bluuebunny/crossref_metadata_2025 huggingface dataset:
No evidence that mutations in SARS-CoV-2 variants of concern derive from homologous fragments in gut microbiota
Authors: Parry Rhys H. , Lytras Spyros , Petrone Mary E. , Wille Michelle , Crits-Christoph Alexander , Gifford Robert J. , Saito Akatsuki , Smura Teemu , Peacock Thomas P.
Published: November 2024

Understanding the origin and evolution of mutations in SARS-CoV-2 variants of concern (VOCs) is a critical area of research. B. Cao, X. Wang, W. Yin, Z. Gao, and B. Xia (mBio 15:e03187-23, 2024,
https://doi.org/10.1128/mbio.03187-23
) proposed that these mutations originated from bacterial sequences incorporated into the viral genome through stochastic template-switching by the viral RNA-dependent RNA polymerase (RdRp). Their analysis suggested that 62% of the viral mutation fragments (VMFs) in key SARS-CoV-2 proteins were identical to bacterial protein sequences. Given the implications of this finding, we re-examined the methods employed and argue that they resulted in false-positive findings. Specifically, the short query length of VMFs, seven amino acids, leads to spurious matches in large protein databases, as indicated by high BLAST Expect values. Furthermore, we analyzed the nucleotide sequence of VMFs, revealing no unique homology between SARS-CoV-2 and bacterial sequences. Consequently, the evidence does not support the hypothesis that bacterial sequences contribute to the evolution of SARS-CoV-2 VOCs. Instead, the emergence of these variants is more plausibly attributed to factors intrinsic to viral replication and evolution, such as the error-prone nature of RdRp, intrahost diversity, and recombination of related viral sublineages.
Limit of detection of
Salmonella
ser. Enteritidis using culture-based versus culture-independent diagnostic approaches
Authors: Bradford L. M. , Yao L. , Anastasiadis C. , Cooper A. L. , Blais B. , Deckert A. , Reid-Smith R. , Lau C. , Diarra M. S. , Carrillo C. , Wong A.
Published: November 2024

To prevent the spread of foodborne illnesses, the presence of pathogens in the food chain is monitored by government agencies and food producers. The culture-based methods currently employed are sensitive but time- and labor-intensive, leading to increasing interest in exploring culture-independent diagnostic tests (CIDTs) for pathogen detection. However, few studies quantify the relative sensitivity and reliability of these CIDTs compared to current approaches. To address this issue, we conducted a comparison of the limit of detection (LOD
50
) for
Salmonella
between a culture-based method and three CIDTs: qPCR (targeting
invA
and
stn
), metabarcode (16S) sequencing, and shotgun metagenomic sequencing. Samples of chicken feed and chicken caecal contents were spiked with
S
. serovar Enteritidis and subjected to culture- and DNA-based detection methods. To explore the impact of non-selective enrichment on LOD
50
, all samples underwent both immediate DNA extraction and overnight enrichment prior to gDNA extraction. In addition to this spike-in experiment, feed and caecal samples acquired from the field were tested with culturing, qPCR, and metabarcoding. In general, LOD
50
was comparable between qPCR and shotgun sequencing methods. Overnight microbiological enrichment resulted in an improvement in LOD
50
with up to a three-log decrease. However,
Salmonella
reads were detected in some unspiked feed samples, suggesting false-positive detection of
Salmonella
. In addition, the LOD
50
in feeds was three logs lower than in caecal contents, underscoring the impact of background microbiota on
Salmonella
detection using all methods.

IMPORTANCE

The appeal of culture-independent diagnostic tests (CIDTs) is increased speed with lowered cost, as well as the potential to detect multiple pathogen species in a single analysis and to monitor other areas of concern such as antimicrobial resistance genes or virulence factors. This study provides quantitative data on the sensitivity of CIDTs relative to current approaches, which is essential for determining the feasibility of implementing these methods in pathogen surveillance programs.
Biofilm matrix regulation by
Candida glabrata
Zap1 under acidic conditions: transcriptomic and proteomic analyses
Authors: Gonçalves Bruna , Pires Diana Priscila , Fernandes Liliana , Pacheco Miguel , Ferreira Tiago , Osório Hugo , Soares Ana Raquel , Henriques Mariana , Silva Sónia
Published: November 2024

