bluuebunny/crossref_metadata_2025 huggingface dataset:
Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in Africa
Authors: Kibirige Davis , Olum Ronald , Kyazze Andrew Peter , Bongomin Felix , Sanya Richard E.
Published: September 2022

Objective

To investigate the current status of the availability and affordability of specific essential medicines and diagnostics for diabetes in Africa.

Methods

Systematic review and meta‐analysis. Studies conducted in Africa that reported any information on the availability and affordability of short‐acting, intermediate‐acting, and premixed insulin, glibenclamide, metformin, blood glucose, glycated haemoglobin or HbA1c, and lipid profile tests were included. Random‐effect model meta‐analysis and descriptive statistics were performed to determine the pooled availability and affordability, respectively.

Results

A total of 21 studies were included. The pooled availability of each drug was as follows: short‐acting insulin 33.5% (95% CI: 17.8%–49.2%, I2 = 95.02%), intermediate‐acting insulin 23.1% (95% CI: 6.3%–39.9%, I2 = 91.6%), premixed insulin 49.4% (95% CI: 24.9%–73.9%, I2 = 90.57%), glibenclamide 55.9% (95% CI: 43.8%–68.0%, I2 = 96.7%), and metformin 47.0% (95% CI: 34.6%–59.4%, I2 = 97.54%). Regarding diagnostic tests, for glucometers the pooled availability was 49.5% (95% CI: 37.9%–61.1%, I2 = 97.43%), for HbA1c 24.6% (95% CI: 3.1%–46.1%, I2 = 91.64), and for lipid profile tests 35.7% (95% CI: 19.4%–51.9%, I2 = 83.77%). The median (IQR) affordability in days' wages was 7 (4.7–7.5) for short‐acting insulin, 4.4 (3.9–4.9) for intermediate‐acting insulin, 7.1 (5.8–16.7) for premixed insulin, 0.7 (0.7–0.7) for glibenclamide, and 2.1 (1.8–2.8) for metformin.

Conclusion

The availability of the five essential medicines and three diagnostic tests for diabetes in Africa is suboptimal. The relatively high cost of insulin, HbA1c, and lipid profile tests is a significant barrier to optimal diabetes care. Pragmatic country‐specific strategies are urgently needed to address these inequities in access and cost.
Evolution of isoform‐level gene expression patterns across tissues during lotus species divergence
Authors: Zhang Yue , Yang Xingyu , Van de Peer Yves , Chen Jinming , Marchal Kathleen , Shi Tao
Published: September 2022

Both gene duplication and alternative splicing (AS) drive the functional diversity of gene products in plants, yet the relative contributions of the two key mechanisms to the evolution of gene function are largely unclear. Here, we studied AS in two closely related lotus plants, Nelumbo lutea and Nelumbo nucifera, and the outgroup Arabidopsis thaliana, for both single‐copy and duplicated genes. We show that most splicing events evolved rapidly between orthologs and that the origin of lineage‐specific splice variants or isoforms contributed to gene functional changes during species divergence within Nelumbo. Single‐copy genes contain more isoforms, have more AS events conserved across species, and show more complex tissue‐dependent expression patterns than their duplicated counterparts. This suggests that expression divergence through isoforms is a mechanism to extend the expression breadth of genes with low copy numbers. As compared to isoforms of local, small‐scale duplicates, isoforms of whole‐genome duplicates are less conserved and display a less conserved tissue bias, pointing towards their contribution to subfunctionalization. Through comparative analysis of isoform expression networks, we identified orthologous genes of which the expression of at least some of their isoforms displays a conserved tissue bias across species, indicating a strong selection pressure for maintaining a stable expression pattern of these isoforms. Overall, our study shows that both AS and gene duplication contributed to the diversity of gene function during the evolution of lotus.
Retention of basic surgical skills in veterinary students
Authors: Hunt Julie A. , Gilley Robert S. , Spangler Dawn , Pulliam Tiffany , Anderson Stacy
Published: September 2022

Objective

To quantify veterinary students' retention of surgical skills after a 5‐month period without practice.

Study design

Prospective longitudinal descriptive study.

Sample population

Convenience sample of second year veterinary students (n = 57).

Methods

Students practiced ovariohysterectomy (OVH) on a model during 4 clinical skills laboratories during spring 2021. Students were assessed performing OVH on their model using a validated 22‐item rubric. Students not meeting expectations repeated their assessment 2 weeks later. All students had a 5‐month period, including summer break, without skills practice. Students were again assessed performing OVH on their model in the fall. Students' rubric scores and pass rates were compared before and after summer break.

Results

Students scored lower on their retention test in fall (median = 43) than at the spring assessment (median = 56, P < .001). No difference was detected between lower and higher performing students. Five students (9%) did not meet expectations on their first assessment; more students (17/57, 30%) failed to meet expectations on their retention test (P = .004).

Conclusion

Students experienced a decay in the surgical skills required to perform OVH after a 5‐month period without practice, regardless of the quality of their initial performance.

