bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of refresher training on the outcomes of trachomatous trichiasis surgery
Authors: Pak Clara , Hall Nathan , Bekele Demissie Tadesse , Kollmann K H Martin , Tadele Tesfaye , Tekle-Haimanot Redda , Taye Tarik , Qureshi Babar , Yalew Wubante , Gower Emily W , Kempen John H
Published: September 2023

Background/aims

Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1–22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.

Methods

Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest.

Results

A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT.

Conclusion

Our results indicate a significant reduction in the risk of PTT after experienced surgeons’ participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.
Overall survival benefits of cancer drugs in the WHO Model List of Essential Medicines, 2015–2021
Authors: Zhou Yue , Naci Huseyin , Chen Dingyi , Bai Lin , Shi Luwen , Guan Xiaodong , Wagner Anita Katharina
Published: September 2023

Introduction

We examined overall survival (OS) benefits for targeted cancer drugs recommended for List of Essential Medicines (EMLs) since 2015. We assessed consistency of decisions in 2019 and 2021 with more specific criteria: OS benefit >4 months and high scores on European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS).

Methods

We identified applications for cancer drug in WHO EMLs from 2015 to 2021. We extracted evidence of OS benefit documented in WHO Technical Report Series (TRS) and compared it to evidence from pivotal trial(s) documented in Food and Drug Administration-approved labels. We retrieved published ESMO-MCBS scores. We summarised availability and magnitude of OS benefit and ESMO-MCBS scores and assessed consistency of inclusion decisions against WHO criteria.

Results

22/54 targeted cancer drug indications were recommended. Among them, 68.2% and 31.8% had OS benefit evidence documented in WHO-TRS and pivotal trials, respectively. Among those not recommended, 59.4% and 56.3% had OS benefit evidence documented in WHO-TRS and pivotal trials, respectively. Of 11 cancer drug indications recommended in 2019 and 2021, 54.5% and 9.1% had evidence of OS benefit >4 months in WHO-TRS and pivotal trials, respectively; 45.5% met ESMO-MCBS criteria. Ten targeted cancer drugs had more than one application for the same indications. Five of those were eventually recommended, including three without new evidence of OS benefit. Additional factors, such as reduced cost, and increased treatment options, seemed to be important factors in the selection.

Conclusion

While WHO has defined approval criteria for cancer drugs EML, we identified areas where adherence of these criteria and communication of the EML approval decision-making processes can be improved.
Hepatectomy combined with apatinib and camrelizumab for CNLC stage IIIb hepatocellular carcinoma: a phase II trial protocol
Authors: Huang Jun Tao , Zhong Jian-Hong , Zhang Jie , Gong Wen Feng , Ma Liang , Li Le Qun , Xiang Bang-De
Published: September 2023

Introduction

Current clinical guidelines recommend systematic antitumour therapy as the primary treatment option for patients with stage IIIb hepatocellular carcinoma (HCC) based on the China liver cancer (CNLC) staging criteria. Several different targeted therapeutics have been applied in combination with immunotherapeutic regimens to date in patients with advanced HCC. The present study was developed to evaluate the relative safety and efficacy of hepatectomy of HCC in combination with targeted apatinib treatment and immunotherapeutic camrelizumab treatment CNLC-IIIb stage HCC patients with the goal of providing evidence regarding the potential value of this therapeutic regimen in individuals diagnosed with advanced HCC.

Methods and analysis

This is a multicentre phase II trial with single-arm in which patients undergo hepatectomy in combination with targeted treatment (apatinib) and immunotherapy (camrelizumab). Patients will undergo follow-up every 2–3 months following treatment initiation to record any evidence of disease progression and adverse event incidence for a minimum of 24 months following the discontinuation of treatment until reaching study endpoint events or trial termination. The primary endpoint for this study is patient mortality.

Ethics and dissemination

This study protocol was approved by the Ethics Committee of the Guangxi Medical University Cancer Hospital (KS2022[124]). The results of this study will be submitted for publication in a peer-reviewed journal.

Trial registration number

NCT05062837.
Early use of oral semaglutide in the UK: A cost-effectiveness analysis versus continuing metformin and SGLT-2 inhibitor therapy
Authors: Ren Hongye , Berry Sasha , Malkin Samuel Joseph Paul , Hunt Barnaby , Bain Stephen
Published: September 2023

Objectives

Many people with type 2 diabetes experience clinical inertia, remaining in poor glycaemic control on oral glucose-lowering medications rather than intensifying treatment with a glucagon-like peptide-1 receptor agonist, despite an efficacious, orally administered option, oral semaglutide, being available. The present study evaluated the long-term cost-effectiveness of initiating oral semaglutide versus continuing metformin plus sodium-glucose cotransporter-2 (SGLT-2) inhibitor therapy in the UK.

