bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of computerised decision aids for patients with chronic diseases in shared decision‐making: A systematic review and meta‐analysis
Authors: Wu Chih‐Jung , Yeh Tzu‐Pei , Chu Ginger , Ho Ya‐Fang
Published: March 2024

Aims

To synthesise the composition and effectiveness of computer‐based patient decision aid (PDAs) in interventions for patients with chronic diseases.

Design

A systematic review with meta‐analysis.

Methods

Five databases were searched, and only randomised controlled trials (RCTs)were included. This review was conducted with the PRISMA guidelines. The JBI Appraisal Tools for randomised trials were used to assess the risk of bias. We used the random‐effects model to conduct meta‐analyses. Evidence from RCTs was synthesised using standardised mean differences or mean differences. The GRADE system was employed to assess the certainty of evidence and recommendations. This study was registered on PROSPERO (number: CRD42022369340).

Data Sources

PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched for studies published before October 2022.

Results

The review included 22 studies, and most computer‐based PDAs reported information on the disease, treatment options, pros and cons and risk comparison and value clarification. The use of computer‐based PDAs showed a significant effect on decision conflict and knowledge, but not on decision regret, satisfaction, self‐efficacy, anxiety and quality of life. The overall GRADE certainty of evidence was low.

Conclusion

Although the quality of evidence was low, however, using computer‐based PDAs could reduce decision conflict and enhance knowledge when making medical decisions. More research is needed to support the contention above.

Relevance to Clinical Practice

Computer‐based PDAs could assist health‐care providers and patients in the shared decision‐making process and improving the quality of decision‐making.

Reporting Method

This study adhered to PRISMA guidelines.

No Patient or Public Contribution
The educational diffusion of divorce: The role of gender and context
Authors: Hogendoorn Bram , van den Berg Lonneke
Published: March 2024

Objective

This study examines the educational diffusion of divorce in Europe and the role of women's decision‐making therein.

Background

As the contextual barriers to divorce have lowered, the divorce rates of less‐educated women have increased in many societies. Changes in divorce barriers are likely more pertinent to married women than to married men. However, no previous study has tested whether less‐educated women increasingly take the initiative to divorce or whether less‐educated women are increasingly left by their husbands.

Method

The authors used retrospective panel data from the Generations and Gender Survey, covering 39,650 marital unions across 49 country‐cohort contexts in Europe. Multilevel models showed how divorce barriers were associated with the educational gradient in divorce. Competing‐risks models decomposed the associations into a wife‐initiated share and a husband‐ or jointly‐initiated share.

Results

Lower divorce barriers are associated with the educational diffusion of divorce. This diffusion is largely driven by women's own divorce initiation.

Conclusion

More permissive family norms and greater economic autonomy enable less‐educated women to leave a dissatisfying marriage.
Middle Managers’ Relational Dynamics in the Context of Acquisitions: Balancing Strategic Interdependence and Organizational Autonomy
Authors: Birollo Gustavo , Rouleau Linda , Wolf Carola
Published: March 2024

During acquisitions, middle managers (MMs) play a crucial role in facilitating the integration of two previously separate organizations, thereby facing the challenge of balancing competing needs for strategic interdependence and organizational autonomy. Drawing on interviews with acquiring and acquired MMs, this study explores the unfolding dynamics of framing the relationships between both groups. We introduce the concept of actionable intersubjectivity as a core ability of MMs to take into account the presence of the other while accomplishing integration tasks. We propose a grounded process model that traces how actionable intersubjectivity is developed to varying degrees throughout the MMs’ relational dynamics occurring in the various interaction spaces provided at each acquisition stage by getting a sense of the other (pre‐acquisition), by deciphering how the other think (approval), by experiencing how the other act and react (post‐acquisition I) and by putting oneself in the place of the other (post‐acquisition II). Our paper contributes to mergers and acquisitions research in two ways: (1) by unpacking the relational dynamics between MMs and introducing actionable intersubjectivity as a crucial ability in the context of acquisitions and (2) by extending our understanding of MMs’ role in balancing strategic interdependence and organizational autonomy during the acquisition process.
CEOs’ Pre‐Career Exposure to Religion and Corporate Tax Avoidance
Authors: Chen Yu , Fu Ruchunyi , Tang Yi , Zhao Xiaoping
Published: March 2024

In response to the burgeoning interest in CEOs’ pre‐career experience, this study focuses on their pre‐career exposure to religion. We argue that CEOs who were exposed to religion before starting their professional career will be imbued with the values that prioritize social obligations. Moreover, these imprinted values become activated in the context of corporate tax payment, such that firms with a CEO who attended a religious university are less likely to avoid tax. We further explore how CEOs’ present social context, including political corruption, corporate social performance and present exposure to religion, provides situational cues that moderate the baseline relationship. An analysis of a sample of US listed firms from 2000 to 2019 provides general support for our predictions.
Transcranial Doppler cerebrovascular reactivity: Thresholds for clinical significance in cerebrovascular disease
Authors: Regenhardt Robert W. , Nolan Neal M. , Das Alvin S. , Mahajan Rahul , Monk Andrew D. , LaRose Sarah L. , Migdady Ibrahim , Chen Yimin , Sheriff Faheem , Bai Xuesong , Dmytriw Adam A. , Patel Aman B. , Snider Samuel B. , Vaitkevicius Henrikas
Published: March 2024

Background and Purpose

Thresholds for abnormal transcranial Doppler cerebrovascular reactivity (CVR) studies are poorly understood, especially for patients with cerebrovascular disease. Using a real‐world cohort with cerebral arterial stenosis, we sought to describe a clinically significant threshold for carbon dioxide reactivity (CO2R) and vasomotor range (VMR).

