bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation and interlaboratory comparison of anticoagulant rodenticide analysis in animal livers using ultra-performance liquid chromatography–mass spectrometry
Authors: Chen Yang , Lopez Salvador , Reddy Ravinder M. , Wan Jason , Tkachenko Andriy , Nemser Sarah M. , Smith Lori , Reimschuessel Renate
Published: June 2023

Anticoagulant rodenticides (ARs) are used to control rodent populations. Poisoning of non-target species can occur by accidental consumption of commercial formulations used for rodent control. A robust method for determining ARs in animal tissues is important for animal postmortem diagnostic and forensic purposes. We evaluated an ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS) method to quantify 8 ARs (brodifacoum, bromadiolone, chlorophacinone, coumachlor, dicoumarol, difethialone, diphacinone, warfarin) in a wide range of animal (bovine, canine, chicken, equine, porcine) liver samples, including incurred samples. We further evaluated UPLC-MS in 2 interlaboratory comparison (ILC) studies; one an ILC exercise (ICE), the other a proficiency test (PT). The limits of detection of UPLC-MS were 0.3–3.1 ng/g, and the limits of quantification were 0.8–9.4 ng/g. The recoveries obtained using UPLC-MS were 90–115%, and relative SDs were 1.2–13% for each of the 8 ARs for the 50, 500, and 2,000 ng/g spiked liver samples. The overall accuracy from the laboratories participating in the 2 ILC studies (4 and 11 laboratories for ICE and PT studies, respectively) were 86–118%, with relative repeatability SDs of 3.7–11%, relative reproducibility SDs of 7.8–31.2%, and Horwitz ratio values of 0.5–1.5. Via the ILC studies, we verified the accuracy of UPLC-MS for AR analysis in liver matrices and demonstrated that ILC can be utilized to evaluate performance characteristics of analytical methods.
Extending the admissible control-loop delays for the inverted pendulum by fractional-order proportional-derivative controller
Authors: Balogh Tamas , Insperger Tamas
Published: June 2023

Stabilization of the inverted pendulum by fractional-order proportional-derivative (PD) feedback with two delays is investigated. This feedback law is obtained as a combination of PD feedback with two delays and fractional-order PD feedback with a single delay. Different types of stabilizability boundaries and the corresponding geometric and multiplicity conditions are determined using the D-subdivision method. The stabilizable region is depicted in the plane of the delay parameters for given fractional derivative orders. Several special cases and the concept of delay detuning are also discussed. It is shown that the admissible delay can be slightly increased compared to the integer-order PD feedback by introducing a fractional-order feedback term.
‘The wisdom of crowds’: When teacher judgments outperform word-frequency as a predictor of students’ vocabulary knowledge
Authors: Robles-García Pablo , Stewart Jeffrey , Nicklin Christopher , Vitta Joseph P. , McLean Stuart , Kramer Brandon
Published: June 2023

This study investigated the effectiveness of word-frequency and teacher judgments in determining students’ vocabulary knowledge and compared the predictive powers of both approaches when estimating vocabulary knowledge. Twenty-nine second language (L2) Spanish teachers were asked to predict how likely their students would know words from a 216-word Yes/No test that measures knowledge of the first 3,000 words in Spanish. The accuracy of their responses was compared with the results of 1,075 L2 Spanish students who completed the same test. To examine if the results could generalize to other L2 settings, 394 L2 English students completed a 70-word Yes/No test that measures knowledge of the first 14,000 words in English, and 15 L2 English language instructors attempted to predict which words would or would not be recognized. Results showed that for both language contexts, (1) the median teacher rater could assess students’ vocabulary knowledge with an accuracy roughly comparable to frequency, (2) the combination of teachers’ judgments displayed a stronger relationship with students’ performance on the vocabulary test than frequency, since the average of three or more teachers’ ratings improved upon frequency when examined with 1,000 bootstrapped samples, and (3) using teacher judgments and frequency together did not substantially improve the prediction of students’ vocabulary knowledge.
The effects of task-induced involvement load and gloss languages on incidental L2 vocabulary learning
Authors: Phadungsilp Parichard , Supasiraprapa Sarut
Published: June 2023

The current study investigated the interaction between task-induced involvement load and the languages used in vocabulary glosses on incidental second language (L2) word learning in low proficiency learners of English as a foreign language (EFL). Using computer-based tasks, the study also probed whether a task with a higher level of involvement load promoted a greater learner engagement with unfamiliar words, as measured by their hypertext gloss lookup frequencies. A total of 160 Thai EFL learners were equally divided into five task conditions based on the relative level of involvement load (low, high) and type of target word gloss (no glosses, L1 glosses, L2 glosses). The findings suggest that a task with a higher level of involvement load and first language (L1) glosses is most conducive to L2 word learning and that gloss language can mediate the effect of involvement load. Moreover, a task with a higher level of involvement load prompted learners to be more engaged with unfamiliar L2 words, irrespective of gloss language. The study provides partial support for the Involvement Load Hypothesis and reveals the differential effects of L1 and L2 glosses on L2 learning, which were not taken into account in the hypothesis. Pedagogical implications are also discussed.
Technocracy above partisanship? Comparing the appeal of non-partisan and partisan experts as ministers – A survey in 14 countries
Authors: Vittori Davide , Rojon Sebastien , Pilet Jean-Benoit , Paulis Emilien
Published: June 2023

