bluuebunny/crossref_metadata_2025 huggingface dataset:
Re-Assessment and Extension: An Ongoing Evaluation of The System for Adult Growth and Emergence-Foundations, a Modified DBT Program to Aid Emerging Adults With Emotion Regulation and Transition
Authors: Taliercio Joseph R. , Wigod Talia , Shen Joy , Garcia Jazmin , Davino Suzanne , Servidio Elaina , Sparapani Erin , McGinn Lata K. , Miller Alec L.
Published: March 2024

Emerging adulthood is associated with change and distress. The System for Adult Growth and Emergence – Foundations (SAGE-F) treatment program, a six-week outpatient DBT intensive, was developed to improve emotional functioning for such individuals. Utilizing a single-group design, the current study aims to re-examine ( n = 48) and expand ( n = 83) initial therapeutic findings of SAGE-F. Participants were administered an assessment battery at pre-treatment, upon immediate completion of SAGE-F, six-weeks after baseline, and at three months following program completion. Results were comparable to the pilot study: the completion of SAGE-F, when compared to baseline, is associated with reductions in mood dysregulation and self-harm, and improvements in functioning capacities, with gains sustained for at least three months. Further, program completion was associated with improved DBT skill use, with individuals demonstrating more insight of skill dysfunction rather than skill growth. Results continue to support that SAGE-F provides both immediate and long-term benefits.
Causes of Intraoperative Neuromonitoring Events in Adult Spine Deformity Surgery: A Systematic Review
Authors: Cottone Chloe , Kim David , Lucasti Christopher , Scott Maxwell M. , Graham Benjamin C. , Aronoff Nell , Hasanspahic Bilal , Kowalski David , Bird Justin , Patel Dil
Published: March 2024

Study Design

Systematic review.

Objectives

Intraoperative neuromonitoring (IOMN) has become a standard practice in the detection and prevention of nerve damage and postoperative deficit. While multicenter studies have addressed this inquiry, there have been no systematic reviews to date. This systematic review identifies the leading causes of IONM alerts during adult spinal deformity (ASD) surgeries.

Methods

Following PRISMA guidelines, a literature search was performed in PubMed and Embase. IONM alert causes were grouped by equivalent terms used across different studies and binned into larger categories, including surgical maneuver, Changes in blood pressure/temperature, Oxygenation, Anesthesia, Patient position, and Unknown.

Results

Inclusion criteria were studies on adult patients receiving ASD correction surgery using IONM with documented alert causes. 1544 references were included in abstract review, 128 in full text review, and 16 studies qualified for data extraction. From those studies, there was a total of 3945 adult patients with 299 IONM alerts. Surgical maneuver led the alert causes (258 alerts/86.3%), with signal loss most commonly occurring at correction or osteotomy (101/33.8% and 95/31.8% respectively). Pedicle screw placement caused 35 alerts (11.7%). Changes in temperature and blood pressure were the third largest category (34/11.4%).

Conclusions

The most frequent causes of IONM alerts in ASD surgery were surgical maneuvers such as correction, osteotomy, and pedicle screw placement. This information provides spine surgeons with a quantitative perspective on the causes of IONM changes and show that most occur at predictable times during ASD surgery.
Maya Guatemalans Seeking Asylum: Race and Gender in a Continuum of State Control
Authors: Menjívar Cecilia , Gómez Cervantes Andrea
Published: March 2024

Central Americans historically have been denied U.S. asylum. From the moment they arrive, they become entangled in a punitive system that criminalizes them through an intricate network of social control sustained by state and private companies. Based on ethnographic fieldwork conducted in rural Kansas between 2016 and 2020 and interviews with Maya Guatemalan women and men asylum seekers, we examine the race and gender power dynamics reproduced through the asylum process that mimics the penal system. We examine three encounters with the asylum system: (1) the credible fear interview, (2) cash bonds, and (3) alternatives to detention programs. The asylum process (re)produces a continuum of state control that reflects the punishing tactics of the carceral state, leaving women and men embedded in the system and perpetually indebted. Maya Guatemalan women’s and men’s experiences navigating the asylum process underscore the intersecting mechanisms of race and gender at the center of the carceral state within the asylum system. Given the expansion of the punitive U.S. asylum bureaucracy, our findings will be relevant beyond our case study.
Obsessive-Compulsive Disorder: A Medical School Curriculum and Textbook Review
Authors: Lahey Chelsea A. , Fawcett Emily J. , Pevie Noah , Seim Rowan B. , Fawcett Jonathan M.
Published: March 2024

OBJECTIVES

We conducted a curriculum review of Canadian undergraduate medical programs to identify why aggressive obsessions (among those with obsessive-compulsive disorder [OCD]) are so often misidentified by primary care physicians and professional students.

METHODS

This study involved standardized interviews with representatives from Canadian medical schools regarding the content, time, and teaching styles used to deliver curricula related to OCD. Further, we utilized a set of standardized criteria to assess the OCD content of recommended textbooks from these schools.

