bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship between Serum Sodium Concentration and Albuminuria: A Retrospective Cohort Study
Authors: Cole Nicholas I. , Swift Pauline A. , Suckling Rebecca J. , He Feng J. , Gallagher Hugh , van Vlymen Jeremy , Byford Rachel , de Lusignan Simon
Published: August 2024

Background: Lowering dietary salt intake reduces albuminuria, an early marker of renal damage and a sensitive predictor of adverse cardiovascular outcomes. The mechanisms underlying this effect are uncertain but small changes in serum sodium concentration may be important: this retrospective cohort study investigated the hypothesis that higher serum sodium concentration is a risk factor for albuminuria (defined as a urine albumin:creatinine ratio [UACR], ≥3 mg/mmol). Methods: Primary care data from the Royal College of General Practitioners Research and Surveillance Centre were used to identify 47,294 individuals with a UACR result available between April 2010 and March 2015, and no known albuminuria prior to this. Exclusion criteria were missing or abnormal serum sodium concentration at baseline (<135 or >146 mmol/L); age <18 years; diabetes mellitus; decompensated liver disease; heart failure; and stage 5 chronic kidney disease. Results: After adjustment for known risk factors, there was a significant “U-shaped” relationship between serum sodium concentration and albuminuria. The lowest risk was associated with a serum sodium of 138–140 mmol/L. In comparison, the risk of albuminuria was 18% higher with a serum sodium of 135–137 mmol/L and 19% higher with a serum sodium of 144–146 mmol/L. There was no association between serum sodium concentration and blood pressure. Conclusion: The finding of a positive association between higher serum sodium concentration and albuminuria is in support of the hypothesis, but the inverse relationship between serum sodium concentration and albuminuria at lower concentrations warrants further explanation.
Wasting and Its Associated Nutritional and Non-Nutritional Factors among Under-Five Children in Marrakesh Province, Morocco
Authors: El Moussaoui Soufiane , Kaoutar Kamal , Chetoui Ahmed , Boutahar Keltoum , El Kardoudi Abdeslam , Najimi Mohamed , Bourrous Mounir , Chigr Fatiha
Published: August 2024

Introduction: Malnutrition is the most common nutritional disorder in developing countries and it remains one of the most common causes of morbidity and mortality among children worldwide. Therefore, the current study aimed to assess the prevalence of wasting and its associated factors among under-five children in Marrakesh province in Morocco. Method: A community-based cross-sectional study design was used to determine the prevalence of wasting and its associated factors among under-5 years old children. A structured questionnaire was used to collect data from 430 children paired with their mothers. Anthropometric measurements and determinant factors were collected. SPSS version 19.0 statistical software was used for analysis. Multivariate logistic regression analysis was conducted to identify factors associated to the wasting of the children. Statistical association was declared significant if p value was less than0.05. Results: In this study, the prevalence of wasting was 9.3%. The proportions of severe and moderate wasting children were 6.5% and 2.8%, respectively. Higher odds of wasting children among illiterate mothers were 17 times more likely compared with mothers with high levels (ORa = 17.17; 95% CI: 1.01–13.70). In line with this, the odds of wasting children among lower household incomes were 13 times more likely when compared to those with higher household incomes (ORa = 13.114; 95% CI: 1.13–7.60). Similarly, the odds of wasting children among mothers primiparous were 12 times more likely compared with multiparous (ORa = 12.88; 95% CI: 1.04–4.08). The odds of wasting children were more observed among children who did not benefit from exclusive breastfeeding (ORa = 12.297; 95% CI: 2.47–13.03, 1.03–5.34). Conclusions: The current study showed that the prevalence of wasting among under-five children in Marrakesh province was relatively common. Mother’s education level, household income, parity, and exclusive breastfeeding were significantly associated with wasting. Therefore, nutritional educational intervention programs in Marrakesh province should focus on these factors.
Making Sense of Spiritual, Metaphysical, and Eschatological Elements in Delusions: A Qualitative Study Using Interpretative Phenomenological Analysis
Authors: Nischk Daniel , Gutschmidt Rico
Published: August 2024