The vaginal acidic environment potentiates the formation of
Candida glabrata
biofilms, leading to complicated and recurrent infections. Importantly, the production of matrix is known to contribute to the recalcitrant features of
Candida
biofilms. In this study, we reveal that Zap1 regulates the matrix of
C. glabrata
acidic biofilms and analyzed the modulation of their transcriptome (by microarrays) and matrix proteome (by LC-MS/MS) by Zap1. For that, the deletion mutant
zap1
Δ and its complemented strain
zap1
Δ::
ZAP1
were constructed, and their biofilms were developed at pH 4 (adjusted with lactic acid). The results revealed that Zap1 is a negative regulator of the total amount of protein and carbohydrate in the biofilm matrix. Accordingly, various genes and matrix proteins with predicted functions in the regulation of carbohydrate metabolism, sugar binding, sugar transport, and adhesion (including Epa family) were repressed by Zap1. Nevertheless, the results also suggested that Zap1 is essential to the delivery and organization of some matrix components. Indeed, Zap1 was required for the secretion of 122 proteins to the matrix and induced the expression of 557 genes, including various targets involved in glucan metabolism. Additionally, Zap1 induced targets with roles in virulence, resistance to antifungals, and host immunity evasion, including yapsins,
ERG
family, and moonlighting proteins. Zap1 was also required for the secretion of acidic-specific matrix proteins, indicating a contribution to the response to the acidic environment. Overall, this study demonstrates that Zap1 is a relevant regulator of the biofilm matrix, contributing to a better understanding of
C. glabrata
acidic biofilms.

IMPORTANCE

The rising prevalence of vulvovaginal candidiasis (VVC) and the increasing presence of
Candida
spp. with aggressive virulence features and low susceptibility to common antifungals, particularly
Candida glabrata
, have resulted in more severe, prolonged, and recurrent cases of VVC, with significant implications for patients. This research offers valuable insights into the molecular changes that contribute to the formation of
C. glabrata
biofilms in the acidic vaginal environment, representing a significant advancement in the understanding of
C. glabrata
’s virulence. Notably, this study identified Zap1 as a critical regulator of
C. glabrata
biofilm matrix, with additional potential roles in adhesion, antifungal resistance, evasion of host immunity, and response to acidic conditions, making it a promising target for new therapeutic approaches. Importantly, Zap1 is the first regulator of the biofilm matrix to be identified in
C. glabrata
, and the elucidation of its targets (including genes and matrix proteins) lays a strong foundation for future research.
Protracted (>100 m.y.) deep crustal orogenesis revealed by in situ monazite petrochronology in the Shuswap Metamorphic Complex, British Columbia, Canada
Authors: Bowie Sarah , Gibson H. Daniel , Dyck Brendan , Godin Laurent , Larson Kyle
Published: November 2024

The Shuswap Metamorphic Complex in southeastern British Columbia, Canada, exposes penetratively deformed rocks exhumed from deep crustal levels (~25–30 km depth) of the Canadian Cordillera. Existing models describing its tectonometamorphic evolution are not directly linked to absolute age constraints acquired through modern petrochronological methods and, therefore, remain ambiguous. To differentiate between proposed models, here we apply U-Th-Pb monazite petrochronology, petrological modeling, and microstructural analysis to quantify conditions and timing of deformation across a transect of the Shuswap Metamorphic Complex. Our results demonstrate that metamorphism decreases in age with increased structural depth associated with progressive localization of NE-directed shearing toward the base of the Shuswap Metamorphic Complex. Monazite U-Th-Pb age data from the structural level exposed in the study area are consistent with protracted northeast-directed compression from ca. 167 Ma to ca. 59 Ma, after which west-directed ductile extension continued until at least ca. 49 Ma and was progressively localized along the Okanagan Valley fault system. New data presented are consistent with a model of basal accretion in front of a foreland-propagating ductile thrust system, followed by exhumation of the Shuswap Metamorphic Complex facilitated in large part by crustal-scale extension.
Economic evaluation of computerised interpretation of fetal heart rate during labour: a cost-consequence analysis alongside the INFANT study
Authors: Schroeder Elizabeth , Yang Miaoqing , Brocklehurst Peter , Linsell Louise , Rivero-Arias Oliver
Published: November 2024

Objective

Economic evaluation of computerised decision-support software intended to assist in the interpretation of a cardiotocography (CTG) during birth.

Design

Individual patient level data from the INFANT study (an unmasked randomised controlled trial).

Setting

Maternity units in the UK and Ireland.

Population

Singleton or twin pregnancy women of 35 weeks’ gestation or more and receiving continuous electronic fetal monitoring during labour.

Intervention

Computerised decision-support software.

Methods

Cost-consequence analysis presenting costs and outcomes with a time horizon of 2 years from a government healthcare perspective. Unit cost data collected from a combination of primary and secondary sources.

Main outcome measures

Primary clinical outcomes were (i) composite ‘poor neonatal outcome’ and (ii) developmental assessment at age 2 years in a subset of surviving children. Mean cost per mother and infant dyad from birth to hospital discharge, and from hospital discharge to 24 months follow-up. Maternal health-related quality of life was assessed at 12 and 24 months follow-up using the EuroQol three-level health-related quality of life instrument (EQ-5D-3L).

Results

Data were analysed for 46 042 women and 46 614 infants. No statistically significant differences were detected between trial arms in any of the primary clinical outcomes or maternal quality of life. No statistically significant differences in costs were detected in maternal or infant costs from trial entry to hospital discharge or overall from hospital discharge to 2-year follow-up.

Conclusions

Decision-support software during labour is not associated with additional maternal or infant benefits and over a 2-year period the software did not lead to additional costs or savings to the National Health Service.