Clinical significance

Veterinary educators should emphasize the importance of continual practice to maintain skills and should consider assisting students in regaining skills during review sessions on models to improve surgical skill retention after a prolonged break.
As Trabalhadores Domésticas e a Dupla Face da Violência Doméstica em Tempos de Pandemia
Authors: Mello Marilia Montenegro Pessoa de
Published: September 2022

Este artigo tem como objeto o trabalho doméstico em tempos de pandemia, tendo como objetivos: entender como o racismo operou no plano legislativo do trabalho doméstico no Brasil; demostrar a dupla violência doméstica que essa profissão está submetida, nos termos da Lei Maria da Penha, e indicar a essencialidade desse trabalho para a saída e a manutenção de outras mulheres no mercado de trabalho. Para isso foi realizado um levantamento da legislação que trata do trabalho doméstico no Brasil, a revisão de literatura sobre o trabalho doméstico no Brasil e a análise de dados secundários. No campo jurídico poucos são os estudos que versam sobre o trabalho doméstico (remunerado ou não) e a paridade de gêneros, que apesar de tão debatida no plano dessas carreiras  não enfrenta os problemas das mulheres que exercem o trabalho doméstico remunerado nas suas diversas formas de cuidados exercidos por essas mulheres e invisibilizados através da categoria generalizante do trabalho doméstico.
Thermal sensitivity and current-voltage-temperature characteristics in Pt/epitaxy n-Si/n+Si structures as a function of Schottky contact area
Authors: Efeoǧlu Hasan , Turut Abdulmecit , Gül Melik
Published: September 2022

We have investigated the thermal sensitivity of Pt/epitaxy n-Si/n+Si Schottky barrier (SB) diodes as a function of the Schottky contact (SC) area. Moreover, we have reported the current-voltage (I-V) of these SB diodes in the temperature range of 40–320 K. The V-T characteristics for the thermal sensitivity have been measured in the 20–320 K range with steps of 2 K at different current levels, which range from 10 nA to 100 μA. The V-T curves have given two linear regions at each current level, one in the low temperature (LT) region and the other in the high temperature (HT) region. The thermal sensitivity coefficient α has increased with the decreasing current level for all diodes. The α value has increased with increasing SC area at the same current level in the LT region. The case may be attributed to the barrier inhomogeneity at low temperatures. However, in the HT region, the α value has decreased very slightly with increasing SC area at the same current level, which may be ascribed to the fact that the current transport occurs over a lateral homogeneous SB height at high temperatures. The SB height and ideality factor n values from the I-V-T curves have remained approximately unchanged from 170 to 320 K.
Expand, push, break, release, repair: A unique way to secrete macromolecules
Authors: Weigert Roberto
Published: September 2022

Regulated exocytosis is a fundamental process in specialized secretory organs. In this issue of
Science Signaling
, Dolan
et al.
describe a distinctive modality of secretion in the goblet cells of the small intestine crypts driven by intracellular cargo expansion.
A Systems-Based Analysis of Mono- and Combination Therapy for Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections
Authors: Luterbach Courtney L. , Qiu Hongqiang , Hanafin Patrick O. , Sharma Rajnikant , Piscitelli Joseph , Lin Feng-Chang , Ilomaki Jenni , Cober Eric , Salata Robert A. , Kalayjian Robert C. , Watkins Richard R. , Doi Yohei , Kaye Keith S. , Nation Roger L. , Bonomo Robert A. , Landersdorfer Cornelia B. , van Duin David , Rao Gauri G.
Published: September 2022

Antimicrobial resistance is a global threat. As “proof-of-concept,” we employed a system-based approach to identify patient, bacterial, and drug variables contributing to mortality in patients with carbapenem-resistant
Klebsiella pneumoniae
(CR
Kp
) bloodstream infections exposed to colistin (COL) and ceftazidime-avibactam (CAZ/AVI) as mono- or combination therapies.
A Ribosomal Protein Homolog Governs Gene Expression and Virulence in a Bacterial Pathogen
Authors: Trautmann Hannah S. , Ramsey Kathryn M.
Published: September 2022

While bacterial ribosomes are commonly heterogeneous in composition (e.g., incorporating different homologs for a ribosomal protein), how heterogeneity impacts translation is unclear. We found that the intracellular human pathogen
Francisella tularensis
has heterogeneous ribosomes, incorporating one of three homologs for ribosomal protein bS21.
Annotation of the Complete Genome Sequences of Bacteriophages Sara and Birdfeeder
Authors: Adams Benjamin M. , Adams Joseph B. , Brewster Reganne L. , Cutler Michael S. , Davis Anthony E. , Gallegos Abby H. , Hernandez Jeremy S. , May Luke H. , Montoya Emma G. , Reagan Andrew T. , Shurley Jack F. , Grinath Anna S. , Thomas Michael A.
Published: September 2022