The literature on technocracy has shown that expertise is a crucial factor in driving support for technocrats. However, the literature has not investigated yet what happens when technocrats are opposed to partisan experts. In this article, we want to fill this gap by analysing the support for two potential ministers of health with relevant expertise for their portfolio but with a different relationship to partisan politics. For this purpose, we run a novel survey in 14 European countries with more than 20,000 respondents. Our main results show that non-partisan experts are preferred over partisan experts across Europe, both when citizens have a high sympathy and a low sympathy for the party appointing the minister. However, in the latter case, the effect is more evident.
Mechanical performance of fiber-reinforced polymer tank under road pavements for stormwater storage
Authors: Zhang Jiehui , Gao Xuelong , Lin Guan , Zhang Pan , Wang Yuhong , Lin Haizhuo , Chen Feng
Published: June 2023

Due to increasing precipitation intensity, rising sea level, and land development, urban flooding has become a major issue in many places around the world. This research aims to develop underground storage tanks (USTs) using fiber-reinforced polymer (FRP) materials for stormwater detention, storage, and reuse. The USTs are intended to be placed underneath highway or street pavements. FRP as one of the emerging structural materials possesses several advantages including high strength-to-weight ratio and corrosion resistance. The mechanical performance of USTs has rarely been visited in the literature, the majority of which focuses on leakage issues and associated environmental problems. This paper presents detailed analyses of the mechanical performance of FRP USTs, including a laboratory test on a small-scale FRP UST and a verified finite element (FE) analysis on full-scale FRP USTs. The influences of various factors on the mechanical performance of the USTs were examined, including wall thickness, water storage, interfacial roughness between FRP and soil, and tank sizes. Both results from experiments and FE studies agree satisfactorily and reveal that (i) underground FRP UST developed tensile axial strains at the top surface at the mid-span of the tank and the side surface at the mid-height; (ii) compressive axial strains developed in most of the cap region; and (iii) large compressive circumference strains developed in the FRP UST in most locations. Insights gained from the laboratory test and the FE analysis are expected to provide a general guidance on the design of FRP USTs under road pavements for urban flooding mitigation and stormwater harvesting.
Development and evaluation of a skeletal mechanism for EHN additized gasoline mixtures in large Eddy simulations of HCCI combustion
Authors: Guleria Gaurav , Lopez-Pintor Dario , Dec John E , Assanis Dimitris
Published: June 2023

Advanced Low Temperature Combustion modes, such as the Sandia proposed Additive-Mixing Fuel Injection (AMFI), can unlock significant potential to boost fuel conversion efficiency and ultimately improve the energy conversion of internal combustion engines. This is a novel improved combustion process that is enabled by supplying small (<5%) variable amounts of autoignition improver to the fuel to enhance the engine operation and control. Common, diesel-fuel ignition-quality enhancing additive, 2-ethylexyl nitrate (EHN), is doped into gasoline to enable Sandia LTGC + AMFI combustion. This manuscript focuses on the development of a reduced sub-mechanism for EHN chemical kinetics at engine relevant conditions that is implemented into a skeletal mechanism for chemical kinetic studies of gasoline surrogate fuels. The mechanism validation utilized zero-dimensional numerical simulations and comparison to shock tube ignition-delay data of pure and EHN-doped n-heptane. Additional validation is presented with Homogeneous Charge Compression-Ignition (HCCI) engine data of pure and EHN-doped research-grade E10 gasoline. Then, the mechanism was deployed in a 3-D computational fluid dynamics (CFD) using Large Eddy Simulations (LES) to model the HCCI engine experiments of 0.4% vol EHN additized E10 gasoline at several equivalence ratios. Simulations showed a very good performance of the mechanism, and the model accurately reproduced (a) the ignition point, (b) combustion phasing, (c) combustion duration, and (d) the peak of the heat release rates of the engine experiments. The results show that EHN promotes Low-Temperature Heat Release, ultimately driving the gasoline to autoignite at thermodynamic conditions where the fuel would not otherwise ignite. Overall, this work demonstrates a viable reduced chemical-kinetic mechanism for EHN and shows that it can be combined with a skeletal gasoline mechanism for CFD-LES analysis of well-mixed LTGC that matches well with experimental results. The CFD-LES analysis also shows the spatial distribution of EHN-fuel interactions that control the autoignition throughout the combustion chamber.
Victims of Technology-Assisted Child Sexual Abuse: A Scoping Review
Authors: Chauviré-Geib Katrin , Fegert Jörg M.
Published: June 2023