Methods

CVR studies were performed during conditions of breathing room air normally, breathing 8% carbon dioxide air mixture, and hyperventilation. The mean and standard deviation (SD) of CO2R and VMR were calculated for the unaffected side in patients with unilateral stenosis; a deviation of 2 SDs below the mean was chosen as the threshold for abnormal. Receiver operating characteristic (ROC) curves for both sides for patients with unilateral and bilateral stenosis were evaluated for sensitivity (Sn) and specificity (Sp).

Results

A total of 133 consecutive CVR studies were performed on 62 patients with stenosis with mean±SD age 55±16 years. Comorbidities included hypertension (60%), diabetes (15%), stroke (40%), and smoking (35%). In patients with unilateral stenosis, mean±SD CO2R for the unaffected side was 1.86±0.53%, defining abnormal CO2R as <0.80%. Mean±SD CO2R for the affected side was 1.27±0.90%. The CO2R threshold predicted abnormal acetazolamide single‐photon emission computed tomography (SPECT) (Sn = .73, Sp = .79), CT/MRI perfusion abnormality (Sn = .42, Sp = .77), infarction on MRI (Sn = .45, Sp = .76), and pressure‐dependent exam (Sn = .50, Sp = .76). For the unaffected side, mean±SD VMR was 39.5±15.8%, defining abnormal VMR as <7.9%. For the affected side, mean±SD VMR was 26.5±17.8%. The VMR threshold predicted abnormal acetazolamide SPECT (Sn = .46, Sp = .94), infarction on MRI (Sn = .27, Sp = .94), and pressure‐dependent exam (Sn = .31, Sp = .90).

Conclusions

In patients with multiple vascular risk factors, a reasonable threshold for clinically significant abnormal CO2R is <0.80% and VMR is <7.9%. Noninvasive CVR may aid in diagnosing and risk stratifying patients with stenosis.
Collaborative or Independent? Buddhist Monks’ Perceptions of Nonconflict Between Religion and Science
Authors: Lu Yulin , Joosse Paul
Published: March 2024

Few studies have explored religious professionals’ interactions with scientific authority in work settings. Fewer still examine professionals outside Western contexts. We analyze the science‐religion interface as it exists in Shaolin Temple—an ancient Chan Buddhist temple with a worldwide reputation for Shaolin Kungfu. Drawing on a near‐exhaustive survey within Shaolin monastery and 23 interviews with Shaolin monks, we discern and differentiate two modes of nonconflict operating in monks’ psychic lives. One group understands Buddhism and science as comprising independent realms—nonconflictual by virtue of their noninteractivity. Another views science and religion as being interpenetrative and nonconflictual in the sense of being mutually constitutive. These differing orientations, which reflect established categories of “transcendentalist” versus “immanentist” religion, further correlate with different facets of religiosity: Monks with high religious knowledge tend to view Buddhism and science as independent, while monks with high levels of piety tend to see them as collaborative or mutually constitutive.
Effect of leukoreduction on the omics phenotypes of canine packed red blood cells during refrigerated storage
Authors: Miglio Arianna , Rocconi Francesca , Cremoni Valentina , D'Alessandro Angelo , Reisz Julie A. , Maslanka Mark , Lacroix Ian S. , Di Francesco Daniela , Antognoni Maria T. , Di Tommaso Morena
Published: March 2024

Background

Red blood cell (RBC) storage promotes biochemical and morphological alterations, collectively referred to as storage lesions (SLs). Studies in humans have identified leukoreduction (LR) as a critical processing step that mitigates SLs. To date no study has evaluated the impact of LR on metabolic SLs in canine blood units using omics technologies.

Objective

Compare the lipid and metabolic profiles of canine packed RBC (pRBC) units as a function of LR in fresh and stored refrigerated (up to 42 days) units.

Animals

Packed RBC units were obtained from 8 donor dogs enrolled at 2 different Italian veterinary blood banks.

Study Design and Methods

Observational study. A volume of 450 mL of whole blood was collected using Citrate‐Phosphate‐Dextrose‐Saline‐Adenine‐Glucose‐Mannitol (CPD‐SAGM) transfusion bags with a LR filter to produce 2 pRBC units for each donor, without (nLR‐pRBC) and with (LR‐pRBC) LR. Units were stored in the blood bank at 4 ± 2°C. Sterile weekly samples were obtained from each unit for omics analyses.