Sara is a siphovirus with a linear 17,362bp genome containing 25 genes. Birdfeeder is a podovirus with a circularly permuted 53,897bp genome containing 52 genes. Sara and Birdfeeder were isolated from environmental samples in Plattsburgh, NY, USA and Forest Hill, MD, USA, respectively, using
Microbacterium foliorum
NRRL B-24224.
Temporal Dynamics of Rare and Abundant Soil Bacterial Taxa from Different Fertilization Regimes Under Various Environmental Disturbances
Authors: Sun Yifei , Deng Xuhui , Tao Chengyuan , Liu Hongjun , Shen Zongzhuan , Liu Yaxuan , Li Rong , Shen Qirong
Published: September 2022

Different climate extremes are expected to be a major threat to crop production, and the soil microbiome has been known to play a crucial role in agricultural ecosystems. In recent years, we have known that organic amendments are an effective method for optimizing the composition and functioning of the soil microbial community and maintaining the health of the soil ecosystem.
Comparing Multiple Locus Variable-Number Tandem Repeat Analyses with Whole-Genome Sequencing as Typing Method for Salmonella Enteritidis Surveillance in The Netherlands, January 2019 to March 2020
Authors: Pijnacker Roan , van den Beld Maaike , van der Zwaluw Kim , Verbruggen Anjo , Coipan Claudia , Segura Alejandra Hernandez , Mughini-Gras Lapo , Franz Eelco , Bosch Thijs
Published: September 2022

Salmonella
is the most frequently reported agent causing foodborne outbreaks and the second most common zoonoses in the European Union. The incidence of the most dominant serotype Enteritidis has increased in recent years.
Utilization of the Abbott SARS-CoV-2 IgG II Quant Assay To Identify High-Titer Anti-SARS-CoV-2 Neutralizing Plasma against Wild-Type and Variant SARS-CoV-2 Viruses
Authors: Lin Yi-Chan J. , Evans David H. , Robbins Ninette F. , Orjuela Guillermo , Hu Queenie , Samson Reuben , Abe Kento T. , Rathod Bhavisha , Colwill Karen , Gingras Anne-Claude , Tuite Ashleigh , Yi Qi-Long , O’Brien Sheila F. , Drews Steven J.
Published: September 2022

The United States Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the use of COVID-19 convalescent plasma (CCP) to treat hospitalized patients with COVID-19 in August 2020. However, by 4 February 2021, the FDA had revised the convalescent plasma EUA.
Supplemental Material: The effects of pre-stress assumptions on dynamic rupture with complex fault geometry in the San Gorgonio Pass, California, region
Authors: Tarnowski J.M. , al. et , Oglesby D.D.
Published: September 2022

Contains alternate dynamic modeling results using different nucleation methods.  
Acquired angioedema: an unusual presentation of haematological malignancy
Authors: Farrugia Daniel , Caruana Dingli Michael , Grech Mark
Published: September 2022

A previously healthy man in his 60s being worked up for splenomegaly presented to the emergency department with recurrent episodes of angioedema. Each episode was attributed to a precipitating cause, and consequently, the predisposing C1 esterase inhibitor (C1-INH) deficiency remained undiagnosed until the third presentation. The aetiology of acquired C1-INH deficiency would be primarily obscure and require further investigations to identify. A clonal B cell population was finally isolated by flow cytometry after multiple repeat marrow samples, and a diagnosis of splenic marginal zone lymphoma was subsequently reached. Response to single-agent rituximab was observed with resolution of splenomegaly, disappearance of the antibody and restoration of C1-INH levels.
Cervical inflammatory mass: a very late complication following neonatal oesophagocoloplasty for oesophageal atresia
Authors: Lemos Mariana , Duque Mariana , Lazaro Andre , Bernardes António
Published: September 2022

We report the case of a man in his 40s who presented to our emergency department with a history of fever and a red, swollen and painful neck mass. Shortly following his birth, a congenital oesophageal atresia had been managed surgically with colonic interposition graft. Contrast CT of the neck revealed filling and distention of a colic stump with content of stasis and infection. The patient received intravenous piperacillin/tazobactam and parenteral nutrition. One week later, an upper digestive endoscopy was performed revealing an inflammatory-looking pseudopolypoid area immediately below the anastomosis, at the level of the proximal portion of the colon, which seemed to correspond to a complicated diverticulum with inflammation. The difficulties in reaching a definitive diagnosis and management of this condition are discussed.
Differentiation of hydrochlorothiazide-induced dermatitis from stasis dermatitis
Authors: Abdelwahab Rewan , Tangalos Eric G , Matulis John
Published: September 2022

A woman in her 60s with a history of hypertension and stasis dermatitis presented to a primary care clinic with a bilateral, erythematous rash on the legs, stomach, and chest. Photosensitive rash and dermatitis may be caused by many conditions. Hydrochlorothiazide-induced dermatitis is a rare side effect of thiazide diuretics. Early identification of sulfa-sensitivity and photoallergic or phototoxic reaction is essential to accurate diagnosis and treatment of photosensitive dermatitis. Soliciting a targeted history is essential to delineating drug-induced dermatitis from stasis dermatitis. A thorough skin examination can elucidate the focal or extensive nature of the rash and is essential to making an accurate diagnosis. Immediate cessation of hydrochlorothiazide and switching drugs classes for hypertension management typically leads to resolution of symptoms.
Whole exome sequencing, clinical exome or targeted gene panels: what to choose for suspected lethal skeletal dysplasia (short rib thoracic dysplasia type IV)
Authors: Das Shreya , Sharma Charu , Gothwal Meenakshi , Tada Nayan
Published: September 2022

Lethal skeletal dysplasias (SDs) are a heterogeneous group of rare but important genetic disorders characterised by abnormal growth and development of bone and cartilage. The phenotypic variation of SD highlights the complex aetiology for this group of disorders. Short rib polydactyly syndrome (SRPS) types I–IV are a group of rare congenital autosomal recessive types of SD.