Trial registration number

ISRCTN98680152.
Primary actinomycotic osteomyelitis of metacarpal bones managed successfully with surgical debridement and Welsh regimen
Authors: K Manjunath Sagarika , Pandey Vivek , B K Amrath Raj , Varma Muralidhar
Published: November 2024

Mycetoma of the hand is a chronic granulomatous disease seen in the tropics and subtropical regions, mainly affecting the skin and subcutaneous tissue of the foot. Primary actinomycotic osteomyelitis involving the metacarpals is rarely reported in the literature. The conventional treatment for actinomycosis has been high-dose penicillin. We report a case of chronic osteomyelitis in the metacarpals of the hand caused by actinomycetes in a woman in her 40s. She underwent surgical intervention in the form of wound debridement and curettage, followed by a 6-month course of Welsh regimen after a biopsy confirmed the diagnosis of actinomycotic osteomyelitis. This case report underscores the importance of recognising primary actinomycosis as a potential cause of chronic osteomyelitis at unusual sites and highlights the efficacy of combined surgical debridement, biopsy and adequate antibiotic management in consultation with infectious disease specialists in achieving good outcomes.
Probable zoonotic pulmonary prosthetic valve infective endocarditis and acalculous cholecystitis caused byStreptococcus equisubspecieszooepidemicus
Authors: Eustace Matthew , Strey Gabriela , Kidd Timothy J , McNamara John F
Published: November 2024

Prosthetic pulmonary valve endocarditis is a rare but serious infective complication following correction of tetralogy of Fallot (ToF). We describe a probable zoonotic case ofStreptococcus equisubspecieszooepidemicusprosthetic pulmonary valve infective endocarditis in a young woman with corrected ToF with regular exposure to horses. The case was further complicated by acalculous cholecystitis, which was the initial presenting syndrome, requiring laparoscopic cholecystectomy. Microbiological analysis of blood cultures yielded growth ofS. equiwith whole genome sequencing confirming the subspecies identification ofzooepidemicus. The patient underwent successful combined medical and surgical management incorporating a 6-week course of intravenous antibiotics and a re-do homograft pulmonary valve replacement followed by prolonged oral antibiotic therapy. Clinicians should be mindful of the increased risk of endocarditis in adult congenital heart disease and relevant bacteraemia detection should prompt thorough valvular assessment.
Benefit equity of social health insurance in China and its provinces (2014–2020): implications for universal health coverage
Authors: Zhang Yaoyun , Mills Anne , Xu Jin
Published: November 2024

Introduction

China has increased fiscal input into social health insurance (SHI) schemes to achieve universal health coverage. Our study aimed to examine the equity of SHI benefits in the country and five representative provinces over the period of 2014–2020.

Methods

We analysed nationally and subnationally representative data from four waves (2014, 2016, 2018 and 2020) of the China Family Panel Studies. Benefit relative to consumption was assessed using concentration indices and concentration curves. We compared benefit distribution against health need across consumption quintiles. We further decomposed the change in the concentration index from 2014 to 2020.

Results

The national concentration index for SHI benefit was pro-rich but became substantially less so over time, falling from 0.262 in 2014 to 0.133 in 2020. Poorer quintiles suffered more ill health but received a smaller share of SHI benefits compared with the richer quintiles. All five provinces improved in benefit equity to varying degrees. Reduced disparity between employee and resident schemes, and use of hospitals as the usual source of care, accounted for 44.47% and 14.70%, respectively, of the national improvement in SHI benefit equity.

Conclusion

The benefit equity of SHI in China has improved, likely influenced by the narrowing funding gap between resident and employee scheme benefits. However, benefits remained skewed towards the richer groups with lower health need, revealing the resilience of an ‘Inverse Benefit Law’. We suggest risk-equalisation of SHI funds and coordinated reform in health financing and service delivery towards a greater focus on primary care.
From curriculum to clinic: a qualitative study of junior doctors’ perceptions of global health and sustainable development
Authors: Agardh Charlotte , Bielik Julia , Ekman Anna-Theresia , Velin Lotta , Herzig van Wees Sibylle
Published: November 2024

Introduction

The role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors’ views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors’ perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work.

Methods

This was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis.

Results

Three themes were identified. The first theme (1) ‘medical doctors have a role in the transition to a sustainable society’, shows that sustainable development is increasingly perceived as relevant for junior doctors’ clinical work. The second theme (2) ‘global health and sustainable development teaching is inconsistent and somewhat outdated’, highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) ‘application of global health and sustainable development is difficult’. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor.

Conclusion

This study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings.
Delivering an innovative multi-infection and female genital mutilation screening to high-risk migrant populations (ISMiHealth): study protocol of a cluster randomised controlled trial with embedded process evaluation
Authors: Cruz Angeline , Cuxart-Graell Alba , Gonçalves Alessandra Queiroga , Vázquez-Villegas José , Vallejo-Godoy Silvia , Salas-Coronas Joaquín , Piqueras Nicolás , Martínez-Torres Sara , Artigues-Barberà Eva , Rando-Matos Yolanda , Margalejo Ana Aguilar , Vizcaíno Jesús , Requena Pilar , Martínez-Pérez Ángela , Ferrer Elisabet , Méndez-Boo Leonardo , Coma Ermengol , Luzón-García María Pilar , Sequeira-Aymar Ethel , Casellas Aina , Vázquez-Montiel Marta , Jacques-Aviñó Constanza , Medina-Perucha Laura , Sicuri Elisa , Evangelidou Stella , Aguilar Martín Carina , Requena-Mendez Ana
Published: November 2024

Introduction

ISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).