RESULTS

Canadian medical curricula failed to provide a comprehensive picture of OCD. One-third of medical programs did not provide an example of aggressive obsessions to students, with textbook case examples centered heavily (70%) on contamination or symmetry. Only 25% of programs (and 60% of textbooks) discussed the composition of the Unacceptable Thought Domain to include aggressive, sexual, and religious obsessions. Finally, over half of medical programs failed to indicate that aggressive obsessions are ego-dystonic and do not lead people to harm themselves or others.

CONCLUSION

A series of recommendations are provided for medical schools intended to improve the comprehensiveness of OCD-related training.
Short and medium-term outcomes in individuals hospitalized with acute myocardial infarction and multiple chronic conditions: The Worcester heart attack study
Authors: Zammitti Christopher , Tisminetzky Mayra , Mehawej Jordy , Abu Hawa O , Miozzo Ruben , Gore Joel M , Lessard Darleen , Bamgbade Benita A , Yarzebski Jorge , Gurwitz Jerry H , Goldberg Robert J
Published: March 2024

Background

Multiple chronic conditions (MCCs) are common in patients hospitalized with acute myocardial infarction (AMI). We examined the association of 12 MCCs with the risk of a 30-day hospital readmission and/or dying within one year among those discharged from the hospital after an AMI. We also examined the five most prevalent pairs of chronic conditions in this population and their association with the principal study endpoints.

Methods

The study population consisted of 3,294 adults hospitalized with a confirmed AMI at the three major medical centers in central Massachusetts on an approximate biennial basis between 2005 and 2015. Patients were categorized as ≤1, 2-3, and ≥4 chronic conditions.

Results

The median age of the study population was 67.9 years, 41.6% were women, and 15% had ≤1, 32% had 2-3, and 53% had ≥4 chronic conditions. Patients with ≥4 conditions tended to be older, had a longer hospital stay, and received fewer cardiac interventional procedures. There was an increased risk for being rehospitalized during the subsequent 30 days according to the presence of MCCs, with the highest risk for those with ≥4 conditions. There was an increased, but attenuated, risk for dying during the next year according to the presence of MCCs. Individuals with diabetes/hypertension and those with heart failure/chronic kidney disease were at particularly high risk for developing the principal study outcomes.

Conclusion

Development of guidelines that include complex patients, particularly those with MCCs and those at high risk for adverse short/medium term outcomes, remain needed to inform best treatment practices.
Implications of input ground-motion selection techniques on site response analyses for different tectonic settings
Authors: Chowdhury Ishika N , Cabas Ashly , Kaklamanos James , Kottke Albert , Gregor Nick
Published: March 2024

This study investigates how current practices of input ground-motion selection influence site response analysis results and their variability, when considering different tectonic settings. Study sites in Seattle and Boston are chosen to represent tectonic settings with contributions to the seismic hazard from shallow crustal and subduction events, as well as stable continental regions, respectively. Selected input ground-motion suites for one-dimensional site response analysis represent variations in the target spectrum definition, spectral period of interest, seismic source, and ground-motion database. When directly incorporating different types of seismic sources (e.g. shallow crustal versus subduction) into target spectrum definitions and selecting ground motions from the corresponding databases (i.e. consistent with such seismic sources), differences on the estimated site response and its variability are observed. These effects are captured by spectral amplification factors and nonspectral intensity measures (significant duration and Arias intensity) and become particularly apparent for subduction zones. The variability in spectral amplification factors stemming from ground-motion selection techniques is found to be also a function of the characteristics of the site, becoming higher near the fundamental period of the site. Estimated responses at stiffer sites are more significantly influenced by ground-motion selection techniques, whereas the onset of nonlinear soil behavior at softer sites can reduce such variability.
Classifying breast cancer subtypes on multi-omics data via sparse canonical correlation analysis and deep learning
Authors: Huang Yiran , Zeng Pingfan , Zhong Cheng
Published: March 2024

Background

Classifying breast cancer subtypes is crucial for clinical diagnosis and treatment. However, the early symptoms of breast cancer may not be apparent. Rapid advances in high-throughput sequencing technology have led to generating large number of multi-omics biological data. Leveraging and integrating the available multi-omics data can effectively enhance the accuracy of identifying breast cancer subtypes. However, few efforts focus on identifying the associations of different omics data to predict the breast cancer subtypes.

Results

In this paper, we propose a differential sparse canonical correlation analysis network (DSCCN) for classifying the breast cancer subtypes. DSCCN performs differential analysis on multi-omics expression data to identify differentially expressed (DE) genes and adopts sparse canonical correlation analysis (SCCA) to mine highly correlated features between multi-omics DE-genes. Meanwhile, DSCCN uses multi-task deep learning neural network separately to train the correlated DE-genes to predict breast cancer subtypes, which spontaneously tackle the data heterogeneity problem in integrating multi-omics data.