We report a case of a non-consanguineous couple whose two successive pregnancies were diagnosed with multiple congenital anomalies in fetuses suggestive of lethal SD (likely SRPS type IV) at 24 and 19 weeks period of gestation, respectively. Pregnancy was terminated, and the whole exome sequencing of the abortus for genetic analysis in the second pregnancy confirmed an autosomal recessive type of short rib thoracic dysplasia-4 (SRTD-4) also called SRPS in homozygous condition. Our case is unique as it was also associated with cystic hygroma which is a rare association with SRPS/SRTD-4.
Efficacy of time-restricted eating and behavioural economic interventions in reducing fasting plasma glucose, HbA1c and cardiometabolic risk factors compared with time-restricted eating alone or usual care in patients with impaired fasting glucose: protocol for an open-label randomised controlled trial
Authors: Suthutvoravut Unyaporn , Anothaisintawee Thunyarat , Boonmanunt Suparee , Pramyothin Sarunporn , Chaithanasarn Arthit , Reutrakul Sirimon , Thakkinstian Ammarin
Published: September 2022

Introduction

Impaired fasting glucose (IFG) is a significant risk factor for diabetes mellitus. Time-restricted eating (TRE) is one type of diet showing positive effects on metabolic signal pathways. However, effects of TRE on cardiometabolic risk factors in humans are limited. Additionally, compliance with TRE remains problematic despite having intention to follow the diet control. Therefore, this study aims to investigate the efficacy of TRE with behavioural economic interventions or TRE alone relative to usual care, in reducing fasting plasma glucose (FPG), haemoglobin A1c (HbA1c) and other cardiometabolic risk factors in patients with IFG.

Methods and analysis

This parallel-group, open-label randomised controlled trial will be conducted at the outpatient clinic of the Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. Patients aged 18–65 years with IFG defined as FPG 100–125 mg/dL and body mass index ≥25 kg/m2will be recruited between October 2021 and October 2022. Patients will be randomly allocated to three groups (1:1:1 ratio) as (1) TRE with behavioural economic interventions including financial incentives and text reminders, (2) TRE alone or (3) usual care. The number of participants will be 38 per group (a total of 114). The duration of the intervention will be 12 weeks. Primary outcome is FPG levels measured at 12 weeks after randomisation. Secondary outcomes are HbA1c, body weight, systolic and diastolic blood pressure, fasting insulin, serum triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and high-sensitivity C reactive protein. P value of <0.05 of two-sided test will be considered as statistical significance.

Ethics and dissemination

The study protocol has been approved by the Ethics Committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University (MURA2021/389). All patients will be informed about the details of the study and sign written informed consent before enrollment in the study. Results from this study will be published in a peer-reviewed journal.

Trial registration number

TCTR20210520002.
COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study
Authors: Dujmovic Morgane , Roederer Thomas , Frison Severine , Melki Carla , Lauvin Thomas , Grellety Emmanuel
Published: September 2022

Introduction

French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment.

Methods

A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021.

Results

The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff.

Conclusion

Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents’ and caregivers’ overall well-being and mental health.
Effect of intensive care unit-specific virtual reality (ICU-VR) to improve psychological well-being in ICU survivors: study protocol for an international, multicentre, randomised controlled trial—the HORIZON-IC study
Authors: Vlake Johan Hendrik , van Bommel Jasper , Wils Evert-Jan , Korevaar Tim IM , Taccone Fabio , Schut Anna FC , Elderman Jan H , Labout Joost AM , Raben Adrienne MTJ , Dijkstra Annemieke , Achterberg Sefanja , Jurriens Amber L , Van Mol Margo MC , Gommers Diederik , Van Genderen Michel E
Published: September 2022

Introduction

A substantial proportion of intensive care unit (ICU) survivors develop psychological impairments after ICU treatment, part of the postintensive care syndrome, resulting in a decreased quality of life. Recent data suggest that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients is feasible and safe, improves satisfaction with ICU aftercare, and might improve psychological sequelae. In the present trial, we firstly aim to determine whether ICU-VR is effective in mitigating post-traumatic stress disorder (PTSD)-related symptoms and secondly to determine the optimal timing for initiation with ICU-VR.