Methods and analysis

This study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.

A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.

Ethics and dissemination

The study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.

Findings will be disseminated in peer-reviewed journals and communications to congresses.

Trial registration number

NCT05868005.
Detection, linkage to care, treatment and monitoring of hypertension in coastal communities in Accra, Ghana: protocol for a quasi-experimental study (The Ghana Heart Initiative Hypertension Study)
Authors: Boima Vincent , Hayfron-Benjamin Charles , Doku Alfred , Twumasi Afua A A , Ottie-Boakye Doris , Selom Juliette Edzeame , Agyemang Charles
Published: November 2024

Introduction

Over the past few decades, the prevalence of hypertension in Ghana has increased significantly. Insufficient diagnosis and suboptimal management of diagnosed cases result in increased mortality and morbidity due to poor blood pressure control and attendant complications. This highlights the need for new models of hypertension control in highly burdened, urban poor communities. This study aims to identify patients with hypertension in the coastal communities of the Greater Accra region, link patients newly diagnosed with hypertension to appropriate medical care and monitor treatment outcomes using task-shifting strategies.

Methods and analysis

In this quasi-experimental study, participants with a mean blood pressure of ≥140/90 mm Hg will be recruited from seven coastal communities of Ghana’s Greater Accra region. Based on proportion to the size of these communities, we will screen and recruit 10 000 and 3000 participants, respectively, from all study sites. We will link the recruited individuals to designated health facilities and follow them for a year to assess treatment outcomes, blood pressure control, adherence to treatment, anthropometric measurements, funduscopic assessment, urinalysis, blood urea nitrogen and creatinine level, ECG and echocardiograms. In addition, we will use mobile health technology to support community screening, blood pressure checks and remote monitoring of patients diagnosed with hypertension, as well as send messages on medication adherence and lifestyle changes. Furthermore, we will conduct focus group discussions among community members and indepth interviews with persons considered to be newly diagnosed with hypertension, community health workers and religious leaders/representatives to assess the knowledge and perceptions of different study participants regarding hypertension diagnosis, management, control, experiences and treatment.

Ethics and dissemination

The study was approved by the Ghana Health Service Ethics Review Committee (protocol identification number GHS-ERC 028/08/22). We will obtain written informed consent from each participant. In addition to journal publication, dissemination activities will include a report to the Ghana Health Service on the outcome of the project.

Trial registration number

ISRCTN76503336.
Expansion and evaluation of level II and III recovery residences for people taking medications for an opioid use disorder: project HOMES (Housing for MAR Expanded Services) study protocol
Authors: Wilkerson J M , Gallardo Kathryn R , Rodriguez Serena , Brown Henry Shelton , Ganduglia Cazaban Cecilia M , Yang James J , Herrera Estevan R , Zoschke Isaiah Niles , Stewart Hannah L N , McCurdy Sheryl A
Published: November 2024

Introduction

As the US continues to battle the opioid epidemic, recovery residences remain valuable services for people in recovery. While there is a growing body of literature describing positive outcomes experienced by people who live in recovery residences, little is known about the experience of people who live in these residences while taking medications for an opioid use disorder (MOUD) as part of their recovery. Thus, this study has three aims: (1) expand the availability of recovery residences that meet the National Alliance for Recovery Residences standards in Texas and serve individuals taking medications for an opioid use disorder as part of their recovery; (2) evaluate recovery residences for people taking MOUD as part of their recovery; and (3) compare the cost-effectiveness of recovery residences to treatment-as-usual.

Methods and analysis

In collaboration with community partners, we opened 15 recovery residences in the State of Texas to house people taking MOUD as part of their recovery. We are collecting quantitative and qualitative data to evaluate outcomes at the intrapersonal, interpersonal, organisational and community levels. At the intrapersonal level, we are assessing changes in behavioural and psychosocial constructs using a longitudinal survey, objectively measuring current substance use with a point-of-interview breathalyser and urinalysis, and examining changes in healthcare utilisation using data obtained from a healthcare information exchange. We are collecting interpersonal data using in-depth individual interviews with residents and staff. We are collecting organisational data using field observation and a cost-effectiveness study, and we are collecting community data using neighbourhood mapping.