Design

Outcomes were projected over patients’ lifetimes using the IQVIA Core Diabetes Model (V.9.0). Clinical data were taken from the oral semaglutide and placebo arms of the patient subgroup receiving metformin plus an SGLT-2 inhibitor in PIONEER 4. Costs, expressed in 2021 Pounds sterling (GBP), were accounted from a healthcare payer perspective.

Interventions

Modelled patients received oral semaglutide immediately (in the first year of the analysis) or after a 2-year delay, after which all physiological parameters were brought to values observed in the immediate therapy arm. During the simulation, patients intensified with the addition of basal insulin and, subsequently, by switching to basal-bolus insulin.

Results

Immediate oral semaglutide therapy was associated with improvements in life expectancy of 0.17 (95% CIs 0.16 to 0.19) years, and quality-adjusted life expectancy of 0.15 (0.14 to 0.16) quality-adjusted life years (QALYs), versus a 2-year delay. Benefits were due to a reduced incidence of diabetes-related complications. Direct costs were estimated to be GBP 1423 (1349 to 1496) higher with immediate oral semaglutide therapy versus a 2-year delay, with higher treatment costs partially offset by cost savings from avoidance of diabetes-related complications. Immediate oral semaglutide therapy was therefore associated with an incremental cost-effectiveness ratio of GBP 9404 (8380 to 10 538) per QALY gained versus a 2-year delay.

Conclusions

Immediate oral semaglutide is likely to represent a cost-effective treatment in people with type 2 diabetes with inadequate glycaemic control on metformin plus an SGLT-2 inhibitor in the UK.

Trial registration number

NCT02863419.
Shufeng Jiedu capsule for acute exacerbation of chronic obstructive pulmonary disease: a protocol of multicentre, randomised, double-blind, placebo-controlled trial
Authors: Xia Ruyu , Fei Yutong , Zhang Lishan , Jie Zhijun , Fan Xiaoyun , Dai Mengyuan , Moore Michael , Willcox Merlin , Hu Xiaoyang , Francis Nick , Liang Changhao , Fei Guanghe , Liu Jianping
Published: September 2023

Introduction

Chronic obstructive pulmonary disease (COPD) represents one of the leading causes of death worldwide. Published clinical trials suggest that the Chinese patent herbal medicine Shufeng Jiedu capsule (SFJD) is safe and may be effective for treating acute exacerbations of COPD (AECOPD). However, these effects have been reported with low or very low certainty evidence. This trial aims to evaluate the effectiveness and safety of SFJD for AECOPD.

Methods and analysis

This study is designed as a multicentre, randomised, double-blind, placebo-controlled trial. Three hundred patients with moderate or severe hospitalised AECOPD will be recruited in Beijing, Shanghai and Hefei. Participants will be randomly assigned to SFJD and usual care or placebo and usual care at a ratio of 1:1. SFJD and placebo will be administered orally four capsules three times daily for 7 consecutive days followed by an 8-week follow-up period. The primary outcome will be COPD symptom severity as measured by the EXAcerbation of Chronic Pulmonary Disease Tool score. Secondary outcomes include clinical symptoms, quality of life, length of hospital stay, a total dose of antibiotics, the frequency of recurrence of AECOPD, haematological biomarkers, death and adverse events. This study will answer the question of whether SFJD was safe to use and will improve symptoms in people with AECOPD, and will therefore reduce the necessity for antibiotics, the risk and duration of admission to hospital, and the risk of recurrence.

Ethics and dissemination

The ethics committee of the first affiliated hospital of Anhui Medical University, Beijing University of Chinese Medicine affiliated Dongzhimen hospital and fifth people’s hospital of Shanghai Fudan University approved the study protocol. Informed written consent will be obtained from all the participants. The results of this trial will be disseminated at academic conferences and in peer-reviewed publications.

Trial registration number

ISRCTN99049821.
Experiences of misuse and symptoms of dependence among people who use gabapentinoids: a qualitative systematic review protocol
Authors: McNeilage Amy Gray , Nielsen Suzanne , Murnion Bridin , Ashton-James Claire
Published: September 2023

Introduction

Gabapentinoids are among the most widely prescribed pain medications. However, there is growing evidence to suggest that gabapentinoids may be associated with dependence and misuse. The aim of this systematic review is to synthesise the qualitative literature on gabapentinoid misuse and symptoms of dependence. The findings of this study will inform efforts to mitigate emerging harms.

Methods and analysis

A systematic review of qualitative research will explore lived experiences of misuse and symptoms of dependence among people who use gabapentinoids. Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE and PsycINFO) and grey literature sources will be searched from inception to May 2023. Qualitative studies that include people with lived experiences of gabapentinoid misuse and symptoms of gabapentinoid dependence will be included. Reference lists of included studies will also be screened for additional studies. The methodological quality of included studies will be appraised using the Critical Appraisal Skills Programme qualitative checklist, and higher quality studies will be prioritised in the thematic synthesis. The GRADE-CERQual approach will be used to assess confidence in the overall findings of the review.