Methods and analysis

This international, multicentre, randomised controlled trial will be conducted in 10 hospitals. Between December 2021 and April 2023, we aim to include 300 patients who have been admitted to the ICU ≥72 hours and were mechanically ventilated ≥24 hours. Patients will be followed for 12 consecutive months. Patients will be randomised in a 1:1:1 ratio to the early ICU-VR group, the late ICU-VR group, or the usual care group. All patients will receive usual care, including a mandatory ICU follow-up clinic visit 3 months after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR within 2 weeks after ICU discharge. Patients in the late VR group will receive ICU-VR during the post-ICU follow-up visit. The primary objective is to assess the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to determine optimal timing for ICU-VR, to assess the effects on anxiety-related and depression-related symptoms and health-related quality of life, and to assess patient satisfaction with ICU aftercare and perspectives on ICU-VR.

Ethics and dissemination

The Medical Ethics Committee United, Nieuwegein, the Netherlands, approved this study and local approval was obtained from each participating centre (NL78555.100.21). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals.

Trial registration number

NL9812.
Impact of prolonged isolation on adolescents with drug-susceptible tuberculosis in Lima, Peru: a qualitative study
Authors: Oliva Rapoport Victoria Elena , Altamirano Elmer , Senador Liz , Wong Milagros , Beckhorn Catherine B , Coit Julia , Roche Stephanie D , Lecca Leonid , Galea Jerome T , Chiang Silvia S
Published: September 2022

Objectives

Patients with tuberculosis (TB) generally are instructed to isolate at the beginning of treatment in order to prevent disease transmission. The duration of isolation varies and may be prolonged (ie, lasting 1 month or more). Few studies have examined the impact of isolation during TB treatment on adolescents, who may be more vulnerable to its negative effects.

Methods

This study took place from 2018 through 2019 in Lima, Peru, where the Ministry of Health mandates the exclusion of patients with TB from educational institutions for at least 2 months. Using semi-structured guides, we conducted individual in-depth interviews with adolescents who received treatment for drug-susceptible TB, their primary caregivers and health providers. We performed thematic analysis of the transcribed interviews.

Results

We interviewed 85 participants: 34 adolescents, 36 caregivers and 15 healthcare workers. At the time of their TB diagnoses, 28 adolescents were in secondary, postsecondary, vocational or military school. Adolescents with drug-susceptible TB were prescribed home isolation usually for 2 (and occasionally for 1) months. Consequently, they could neither attend school nor socialise with family members or friends. Two primary themes emerged from the interviews. First, as a result of their exclusion from school, most adolescents fell behind academically and had to repeat a semester or academic year. Second, absence from school, separation from friends and loved ones, and reinforcement of TB-related stigma (arising from fear of TB transmission) harmed adolescents’ mental health.

Conclusion

Prolonged isolation led to educational setbacks and emotional trauma among adolescents with TB. Prolonged isolation is not supported by current evidence on TB transmission and is problematic from a human rights perspective, as it violates adolescents’ rights to education and freedom of movement. Isolation recommendations should be re-evaluated to align with data on TB transmission and the principles of patient-centred care.
Police officers’ work–life balance, job satisfaction and quality of life: longitudinal effects after changing the shift schedule
Authors: Rohwer Elisabeth , Velasco Garrido Marcial , Herold Robert , Preisser Alexandra Marita , Terschüren Claudia , Harth Volker , Mache Stefanie
Published: September 2022

Objectives

To evaluate mental health-related outcomes of police officers 5.5 years after implementing a new alternating shift schedule which was supposed to improve their health and work–life balance.

Design

Pre–post study design with a baseline survey at the beginning of the piloting of the new shift schedule in 2015 and another survey 5.5 years later in 2020.

Setting

Police departments of a German metropolitan police force piloting the new shift schedule.

Participants

116 shift-working police officers out of a population of 1673 police officers at the follow-up date.

Interventions

New shift schedule based on occupational health recommendations.

Outcomes measures

Work–life balance, job satisfaction and quality of life.

Methods

Mixed analyses of variances were used to test the hypotheses of within-subject and between-subject differences regarding time and gender.

Results

We found partly significant differences between the baseline and follow-up survey for work–life balance (F(1, 114) = 6.168, p=0.014, ηp² = 0.051), job satisfaction (F(1, 114) = 9.921, p=0.002, ηp² = 0.080) and quality of life (F(1, 114) = 0.593, p=0.443, ηp² = 0.005). Neither significant differences between male and female police officers nor interaction effects of time and gender were found.

Conclusion

An increase was found for each of the three outcomes 5.5 years after implementing the new shift schedule. The results contribute to the current state of research on mental health-related outcomes of working conditions in shift work. On this basis, recommendations for designing shift schedules can be deduced to promote mental health and job satisfaction for employees in shift work.
What are the characteristics of excellent physicians and residents in the clinical workplace? A systematic review
Authors: Khawar Abdullah , Frederiks Femke , Nasori Mana , Mak Marianne , Visser Mechteld , van Etten-Jamaludin Faridi , Diemers Agnes , Van Dijk Nynke
Published: September 2022

Objectives

In order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes loss of talent, loss of role models and it lowers work ethos. This causes less than excellent patient care and lack of commitment to improve the healthcare system.

Design

Systematic review performed according to the Association for Medical Education in Europe guideline.