Over the past two decades, technology-assisted child sexual abuse (TA-CSA) has become the focus of attention in politics, legislation, society, as well as research. However, the majority of literature and studies focus primarily on the offenders. This scoping review therefore aims to illustrate how victims of TA-CSA are represented in studies as primary participants. The databases Embase, PsychInfo, PSYNDEX, Cochrane Library, and Web of Science as well as reference lists were searched. Studies needed to be published between 2007 and 2021 and obtain data directly from and about victims to be included in this review. A total of 570 articles were identified from which 20 studies met inclusion criteria. The analysis showed that data can be obtained via different samples like adult and minor victims or other data such as legal documents or sexualized images. The studies researched different types of TA-CSA including exposure to pornographic material, online grooming leading to both online and offline sexual abuse, sexting and sexualized images, and the visual depiction of sexually explicit content. Consequences due to the abuse were of an emotional and psychological nature, medical or physical or impacted relationships, and the social environment. Even though the impact of the abuse on the victims appeared to be similar between different types of TA-CSA, much remains unknown. In order to gain further and more detailed insight into victims of TA-CSA, a universally accepted definition of TA-CSA as well as its different types and their distinctions needs to be established.
Off-Pump Neochordae Implantation via Left Minithoracotomy for Recurrent Regurgitation Following Mitral Valve Repair: The First Case in Japan
Authors: Seguchi Ryuta , Watanabe Go , Miyagi Motomu , Koakutsu Toru , Horikawa Takafumi , Shigematsu Sayaka , Miyata Kazuto , Kuroiwa Nobuyuki
Published: June 2023

Surgical fixation after recurrent regurgitation following surgical mitral repair has been technically demanding and associated with high morbidity and mortality. Avoiding reopening the adhesive site or limiting the usage of cardiopulmonary bypass are solutions for reducing the operative risk. We report a case of recurrent mitral regurgitation treated by off-pump neochordae implantation via left minithoracotomy. A 69-year-old woman with a history of conventional mitral repair via median sternotomy developed heart failure due to mitral regurgitation from recurrent posterior leaflet P2 prolapse. Four neochordaes were implanted off-pump via left minithoracotomy using a NeoChord DS1000 in the seventh intercostal space. No transfusion was required. The patient was discharged a week after the procedure with no complications. The regurgitation remains trivial 6 months after the NeoChord procedure.
BASIC: A Bayesian adaptive synthetic-control design for phase II clinical trials
Authors: Jiang Liyun , Thall Peter F , Yan Fangrong , Kopetz Scott , Yuan Ying
Published: June 2023

Background

Randomized controlled trials are considered the gold standard for evaluating experimental treatments but often require large sample sizes. Single-arm trials require smaller sample sizes but are subject to bias when using historical control data for comparative inferences. This article presents a Bayesian adaptive synthetic-control design that exploits historical control data to create a hybrid of a single-arm trial and a randomized controlled trial.

Methods

The Bayesian adaptive synthetic control design has two stages. In stage 1, a prespecified number of patients are enrolled in a single arm given the experimental treatment. Based on the stage 1 data, applying propensity score matching and Bayesian posterior prediction methods, the usefulness of the historical control data for identifying a pseudo sample of matched synthetic-control patients for making comparative inferences is evaluated. If a sufficient number of synthetic controls can be identified, the single-arm trial is continued. If not, the trial is switched to a randomized controlled trial. The performance of The Bayesian adaptive synthetic control design is evaluated by computer simulation.

Results

The Bayesian adaptive synthetic control design achieves power and unbiasedness similar to a randomized controlled trial but on average requires a much smaller sample size, provided that the historical control data patients are sufficiently comparable to the trial patients so that a good number of matched controls can be identified in the historical control data. Compared to a single-arm trial, The Bayesian adaptive synthetic control design yields much higher power and much smaller bias.

Conclusion

The Bayesian adaptive synthetic-control design provides a useful tool for exploiting historical control data to improve the efficiency of single-arm phase II clinical trials, while addressing the problem of bias when comparing trial results to historical control data. The proposed design achieves power similar to a randomized controlled trial but may require a substantially smaller sample size.
Self-management interventions for chronically ill patients with limited health literacy: A descriptive analysis
Authors: van der Gaag M. , Heijmans M. , Valli C. , Orrego C. , Ballester M. , Rademakers J.
Published: June 2023

Objectives

To support patients with limited health literacy with the challenges they face in the day-to-day management of their disease(s), numerous self-management interventions (SMIs) have been developed. To date, it is unclear to what extent SMIs have been developed for chronically ill patients with limited health literacy. This study aims to provide a description of these SMIs and to provide insight in their methodological components.

Methods

A secondary analysis of the COMPAR-EU database, consisting of SMIs addressing patients with diabetes, chronic obstructive pulmonary disease, obesity and heart failure, was conducted. The database was searched for SMIs addressing health literacy, including cognitive aspects and the capacity to act.

Results

Of the 1681 SMIs in the COMPAR-EU database, 35 studies addressed health literacy, describing 39 SMIs. The overview yields a high variety in interventions given, with overlapping information, but also lacking of specific details.