Results

A significant effect of LR on fresh and stored RBC metabolic phenotypes was observed. The nLR‐pRBC were characterized by higher concentrations of free short and medium‐chain fatty acids, carboxylic acids (pyruvate, lactate), and amino acids (arginine, cystine). The LR‐pRBC had higher concentrations of glycolytic metabolites, high energy phosphate compounds (adenosine triphosphate [ATP]), and antioxidant metabolites (pentose phosphate, total glutathione).

Conclusion and Clinical Importance

Leukoreduction decreases the metabolic SLs of canine pRBC by preserving energy metabolism and preventing oxidative lesions.
Shining a spotlight on sarcopenia and myosteatosis in liver disease and liver transplantation
Authors: Reichelt Sophie , Merle Uta , Klauss Miriam , Kahlert Christoph , Lurje Georg , Mehrabi Arianeb , Czigany Zoltan
Published: March 2024

Muscle‐wasting and disease‐related malnutrition are highly prevalent in patients with chronic liver diseases (CLD) as well as in liver transplant (LT) candidates. Alterations of body composition (BC) such as sarcopenia, myosteatosis and sarcopenic obesity and associated clinical frailty were tied to inferior clinical outcomes including hospital admissions, length of stay, complications, mortality and healthcare costs in various patient cohorts and clinical scenarios. In contrast to other inherent detrimental individual characteristics often observed in these complex patients, such as comorbidities or genetic risk, alterations of the skeletal muscle and malnutrition are considered as potentially modifiable risk factors with a major clinical impact. Even so, there is only limited high‐level evidence to show how these pathologies should be addressed in the clinical setting. This review discusses the current state‐of‐the‐art on the role of BC assessment in clinical outcomes in the setting of CLD and LT focusing mainly on sarcopenia and myosteatosis. We focus on the disease‐related pathophysiology of BC alterations. Based on these, we address potential therapeutic interventions including nutritional regimens, physical activity, hormone and targeted therapies. In addition to summarizing existing knowledge, this review highlights novel trends, and future perspectives and identifies persisting challenges in addressing BC pathologies in a holistic way, aiming to improve outcomes and quality of life of patients with CLD awaiting or undergoing LT.
The Japan MSA registry: A multicenter cohort study of multiple system atrophy
Authors: Chikada Ayaka , Orimo Kenta , Mitsui Jun , Matsukawa Takashi , Ishiura Hiroyuki , Toda Tatsushi , Mizusawa Hidehiro , Takahashi Yuji , Katsuno Masahisa , Hara Kazuhiro , Onodera Osamu , Ishihara Tomohiko , Tada Masayoshi , Kuwabara Satoshi , Sugiyama Atsuhiko , Yamanaka Yoshitaka , Takahashi Ryosuke , Sawamoto Nobukatsu , Sakato Yusuke , Ishimoto Tomoyuki , Hanajima Ritsuko , Watanabe Yasuhiro , Takigawa Hiroshi , Adachi Tadashi , Abe Koji , Yamashita Toru , Takashima Hiroshi , Higashi Keiko , Kira Junichi , Yabe Ichiro , Matsushima Masaaki , Ogata Katsuhisa , Ishikawa Kinya , Nishida Yoichiro , Ishiguro Taro , Ozaki Kokoro , Nagata Tetsuya , Tsuji Shoji
Published: March 2024

Background

Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by autonomic failure and various motor symptoms. While MSA‐C (cerebellar type) predominates in East Asia, MSA‐P (parkinsonian type) predominates in Europe and North America. This nationwide patient registry aimed to (1) conduct a prospective natural history study of MSA in Japan, (2) facilitate patient recruitment for clinical trials, and (3) deposit bioresources and clinical information in a biobank.

Methods

Thirteen institutions participated in this study. Clinical information was obtained by neurologists from the patients visiting the hospital every 12 months to assess the UMSARS Part 2 scores and by telephone interviews by nurses every 6 months to assess UMSARS Part 1 scores and to determine whether clinical events had occurred.

Results

Demographic data from 329 MSA patients (216 MSA‐C and 113 MSA‐P) were analyzed. The mean age at symptom onset was 58.2 years (standard deviation, 8.9); the mean duration of symptoms at enrollment was 3.5 years (standard deviation, 2.2). The mean 12‐month changes in the UMSARS Part 1 and Part 2 scores were 7.9 (standard deviation, 5.6) and 6.4 (standard deviation, 5.9), respectively. The patient registry proved useful in recruiting participants for clinical trials, including those with gene variants. Clinical information and biospecimens were deposited in a biobank.

Discussion

The study highlighted the importance of telephone interviews in minimizing drop‐out rates in natural history studies and demonstrated similar MSA progression rates across populations. The deposited bioresources are available to researchers upon request, aiming to contribute to future MSA researches.
Parent and staff experiences of a feasibility trial evaluating neurally adjusted ventilatory assist in infants with acute viral bronchiolitis: A qualitative study
Authors: Harris Julia , Tibby Shane M. , Latour Jos M.
Published: March 2024

Background

There is limited literature regarding family and staff experiences of participating in clinical trials. A qualitative study was embedded in the NAVABronch feasibility trial evaluating the effectiveness of a novel mode of ventilation, neurally adjusted ventilatory assist (NAVA), in infants with acute viral bronchiolitis.