Ethics and dissemination

The UTHealth institutional review board approved all protocols. We will disseminate study findings via conference presentations, peer-reviewed publications and brief community reports.
Achieving and sustaining reduction in hospital-acquired complications in an Australian local health service
Authors: Li Qun Catherine , Codde Jim , Karnon Jonathan , Hince Dana
Published: November 2024

Background

Reducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient’s recovery and health service delivery by diverting resources away from other core patient care activities. While numerous reports are available in the literature for projects that successfully reduce specific HAC, questions remain about the sustainability of this isolated approach and there may be benefits for more wholistic programmes that aim to align prevention strategies across a hospital. This study describes such a programme that uses evidence and theories in the literature to achieve and sustain a reduction in HACs in an Australian local health service between 2019 and 2022.

Methods

An organisation-wide HACs Reduction Programme underpinned by a 3-pillar strategic framework (complete documentation, accurate coding, clinical effectiveness) and a 5-year roadmap to clinical excellence was developed. Priorities were identified through Pareto analysis and aligned at organisational, service and specialty levels. The Institute for Healthcare Improvement (IHI) 90-day cycle was modified to implement contextualised evidence-based interventions supported by the application of the Awareness, Desire, Knowledge, Ability and Reinforcement change management model. Under this wholistic umbrella, specific projects were data-driven, evidence-based and outcome-oriented to promote clinical engagement and a continuous improvement culture.

Results

Overall mean HAC rate per 10 000 episodes of care decreased from a baseline of 459.5 across 2017 and 2018 to 363.1 in 2019 and remained lower through to the end of 2022 indicating sustained improvement in performance.

Conclusion

A wholistic approach to reduce HACs increased the likelihood of multidisciplinary integration for contextualised strategies and interventions. Improvement work, particularly in relation to patient outcomes, is a dynamic process that needs to be intentionally cultivated, targeted and coordinated. The modified IHI 90-day cycle proved to be an effective tool for implementation that contributed to sustained change.
Depressive symptom trajectories among general population during the COVID-19 pandemic in Iceland: a prospective cohort study (2020–2023)
Authors: Wang Yue , Hauksdóttir Arna , Thordardottir Edda Bjork , Ge Fenfen , Gísladóttir Elísabet Unnur , Jakobsdóttir Jóhanna , Ásbjörnsdóttir Kristjana Hrönn , Rúnarsdóttir Harpa , Unnarsdóttir Anna Bára , Magnúsdóttir Ingibjörg , Love Thorvardur Jon , Kristinsson Sigurdur Yngvi , Palsson Runolfur , Zoega Helga , Fang Fang , Tómasson Gunnar , Song Huan , Aspelund Thor , Valdimarsdottir Unnur
Published: November 2024

Introduction

While changes in the prevalence of depressive symptoms during the COVID-19 pandemic have been described across populations, few studies have incorporated multidimensional variables to characterise the varying effects of the pandemic on the population’s mental health.

Methods

This cohort study included 6423 participants aged ≥18 years from the Icelandic COVID-19 National Resilience Cohort. Data on depressive symptoms and pandemic-related and non-pandemic-related factors were obtained during three pandemic assessment periods (baseline, follow-up wave 1 and follow-up wave 2; April 2020–December 2021), while health outcomes were obtained during the post-pandemic assessment period (follow-up wave 3; September 2022–February 2023). We used latent growth mixture models to identify variation in depressive symptom trajectories during the pandemic. We then used XGBoost models with 37 pandemic-related and non-pandemic-related factors to characterise these trajectories. Moreover, we performed linear regression to assess the association between the identified trajectories and post-pandemic health outcomes.

Results

Of the included participants, we identified four depressive symptom trajectories, including consistently low (83.7%), consistently high (5.3%), initially high (5.1%) and late-onset high (5.9%) symptom trajectories. Individuals who exercised frequently (≥3 days/week) and enjoyed social and family support were more likely to experience a consistently low symptom trajectory. In contrast, individuals with a history of psychiatric disorders, women and young adults (18–39 years) were less likely to follow the consistently low symptom trajectory. Moreover, compared with the consistently low symptom trajectory, the other trajectories were associated with significantly higher levels of depressive, anxiety and somatic symptoms and cognitive problems during the post-pandemic period.

Conclusions

Our results underscore the long-lasting impact of the COVID-19 pandemic on population mental health. Interventions focusing on exercise, social support and family support may mitigate the adverse mental health effects of future pandemics.
Well-being interventions for emergency department staff: ‘necessary’ but ‘inadequate’ – a phenomenographic study
Authors: Beckham Andrew , Cooper Nicola
Published: November 2024

Introduction

Stress and burnout are prevalent among emergency department (ED) staff in the UK. The concept of well-being interventions for ED staff is a growing area of interest and research worldwide. Various interventions are described in the literature, yet little is known about the experience of ED staff in the UK of interventions designed to support their well-being. This study therefore aimed to understand their experiences of these interventions.

Methods

Semi-structured interviews were carried out with nine members of staff from different professional backgrounds at a tertiary trauma centre in the UK between June and July 2023. The inclusion criteria were staff who had worked in a National Health Service ED setting in the UK for more than 12 months. Participants were asked about their experience and perceptions of well-being interventions delivered in the workplace. A phenomenographical approach was applied to analyse the narrative data.