Discussion

This descriptive analysis shows that there was a large variety in the extensiveness of the description of intervention characteristics and their justification or explanation. A focus on the broad concept of health literacy, including functional skills, cognitive skills and the capacity to act could improve the effectiveness. This should be taken into account in the future development of SMIs.
The Longitudinal Relationship Between Parenting and Self-Control Needs Reconsideration: A Commentary on Li et al. (2019)
Authors: Chen Cheng , Dang Junhua
Published: June 2023

The relationship between parenting and self-control has received much attention from social and developmental psychologists. In a meta-analytic review, Li et al. (2019) identified a longitudinal association between parenting and subsequent self-control (P → SC) of r = .157, p < .001, and a longitudinal association between adolescent self-control and subsequent parenting (SC → P) of r = .155, p < .001. However, the longitudinal associations may have been substantially biased because Li et al. (2019) utilized the bivariate correlation between the predictor at Time 1 and the outcome at Time 2 to estimate the effect size. To provide a more accurate estimate of the longitudinal association between parenting and adolescent self-control, we reexamined the data on the basis of the cross-lagged association. The results showed weaker longitudinal associations for both P → SC ( r = .059, p < .001) and SC → P ( r = .062, p < .001). Our results point to the importance of utilizing the cross-lagged association in meta-analyzing the longitudinal relationship between variables.
Associations of Changes in Knee Hyaline Cartilage Composition Measured With Dual-Energy Computed Tomography in Gout, Aging and Osteoarthritis
Authors: Legrand Julie , Marzin Claire , Neogi Tuhina , Norberciak Laurène , Budzik Jean-François , Pascart Tristan
Published: June 2023

Objective

To characterize dual-energy computed tomography (DECT) changes depicting hyaline cartilage changes in gout patients with and without osteoarthritis (OA) and in comparators without gout.

Design

Patients with suspected crystal-associated arthropathy were enrolled and underwent bilateral DECT scans of the knees. Standardized regions of interest were defined in the femorotibial hyaline cartilage. Five DECT parameters were obtained: CT numbers in Hounsfield units (HU) at 80 and 140 kV, the electron density (Rho), the effective atomic number (Zeff), and the dual-energy index (DEI). Zones were compared between patients with gout, with and without knee OA, and between patients with gout and comparators without gout, after adjustment for confounders.

Results

A total of 113 patients with gout (mean age 63.5 ± 14.3 years) and 15 comparators without gout (mean age 75.8 ± 11.5 years) were included, n = 65 (51%) had knee OA, and 466 zones of hyaline cartilage were analyzed. Older age was associated with lower attenuations at 80 kV ( P < 0.01) and 140 kV ( P < 0.01), and with Rho ( P < 0.01). OA was characterized by lower attenuation at 140 kV ( P = 0.03), but the lower Rho was nonsignificant after adjustment for confounders. In gout, hyaline cartilage exhibited lower Rho values (adjusted P = 0.04). Multivariable coefficients of association with Rho were −0.21 [−0.38;−0.04] ( P = 0.014) for age, −4.15 [−9.0;0.7] ( P = 0.093) for OA and 0.73 [−0.1;1.56] ( P = 0.085) for monosodium urate volume.

Conclusion

Gout was associated with DECT-detected changes in cartilage composition, similar to those observed in older patients, with some similarities and some differences to those seen in OA. These results suggest the possibility of potential DECT biomarkers of OA.
Atopic dermatitis treated with tralokinumab and upadacitinib combination therapy: A case report
Authors: Lansang Rafael Paolo , Zhao Irene X , Lansang Perla
Published: June 2023

A patient presented to clinic with atopic dermatitis that had been previously unresponsive to multiple topical and systemic therapies. They were successfully treated with a combination of tralokinumab and upadacitinib, showing significant improvement after 3 weeks and near-resolution after 6 months.
Knowledge and perception of primary care healthcare professionals on the use of artificial intelligence as a healthcare tool
Authors: Catalina Queralt Miró , Fuster-Casanovas Aïna , Vidal-Alaball Josep , Escalé-Besa Anna , Marin-Gomez Francesc X , Femenia Joaquim , Solé-Casals Jordi
Published: June 2023

Objective

The rapid digitisation of healthcare data and the sheer volume being generated means that artificial intelligence (AI) is becoming a new reality in the practice of medicine. For this reason, describing the perception of primary care (PC) healthcare professionals on the use of AI as a healthcare tool and its impact in radiology is crucial to ensure its successful implementation.

Methods

Observational cross-sectional study, using the validated Shinners Artificial Intelligence Perception survey, aimed at all PC medical and nursing professionals in the health region of Central Catalonia.

Results

The survey was sent to 1068 health professionals, of whom 301 responded. And 85.7% indicated that they understood the concept of AI but there were discrepancies in the use of this tool; 65.8% indicated that they had not received any AI training and 91.4% that they would like to receive training. The mean score for the professional impact of AI was 3.62 points out of 5 (standard deviation (SD)  =  0.72), with a higher score among practitioners who had some prior knowledge of and interest in AI. The mean score for preparedness for AI was 2.76 points out of 5 (SD  =  0.70), with higher scores for nursing and those who use or do not know if they use AI.

Conclusions

The results of this study show that the majority of professionals understood the concept of AI, perceived its impact positively, and felt prepared for its implementation. In addition, despite being limited to a diagnostic aid, the implementation of AI in radiology was a high priority for these professionals.
The lived experience of people with disabilities during the COVID-19 pandemic on Twitter: Content analysis
Authors: Diaz Marlon I. , Medford Richard J. , Lehmann Christoph U. , Petersen Carolyn
Published: June 2023

Objective

People with disabilities (PWDs) are at greater risk of COVID-19 infection, complications, and death, and experience more difficulty accessing care. We analyzed Twitter tweets to identify important topics and investigate health policies’ effects on PWDs.