Aim

The aim of this qualitative study was to explore the experiences of parents and health care practitioners (HCPs) involved in the NAVABronch Trial.

Study Design

Semi‐structured interviews were conducted with two parents and two focus groups were held with six HCPs.

Results

Four themes were identified from the focus groups: (1) Creating staff engagement, (2) Education to deliver NAVA, (3) Normalizing NAVA in clinical practice (4) Creating meaningful study outcomes and (5) support of parents during the trial, this theme was generated from the parent interviews. The findings indicated the need for education regarding NAVA for HCPs which would lead to increased confidence, better guidance around the use of NAVA and the need for NAVA to be normalized and embedded into the unit culture. Parents identified the need for further support around preparation for what may happen as a result of the interventions, particularly the weaning of sedation.

Conclusion

Our study indicates that staff and parents had no concerns regarding the trial methods and procedures.

Relevance to Clinical Practice

Conducting clinical trials in Paediatric Intensive Care Units (PICUs) is challenging and complex. There is limited literature regarding family and staff experiences of participating in clinical trials. Understanding their experiences is crucial in ensuring trial success.
Pediatric en bloc kidney transplant from donors <15 kg: An excellent approach to expand the pediatric deceased donor pool
Authors: Azzam Ahmad , Tawfeeq Mansour , Obeid Mahmoud , Khan Iftikhar , Almaghrabi Mohammed , AlQahtani Mohammed , Alshami Alanoud
Published: March 2024

Introduction

Most kidneys from small pediatric donors are transplanted to adult recipients because of the perceived risk of surgical complications and graft thrombosis. In this study, we aim to demonstrate our favorable outcomes in transplanting pediatric kidneys from donors <15 k into pediatric recipients.

Methods

This study retrospectively analyzes the outcomes of seven pediatric recipients of en block kidney transplants from pediatric donors weighing <15 kg performed at King Fahad Specialist Hospital‐Dammam from December 2014 to January 2018.

Baseline characteristics of donors and recipients were collected. The incidences of surgical complication, immediate, and intermediate graft function were the primary outcomes.

Results

The study included seven recipients monitored for a mean duration of 6.86 ± 1.35. Donors’ and recipients’ mean weights were 7.4 ± 3.2 kg and 20.7 ± 9.2 kg, respectively. Ureteric stricture occurred in one patient. There was a substantial improvement of 1‐year estimated glomerular filtration rate (eGFR) compared to the 1‐week mark (106.7 ± 26.38 mL/min. 1.73 m2 vs. 63.7 ± 22.92 mL/min/1.73 m2, p = .0069). The observed improvement in renal function persisted at the 5‐year mark and during the last follow‐up, with eGFR of 70.3 ± 40.7 mL/min/1.73 m2, and 79.8 ± 30.8 mL/min/1.73 m2, respectively. There was also increase of 27.9% in the size of the en bloc kidney observed at the 6 months.

Conclusion

In a specialized transplant center with highly skilled surgeons, the utilization of en bloc kidney transplant from donors weighing less than 15 kg is an effective strategy for expanding the donor pool and ensuring favorable graft outcomes.
Optimizing the approach to monitoring allograft inflammation using serial urinary CXCL10/creatinine testing in pediatric kidney transplant recipients
Authors: Barrett‐Chan Ella , Wang Li , Bone Jeffrey , Thachil Amy , Vytlingam Kevin , Blydt‐Hansen Tom
Published: March 2024

Background

Urinary CXCL10/creatinine (uCXCL10/Cr) is proposed as an effective biomarker of subclinical rejection in pediatric kidney transplant recipients. This study objective was to model implementation in the clinical setting.

Methods

Banked urine samples at a single center were tested for uCXCL10/Cr to validate published thresholds for rejection diagnosis (>80% specificity). The positive predictive value (PPV) for rejection diagnosis for uCXCL10/Cr‐indicated biopsy was modeled with first‐positive versus two‐test‐positive approaches, with accounting for changes associated with urinary tract infection (UTI), BK and CMV viremia, and subsequent recovery.

Results

Seventy patients aged 10.5 ± 5.6 years at transplant (60% male) had n = 726 urine samples with n = 236 associated biopsies (no rejection = 167, borderline = 51, and Banff 1A = 18). A threshold of 12 ng/mmol was validated for Banff 1A versus no‐rejection diagnosis (AUC = 0.74, 95% CI = 0.57–0.92). The first‐positive test approach (n = 69) did not resolve a clinical diagnosis in 38 cases (55%), whereas the two‐test approach resolved a clinical diagnosis in the majority as BK (n = 17/60, 28%), CMV (n = 4/60, 7%), UTI (n = 8/60, 13%), clinical rejection (n = 5/60, 8%), and transient elevation (n = 18, 30%). In those without a resolved clinical diagnosis, PPV from biopsy for subclinical rejection is 24% and 71% (p = .017), for first‐test versus two‐test models, respectively. After rejection treatment, uCXCL10/Cr level changes were all concordant with change in it‐score. Sustained uCXCL10/Cr after CMV and BK viremia resolution was associated with later acute rejection.