Background: Spiritual, metaphysical, or eschatological elements in delusions (SMEDs) are frequent and often subjectively regarded as profound transformational experiences, similar to mystical experiences. This study aimed (1) to explore how SMEDs are experienced and in which aspects they are similar to mystical experiences and (2) to investigate how individuals make sense of SMED. Methods: Seven participants were interviewed, and their expressions were analyzed using interpretative phenomenological analysis. Results: We found that SMEDs were similar to mystical experiences with regard to alterations in perception of space, time, and unity. Furthermore, SMEDs were accompanied by a sense of enlightenment that however remained ineffable. SMEDs were interpreted from different viewpoints, i.e., as a source of ontological insight, as a mental health issue, as an inspiration for a new orientation in the world, and, for some participants, as an example of the limits of knowledge. Making sense of SMED appeared to follow a lively internal dialogue in which various, sometimes contradictory positions were reflected upon. Participants usually struggled to align the ostensible ontological significance of SMED to the dominating illness explanation. Conclusion: SMEDs have similarities to mystical experiences, but integrating SMED into one’s own life is challenging. We propose a philosophical, non-pathological interpretation of SMED derived from a novel perspective on mystical experience which may also have some therapeutic utility.
Construction of Risk-Prediction Models for Autogenous Arteriovenous Fistula Thrombosis in Patients on Maintenance Hemodialysis
Authors: Jin Xiaoyu , Fan Yuying , Li Jingshu , Qi Xiaona , Li Xue , Li Hongyi
Published: August 2024

Introduction: Autogenous arteriovenous fistula (AVF) is the preferred vascular access in patients undergoing maintenance hemodialysis (MHD). However, complications such as thrombosis may occur. This study aimed to construct and validate a machine learning-based risk-prediction model for AVF thrombosis, hypothesizing that such a model can effectively predict occurrences, providing a foundation for early clinical intervention. Methods: The retrospective longitudinal study included a total of 270 patients who underwent MHD at the Hemodialysis Center of the Second Affiliated Hospital of Harbin Medical University between March 2021 and December 2022. During this study, baseline data and scale information of patients between March 2020 and December 2021 were collected. We recorded outcome indicators between March 2021 and December 2022 for subsequent analyses. Five machine learning models were developed (artificial neural network, logistic regression, ridge classification, random forest, and adaptive boosting). The sensitivity (recall), specificity, accuracy, and precision of each model were evaluated. The effect size of each variable was analyzed and ranked. Models were assessed using the area under the receiver-operating characteristic (AUROC) curve. Results: Among the 270 included patients, 105 had AVF thrombosis (55 male and 50 female patients; age range, 29–79 years; mean age, 56.72 years; standard deviation [SDs], ±13.10 years). Conversely, 165 patients did not have AVF thrombosis (99 male and 66 female patients; age range, 23–79 years; mean age, 53.58 years; SD, ± 13.33 years). During the observation period, approximately 52.6% of patients with AVF experienced long-term complications. The most common complications associated with AVF were thrombosis (105; 38.9%), aneurysm formation (27; 10%), and excessively high output flow (10; 3.7%). Fifty-four (20%) patients with AVF required intervention because of complications associated with vascular access. The AUROC curve of the testing set was between 0.858 and 0.903. Conclusion: In this study, we developed five machine learning models to predict the risk of AVF thrombosis, providing a reference for early clinical intervention.
Intracranial Atherosclerotic Disease and Incident Dementia: The ARIC Study (Atherosclerosis Risk in Communities)
Authors: Zhao Di , Guallar Eliseo , Qiao Ye , Knopman David S. , Palatino Maylin , Gottesman Rebecca F. , Mosley Thomas H. , Wasserman Bruce A.
Published: August 2024

BACKGROUND:

Studies of the neurovascular contribution to dementia have largely focused on cerebral small vessel disease (CSVD), but the role of intracranial atherosclerotic disease (ICAD) remains unknown in the general population. The objective of this study was to determine the risk of incident dementia from ICAD after adjusting for CSVD and cardiovascular risk factors in a US community-based cohort.

METHODS:

We acquired brain magnetic resonance imaging examinations from 2011 through 2013 in 1980 Black and White participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective cohort conducted in 4 US communities. Magnetic resonance imaging examinations included high-resolution vessel wall magnetic resonance imaging and magnetic resonance angiography to identify ICAD. Of these participants, 1590 without dementia, without missing covariates, and with adequate magnetic resonance image quality were followed through 2019 for incident dementia. Associations between ICAD and incident dementia were assessed using Cox proportional hazard ratios adjusted for CSVD (characterized by white matter hyperintensities, lacunar infarctions, and microhemorrhages), APOE4 genotype (apolipoprotein E gene ε4), and cardiovascular risk factors.

RESULTS:

The mean age (SD) of study participants was 77.4 (5.2) years. ICAD was detected in 34.6% of participants. After a median follow-up of 5.6 years, 286 participants developed dementia. Compared with participants without ICAD, the fully adjusted hazard ratios (95% CIs) for incident dementia in participants with any ICAD, with ICAD only causing stenosis ≤50%, and with ICAD causing stenosis >50% in ≥1 vessel were 1.57 (1.17–2.11), 1.41 (1.02–1.95), and 1.94 (1.32–2.84), respectively. ICAD was associated with dementia even among participants with low white matter hyperintensities burden, a marker of CSVD.