Methods

Twitter's application programming interface was used to access its public COVID-19 stream. English-language tweets from January 2020 to January 2022 containing a combination of keywords related to COVID-19, disability, discrimination, and inequity were collected and refined to exclude duplicates, replies, and retweets. The remaining tweets were analyzed for user demographics, content, and long-term availability.

Results

The collection yielded 94,814 tweets from 43,296 accounts. During the observation period, 1068 (2.5%) accounts were suspended and 1088 (2.5%) accounts were deleted. Account suspension and deletion among verified users tweeting about COVID-19 and disability were 0.13% and 0.3%, respectively. Emotions were similar among active, suspended, and deleted users, with general negative and positive emotions most common followed by sadness, trust, anticipation, and anger. The overall average sentiment for the tweets was negative. Ten of the 12 topics identified (96.8%) related to pandemic effects on PWDs; “politics that rejects and leaves the disabled, elderly, and children behind” (48.3%) and “efforts to support PWDs in the COVID crisis” (31.8%) were most common. The sample of tweets by organizations (43.9%) was higher for this topic than for other COVID-19-related topics the authors have investigated.

Conclusions

The primary discussion addressed how pandemic politics and policies disadvantage PWDs, older adults, and children, and secondarily expressed support for these populations. The increased level of Twitter use by organizations suggests a higher level of organization and advocacy within the disability community than in other groups. Twitter may facilitate recognition of increased harm to or discrimination against specific populations such as people living with disability during national health events.
Integrated Short-term Palliative Rehabilitation to improve quality of life and equitable care access in incurable cancer (INSPIRE): a multinational European research project
Authors: Bayly Joanne , Ahmedzai Hilde Hjelmeland , Blandini Maria Grazia , Bressi Barbara , Caraceni Augusto Tommaso , Carvalho Vasconcelos Joana , Costi Stefania , Fugazzaro Stefania , Guberti Monica , Guldin Mai-Britt , Hauken May , Higginson Irene , Laird Barry J.A. , Ling Julie , Normand Charles , Nottelmann Lise , Oldervoll Line , Payne Cathy , Prevost A. Toby , Stene Guro B. , Vanzulli Elisa , Veber Eduardo , Economos Guillaume , Maddocks Matthew
Published: June 2023

Background:

Disability related to incurable cancer affects over a million Europeans each year and people with cancer rank loss of function among the most common unmet supportive care needs.

Objectives:

To test the clinical and cost-effectiveness of an integrated short-term palliative rehabilitation intervention, to optimise function and quality of life in people affected by incurable cancer.

Design:

This is a multinational, parallel group, randomised, controlled, assessor blind, superiority trial.

Methods:

The INSPIRE consortium brings together leaders in palliative care, oncology and rehabilitation from partner organisations across Europe, with complementary expertise in health service research, trials of complex interventions, mixed-method evaluations, statistics and economics. Partnership with leading European civil society organisations ensures citizen engagement and dissemination at the highest level. We will conduct a multinational randomised controlled trial across five European countries, recruiting participants to assess the effectiveness of palliative rehabilitation for people with incurable cancer on the primary outcome – quality of life – and secondary outcomes including disability, symptom burden and goal attainment. To support trial conduct and enhance analysis of trial data, we will also conduct: comparative analysis of current integration of rehabilitation across oncology and palliative care services; mixed-method evaluations of equity and inclusivity, processes and implementation for the intervention, at patient, health service and health system levels. Finally, we will conduct an evidence synthesis, incorporating INSPIRE findings, and a Delphi consensus to develop an international framework for palliative rehabilitation practice and policy, incorporating indicators, core interventions, outcomes and integration methods.

Scientific contribution:

If positive, the trial could produce a scalable and equitable intervention to improve function and quality of life in people with incurable cancer and reduce the burden of care for their families. It could also upskill the practitioners involved and motivate future research questions. The intervention could be adapted and integrated into different health systems using existing staff and services, with little or no additional cost.
Model selection for component network meta-analysis in connected and disconnected networks: a simulation study
Authors: Petropoulou Maria , Rücker Gerta , Weibel Stephanie , Kranke Peter , Schwarzer Guido
Published: June 2023

Background

Network meta-analysis (NMA) allows estimating and ranking the effects of several interventions for a clinical condition. Component network meta-analysis (CNMA) is an extension of NMA which considers the individual components of multicomponent interventions. CNMA allows to “reconnect” a disconnected network with common components in subnetworks. An additive CNMA assumes that component effects are additive. This assumption can be relaxed by including interaction terms in the CNMA.

Methods

We evaluate a forward model selection strategy for component network meta-analysis to relax the additivity assumption that can be used in connected or disconnected networks. In addition, we describe a procedure to create disconnected networks in order to evaluate the properties of the model selection in connected and disconnected networks. We apply the methods to simulated data and a Cochrane review on interventions for postoperative nausea and vomiting in adults after general anaesthesia. Model performance is compared using average mean squared errors and coverage probabilities.

Results

CNMA models provide good performance for connected networks and can be an alternative to standard NMA if additivity holds. For disconnected networks, we recommend to use additive CNMA only if strong clinical arguments for additivity exist.