Conclusions

Urinary CXCL10/Cr reliably identifies kidney allograft inflammation. These data support a two‐test approach to reliably exclude other clinically identifiable sources of inflammation, for kidney biopsy indication to rule out subclinical rejection.
Relaxed realism, robust realism, and the truthmaker challenge
Authors: Karimi Paiman
Published: March 2024

Relaxed realist theories are becoming more common in metanormative theory. They want the advantages of robust forms of realism but without their metaphysical underpinnings. However, it is not always clear how we should understand relaxed realist theories in general. In this paper I clarify and defend relaxed realism. First, I characterise and distinguish relaxed realist theories from robust realist theories. Second, I defend relaxed realism against a challenge from truthmaker theory.
Predicting adolescents' continuation in club sports: A prospective cohort study of the importance of personal and contextual motivational factors in five sports in Denmark
Authors: Nielsen Glen , Wikman Johan Michael , Appleton Paul R. , Bentsen Peter , Elsborg Peter
Published: March 2024

Purpose

The purpose of this prospective cohort study was to investigate the influence of types of motivation, basic psychological needs satisfaction and of a coach‐created motivational climate on continued participation in youth sports across types of sport, competitive levels, ages, and gender.

Methods

Participants were 7110 adolescent (age 12–20 years) members of leisure time club organized in basketball, handball, football, badminton, and gymnastics in Denmark. Motivational regulation was measured with BRSQ‐6, basic psychological needs satisfaction and frustration were measured with PNSS‐S, and coach‐created climate was measured with the EDMCQ‐C. The participants' continuation or dropout was measured at the beginning of the following season with a short electronic questionnaire.

Results

Intrinsic motivation, identified behavior regulation, experiences of competence, relatedness, and autonomy, as well as a coach‐created empowering motivational climate, were associated with continuation both in the sport and in the club the following season across different sports, genders, age groups, and competitive levels. Introjected and external behavior regulation, frustrations with the need to experience competence, relatedness, and autonomy, as well as a disempowering coach‐created climate, were associated with dropout.

Conclusion

In Danish youth sports, autonomous motivation, satisfaction of basic psychological needs, and an empowering coach‐created motivational climate have a positive impact on the continuation of the sport and the club the following season. In contrast, controlled types of motivation, needs frustration, and a disempowering coach‐created climate are associated with dropout. This is the case at both elite and recreational levels, for boys and girls, adolescents, and youth.
Revisiting the role of social work in the substantial realization of social rights in local welfare systems: Transforming and changing the rules of the institutional game?
Authors: Dewanckel Lore , Schiettecat Tineke , Hermans Koen , Roose Rudi , Van Lancker Wim , Kessl Fabian , Roets Griet
Published: March 2024

Although diverse European welfare states have institutionalized an extensive infrastructure of public welfare services to redistribute resources, governments have been confronted with barriers in realizing the social rights of certain groups of citizens. Decentralization and increasingly local welfare provision has been promoted as a strategy to substantially realize social rights. In that sense, the vital role of frontline social work has been stressed in local welfare systems, being considered as dynamic arrangements in which local policymakers and professional social work actors are involved in the substantial realization of social rights. These trends have been frequently studied from a social policy perspective, but the role of professional social work on the frontline level has received much less attention. In this study, we accordingly rely on neo‐institutional theory to explore how frontline social workers employ their professional discretion during processes of local social policy implementation, related to the broader circumstances in which they operate. Our qualitative study aims to tease out whether their strategic actions might transform and/or change the rules of the local institutional game. The qualitative analysis is based on policy documents and qualitative interviews with key actors in two municipalities in Belgium. Our research findings reveal three central fields of tension: (1) Rescaling of responsibilities to the local welfare system and community level versus in‐built spatial concentrations of social problems and inequalities, (2) Efficient local welfare system organization versus wicked social problems, and (3) Fast local welfare system logics versus slow realities.
The Enhanced Literate Mind Hypothesis
Authors: Huettig Falk , Hulstijn Jan
Published: March 2024

In the present paper, we describe the Enhanced Literate Mind (ELM) hypothesis. As individuals learn to read and write, they are, from then on, exposed to extensive written‐language input and become literate. We propose that acquisition and proficient processing of written language (“literacy”) leads to, both, increased language knowledge as well as enhanced language and nonlanguage (perceptual and cognitive) skills. We also suggest that all neurotypical native language users, including illiterate, low literate, and high literate individuals, share a Basic Language Cognition (BLC) in the domain of oral informal language. Finally, we discuss the possibility that the acquisition of ELM leads to some degree of “knowledge parallelism” between BLC and ELM in literate language users, which has implications for empirical research on individual and situational differences in spoken language processing.
A criterion for nondensity of integral points
Authors: Garcia‐Fritz Natalia , Pasten Hector
Published: March 2024

We give a general criterion for Zariski degeneration of integral points in the complement of a divisor with components in a variety of dimension defined over or over a quadratic imaginary field. The key condition is that the intersection of the components of is not well approximated by rational points, and we discuss several cases where this assumption is satisfied. We also prove a greatest common divisor (GCD) bound for algebraic points in varieties, which can be of independent interest.
Intrinsic motoneuron properties in typical human development
Authors: Mohammadalinejad Ghazaleh , Afsharipour Babak , Yacyshyn Alex , Duchcherer Jennifer , Bashuk Jack , Bennett Erin , Pearcey Gregory E. P. , Negro Francesco , Quinlan Katharina A. , Bennett David J. , Gorassini Monica A.
Published: March 2024