Results

The findings resulted in seven qualitatively different but related categories. Participants experienced interventions to be: (1) necessary due to their stressful working environment; (2) beneficial in supporting their well-being; (3) feasible in an ED setting; (4) inadequate due to lack of quality and accessibility; (5) improving with increased acceptability and support; (6) restricted by clinical and organisational factors; and (7) ambiguous in definition, measurement and individual interpretation. Space for facilitated reflection and role modelling by leaders were felt to be important.

Conclusions

Job demands simultaneously necessitate and restrict the provision of adequate interventions to support well-being in the ED. These demands need to be addressed as part of wider organisational change including the provision of self-care facilities and opportunities, protected time for facilitated reflection, high-quality and accessible learning opportunities for personal and professional development, training for staff delivering well-being interventions and positive role modelling by leaders.
Myeloid subsets impede the efficacy of anti-PD1 therapy in patients with advanced gastric cancer (WJOG10417GTR study)
Authors: Shoji Hirokazu , Kudo-Saito Chie , Nagashima Kengo , Imazeki Hiroshi , Tsugaru Kai , Takahashi Naoki , Kawakami Takeshi , Amanuma Yusuke , Wakatsuki Takeru , Okano Naohiro , Narita Yukiya , Yamamoto Yoshiyuki , Kizawa Rika , Muro Kei , Aoki Kazunori , Boku Narikazu
Published: November 2024

Background

Gastric cancer (GC) is one of the most common and deadly malignant diseases worldwide. Despite revolutionary advances, the therapeutic efficacy of anti-PD1/PDL1 monoclonal antibodies in advanced GC is still low due to the emergence of innate and acquired resistance to treatment. Myeloid cells represent the majority of human immune cells. Therefore, their increase, decrease, and abnormality could have a significant impact on the patient’s immune system and the progression of cancer, and reprogramming, inhibiting, and eliminating the tumor-supportive types may improve the immunological situation and efficacy of immunotherapy. However, the significance of myeloid cells in anti-PD1/PDL1 therapy remains unclear in GC. In the WJOG10417GTR study on GC, we sought to identify myeloid determinants that could predict anti-PD1 therapeutic efficacy and also serve as potential therapeutic targets.

Methods

We collected tumor tissues and peripheral blood from 96 patients with advanced GC before and 1 month after anti-PD1 nivolumab monotherapy, and the isolated whole leucocytes were analyzed by flow cytometry for various immune cell populations, including many myeloid subsets. Then, the relationship between the cellular levels and progression-free survival (PFS) or overall survival (OS) was statistically analyzed.

Results

We found that high levels of several myeloid subsets expressing molecules that have been targeted in drug discovery but not yet approved for clinical use were significantly associated with shorter PFS/OS as compared with low levels: PDL1+and CTLA4+myeloid subsets within tumors at baseline, PDL1+, B7H3+and CD115+myeloid subsets in peripheral blood at baseline, and LAG3+, CD155+and CD115+myeloid subsets in peripheral blood at post-treatment.

Conclusions

This study revealed that these myeloid subsets are significant risk factors in nivolumab therapy for advanced GC. Targeting them may be useful as diagnostic biomarkers to predict potential anti-PD1 therapeutic efficacy, and also as therapeutic targets for accelerating the development of new drugs to improve clinical outcomes in immunotherapy for GC.
Clinical and mutational signatures ofCRB1-associated retinopathies: a multicentre study
Authors: Wang Mo-Ying , Gao Feng-Juan , Ju Yu-Qiao , Guo Lin-Ying , Duan Cong , Chang Qing , Zhang Ting , Xu Ge-Zhi , Du Hui , Zong Yuan , Huang Xin
Published: November 2024

Background

To delineate the clinical and mutational signatures of patients withCRB1-associated retinopathies.

Methods

This multicentre retrospective cohort study involved 40 patients withCRB1mutations and 40 age-matched and gender-matched inherited retinal diseases (IRDs). The detailed phenotyping and genotyping characteristics and genotype‒phenotype correlations of the patients were analysed.

Results

The mean age ofCRB1cohort was 27.33±14.63 years. Results showed that yellowish geographic macular degeneration (66.67%), small white or yellow dots (65.6%), hyperopia (62.5%), abnormally laminated retina (61.61%), epiretinal membrane (60.6%) and nummular pigment deposits (50%) were the most common signatures in patients withCRB1mutations. These clinical signatures were notably more prevalent amongCRB1patients than among individuals in other IRD groups (p<0.001). Early-onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA) patients are more likely to present these signatures than retinitis pigmentosa (RP) and macular dystrophy (MD) patients. Furthermore, a significant reduction in central foveal thickness coupled with pronounced thickening of the peripheral retina was observed more distinctly in patients with EOSRD/LCA (p<0.001). The choroidal thickness was not significantly altered compared to the normal controls, but was markedly reduced in the other IRD groups (p<0.001). 55 pathogenic variants were identified, 20 of which were novel. Null mutations were associated with EOSRD/LCA patients, and missense mutations were more prevalent in MD and RP patients.