CONCLUSIONS:

ICAD was associated with an increased risk of incident dementia, independent of CSVD, APOE4 genotype, and cardiovascular risk factors. The increased risk of dementia was evident even among participants with low CSVD burden, a group less likely to be affected by vascular dementia, and in participants with ICAD causing only low-grade stenosis. Our results suggest that ICAD may partially mediate the effect that cardiovascular risk factors have on the brain leading to dementia. Both ICAD and CSVD must be considered to understand the vascular contributions to cognitive decline.
Role of Computed Tomography Angiography Enhancement Ratio in Predicting Prognosis in Patients With Stroke Undergoing Endovascular Treatment
Authors: Liao Anyu , Huang Lijun , Huang Kangmo , Pan Liangyuan , Kasaer Feiluola , Wang Fang , Zhou Changsheng , Jiang Yangyang , Song Zhiruo , Zhu Xijing , Lan Wenya , Xiao Lulu , Cheng Xiaoqing , Zhu Wusheng
Published: August 2024

Background

The computed tomography angiography enhancement ratio (CTA‐ER), calculated through the net water uptake formula, is a valuable predictive tool for detecting adverse events after stroke. However, limited research has investigated the correlation between CTA‐ER and the prognosis of patients receiving endovascular treatment. Therefore, we aimed to examine whether CTA‐ER could predict favorable outcomes in patients undergoing endovascular treatment.

Methods

We conducted a retrospective study enrolling patients with acute anterior circulation large‐vessel occlusive stroke undergoing endovascular treatment between January 2016 and January 2023. All patients received noncontrast computed tomography and computed tomography angiography scans upon admission. Multivariate logistic regression analysis and receiver operator characteristic curve were used to assess the predictive efficacy in determining favorable outcomes. The favorable outcome at 90 days was a modified Rankin scale score of 0 to 2.

Results

A total of 206 participants (median age, 68 [60–77] years; 77 women) were included in the study, with 82 (39.8%) individuals demonstrating favorable outcomes. Patients with favorable outcomes had lower noncontrast computed tomography net water uptake (6.42% versus 7.76%;
P
< 0.001) and CTA‐ER (8.31% versus 10.56%;
P
< 0.001). Multivariate logistic regression analysis identified that CTA‐ER was a significant predictor for favorable outcomes (
P
<0.05 in all models). Furthermore, the receiver operator characteristic analysis revealed that CTA‐ER exhibited superior predictive performance, surpassing noncontrast computed tomography net water uptake (area under the curve, 0.707 versus 0.636, Delong test;
P
= 0.046).

Conclusion

CTA‐ER is a significant predictor of favorable outcomes in patients with acute large‐vessel occlusion stroke undergoing endovascular treatment.
Prolonged Venous Transit Is Associated With Lower Likelihood of Favorable Clinical Recovery in Reperfused Anterior Circulation Large‐Vessel Occlusion Stroke
Authors: Yedavalli Vivek S. , Koneru Manisha , Balar Aneri B. , Lakhani Dhairya A. , Cho Andrew , Wen Sijin , Mei Yanqing , Hoseinyazdi Meisam , Greene Cynthia , Xu Risheng , Luna Licia P , Caplan Justin M. , Dmytriw Adam A. , Guenego Adrien , Heit Jeremy J , Albers Gregory W. , Wintermark Max , Gonzalez Luis Fernando , Urrutia Victor C. , Huang Judy , Nael Kambiz , Faizy Tobias D. , Leigh Richard , Marsh Elisabeth B. , Hillis Argye E. , Llinas Rafael H.
Published: August 2024

Background

Unfavorable clinical outcomes in patients with acute ischemic stroke caused by large‐vessel occlusions despite successful reperfusion have been associated with poor venous outflow. The objective of this study is to assess the relationship between prolonged venous transit (PVT), a novel perfusion imaging surrogate for poor venous outflow, and likelihood of favorable clinical recovery.

Methods

In this retrospective review of prospectively collected data of consecutive patients (2017–2022) with successfully reperfused, anterior circulation acute ischemic stroke caused by large‐vessel occlusions, we assessed the association between PVT+, defined as time to maximum ≧10‐second timing delays within either the posterior superior sagittal sinus, torcula, or both regions on pretreatment perfusion imaging, and favorable clinical outcomes defined as 90‐day modified Rankin Scale score of 0 to 2. Patients were dichotomized into PVT+ and PVT− for analysis. Multivariable logistic regression analyses for favorable recovery were performed with demographic variables and stroke characteristics.