Ethics and dissemination

Ethical approval is not required for this systematic review. The findings of this review will be disseminated in peer-reviewed journals, at conferences and on social media.

PROSPERO registration number

CRD42023401832.
Goal-directed versus outcome-based financial incentives for smoking cessation among low-income, hospitalised patients: rationale and design of the Financial Incentives for Smoking Treatment II (FIESTA II) randomised controlled trial
Authors: Wali Soma , Gaitonde Anisha , Sherman Scott , Min Noelle , Pesantes Andrea , Bidgoli Ava , Shirley Abraelle , Tseng Chi-Hong , Ladapo Joseph
Published: September 2023

Introduction

Smoking remains the leading preventable cause of death in the USA. Low utilisation of treatments for smoking cessation remains a major barrier for reducing smoking rates. Financial incentives represent an innovative approach to increasing use of therapies for smoking cessation. This paper will describe the rationale and design of the Financial Incentives for Smoking Treatment II (FIESTA II) study, a randomised controlled trial to evaluate the effectiveness and feasibility of goal-directed and outcome-based financial incentives to promote smoking cessation among hospitalised smokers.

Methods and analysis

We are recruiting adult participants who smoked tobacco in the 30 days prior to initial interview and are contemplating quitting smoking. These participants will come from two hospitals in underserved communities in New York City and Los Angeles. They will be randomised into one of three arms. The first arm consists of goal-directed financial incentives plus enhanced usual care, which includes hospital-directed information about quitting smoking, nicotine replacement therapy and referral to a Quitline. The second arm involves outcome-based financial incentives plus enhanced usual care. The third arm consists of enhanced usual care alone. Multiple phone interviews with the participants will be completed after randomisation to assess smoking cessation. Participants will earn $20 for each follow-up interview completed and $30 for each smoking cessation test completed. Those who are randomised to the financial incentive groups can earn an additional $700. The participants in the outcome-based group will receive payments solely for exhibiting cessation, whereas the participants in the goal-based group are also eligible for receiving payments after meeting milestones such as speaking with a helpline coach.

Ethics

Human research protection committees at New York University School of Medicine and the University of California Los Angeles (UCLA) David Geffen School of Medicine granted ethics approval.

Protocol number:IRB#19-000 084.

Trial registration number

NCT03979885.
Barriers to equitable access to quality trauma care in Rwanda: a qualitative study
Authors: Nzasabimana Pascal , Ignatowicz Agnieszka , Alayande Barnabas Tobi , Abdul-Latif Abdul-Malik , Odland Maria Lisa , Davies Justine , Bekele Abebe , Byiringiro Jean Claude
Published: September 2023

Objectives

Using the ‘Four Delay’ framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients’, caregivers’ and community leaders’ perspectives.

Design

A qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was conducted. The data were analysed thematically.

Setting

This qualitative study was conducted in Rwanda’s rural Burera District, located in the Northern Province, and in Kigali City, the country’s urban capital, to capture both the rural and urban population’s experiences of being injured.

Participants

Purposively selected participants were individuals from urban and rural communities who had accessed injury care in the previous 6 months or cared for the injured people, and community leaders. Fifty-one participants, 13 females and 38 males ranging from 21 to 68 years of age participated in interviews and focus group discussions. Thirty-six (71%) were former trauma patients with a wide range of injuries including fractured long bones (9, 45%), other fractures, head injury, polytrauma (3, 15% each), abdominal trauma (1, 5%), and lacerations (1, 5%), while the rest were caregivers and community leaders.

Results

Multiple barriers were identified cutting across all levels of the ‘Four Delays’ framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients.

Conclusions

Future interventions to improve access to injury care in Rwanda must be informed by the identified barriers along the spectrum of care, from the point of injury to receipt of care and rehabilitation.
Addressing the marketing and availability of unhealthy food and beverages in and around selected schools in Ghana: a community readiness appraisal
Authors: Tandoh Akua , Laar Amos , Pradeilles Rebecca , Le Port Agnes , Osei-Kwasi Hibbah , Amevinya Gideon Senyo , Aryeetey Richmond Nii Okai , Agyemang Charles , Holdsworth Michelle
Published: September 2023

Objective

This study assessed stakeholder readiness to address unhealthy food and beverage marketing and availability in/around Public Basic Schools (for children 4–15 years) in Greater Accra Region, the highly urbanised administrative capital of Ghana.

Design

The community readiness model was used to conduct in-depth mixed methods interviews with stakeholders. Using predefined anchored rating statements, quantitative readiness scores ranging from 1 to 9 were generated. Thematic qualitative analysis was undertaken to understand barriers and facilitators that could influence the implementation of interventions.

Setting

Greater Accra Region, Ghana.

Participants

18 key informants from various school/education/citizen sectors, which together represented the ‘school community’ of Greater Accra Region.