Conclusions

The experimental results show that by mining the associations among multi-omics data, DSCCN is more capable of accurately classifying breast cancer subtypes than the existing methods.
Genome-wide association study for in vitro digestibility and related traits in triticale forage
Authors: De Zutter Anneleen , Piro Maria Chiara , Maenhout Steven , Maurer Hans Peter , De Boever Johan , Muylle Hilde , Roldán-Ruiz Isabel , Haesaert Geert
Published: March 2024

Background

Triticale is making its way on dairy farms as an alternative forage crop. This requires the availability of high-yielding triticale varieties with good digestibility. Triticale forage breeding mainly focussed on biomass yield, but efforts to improve digestibility are increasing. We previously investigated the interrelationships among different quality traits in soft dough triticale: starch, acid detergent fibre and in vitro digestibility of organic matter (IVOMD) and of neutral detergent fibre (IVNDFD) of the total plant, IVNDFD and Klason lignin of the stems, and ear proportion and stem length. Here we determine the genetic control of these traits, using a genome-wide association (GWAS) approach. A total of 33,231 DArTseq SNP markers assessed in a collection of 118 winter triticale genotypes, including 101 varieties and 17 breeding lines, were used.

Results

The GWAS identified a total of 53 significant marker-trait associations (MTAs). The highest number of significantly associated SNP markers (n = 10) was identified for total plant IVNDFD. A SNP marker on chromosome 1A (4211801_19_C/T; 474,437,796 bp) was found to be significantly associated with ear proportion, and plant and stem IVNDFD, with the largest phenotypic variation for ear proportion (R²p = 0.23). Based on MTAs, candidate genes were identified which were of particular relevance for variation in in vitro digestibility (IVD) because they are putatively involved in plasma membrane transport, cytoskeleton organisation, carbohydrate metabolic processes, protein phosphorylation, and sterol and cell wall biogenesis. Interestingly, a xyloglucan-related candidate gene on chromosome 2R, SECCE2Rv1G0126340, was located in close proximity of a SNP significantly associated with stem IVNDFD. Furthermore, quantitative trait loci previously reported in wheat co-localized with significantly associated SNP markers in triticale.

Conclusions

A collection of 118 winter triticale genotypes combined with DArTseq SNP markers served as a source for identifying 53 MTAs and several candidate genes for forage IVD and related traits through a GWAS approach. Taken together, the results of this study demonstrate that the genetic diversity available in this collection can be further exploited for research and breeding purposes to improve the IVD of triticale forage.
Accelerated lymph flow from infusion of crystalloid fluid during general anesthesia
Authors: Hahn Robert G.
Published: March 2024

Background

Kinetic analysis of crystalloid fluid yields a central distribution volume (Vc) of the same size as the expected plasma volume (approximately 3 L) except during general anesthesia during which Vc might be only half as large. The present study examined whether this difference is due to influence of the intravascular albumin balance.

Methods

A population volume kinetic analysis according to a three-compartment model was performed based on retrospective data from 160 infusion experiments during which 1–2.5 L of crystalloid fluid had been infused intravenously over 20–30 min. The plasma dilution based on blood hemoglobin (Hb) and plasma albumin (Alb) was measured on 2,408 occasions and the urine output on 454 occasions. One-third of the infusions were performed on anesthetized patients while two-thirds were given to awake healthy volunteers.

Results

The Hb-Alb dilution difference was four times greater during general anesthesia than in the awake state (+ 0.024 ± 0.060 versus − 0.008 ± 0.050; mean ± SD; P < 0.001) which shows that more albumin entered the plasma than was lost by capillary leakage. The Hb-Alb dilution difference correlated strongly and positively with the kinetic parameters governing the rate of fluid transfer through the fast-exchange interstitial fluid compartment (k12 and k21) and inversely with the size of Vc. Simulations suggest that approximately 200 mL of fluid might be translocated from the interstitial space to the plasma despite ongoing fluid administration.

Conclusions

Pronounced plasma volume expansion early during general anesthesia is associated with a positive intravascular albumin balance that is due to accelerated lymphatic flow. This phenomenon probably represents adjustment of the body fluid volumes to anesthesia-induced vasodilatation.
The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial
Authors: Alseoudy Mahmoud Mohammed , Abdelkarime Elsayed Mohamed , Nour Khaled , Badr May Elsherbiny
Published: March 2024

Background

The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study.

Methods

A total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score.

Results

Total morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively.

Conclusion

Dexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption.

Trial registration

(ID: PACTR202203906027106; Date: 31/07/2023).
Correlation between the cardiometabolic index and arteriosclerosis in patients with type 2 diabetes mellitus
Authors: Tang Chaoyan , Pang Tianjiao , Dang Chaozhi , Liang Hui , Wu Junfeng , Shen Xiaofang , Wang Lielin , Luo Ruiqiong , Lan Haiyun , Zhang Ping
Published: March 2024

Background

The cardiometabolic index (CMI) is a new metric derived from the triglyceride-glucose index and body mass index and is considered a potential marker for cardiovascular risk assessment. This study aimed to examine the correlation between the CMI and the presence and severity of arteriosclerosis in patients with type 2 diabetes mellitus (T2DM).

Methods

This study involved 2243 patients with T2DM. The CMI was derived by dividing the triglyceride level (mmol/L) by the high-density lipoprotein level (mmol/L) and then multiplying the quotient by the waist-to-height ratio. Multivariate logistic regression was used to analyze the correlations between the CMI and BMI blood biomarkers, blood pressure, and brachial-ankle pulse wave velocity (baPWV).