Results

A total of 127 consecutive patients (median age, 71 [interquartile range 61—77] years; 59.1% women) were included, and 40 of 127 (31.5%) were PVT+. PVT+ (adjusted odds ratio [aOR], 0.23 [95% CI, 0.07–0.81];
P
= 0.02) and advanced age (aOR, 0.92 [95% CI, 0.88–0.97];
P
= 0.01) were significantly associated with the primary outcome.

Conclusion

PVT+ was associated with a lower likelihood of achieving favorable clinical recovery in successfully reperfused patients with acute ischemic stroke caused by large vessel occlusion. PVT may serve as a clinically useful adjunctive imaging parameter.
50 Years of the Proposed Crime of Ecocide: Challenges Regarding its Definition and Possible Answers
Authors: Valencia Arias Francisca , Reinefeld Ann-Kathrin
Published: August 2024

More than 50 years have passed since the first proposal of a crime of ecocide under international criminal law. What seemed to be slow progress at first reached a peak of proliferation in public-legal discussion over the recent years. This paper is an effort to recapitulate the development of ecocide as a crime, analysing the different proposals from a critical point of view that will attempt to crystallise the challenges that they present. This analysis will be based on four main criteria: (a) the punishable conduct described, which will necessarily raise the discussion of the anthropocentric vis-à-vis an ecocentric vision; (b) the subjective element proposed and its compatibility with the Rome Statute; (c) the possible perpetrator; and (d) the legal instrument through which it is sought to be enshrined. Finally, we present certain guidelines regarding an International Criminal Court for the Environment and its compatibility with the International Criminal Court.
Supplement to the genus Pseudokuzicus Gorochov, 1993 (Orthoptera: Tettigoniidae: Meconematinae) with one new species from China
Authors: LV WENQING , SHI FUMING , CHANG YANLIN
Published: August 2024

This paper describes one new species of the genus Pseudokuzicus Gorochov, 1993 from Guangxi, China, i.e. Pseudokuzicus (Similkuzicus) multispinus sp. nov., which is similar to Pseudokuzicus (Similkuzicus) quadridentatus Shi, Mao & Chang, 2007. Morphological photographs of the new species, supplementary description and photographs of male genitalia of Pseudokuzicus (Similkuzicus) quadridentatus Shi, Mao & Chang, 2007 are provided.
Online Signals of Extremist Mobilization
Authors: Brown Olivia , Smith Laura G. E. , Davidson Brittany I. , Racek Daniel , Joinson Adam
Published: August 2024

Psychological theories of mobilization tend to focus on explaining people’s motivations for action, rather than mobilization (“activation”) processes. To investigate the online behaviors associated with mobilization, we compared the online communications data of 26 people who subsequently mobilized to right-wing extremist action and 48 people who held similar extremist views but did not mobilize ( N = 119,473 social media posts). In a three-part analysis, involving content analysis (Part 1), topic modeling (Part 2), and machine learning (Part 3), we showed that communicating ideological or hateful content was not related to mobilization, but rather mobilization was positively related to talking about violent action, operational planning, and logistics. Our findings imply that to explain mobilization to extremist action, rather than the motivations for action, theories of collective action should extend beyond how individuals express grievances and anger, to how they equip themselves with the “know-how” and capability to act.
eCoaching in Rural Schools: Effects on Literacy Planning and Instruction for Students With Extensive Support Needs
Authors: Cheek Aftynne E. , Bennett Carolina , Carter Tamela
Published: August 2024

Literacy is the ability to read, write, speak, and listen in a way that facilitates effective communication. For students with extensive support needs (ESN), acquiring literacy skills is challenging because these students often need accommodations, modifications, and multiple layers of support to learn and practice literacy. These challenges are often exacerbated in rural locations due to a lack of resources and access to professionals. Additionally, the literature base available to assist educators is lacking, and many special education teachers rely on professional development to acquire new strategies (e.g., Modified Anchor-Read-Apply). Using an ABA single-subject research design, the authors investigated the impact of eCoaching on a special education teacher’s use of the Modified Anchor-Read-Apply strategy to teach literacy and the impact on three students’ interactive reading practices. Results indicated that the special education teacher was able to use the strategy with fidelity, enabling both teacher and students to increase their interactive reading practices.
Hold the Bets! Should Quasi-Experiments Be Preferred to True Experiments When Causal Generalization Is the Goal?
Authors: Jaciw Andrew P.
Published: August 2024