Information sources

We searched Medline, Embase, Psycinfo, ERIC and CINAHL until 14 March 2022.

Eligibility criteria

We included original studies describing characteristics of excellent medical doctors, using a broad approach as to what is considered excellence. Assuming that excellence will be viewed differently depending on the interplay, and that different perspectives (peers, supervisors and patients) will add to a complete picture of the excellent medical doctor, we did not limit this review to a specific perspective.

Data extraction and synthesis

Data extraction and quality assessment were performed independently by two researchers. We used the Quality Assessment Tool for Different Designs for quality assessment.

Results

Eleven articles were eligible and described the characteristics from different perspectives: (1) physicians on physicians, (2) physicians on residents, (3) patients on physicians and (4) mixed group (diverse sample of participants on physicians). The included studies showed a wide range of characteristics, which could be grouped into competencies (communication, professionalism and knowledge), motivation (directed to learning and to patient care) and personality (flexibility, empathy).

Conclusions

In order to define excellence of medical doctors three clusters seem important: competence, motivation and personality. This is in line with Renzulli’s model of gifted behaviour. Our work adds to this model by specifying the content of these clusters, and as such provides a basis for definition and recognition of medical excellence.
The Australian and New Zealand Fontan Registry Quality of Life Study: Protocol for a population-based assessment of quality of life among people with a Fontan circulation, their parents, and siblings
Authors: Marshall Kate H , d’Udekem Yves , Winlaw David S , Dalziel Kim , Woolfenden Susan R , Zannino Diana , Costa Daniel S J , Bishop Rachel , Celermajer David S , Sholler Gary F , Kasparian Nadine A
Published: September 2022

Introduction

Advances in the care of patients with single-ventricle congenital heart disease have led to a new generation of individuals living with a Fontan circulation. For people with Fontan physiology, physical, psychological and neurodevelopmental challenges are common. The objective of this study is to describe and develop a deeper understanding of the factors that contribute to quality of life (QOL) among children, adolescents and adults living with a Fontan circulation across Australia and New Zealand, their parents and siblings.

Methods and Analysis

This article presents the protocol for the Australian and New Zealand Fontan Registry (ANZFR) QOL Study, a cross-sectional, population-based study designed to examine QOL among people of all ages with a Fontan circulation, their parents and siblings. Study eligibility criteria includes (1) individuals with a Fontan circulation aged ≥6 years, at least 12 months post-Fontan procedure and enrolled in the ANZFR; (2) parents of individuals enrolled in the ANZFR; and (3) siblings aged ≥6 years of an individual enrolled in the ANZFR. A novel, online research platform is used to distribute personalised assessments tailored to participant age and developmental stage. A suite of validated psychometric self-report and parent-proxy report instruments capture potential correlates and predictors of QOL, including symptoms of psychological distress, personality attributes, coping and cognitive appraisals, family functioning, healthcare experiences and costs, access to emotional support and socioeconomic factors. Clinical characteristics are captured via self-report and parent-proxy report, as well as the ANZFR. Descriptive analyses and multilevel models will be used to examine QOL across groups and to investigate potential explanatory variables.

Ethics and Dissemination

Approval has been obtained from all relevant Human Research Ethics Committees (HRECs), including the Sydney Children’s Hospitals Network and the Royal Children’s Hospital Melbourne HRECs. Study findings will be published in peer-reviewed journals and presented at national and international meetings and seminars.
Involving parents in paediatric clinical ethics committee deliberations: a current controversy
Authors: Archard David , Cave Emma , Brierley Joe
Published: September 2022

In cases where the best interests of the child are disputed or finely balanced, Clinical Ethics Committees (CECs) can provide a valuable source of advice to clinicians and trusts on the pertinent ethical dimensions. Recent judicial cases have criticised the lack of formalised guidance and inconsistency in the involvement of parents in CEC deliberations. In Manchester University NHS FT v Verden [2022], Arbuthnot J set out important procedural guidance as to how parental involvement in CEC deliberations might be managed. She also confirmed substantive guidance on the role of parental views in determining the child’s best interests. We agree that it is good practice to ensure that the patient voice is heard in ethics processes, but how that is achieved is controversial. Surely it is best that what matters most to a patient and their family, whether facts or values, is conveyed directly to those considering the moral issues involved, rather than via a prism of another party. The approach suggested in theVerdencase has much in common with the process used by our CEC. In this article, we commend Arbuthnot J’s approach, provide an example of its effective operation and consider what it might mean for ethics processes.
Relationship between hyperglycaemia at admission and prognosis in patients with acute myocardial infarction: a retrospective cohort study
Authors: Liu Linlin , Qian Jun , Yan Wenwen , Liu Xuebo , Zhao Ya , Che Lin
Published: September 2022

Background

The optimal threshold of hyperglycaemia at admission for identifying high-risk individuals in patients with acute myocardial infarction (AMI) and its impact on clinical prognosis are still unclear.