Results

Patients were categorized into three groups based on their CMI: Group C1 (CMI < 0.775; n = 750), Group C2 (CMI: 0.775–1.355; n = 743), and Group C3 (CMI > 1.355; n = 750). Increased BMI, fasting glucose, insulin (at 120 min), total cholesterol (TC), and baPWV values were observed in Groups C2 and C3, with statistically significant trends (all trends P < 0.05). The CMI was positively correlated with systolic blood pressure (r = 0.74, P < 0.001). Multivariate analysis revealed that an increased CMI contributed to a greater risk for arteriosclerosis (OR = 1.87, 95%CI: 1.66–2.10, P < 0.001). Compared to the C1 group, the C2 group and C3 group had a greater risk of developing arteriosclerosis, with ORs of 4.55 (95%CI: 3.57–5.81, P<0.001) and 5.56 (95%CI: 4.32–7.17, P<0.001), respectively. The association was notably stronger in patients with a BMI below 21.62 kg/m² than in those with a BMI of 21.62 kg/m² or higher (OR = 4.53 vs. OR = 1.59).

Conclusions

These findings suggest that the CMI is a relevant and independent marker of arteriosclerosis in patients with T2DM and may be useful in the risk stratification and management of these patients.
Methodological insights into ChatGPT’s screening performance in systematic reviews
Authors: Issaiy Mahbod , Ghanaati Hossein , Kolahi Shahriar , Shakiba Madjid , Jalali Amir Hossein , Zarei Diana , Kazemian Sina , Avanaki Mahsa Alborzi , Firouznia Kavous
Published: March 2024

Background

The screening process for systematic reviews and meta-analyses in medical research is a labor-intensive and time-consuming task. While machine learning and deep learning have been applied to facilitate this process, these methods often require training data and user annotation. This study aims to assess the efficacy of ChatGPT, a large language model based on the Generative Pretrained Transformers (GPT) architecture, in automating the screening process for systematic reviews in radiology without the need for training data.

Methods

A prospective simulation study was conducted between May 2nd and 24th, 2023, comparing ChatGPT’s performance in screening abstracts against that of general physicians (GPs). A total of 1198 abstracts across three subfields of radiology were evaluated. Metrics such as sensitivity, specificity, positive and negative predictive values (PPV and NPV), workload saving, and others were employed. Statistical analyses included the Kappa coefficient for inter-rater agreement, ROC curve plotting, AUC calculation, and bootstrapping for p-values and confidence intervals.

Results

ChatGPT completed the screening process within an hour, while GPs took an average of 7–10 days. The AI model achieved a sensitivity of 95% and an NPV of 99%, slightly outperforming the GPs’ sensitive consensus (i.e., including records if at least one person includes them). It also exhibited remarkably low false negative counts and high workload savings, ranging from 40 to 83%. However, ChatGPT had lower specificity and PPV compared to human raters. The average Kappa agreement between ChatGPT and other raters was 0.27.

Conclusions

ChatGPT shows promise in automating the article screening phase of systematic reviews, achieving high sensitivity and workload savings. While not entirely replacing human expertise, it could serve as an efficient first-line screening tool, particularly in reducing the burden on human resources. Further studies are needed to fine-tune its capabilities and validate its utility across different medical subfields.
Patients with chronic hepatitis B who have persistently normal alanine aminotransferase or aged < 30 years may exhibit significant histologic damage
Authors: Wei Sufang , Xie Qiuli , Liao Guichan , Chen Hongjie , Hu Meixin , Lin Xiaoli , Li Hong , Peng Jie
Published: March 2024

Background

The timing of antiviral therapy for chronic hepatitis B (CHB) patients with normal alanine transaminase (ALT) or aged < 30 years is still undetermined. We aimed to elucidate the correlation between liver histology, age, and ALT level in CHB patients and analyze the histological characteristics of the liver among patients with persistently normal ALT or aged < 30 years.

Methods

A retrospective analysis was conducted on 697 treatment-naive CHB patients. Liver biopsies were performed, and significant histological damage was defined as the grade of liver inflammation ≥ G2 and/or fibrosis ≥ S2 based on the Scheuer scoring system.

Results

The liver inflammation grades and fibrosis stages correlated positively with age, ALT, AST, GGT levels and negatively with the counts of PLT (all p < 0.050) in HBeAg-positive patients. Higher ALT levels and lower PLT counts were independently associated with significant liver inflammation and fibrosis in both HBeAg-positive and HBeAg-negative patients. Furthermore, among those with persistently normal ALT levels, the incidence of significant liver inflammation and fibrosis were 66.1% and 53.7% in HBeAg-positive groups, and 63.0% and 55.5% in HBeAg-negative groups. Moreover, there was no significant difference in the prevalence of significant liver damage between patients aged < 30 years and those aged ≥ 30 years, in both HBeAg-positive (≥ G2 or ≥ S2: 63.8% vs. 75.8%, p = 0.276) and HBeAg-negative (≥ G2 or ≥ S2: 65.9% vs. 72.5%, p = 0.504) groups, among patients with persistently normal ALT levels.