By design, randomized experiments (XPs) rule out bias from confounded selection of participants into conditions. Quasi-experiments (QEs) are often considered second-best because they do not share this benefit. However, when results from XPs are used to generalize causal impacts, the benefit from unconfounded selection into conditions may be offset by confounded selection into locations. This work shows that this tradeoff can lead to situations where estimates from QEs are less-biased from selection than are estimates from uncompromised XPs when drawing causal generalizations. This work establishes the conditions theoretically, demonstrates the idea empirically, and discusses the implications of the results.
A Community of People Like Me. An Analysis of Members’ Perceptions of Their Engagement in Party Youth Wings
Authors: Bolin Niklas , Jungar Ann-Cathrine
Published: August 2024

This study investigates how members of party youth wings perceive their respective youth wings and identifies areas they believe require improvement. Empirically, the study surveys the youth wings of eight Swedish political parties, exploring members’ experiences using open-ended questions. The findings confirm that political and social aspects hold greater importance for youth wing members compared to material benefits. Additionally, the analysis reveals how members view the youth wing as a transformative community fostering personal growth, self-exploration and the development of values. Notably, the youth wing is seen as a community unified by shared values, with a collective vision for the world and a focus on collaborative efforts to realize that vision. Challenges include expectations set by the mother party, such as campaigning and career aspirations, and negative perceptions of the competitive political landscape, citing conflicts and factionalism.
The Effect of IVF Treatments for Infertility on Occupational Balance
Authors: Leigh Lindsay , Skuthan Alysha
Published: August 2024

The utilization of assisted reproductive technologies (ART), including in vitro fertilization (IVF), has doubled in the past decade. The occupational balance of women undergoing infertility and its treatments is unknown. A qualitative study to investigate the occupational balance of women undergoing IVF for infertility was completed. Ten women currently undergoing or having undergone IVF were interviewed. Thematic analysis was used to analyze the effect of IVF on occupational balance. Three themes emerged, tunnel vision, it’s all on me, and I’m not enough, highlighting the challenges faced by women during the IVF journey that affect their occupational balance. Participants reported a lack of occupational balance due to the intense focus on IVF, overwhelming responsibilities, inadequate support, anxiety, depression, and self-doubt. Comprehensive, holistic support and intervention are necessary to address the occupational well-being of women undergoing IVF and can be provided by OTPs.
Assessing Clinical Reasoning and Decision-Making in Swedish Prehospital Emergency Care: A Mixed Methods Study With an Experimental Design
Authors: Fager Olof , Hindsberg Ulrika , Johansson André , Axelsson Christer , Andersson Hagiwara Magnus
Published: August 2024

Clinical reasoning and decision-making in prehospital contexts are complex, and patient assessments may be influenced by stress or biases, thus potentially risking patient safety. Previous research has shown mixed results regarding cognitive interventions designed to counteract biases and improve decision-making. In educational settings, there are no tools that assess clinical reasoning while also measuring important decision-making outcomes. This study employed a mixed-methods design and a novel assessment model to evaluate clinical reasoning and decision-making among Swedish prehospital nurse specialists. Additionally, the effect of the metacognitive TWED mnemonic was investigated. Thirteen participants were randomly assigned to two groups and assessed patients in simulation settings, with groups switching cases after brief training on the TWED mnemonic. The primary outcomes included point-based scoring on decision-making, grading of potential risks of patient harm, and analysis of clinical reasoning through reflections. The results showed large variation, without overall differences between groups or demographics. A complex case presentation resulted in lower scores and greater risks of potential patient harm. Qualitative analysis highlighted participants’ ability to handle conflicting data, which correlated with better outcomes. The use of the TWED mnemonic may have increased commission bias. Further research is needed to validate and understand these findings.
Social Justice in the Name of __________: Cultivating Abolitionist Visions of Justice with Project-Based Learning
Authors: de la Tierra Albert
Published: August 2024

This article focusses on the creative and generative aspects of abolitionism. It presents a two-part group project–based lesson plan designed to increase students’ understanding of and affinity for abolitionism by cultivating empathy, increasing comprehension of systemic issues, and inspiring them to actively pursue transformative change. At its core, the lesson plan aims to encourage students to envision and actively build alternatives to the current status quo, fostering critical analysis and transformative thinking.
Novel Batch Polishing Method of Ceramic Cutting Inserts for Reducing Tool Wear
Authors: Gao Rui , Wang Chunjin , Loh Yee Man , Liang Xiaoliang , Jiang Chen , Cheung Chi Fai
Published: August 2024