Methods

We retrospectively reviewed 2027 patients with AMI admitted from June 2001 to December 2012 in the ‘Medical Information Mart for Intensive Care III’ database. The significant cut-off values of admission blood glucose (Glucose_0) for predicting hospital mortality in patients with AMI with and without diabetes were obtained from the receiver operating characteristic (ROC) curve, then patients were assigned to hyperglycaemia and non-hyperglycaemia groups based on corresponding cut-off values. The primary endpoints were the hospital and 1-year mortality.

Results

Among 2027 patients, death occurred in 311 patients (15.3%). According to the ROC curve, the significant cut-off values of Glucose_0 to predict hospital mortality were 224.5 and 139.5 mg/dL in patients with diabetes and without diabetes, respectively. The crude hospital and 1-year mortality of the hyperglycaemia subgroup were higher than the corresponding non-hyperglycaemia group (p< 0.01). After adjustment, regardless of the state of diabetes, hyperglycaemia at admission was related to significantly increased hospital mortality in patients with AMI. For patients with AMI without diabetes, hyperglycaemia at admission was positively correlated with the increase of 1-year mortality (HR, 1.47; 95% CI 1.18 to 1.82; p=0.001). Nevertheless, this trend disappeared in those with diabetes (HR, 1.35; 95% CI 0.93 to 1.95; p=0.113).

Conclusion

Hyperglycaemia at admission was an independent predictor for mortality during hospitalisation and at 1-year in patients with AMI, especially in patients without diabetes.
Monitoring real-time junior doctor sentiment from comments on a public social media platform: a retrospective observational study
Authors: Sirkis Tamir , Maitland Stuart
Published: September 2022

Objectives

To investigate whether sentiment analysis and topic modelling can be used to monitor the sentiment and opinions of junior doctors.

Design

Retrospective observational study based on comments on a social media website.

Setting

Every publicly available comment in r/JuniorDoctorsUK on Reddit from 1 January 2018 to 31 December 2021.

Participants

7707 Reddit users who commented in the r/JuniorDoctorsUK subreddit.

Main outcome measure

Sentiment (scored −1 to +1) of comments compared with results of surveys conducted by the General Medical Council.

Results

Average comment sentiment was positive but varied significantly during the study period. Fourteen topics of discussion were identified, each associated with a different pattern of sentiment. The topic with the highest proportion of negative comments was the role of a doctor (38%), and the topic with the most positive sentiment was hospital reviews (72%).

Conclusion

Some topics discussed in social media are comparable to those queried in traditional questionnaires, whereas other topics are distinctive and offer insight into what themes junior doctors care about. Events during the coronavirus pandemic may explain the sentiment trends in the junior doctor community. Natural language processing shows significant potential in generating insights into junior doctors’ opinions and sentiment.
Poliovirus returns to the UK after nearly 40 years: current efforts and future recommendations
Authors: Uwishema Olivier , Eneh Stanley Chinedu , El Jurdi Elissa , Olanrewaju Omotayo Faith , Abbass Zahraa , Jolayemi Mubarak Mustapha , Mina Nour , Kseiry Lea , Adanur Irem , Onyeaka Helen , Wellington FGMS Jack
Published: September 2022

On 22 June 2022, the UK Health Security Agency declared a ‘rare national incidence’ after finding poliovirus in sewage in London for the first time in nearly 40 years. Although no cases of the disease or accompanying paralysis have been documented, the general public's risk is considered minimal. However, public health experts recommend that families are up to date on their polio vaccines to decrease the chance of harm. This article discusses the epidemiology of poliovirus by examining the aetiology of the disease and current mitigation policies implemented to prevent the spread of type 2 vaccine-deceived poliovirus in the UK. Finally, by examining the clinical features of polio, which range from mild gastroenteritis episodes, respiratory sickness, malaise and severe paralysis type, this article offers an advice on particular therapies and tactics to avoid poliovirus outbreaks and other future outbreaks.
Optimized Fault-Tolerant Adder Design Using Error Analysis
Authors: Raghavendra Kumar Sakali , Balasubramanian P , Reddy Ramesh , Veeramachaneni Sreehari , Sk Noor Mahammad
Published: September 2022

Field Programmable Gate Arrays (FPGAs) are often used in space, military, and commercial applications due to their re-programmable feature. FPGAs are semiconductor components susceptible to soft errors due to radiation effects. Fault tolerance is a critical feature for improving the reliability of electronic and computational components in high-safety applications. Triple Modular Redundancy (TMR) is electronic systems’ most commonly used fault-tolerant technique. TMR is reliable and efficient to recover the single-event upsets. However, the limitation of this technique is the area overhead. Prior work has proposed many conventional fault-tolerant approaches that have been unable to avoid area overhead. This paper introduces a novel work related to an error analysis-based technique. This technique works with an error percentage, and a preferential algorithm, which is also proposed to reduce the hardware complexity in the existing works. This technique can be applied on various types of arithmetic circuits. The proposed technique is applied to the adder circuit to verify the hardware usage, power consumption, and delay; it has been implemented on the Proasic3e 3000 FPGA. The simulated results were observed as 39.89% fewer IO cells, 47.10% fewer core cells, and 5.32% less power as compared to the TMR-based adder.
Improved Turn-On Speed of Low-Power Loads in Pulsed Power Supply Scheme and High-Energy Efficiency
Authors: Amraee Meysam , Farshidi Ebrahim , Kosarian Abdolnabi
Published: September 2022