Conclusions

CNMA methods are feasible for connected networks but questionable for disconnected networks.
Use of days alive without life support and similar count outcomes in randomised clinical trials – an overview and comparison of methodological choices and analysis methods
Authors: Granholm Anders , Kaas-Hansen Benjamin Skov , Lange Theis , Munch Marie Warrer , Harhay Michael O. , Zampieri Fernando G. , Perner Anders , Møller Morten Hylander , Jensen Aksel Karl Georg
Published: June 2023

Background

Days alive without life support (DAWOLS) and similar outcomes that seek to summarise mortality and non-mortality experiences are increasingly used in critical care research. The use of these outcomes is challenged by different definitions and non-normal outcome distributions that complicate statistical analysis decisions.

Methods

We scrutinized the central methodological considerations when using DAWOLS and similar outcomes and provide a description and overview of the pros and cons of various statistical methods for analysis supplemented with a comparison of these methods using data from the COVID STEROID 2 randomised clinical trial. We focused on readily available regression models of increasing complexity (linear, hurdle-negative binomial, zero–one-inflated beta, and cumulative logistic regression models) that allow comparison of multiple treatment arms, adjustment for covariates and interaction terms to assess treatment effect heterogeneity.

Results

In general, the simpler models adequately estimated group means despite not fitting the data well enough to mimic the input data. The more complex models better fitted and thus better replicated the input data, although this came with increased complexity and uncertainty of estimates. While the more complex models can model separate components of the outcome distributions (i.e., the probability of having zero DAWOLS), this complexity means that the specification of interpretable priors in a Bayesian setting is difficult.

Finally, we present multiple examples of how these outcomes may be visualised to aid assessment and interpretation.

Conclusions

This summary of central methodological considerations when using, defining, and analysing DAWOLS and similar outcomes may help researchers choose the definition and analysis method that best fits their planned studies.

Trial registration

COVID STEROID 2 trial, ClinicalTrials.gov: NCT04509973, ctri.nic.in: CTRI/2020/10/028731.
Determinants of medication adherence in hemodialysis patients: a cross-sectional study based on capability-opportunity-motivation and behavior model
Authors: Mirzaei-Alavijeh Mehdi , Hamzeh Behrooz , Omrani Hamidreza , Esmailli Sharareh , Khakzad Saeid , Jalilian Farzad
Published: June 2023

Background

Medication adherence is a key component of successful dialysis in end-stage renal disease (ESRD). The aim of this study was to use the Capability-Opportunity-Motivation and Behavior (COM-B) model in order to identify the most important determinants of medication adherence among ESRD patients.

Methods

This research was a cross-sectional design that was conducted in two steps in 2021. In the first step, COM-B components of patients undergoing hemodialysis (HD) therapy were extracted through literature review. The second step was a cross-sectional study among 260 ESRD patients referred to the dialysis unit from Kermanshah, in the west of Iran. Data was collected using a written questionnaire by interviews. The data was analyzed in SPSS version 16 software.

Results

The mean age of respondents was 50.52 years [95% CI: 48.71, 52.33], ranged from 20 to 75 years. The mean score of medication adherence was 11.95 [95% CI: 11.64, 12.26], ranged from 4 to 20. Medication adherence is higher among patients with higher education (P = 0.009) and those who were employed (P < 0.001) and was significantly related to income (r = 0.176), while it was inversely and significantly related to the medication duration (r=-0.250). Motivation (Beta: 0.373), self-efficacy (Beta: 0.244), and knowledge (Beta: 0.116) are stronger determinants of medication adherence.

Conclusion

COM-B model can be proposed as an integrated framework in predicting medication adherence among ESRD patients. Our findings provide theory-based recommendations that can help future clinical and research decision-making for the development, implementation, and evaluation of treatment adherence interventions in Iranian ESRD patients. The use of COM-B model can provide a comprehensive explanation about medication adherence in ESRD patients. Future research should be focus on increasing motivation, self-efficacy and knowledge of Iranian ESRD patients in order to increasing medication adherence.
A multi-centre randomized controlled trial investigating Consolidation Chemotherapy with and without oxaliplatin in distal rectal cancer and Watch & Wait
Authors: Habr-Gama Angelita , São Julião Guilherme Pagin , Ortega Cinthia D. , Vailati Bruna Borba , Araujo Sergio , Jorge Thiago , Sabbaga Jorge , Rossi Gustavo L. , D’Alpino Renata , Kater Fabio Roberto , Aguilar Patricia Bailão , Mattacheo Adrian , Perez Rodrigo Oliva ,   Latin American Rectal Cancer Consortium (LARCC)
Published: June 2023

Background

Neoadjuvant chemoradiation(nCRT) has been considered the preferred initial treatment strategy for distal rectal cancer. Advantages of this approach include improved local control after radical surgery but also the opportunity for organ preserving strategies (Watch and Wait-WW). Consolidation chemotherapy(cCT) regimens using fluoropyrimidine-based with or without oxalipatin following nCRT have demonstrated to increase complete response and organ preservation rates among these patients. However, the benefit of adding oxaliplatin to cCT compared to fluoropirimidine alone regimens in terms of primary tumor response remains unclear. Since oxalipatin-treatment may be associated with considerable toxicity, it becomes imperative to understand the benefit of its incorporation into standard cCT regimens in terms of primary tumor response. The aim of the present trial is to compare the outcomes of 2 different cCT regimens following nCRT (fluoropyrimidine-alone versus fluoropyrimidine + oxaliplatin) for patients with distal rectal cancer.