Motoneuron properties and their firing patterns undergo significant changes throughout development and in response to neuromodulators such as serotonin. Here, we examined the age‐related development of self‐sustained firing and general excitability of tibialis anterior motoneurons in a young development (7–17 years), young adult (18–28 years) and adult (32–53 years) group, as well as in a separate group of participants taking selective serotonin reuptake inhibitors (SSRIs, aged 11–28 years). Self‐sustained firing, as measured by ΔF, was larger in the young development (∼5.8 Hz, n = 20) compared to the young adult (∼4.9 Hz, n = 13) and adult (∼4.8 Hz, n = 8) groups, consistent with a developmental decrease in self‐sustained firing mediated by persistent inward currents (PIC). ΔF was also larger in participants taking SSRIs (∼6.5 Hz, n = 9) compared to their age‐matched controls (∼5.3 Hz, n = 26), consistent with increased levels of spinal serotonin facilitating the motoneuron PIC. Participants in the young development and SSRI groups also had higher firing rates and a steeper acceleration in initial firing rates (secondary ranges), consistent with the PIC producing a steeper acceleration in membrane depolarization at the onset of motoneuron firing. In summary, both the young development and SSRI groups exhibited increased intrinsic motoneuron excitability compared to the adults, which, in the young development group, was also associated with a larger unsteadiness in the dorsiflexion torque profiles. We propose several intrinsic and extrinsic factors that affect both motoneuron PICs and cell discharge which vary during development, with a time course similar to the changes in motoneuron firing behaviour observed in the present study.

image

Key points

Neurons in the spinal cord that activate muscles in the limbs (motoneurons) undergo increases in excitability shortly after birth to help animals stand and walk.

We examined whether the excitability of human ankle flexor motoneurons also continues to change from child to adulthood by recording the activity of the muscle fibres they innervate.

Motoneurons in children and adolescents aged 7–17 years (young development group) had higher signatures of excitability that included faster firing rates and more self‐sustained activity compared to adults aged ≥18 years.

Participants aged 11–28 years of age taking serotonin reuptake inhibitors had the highest measures of motoneuron excitability compared to their age‐matched controls.

The young development group also had more unstable contractions, which might partly be related to the high excitability of the motoneurons.
Pre-COVID-19 hospital quality and hospital response to COVID-19: examining associations between risk-adjusted mortality for patients hospitalised with COVID-19 and pre-COVID-19 hospital quality
Authors: Peter Doris , Li Shu-Xia , Wang Yongfei , Zhang Jing , Grady Jacqueline , McDowell Kerry , Norton Erica , Lin Zhenqiu , Bernheim Susannah , Venkatesh Arjun K , Fleisher Lee A , Schreiber Michelle , Suter Lisa G , Triche Elizabeth W
Published: March 2024

Objectives

The extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19.

Design

This is a retrospective observational study. We calculated hospital-level risk-standardised in-hospital and 30-day mortality rates (risk-standardised mortality rates, RSMRs) for patients hospitalised with COVID-19, and correlation coefficients between RSMRs and pre-COVID-19 hospital quality, overall and stratified by hospital characteristics.

Setting

Short-term acute care hospitals and critical access hospitals in the USA.

Participants

Hospitalised Medicare beneficiaries (Fee-For-Service and Medicare Advantage) age 65 and older hospitalised with COVID-19, discharged between 1 April 2020 and 30 September 2021.

Intervention/exposure

Pre-COVID-19 hospital quality.

Outcomes

Risk-standardised COVID-19 in-hospital and 30-day mortality rates (RSMRs).

Results

In-hospital (n=4256) RSMRs for Medicare patients hospitalised with COVID-19 (April 2020–September 2021) ranged from 4.5% to 59.9% (median 18.2%; IQR 14.7%–23.7%); 30-day RSMRs ranged from 12.9% to 56.2% (IQR 24.6%–30.6%). COVID-19 RSMRs were negatively correlated with star rating summary scores (in-hospital correlation coefficient −0.41, p<0.0001; 30 days −0.38, p<0.0001). Correlations with in-hospital RSMRs were strongest for patient experience (−0.39, p<0.0001) and timely and effective care (−0.30, p<0.0001) group scores; 30-day RSMRs were strongest for patient experience (−0.34, p<0.0001) and mortality (−0.33, p<0.0001) groups. Patients admitted to 1-star hospitals had higher odds of mortality (in-hospital OR 1.87, 95% CI 1.83 to 1.91; 30-day OR 1.46, 95% CI 1.43 to 1.48) compared with 5-star hospitals. If all hospitals performed like an average 5-star hospital, we estimate 38 000 fewer COVID-19-related deaths would have occurred between April 2020 and September 2021.