There are cases in energy supply applications with low-power batteries, where the power required by the load is larger than the supply maximum deliverable power. Using a capacitor to create a high instantaneous power for the load was investigated as a useful solution. To increase the charging efficiency, a stepwise method for charging the capacitor was employed. This paper presents a new pulsed power supply approach in which the charging process is resumed after high instantaneous power delivery. Through this, the loss of residual energy in the capacitor was decreased and load turn-on speed and energy efficiency were significantly improved. The proposed structure consists of a buck converter that charges the capacitor using inductor current. A pulse frequency modulation (PFM) technique was used to generate the necessary signals for the buck converter switches, which resulted in controlling the inductor current. The proposed circuit was designed and simulated in a 0.18 [Formula: see text]m CMOS technology. It was shown that the designed CMOS circuit could reach a peak energy efficiency of 93.2% with a sleep period of 1.05 ms when the load consumes 7.06 [Formula: see text]J of energy.
Exploring the Impact of Balanced and Imbalanced Learning in Source Code Suggestion
Authors: Hussain Yasir , Huang Zhiqiu , Zhou Yu , Khan Izhar Ahmed
Published: September 2022

Studies have confirmed the robust performance of machine learning classifiers for various source code modeling tasks. In general, machine learning approaches are incapable of handling imbalanced datasets, since they are sensitive to the choice of diverse classes. Therefore, these approaches may lean towards the classes with a large percentage of observations. In this work, we investigate and explore the impact of balanced and imbalanced learning on source code suggestion task otherwise known as code completion, covering a large number of imbalanced classes. We further explore the impact of vocabulary size on modeling performance. First, we provide the essentials to formulate the problem of source code suggestion as a classification task and investigate the level of imbalanced classes. Second, we train the four most adapted neural language models as a baseline to assess the modeling performance. Third, we impose two diverse class balancing techniques, TomekLinks and AllKNN, to balance the datasets and evaluate their impact on the modeling performance. Finally, we trained these models with a weighted imbalanced learning approach and compared the performance with balanced learning approaches. Additionally, we train models by varying the vocabulary size to study their impact. In total, we trained 230 models on 10 real-world software projects and extensively evaluated these models with widely used performance metrics such as Precision, Recall, FScore, mean reciprocal rank (MRR), and Receiver operating characteristics (ROC). Additionally, we employed ANOVA statistical analysis to study the statistical significance and differences between these approaches. This study has demonstrated that the modeling performance decreases during balanced model training, whereas the weighted imbalance training produces comparable results and is more efficient in terms of time cost. Additionally, this study exhibits that a large size of vocabulary does not necessarily improve the modeling performance when out-of-vocabulary predictions are disregarded.
A New Indirect Adaptive Neural Control for Nonlinear Systems: A Real Validation on a Chemical Process
Authors: Hamza Rabab , Farhat Yassin , Zribi Ali
Published: September 2022

In the present work, an indirect adaptive neural control method for nonlinear systems having unknown dynamics is proposed. The proposed control architecture is composed by a neural emulator (NE) and a neural controller (NC) where a new decoupled variable learning rates (VLRs) combined with Taylor development (TD) are used to train the NE and the NC. The developed VLRs mixed with the TD (TDVLRs) ensure a quick adaptation of neural networks parameters guaranteeing a faster output convergence and reducing the tracking error. The effectiveness of the proposed TDVLRs is illustrated by simulation with a nonlinear dynamic system. In order to validate simulation results, an application on a transesterification reactors is, also, presented.
MELTING HEAT TRANSFER IMPROVEMENT BY VENATION-FINNED POROUS NETWORKS
Authors: HAN QUN , ZHANG CHENGBIN , CHEN YONGPING
Published: September 2022

The venation-finned porous network has been demonstrated as a promising method to maximize the thermal transport access. To improve the heat storage efficiency, an innovative venation-finned porous network is employed here to enhance the melting performance of phase change materials (PCMs). The venation-finned porous network is quantitatively described by Murray’s law and Voronoi method, and a modified thermal lattice Boltzmann model of PCM melting processes in a square cavity is developed and numerically analyzed to optimize the venation-finned porous network. The melting performance of composite PCMs with three configurations (venation fin, porous network and venation-finned porous network) are compared and analyzed. Moreover, the effects of branching angle and Murray coefficient on melting performance are comprehensively studied. It indicates that venation-finned porous network is favorable to melting performance improvement due to venation’s inherent efficient heat transfer paths. Compared to venation fins and porous networks, the melting duration time of venation-finned porous networks is reduced by 78.4% and 21.4%, respectively. Furthermore, the branching angle of 45[Formula: see text] and Murray coefficient of 3 are suggested for maximizing the melting efficiency. Importantly, the melting mechanism is conduction and convective conjugated heat transfer in composite PCMs with venation fins, however, it is dominated by heat conduction for those with porous networks or venation-finned porous networks.