Methods

In this multi-centre study, patients with magnetic resonance-defined distal rectal tumors will be randomized on a 1:1 ratio to receive long-course chemoradiation (54 Gy) followed by cCT with fluoropyrimidine alone versus fluoropyrimidine + oxaliplatin. Magnetic resonance(MR) will be analyzed centrally prior to patient inclusion and randomization. mrT2-3N0-1 tumor located no more than 1 cm above the anorectal ring determined by sagittal views on MR will be eligible for the study. Tumor response will be assessed after 12 weeks from radiotherapy(RT) completion. Patients with clinical complete response (clinical, endoscopic and radiological) may be enrolled in an organ-preservation program(WW). The primary endpoint of this trial is decision to organ-preservation surveillance (WW) at 18 weeks from RT completion. Secondary endpoints are 3-year surgery-free survival, TME-free survival, distant metastases-free survival, local regrowth-free survival and colostomy-free survival.

Discussion

Long-course nCRT with cCT is associated with improved complete response rates and may be a very attractive alternative to increase the chances for organ-preservation strategies. Fluoropyrimidine-based cCT with or without oxaliplatin has never been investigated in the setting of a randomized trial to compare clinical response rates and the possibility of organ-preservation. The outcomes of this study may significantly impact clinical practice of patients with distal rectal cancer interested in organ-preservation.

Trial registration

www.clinicaltrials.gov NCT05000697; registered on August 11th, 2021.
Risk of retinal vein occlusion in colorectal cancer patients receiving anti-vascular endothelial growth factors – a population-based cohort study
Authors: Lee Wan-Ju Annabelle , Chung Wei-Pang , Shao Shih-Chieh , Lai Edward Chia-Cheng , Chen Yi-Chen , Ho Chung-Han
Published: June 2023

Background

Anti−vascular endothelial growth factors (VEGFs) treatment has been associated with an increased risk of thromboembolic events. Therefore, the use of anti−VEGFs for patients with colorectal cancers (CRC) has raised concerns about the potential risk of retinal vein occlusion (RVO), an ocular disease caused by embolism or venous stasis. This study aims to evaluate the risk of RVO in patients with CRC treated with anti−VEGFs.

Method

We conducted a retrospective cohort study using the Taiwan Cancer Registry and National Health Insurance Database. The study cohort comprised patients newly diagnosed with CRC between 2011 and 2017, who received anti-VEGF treatment. For each patient in the study cohort, a control group comprising four patients newly diagnosed with CRC, but not receiving anti-VEGF treatment, was randomly selected. A washout period of 12 months was implemented to identify new cases. The index date was defined as the date of the first prescription of anti-VEGF drugs. The study outcome was the incidence of RVO, as identified by ICD-9-CM (362.35 and 362.36) or ICD-10-CM codes (H3481 and H3483). Patients were followed from their index date until the occurrence of RVO, death or the end of the study period. Covariates, including patients' age at index date, sex, calendar year of CRC diagnosis, stage of CRC and comorbidities related to RVO, were included. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with adjustments for all covariates to compare the risk of RVO between the anti-VEGF and control groups.

Results

We recruited 6285 patients in the anti-VEGF group and 37,250 patients in the control group, with mean ages of 59.49 ± 12.11 and 63.88 ± 13.17 years, respectively. The incidence rates were 1.06 per 1000 person-years for the anti-VEGF group, and 0.63 per 1000 person-years for the controls. There was no statistically significant difference in RVO risk between the anti-VEGF and control groups (HR: 2.21, 95% CI: 0.87–5.61).

Conclusion

Our results indicated no association between use of anti-VEGF and occurrence of RVO among CRC patients, although the crude incidence rate of RVO was higher in patients receiving anti-VEGF, compared to control patients. Future study with larger sample size is required to confirm our findings.
Microstructural and microperimetric comparison of internal limiting membrane peeling and insertion in large idiopathic macular hole
Authors: Liu Lingzi , Wang Zengyi , Yu Yanping , Yang Xiaohan , Qi Biying , Zhang Ke , Liu Wu
Published: June 2023

Background

The internal limiting membrane (ILM) insertion technique was widely used to treat large macular hole (MH) for the high closure rate. However, the prognosis of closed MH after ILM insertion compared to ILM peeling remains controversial. This study aimed to compare foveal microstructure and microperimeter in large idiopathic MH surgically closed by ILM peeling and ILM insertion.

Methods

This retrospective, non-randomized, comparative study included patients with idiopathic MH (minimum diameter ≥ 650 μm) who underwent primary pars plana vitrectomy (PPV) with ILM peeling or ILM insertion. The initial closure rate was recorded. Patients with initially closed MHs were divided into two groups according to the surgery methods. The best-corrected visual acuity (BCVA), optical coherence tomography (OCT) and microperimeter-3 (MP-3) outcomes of two groups were compared at baseline, 1 and 4 months postoperatively.