Conclusions

Hospitals with better prepandemic quality may have care structures and processes that allowed for better care delivery and outcomes during the COVID-19 pandemic. Understanding the relationship between pre-COVID-19 hospital quality and COVID-19 outcomes will allow policy-makers and hospitals better prepare for future public health emergencies.
Mixed-methods study exploring health service access and social support linkage to the mental well-being of Canadian Indigenous pregnant persons during the COVID-19 pandemic
Authors: Mollons Meghan , Levasseur-Puhach Sydney , Kaur Jasleen , Doyle Jennifer , Giesbrecht Gerald , Lebel Catherine A , Woods Lindsay , Tomfohr-Madsen Lianne , Roos Leslie
Published: March 2024

Objectives

This study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors.

Design

The current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic.

Setting

Participants responded to an online questionnaire consisting of standardised measures from 2020 to 2021.

Participants

The study included 336 self-identifying Indigenous pregnant persons in Canada.

Results

Descriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic.

Conclusions

Given the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.
Influence of COVID-19 pandemic in India on coronary artery disease clinical presentation, angiography, interventions and in-hospital outcomes: a single centre prospective registry-based observational study
Authors: Gupta Rajeev , Sharma Krishnakumar , Khedar Raghubir Singh , Sharma Sanjeev Kumar , Makkar Jitender Singh , Natani Vishnu , Bana Ajeet , Sharma Samin
Published: March 2024

Objective

The study examined the influence of the COVID-19 pandemic in India on variation in clinical features, management and in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI).

Design

Prospective registry-based observational study.

Setting

A tertiary care hospital in India participant in the American College of Cardiology CathPCI Registry.

Participants

7089 successive patients who underwent PCI from April 2018 to March 2023 were enrolled (men 5627, women 1462). Details of risk factors, clinical presentation, coronary angiography, coronary interventions, clinical management and in-hospital outcomes were recorded. Annual data were classified into specific COVID-19 periods according to Government of India guidelines as pre-COVID-19 (April 2018 to March 2019, n=1563; April 2019 to March 2020, n=1594), COVID-19 (April 2020 to March 2020, n=1206; April 2021 to March 2022, n=1223) and post-COVID-19 (April 2022 to March 2023, n=1503).

Results

Compared with the patients in pre-COVID-19 and post-COVID-19 periods, during the first COVID-19 year, patients had more hypertension, non-ST elevation myocardial infarction (NSTEMI), lower left ventricular ejection fraction (LVEF) and multivessel coronary artery disease (CAD). In the second COVID-19 year, patients had more STEMI, lower LVEF, multivessel CAD, primary PCI, multiple stents and more vasopressor and mechanical support. There were 99 (1.4%) in-hospital deaths which in the successive years were 1.2%, 1.4%, 0.8%, 2.4% and 1.3%, respectively (p=0.019). Compared with the baseline year, deaths were slightly lower in the first COVID-19-year (age-sex adjusted OR 0.68, 95% CI 0.31 to 1.47) but significantly more in the second COVID-19-year (OR 1.97, 95% CI 1.10 to 3.54). This variation attenuated following adjustment for clinical presentation, extent of CAD, in-hospital treatment and duration of hospitalisation.

Conclusions

In-hospital mortality among patients with CAD undergoing PCI was significantly higher in the second year of the COVID-19 pandemic in India and could be one of the reasons for excess deaths in the country. These patients had more severe CAD, lower LVEF, and more vasopressor and mechanical support and duration of hospitalisation.
Pain Neuroscience Education in elective surgery patients: study protocol for a randomised controlled trial
Authors: de Souza Raquel Pereira , Lopes Laura Borges , Carmo Anne Caroline Nunes , Machado Paula Muniz , de Andrade Joanlise Marco Leon , Funez Mani Indiana
Published: March 2024

Background

Pain Neuroscience Education (PNE) consists of an educational strategy that seeks to understand the biological processes of pain and how to control it. The main objective of this study will be to evaluate the impact of PNE on outcomes related to the postoperative period. The hypothesis is that the intervention may positively influence postoperative recovery, contributing to pain control, clinical indications, acceptance and consumption of analgesics and other pharmacological drugs that contribute to its control, as well as psychological aspects, such as anxiety, depression and pain catastrophising.

Methods and analysis

This will be an open, parallel, multicentre and randomised controlled clinical trial. A total of 100 participants aged between 18 and 59 years of age, of both genders, who are going to have elective general surgery will be evaluated. The intervention group will participate in a preoperative pain neuroscience educational session and also receive usual preoperative care, while the control group receives usual preoperative care as well. The educational session will last 30 min and consists of a video (5:20 min), a questionnaire about the content, time for participants to express their beliefs, thoughts and doubts. Participants will be evaluated preoperatively and there will be one postintervention evaluation. The intensity and characteristics of pain and anxiety are evaluated as primary outcomes. As secondary outcomes, pain catastrophising and depression are taken into account.

Ethics and dissemination

The project was approved by the Research Ethics Committee of the Faculty of Ceilandia, the Research Ethics Committee of the Institute of Strategic Health Management of the Federal District and the Research Council of the Hospital of Brasília—Rede Dasa (CAAE: 28572420.3.0000.8093). Recruitment began in June of 2023. All participants were included in the study only after their written consent. All data obtained will be analysed and distributed through publication in journals and at scientific events.