Conclusions

Key clinical and mutational signatures were demonstrated in this study, providing a comprehensive update onCRB1-associated retinopathies that will aid in diagnosis and lay the foundation for future therapeutic studies.
FRED X flow diversion stenting for unruptured intracranial aneurysms: US multicenter post-market study
Authors: Hendrix Philipp , Hemmer Sina , Sioutas Georgios S , Field Nicholas C , Essibayi Muhammed Amir , Salem Mohamed M , Srinivasan Visish M , Custozzo Amanda , Karandish Alireza , Altschul David , Paul Alexandra R , Burkhardt Jan-Karl , Schirmer Clemens M , Goren Oded
Published: November 2024

Background

The Flow Re-direction Endoluminal Device (FRED) X is a next generation flow-diverting stent for treating intracranial aneurysms. Its surface modification (X technology) aims to minimize device thrombogenicity. Early post-market multicenter data from the US are lacking.

Methods

We conducted a retrospective multicenter analysis of consecutive FRED X procedures performed to treat unruptured intracranial aneurysms at four US centers (March 2022 to January 2024). Cases with ruptured aneurysms or extracranial aneurysm location were excluded (n=10). We assessed patient and aneurysm characteristics, antithrombotic management, safety events, and both clinical and angiographic (effectiveness) outcomes.

Results

In this cohort, 101 patients underwent FRED X stenting for 117 aneurysms. Most aneurysms were saccular in shape (95.7%) and located at the C6–C7 segments of the internal carotid artery (72.6%). Thromboembolic events occurred in 5.9% of the cases, leading to one instance of permanent procedure related morbidity (1.0%). No procedure related mortality (0%) was observed. Device related issues were recorded in 2.0% of cases. At the 6 month follow-up, complete aneurysm occlusion was achieved in 58% of aneurysms. At the last available follow-up (6–12 months), 74.8% of aneurysms were adequately occluded.

Conclusions

FRED X stenting for unruptured intracranial aneurysms demonstrated low rates of neurological morbidity and periprocedural complications. Early aneurysm occlusion rates were appropriate, but further mid-term and long term follow-up is required. These findings support the early safety and effectiveness of the FRED X device for intracranial aneurysm treatment.
EXPLOITING REMOTE SENSING IMAGERY FOR VEHICLE DETECTION AND CLASSIFICATION USING ROBUST COMPETITIVE ALGORITHM WITH DEEP CONVOLUTIONAL NEURAL NETWORK
Authors: OTHMAN KAMAL M. , ALFRAIHI HESSA , NEMRI NADHEM , MILED ACHRAF BEN , ALRUWAIS NUHA , MAHMUD AHMED
Published: November 2024

Fast and robust vehicle recognition from remote sensing images (RSIs) has excellent economic analysis, emergency management, and traffic surveillance applications. Additionally, vehicle density and location data are vital for intelligent transportation systems. However, correct and robust vehicle recognition in RSIs has been complex. Conventional vehicle recognition approaches depend on handcrafted extracted features in sliding windows with distinct scales. Recently, the convolutional neural network can be executed for aerial image object recognition, and it has accomplished promising outcomes. This research projects an automatic vehicle detection and classification utilizing an imperialist competitive algorithm with a deep convolutional neural network (VDC-ICADCNN) technique. The primary purpose of the VDC-ICADCNN technique is to develop the RSI and apply deep learning (DL) models for the recognition and identification of vehicles. Three main procedures were involved in the presented VDC-ICADCNN technique. At the primary stage, the VDC-ICADCNN technique employs the EfficientNetB7 approach for the feature extractor. Then, the hyperparameter fine-tuning of the EfficientNet approach takes place utilizing ICA, which aids in attaining improved performance in the classification process. The VDC-ICADCNN technique utilizes a variational autoencoder (VAE) model for the vehicle recognition method. Extensive experiments can be implemented to establish the superior solution of the VDC-ICADCNN technique. The obtained outcomes of the VDC-ICADCNN technique highlighted a superior accuracy value of 96.77% and 98.59% with other DL approaches under Vehicle Detection in Aerial Imagery (VEDAI) and Potsdam datasets.
HARNESSING PRIVACY-PRESERVING FEDERATED LEARNING WITH BLOCKCHAIN FOR SECURE IOMT APPLICATIONS IN SMART HEALTHCARE SYSTEMS
Authors: ALKHALIFA AMAL K. , ALANAZI MESHARI H. , MAHMOOD KHALID , ALMUKADI WAFA SULAIMAN , QURASHI MOHAMMED AL , ALSHEHRI ASMA HASSAN , ALANAZI FUHID , MOHAMED ABDELMONEIM ALI
Published: November 2024