Conclusions

A considerable proportion of CHB patients with persistently normal ALT, including those below the age of 30 years, exhibited significant histological damage. This highlights the importance of initiating early antiviral therapy for HBV-infected individuals, even in the absence of elevated ALT levels.
Associations between cooking fuel use, its transitions, and worsening sensory impairments among Chinese middle-aged and older adults: a cohort study
Authors: Li Shaojie , Cui Guanghui , Hu Mingzheng , Hu Yang , Ren Longbing , Jiang Yuling , Sun Jing , Luan Zhe , Hu Kejia , Zhang Yunquan , Sun Gang , Yao Yao
Published: March 2024

Background

This study aimed to explore the associations between household air pollution (HAP), measured by cooking fuel use, sensory impairments (SI), and their transitions in Chinese middle-aged and older adults.

Methods

Participants were recruited from the 2011 China Health and Retirement Longitudinal Study (CHARLS) and were subsequently followed up until 2018. Data on SI were collected by self-reported hearing and vision impairments, which were divided into three categories: non-SI, single SI (hearing or vision impairment), and dual SI (DSI). Cooking fuels, including solid and clean fuels, are proxies for HAP. The transitions of cooking fuels and SI refer to the switching of the fuel type or SI status from baseline to follow-up. Cox proportional hazard regression models were used to explore associations, and hazard ratios (HRs) and 95% confidence intervals (CI) were used to evaluate the strength of the association.

Results

The prevalence of non-SI, single SI, and DSI was 59.6%, 31.8%, and 8.6%, respectively, among the 15,643 participants at baseline in this study. Over a median follow-up of 7.0 years, 5,223 worsening SI transitions were observed. In the fully adjusted model, solid fuel use for cooking was associated with a higher risk of worsening SI transitions, including from non-SI to single SI (HR = 1.08, 95% CI = 1.01–1.16) and from non-SI to DSI (HR = 1.26, 95% CI = 1.09–1.47), but not from single SI to DSI. In addition, compared to those who always used solid fuels, participants who switched from solid to clean fuel for cooking appeared to have attenuated the risk of worsening SI transitions. The statistical significance of the associations remained in the set of sensitivity analyses.

Conclusion

Solid fuel use was associated with higher risks of worsening SI transitions, while converting the type of cooking fuel from solid to clean fuels may reduce the risk of worsening SI transitions. Our study suggests that tailored clean fuel interventions, especially in developing countries, should be implemented to prevent sensory impairments and hence reduce the burden of sensory impairment-related disability.
The symptoms and interval of Omicron SARS-CoV-2 reinfection among healthcare workers in a hospital of Southern China: a cross-sectional study
Authors: Ma Xiaoju , Wang Zheng , Chen Youpeng , Li Zhanjie
Published: March 2024

Background

The prevalence and distinction between first Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reinfection with the Omicron variant among healthcare workers (HCWs) remain unclear.

Methods

A cross-sectional study was conducted at a hospital in Southern China. The study included 262 HCWs who were infected with SARS-CoV-2 between April and June 2023, with 101 cases of first infection and 161 ones of reinfection. Student’s t-test, Analysis of Variance (ANOVA), and Mann-Whitney U tests were used based on the distribution of quantitative variables. Pearson’s chi-square and Fisher’s exact tests were used based on the expected frequencies of categorical variables.

Results

The reinfection rate among HCWs was 11.5% (161/1406). The majority of the infected HCWs were female (212/262, 80.9%, first infection vs. reinfection: 76.2% vs. 83.9%). The nursing staff, had the highest percentage of SARS-CoV-2 infection (42.0%), especially of its reinfection (47.8%). Out of the 262 infected individuals, 257 had received SARS-CoV-2 vaccination, primarily inactivated vaccines (243/257, 91.1%). The first infection group, which received four doses (24, 23.8%), was significantly higher than that in the reinfection group (6, 3.7%) (P < 0.001). The proportion of asymptomatic infections among HCWs in the two groups was 1.0% and 1.2%. The main symptoms during the first infection and reinfection were fever (83.2% and 50.9%) and sore throat (78.2% and 77.0%). There were significant differences in the prevalence of fever (83.2% vs. 50.9%), rhinorrhea (45.5% vs. 60.9%) and myalgia (56.4% vs. 37.9%) between the first infection and reinfection (P < 0.05). The average interval for SARS-CoV-2 reinfection was 149.9 (range: 114–182, SD = 11.9) days. Notably, physicians had the shortest average interval of 142.8 (8.8) days, while management and administrative staff had the longest average interval of 153.8 (13.5) days.

Conclusions

Although the symptoms of HCWs during reinfection with SARS-CoV-2 were milder, the high reinfection rate and short interval between infections indicate the need to enhance monitoring and protective measures for HCWs during the epidemic.
Collateral effects of COVID-19 countermeasures on hepatitis E incidence pattern: a case study of china based on time series models
Authors: Qin Yajun , Peng Haiyang , Li Jinhao , Gong Jianping
Published: March 2024

Background

There are abundant studies on COVID-19 but few on its impact on hepatitis E. We aimed to assess the effect of the COVID-19 countermeasures on the pattern of hepatitis E incidence and explore the application of time series models in analyzing this pattern.