Results

The mean readiness scores indicated that the ‘school community’ was at the ‘preplanning’ stage of readiness (4.44±0.98) to address the marketing and availability of unhealthy food and beverages in and around schools. The mean readiness score for ‘leadership’ was the highest of all dimensions (5.36±1.60), corresponding to the ‘preparation’ stage. The lowest scores were found for ‘community knowledge of efforts’ (3.19±2.45) and ‘resources for efforts’ (3.64±0.87), both of which were at a ‘vague awareness’ stage.

Conclusions

The ‘school community’ recognised that the marketing and availability of unhealthy food and beverages was a problem. Additionally, current leadership was actively supportive of continuing/improving efforts that create healthier children’s food environments. However, actions that aim to increase the ‘school community’s’ knowledge of existing interventions and securing resources to sustain those interventions are needed before introducing readiness appropriate strategies.
Diagnostic value of triglyceride–glucose index and related parameters in metabolism-associated fatty liver disease in a Chinese population: a cross-sectional study
Authors: Yu Rong , Xie Weijiang , Peng Hewei , Lu Lili , Yin Shuo , Xu Shanghua , Hu Zhijian , Peng Xian-E
Published: September 2023

Objective

Our study aimed to explore the diagnostic value of triglyceride–glucose (TyG) and its related parameters in metabolism-associated fatty liver disease (MAFLD).

Design

A cross-sectional study of residents who attended medical checkups at the First Hospital of Nanping City, Fujian Medical University, between 2015 and 2017.

Setting

One participation centre.

Participants

2605 subjects met the inclusion–exclusion criteria and were grouped according to whether they had MAFLD.

Results

The TyG index and its associated parameters are positively associated with the risk of developing MAFLD (p<0.001). Restriction cube spline analysis showed a significant dose–response relationship between the TyG index and MAFLD. The risk of developing MAFLD increases significantly with a higher TyG index. After adjusting for confounders, this relationship remains (OR: 4.89, 95% CI 3.98 to 6.00). The areas under the receiver operating characteristic curves of the TyG index for MAFLD detection were 0.793 (0.774 to 0.812). The areas under the curve (AUC) of TyG-related parameters were improved, among which TyG-waist circumference (TyG-WC) showed the largest AUC for MAFLD detection (0.873, 95% CI 0.860 to 0.887). In addition, the best cut-off value of the TyG-WC was 716.743, with a sensitivity and specificity of 88.7% and 71.4%, respectively.

Conclusion

The TyG index effectively identifies MAFLD, and the TyG-related parameters improved the identification and diagnosis of MAFLD, suggesting that TyG-related parameters, especially TyG-WC, may be a useful marker for diagnosing MAFLD.
Are people interested in receiving advice from their general practitioner on how to protect their health during heatwaves? A survey of the German population
Authors: Kastaun Sabrina , Herrmann Alina , Müller Beate S , Klosterhalfen Stephanie , Hoffmann Barbara , Wilm Stefan , Kotz Daniel
Published: September 2023

Objective

Climate change increases the frequency, intensity and length of heatwaves, which puts a particular strain on the health of vulnerable population groups. General practitioners (GPs) could reach these people and provide advice on protective health behaviour against heat. Data is lacking on whether and what topic of GP advice people are interested in, and whether specific person characteristics are associated with such interests.

Design

Cross-sectional, nationwide, face-to-face household survey, conducted during winter 2022/2023.

Setting

Germany.

Participants

Population-based sample of 4212 respondents (aged 14–96 years), selected by using multistratified random sampling (50%) combined with multiquota sampling (50%).

Main outcome measure

Interest in receiving GP advice on health protection during heatwaves (yes/no), and the topic people find most important (advice on drinking behaviour, nutrition, cooling, cooling rooms, physical activity or medication management). Associations between predefined person characteristics and the likelihood of interest were estimated using adjusted logistic regressions.

Results

A total of 4020 respondents had GP contact and provided data on the outcome measure. Of these, 23% (95% CI=22% to 25%) expressed interest in GP advice. The likelihood of expressing interest was positively associated with being female, older age (particularly those aged 75+ years: 38% were interested), having a lower level of educational attainment, having a migration background, living in a more urban area, and living in a single-person household. It was negatively associated with increasing income. Advice on medication management received highest interest (25%).

Conclusions

During winter season 2022/2023, around one quarter of the German population with GP contact—and around 40% of those aged 75+ years—was estimated to have a stated interest in receiving GP advice on protective health behaviour during heatwaves, especially on medication management. Climate change is creating new demands for healthcare provision in general practice. This study provides initial relevant information for research and practice aiming to address these demands.
General psychiatric inpatient care for persons with anorexia nervosa—an integrative literature review protocol
Authors: Sandsten Anna , Lindgren Britt-Marie , Strömbäck Maria , Ejneborn-Looi Git-Marie , Gabrielsson Sebastian
Published: September 2023

Introduction

People diagnosed with anorexia nervosa are offered or compelled to undergo various treatments and therapies. In Sweden, the lack of highly specialised eating disorder services means that people with anorexia nervosa might be cared for in general psychiatric wards. However, there has been limited research attention paid to how this specific context might benefit or harm persons with anorexia nervosa. There is also limited evidence regarding which form of care is most effective in anorexia nervosa and which type of treatment is optimal in general psychiatric inpatient care. Our intention is to highlight personal and professional perspectives of care for patients with anorexia nervosa in this context, with a focus on person-centred care, gender and power. This protocol describes an integrative literature review aiming to synthesise existing knowledge on general psychiatric inpatient care for persons with anorexia nervosa.