Ceramic cutting inserts are a type of cutting tool commonly used in high-speed metal cutting applications. However, the wear of these inserts caused by friction between the workpiece and cutting inserts limits their overall effectiveness. In order to improve the tool life and reduce wear, this study introduces an emerging method called magnetic field-assisted batch polishing (MABP) for simultaneously polishing multiple ceramic cutting inserts. Several polishing experiments were conducted under different conditions, and the wear characteristics were clarified by cutting S136H steel. The results showed that after 15 min of polishing, the surface roughness at the flank face, edge, and nose of the inserts was reduced to below 2.5 nm, 6.25 nm, and 45.8 nm, respectively. Furthermore, the nose radii of the inserts did not change significantly, and there were no significant changes in the weight percentage of elements before and after polishing. Additionally, the tool life of the batch polished inserts was found to be up to 1.75 times longer than that of unpolished inserts. These findings suggest that the MABP method is an effective way to mass polish ceramic cutting inserts, resulting in significantly reduced tool wear. Furthermore, this novel method offers new possibilities for polishing other tools.
An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension – a comprehensive assessment of patient satisfaction
Authors: Bsteh Gabriel , Macher Stefan , Krajnc Nik , Marik Wolfgang , Michl Martin , Müller Nina , Zaic Sina , Harreiter Jürgen , Novak Klaus , Wöber Christian , Pemp Berthold
Published: August 2024

Background

Management of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop concept. Here, we aimed to evaluate effects of this one-stop concept on subjective patient satisfaction and economic outcome in patients with IIH.

Methods

In a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding subjective patient satisfaction (assessed by the Vienna Patient Inventory). Multivariable binary linear regression models were used to adjust for confounders.

Results

Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, management within IC concept was associated with statistically significantly higher subjective patient satisfaction (beta = 0.93; p < 0.001) with the strongest effects observed in satisfaction with treatment accessibility and availability (beta = 2.05; p < 0.001). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of IC in these groups.

Conclusions

Interdisciplinary integrated management of IIH statistically significantly and clinically meaningfully improves patient satisfaction – particularly in socioeconomically underprivileged patient groups. Providing structured central coordination to facilitate and improve access to interdisciplinary management provides means to further improve outcome.
Income and consumption inequality trends: a comparative analysis between paid employees and the self-employed
Authors: Sadaf Sadaf
Published: August 2024

This paper aims to analyze trends in income and consumption inequality for paid and self-employed households and examine to what extent changes in aggregate consumption and income inequality can be explained by changes in their permanent and transitory components over time using data from the Italian Survey of Household Wealth (SHIW) covering the period 1989-2016. The results obtained from the Generalized Method of Moments (GMM) analysis reveal differences in consumption and income inequality, as well as their permanent and transitory components, between self-employed and payroll households. In particular, self-employed households experience higher levels of both income and consumption inequality, the increase in total income and consumption inequality is mainly driven by an increase in its transitory component. Furthermore, findings from other descriptive measures of inequality, such as the Gini coefficient, the variance of the log, 90th/10th, and 50th/10th percentile ratios, support the notion that income inequality is higher than consumption inequality across all groups, with self-employed households exhibiting a more pronounced difference.
A QR code-enabled framework for fast biomedical image processing in medical diagnosis using deep learning
Authors: Mashat Arwa
Published: August 2024

In the realm of disease prognosis and diagnosis, a plethora of medical images are utilized. These images are typically stored either within the local on-premises servers of healthcare providers or within cloud storage infrastructures. However, this conventional storage approach often incurs high infrastructure costs and results in sluggish information retrieval, ultimately leading to delays in diagnosis and consequential wastage of valuable time for patients. The methodology proposed in this paper offers a pioneering solution to expedite the diagnosis of medical conditions while simultaneously reducing infrastructure costs associated with data storage. Through this study, a high-speed biomedical image processing approach is designed to facilitate rapid prognosis and diagnosis. The proposed framework includes Deep learning QR code technique using an optimized database design aimed at alleviating the burden of intensive on-premises database requirements. The work includes medical dataset from Crawford Image and Data Archive and Duke CIVM for evaluating the proposed work suing different performance metrics, The work has also been compared from the previous research further enhancing the system's efficiency. By providing healthcare providers with high-speed access to medical records, this system enables swift retrieval of comprehensive patient details, thereby improving accuracy in diagnosis and supporting informed decision-making.
Differentiating low-risk thymomas from high-risk thymomas: preoperative radiomics nomogram based on contrast enhanced CT to minimize unnecessary invasive thoracotomy
Authors: Gao Chao , Yang Liping , Xu Yuchao , Wang Tianzuo , Ding Hongchao , Gao Xing , Li Lin
Published: August 2024

Background

This study was designed to develop a combined radiomics nomogram to preoperatively predict the risk categorization of thymomas based on contrast-enhanced computed tomography (CE-CT) images.