Methods

Our pivotal idea was to fit a pre-COVID-19 model with data from before the COVID-19 outbreak and use the deviation between forecast values and actual values to reflect the effect of COVID-19 countermeasures. We analyzed the pattern of hepatitis E incidence in China from 2013 to 2018. We evaluated the fitting and forecasting capability of 3 methods before the COVID-19 outbreak. Furthermore, we employed these methods to construct pre-COVID-19 incidence models and compare post-COVID-19 forecasts with reality.

Results

Before the COVID-19 outbreak, the Chinese hepatitis E incidence pattern was overall stationary and seasonal, with a peak in March, a trough in October, and higher levels in winter and spring than in summer and autumn, annually. Nevertheless, post-COVID-19 forecasts from pre-COVID-19 models were extremely different from reality in sectional periods but congruous in others.

Conclusions

Since the COVID-19 pandemic, the Chinese hepatitis E incidence pattern has altered substantially, and the incidence has greatly decreased. The effect of the COVID-19 countermeasures on the pattern of hepatitis E incidence was temporary. The incidence of hepatitis E was anticipated to gradually revert to its pre-COVID-19 pattern.
The value of a neural network based on multi-scale feature fusion to ultrasound images for the differentiation in thyroid follicular neoplasms
Authors: Chen Weiwei , Ni Xuejun , Qian Cheng , Yang Lei , Zhang Zheng , Li Mengdan , Kong Fanlei , Huang Mengqin , He Maosheng , Yin Yifei
Published: March 2024

Objective

The objective of this research was to create a deep learning network that utilizes multiscale images for the classification of follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA) through preoperative US.

Methods

This retrospective study involved the collection of ultrasound images from 279 patients at two tertiary level hospitals. To address the issue of false positives caused by small nodules, we introduced a multi-rescale fusion network (MRF-Net). Four different deep learning models, namely MobileNet V3, ResNet50, DenseNet121 and MRF-Net, were studied based on the feature information extracted from ultrasound images. The performance of each model was evaluated using various metrics, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, F1 value, receiver operating curve (ROC), area under the curve (AUC), decision curve analysis (DCA), and confusion matrix.

Results

Out of the total nodules examined, 193 were identified as FTA and 86 were confirmed as FTC. Among the deep learning models evaluated, MRF-Net exhibited the highest accuracy and area under the curve (AUC) with values of 85.3% and 84.8%, respectively. Additionally, MRF-Net demonstrated superior sensitivity and specificity compared to other models. Notably, MRF-Net achieved an impressive F1 value of 83.08%. The curve of DCA revealed that MRF-Net consistently outperformed the other models, yielding higher net benefits across various decision thresholds.

Conclusion

The utilization of MRF-Net enables more precise discrimination between benign and malignant thyroid follicular tumors utilizing preoperative US.
Lessons learned from COVID-19 vaccine acceptance among pregnant and lactating women from two districts in Kenya to inform demand generation efforts for future maternal RSV vaccines
Authors: Limaye Rupali J. , Singh Prachi , Fesshaye Berhaun , Karron Ruth A.
Published: March 2024

Background

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infections globally, with most RSV-related deaths occurring in infants < 6 months of age. The highest burden of RSV is in low-and-middle income countries, and in sub-Saharan Africa, RSV may be responsible for almost half of all hospital admissions with severe or very severe pneumonia among infants under 1 year. There is a maternal RSV vaccine on the horizon. Our study objective was to better understand how lessons learned from the COVID-19 vaccine experience rollout among pregnant and lactating people in Kenya could inform future maternal RSV vaccine rollout.

Methods

This qualitative study interviewed 16 healthcare providers including doctors, nurses, midwives, community health workers, and vaccinators. Participants were recruited from two counties in Kenya and included healthcare providers that served diverse communities. A grounded theory approach was used to analyze the data.

Results

As healthcare providers interviewed were instrumental in COVID-19 vaccine rollout among pregnant women in Kenya, they provided lessons learned from the COVID-19 vaccine experience to inform future maternal RSV vaccine rollout. Community sensitization emerged as the most critical lesson learned, including communication, mobilization, and education. Using communication to ensure community awareness of RSV, community awareness of RSV harms and benefits of RSV maternal vaccines, and providing up-to-date, clear information about maternal RSV vaccines emerged as lessons. Related to mobilization, participants identified the need for healthcare providers and community leaders to gain the trust of communities, and the importance of routinizing the vaccine. Finally, for education, participants outlined critical questions patients would have about a maternal RSV vaccine, including those related to vaccine safety concerns, duration of protection, and vaccine dosing.