Methods and analysis

The study will be an integrative literature review following Whittemore and Knafl. We will search the academic databases PubMed, CINAHL and PsycInfo in accordance with a specific search strategy determined in collaboration with a librarian with expertise on systematic reviews. Data will be analysed using a constant comparison method. Persons with their own experience of anorexia nervosa in general psychiatric inpatient care will be involved as coresearchers.

Ethics and dissemination

As this is a literature review, formal ethical review is not required. The findings will be disseminated through peer-reviewed publication and presented at conferences related to this field.

Amendments

If we need to amend this protocol, we will give the date of each amendment, describe the change and give the rationale in this section.

PROSPERO registration number

CRD42023426095.
Optimising psoriatic arthritis therapy with immunological methods to increase standard evaluation: the protocol of an open-label multicentre, parallel-group, two-arm randomised controlled study evaluation precision medicine approach in the treatment of psoriatic arthritis
Authors: Ooms Alexander , Al-Mossawi Hussein , Bennett Louise , Bogale Mimi , Bowness Paul , Francis Anne , Goodyear Carl , Kirkham Bruce W , Lalnunhlimi Sylvine , McInnes Iain B , Richards Duncan , Siebert Stefan , Taams Leonie S , Tulunay Virlan Aysin , Yager Nicole , Coates Laura C
Published: September 2023

Introduction

Psoriatic arthritis (PsA) affects around 150 000 people in the UK of whom around 50% require treatment with biologics. The most used biologics for PsA target tumour necrosis factor (TNF) or interleukin-17A (IL-17A). About 50% of patients respond to each, but it is not currently possible to predict response for individual patients, necessitating sequential treatment steps. A recent proof of concept study in PsA suggested that using peripheral immunophenotype to choose therapy could improve time to treatment response.

This study will test the hypothesis, within an open-label parallel-group biomarker-stratified multicentre randomised controlled trial, which the baseline proportion of CD4+T cells with an activated type 17 immunophenotype (Th17 levels) predicts response to IL-17A or TNF inhibitors in PsA. Additional analyses will identify if the model can be refined by combining additional clinical and immunophenotypic factors. Statistical modelling will be used to predict the likely effectiveness of these approaches compared with standard care.

Methods and analysis

Patients with PsA eligible to start their first biologic as part of standard care are recruited and baseline blood tests are taken for immunophenotyping. Participants are stratified equally by Th17 levels and randomised 1:1 to receive either TNF (adalimumab) or IL-17A (secukinumab) inhibitors. The primary analysis will establish the interaction between baseline immunophenotype and treatment on the primary outcome (achievement of minimal disease activity criteria at week 24). In secondary analysis, modelling will identify if this prediction model can be optimised further by incorporating clinical phenotypes and additional immunophenotyping techniques.

Ethics and dissemination

Ethical approval for the study was granted by the North West Preston Research Ethics Committee (ref 21/NW/0016). Dissemination will be via conference presentations and peer-reviewed publications, aiming to impact on treatment guidelines.

Trial registration number

ISRCTN17228602.
Quality of care for secondary cardiovascular disease prevention in 2009–2017: population-wide cohort study of antiplatelet therapy use in Scotland
Authors: Thalmann Inna , Preiss David , Schlackow Iryna , Gray Alastair , Mihaylova Borislava
Published: September 2023

Background

Antiplatelet therapy (APT) can substantially reduce the risk of further vascular events in individuals with established atherosclerotic cardiovascular disease (ASCVD). However, knowledge regarding the extent and determinants of APT use is limited.

Objectives

Estimate the extent and identify patient groups at risk of suboptimal APT use at different stages of the treatment pathway.

Methods

Retrospective cohort study using linked NHS Scotland administrative data of all adults hospitalised for an acute ASCVD event (n=150 728) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and re-initiating APT were calculated overall and separately for myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD). Multivariable logistic regression and Cox proportional hazards models were used to assess the contribution of patient characteristics in initiating and discontinuing APT.

Results

Of patients hospitalised with ASCVD, 84% initiated APT: 94% following an MI, 83% following an ischaemic stroke and 68% following a PAD event. Characteristics associated with lower odds of initiation included female sex (22% less likely than men), age below 50 years or above 70 years (aged <50 years 26% less likely, and aged 70–79, 80–89 and ≥90 years 21%, 39% and 51% less likely, respectively, than those aged 60–69 years) and history of mental health-related hospitalisation (45% less likely). Of all APT-treated individuals, 22% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.