Trial registration number

Brazilian Registry of Clinical Trials (ReBEC) (RBR-23mr7yy).
Dipsticks and point-of-care Microscopy to reduce antibiotic use in women with an uncomplicated Urinary Tract Infection (MicUTI): protocol of a randomised controlled pilot trial in primary care
Authors: Kurotschka Peter K , Borgulya Gábor , Bucher Eva , Endrich Isabell , Figueiras Adolfo , Gensichen Jochen , Hay Alastair D , Hapfelmeier Alexander , Kretzschmann Christian , Kurzai Oliver , Lam Thien-Tri , Massidda Orietta , Sanftenberg Linda , Schmiemann Guido , Schneider Antonius , Simmenroth Anne , Stark Stefanie , Warkentin Lisette , Ebell Mark H , Gágyor Ildikó
Published: March 2024

Introduction

Uncomplicated urinary tract infections (uUTIs) in women are common infections encountered in primary care. Evidence suggests that rapid point-of-care tests (POCTs) to detect bacteria and erythrocytes in urine at presentation may help primary care clinicians to identify women with uUTIs in whom antibiotics can be withheld without influencing clinical outcomes. This pilot study aims to provide preliminary evidence on whether a POCT informed management of uUTI in women can safely reduce antibiotic use.

Methods and analysis

This is an open-label two-arm parallel cluster-randomised controlled pilot trial. 20 general practices affiliated with the Bavarian Practice-Based Research Network (BayFoNet) in Germany were randomly assigned to deliver patient management based on POCTs or to provide usual care. POCTs consist of phase-contrast microscopy to detect bacteria and urinary dipsticks to detect erythrocytes in urine samples. In both arms, urine samples will be obtained at presentation for POCTs (intervention arm only) and microbiological analysis. Women will be followed-up for 28 days from enrolment using self-reported symptom diaries, telephone follow-up and a review of the electronic medical record. Primary outcomes are feasibility of patient enrolment and retention rates per site, which will be summarised by means and SDs, with corresponding confidence and prediction intervals. Secondary outcomes include antibiotic use for UTI at day 28, time to symptom resolution, symptom burden, number of recurrent and upper UTIs and re-consultations and diagnostic accuracy of POCTs versus urine culture as the reference standard. These outcomes will be explored at cluster-levels and individual-levels using descriptive statistics, two-sample hypothesis tests and mixed effects models or generalised estimation equations.

Ethics and dissemination

The University of Würzburg institutional review board approved MicUTI on 16 December 2022 (protocol n. 109/22-sc). Study findings will be disseminated through peer-reviewed publications, conferences, reports addressed to clinicians and the local citizen’s forums.

Trial registration number

ClinicalTrials.govNCT05667207.
Comparison of home-based rehabilitation and a centre-based exercise in terms of functional capacity, muscle oxygenation and quality of life in people with peripheral arterial disease: a protocol for a randomised controlled trial
Authors: Nascimento Isabella de Oliveira , Geisel Patrícia Paulino , de Faria Valéria Cristina , Ferreira Ana Paula , Passos Bruno Rezende , Prado Déborah , Parreira Veronica Franco , Gomes Pereira Danielle
Published: March 2024

Introduction

Peripheral arterial disease (PAD) is increasingly prevalent, and supervised physical exercise programmes are recommended as the first-line treatment. However, these programmes are underused. Alternative delivery models may be able to expand treatment coverage. The objective of this study was to compare a home-based exercise programme (HBEP) and a centre-based exercise (CBE) in terms of their effects on functional capacity, peripheral muscle oxygenation and quality of life in individuals with PAD.

Methods and analysis

This single-blind, parallel randomised clinical trial will consist of two groups: HBEP and CBE. A qualitative analysis will be carried out to investigate acceptability and satisfaction. The primary outcome will be functional capacity, assessed by the incremental shuttle walk test. Secondary outcomes will include functional capacity, assessed by a treadmill walking test; peripheral muscle oxygenation and quality of life; and self-reported functional impairment, risk factors, morbidity, level of physical activity, adherence, acceptability and satisfaction. The intervention protocols will consist of 12 weeks of intermittent walking until claudication symptoms, three times a week. Participants randomly assigned to the CBE group will participate in supervised face-to-face sessions. The HBEP group will perform exercises at home with remote supervision, monitored by a pedometer and heart rate monitor, and subjective perception of effort during each session will be recorded by participants in a training diary; follow-up will be conducted by telephone calls. Statistical analyses will follow the intention-to-treat principle. Participants allocated to the HBEP group will be interviewed about their experience of remote treatment using a qualitative approach.

Ethics and dissemination

Ethics approval was obtained from the Ethics Committee of the Universidade Federal de Minas Gerais. The results will be disseminated in a peer-reviewed journal and presented at international congresses. This research has the potential to improve the care of people with PAD because if home-based rehabilitation demonstrates effectiveness, it could be considered an alternative or support resource to the usual centre-based treatment models, expanding access, coverage and participation in vascular physiotherapy

Trial registration

https://ensaiosclinicos.gov.br/rg/RBR-97vy9n7on 14 April 2022.