Conclusions

This is one of the first studies that has examined how lessons learned from the COVID-19 vaccine rollout for pregnant and lactating women can inform the rollout of future maternal vaccines, including an RSV maternal vaccine. As healthcare providers are directly involved in vaccine rollout, their perspectives are crucial for successful vaccine acceptance.
Association of hormone receptors and human epidermal growth factor receptor-2/neu expressions with clinicopathologic factors of breast carcinoma: a cross-sectional study in a tertiary care hospital, Kabul, Afghanistan
Authors: Esmat Esmatullah , Haidary Ahmed Maseh , Saadaat Ramin , Rizvi Syeda Naghma , Aleena Syeda , Haidari Mujtaba , Hofiani Sayed Murtaza Sadat , Hussaini Nasrin , Hakimi Ahmadullah , Khairy Abdullatif , Abdul-Ghafar Jamshid
Published: March 2024

Background

Breast cancer (BC) is one of the major causes of death worldwide. It is the most common cause of death before the age of 70 years. The incidence and mortality of BC are rapidly increasing, posing great challenges to the health system and economy of every nation.

Methodology

A cross-sectional analytical study was conducted at the Department of Pathology and Clinical Laboratory of the French Medical Institute for Mothers and Children (FMIC) to demonstrate the association of human epidermal growth factor receptor 2 (Her2/Neu) and estrogen receptor (ER)/ progesterone receptor (PR) with clinical as well as pathological parameters among women with BC. A consecutive nonprobability sampling method was used for this study over a span of one and a half years.

Results

One hundred twenty participants diagnosed with breast cancer were included in the study. The mean age at diagnosis was 44.58 ± 11.16 years. Out of the total patients, 68 (56.7%) were above 40 years old, 108 (90%) were married, 94 (78.3%) were multiparous, and 88 (73.3%) had a history of breastfeeding. 33.3% of cases were within the age range of menopause (40–50 years). The positive expression rates of ER, PR, and Her2/neu were found to be 48.8%, 44.6%, and 44.6%, respectively, and Her2/neu overexpression was found to be higher among ER/PR-negative cases.

Conclusion

In our study, we demonstrated that among Afghan women, grade II invasive ductal carcinoma, not otherwise specified, was the most common type of BC and frequently affected women above the age of 40. We also revealed that the percentage of negative ER (50.4%), negative PR (54.4%), and concordant ER/PR-negative cases were high compared to other possibilities. Additionally, the study revealed that expression of Her2/neu was in contrast with the expression of ER and PR receptors. The findings of our study still support the importance of performing immunohistochemical stains for hormonal receptor classification in terms of better clinical outcomes and prognosis.
Attitudes of oncology patients’ towards biospecimen donation for biobank research
Authors: Domaradzki Jan , Czekajewska Justyna , Walkowiak Dariusz
Published: March 2024

Background

Since the biological material that remains after diagnostic and therapeutic procedures plays crucial role in biobank research, this study aims to explore cancer patients’ views on the donation of biospecimens for research purposes.

Methods

548 oncology patients from two hospitals with oncology treatment units in Poznan, Poland, completed an anonymous, self-administered pen-and-paper questionnaire.

Results

Although only 43.4% of patients had heard of biobanks, 93.1% declared themselves willing to donate. 71.1% of patients believed that doctors should ask patients to donate, and 60.9% that this should be done before the medical procedure. While 65% of patients were willing to donate any type of tissue that remained after a medical procedure, blood, saliva and hair were indicated most frequently. 40.5% of patients would donate their entire body after death and 21% would refuse. Patients’ support for biobanks was mainly driven by the desire to support science, help advance cancer research and altruism. Some respondents expected health information or medical treatment. The most common barriers for donation were physical distance, repeated examinations, concerns over the privacy and confidentiality of data and the commercial or unethical use of samples. Patients’ attitudes toward biobank donation seemed to be associated with age, education level, declared religiousness, a family history of genetically determined diseases and whether they were a blood donor.

Conclusions

Although cancer patients’ lack of biobank awareness had no effect on their affirmative attitudes towards biobank research, there is a need to further increase patients’ support and overcome possible barriers that might hinder their willingness to donate.
Internal limiting membrane separation and posterior vitreous hyperreflective dots: novel OCT findings in Purtscher-like retinopathy
Authors: Prabhu Vishma , Joshi Aishwarya , Chitturi Sai Prashanti , Yadav Naresh Kumar , Chhablani Jay , Venkatesh Ramesh
Published: March 2024

Background

Purtscher or Purtscher-like retinopathy is diagnosed by retinal hemorrhages and areas of retinal whitening on fundus examination, as well as a reduction in visual acuity due to microvascular occlusion of the precapillary retinal arterioles. We describe novel optical coherence tomography (OCT) findings of internal limiting membrane (ILM) separation and posterior hyperreflective dots in a case of Purtscher-like retinopathy in this report.

Methods

A 33-year-old man with acute pancreatitis and alcohol-induced liver disease presented to the retina department complaining of four days of painless vision loss in both eyes. Both eyes’ anterior segment examination and intraocular pressure were normal. Dilated fundus examination of both eyes revealed confluent areas of retinal whitening, hemorrhages, and cotton-wool spots over the posterior pole, indicating Purtscher-like retinopathy. OCT scans through the macula revealed dense inner retinal reflectivity, thickening, and loss of retinal layer stratification, as well as outer retinal layer shadowing and islands of ILM separation, posterior vitreous hyperreflective dots, and minimal subfoveal fluid, all of which corresponded to areas of retinal whitening on fundus photographs. The patient was given a brief course of systemic steroids.