Materials

The clinical and CT data of 178 patients with thymoma (100 patients with low-risk thymomas and 78 patients with high-risk thymomas) collected in our hospital from March 2018 to July 2023 were retrospectively analyzed. The patients were randomly divided into a training set (n = 125) and a validation set (n = 53) in a 7:3 ratio. Qualitative radiological features were recorded, including (a) tumor diameter, (b) location, (c) shape, (d) capsule integrity, (e) calcification, (f) necrosis, (g) fatty infiltration, (h) lymphadenopathy, and (i) enhanced CT value. Radiomics features were extracted from each CE-CT volume of interest (VOI), and the least absolute shrinkage and selection operator (LASSO) algorithm was performed to select the optimal discriminative ones. A combined radiomics nomogram was further established based on the clinical factors and radiomics scores. The differentiating efficacy was determined using receiver operating characteristic (ROC) analysis.

Results

Only one clinical factor (incomplete capsule) and seven radiomics features were found to be independent predictors and were used to establish the radiomics nomogram. In differentiating low-risk thymomas (types A, AB, and B1) from high-risk ones (types B2 and B3), the nomogram demonstrated better diagnostic efficacy than any single model, with the respective area under the curve (AUC), accuracy, sensitivity, and specificity of 0.974, 0.921, 0.962 and 0.900 in the training cohort, 0.960, 0.892, 0923 and 0.897 in the validation cohort, respectively. The calibration curve showed good agreement between the prediction probability and actual clinical findings.

Conclusions

The nomogram incorporating clinical factors and radiomics features provides additional value in differentiating the risk categorization of thymomas, which could potentially be useful in clinical practice for planning personalized treatment strategies.
Analysis of the impact of maternal sepsis on pregnancy outcomes: a population-based retrospective study
Authors: Chen Hsin-Hua , Wu Chieh-Liang , Chao Wen-Cheng
Published: August 2024

Background

To investigate the association between maternal sepsis during pregnancy and poor pregnancy outcome and to identify risk factors for poor birth outcomes and adverse perinatal events.

Methods

We linked the Taiwan Birth Cohort Study (TBCS) database and the Taiwanese National Health Insurance Database (NHID) to conduct this population-based study. We analysed the data of pregnant women who met the criteria for sepsis-3 during pregnancy between 2005 and 2017 as the maternal sepsis cases and selected pregnant women without infection as the non-sepsis comparison cohort. Sepsis during pregnancy and fulfilled the sepsis-3 definition proposed in 2016. The primary outcome included low birth weight (LBW, < 2500 g) and preterm birth (< 34 weeks), and the secondary outcome was the occurrence of adverse perinatal events.

Results

We enrolled 2,732 women who met the criteria for sepsis-3 during pregnancy and 196,333 non-sepsis controls. We found that the development of maternal sepsis was highly associated with unfavourable pregnancy outcomes, including LBW (adjOR 9.51, 95% CI 8.73–10.36), preterm birth < 34 weeks (adjOR 11.69, 95%CI 10.64–12.84), and the adverse perinatal events (adjOR 3.09, 95% CI 2.83–3.36). We also identified that socio-economically disadvantaged status was slightly associated with an increased risk for low birth weight and preterm birth.

Conclusion

We found that the development of maternal sepsis was highly associated with LBW, preterm birth and adverse perinatal events. Our findings highlight the prolonged impact of maternal sepsis on pregnancy outcomes and indicate the need for vigilance among pregnant women with sepsis.
Significant association between methyl mercury level and latent tuberculosis infection risk: a cross-sectional study
Authors: Hua Hai-bo , Wang Hui-jie
Published: August 2024

Objectives

This cross-sectional study aimed to explore the association between methyl mercury (MeHg) level and latent tuberculosis infection (LTBI) risk based on the data from National Health and Nutrition Examination Survey (NHANES 2011–2012).

Methods

A total of 5243 participants with 20 variables were enrolled. The importance of these variables on TB infection was first ranked by XGBoost and Random Forest methods. Then the association between MeHg level and infection risk was evaluated by restricted cubic spline, threshold effect, and generalized linear regression analyses. We also explored the factors correlated with the difference in MeHg level and finally conducted a mediation analysis to assess the mediating effect of MeHg in LTBI.

Results

521 participants were experiencing the LTBI, and 12 variables showed the differences between infection and non-infection groups (all P < 0.05). Of them, MeHg presented the highest importance on the LTBI. Restricted cubic spline (RCS) next revealed a significant non-linear correlation of MeHg with LTBI (all P < 0.05). Adjusted regression models further indicated their independent association (all P < 0.05), and infection risk increased with the increase of MeHg (P for trend < 0.05). We also found a significant turning point, and their association was significantly observed when MeHg > 5.75 µg/L (P < 0.05). In addition, asthma history was related to the difference in MeHg levels between LTBI and non-LTBI groups. Mediation analysis found that MeHg level partially mediated the association of asthma and LTBI risk (all P < 0.05).