Conclusions

APT use remains suboptimal for the secondary prevention of ASCVD, particularly among women and older patients, and following ischaemic stroke and PAD hospitalisations.
Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models
Authors: Spina Stefano , Gianquintieri Lorenzo , Marrazzo Francesco , Migliari Maurizio , Sechi Giuseppe Maria , Migliori Maurizio , Pagliosa Andrea , Bonora Rodolfo , Langer Thomas , Caiani Enrico Gianluca , Fumagalli Roberto
Published: September 2023

Background

The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR).

Methods

This was an observational, retrospective cohort study using data from October 2020 to July 2021 (training set) and October 2021 to December 2021 (validation set) from patients who underwent a SARS-CoV-2 rtPCR test within 7 days of an EMS call. The performance of an operator-based interview using close contact history and signs/symptoms of COVID-19 was assessed in the training set for its ability to determine which patients had an rtPCR in the 7 days before or after the call. The interview accuracy was compared with four supervised ML models to predict positivity for SARS-CoV-2 within 7 days using readily available prehospital data retrieved from both training and validation sets.

Results

The training set includes 264 976 patients, median age 74 (IQR 55–84). Test characteristics for the detection of COVID-19-positive patients of the operator-based interview were: sensitivity 85.5%, specificity 58.7%, positive predictive value (PPV) 37.5% and negative predictive value (NPV) 93.3%. Contact history, fever and cough showed the highest association with SARS-CoV-2 infection. In the validation set (103 336 patients, median age 73 (IQR 50–84)), the best-performing ML model had an AUC of 0.85 (95% CI 0.84 to 0.86), sensitivity 91.4% (95 CI% 0.91 to 0.92), specificity 44.2% (95% CI 0.44 to 0.45) and accuracy 85% (95% CI 0.84 to 0.85). PPV and NPV were 13.3% (95% CI 0.13 to 0.14) and 98.2% (95% CI 0.98 to 0.98), respectively. Contact history, fever, call geographical distribution and cough were the most important variables in determining the outcome.

Conclusion

ML-based models might help EMS identify patients with SARS-CoV-2 infection, and in guiding EMS allocation of hospital resources based on prespecified criteria.
Neurological involvement by Behçet’s syndrome: clinical features, diagnosis, treatment and outcome
Authors: Kidd Desmond Patrick
Published: September 2023

Neurological involvement in Behçet’s syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to activation of Th-17 immunological pathways. The brainstem is involved in 50% of cases, the diencephalon and other areas of the brain in 30%, and the spinal cord in 10%. Movement disorders and epilepsy may occur. Psychiatric syndromes may arise with brain and brainstem involvement, and cognitive disorders relate to the brain disease, to circulating inflammatory factors, and to fatigue and despondency. Eighty per cent of cases begin with a relapsing disease course, of whom 70% have only one attack, and 30% have a progressive disease course either from onset or following an initially relapsing course. Venous thrombosis leading to intracranial hypertension and cerebral venous infarction is less common and caused by inflammation in affected veins and a circulating prothrombotic state. Arterial involvement is rare and relates to an arteritis affecting large-sized and medium-sized vessels within the brain leading to infarction, subarachnoid and parenchymal haemorrhage, aneurysm formation and arterial dissection. There is a newly recognised disorder of cerebral cortical hypoperfusion. Cranial neuropathy, peripheral neuropathy and myositis are rare. There has been significant progress in understanding the pathophysiology and treatment of the systemic disease, leading to improved outcomes, but there has been no randomised trial of treatment in the neurological disorder.
Comparison between low-volume local anesthetic with intravenous dexamethasone and conventional volume without dexamethasone for superior trunk block after arthroscopic shoulder surgery: a randomized controlled non-inferiority trial
Authors: Kim Youngwon , Yoo Seokha , Kim Sae Hoon , Kim Hansol , Bae Jinyoung , Park Sun-Kyung , Kim Jin-Tae , Lim Young-Jin
Published: September 2023

Introduction

This study aimed to investigate whether low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while maintaining the analgesic duration compared with conventional volume of local anesthetic without intravenous dexamethasone when performing ultrasound-guided superior trunk block in patients undergoing arthroscopic shoulder surgery.

Methods

Eighty-four adult patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly assigned to receive ultrasound-guided superior trunk block using 7 mL of 0.5% ropivacaine with 0.15 mg/kg of intravenous dexamethasone (treatment group), or 15 mL of 0.5% ropivacaine with intravenous normal saline (control group). The co-primary outcomes were (1) the duration of analgesia (time between block completion and onset of surgical pain with a Numeric Rating Scale pain score of 4 or higher), which was compared against a non-inferiority margin of 3 hours, and (2) the incidence of diaphragmatic paresis evaluated using M-mode ultrasonography in the post-anesthesia care unit.