Results

On the tenth day after the presentation, visual acuity in the right eye had improved to 6/18 and finger counting at 1 m in the left eye. The retinal findings had faded. The retina had reverted to its normal thickness on the OCT scans, with minimal hyperreflectivity remaining. The ILM separation and posterior vitreous hyperreflective dots were no longer present.

Conclusion

Following Purtscher or Purtscher-like retinopathy, we believe inflammation could play a major role in the development of these two novel OCT findings. This case offers an additional perspective on the underlying mechanisms responsible for the retinal manifestations observed in Purtscher or Purtscher-like retinopathy.
Evaluating the association between duration of breastfeeding and fine motor development among children aged 20 to 24 months in Butajira, Ethiopia: a case-control study
Authors: Shiferaw Rediate , Yirgu Robel , Getnet Yalemwork
Published: March 2024

Background

A Suitable environment and proper child nutrition are paramount to a child’s physical and mental development. Different environmental factors contribute to proper child development. Breast milk is an important source of nutrition during the early years of life and contains essential nutrients that are the building blocks for growth and development.

Objective

To assess the association between the duration of breastfeeding and fine motor development among children aged 20 to 24 months living in Butajira, southern Ethiopia.

Method

Community-based case-control study design was employed among mother-child dyads of children aged 20 to 24 months in Butajira Southern Ethiopia. Children were screened for fine motor delay using the Denver II developmental screening and identified as cases and controls. A repeated visit was done to gather the rest of the information and 332 samples, 83 cases, and 249 controls were available and assessed. Epi-data version 4.4.2.1 software was used to prepare a data entry template, which was later exported to and analyzed using STATA version 14 statistical software. Finally, a Multivariable logistic regression model was used to adjust for confounders and estimate the independent effect of breastfeeding duration on fine motor development.

Result

We didn’t find a significant association between the duration of breastfeeding from 21 to 24 months and fine motor delay compared to children who were breastfed less than 18 months[AOR: 0.86, 95% CI: (0.36, 2.05)]. Children who have mothers > 35 years of age were 78% less likely than children who had mothers younger than 25 years, Children who had mothers in secondary school and above were 77% less likely than mothers who didn’t have formal education, Females were 1.86 times more likely than males, and Children who scored 20–29 on the Home score were 51% less likely than Children who scored < 20 to have fine motor delay.

Conclusion

Duration of breastfeeding was not significantly associated with fine motor delay for children aged 20 to 24 months old. The age of the mother, the educational status of the mother, being female, and Home score were identified to have a significant association with fine motor delay. Improving the educational status and empowerment of women is essential. Further work should be done on avoiding gender differences starting from a young age and creating a conducive environment for child development is crucial.
Screening for symptoms of childhood traumatic stress in the primary care pediatric clinic
Authors: Campbell Kristine A. , Byrne Kara A. , Thorn Brian L. , Abdulahad Lindsay Shepard , Davis R. Neal , Giles Lisa L. , Keeshin Brooks R.
Published: March 2024

Background

Childhood traumatic experiences may result in post-traumatic stress disorder. Although pediatricians are encouraged to address these traumas in clinical encounters, measures of childhood traumatic stress have not been adopted by primary care clinicians. In this study, we describe the feasibility and potential utility of the UCLA Brief Screen, a validated screener for childhood traumatic stress symptoms, in pediatric primary care clinics.

Methods

Children 6–17 years of age presenting for routine well-child care in community-based pediatric clinics were eligible for traumatic stress screening. We described the feasibility and acceptability of screening based on screener adoption by eligible pediatric clinicians. We assessed the potential utility of screening based on prevalence and distribution of potentially traumatic events and traumatic stress symptoms in this general pediatric population. Finally, we compared results of the UCLA Brief Screen with those of the Patient Health Questionnaire-A to evaluate associations between symptoms of traumatic stress, depression, and suicidality among adolescents in this community setting.

Results

14/18 (77.8%) pediatric clinicians in two clinics offered an adapted UCLA Brief Screen during 2359/4959 (47.6%) eligible well-child checks over 14 months. 1472/2359 (62.4%) of offered screeners were completed, returned, and scored. One-third (32.5%) of completed screeners captured a potentially traumatic event experience described by either children or caregivers. Moderate to severe traumatic stress symptoms were identified in 10.7% and 5.2% of patients, respectively. Concurrent depression screening revealed that 68.3% of adolescents with depressive symptoms reported a potentially traumatic event (PTE) and 80.5% had concurrent traumatic stress symptoms. Adolescents reporting a PTE were 3.5 times more likely to report thoughts of suicide or self-harm than those without this history.

Conclusions

Results from this pilot study suggest that traumatic stress screening in the pediatric primary care setting may be feasible and may identify and classify mental health symptoms missed with current screening practices for depression. The prevalence of PTEs and traumatic stress symptoms associated with PTEs support the potential utility of a standardized screening in early identification of and response to children with clinically important symptoms of childhood traumatic stress. Future research should evaluate meaningful clinical outcomes associated with traumatic stress screening.