Conclusions

Our study identified MeHg as an independent risk factor for LTBI risk. Their causal relationship needs more investigation to verify.
Variations in the alveolar bone morphology in maxillary molar area: a retrospective CBCT study
Authors: Tang Yao , Lu Wenhsuan , Zhang Yunfan , Wu Weiqiang , Sun Qiannan , Zhang Yuning , Liu Xiaomo , Liang Wei , Chen Si , Han Bing
Published: August 2024

Background

This study quantitatively analyzed the anatomic structure of the alveolar bone in the maxillary molar region at three potential locations for Temporary Anchorage Device (TAD) placement. Additionally, the study compared the variability in this region across different age groups, sagittal skeletal patterns, vertical facial types, and sexes.

Methods

In this retrospective cone-beam computed tomography study, the buccal alveolar bone was analyzed in the posterior molar area of 200 patients, the measurement items include buccal alveolar bone height, alveolar bone thickness, interradicular distance, and maxillary retromolar space.

Results

Buccal alveolar height was greatest in the U56 region. The interradicular space was largest in the U56 region and increased from the alveolar crest to the sinus floor. Buccal alveolar bone thickness was highest in the U67 region and generally increased from the alveolar crest to the sinus floor. The maxillary retromolar space gradually increased from the alveolar crest to the root apex.

Conclusions

TADs are safest when placed in the buccal area between the maxillary second premolar and the first molar, particularly at the 9 mm plane. The U67 region is the optimal safe zone for TAD placement for maxillary dentition distalization. TADs placement in adolescents can be challenging. Maxillary third molar extraction can be considered for maxillary dentition distalization.
Barriers and facilitators for strengthening physiotherapy services in Nepal: perspectives from physiotherapists and health providers
Authors: Shakya Nishchal Ratna , Emén Amanda , Webb Gillian , Myezwa Hellen , Karmacharya Biraj Man , Stensdotter Ann-Katrin
Published: August 2024

Background

Physiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes. Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy.

Objective

This qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal.

Methods

Forty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators.

Results

The study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central.

Conclusions

The results provide information for the development of physiotherapy by pointing out key elements that need attention. Our broad and structured investigation strategy is applicable to others for a comprehensive analysis of barriers and facilitators for physiotherapy services.
Peripheral blood regulatory T cells and disease activity, quality of life, and outcomes in children with juvenile idiopathic arthritis
Authors: Quilis Neus , Mesa-del-Castillo Bermejo Pablo , Boix Paula , Juanola Oriol , Bernabeu Pilar , Francés Rubén , Andrés Mariano
Published: August 2024

Objectives

To measure regulatory T cell (Treg) levels in the peripheral blood of children with juvenile idiopathic arthritis (JIA) and analyse the association of this measure with disease activity, quality of life, adjustment of treatment, and hospitalisation.

Methods

We conducted a two-phase study (cross-sectional and prospective), including consecutive children with a JIA diagnosis according to ILAR criteria. Our independent variables were Tregs, Th1, Th2, and cytokines in peripheral blood, and our dependent variables in the cross-sectional phase were arthritis category, JIA activity, and patient-reported outcomes. To test associations, we used Spearman’s correlation coefficient and the Mann-Whitney U test. In the prospective phase, we explored the probability of treatment adjustment and hospitalisation for JIA during follow-up according to Tregs levels at baseline, using Cox proportional regression.

Results

Our sample included 87 participants (median age 11 years, 63.2% girls). Tregs were not associated with most variables of interest. However, we found that higher Tregs concentration was associated with lower erythrocyte sedimentation rate (ESR) and better subjective disease status and course, while higher IL-10 and TGF-β levels were associated with lower ESR, less pain, and better subjective disease status We found no association between Tregs and treatment adjustments or hospitalisation.

Conclusions

Higher baseline Treg levels in the peripheral blood of children with JIA may be associated with reduced disease activity and better quality of life, though were not informative on the inflammatory progression on the follow-up.
Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial
Authors: Buele Jorge , Avilés-Castillo Fátima , Del-Valle-Soto Carolina , Varela-Aldás José , Palacios-Navarro Guillermo
Published: August 2024

Background

The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant.

Objective

To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI.

Methods

Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions).

Results

Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level.

Conclusions

The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements.

Trial registration

ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931.