The Internet of Medical Things (IoMT) refers to interconnected medical systems and devices that gather and transfer healthcare information for several medical applications. Smart healthcare leverages IoMT technology to improve patient diagnosis, monitoring, and treatment, providing efficient and personalized healthcare services. Privacy-preserving Federated Learning (PPFL) is a privacy-enhancing method that allows collaborative method training through distributed data sources while ensuring privacy protection and keeping the data decentralized. In the field of smart healthcare, PPFL enables healthcare professionals to train machine learning algorithms jointly on their corresponding datasets without sharing sensitive data, thereby maintaining confidentiality. Within this framework, anomaly detection includes detecting unusual events or patterns in healthcare data like unexpected changes or irregular vital signs in patient behaviors that can represent security breaches or potential health issues in the IoMT system. Smart healthcare systems could enhance patient care while protecting data confidentiality and individual privacy by incorporating PPFL with anomaly detection techniques. Therefore, this study develops a Privacy-preserving Federated Learning with Blockchain-based Smart Healthcare System (PPFL-BCSHS) technique in the IoMT environment. The purpose of the PPFL-BCSHS technique is to secure the IoMT devices via the detection of abnormal activities and FL concepts. Besides, BC technology can be applied for the secure transmission of medical data among the IoMT devices. The PPFL-BCSHS technique employs the FL for training the model for the identification of abnormal patterns. For anomaly detection, the PPFL-BCSHS technique follows three major processes, namely Mountain Gazelle Optimization (MGO)-based feature selection, Bidirectional Gated Recurrent Unit (BiGRU), and Sandcat Swarm Optimization (SCSO)-based hyperparameter tuning. A series of simulations were implemented to examine the performance of the PPFL-BCSHS method. The empirical analysis highlighted that the PPFL-BCSHS method obtains improved security over other approaches under various measures.
MULTI-CLASS SPOKEN LANGUAGE DETECTION USING ARTIFICIAL INTELLIGENCE WITH FRACTAL AL-BIRUNI EARTH RADIUS OPTIMIZATION ALGORITHM
Authors: AL-SHATHRY NAJLA I. , ELTAHIR MAJDY M. , ASKLANY SOMIA A. , AL GHAMDI SAMI A. , ALMUHAIMEED ABDULLAH , ALANAZI FUHID , MOHAMED ABDELMONEIM ALI , RIZWANULLAH MOHAMMED
Published: November 2024

Spoken Language Identification (SLID) is the problem of categorizing the language spoken by a speaker in the audio clips. SLID is valuable in multi-language speech recognition systems, personalized voice assistants, and automated speech translation systems in call centers to automatically route calls to the language operator. A primary challenge is the language detection from audio with different noise levels and sampling rates, accurately and with a short delay. A further problem is to differentiate between short-duration languages. Previous research works have applied SLID’s lexical, phonetic, phonotactic, and prosodic features. Spoken language detection using deep learning (DL) usually includes training RNN or CNN approaches on audio features such as spectrograms or MFCCs to categorize the language spoken in audio samples. Pioneering methodologies, such as CNN–RNN transformers or hybrids, can capture the spatial and temporal features for better performance. This paper presents a Multi-Class Spoken Language Detection using Artificial Intelligence with Fractal Al-Biruni Earth Radius Optimization (MCSLD-AIBER) technique. The MCSLD-AIBER technique mainly aims to identify the various classes of spoken languages. In the MCSLD-AIBER technique, the Constant-[Formula: see text] Transform (CQT) approach is applied to transform the speech signals. Additionally, the MCSLD-AIBER technique employs Inception with a Residual Network model for the feature extraction process. Moreover, the hyperparameters can be adjusted using the BER approach. A long short-term memory (LSTM) network can be utilized to identify multiple spoken languages. A set of experiments were involved to illustrate the efficient performance of the MCSLD-AIBER technique. The simulation outcomes indicated that the MCSLD-AIBER method performs optimally over other models.
Investigation on the failure mechanism of slope deformations induced by water-level fluctuation with InSAR and numerical simulation: a case study
Authors: Jiang Long , Zheng Yanni , Zhang Qiang , Yu Jun , Jia Chaojun
Published: November 2024

The Alagou Reservoir was officially closed for water storage in November 2014. Since September 2016, gradual slope collapse and deformation have been observed at elevations ranging from 600 to 1050 m upstream of the left bank of the Alagou Reservoir dam site. The increasing annual deformation raises significant concerns about a potential landslide, which could lead to surge waves, posing a threat to both the dam and the surrounding environment. Owing to difficult access and worsening conditions, thorough exploration of the site was challenging. Consequently, after emptying the reservoir, we conducted on-site investigations using satellite D-InSAR analysis, numerical modelling and post-event monitoring. This multidisciplinary approach aimed to investigate the relationship between deformation behaviour, triggering conditions and reservoir water-level changes. Our study provides valuable insights into the complex geological processes involved in slope deformation and failure mechanisms induced by water-level fluctuations. We elucidated the interplay between deformation behaviour and triggering conditions, which is essential for designing effective reinforcement treatments for deformed slopes. Although InSAR has proven to be a cost-effective tool for monitoring surface deformation, it offers limited insights alone. Therefore, we recommend a multi-technique approach incorporating geophysical, geotechnical and remote sensing data for a comprehensive understanding of slope stability.