Results

For idiopathic MH (minimum diameter ≥ 650 μm), ILM insertion had a significantly higher initial closure rate than ILM peeling (71.19% vs. 97.62%, P = 0.001). Among 39 patients with initially closed MHs who were on regular follow-up, twenty-one were assigned to the ILM peeling group and 18 to the ILM insertion group. Postoperative BCVA improved significantly in both groups. The final BCVA (logMAR) (0.40 vs. 0.88, P < 0.001), macular hole sensitivity (19.66 dB vs. 14.14 dB, P < 0.001), peripheral sensitivity of macular hole (24.63 dB vs. 21.95 dB, P = 0.005), and fixation stability (FS) within 2 degrees (82.42% vs. 70.57%, P = 0.031) were significantly better and external limiting membrane (ELM) defect (330.14 μm vs. 788.28 μm, P < 0.001) and ellipsoid zone (EZ) defect (746.95 μm vs. 1105.11 μm, P = 0.010) were significantly smaller in the ILM peeling group than in the ILM insertion group.

Conclusion

For initially closed MHs (minimum diameter ≥ 650 μm), both ILM peeling and ILM insertion significantly improved the microstructure and microperimeter in the fovea. However, ILM insertion was less efficient at microstructural and functional recovery after surgery.
Relationship between fatigue and quality of life and related factors in family caregivers of patients on hemodialysis
Authors: Akbari Roghayeh , Farsi Zahra , Sajadi Seyedeh Azam
Published: June 2023

Background

The incessant and stressful nature of providing care to patients with chronic diseases can cause fatigue in caregivers. Caregivers’ fatigue and reduced quality of life can reduce the patient’s quality of care. Since it is important to pay attention to the mental health of family caregivers, this study investigated the relationship between fatigue and quality of life and their related factors in family caregivers of patients on hemodialysis.

Methods

This cross-sectional descriptive-analytical study was performed in 2020–2021. One hundred seventy family caregivers were recruited by convenience sampling from two hemodialysis referral centers in the east of Mazandaran province, Iran. The data collection tools were the Family Caregiver Quality of Life questionnaire and Krupp’s fatigue severity scale.

Results

The majority (88%) of caregivers had moderate to severe fatigue. Caregivers’ fatigue was a major factor influencing their quality of life. There was a significant fatigue difference between some categories of kinship and the caregiver’s income level (P < 0.05). Caregivers with lower income and education levels, those who were the patient’s spouse, and those who could not leave the patient alone had significantly worse quality of life than other caregivers (P < 0.05). Also, caregivers living with the patient in the same house had a worse quality of life than those living separately (P = 0.05).

Conclusion

Considering the high prevalence of fatigue among family caregivers of patients on hemodialysis and its adverse effect on their quality of life, it is recommended to perform routine screenings and implement fatigue alleviation interventions for these caregivers.
Exploring spatial patterns, and identifying factors associated with insufficient cash or food received from a productive safety net program among eligible households in Ethiopia: a spatial and multilevel analysis as an input for international food aid programmers
Authors: Demsash Addisalem Workie , Emanu Milkias Dugassa , Walle Agmasie Damtew
Published: June 2023

Background

In low-income countries, households’ food insecurity and the undernutrition of children are the main health problems. Ethiopia is vulnerable to food insecurity and undernutrition among children because its agricultural production system is traditional. Hence, the productive safety net program (PSNP) is implemented as a social protection system to combat food insecurity and enhance agricultural productivity by providing cash or food assistance to eligible households. So, this study aimed to explore spatial patterns of households’ insufficient cash or food receiving from PSNP, and identify its associated factors in Ethiopia.

Methods

The 2019 Ethiopian Mini Demographic and Health Survey dataset was used. A total of 8595 households were included in this study. Data management and descriptive analysis were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for spatial exploration and visualization. SaTScan version 9.5 software was used for spatial scan statistics reports. In the multilevel mixed effect logistic regression analysis, explanatory variables with a p-value of less than 0.05 were considered significant factors.

Results

Overall, 13.5% (95% CI: 12.81–14.27%) of the households’ level beneficiaries received cash or food from PSNP. The spatial distribution of households’ benficiaries received cash or food from PSNP was not random, and good access to cash or food from PSNP was detected in Addis Ababa, SNNPR, Amhara, and Oromia regions. Households’ heads aged 25–34 (AOR:1.43, 95% CI: 1.02, 2.00), 35–44 (AOR: 2.41, 95% CI: 1.72, 3.37), and > 34 (AOR: 2.54, 95% CI: 1.83, 3.51) years, being female (AOR: 1.51, 95% CI: 1.27,1.79), poor households (AOR: 1.91, 95% CI:1.52, 2.39), Amhara (AOR:.14, 95% CI: .06, .39) and Oromia (AOR:.36, 95% CI:.12, 0.91) regions, being rural residents (AOR:2.18, 95% CI: 1.21,3.94), and enrollment in CBHS (AOR: 3.34, 95% CI:2.69,4.16) are statistically significant factors.

Conclusions

Households have limited access to cash or food from the PSNP. Households in Addis Ababa, SNNPR, Amhara, and Oromia regions are more likely to receive benefits from PSNP. Encouraging poor and rural households to receive benefits from the PSNP and raise awareness among beneficiaries to use the benefits they received for productivity purposes. Stakeholders would ensure the eligibility criteria and pay close attention to the hotspot areas.