Results

The mean duration of analgesia was 12.4 (6.8) and 11.2 (4.6) hours in the treatment and control groups, respectively (mean difference: −1.2 hours; 95% CI −3.8 to 1.3]; p for non-inferiority<0.001), meeting the non-inferiority criteria. The incidence of diaphragmatic paresis was 45.2% and 85.4% in the treatment and control groups, respectively (relative risk: 0.53; 97.5% CI 0.35 to 0.80; p<0.001).

Conclusions

Superior trunk block using low-volume local anesthetic with intravenous dexamethasone can reduce the incidence of diaphragmatic paresis while providing non-inferior analgesic duration compared with the conventional volume of local anesthetic in patients undergoing arthroscopic shoulder surgery.

Trial registration number

Clinical Research Information Service of Republic of Korea Registry (KCT0005998).
Reviving sub-TeV $$SU(2)_L$$ lepton doublet dark matter
Authors: Ghosh Purusottam , Jeesun Sk
Published: September 2023

In this work we study the hybrid kind of dark matter (DM) production mechanism where both thermal and non-thermal contribution at two different epochs set the DM relic abundance. This hybrid set up in turn shifts the parameter space of DM in contrast to pure thermal DM scenario. We review such production mechanism in the context of the$$SU(2)_L$$SU(2)Llepton doublet dark matter$$(\Psi )$$(Ψ)augmented with an additional singlet dark scalar (S). The neutral component of the dark doublet can serve as a stable DM candidate and in pure thermal scenario, it is under-abundant as well as excluded from direct detection constraints due to its strong gauge interactions in the sub-TeV mass regime. However, in addition to the thermal contribution, the late time non-thermal DM production from the decay of the long-lived dark scalarShelps to fulfill the deficit in DM abundance. On the other hand, the strong gauge mediated direct detection constraint can be evaded with the help of a$$SU(2)_L$$SU(2)Ltriplet scalar(with$$Y=2),$$Y=2),resulting a pseudo-Dirac DM. To realize our proposed scenario we impose a discrete$${\mathcal {Z}}_2$$Z2symmetry under which both$$\Psi $$ΨandSare odd while rest of the fields are even. We find the lepton doublet pseudo-Dirac DM with mass$$\sim 450{-}1200$$∼450-1200 GeV, compatible with the observed relic density, direct, indirect, and existing collider search constraints.
Parameterized Algorithms for Fixed-Order Book Drawing with Few Crossings Per Edge
Authors: Huang Jingui , Chen Jie , Liu Yunlong , Xiao Guang , Wang Jianxin
Published: September 2023

Given an [Formula: see text]-vertex graph [Formula: see text] with a fixed linear ordering of [Formula: see text] and two integers [Formula: see text], the problem FIXED-ORDER BOOK DRAWING with few crossings per edge asks whether or not [Formula: see text] admits a [Formula: see text]-page book drawing where the maximum number of crossings per edge can be upper bounded by the number [Formula: see text]. This problem was posed as an open question by Bhore et al. (J. Graph Algorithms Appl. 2020). In this paper, we study this problem from the viewpoint of parameterized complexity, in particular, we develop fixed-parameter tractable algorithms for it. More specifically, we show that this problem parameterized by both the bound number [Formula: see text] of crossings per edge and the vertex cover number [Formula: see text] of the input graph admits an algorithm with running time in [Formula: see text], and this problem parameterized by both the bound number [Formula: see text] of crossings per edge and the pathwidth [Formula: see text] of the vertex ordering admits an algorithm with running time in [Formula: see text]. Our results provide a specific answer to Bhore et al.’s question.
Deep Learning-Based Classification of Epileptic Electroencephalography Signals Using a Concentrated Time-Frequency Approach
Authors: Yousif Mosab A. A. , Ozturk Mahmut
Published: September 2023

ConceFT (concentration of frequency and time) is a new time-frequency (TF) analysis method which combines multitaper technique and synchrosqueezing transform (SST). This combination produces highly concentrated TF representations with approximately perfect time and frequency resolutions. In this paper, it is aimed to show the TF representation performance and robustness of ConceFT by using it for the classification of the epileptic electroencephalography (EEG) signals. Therefore, a signal classification algorithm which uses TF images obtained with ConceFT to feed the transfer learning structure has been presented. Epilepsy is a common neurological disorder that millions of people suffer worldwide. Daily lives of the patients are quite difficult because of the unpredictable time of seizures. EEG signals monitoring the electrical activity of the brain can be used to detect approaching seizures and make possible to warn the patient before the attack. GoogLeNet which is a well-known deep learning model has been preferred to classify TF images. Classification performance is directly related to the TF representation accuracy of the ConceFT. The proposed method has been tested for various classification scenarios and obtained accuracies between 95.83% and 99.58% for two and three-class classification scenarios. High results show that ConceFT is a successful and promising TF analysis method for non-stationary biomedical signals.
Griffiths phase for quenched disorder in timescales
Authors: Bhoyar Priyanka D. , Gade Prashant M.
Published: September 2023

