherapy in a patient with metastatic breast cancer in a low-income country: a case report
Authors: Sada Raghad , Karim Nouralhuda , Rohaibani Ghina , Alali Mousa , Saifo Maher
Published: September 2024

Background

Breast cancer is the most common cancer in women. Progression-free survival for hormone receptor-positive/human epidermal growth factor receptor-2-negative metastatic breast cancer treated with endocrine therapy in combination with cyclin4/6-dependent kinase is approximately 25 months. This case represents metastatic breast cancer treated with endocrine therapy, leading to long-term survival.

Case presentation

A 40-year-old Syrian woman diagnosed with hormone receptor-negative breast cancer was treated surgically with adjuvant chemotherapy and radiotherapy. She developed local and nodal recurrences that were hormone receptor-positive, followed by a recurrence of malignant pleural effusion. She was initially treated with chemotherapy and then placed on endocrine therapy with a complete response from 2014 until now. The patient also suffered from adverse events of medications, such as heart failure and osteoporosis, which were treated appropriately.

Conclusion

This case demonstrates a long-lasting complete response to metastatic breast cancer with malignant pleural effusion. This shows the validity of endocrine therapy in recurrent hormone receptor-positive breast cancer, especially in countries that cannot afford targeted therapies or genetic tests. It also highlights the necessity for a better understanding of the prognostic and predictive factors.
Knowledge, attitudes, and readiness about critical antimicrobial resistant organisms among healthcare workers at colonial war memorial hospital in Fiji: a pre and post intervention study
Authors: Buising Kirsty , Naidu Ravi , Prasad Shammi , Richards Matthew , Kumar Savneel Shivam , Lata Alvina , Datt Ashlyn , Genaro Sisilia Assisi , Ratusela Timaima , Nabose Ilisapeci , Cameron Donna , Suka Ana , Young-Sharma Tracey , Howden Benjamin P , Getahun Strobel Aneley
Published: September 2024

Background

Gram-negative bacteria resistant to carbapenems are also known as critical antimicrobial resistant organisms. Their emergence at Colonial War Memorial Hospital (CWMH), the largest hospital in Fiji, is a major clinical concern. This study was conducted to determine the knowledge, attitudes, and readiness of healthcare workers (HCW) at CWMH regarding management of patients with infections caused by critical antimicrobial resistant organisms.

Methods

A questionnaire was designed using a Likert scale to assess knowledge, attitudes, and readiness. Two cross-sectional studies were conducted, before and after the implementation of targeted educational activities which were informed by the pre-intervention study findings.

Results

A total of 393 and 420 HCW participated in the pre- and post-intervention studies, respectively. The majority of respondents were female (77.3%) and 18–34 years of age (67%). HCW professional roles included nurses (56.3%), doctors (31.6%), and laboratory personnel (12.2%). In the post-intervention study, significantly more HCW reported having received infection prevention and control (IPC) and antimicrobial resistance education and training (26.8% in pre to 45.5% in post intervention, p < 0.001). The majority of nurses and doctors (> 85% to ≥ 95%) were aware of how AMR organisms spread in healthcare settings and knew the IPC measures to prevent transmission of AMR infections including hand hygiene, standard and transmission-based precautions. Attitudes towards AMR were positive, with 84.2% pre intervention and 84.8% of HCW post intervention expressing their willingness to change their work environment to assist with AMR prevention. Perceived readiness to address the problem showed mixed results. Improvements in laboratory AMR surveillance data availability were noted (29.4–52.4%, p < 0001). Modest improvement in the hospital’s capacity for outbreak response (44–51.9%, p = 0.01), and treatment of AMR infections (38.9–44.4%, p = 0.01) was reported.

Conclusions

Our data revealed high levels of staff awareness and knowledge about AMR and IPC. However, readiness for outbreak response and treatment of critical AMR infections requires more attention. Improving AMR prevention and containment in CWMH will likely require sustained and multisectoral interventions with strong administrative commitment.
Efficient microservices offloading for cost optimization in diverse MEC cloud networks
Authors: Mahesar Abdul Rasheed , Li Xiaoping , Sajnani Dileep Kumar
Published: September 2024

In recent years, mobile applications have proliferated across domains such as E-banking, Augmented Reality, E-Transportation, and E-Healthcare. These applications are often built using microservices, an architectural style where the application is composed of independently deployable services focusing on specific functionalities. Mobile devices cannot process these microservices locally, so traditionally, cloud-based frameworks using cost-efficient Virtual Machines (VMs) and edge servers have been used to offload these tasks. However, cloud frameworks suffer from extended boot times and high transmission overhead, while edge servers have limited computational resources. To overcome these challenges, this study introduces a Microservices Container-Based Mobile Edge Cloud Computing (MCBMEC) environment and proposes an innovative framework, Optimization Task Scheduling and Computational Offloading with Cost Awareness (OTSCOCA). This framework addresses Resource Matching, Task Sequencing, and Task Scheduling to enhance server utilization, reduce service latency, and improve service bootup times. Empirical results validate the efficacy of MCBMEC and OTSCOCA, demonstrating significant improvements in server efficiency, reduced service latency, faster service bootup times, and notable cost savings. These outcomes underscore the pivotal role of these methodologies in advancing mobile edge computing applications amidst the challenges of edge server limitations and traditional cloud-based approaches.
Local earthquake monitoring with a low-cost seismic network: a case study in Nepal
Authors: Subedi Shiba , Hetényi György , Frédérick Massin , Adhikari Lok Bijaya , Michailos Konstantinos
Published: September 2024

Seismic monitoring matters both for research and for populations living in areas of seismic hazard; however, it comes with a cost that is not fully affordable for developing countries. Compared to classical approaches with very quiet sites and high-quality instrumentation, it is therefore worth investigating low-cost seismic networks and how well they perform at detecting and characterizing seismicity. We analyze 1 year of seismic data from an educational seismology network in Nepal, create our own earthquake catalog, and compare it to the publicly available national observatory catalog. We find that despite the noisier seismic station sites, the overall results are comparable and all the main features relevant for seismicity are found. We present quantitative analyses of locations, magnitudes and their frequency distribution in our catalog, as well as differences with the observatory catalog. Differences between the two catalogs primarily stem from the respective network geometries and their coverage, as well as daytime noise level differences. We conclude that if properly planned and installed, low-cost seismic networks are a viable, feasible and significant complement to monitor seismic activity.

Graphical Abstract