In contact processes, the population can have heterogeneous recovery rates for various reasons. We introduce a model of the contact process with two coexisting agents with different recovery times. Type A sites are infected with probability [Formula: see text], only if any neighbor is infected independent of their own state. The type [Formula: see text] sites, once infected recover after [Formula: see text] time-steps and become susceptible at [Formula: see text] time-step. If susceptible, type [Formula: see text] sites are infected with probability [Formula: see text], if any neighbor is infected. The model shows a continuous phase transition from the fluctuating phase to the absorbing phase at [Formula: see text]. The model belongs to the directed percolation universality class for small [Formula: see text]. For larger values of [Formula: see text], the model belongs to the activated scaling universality class. In this case, the fraction of infected sites of either type shows a power-law decay over a range of infection probability [Formula: see text] in the absorbing phase. This region of generic power laws is known as the Griffiths phase. For [Formula: see text], the fraction of infected sites saturates. The local persistence [Formula: see text] also shows a power-law decay with continuously changing exponent for either type of agent. Thus, the quenched disorder in timescales can lead to the temporal Griffiths phase in models that show a transition to an absorbing state.
DOES CARBON EMISSION TRADING PROMOTE THE APPLICATION OF PATENTS RELATED TO CLIMATE CHANGE? — EVIDENCE FROM 820,000 PATENTS IN CHINA
Authors: WU XIANHUA , XI DONGYU
Published: September 2023

In order to cope with climate change, many countries and regions implement carbon emission reduction through market transaction and technological innovation. However, there are only few empirical studies on the relationship between these strategies. This paper uses 820,000 pieces of patent application data from 2005 to 2018 in China, and takes the region and time point of whether to implement carbon emissions trading as the demarcation point. It studies the impact of carbon emissions trading on climate change patent application based on the double difference model. The results demonstrate the following: (1) The implementation of carbon trading in China has a negative impact on the quantity and quality of climate change patent application and authorized patents. (2) The application entities and the number of applicants are affected by heterogeneity. Individuals, enterprises and colleges have all been negatively affected, and the negative impact on separate application is greater than that on the cooperative application. In view of this, we propose some suggestions as follows: (1) Various strategies should be designed properly, so that they each have their own emphasis and promote emission reduction in coordination. (2) Different regions adopt different strategies according to their emission reduction targets and their real conditions. (3) It is necessary to enhance public opinion guidance and publicity, and encourage emission reduction through technological innovation. This study can deepen the understanding of the relationship among various emission reduction strategies, and provide reference for the practical work of carbon emission reduction.
THE IMPACT OF THE AGRICULTURAL PRODUCTIVE SERVICE INDUSTRY ON THE INCOME GAP BETWEEN URBAN AND RURAL RESIDENTS: EVIDENCE FROM 276 CHINESE PREFECTURE-LEVEL CITIES
Authors: DU RONG , QIAO JUN , FENG YOU-SHUAI
Published: September 2023

Based on the panel data of 276 prefecture-level cities in China from 2009 to 2018, this paper explores the impact of the agricultural productive service industry on the income gap between urban and rural residents by constructing the spatial econometric model and threshold regression model. The results show that the development of the agricultural productive service industry has a significant spatial spillover effect, which has a significant restraining effect on widening the income gap between urban and rural residents in the neighboring areas. Developing the agricultural productive service industry in the eastern and central regions significantly narrows the income gap between urban and rural residents. There is a significant urbanization threshold effect on the impact of the agricultural productive service industry on the income gap between urban and rural residents. When the urbanization level crosses the threshold of 3.7469, the role of the agricultural productive service industry in reducing the income gap between urban and rural residents increases significantly. Therefore, this paper proposes accelerating the development of the agricultural productive service industry, improving the urban–rural integration mechanism, strengthening the coordinated development between regions and playing the external effects of the agricultural productive service industry.
Generalized Vaidya spacetime: Horizons, conformal symmetries, surface gravity and diagonalization
Authors: Vertogradov Vitalii , Kudryavcev Dmitriy
Published: September 2023

In this paper, the different properties of generalized Vaidya spacetime are considered. We define the location of horizons. We show that the apparent horizon can contain the event horizon. The locations of all types of horizons are compared with the ones in the usual Vaidya spacetime. We investigate the time-like geodesics in this spacetime. New corrections to Schwarzschild and Vaidya cases appear and we give conditions when these corrections are not negligible. Also, we consider the conformal Killing vector and transform the metric to conformally static coordinates. We introduce a new constant of motion along null and time-like geodesics, which is generated by a homothetic Killing vector. The conformally static coordinates allow diagonalizing of the generalized Vaidya spacetime. The surface gravity has been calculated for the dust and stiff fluid cases.